Differences in survivorship between an occupational group 2 Introduction and the general population resulting from disparities in the quality and accessibility of medical care or other factors may result in misleading conclusions about disease prevalence order 2mg ginette-35 visa menstrual 3 times a month. An increase in the prevalence of a medical condition arising from workplace exposures may therefore be missed with comparison to the general population order discount ginette-35 online women's health center amarillo tx. This healthy worker effect is accentuated with fire fighters who are extremely healthy buy discount ginette-35 2mg on line breast cancer blood test, and has been termed the super healthy worker effect. The ability of a study to identify and establish the increased rates in these sub-groups may be limited due to statistical and study design constraints. Some are confused on the issue of paying for treatment of a fire fighter injured at work, in this case through an exposure to a toxic material, carcinogen or an infectious disease. Some also state that fire fighters are entitled to worker s compensation for injuries and illnesses and that their bills are routinely paid for and the fire fighter is compensated for lost productivity. It provides for a rebuttable presumption -- that is, the employer may tangibly demonstrate that the exposure did not occur in the line of duty -- to compensate a fire fighter if an exposure leads to a disease. Just as a fire fighter would be compensated for injuries that occurred after falling through the roof of a burning structure, a fire fighter who develops a respiratory disease from job exposure would and should be compensated. The worker s compensation system was designed decades ago to handle injuries easily linked to the workplace, such as a broken leg or a cut hand. As medical science has improved, we ve learned that respiratory diseases as well as heart diseases, infectious diseases and cancer are directly related to the work environment, including toxic chemicals in smoke or particulates. Introduction 3 In recognition of the causal relationship of the fire fighting occupation and respiratory disease, 41 states and 7 provinces have adopted some type of presumptive disease law to afford protection to fire fighters with these conditions. The states and provinces that have occupational disease presumptive laws are identified in Table 1. Consequently, their provisions rightfully place the burden of proof to deny worker compensation and/or retirement benefits on the fire fighter s employer. Additionally, many pension and workers compensation boards in the United States and Canada have established a history of identifying heart, respiratory and infectious diseases and cancer in fire fighters as employment- 4 Introduction related. While all these state and provincial laws recognize these diseases as occupationally related, some have exclusions and prerequisites for obtaining benefits (see Table 2). Table 2: Presumptive Disability Laws Inclusions and Prerequisites In a recent study, Dr. Tee Guidotti, from the George Washington University Medical Center, addressed the fire fighter occupational disease issues relevant to worker compensation issues and reasonableness of adopting a policy of presumption for those diseases associated with the occupation of fire fighting. Guidotti states that these presumptions are based on the weight of evidence, as required by adjudication, not on scientific certainty, but reflect a legitimate and necessary interpretation of the data for the intended purpose of compensating a worker for an injury (in this case an exposure that led to a disease outcome). Guidotti made it clear that the assessments are for medicolegal Introduction 5 and adjudicatory purposes and are not intended to replace the standards of scientific certainty that are the foundation of etiologic investigation for the causation of disease. They are social constructs required to resolve disputes in the absence of scientific certainty. Understanding this is why most states and provinces have adopted legislation or revised compensation regulations that provide a rebuttable presumption when a fire fighter develops occupational diseases. Further, based on actual experience in those states and provinces, the cost per claim is substantially less than the unsubstantiated figures asserted by others. The reason for this, unlike benefits for other occupations, is the higher mortality rate and significantly shorter life expectancy associated with fire fighting and emergency response occupations. These individuals are dying too quickly from occupational diseases, unfortunately producing a significant savings in worker compensation costs and pension annuities for states, provinces and municipalities. This website provides the full legislation from each state and province where a presumptive disease law was enacted. These programs have also been shown to provide the additional benefit of being cost effective, typically by reducing the number of work-related injuries and lost workdays due to injury or illness. All must assess aerobic capacity, strength, endurance, and flexibility using the specified protocols. The medical component was specifically designed to provide a cost-effective investment in early detection, disease prevention, and health promotion for fire fighters. It provides for the initial creation of a baseline from which to monitor future effects of exposure to specific biological, physical, or chemical agents. The baseline and then subsequent annual evaluations provide the ability to detect changes in an individual s health that may be related to their work environment. It allows for the physician to provide the fire fighter with information about their occupational hazards and current health status. Clearly, it provides the jurisdiction the ability to limit out-of-service time through prevention and early intervention of health problems. The fires that continued to burn at the site until mid-December created additional exposures and resulted in repeated dust aerosolization. Most importantly, possession of one or more of the conditions listed within the standard for incumbent fire fighters does not indicate a blanket prohibition from continuing to perform the essential job tasks, nor does it require automatic retirement or separation from the fire department. The