Katarzyna Jadwiga Macura, M.D., Ph.D.
- Assistant Director ICTR Imaging Translational Program
- Professor of Radiology and Radiological Science
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0015445/katarzyna-macura
Divergences are widening on numerous dimensions medications given during labor generic 500 mg lincocin free shipping, such as values medications bladder infections purchase lincocin 500mg fast delivery, age medications 4 times a day buy lincocin 500mg line, education symptoms 4dp5dt buy generic lincocin 500 mg on-line, power and prosperity. What if a tipping point is reached at which the urban-rural divide becomes so sharp that the unity of states begins to erode Domestically, divergent values between urban and rural areas are already fuelling polarization and electoral volatility in many countries. Greater bitterness and rivalry could lead to localized nativism and even violent clashes. Separatist movements might break through in wealthy city-regions that resent diverting revenues to poorer rural areas with which they feel diminishing affinity. Leading cities might look to bypass national structures and play an international role directly. Economically, accelerating urban migration could lead to rural depopulation and the decline of local economies, with potential food security implications in some countries. Better long-term planning-for both expanding cities and rural areas at risk of decline-might help to mitigate these dangers. Stronger transport and communications links could help to soften the urban-rural divide. Resources will be needed, which might require more fiscal creativity, such as finding ways to decentralize revenue-raising powers or more widely redistribute the productivity gains that urbanization generates. Worsening trade wars might spill over into high-stakes threats to disrupt food or agricultural supplies. Conflict affecting supply-chain chokepoints could lead to disruption of domestic and cross-border flows of food. At the extreme, state or non-state actors could target the crops of an adversary state, for example with a clandestine biological attack. Widespread famine risk in recent years suggests that greater hunger and more deaths-in least-developed countries, at any rate-might not trigger a major international reaction. If similar suffering were inflicted on more powerful countries, the responses would be swift and severe. More resilient trade and humanitarian networks would help to limit the impact of food supply disruption. But if trade wars were a contributing factor, then countries might seek greater self-sufficiency in food production and agriculture. In some advanced economies, this might require rebuilding skills that have been allowed to fade in recent decades. This makes possible increasingly individualized public and private services, but also new forms of conformity and micro-targeted persuasion. If humans are increasingly replaced by machines in crucial decision loops, the result may lead not only to greater efficiency but also to greater societal rigidity. Global politics will be affected: authoritarianism is easier in a world of total visibility and traceability, while democracy may turn out to be more difficult-many societies are already struggling to balance threats to privacy, trust and autonomy against promises of increased security, efficiency and novelty. Geopolitically, the future may hinge in part on how societies with different values treat new reservoirs of data. Strong systems of accountability for governments and companies using these technologies could help to mitigate the risks to individuals from biometric surveillance. This will be possible in some domestic contexts, but developing wider global norms with any traction will be a struggle. These include population growth, migration, industrialization, climate change, drought, groundwater depletion, weak infrastructure and poor urban planning. Short-termist and polarized politics at both municipal and national levels in many countries further heighten these dangers. The societal shock of running out of water could lead in sharply differing directions depending on the context. Conflict might erupt over access to whatever water was still available, or wealthier residents might start to import private supplies. But a water shock could also galvanize communities in the face of a shared existential challenge.
