BiDi https://store.theartofservice.com/itil-2011-foundation-complete-certification-kit-fourth-editi - PowerPoint Presentation

Slide1

BiDi

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Slide2

Opto-isolator - Bidirectional opto-isolators

The simplest bidirectional opto-isolator is merely a pair of LEDs placed face to face and held together with heat-shrink tubing

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Slide3

Opto-isolator - Bidirectional opto-isolators

Visible spectrum LEDs have relatively poor transfer efficiency, thus near infrared spectrum GaAs, GaAs:Si and AlGaAs:Si LEDs are the preferred choice for bidirectional devices. Bidirectional opto-isolators built around pairs of GaAs:Si LEDs have current transfer ratio of around 0.06% in either photovoltaic or photoconductive mode — less than photodiode-based isolators, but sufficiently practical for real-world applications.

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Slide4

Travel medicine - Mortality and morbidity

Mortality studies indicate that cardiovascular disease accounts for most deaths during travel (50-70%), while injury and accident follow (~25%). Infectious disease accounts for about 2.8-4% of deaths during/from travel. Morbidity studies suggest that about half of people from a developed country who stay one month in a developing country will get sick. Traveler's diarrhea is the most common problem encountered.

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Slide5

Rendering (computer graphics) - The bidirectional reflectance distribution function

The 'bidirectional reflectance distribution function' (BRDF) expresses a simple model of light interaction with a surface as follows:

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Slide6

Rendering (computer graphics) - The bidirectional reflectance distribution function

Light interaction is often approximated by the even simpler models: diffuse reflection and specular reflection, although both can ALSO be BRDFs.

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Slide7

Delayed sleep phase disorder - Comorbidity

In the DSPD cases reported in the literature, about half of the patients have suffered from clinical depression or other psychological problems, about the same proportion as among patients with chronic insomnia. According to the International Classification of Sleep Disorders|ICSD:

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Slide8

Delayed sleep phase disorder - Comorbidity

A direct neurochemical relationship between sleep mechanisms and depression is another possibility. DSPD may cause excessive or inappropriate production of melatonin. Serotonin, a mood regulator, is a precursor to melatonin. As a result, increased endogenous melatonin production can deplete serotonin levels and may cause depression.

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Slide9

Delayed sleep phase disorder - Comorbidity

It is conceivable that DSPD often has a major role in causing depression because it can be such a stressful and misunderstood disorder. A recent study from the University of California, San Diego found no association of bipolar disorder (history of mania) with DSPD, and it states that there may be

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Slide10

Delayed sleep phase disorder - Comorbidity

The fact that half of DSPD patients are not depressed indicates that DSPD is not merely a symptom of depression. Sleep researcher M. Terman has suggested that those who follow their internal circadian clocks may be less likely to suffer from depression than those trying to live on a different schedule.

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Slide11

Delayed sleep phase disorder - Comorbidity

DSPD patients who also suffer from depression may be best served by seeking treatment for both problems. There is some evidence that effectively treating DSPD can improve the patient's mood and make antidepressants more effective.

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Slide12

Delayed sleep phase disorder - Comorbidity

Vitamin D deficiency has been linked to depression. As it is a condition which comes from lack of exposure to sunlight, anyone who does not get enough sunlight exposure during the daylight hours could be at risk.

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Slide13

Delayed sleep phase disorder - Comorbidity

Persons with obsessive-compulsive disorder are also diagnosed with DSPD at a much higher rate than the general public.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219909/?tool=pmcentrez

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Slide14

Body dysmorphic disorder - Comorbidity

There is comorbidity with other psychological disorders, which often results in misdiagnoses by medical individuals.

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Slide15

Impulse control disorder - Co-morbidity

Complications of late Parkinson's disease may include a range of impulse control disorders, including eating, buying, compulsive gambling and sexual behavior. One study found that 13.6% of Parkinson's patients exhibited at least one form of ICD.

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Slide16

Impulse control disorder - Co-morbidity

There is a significant co-occurrence of pathological gambling and personality disorder, and is suggested to be caused partly by their common genetic vulnerability.Brewer, Potenza(2008). The Neurobiology and Genetics of Impulse Control Disorders: Relationships to Drug Addictions. Biochemical Pharmacology '75'(1) 63–75. PMID 17719013

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Slide17

Impulse control disorder - Co-morbidity

The degree of heritability to ICD is similar to other psychiatric disorders including substance abuse disorder. There has also been found a genetic factor to the development of ICD just as there is for substance abuse disorder. The risk for subclinical PG in a population is accounted for by the risk of alcohol dependence by about 12-20% genetic and 3-8% environmental factors.

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Slide18

Impulse control disorder - Co-morbidity

There is a high rate of comorbidity between ADHD and impulse control disorders.

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Slide19

Insomnia - Causes and comorbidity

Symptoms of insomnia can be caused by or be co-morbid with:

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Slide20

Insomnia - Causes and comorbidity

*Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake.

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Slide21

Insomnia - Causes and comorbidity

*Withdrawal from anti-anxiety drugs such as benzodiazepine withdrawal|benzodiazepines or pain-relievers such as opioid withdrawal|opioids.

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Slide22

Insomnia - Causes and comorbidity

*Use of fluoroquinolone antibiotic drugs is associated with more severe and chronic types of insomnia.

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Slide23

Insomnia - Causes and comorbidity

*Restless legs syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations.

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Slide24

Insomnia - Causes and comorbidity

*Periodic limb movement disorder (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware.

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Slide25

Insomnia - Causes and comorbidity

*Pain An injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can in addition cause awakening.

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Slide26

Insomnia - Causes and comorbidity

*Hormone shifts such as those that precede menstruation and those during menopause.

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Slide27

Insomnia - Causes and comorbidity

*Life events such as fear, stress (psychology)|stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement.

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Slide28

Insomnia - Causes and comorbidity

*Gastrointestinal issues such as heartburn or constipation.

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Slide29

Insomnia - Causes and comorbidity

*Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, and dementia.Gelder, M., Mayou, R. and Geddes, J. (2005). Psychiatry. 3rd ed. New York: Oxford. p. 167, ISBN 0198528639. or ADHD

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Slide30

Insomnia - Causes and comorbidity

*Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic Circadian rhythm sleep disorder|circadian rhythm disorders are characterized by similar symptoms.

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Slide31

Insomnia - Causes and comorbidity

* Certain Neurology|neurological disorders, brain damage|brain lesions, or a Medical history|history of traumatic brain injury.

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Slide32

Insomnia - Causes and comorbidity

*Disease|Medical conditions such as hyperthyroidism and rheumatoid arthritis.

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Slide33

Insomnia - Causes and comorbidity

*Abuse of over-the counter or prescription sleep aids (sedative or depressant drugs) can produce rebound insomnia.

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Slide34

Insomnia - Causes and comorbidity

*Poor sleep hygiene, e.g., Noise health effects|noise or over consumption of caffeine

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Slide35

Insomnia - Causes and comorbidity

*A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia.

