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Two Natural History of Occupational types of asthma have been described: asthma that Asthma follows a latent period of exposure to either a high- or low-molecular-weight sensitizing antigen arrhythmia heart episode buy sotalol with a mastercard, and Numerous useful reviews heart attack telugu movie purchase sotalol us, both brief and com- prehensive blood pressure 10070 best sotalol 40mg, are available. One form of irritant asthma is begin weeks to years after working with a new sub- called reactive airways dysfunction syndrome, a condi- stance that can cause asthma. Symptoms may be tion that usually results from the sudden inhalation minor or intermittent at first and gradually increase of a large dose of a highly irritating substance. Most Frequently Reported Specific Causes or Contributors Pathophysiology, Histopathology, and to Work-Related Asthma in the United States* Physiologic Mechanisms Di-isocyanates Stainless steel welding plume In these respects, occupational asthma does not dif- Formaldehyde fer, or differs only in minor ways, from other types Paint 14,15 of asthma. History: The combination of the following four elements of the patient’s medical history has a 64% In some cases, patients will have had childhood positive predictive value in the diagnosis of oc- asthma that remitted in adolescence, but for others, cupational asthma16: current diagnosis of asthma; this onset of asthma will be the first. The cardinal and onset of asthma after entering the workplace; feature is the onset of asthma while working with association between symptoms of asthma and inhalational exposure to a substance that can cause work; and workplace exposure to an agent known asthma, although there is emerging evidence that to give rise to occupational asthma. Allergic rhinitis repeated skin contact with some substances can to the offending substance often precedes the onset result in respiratory sensitization. Pulmonary Function Testing: Comprehensive, evidence-based reviews of diagnostic approaches to occupational asthma17,18 recommend the following Causes of Occupational Asthma tests in addition to a medical history and physical More than 400 substances have been identified examination: as causes of occupational asthma. Some allergists also have skin-prick asthma for a few causes of occupational asthma, testing reagents for some of the large-molecular- but testing for these is not clinically useful. However, there is no specific tory of atopy or cigarette smoking is a risk factor for IgE for many of the less common low-molecular- sensitization to high-molecular-weight substances weight substances. A positive test result for a (eg, biologically derived antigens, such as proteins specific IgE to the suspected antigen increases from laboratory animals or wheat flour) but not for the diagnostic certainty of occupational asthma. Unlike other types of occupational four times per day during days at work and days asthma, severe cases may be associated with epi- away from work may also help to distinguish sodic fever on exposure. Clinical inter- In the case of occupational asthma, a most pretation by visual comparison of the patient’s difficult initial decision may be in determining exposure history has been found to be as accurate whether it is safe to allow the patient to return to as computer-based interpretation. Once a diagnosis of occupational asthma is made, it is often important for the treat- Treatment of Occupational Asthma ing physician to determine whether disability is present and, if so, to what extent. As with all asthma, the treatment goal is to For any pulmonary patient who presents with remove the patient from exposure to triggers and a request for disability evaluation, the physi- to minimize symptoms by controlling asthma with cian must first decide whether the lung disease medications that have the least adverse effects for is nonoccupational (in which case federal Social the patient. Once diagnosed, the main difference Security Administration disability criteria apply between treating occupational and nonoccupational if the patient is totally disabled), or whether it is asthma is removing the patient from exposure. This occupational (ie, caused by the job) in which state- treatment begins with notifying the patient and, with specific worker compensation disability rules may the patient’s permission, the employer, and trying to apply. It is usually much to the patient’s advan- American Medical Association Guides tage to continue working for the same employer, but in circumstances in which the offending agent has Many states require the physician to apply the been removed, the reduction of air levels has been criteria of the Guides to the Evaluation of Permanent achieved or, in some cases, respiratory protection Impairment20 in rating the degree of disability for has been added. For the patient who is unable to work at all because of lung disease, whether occupational or Byssinosis nonoccupational, Social Security Administration disability criteria may apply. Each review takes control of asthma counts as two attacks, and a little different tack but covers essentially the same an evaluation period of at least 12 consecu- material. Although infrequently reported, fatal cases of Can Respir J 1998; 5:289–300 occupational asthma22 have occurred in patients Perhaps the clearest, most clinically useful review addres- for whom the association with the workplace was sing diagnosis. Outcome of Excellent short review