It is a lighter shade of gray than fat symptoms jet lag lincocin 500 mg free shipping, but not as white as the mineral seen in bone or the really white appearance of metal medicine 1950 lincocin 500 mg cheap, such as seen in an ingested foreign body like a coin medications you cant crush discount lincocin 500mg amex. In figure # 1 we have appropriately labeled the four densities on a plain film of the abdomen medications that raise blood sugar buy 500mg lincocin with mastercard. The red arrow points to the black density of gas seen in the right side of the colon. The yellow arrows indicate the slightly lighter density (than gas) of fat in the left hip joint capsule. The blue arrow shows the bright density of metal (mineral) in the "R" of the film marker. Mineral density, not quite as bright as the heavy metal marker, is also noted throughout the bones of the skeleton. One of the keys to successful film interpretation, like most diagnostics, is recognizing normals. Helpful aids to gaining experience include the use of standard references that depict variants of normal that one might see on a radiograph. Borderlands of the Normal and Early Pathologic in Skeletal Roentgenology, 3rd Edit. Yellow arrows indicate fat density in the cardiac fat pad and in the supraclavicular fossae. The red arrows point to the black density of air (gas) in the lungs and the green arrow indicates the water density of the heart muscle. The first part of the triangle is made up of the objective findings, which gives rise to the second side of the triangle, the differential diagnosis. I tell my students that if they learn nothing else during their short stay with us, they should learn to give the radiologist the third side of the triangle, which is history! Differential diagnosis for groups or single objective findings have been compiled by Drs. I consider their reference text an essential part of my library, and use it frequently. After awhile use of the gamuts becomes part of daily practice, and part of memory, so that the text needs to be referred to only in unusual cases or to refresh memory. The text is listed below for those interested, and I would advise diagnostic radiology residents to have a copy on hand. There are other things, which can aid the fledgling interpreter to gain confidence in seeing objective findings on the film. Lights overhead or empty adjacent lighted view boxes compromise what can be seen on the radiograph. However never accept a technically unsatisfactory film in the fear of exposing the patient to too much radiation. To put it in perspective, a single view of the chest exposes the patient to about the same amount of radiation he or she would get by flying from Denver to San Francisco in an airliner. For example, in the chest, the heart should be about half the size of the width of the rib cage (C-T ratio). Even experienced radiologists get caught once in awhile comparing films from two different patients, or rendering an opinion on the wrong patient because someone mixed up the films. Often it can be recovered by use of the hot light, or a lighter copy can be made in the dark room. Use a system to be sure you have gotten every bit of information necessary from the radiograph to make a reasonable diagnosis. Now with these basics in mind, let us turn to the first topic, one which is the most common, and one in which the second part of the diagnostic triangle, i. To that system I would add 1) the corners of the film and 2) a check of the labels. I also routinely check the medial ends of the clavicles when there are prior studies to compare.
Estimating the joint effects of multiple risk factors is symptoms before period purchase 500mg lincocin with amex, in practice medicine of the prophet buy lincocin 500mg free shipping, complex and does not follow the simple treatment 0 rapid linear progression 500 mg lincocin for sale, independent treatment rosacea order 500 mg lincocin amex, and uncorrelated relationship of equation 4. When estimating the total effects of individual distal factors on disease, both mediated and direct effects should be considered, because, in the presence of mediated effects, controlling for the intermediated factor would attenuate the effects of the more distal one (Greenland 1987). First, some of the effects of the more distal factors, such as physical inactivity, are mediated through intermediate factors. For instance, a proportion of the hazards of physical inactivity is mediated through overweight and obesity, which is itself mediated through elevated blood pressure (figure 4. Estimating the joint effects of distal and intermediate factors requires knowledge of independent hazards of the distal ones (versus individual risk factor effects, which are based on total hazard). Second, the hazard due to a risk factor may depend on the presence of other risk factors (Koopman 1981; Rothman and Greenland 1998) (effect modification). For example, undernutrition, unsafe water and sanitation, and use of solid fuels are more common among poor rural households in developing countries and smokers generally have higher and more harmful patterns of alcohol consumption and worse diets than nonsmokers. The epidemiological literature refers to the first and second issues as biological interaction and the third issue as statistical interaction (Miettinen 1974; Rothman and Greenland 