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Slide36

Insomnia - Causes and comorbidity

*Physical exercise. Exercise-induced insomnia is common in athletes in the form of prolonged sleep onset latency.[http://cev.org.br/biblioteca/the-epidemiological-survey-of-exercise-induced-insomnia-in-chinese-athletes The epidemiological survey of exercise-induced insomnia in chinese athletes] Youqi Shi, Zhihong Zhou, Ke Ning, Jianhong LIU. Athens 2004: Pre-Olympic Congress.

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Slide37

Insomnia - Causes and comorbidity

Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study

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Slide38

Generalized anxiety disorder - Other comorbidities

In addition to coexisting with depression, research shows that GAD often coexists with conditions associated with Stress (medicine)|stress, such as irritable bowel syndrome. Patients with GAD can sometimes present with physical symptoms such as insomnia or headaches.

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Slide39

Generalized anxiety disorder - Other comorbidities

Further research suggests that about 20 to 40 percent of individuals with attention deficit hyperactivity disorder have comorbid anxiety disorders, with GAD being the most prevalent.

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Slide40

Kleptomania - Comorbidity

Psychopathology and comorbidity of psychiatric disorders in patients with kleptomania

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Slide41

Kleptomania - Comorbidity

Family history and psychiatric comorbidity in persons with kleptomania

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Slide42

Kleptomania - Comorbidity

It has been suggested that because kleptomania is linked to strong compulsive and impulsive qualities, it can be viewed as a variation of obsessive-compulsive spectrum disorders, together with pathological gambling, compulsive buying, pyromania, nailbiting and trichotillomania

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Slide43

Autism spectrum - Comorbidity

Autism spectrum disorders tend to be highly comorbid with other disorders. Comorbidity may increase with age and may worsen the course of youth with ASDs and make intervention/treatment more difficult. Distinguishing between ASDs and other diagnoses can be challenging because the traits of ASDs often overlap with symptoms of other disorders and the characteristics of ASDs make traditional diagnostic procedures difficult.

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Slide44

Autism spectrum - Comorbidity

The most common medical condition occurring in individuals with autism spectrum disorders is seizure disorder or epilepsy, which occurs in 11-39% of individuals with ASD. Tuberous sclerosis, a medical condition in which non-malignant tumors grow in the brain and on other vital organs, occurs in 1-4% of individuals with ASDs.

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Slide45

Autism spectrum - Comorbidity

Intellectual disabilities are some of the most common comorbid disorders with ASDs. Recent estimates suggest that 40-69% of individuals with ASD have some degree of mental retardation, with females more likely to be in severe range of mental retardation. Learning disabilities are also highly comorbid in individuals with an ASD. Approximately 25-75% of individuals with an ASD also have some degree of learning disability.

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Slide46

Autism spectrum - Comorbidity

A variety of anxiety disorders tend to co-occur with autism spectrum disorders, with overall comorbidity rates of 7-84%. Rates of comorbid Depression (mood)|depression in individuals with an ASD range from 4–58%.

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Slide47

Autism spectrum - Comorbidity

Deficits in ASD are often linked to behavior problems, such as difficulties following directions, being cooperative, and doing things on other people's terms. Attention Deficit Hyperactivity Disorder (ADHD)-like symptoms are seen to be part of the ASD diagnosis.

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Slide48

Major depressive disorder - Comorbidity

The 1990–92 National Comorbidity Survey (US) reports that 51% of those with major depression also suffer from lifetime anxiety

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Slide49

Major depressive disorder - Comorbidity

Depression and pain often co-occur. One or more pain symptoms are present in 65% of depressed patients, and anywhere from 5 to 85% of patients with pain will be suffering from depression, depending on the setting; there is a lower prevalence in general practice, and higher in specialty clinics. The diagnosis of depression is often delayed or missed, and the outcome worsens. The outcome can also worsen if the depression is noticed but completely misunderstood.

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Slide50

Major depressive disorder - Comorbidity

Depression is also associated with a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity

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Slide51

Conduct disorder - Comorbidity

In this way, there seems to be reciprocal effects of comorbidity with certain disorders, leading to increased overall risk for these youth.

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Slide52

Neuroeducation - A bidirectional relationship

Katzir and Pareblagoev (2006) suggest the example of dyslexia research as a model of how this bidirectional collaboration might be achieved

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Slide53

Social anxiety disorder - Comorbidity

There is a high degree of comorbidity with other psychiatric disorders

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Slide54

Social anxiety disorder - Comorbidity

Although the DSM-IV criteria state that an individual cannot receive a diagnosis of social anxiety disorder if their symptoms are better accounted for by one of the autism spectrum disorders such as autism and Asperger syndrome, some people suffer from these disorders along with social anxiety disorder. One study found a comorbidity of 28%, and it is more common in higher-functioning individuals who have a desire for social interactions, but who are also aware of their social deficits.

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Slide55

Social anxiety disorder - Comorbidity

Because of its close relationship and overlapping symptoms with other illnesses, treating people with social phobia may help understand underlying connection in other psychiatric disorders

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Slide56

Cannabinoid - Cannabidiol

Cannabidiol has also been shown to act as a 5-HT1A receptor|5-HT1A receptor agonist, an action that is involved in its antidepressant, anxiolytic, and neuroprotective effects.

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Slide57

Cannabinoid - Cannabidiol

It appears to relieve convulsion, inflammation, anxiety, and nausea. CBD has a greater affinity for the CB2 receptor than for the CB1 receptor.

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Slide58

Cannabinoid - Cannabidiol

CBD shares a wiktionary:Precursor|precursor with THC and is the main cannabinoid in low-THC Cannabis strains. CBD apparently plays a role in preventing the short-term memory loss associated with THC in mammals.

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Slide59

Cannabinoid - Cannabidiol

Some research suggests that the antipsychotic effects of cannabidiol potentially represent a novel mechanism in the treatment of schizophrenia.

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Slide60

Cannabinoid - Cannabidiol

Researchers at California Pacific Medical Center discovered CBD's ability to turn off the activity of ID1, the gene responsible for metastasis in breast and other types of cancers, including the particularly aggressive triple negative breast cancer.[http://www.sfgate.com/health/article/Pot-compound-seen-as-tool-against-cancer-3875562.php#ixzz2GZmg5kGr Pot compound seen as tool against cancer - SFGate] The researchers hope to start human trials soon.[http://www.nbcbayarea.com/news/local/Marijuana-Compound-Fights-Cancer-Human-Trials-Next-170406116.html Marijuana Compound Fights Cancer; Human Trials Next | NBC Bay Area]

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Slide61

Cannabinoid - Cannabidivarin

Although cannabidivarin (CBDV) is usually a minor constituent of the cannabinoid profile, enhanced levels of CBDV have been reported in feral cannabis plants from the northwest Himalayas, and in hashish from Nepal.