with a balanced discussion of the occupational asthma after cessation of exposure: a controversial areas of this disorder. Accessed April 22, 2009 racic Society statement: occupational contribution If you know only the brand names or product names of the to the burden of airway diseases. Eur Respir J 2003; 22:364–373 Both articles discuss the known facts and the proposed Work/Disability Evaluation theories of the pathogenetic mechanisms at work in occupational asthma. Is the This rating system is the one most widely required by clinical history a satisfactory means of diagnosing individual state worker compensation systems. It is recommended that methacholine challenge tests March 29, 2009 and specific IgE assays or skin-prick tests (when available) be used to improve diagnostic accuracy. Fatal asthma Environ Med 2005; 62:290–299 from powdering shark cartilage and review of fatal Similar guidelines from the United Kingdom that place occupational asthma literature.

One study identified focal sensory deficits rapid improvement of headache and visual function blood pressure stages cheap sotalol 40 mg fast delivery. A hemorrhagic lesion diuretic drugs are not as quickly eliminated from in the acute brain scan was the strongest predictor of the intracerebral circulation as in other conditions post-acute seizures [22] heart attack grill calories generic 40mg sotalol with visa. Osmodiuretics common in patients with early symptomatic seizures may thus reduce venous drainage and should there- than in those patients with none arrhythmia quiz ecg cheap sotalol 40 mg without a prescription. Increased intracranial pressure in most cases Epileptic seizures should be treated with paren- responds to improved venous drainage after anti- terally administered antiepileptic drugs (phenytoin, coagulation. Chapter 11: Cerebral venous thrombosis occluded cerebral veins, but also in order to prevent Infectious thrombosis the recurrence of intra- or extracerebral thrombosis. Antithrombo- ingly favorable, with an overall death or dependency tic prophylaxis during pregnancy is probably unneces- rate of about 15% [2]. However, women on vitamin K antagonists nancy, deep venous system thrombosis, intracranial should be advised not to become pregnant because of hemorrhage, coma upon admission, age and male sex. The main causes of acute death are transtentorial herniation secondary to a large hemorrhagic lesion, multiple brain lesions or diffuse Special aspects brain edema. Fatalities after the acute phase are predominantly eclampsia, gestational or chronic diabetes mellitus). There is a high incidence of intracranial hemorrhages (40–60% hemorrhagic infarctions, 20% intraventricular bleedings). A significant number of Recurrence of cerebral venous children are left with a considerable impairment thrombosis (motor or cognitive deficits, epilepsy). Future developments Treatment of bacterial infections with broad antibiotics and surgery. Open questions con- Treatment of epileptic seizures with parenterally cern many of our current management decisions, administered antiepileptic drugs (phenytoin, such as the role of local or systemic thrombolysis, valproic acid, levetiracetam). It is mandatory to increase the level of evidence supporting our diagnostic or Acknowledgement therapeutic decisions through prospective registries, The author expresses his gratitude to Dr Ioannis case–control studies, and, whenever possible, random- Tsitouridis, Director of the Department of Diagnostic ized controlled trials. Prognosis of The most common and frequently the first cerebral vein and dural sinus thrombosis. Martins and Lara Caeiro Cognitive functions are related to our ability to build lesions are circumscribed, the conceptual representa- an internal representation of the world, the concep- tion system is not affected and these patients are not tual representation system, based on a large-scale demented. Although tion, organized according to their specific processing these tests are also included in brief exams of cogni- capacities. In fact, language impairment will affect typed, since it follows the distribution of the vascular the majority of cognitive functions and needs to be territories. However, in the hyperacute stage symp- ruled out before proceeding to the assessment of toms are likely to be amplified by additional regions orientation, memory or executive functions. It is also a rough plasticity mechanisms make neuroanatomical corre- measure of aphasia severity. Presented objects should be venous thrombosis the pattern of cognitive defects is common and easily recognized (spoon, comb, spec- less stereotyped due to the variability of lesion local- tacles, pencil, wristwatch), to make the task specific ization, size and number, or particular pathogenic for aphasia and not sensitive to cultural factors or mechanisms that may cause diffuse impairment. Patients’ responses vary from pauses (word- In this chapter we will present the most common finding difficulties), tip-of-the tongue phenomenon, cognitive and neurobehavioral deficits secondary to paraphasias, the use of supraordinal responses (fruit stroke, according to symptom presentation. There are rare patients who suffer from a selective naming difficulty affecting a single category of names Language disorders (“category-specific impairments”), such as living Language disorders, or aphasia, occur following peri- entities, actions but not objects, or proper names sylvian lesions (middle cerebral artery territory) of the but not common names.