standard gives the fire department physicians guidance for determining a member s ability to medically and physically function using the individual medical assessment. Respiratory diseases in fire fighters have been an area of concern and focus for the International Association of Fire Fighters and others for several decades. Although medical progress has led to improvements in the diagnosis and treatment of respiratory diseases, prevention remains the best method of decreasing the number of such diseases and related deaths. Understanding diseases of the respiratory system, identifying respiratory disease-causing agents, and avoiding exposure to these agents are key in preventing respiratory diseases. It is important to have an understanding of the normal structure and function of the lungs prior to discussing the diseases and injuries that can occur in the lungs. The main airways into the lungs are the right and left main stem bronchi which branch off of the trachea. Each of these branch to form the bronchi which lead into the main lobes of the lungs. The airways continue to divide separating the lung into smaller and smaller units. As the airways divide they can be grouped into several distinct categories based on structure. The bronchi are the larger airways and are distinguished by the presence of cartilage in the wall and glands just below the mucosal surface. Distal to the terminal bronchiole is the respiratory unit of the lung or acinus, the site of gas exchange. The airway walls of the respiratory unit are very thin, the width of a single cell, to facilitate the transfer of gases. The airways to the level of the terminal bronchiole are surrounded by a layer of smooth muscle that is able to control the diameter of the airways by contracting and relaxing. The smooth muscle cells are controlled by the autonomic nervous system and also by chemical signals released from near by cells. Alveoli The alveoli and respiratory bronchioles warrant further discussion given the essential role they play in supplying the body with oxygen. As discussed above the walls of the alveoli are thin and designed to allow for efficient transfer of gas with the blood.
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There are a lot of applications in artificial intelligence domain that try to help human experts offering solutions for a problem. This paper describes an expert system developed in order to make some predictions regarding the hepatitis infection. There are a lot of tools which try to reduce the risk of error apparition in medical life. It is the first step from a set of therapeutic actions; an error at this level can have dramatic consequences. The tech- nology doesn t replace human experts in this point of medical assistance; it only tries to help them, implementing systems that are able to select or to generate data which are relevant for the physicians. It is made using the main two branches of artificial intelligence: the traditional one, represented by expert systems (based on logical and statistical inference); the connexionist one, where the most common forms used are artificial neural networks. The goal of the system is to offer predictions about patients infected with hepatitis virus. A correct diagnosis and an adequate treatment could reduce the risks of liver cancer apparition. The first step is to decide, using logical inference, what type of hepatitis virus is present. The system described in this pa- per will decide, based on statistical inference, which one is possible to appear for a patient. If the disease is hepatitis C, it will be important to predict the treatment response and the evolution of laboratory analysis during the treatment, because hepatitis C has a very expensive treatment and severe side effects can often ap- pear. Artificial neural networks will be used in order to do the predictions regard- ing hepatitis C. A tool made to suggest a decision is able to extract information from other solved cases so it can obtain experience and can also take into consideration the results of the last researches, but won t be able to replace the most important factor in decision making: human judgment . Both of them were used in this system, in order to make some predictions regarding the hepatitis diagnosis and the evolution of an infected patient. Logical Inference The logical inference could be used in medicine to build expert systems that will produce a diagnosis starting from a set of premises. An expert system implements human reasoning and it needs some rules to make it possible. This type of system is also called rules based expert system and it is the most used system for imple- menting medical diagnosis . It has a graph structure and a chain logical evalua- tion is applied on this structure. Such an expert system could be easy to implement and also very easy to use for a non-engineer because its rules are similarly with the natural medical language. For hepatitis diagnosis it is necessary to specify which are the factors that define different types of hepatitis. There is a set of markers that have to be analyzed in order to decide what type of hepatitis is present in a patient organism. The logical model consists of the following rules, which are created using the markers that appear in Table I: R1: If M1 and M3 then B R2: If M1 and M4 then B+D R3: If M2 and M5 then C Fig. Fre- quently, it is hard to express the rules for the system and also the translation of implicit knowledge into explicit rules would lead to loss and distortion of infor- mation content . On the other hand, the tree structure of rule-based relation- ships becomes too complex if new levels of knowledge are added. For example, there are many types of hepatitis B and if the system described before has to de- cide between these types, it will be difficult to implement it. A problem that must be taken into consideration is linked to the fact that inferences are done based on the informa- tion contained in a sample, which is only a part of the whole population. The probabil- ity plays an important role, being used to define the quality of an affirmation, to measure the uncertainty or to describe the chance for an event to happen. In this area, the most frequently used method is the Bayes s theorem, which sets a probabilistic value for each considered output (disease, if the system is applied in medical diagnosis).