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Slide62

Cognitive epidemiology - Overall mortality and morbidity

A strong inverse correlation between early life intelligence and mortality has been shown across different populations, in different countries, and in different epochs. Various explanations for these findings have been proposed:

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Slide63

Cognitive epidemiology - Overall mortality and morbidity

First, ...intelligence is associated with more education, and thereafter with more professional occupations

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Slide64

Cognitive epidemiology - Overall mortality and morbidity

that might place the person in healthier environments. ...Second, people with higher intelligence might engage in more healthy behaviours. ...Third, mental test scores from early life might act as a record of insults to the brain that have occurred before that date. ...Fourth, mental test scores obtained in youth might be an indicator of a well-put-together system. It is hypothesized that a well-wired body is more able to respond effectively to environmental insults...

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Slide65

Cognitive epidemiology - Overall mortality and morbidity

A study of one million Swedish men found showed a strong link between cognitive ability and the risk of death.

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Slide66

Cognitive epidemiology - Overall mortality and morbidity

quote|People with higher IQ test scores tend to be less likely to smoke or drink alcohol heavily. They also eat better diets, and they are more physically active. So they have a range of better behaviours that may partly explain their lower mortality risk.|-Dr. David Batty

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Slide67

Cognitive epidemiology - Overall mortality and morbidity

A similar study of 4,289 former US soldiers showed a similar relationship between IQ and Mortality rate|mortality.

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Slide68

Cognitive epidemiology - Overall mortality and morbidity

The strong correlation between intelligence and mortality has raised questions as to how better public education could delay mortality.

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Slide69

Cognitive epidemiology - Overall mortality and morbidity

There is a known inverse correlation between socioeconomic position and health. A 2006 study found that controlling for IQ caused a marked reduction in this association.

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Slide70

Personality disorder - Comorbidity

There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another. Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

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Slide71

Personality disorder - Comorbidity

Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria.

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Slide72

Personality disorder - Comorbidity

'Abbreviations used:' PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder.

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Slide73

Haloperidol - Psychosis and general morbidity

Larger, controlled studies of randomized populations must be performed to differentiate medication-induced from behavior-induced morbidity before definitive conclusions can be drawn.

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Slide74

Promoter (biology) - Bidirectional promoters (mammalian)

http://dx.doi.org/10.1016/j.gene.2005.04.027 About 11% of human genes are bidirectionally paired.

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Slide75

Promoter (biology) - Bidirectional promoters (mammalian)

Functional consequences of bidirectional promoters

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Slide76

Promoter (biology) - Bidirectional promoters (mammalian)

Some functional classes of genes are more likely to be bidirectionally paired than others. Genes implicated in DNA repair are five times more likely to be regulated by bidirectional promoters than by unidirectional promoters. Chaperone proteins are three times more likely, and mitochondrial genes are more than twice as likely. Many basic Housekeeping gene|housekeeping and cellular metabolic genes are regulated by bidirectional promoters.

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Slide77

Promoter (biology) - Bidirectional promoters (mammalian)

The overrepresentation of bidirectionally paired DNA repair genes associates these promoters with cancer. Forty-five percent of human somatic oncogenes seem to be regulated by bidirectional promoters - significantly more than non-cancer causing genes. Hypermethylation of the promoters between gene pairs WNT9A/CD558500, CTDSPL/BC040563, and KCNK15/BF195580 has been associated with tumors.

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Slide78

Promoter (biology) - Bidirectional promoters (mammalian)

Transcription factor binding and modified histones in human bidirectional promoters

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Slide79

Promoter (biology) - Bidirectional promoters (mammalian)

It has been hypothesized that the recruitment and initiation of RNA Polymerase II usually begins bidirectionally, but divergent transcription is halted at a checkpoint later during elongation

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Slide80

Synchronous Digital Hierarchy - Bidirectional line-switched ring

Bidirectional line-switched ring (BLSR) comes in two varieties: two-fiber BLSR and four-fiber BLSR

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Slide81

Synchronous Digital Hierarchy - Bidirectional line-switched ring

BLSRs can operate within a metropolitan region or, often, will move traffic between municipalities

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Slide82

Blindness - Comorbidities

Blindness can occur in combination with such conditions as intellectual disability, autism spectrum disorders, cerebral palsy, hearing impairments, and epilepsy. In a study of 228 visually impaired children in Atlanta metropolitan area|metropolitan Atlanta between 1991 and 1993, 154 (68%) had an additional disability besides visual impairment. Blindness in combination with hearing loss is known as deafblindness.

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Slide83

Blindness - Comorbidities

It has been estimated that over half of totally blind people have non-24-hour sleep–wake disorder, a condition in which a person's circadian rhythm is longer than 24 hours.

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Slide84

Nephelometer - Turbidity units

*Because optical properties depend on suspended particle size, a stable synthetic material called Formazin with uniform particle size is often used as a standard for calibration and reproducibility.Formazin was first used for standardizing turbidity measurements in 1926. The unit is called Formazin Turbidity Unit (FTU).

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Slide85

Nephelometer - Turbidity units

*Nephelometric Turbidity Units (NTU) specified by United States Environmental Protection Agency is a special case of FTU, where a white light source and certain geometrical properties of the measurement apparatus are specified. (Sometimes the alternate form nephelos turbidity units is used[http://www.freepatentsonline.com/5034211.html Reducing turbidity in chromic acid solutions], Zeller, III, Robert L.; Morgan, Russell J.; Rabbe, Gilbert D.; Fiscus, Donna R.; Wilkes, Jr., Richard L.;

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Slide86

Nephelometer - Turbidity units

United States Patent 5034211, Filing date 1990-10-29, Publication date 1991-07-23[http://www.floridaconservation.org/codebook/2006/Deptartment_of_Agriculture_and_Consumer_Services.pdf Florida Department of Agriculture and Consumer Services 2006 Codebook Chapter 5L-1: The Comprehensive Shellfish Control code])

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Slide87

Nephelometer - Turbidity units

*Formazin Nephelometric Units (FNU), prescribed for 9 measurements of turbidity in water treatment by ISO 7027, another special case of FTU with near infrared light (NIR) and 90° scatter.

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Slide88

Nephelometer - Turbidity units

*Formazin Attenuation Units (FAU) specified by ISO 7027 for water treatment standards for turbidity measurements at 0°, also a special case of FTU.

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Slide89

Nephelometer - Turbidity units

*Formazin Backscatter Units (FBU), not part of a standard, is the unit of optical backscatter detectors (OBS), measured at c. 180°, also a special case of FTU.

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Slide90

Nephelometer - Turbidity units

*European Brewery Convention (EBC) turbidity units

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Slide91

Nephelometer - Turbidity units

*Concentration Units (C.U.)

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Slide92

Nephelometer - Turbidity units

*Jackson Candle Turbidity Units (JTU; an early measure)

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Slide93

Nephelometer - Turbidity units

*American Society of Brewing Chemists (ASBC-FTU) turbidity units

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Slide94

Nephelometer - Turbidity units

*Parts Per Million of standard substance, such as PPM/DE (Kieselguhr)

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Slide95

Nephelometer - Turbidity units

*Trübungseinheit/Formazin (TE/F) a German standard, now replaced by the FNU unit.