The artery is subdivided into the M1 segment prehypertension yahoo sotalol 40 mg cheap, leading to an ipsilateral fixed mydriasis and the contra- from which start the deep perforating lenticulostriate lateral cerebral peduncle is compressed against the cere- arteries blood pressure 9058 purchase 40mg sotalol overnight delivery, the M2 segment blood pressure 8550 order generic sotalol from india, corresponding to the seg- bellar tentorium, leading to ipsilateral corticospinal ment after the bifurcation into superior and inferior signs, such as Babinski’s sign and paresis (Kernohan divisions, and the M3 segment, including the insular notch). Early recognition of frontal, prefrontal, precentral, central sulcus, anterior patients at risk enables the medical team to propose a parietal, posterior parietal, angular and temporal arter- hemicraniectomy for selected patients, a treatment ies, with important variations in their territories. As collateral networks are highly variable, an of the lower limbs are less involved than the face and occlusion of the same artery at the same place may arms. The patient is usually awake or presents mild partial brachiofacial sensitive loss (mainly tactile and drowsiness or agitation, particularly with a right discriminative modalities), transient conjugate ipsilat- infarct. Cognitive signs are always present: in the case eral eye and head deviation and aphasia (aphemia or of a left lesion, aphasia, and most of the time global, Broca aphasia) frequently associated with buccolin- ideomotor apraxia. In the case of a right lesion, gual apraxia in the case of left infarcts and various contralateral multimodal hemineglect (visual, motor, degrees of multimodal hemineglect, anosognosia, 122 sensitive, visual, spatial, auditive), anosognosia (denial anosodiaphoria, confusion and monotone language of illness), anosodiaphoria (indifference to illness), in right lesions. Ischemia in their glect, transcortical motor aphasia and behavioral dis- territory can therefore produce severe deficits with a turbances (with involvement of the supplementary very small-volume lesion. Sensory hemisyndromes affecting mainly minor, except in the case of deafferentation of the cortex the contralateral leg are also described. Clinical function, mutism, anterograde amnesia, grasping, signs include proportional hemiparesis, hemihypesthe- and behavioral disturbances are particularly frequent sia, dysarthria, hypophonia, and occasionally abnormal in ischemia of the deep perforating arteries and the movements in the case of involvement of basal ganglia. Involvement of the corpus callosum can produce The centrum ovale receives its blood supply from the callosal disconnection syndrome, secondary to medullary perforating arteries coming principally interruption of the connection of physical informa- from leptomeningeal arteries. Small infarcts (less than tion from the right hemisphere to cognitive center in 1. Therefore, it is restricted to the deficits are often less proportional than in pontine left hand, which presents ideomotor apraxia, agra- or internal capsule lacunes. A rare but specific visual field defect less severe, with a classic subacute two-phase pre- is a homonymous defect in the upper and lower sentation or even asymptomatic. The two vertebral arteries leave the and repetition but anomia, jargon speech and seman- subclavian arteries, pass through transverse foramina tic paraphasic errors) with left infarct. The manifestations of acute internal carotid occlusion are quite variable, depending on the collateral status Clinical clues to differentiate posterior from and preexisting carotid stenosis. Consciousness is usually more posterior circulation stroke and should be recognized. In contrast, a progressive atherosclerotic occlusion Similarly, headache is more frequent in the posterior is usually less severe, with a classic subacute two- circulation, is typically ipsilateral to the infarct, and phase