1998; Rothman, Greenland, and Walker 1980). This distinction is, however, somewhat arbitrary, and the three scenarios may occur simultaneously. Data Sources for Mediated Effects and Effect Modification Despite the emphasis on removing or minimizing the effects of confounding in epidemiological research, mediated and stratified hazards have received disproportionately little empirical attention. We therefore reviewed the literature and reanalyzed cohort data to strengthen the empirical basis for considering interactions. The sensitivity of estimates to these assumptions were negligible as described in detail elsewhere (Ezzati, Vander Hoorn, and others 2004; Ezzati and others 2003). Epidemiological studies of the effects of overweight and obesity, physical inactivity, and low fruit and vegetable intake on cardiovascular diseases have illustrated some attenuation of the effects after adjustment for intermediate factors such as blood pressure or cholesterol (Berlin and Colditz 1990; Blair, Cheng, and Holder 2001; Eaton 1992; Gaziano and others 1995; Jarrett, Shipley, and Rose 1982; Jousilahti and others 1999; Khaw and Barrett-Connor 1987; Liu and others 2000, 2001; Manson and others 1990, 2002; Comparative Quantification of Mortality and Burden of Disease Attributable to Selected Risk Factors 253 Rosengren, Wedel, and Wilhelmsen 1999; Tate, Manfreda, and Cuddy 1998). This attenuation confirms that some of the hazard of the more distal factors is mediated through the intermediate ones (figure 4. The extent of attenuation has varied from study to study, but has consistently been less than half of the excess risk of the distal factors. We used an estimate of 50 percent as the proportion of the excess risk from these risk factors mediated through intermediate factors that are themselves among the selected risks. To include effect modification, we used deviations from the multiplicative model of 10 percent for ischemic heart disease and 30 percent for ischemic stroke based on existing studies, both submultiplicative (Eastern Stroke and Coronary Heart Disease Collaborative Research Group 1998; Neaton and Wentworth 1992). Liu and others (1998, figures 4 and 6) find that in China, the relative risks of mortality from lung and other cancers, respiratory diseases, and vascular diseases are approximately constant in different cities where mortality rates for these diseases among nonsmokers varied by a factor of 4 to 10. Studies that stratified hazards of smoking on serum cholesterol have confirmed this finding (Jee and others 1999). Zinc affects growth in children (Brown and others 2002), and some of its effects on infectious diseases may be mediated through reducing growth. We used an upper bound of 50 percent on the proportion of zinc deficiency risk mediated through underweight. Investigators have found that vitamin A deficiency, which affects some of the same diseases as underweight and zinc deficiency, does not change the hazard size for the other two risk factors based on stratified results from clinical trials and recent reviews of the literature on micronutrient deficiencies (Christian and West 1998; Ramakrishnan, Latham, and Abel 1995; Ramakrishnan and Martorell 1998; West and others 1991). Joint Hazards of Undernutrition and Environmental Risk Factors in Childhood Diseases. Therefore, some of the risks from indoor smoke from household use of solid fuels and unsafe water, sanitation, and hygiene, which result in lower respiratory infections and diarrhea respectively, may be mediated through underweight. In a review of the literature, Briend (1990) concludes that attempts to disentangle direct and mediated contributions, especially over the long periods needed to affect population-level anthropometry, have not established diarrhea as a significant cause of underweight. Other works, however, have found evidence that infection, especially diarrhea, could reduce growth and increase the prevalence of underweight (Black 1991; Guerrant and others 1992; Lutter and others 1989, 1992; Martorell, Habicht and others 1975; Martorell, Yarbrough, and others 1975; Stephensen 1999). To account for potential mediated effects, we considered an upper bound of 50 percent on the proportion of the excess risks from indoor smoke from household use of solid fuels and unsafe water, sanitation, and hygiene mediated through underweight in regions where underweight was present. Globally, an estimated 45 percent of mortality and 36 percent of the disease burden were attributable to the joint effects of the 19 selected risk factors. As the table shows, for most diseases the joint effects of these risk factors were substantially less than the crude sum of their individual effects. This confirms that the joint actions of more than one of these risk factors acting simultaneously or through other factors cause a large proportion of disease. Even though the fraction of the total malaria burden attributable to childhood undernutrition was relatively large (59 percent), this was because of the contribution of mortality at younger ages to the malaria burden. Finally, with the exception of alcohol and drug dependence, which were fully attributable to their namesake risk factors, small or zero fractions of neuropsychiatric conditions, tuberculosis, congenital anomalies, and a number of other diseases were attributed to the risk factors considered here.