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Slide96

Nephelometer - Turbidity units

*diatomaceous earth (ppm SiO2) an older standard, now obsolete

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Slide97

Nephelometer - Turbidity units

The most generally applicable unit is Formazin Turbidity Unit ('FTU'), although different measurement methods can give quite different values as reported in FTU (see below).

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Slide98

Nephelometer - Turbidity units

Gas-phase nephelometers are also used to study the atmosphere

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Slide99

Subsurface currents - Turbidity current

There is one additional effect of turbidity currents: upwelling

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Slide100

Contourite - Modified drift-turbidite systems

Croix were studied by Stanley (1993) in which he found an ancient analog of an alternating turbidite and contourite deposit and generated a stratigraphic model of a continuum from a turbidite dominant environment to a contourite dominant one.

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Slide101

Contourite - Modified drift-turbidite systems

Stanley (1993) proposes that the transition from a turbidite to a contourite involves a continuous transition from a sandy deposit to lenticular bedding passing through wavy bedding.

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Slide102

Rubidium

Natural rubidium is a mix of two isotopes: 85Rb, the only stable one, constitutes 72% of it

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Slide103

Rubidium

German chemists Robert Bunsen and Gustav Kirchhoff discovered rubidium in 1861 by the newly developed method of Atomic emission spectroscopy#Flame emission spectroscopy|flame spectroscopy.

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Slide104

Rubidium

Rubidium's compounds have various chemical and electronic applications. Rubidium metal is easily vaporized and has a convenient spectral absorption range, making it a frequent target for laser manipulation of atoms.

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Slide105

Rubidium

Rubidium is not known to be necessary for any organism|living organisms. However, rubidium ions are handled by living organisms in a manner similar to potassium ions, being actively taken up by plants and by animal cells.

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Slide106

Rubidium - Characteristics

Rubidium and potassium show a very similar purple color in the flame test, which makes spectroscopy methods necessary to distinguish the two elements.

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Slide107

Rubidium - Compounds

Rubidium silver iodide (RbAg4I5) has the highest room temperature electrical conductivity|conductivity of any known ionic crystal, a property that is being exploited in thin film battery (electricity)|batteries and other applications.

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Slide108

Rubidium - Compounds

Rubidium has a number of Rubidium oxide|oxides, including rubidium monoxide (Rb2O), Rb6O and Rb9O2, which form if rubidium metal is exposed to air; rubidium in excess oxygen gives the superoxide RbO2. Rubidium forms salts with halides, making rubidium fluoride, rubidium chloride, rubidium bromide, and rubidium iodide.

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Slide109

Rubidium - Isotopes

Aside from 85Rb and 87Rb, another 24 synthetically produced isotopes of rubidium are known, with half times of under 3months; most of these are highly radioactive and have few uses.

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Slide110

Rubidium - Isotopes

The dates indicate the true age of the minerals only if the rocks have not been subsequently altered (see rubidium-strontium dating).

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Slide111

Rubidium - Isotopes

Rubidium-82, one of the element's non-natural isotopes, is produced by electron capture|electron-capture decay of strontium-82 with a half-life of 25.36days. The subsequent decay of rubidium-82 with a half-life of 76 seconds to stable krypton-82 happens by positron emission.

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Slide112

Tidal barrage - Turbidity

Turbidity (the amount of matter in suspension in the water) decreases as a result of smaller volume of water being exchanged between the basin and the sea. This lets light from the Sun penetrate the water further, improving conditions for the phytoplankton. The changes propagate up the food chain, causing a general change in the ecosystem.

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Slide113

Global health - Morbidity

Morbidity measures include incidence rate, prevalence and cumulative incidence. Incidence rate is the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.

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Slide114

Hippocampal prosthesis - Bidirectional communication

In order to fully assume the function of the damaged hippocampus the prosthesis must be able to communicate with the existing tissue in a bidirectional manner. in other words the implant must be able to receive information from the brain and give an appropriate and compressible feedback to the surrounding nerve cell.W.BERGER, THEODORE. TOWARD REPLACEMENT PARTS FOR THE BRAIN. Chap 12 Brain-implantable Electronics as a Neural Prosthesis for hippocampal memory Function.

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Slide115

Basenji - Morbidity

Among 78 live dogs in the 2004 UKC survey, the most common health issues noted by owners were dermatologic and urologic (urologic issues in Basenjis can be signs of Fanconi syndrome).

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Slide116

Premature birth - Mortality and morbidity

The shorter the term of pregnancy, the greater the risks of mortality and morbidity for the baby primarily due to the related prematurity. Preterm-premature babies have an increased risk of death in the first year of life (infant mortality), with most of that occurring in the first month of life (neonatal mortality). Worldwide, prematurity accounts for 10% of neonatal mortality, or around 500,000 deaths per year.

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Slide117

Premature birth - Mortality and morbidity

In the U.S. where many infections and other causes of neonatal death have been markedly reduced, prematurity is the leading cause of neonatal mortality at 25%.

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Slide118

Premature birth - Mortality and morbidity

Prematurely born infants are also at greater risk for having subsequent serious chronic health problems as discussed below.

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Slide119

Premature birth - Mortality and morbidity

The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability. As NICU care has improved over the last 40 years, viability has reduced to approximately 24 weeks,

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Slide120

Premature birth - Mortality and morbidity

— in particular see [http://pediatrics.aappublications.org/cgi/content-nw/full/117/1/22/T1 TABLE 1 Survival and Neurologic Disability Rates Among Extremely Premature Infants]

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Slide121

Premature birth - Mortality and morbidity

although rare survivors have been documented as early as 21 weeks.[http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070220/baby_premature_070219/20070220?hub=CTVNewsAt11] This date is controversial, as gestation in the case reported was measured from the known date of conception (by IVF) rather than, as usual, the date of the mother's last menstrual period, making gestation appear two weeks less than if calculated by the conventional method in this case.

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Slide122

Premature birth - Mortality and morbidity

As risk of brain damage and developmental delay is significant at that threshold even if the infant survives, there are medical ethics|ethical controversies over the aggressiveness of the care rendered to such infants. The limit of viability has also become a factor in the abortion debate.

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Slide123

Correlation does not imply causation - A causes B and B causes A (bidirectional causation)

:Increased pressure is associated with increased temperature.

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Slide124

Correlation does not imply causation - A causes B and B causes A (bidirectional causation)

The ideal gas law, PV=nRT, describes the direct relationship between pressure and temperature (along with other factors) to show that there is a direct correlation between the two properties. For a fixed volume and mass of gas, an increase in temperature causes an increase in pressure; likewise, increased pressure causes an increase in temperature. This demonstrates bidirectional causation. The conclusion that pressure causes temperature is true but is not logically guaranteed by the premise.

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Slide125

Abiding Truth Ministries

The Southern Poverty Law Center regards Abiding Truth Ministries as a hate group.