presentation. Chapter 8: Common stroke syndromes On exam, a disconjugate gaze strongly suggests a eyelid, and hemifacial anhydrosis. It may occur as a fixed misalign- ipsilateral dorsolateral brainstem, upper cervical, or ment of the ocular axis, such as in vertical skew thalamic lesion, but may also occur due to a carotid deviation of the eyes as part of the ocular tilt reaction. If the eyes are deviated toward the hemiparesis, nerves and fascicles that produce ipsilateral signs and i. If somnolence, early anisocoria or vertical A vertical gaze paresis (upwards, downwards, or gaze palsy are present, posterior circulation stroke is both) points to a dorsal mesencephalic lesion and may more probable than carotid territory stroke. The latter structure may also Section 3: Diagnostics and syndromes receive direct (long circumferential) branches from the case, the patient develops paresthesia in the shoulder, vertebral artery. Three classic clinical syndromes are neck stiffness up to opisthotonos, no motor recognized in their territory: the medial medullary responses, small and unreactive pupils, ataxic then stroke (or Déjerine syndrome); the dorsolateral medul- superficial respiratory pattern, Cushing’s triad lary stroke (or Wallenberg syndrome); and the hemi- (hypertension, bradycardia, apnea) and finally cardio- medullary stroke (or Babinski-Nageotte syndrome). With transtentorial herniation, The medial medullary stroke is a rare stroke lethargy and coma are accompanied by central hyper- syndrome and classically includes contralateral hemi- ventilation, upward gaze paralysis, unreactive, mid- paresis sparing the face (corticospinal tract), contra- position pupils and decerebration. The laterodorsal medullary stroke syndrome, leading to contralateral motor and all- is the most common of those three syndromes and modalities sensory deficits, ipsilateral tongue, phar- is named the Wallenberg syndrome, after Adolf ynx and vocal cord weakness and facial thermoalgesic Wallenberg (1862–1946), a German neurologist.

As a matter of fact pulse pressure mitral stenosis safe sotalol 40mg, by providing a description of the picture hypertension drug discount 40mg sotalol fast delivery, captions also give an explanation of a specific process that is highlighted in the article it refers to . The following examples are in- stances of descriptions in the three languages: (16) The Bielefeld chemist Michael Schwake and his colleagues have discovered a new protein fold heart attack proof generic sotalol 40 mg line. Recourse to quotations in captions help contribute to em- phasizing authoritativeness of the sources of the article, and at the same time, it serves as a form of hedging, limiting the journalist’s res- ponsibility since he/she simply reports something stated by someone else. As is possible to observe in the table, French magazines tend to use more summarizing captions (147 instances), whereas English maga- zines show an equal preference for descriptive and summarizing cap- tions (46 occurrences for both categories). French magazines, conversely, are almost the only ones (apart from two instances in Science Daily) in which it is possible to find the category captions using title (13 occur- rences). Similarly, the classes captions using paragraphs and using quotations are nearly exclusively adopted in English science populari- zation magazines (20 and 13 instances respectively). Conclusions The results of our analysis show that even though there are differences between corpora which might be due to culture-based (in terms of nationality) ways of dealing with science and of using popularizing re- sources, there are also some striking similarities in terms of function, which seem to be distinctive of the popularization of medical-scienti- fic discourse. In this way, captions serve to anticipate the content of the text and they allow the potential audience to have a better understanding of the phe- nomena described in the articles. A second