Endocrine test- tivity) or may act directly on local tissue (paracrine ing is used to both identify the lack of hormone and to activity) buy 2mg ginette-35 overnight delivery menstruation quotes. For example generic 2mg ginette-35 visa womens health medicaid, tides cheapest generic ginette-35 uk breast cancer donation, glycoproteins, steroids or amines such as cate- r measurement of thyroid hormones is used to detect cholamines. Steroid hormones and thyroid hormones circulate Clinical features of apparent hormone deciency may freely and bound to plasma proteins. The bound hormone acts as a buffer against rapid In these cases a single random hormone sample will not changes in hormone levels. In such ins- intracellular receptors, which travel to the cell nucleus tances either testing at specic times of day (e. Dynamic endocrine testing uses techniques to The sensitivity of target organs to a hormone is depen- stimulate or suppress hormone secretion. The hypothalamus and pituitary form the basis of the Introduction to the hypothalamus central control of various endocrine axes, which are vital and pituitary to everyday function (see Fig. Disorders of the The pituitary gland lies in the sella turcica, which is a hypothalamus itself are very rare; however, disorders of tightly enclosed bony space at the base of the cranium, the pituitary are common. The optic chiasm lies just above the pituitary fossa and the cavernous sinuses Pituitary adenomas run lateral to it. It consists of two lobes: Denition r The posterior lobe is a physical and functional exten- Pituitary adenomas are benign slow growing tumours sion of the ventral hypothalamus. Gene though the anterior lobe is of separate origin to the hy- mutationshavebeencharacterisedinsomepituitaryade- pothalamus,itisunderitsclosecontrol. The hy- Pathophysiology pothalamussecretespolypeptidehormonesthatregulate Seventy per cent of pituitary adenomas are functioning, anterior pituitary hormone secretion, mostly by stim- i. Increasingly asymptomatic hormone (10%) pituitary adenomas are found at incidental imag- ing. Continuing growth disrupts other hormone secretion and can result in hypopituitarism. Denition Macroscopy Hypopituitarism is a clinical term referring to under- r Tumours less than 1 cm in diameter without enlarge- function of the pituitary gland. This may imply a de- ment of, or extension outside the pituitary fossa are ciency of single or multiple hormones. The commonest causes are pituitary or hypothalamic r Tumours 1 2 cm may extend outside the fossa to- tumours, or secondary to pituitary surgery or cranial wards the hypothalamus and optic chiasm, laterally radiotherapy (see Table 11. Pathophysiology Hypopituitarism may be primary due to destruction of Investigations the anterior pituitary gland or secondary to a deciency r A mass within the sella turcica (pituitary fossa) may of hypothalamic stimulation (or excess of inhibition). Microadenomas take up less Symptoms and signs are related to the deciency of hor- contrast and macroadenomas take up more contrast. General symptoms of panhy- Ifapituitarymassisidentied,hormoneassaysshould popituitarism include dry, pale skin with sparse body beundertakentoidentifyfunctioningadenomas. On examination postural hypotension and brady- ing also helps identify any associated hypopituitarism, cardia may be found with decreased muscle power and with stimulation or suppression testing where appro- delayed deep tendonreexes. Management Investigations r Forprolactinomas medical treatment with a All functions of the pituitary should be assessed using dopaminergic drug is the treatment of choice (see sec- basal levels, stimulation tests and suppression testing tion on Hyperprolactinaemia, page 424). Progestagen is used to induce bleeding and Type Causes prevent endometrial hyperplasia. In ado- Pituitary