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Slide126

Abiding Truth Ministries - History

Abiding Truth Ministries was founded by Scott Lively, an American author, attorney and activist, noted for his LGBT rights opposition|opposition to LGBT rights and his involvement in the ex-gay movement

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Slide127

Abiding Truth Ministries - History

ATM has contributed to organizations including NARTH, American Family Association, Americans for Truth about Homosexuality, Parents' Rights Coalition, Family Research Institute and Mission: America. Lively is the former state director for the California branch of the American Family Association

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Slide128

Abiding Truth Ministries - History

Along with Kevin E

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Slide129

Abiding Truth Ministries - History

The Southern Poverty Law Center regards Abiding Truth Ministries as a hate group. Lively has responded in his blog.[http://www.exposethesplc.blogspot.com/ HatewatchWatch]. Blogger (service)|Blogspot.

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Slide130

Abiding Truth Ministries - Positions and issues

ATM promotes its message via its Defend the Family website. The website's mission statement is to promote and defend the Biblical view of marriage and family through... education, training, and funding. The Resources section sells books by Lively.

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Slide131

Abiding Truth Ministries - Positions and issues

ATM has influenced the upsurge in politicized homophobia in Uganda

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Slide132

Antisocial personality disorder - Comorbidity

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.

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Slide133

Earthquake liquefaction - Turbidity currents

Investigators suggested that a 60-mile-per-hour (100km/h) submarine landslide or turbidity current of water saturated sediments swept 400 miles (600km) down the continental slope from the earthquake’s epicenter, snapping the cables as it passed.

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Slide134

Correlates of crime - General morbidity

Criminals probably suffer from more illnesses.

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Slide135

Morbidity

A 'disease' is an abnormal condition that affects the body of an organism

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Slide136

Morbidity

Death due to disease is called death by natural causes

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Slide137

Morbidity - Concepts

In many cases, the terms disease, disorder, morbidity and illness are used interchangeably. In some situations, specific terms are considered preferable.

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Slide138

Morbidity - Concepts

:The term disease broadly refers to any condition that impairs normal function, and is therefore associated with dysfunction of normal homeostasis

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Slide139

Morbidity - Concepts

:Illness and sickness are generally used as synonyms for disease. However, this term is occasionally used to refer specifically to the patient's personal experience of his or her disease.

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Slide140

Morbidity - Concepts

:In this model, it is possible for a person to have a disease without being ill (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalization|medicalizes a non-disease situation in his or her life)

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Slide141

Morbidity - Concepts

:In medicine, a 'disorder' is a functional abnormality or disturbance

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Slide142

Morbidity - Concepts

:A 'medical condition' is a broad term that includes all diseases and disorders

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Slide143

Morbidity - Concepts

:As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider deleterious. On the other hand, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement.

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Slide144

Morbidity - Concepts

:The term medical condition is also a synonym for medical state, in which case it describes an individual patient's current state from a medical standpoint. This usage appears in statements that describe a patient as being in critical condition, for example.

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Slide145

Morbidity - Concepts

Comorbidity is the simultaneous presence of two or more medical conditions, such as schizophrenia and substance abuse.

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Slide146

Morbidity - Concepts

:In epidemiology and actuarial science, the term morbidity rate can refer to either the incidence (epidemiology)|incidence rate, or the prevalence of a disease or medical condition. This measure of sickness is contrasted with the mortality rate of a condition, which is the proportion of people dying during a given time interval.

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Slide147

Morbidity - Concepts

:A syndrome is the association of several medical signs, symptoms, and or other characteristics that often occur together. Some syndromes, such as Down syndrome, have only one cause; others, such as Parkinsonian syndrome, have multiple possible causes. In other cases, the cause of the syndrome is unknown. A familiar syndrome name often remains in use even after an underlying cause has been found, or when there are a number of different possible primary causes.

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Slide148

Morbidity - Concepts

:'Predisease' is a type of disease creep or medicalization in which currently healthy people with risk factors for disease, but no evidence of actual disease, are told that they are sick. Prediabetes and prehypertension are common examples. Labeling a healthy person with predisease can result in overtreatment, such as taking drugs that only help people with severe disease, or in useful preventive measures, such as motivating the person to get a healthful amount of physical exercise.

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Slide149

Morbidity - Types

;Infectious diseases

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Slide150

Morbidity - Types

;Contagious diseases

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Slide151

Morbidity - Types

:Foodborne illness or food poisoning is any illness resulting from the consumption of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.

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Slide152

Morbidity - Types

;Communicable diseases

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Slide153

Morbidity - Types

;Non-communicable diseases

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Slide154

Morbidity - Types

:A lifestyle disease is any disease that appears to increase in frequency as countries become more industrialized and people live longer, especially if the risk factors include behavioral choices like a sedentary lifestyle or a diet high in unhealthful foods such as refined carbohydrates, trans fats, or alcoholic beverages.

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Slide155

Morbidity - Types

:Mental illness is a broad, generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, and/or cognitive dysfunction or impairment

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Slide156

Morbidity - Types

:An organic disease is one caused by a physical or physiological change to some tissue or organ of the body. The term sometimes excludes infections. It is commonly used in contrast with mental disorders. It includes emotional and behavioral disorders if they are due to changes to the physical structures or functioning of the body, such as after a stroke or a traumatic brain injury, but not if they are due to psychosocial issues.

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Slide157

Morbidity - Scope

:A localized disease is one that affects only one part of the body, such as athlete's foot or an eye infection.

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Slide158

Morbidity - Scope

:A disseminated disease has spread to other parts; with cancer, this is usually called metastatic disease.

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Slide159

Morbidity - Scope

:A systemic disease is a disease that affects the entire body, such as influenza or hypertension|high blood pressure.

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Slide160

Morbidity - Causes and transmissibility

Only some diseases such as influenza are contagious and commonly believed infectious

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Slide161

Morbidity - Causes and transmissibility

Some diseases, such as most (but not all) forms of cancer, heart disease and mental disorders, are non-infectious diseases. Many non-infectious diseases have a partly or completely genetic basis (see genetic disorder) and may thus be transmitted from one generation to another.

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Slide162

Morbidity - Causes and transmissibility

Social determinants of health are the social conditions in which people live that determine their health

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Slide163

Morbidity - Causes and transmissibility

When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as a metaphor or symbol of whatever that culture considers evil. For example, until the bacterial cause of tuberculosis was discovered in 1882, experts variously ascribed the disease to hereditary disease|heredity, a sedentary lifestyle, depression (mood)|depressed mood, and overindulgence in sex, rich food, or alcohol—all the social ills of the time.

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Slide164

Morbidity - Burdens of disease

Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators.

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Slide165

Morbidity - Burdens of disease

There are several measures used to quantify the burden imposed by diseases on people

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Slide166

Morbidity - Burdens of disease

A disease that has high morbidity, but low mortality, has a high DALY and a low YPLL

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Slide167

Morbidity - Burdens of disease

:Standard DALYs (3% discounting, age weights).