important function of captions that our evidence indi- cates is the descriptive one (descriptive captions) since they explain the main physical characteristics of the elements depicted in the image they are linked to . Hence, they enhance the reader’s comprehension by means of simple references to the image, explaining what cannot be drawn from an in- tuitive mental process. Moreover, a third function of captions identified in our data is anchoring the image to a specific part of the article (captions using title, paragraphs or quotations). To conclude, it is possible to confirm our initial hypothesis that images and captions offer invaluable help in the construction of strate- gies of science popularization even though they have been scarcely considered by the literature. In fact, they provide important cognitive 102 Silvia Cavalieri guidelines, interpretive framework as to how to correctly and effect- ively process the information contained in the whole article. Acknowledgements This research has been carried out in collaboration with Dr Alida Maria Silletti (Università degli studi di Bari “Aldo Moro”) for the collection of the corpus as well as for the analysis of French and Italian data. The Analysis of Popularization Discourse: Con- ceptual Changes and Methodological Evolutions In Kermas, Susan / Christiansen, Thomas (eds) The Popularization of Spe- cialized Discourse and Knowledge across Communities and Cultures. Introduction Recent years have seen a growing interest in the application of pragmatic aspects of communication in the area of research into language disorders. Since the major deficits in pragmatic communication refer to qualitative impairments in social communication, standardized measures may not be appropriate for all racial and ethnic populations: To deny the validity of the notion of culture-specific […] patterns (including ‘Anglo’ cultural patterns) is to place the values of political correctness above the interests of socially disadvantaged individuals and groups. To apply the same criteria to every child would not only be a culturally insensitive choice, but could also result in serious misclassification of symptoms, since the way a child does or does not respond to specific social situations may very well be mediated by cultural factors. Accordingly, the present study intends to address this gap from a broad critical discourse analysis perspective and within the domain of Applied Descriptive Translation Studies (Snell-Hornby 2006). Background Pragmatics plays a critical role in day-to-day communication: speak- ers who cannot adapt language to the needs of interlocutor(s) and/or the context of the situation nor follow socio-culturally shared rules for conversations and storytelling are penalized in conversation (Vaughan 2008). More specifically, the behavioural abilities include turn-taking, reciprocity and topic maintenance in conversation, as well as providing the necessary background information and clarification. The abilities to initiate interactions, maintain eye contact and interpret facial expressions and body language are also important, in addition to sharing skills and sportsmanship. Other crucial socio-cognitive skills include the abilities to make inferences and understand non-literal language, together with the competence to independently analyze social problems and arrive at solution options rapidly, also by envisioning multiple interpretations of situations (Ketelaars 2010). Early diagnosis is thus both difficult and essential since the de- velopment of abnormal language skills in children can be reduced and clinically treated if addressed from the outset; otherwise symptoms may more severely interfere with learning and social interaction. Hence, the need to develop efficient tools, especially for screening the youth population, is increasingly felt, as well as the need to account for the impact of cultural differences in the communicative perfor- mances of the subjects.