apoplexy (haemorrhagic infarction of lescent males testosterone induces epiphyseal closure, pituitary tumour) so replacement therapy should be delayed as long as Inltration Sarcoidosis, haemochromatosis, histiocytosis X possible. Treatment of associated infertility requires Injury Head trauma complex hormone replacement to stimulate ovula- Immunologic Organ-specic autoimmune disease Iatrogenic Surgery, irradiation tion/spermatogenesis. Pituitary haemorrhage causing death of the r Gonadotrophin deciency in women may be treated lactotrophs results in failure of lactation (Sheehan s with cyclical oestrogen replacement to maintain syndrome). The zona deciency glomerulosa and aldosterone secretion usually remains relatively intact, so Addisonian crisis is rare. Clinical features Hyperprolactinaemia In women hyperprolactinaemia causes primary or sec- ondary amenorrhoea, oligomenorrhoea with anovula- Denition tion or infertility. Hyperprolactinaemia is a raised serum prolactin level Oestrogen deciency can cause vaginal dryness and causing galactorrhoea and gondadal dysfunction. In men galactor- Incidence rhoea occurs occasionally, but the most common early Most common endocrine abnormality of the hypothala- features are decreased libido and sexual dysfunction, mic pituitary axis. Complications Acromegaly Headache, visual impairment and hypopituitarism due to local effects of the adenoma. Sex Management M = F Prolactinomasaretreatedwithdopaminergicdrugssuch as cabergoline. The minority of tumours that do not Aetiology respond to medical treatment and hyperprolactinaemia r 95% of cases result from growth-hormone-secreting due to stalk compression are treated surgically. Sleep, exercise, stress Hypoglycaemia Postprandial hyperglycaemia/ free fatty acids Clinical features Glucocorticoids (hence short The course of the disease is slowly progressive. Soft tissue stature in children on overgrowth is the characteristic early feature, causing long-term oral steroids) enlargement of hands and feet, coarse facial features. Acne, sebaceous r Accompanying hypopituitarism is treated as appro- cysts and skin tags are common. Acanthosis nigricans priate with corticosteroids, thyroxine and gonadal of the axillae and neck may occur. Acromegaly causes increased morbidity and r Organomegaly: Thyroid and salivary gland enlarge- mortality mainly due to diabetes and cardiovascular dis- ment, hepatomegaly. Thyroid axis Macroscopy/microscopy The tumour is solid and trabecular, often 1 cm in diame- terbythe time of diagnosis. Oestrogens conversely increase the sensitivity suppress growth hormone production. Large tumours re-absorption of colloid by the cells and the production may be resected by transfrontal craniotomy. The majority of T is converted from the less active 3 r Octreotide or lanreotide, a long-acting somatostatin T4 by peripheral tissues. Disorders of the thyroid axis are analogue, may be used prior to surgery, following in- shown in Table 11. Fur- Age ther classication is based on whether the patient is hy- Increases with age. Irregularmultinodularenlargementofthethyroidgland, which may be hyperthyroid (toxic) or is commonly eu- thyroid (nontoxic). Clinical features Patients may present for cosmetic reasons, with thyro- Incidence/prevalence toxic symptoms, or because of complications. Multin- 25% of cases of thyrotoxicosis are due to multinodular odular goitre can present with a particularly promi- goitre. Causes include the following: r Benign follicular adenoma: Single lesions with well- Macroscopy/microscopy developed brous capsules. Nodules may be cystic, haemorrhagic and - hormones, which may result in hyperthyroidism. Enlargement of the gland can cause tracheal compres- r Thyroid cyst (15 25%): These may be simple cysts sion leading to shortness of breath and choking.
By Z. Trano. Aspen University.