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Slide168

Morbidity - Burdens of disease

:[http://www.who.int/entity/healthinfo/global_burden_disease/DALY14_2004.xls DALY spreadsheet]

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Slide169

Morbidity - Burdens of disease

:[http://www.who.int/entity/healthinfo/global_burden_disease/YLL14_2004.xls YLL spreadsheet]. In the developed world, heart disease and stroke cause the most loss of life, but neuropsychiatric conditions like major depressive disorder cause the most years lost to being sick.

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Slide170

Morbidity - Prevention

Many diseases and disorders can be prevented through a variety of means. These include sanitation, proper nutrition, adequate exercise, vaccinations, circumcision of male infants, and other self-care and public health measures.

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Slide171

Morbidity - Treatments

Medical therapies or treatments are efforts to cure or improve a disease or other health problem. In the medical field, therapy is synonymous with the word treatment. Among psychologists, the term may refer specifically to psychotherapy or talk therapy. Common treatments include medications, surgery, medical devices, and self-care. Treatments may be provided by an organized health care system, or informally, by the patient or family members.

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Slide172

Morbidity - Treatments

A Preventive medicine|prevention or preventive therapy is a way to avoid an injury, sickness, or disease in the first place

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Slide173

Morbidity - Treatments

Treatment for medical emergencies must be provided promptly, often through an emergency department or, in less critical situations, through an urgent care facility.

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Slide174

Morbidity - Epidemiology

Epidemiology is the study of the factors that cause or encourage diseases. Some diseases are more common in certain geographic areas, among people with certain genetic or socioeconomic characteristics, or at different times of the year.

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Slide175

Morbidity - Epidemiology

Epidemiology is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease

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Slide176

Morbidity - Epidemiology

In studying diseases, epidemiology faces the challenge of defining them. Especially for poorly understood diseases, different groups might use significantly different definitions. Without an agreed-on definition, different researchers may report different numbers of cases and characteristics of the disease.

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Slide177

Morbidity - Epidemiology

Some morbidity databases are compiled with data supplied by states and territories health authorities, at national level (National hospital morbidity database (NHMD), for example[http://www.aihw.gov.au/national-hospital-morbidity-database/ National hospital morbidity database] retrieved 2013-07-11 [http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurveySDDS=3203Item_Id=1724 database containing demographic, administrative and clinical data on inpatient hospitalizations in Canada.]), or at European scale (European Hospital Morbidity Database or HMDB[http://data.euro.who.int/hmdb/ European Hospital Morbidity Database] wich contains hospital discharge data by detailed diagnosis, age and sex, which were submitted by European countries to the WHO Regional Office for Europe.; World Health Organization Regional Office for Europe ; updated oct 2012, retrieved 2013-07-11) but not yet at world scale.

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Slide178

Morbidity - Social and cultural responses

How a society responds to diseases is the subject of medical sociology.

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Slide179

Morbidity - Social and cultural responses

A condition may be considered a disease in some cultures or eras but not in others. For example, obesity can represent wealth and abundance, and is a status symbol in famine-prone areas and some places hard-hit by AIDS wasting|HIV/AIDS. Epilepsy is considered a sign of spiritual gifts among the Hmong people.

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Slide180

Morbidity - Social and cultural responses

Sickness confers the social legitimization of certain benefits, such as illness benefits, work avoidance, and being looked after by others

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Slide181

Morbidity - Social and cultural responses

Most religions grant exceptions from religious duties to people who are sick. For example, one whose life would be endangered by fasting on Yom Kippur or during Ramadan is exempted from the requirement, or even forbidden from participating. People who are sick are also exempted from social duties. For example, ill health is the only socially acceptable reason for an American to refuse an invitation to the White House.

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Slide182

Morbidity - Social and cultural responses

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications

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Slide183

Morbidity - Social and cultural responses

Leprosy|Lepers were people who were historically shunned because they had an infectious disease, and the term leper still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma.

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Slide184

Morbidity - Social and cultural responses

Social standing and economic status affect health

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Slide185

Chronic pain - Comorbidities and sequelae

Chronic pain is associated with higher rates of depression and anxiety. Sleep disturbance, and insomnia due to medication and illness symptoms are often experienced by those with chronic pain. Chronic pain may contribute to decreased physical activity due to fear of exacerbating pain, often resulting in weight gain. Such comorbid disorders can be very difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors.

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Slide186

Histrionic personality disorder - Comorbidity

Most histrionics also have other mental disorders

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Slide187

Night eating syndrome - Co-morbidities

NES is sometimes associated with excess weight; as many as 28% of individuals seeking gastric bypass surgery were found to suffer from NES in one study.O'Reardon, J.P.,  Stunkard, A.J., Allison, K.C

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Slide188

ICD-10 Chapter X - (Y85–Y89) Sequelae of external causes of morbidity and mortality

* () Sequelae of specified injuries

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Slide189

ICD-10 Chapter X - (Y90–Y98) Supplementary factors related to causes of morbidity and mortality classified elsewhere

* () Environmental-pollution-related condition

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Slide190

Sadistic personality disorder - Comorbidity with other personality disorders

Studies have found other types of illnesses, such as alcoholism, to have a high rate of comorbidity with sadistic personality disorder.http://www.sciencedirect.com.proxy.bc.edu/science/article/pii/016517819390077T

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Slide191

Sadistic personality disorder - Comorbidity with other personality disorders

Because of its high level of comorbidity with other disorders, researchers have had some level of difficulty distinguishing sadistic personality disorder from other forms of personality disorder. While sadistic personality disorder itself is no longer included in the DSM, partially for this reason, other types of disorders involving sadism, such as sexual sadism, are still found in the DSM as paraphilias.

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Slide192

Borderline personality disorder - Differential diagnosis and comorbidity

Lifetime comorbid (co-occurring) conditions are common in BPD. Compared to those diagnosed with other personality disorders, people with BPD showed a higher rate of also meeting criteria for

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Slide193

Borderline personality disorder - Differential diagnosis and comorbidity

* mood disorders, including major depression and bipolar disorder

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Slide194

Borderline personality disorder - Differential diagnosis and comorbidity

* anxiety disorders, including panic disorder, social anxiety disorder, and post-traumatic stress disorder|post-traumatic stress disorder (PTSD)

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Slide195

Borderline personality disorder - Differential diagnosis and comorbidity

* eating disorders, including anorexia nervosa and bulimia

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Slide196

Exercise addiction - Comorbidity

An addiction, by definition, includes repeated compulsive behaviors that negatively affect daily living

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Slide197

Psychopaths - Comorbidity

Studies especially suggest strong comorbidity with antisocial personality disorder

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Slide198

Psychopaths - Comorbidity

Attention deficit hyperactivity disorder (ADHD) is known to be highly comorbid with conduct disorder (a theorized precursor to ASPD), and may also co-occur with psychopathic tendencies

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Slide199

Psychopaths - Comorbidity

It has been suggested that psychopathy may be comorbid with several other conditions than these, but limited work on comorbidity has been carried out. This may be partly due to difficulties in using inpatient groups from certain institutions to assess comorbidity, owing to the likelihood of some bias in sample selection.