However hypertension quality improvement discount sotalol 40 mg with mastercard, it should be remembered that continuous responses Less common are trial designs that specifically and can be converted into quantal responses with adaptively minimize the number of patients appropriate prehypertension uk sotalol 40 mg without prescription, prospective efficacy criteria low vs diamond heart attack safe 40 mg sotalol, e. All is quantal-positive after a 15 mmHg fall in diastolic minimization designs involve arduous statistical blood pressure within 60 days of commencing planning, and the pharmaceutical physician should therapy. In this example, patients who do not respond ( ) are followed by a patient treated at the next higher dose size; vice versa, patients who do respond ( ) are followed by a patient treated at the next lower dose. Patients or groups requires an independent coordinator who allocates of patients are paired, and then treated with alter- each patient, as he/she is recruited, to one or other native therapies. The independent coordinator al- records the result of each comparison with time, locates each patient so as to minimize the difference and crossing a boundary on the chart, after an between the two treatment groups, according to unpredictable number of paired comparisons, prospectively defined patient characteristics, e. For a trial of a new therapy age, sex, genotype, disease state or stage, or con- that can both benefit and harm the patient, a typical comitant therapy. The design of control charts is always to a treatment group by the chance of a random- prospective, and their shape depends upon the a ization schedule. Second, the independent co- under test, control charts can be rhomboidal, par- ordinator need only allocate patients to anonym- allelogram-shaped, or many other shapes. White- ous groups A or B, and the study pharmacist need head (1999) is the best entry to the literature on this be the only person who knows which treatments specialized topic. If the patient receiving treatment A does better than the one receiving treatment B (A > B), then the line moves upwards; vice versa, if the patient receiving B does better than the one receiving A (B > A), then the line moves downward. This is of use when, for example, it may be desirable to expose Stratification Studies fewer patients to placebo than to active therapy, especially when conducting a trial of compounds In pivotal studies, large numbers of patients are whose properties are fairly well known or may be studied so that their diverse clinical characteristics predicted with some confidence. On the other hand, when designing a mini- then randomized to active or placebo for a total of mization study, the assumption is that the treat- four treatment groups, although only two test ment groups will be devoid of relevant differences treatments. Separate statistical analyses for the in baseline characteristics, and therefore clinical strata can then be planned, and the study size significance might only be assumed to follow from adjusted accordingly. Regulatory authorities it increases, may compensate for the reduction in will often approve indications with caveats based variability amongst study group samples, and thus on such subsets. The risk of stratification studies is where, in any case, large numbers of patients are that conservative regulatory authorities will needed for a tolerability database. If the controlled want to see statistical significance in all patient clinical trial is a gold standard, then it would be subsets before allowing a short, broad indication wrong to assert that the independent treatment al- in labeling. Trials of can then be ethical to recruit patients into a study cardiovascular drugs, on an almost epidemi- with inclusion criteria that include that they are ological scale, have been the most significant already being treated with the drug of interest. Literally Almost any of the designs discussed above may tens of thousands of patients have been recruited then be used, where patients are randomized either under these protocols with case report forms to remain on the treatment of interest or to be having fewer than 10 pages for each patient. These two-stage designs usually include a Kaplan±Meier analysis and other epidemiological small number of open label-treated patients (usu- approaches may also be applied to such data- ally n 14) in the first stage. Stopping a clinical trial because of an emergent Large simple studies can thus create undue confi- safety problem, either by a medical monitor or by dence in product tolerability (`thousands of pa- a safety committee, is always a unique situation. There are several statistical points of view on this subject, and Efficacy Issues regulatory authorities have a habit of believing only the most conservative. Efficacy, like safety, of thumb, pharmaceutical physicians should expect can cause ethical concerns to the pharmaceutical statisticians to provide alternatives that obey a physician when he/she suspects that patients will be simple subtraction rule. In that Interim Efficacy Analyses case, if the study continues after the interim analy- sis fails to achieve p < 0:01, then it will be required These usually make a mess! They require either that to achieve approximately p < 0:04 for the whole the overall size of the trial has to be greater than if patient population in the final statistical analysis no interim analysis was performed, or that a in order to demonstrate the efficacy of the test smaller a must be accepted as indicating statistical drug. Stopping method which takes into account the uncertainties the trial by reason of the unethical basis for treating associated with small and unequal treatment group the patients with anything else is a rare and pleas- sizes. Eventu- that, when considering a new trial, he/she should ally, the several test therapies are reduced to two at least consider whether a Bayesian approach and a definitive demonstration of superiority or might help. It is unlikely imum number of patients have entered the trial, an that enough patients could ever be collected at any interim analysis is done every time another patient reasonably small number of study sites for any completes the trial.

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