The aggregates are thus weighted by the different population sizes of individual countries medications like gabapentin generic lincocin 500mg mastercard. As a result treatment goals for ptsd purchase lincocin 500 mg without prescription, the age and sex structures reported here 4 medications at walmart cheap 500 mg lincocin with visa, as well as any indicators derived from them (such as crude birth and death rates) are not strictly internally consistent medicine list lincocin 500mg low price. Distribution by Age, Sex, and Location Population Size and Growth Between 1990 and 2001, global population increased from about 5. Estimates at the global level conceal large differences in population growth among regions, which in turn consist of countries that may have quite different demographic trends. For example, Europe and Central Asia added just 1 million people per year between 1990 and 2001, whereas South Asia added 25 million people each year. The World Bank regions (see map 1 inside the front cover of this volume) vary substantially in terms of population How populations are distributed by age matters a great deal for public health, because many aspects of risk behavior, as well as disease and injury outcomes, are strongly associated with age. While many other factors contribute to mortality and fertility levels, the age distribution of a population is an important factor in explaining differences in demographic and epidemiological indicators. Regions differ significantly in how their populations are distributed across age groups, with almost 45 percent of the population of Sub-Saharan Africa being younger than 15, compared with 20 percent of the population in high-income countries, where fertility has been low for decades. At the same time, the population aged 70 and older has been increasing in most regions as mortality has declined, and this age group now represents more than 10 percent of the population in the high-income countries. These changes in the relative age distribution of populations since 1990 reflect changes in the growth rates of different age groups (figure 2. In three of the six regions (East Asia and Pacific, Europe and Central Asia, and the Middle East and North Africa), as well as the world as a whole, the number of children under five was smaller in absolute terms in 2001 than in 1990. The highest growth rates during this period were in the 40- through 55-year-old age group and among those over 70. The irregularities in growth rates of different age groups reflect past trends in the initial size of each cohort and its subsequent mortality and migration experiences. This is particularly evident for Europe and Central Asia, where the impact of the regional conflicts in the early 1990s on demographic structure is particularly evident. Along with the progressive aging of the population, the relentless trend toward increasing urbanization has continued, with consequences for health in terms of both health service provision, which, in principle, is better with urbanization, and risk of exposure to chronic disease, which is, on balance, worse (Ezzati and others 2005). The increase in urbanization was particularly marked in East Asia and the Pacific (increase from 29 to 37 percent of the population) and in SubSaharan Africa (from 28 to 34 percent). Overall, 42 percent of the population in low- and middle-income countries now live in urban areas. Differential mortality and, to a limited extent, migration, shape the sex ratio at other ages (figure 2. In South Asia, higher mortality for girls and for women during their childbearing years leads at first to an increasing and then to a constant sex ratio to about age 45, after which male mortality is higher. Excess mortality of adult males in Europe and Central Asia explains the particularly low sex ratio observed there (Lopez and others 2002). In all regions, the higher mortality of males relative to females accounts for the sharp decline in the population sex ratio after age 50 or thereabouts. The overall effects of the age-specific mortality differences between the sexes are relatively minor in terms of total population sex ratios. All regions have roughly equal numbers of males and females in the population, with the proportion of males being slightly higher in Europe and Central Asia and in the high-income regions (51 to 52 percent) than in East Asia and the Pacific and South Asia (49 percent). Even though fertility levels vary a good deal among regions, all low- and middle-income regions witnessed large declines in fertility levels during the 1990s. Overall fertility levels in low- and middle-income countries fell by almost 20 percent over the decade, a remarkable decline, with levels falling by as much as 33 percent in the Middle East and North Africa, and even by 10 percent in Sub-Saharan Africa. However, fertility rates in Sub-Saharan Africa remain high, with the total fertility rate of 5. Fertility is below replacement levels (about two children) in all but five high-income countries (Brunei Darussalam, Israel, Kuwait, Qatar, and the United Arab Emirates), as well as in most countries in Europe and Central Asia. When fertility drops to below replacement levels, population growth often continues for several decades,as the number of births exceeds the number of deaths because of the high proportion of women of childbearing age.
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References
- LevineMS, KellyMR, Laufer I, et al. Gastrocolic fistulas: the increasing role of aspirin. Radiology 1993; 187:359-361.
- Papon JF, Coste A, Roudot-Thoraval F, et al. A 20-year experience of electron microscopy in the diagnosis of primary ciliary dyskinesia. Eur Respir J 2010;35:1057-63.
- D'Hoore A, Penninckx F. Laparoscopic ventral recto(colopo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20(12):1919-23.
- Cetin G, Dogan R, Yuksel M, et al. Surgical treatment of bilateral hydatid disease of the lung via median sternotomy: experience in 60 consecutive patients. J Thorac Cardiovasc Surg 1988; 36: 114-117.
- Cook D, Orszulak T, Daly R, et al: Cerebral hyperthermia during cardiopulmonary bypass in adults, J Thorac Cardiovasc Surg 111:268-269, 1996.
- Tanoue Y, Sese A, Ueno Y, et al. Bidirectional Glenn procedure improves the mechanical efficiency of a total cavopulmonary connection in high-risk Fontan candidates. Circulation. 2001;103:2176.
- Tangel DJ, Mezzanotte WS, White DP. Influence of sleep on tensor palatini EMG and upper airway resistance in normal men. J Appl Physiol 1991;70(6):2574-81.