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Slide200

Irritable bowel syndrome - Comorbidities

Researchers have identified several medical conditions, or comorbidities, which appear with greater frequency in patients diagnosed with IBS.

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Slide201

Irritable bowel syndrome - Comorbidities

* 'Headache, fibromyalgia, chronic fatigue syndrome and depression': A study of 97,593 individuals with IBS identified comorbidities such as headache, fibromyalgia, and depression. A systematic review found that IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients, and psychiatric disorders were found to occur in 94% of IBS patients.

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Slide202

Irritable bowel syndrome - Comorbidities

* 'Inflammatory bowel disease (IBD)': Some researchers have suggested that IBS is a type of low-grade inflammatory bowel disease

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Slide203

Irritable bowel syndrome - Comorbidities

* 'Abdominal surgery': A 2008 study found that IBS patients were at increased risk of having unnecessary cholecystectomy (gall bladder removal surgery) not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications

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Slide204

Irritable bowel syndrome - Comorbidities

* 'Endometriosis': One study reported a statistically significant link between migraine headaches, IBS, and endometriosis.

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Slide205

Irritable bowel syndrome - Comorbidities

* 'Other chronic disorders': Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown.

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Slide206

Shift work sleep disorder - Causes and comorbidities

Insomnia and wake-time sleepiness are related to misalignment between the timing of the non-standard wake–sleep schedule and the endogenous circadian rhythm|circadian propensity for sleep and wake

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Slide207

Radiometric dating - Rubidium-strontium dating method

This is based on the beta decay of rubidium-87 to strontium-87, with a half-life of 50 billion years. This scheme is used to date old igneous rocks|igneous and metamorphic rocks, and has also been used to date moon rock|lunar samples. Closure temperatures are so high that they are not a concern. Rubidium-strontium dating is not as precise as the uranium-lead method, with errors of 30 to 50 million years for a 3-billion-year-old sample.

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Slide208

Chronic fatigue syndrome - Co-morbidity

Many CFS patients will also have, or appear to have, other medical problems or related diagnoses

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Slide209

Airedale Terrier - Morbidity

Like most terriers, they have a propensity towards dermatitis

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Slide210

Airedale Terrier - Morbidity

An Airedale's coat was originally designed to protect the dog from its predators—the coat was designed to come out in the claws of the predator the dog was designed to hunt, leaving the dog unharmed

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Slide211

Airedale Terrier - Morbidity

Gastric torsion, or bloat, affects Airedale Terriers. Bloat can turn and block the stomach, causing a buildup of gas. Bloat can be fatal, it can lead to cardiovascular collapse. Signs of bloat are gastric distress (stomach pain), futile attempts at vomiting, and increased salivation. Bloat usually occurs when the dog is exercised too soon after eating. They will eat up to 4-6 cups of food at a time.

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Slide212

Urine - Turbidity

Turbidity|Turbid (cloudy) urine may be a symptom of a bacterial infection, but can also be caused by crystallization of salts such as calcium phosphate.

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Slide213

Lymphocytic choriomeningitis - Morbidity and Mortality

Lymphocytic choriomeningitis is not a commonly reported infection in humans, though most infections are mild and are often never diagnosed

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Slide214

Lymphocytic choriomeningitis - Morbidity and Mortality

More than 50 infants with congenital LCMV infection have been reported worldwide

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Slide215

Lymphocytic choriomeningitis - Morbidity and Mortality

Transplant-acquired lymphocytic choriomeningitis proves to have a very high morbidity and mortality rate. In the three clusters reported in the U.S. from 2005 to 2010, nine of the ten infected recipients died. One donor had been infected from a recently acquired pet hamster while the sources of the virus in the other cases were unknown.

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Slide216

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: vehicle and traffic injuries

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Slide217

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: falling (accident)|falls

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Slide218

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W20 Struck by thrown, projected or falling object

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Slide219

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W21 Striking against or struck by sports equipment

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Slide220

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W22 Striking against or struck by other objects

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Slide221

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W23 Caught, crushed, jammed or pinched in or between objects

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Slide222

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W29 Contact with other powered hand tools and household machinery

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Slide223

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W30 Contact with agricultural machinery

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Slide224

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W31 Contact with other and unspecified machinery

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Slide225

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W33 Rifle, shotgun and larger firearm discharge

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Slide226

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W34 Discharge from other and unspecified firearms

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Slide227

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W35 Explosion and rupture (engineering)|rupture of boiler

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Slide228

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W36 Explosion and rupture of gas cylinder

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Slide229

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W37 Explosion and rupture of pressurized Tire, pipe (material)|pipe or Hose (tubing)|hose

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Slide230

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W38 Explosion and rupture of other specified pressurized devices

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Slide231

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W43 Exposure to vibration

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Slide232

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W44 Foreign body entering into or through eye or natural orifice

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Slide233

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W49 Exposure to other and unspecified inanimate mechanical forces

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Slide234

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: hit/struck/wikt:bite|bitten by person or animal

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Slide235

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W50 Hit, struck, kicked, twisted, bitten or scratched by another person

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Slide236

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W51 Striking against or bumped into by another person

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Slide237

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W55 Bitten or struck by other mammals

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Slide238

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods

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Slide239

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W58 Bitten or struck by crocodile or alligator

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Slide240

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** W64 Exposure to other and unspecified animate mechanical forces

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Slide241

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: exposure to electrical current or radiation

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Slide242

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: fire/flames/hot objects

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Slide243

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

* () Unintentional: nature/natural environment|environmental

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Slide244

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X20 Contact with venomous snakes and lizards

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Slide245

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X21 Contact with venomous spiders

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Slide246

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X24 Contact with centipedes and venomous millipedes (tropical)

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Slide247

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X25 Contact with other venomous arthropods

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Slide248

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X26 Contact with venomous marine animals and plants

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Slide249

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X27 Contact with other specified venomous animals

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Slide250

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X28 Contact with other specified venomous plants

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Slide251

ICD-10 Chapter XX: External causes of morbidity and mortality - (V01–X59) Accidents

** X29 Contact with unspecified venomous animal or plant

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Slide252

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

* () Intentional: assault/homicide

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Slide253

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by drugs, medicaments and biotic material|biological substances

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Slide254

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by corrosive substance

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Slide255

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by other specified chemicals and Poison|noxious substances

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Slide256

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by unspecified chemical or Poison|noxious substance

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Slide257

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by drowning and wikt:submersion|submersion

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Slide258

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by rifle, shotgun and larger firearm discharge

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Slide259

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by other and unspecified firearm discharge

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Slide260

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by explosive material

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Slide261

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by smoke, fire and flames

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Slide262

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by pushing from high place

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Slide263

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by pushing or placing victim before moving object

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Slide264

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Assault by crashing of motor vehicle

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Slide265

ICD-10 Chapter XX: External causes of morbidity and mortality - (X85–Y09) Assault

** () Sexual assault by bodily force

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Slide266

Cannabidiol

'Cannabidiol' ('CBD') is one of at least 85 Psychoactive drug|active cannabinoids identified in cannabis. It is a major phytocannabinoid, accounting for up to 40% of the plant's extract. CBD is considered to have a wider scope of medical applications than tetrahydrocannabinol (THC). An orally-administered liquid containing CBD has received orphan drug status in the US, for use as a treatment for dravet syndrome, under the brand name 'Epidiolex'.

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Slide267

Cannabidiol - Antimicrobial actions

CBD absorbed transcutaneously may attenuate the increased sebum production at the root of acne, according to an untested hypothesis.

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Slide268

Cannabidiol - Neurological effects

A 2010 study found that strains of cannabis containing higher concentrations of cannabidiol did not produce short-term memory impairment vs. strains with similar concentrations of THC, but lower concentrations of CBD. The researchers attributed this attenuation of memory effects to CBD's role as a Cannabinoid receptor#CB1|CB1 antagonist. Transdermal CBD is neuroprotective in animals.

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Slide269

Cannabidiol - Neurological effects

Cannabidiol's strong antioxidant properties have been shown to play a role in the compound's neuroprotection|neuroprotective and ischemia|anti-ischemic effects.

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Slide270

Cannabidiol - Psychotropic effect

While there was no statistical difference between the two treatment groups, cannabidiol induced significantly fewer side effects (extrapyramidal symptoms, increase in prolactin, weight gain) when compared to amisulpride.

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Slide271

Cannabidiol - Psychotropic effect

Studies have shown cannabidiol decreases activity of the limbic system and decreases social isolation induced by THC. Cannabidiol has also been shown to reduce anxiety in social anxiety disorder.

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Slide272

Cannabidiol - Psychotropic effect

Chronic cannabidiol administration in rats was found to produce anxiogenic-like effects, indicating that prolonged treatment with cannabidiol might incite anxiogenic effects.

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Slide273

Cannabidiol - Psychotropic effect

Those results have been contested by, and contradict whose experimentation cover the same duration.

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Slide274

Cannabidiol - Dravet syndrome

Dravet syndrome is a rare form of epilepsy that is difficult to treat

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Slide275

Cannabidiol - CBD-enhanced cannabis

Decades ago, selective breeding by growers in US dramatically lowered the CBD content of cannabis; their customers preferred varietals that were more mind-altering due to a higher THC, lower CBD content. To meet the demands of medical cannabis patients, growers are currently developing more CBD-rich strains.

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Slide276

Cannabidiol - CBD-enhanced cannabis

In November 2012, Tikun Olam, an Israeli medical cannabis facility announced a new strain of the plant which has only cannabidiol as an active ingredient, and virtually no THC, providing some of the medicinal benefits of cannabis without the euphoria

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Slide277

Cannabidiol - Industrial hemp

Several industrial hemp varieties can be legally cultivated in western Europe. They might seem to contain very small portion of cannabinoid, which is true in one sense. Nevertheless a variety such as Fedora 17 has a cannabionoid profile consistently around 1% cannabidiol (CBD) with THC less than 0.1%.

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Slide278

Cannabidiol - Industrial hemp

1% is little though for 1kg of raw plant it yields 10g of pure CBD.

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Slide279

Cannabidiol - Industrial hemp

Hemp world production is around 30000tonnes per year.

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Slide280

Cannabidiol - Pharmacodynamics

While one would assume that this would cause cannabidiol to reduce the effects of THC, it may potentiate THC's effects by increasing Cannabinoid receptor#CB1|CB1 receptor density or through another Cannabinoid receptor#CB1|CB1-related mechanism

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Slide281

Cannabidiol - Pharmacodynamics

Cannabidiol's pharmacological effects have also been attributed to Peroxisome proliferator-activated receptor gamma|PPAR-γ receptor agonist|agonism and Intracellular signaling pathway#Calcium|intracellular calcium release.

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Slide282

Cannabidiol - Pharmacokinetic interactions

There is some preclinical evidence to suggest that cannabidiol may reduce THC clearance, modestly increasing THC's plasma concentrations resulting in a greater amount of THC available to receptors, increasing the effect of THC in a dose-dependent manner. Despite this the available evidence in humans suggests no significant effect of CBD on THC plasma levels.

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Slide283

Cannabidiol - Pharmaceutical preparations

Nabiximols (United States Adopted Name|USAN, trade name 'Sativex') is an aerosolized mist for oral administration containing a near 1:1 ratio of CBD and THC. The drug was approved by Canadian authorities in 2005 to alleviate pain associated with multiple sclerosis.United States Adopted Names Council: [http://www.ama-assn.org/ama1/pub/upload/mm/365/nabiximols.pdf Statement on a nonproprietary name][http://www.gwpharm.com/ GWPharma- Welcome]

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Slide284

Cannabidiol - Isomerism

Based on: [http://arizona.openrepository.com/arizona/handle/10150/184033 Nagaraja, Kodihalli Nanjappa, Synthesis of delta-3-cannabidiol and the derived rigid analogs, Arizona University 1987].

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Slide285

Cannabidiol - Chemistry

Cannabidiol is insoluble in water but soluble in organic solvents, such as pentane. At room temperature it is a colorless crystalline solid. In strongly basic medium and the presence of air it is oxidized to a quinone. Under acidic conditions it cyclizes to THC. The synthesis of cannabidiol has been accomplished by several research groups.

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Slide286

Cannabidiol - Biosynthesis

Cannabis produces CBD-carboxylic acid through the same metabolic pathway as THC, until the last step, where CBDA synthase performs catalysis instead of THCA synthase.

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Slide287

Cannabidiol - Legal status

Cannabidiol is not scheduled by the Convention on Psychotropic Substances.

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Slide288

Cannabidiol - Legal status

Cannabidiol is a Schedule II drug in Canada.[http://laws-lois.justice.gc.ca/eng/acts/c-38.8/page-25.html#h-29 Controlled Drugs and Substances Act - Schedule II]

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Slide289

Cannabidiol - Legal status

Cannabidiol's legal status in the United States:

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Slide290

Cannabidiol - Legal status

While the DEA Drug Schedule classifies THC (Tetrahydrocannabinols) and marijuana as Schedule I, cannabidiol is not found on the list.[http://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf CSA Schedule], List of drugs by schedule. Other synthetic cannabinoids such as JWH-019,073,081,122,200,203,250,398 are also listed in Schedule I, but cannabidiol is absent.

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Slide291

Cannabidiol - Legal status

Hemp finished products, including hemp oil high in cannabidiol, are legal in the United States for this reason.

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Slide292

Cannabidiol - Legal status

In other words, cannabidiol's legal status depends on where it is derived from, as cannabidiol itself is not scheduled.

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Slide293

Cannabidiol - US patent

The patent mentions cannabidiol's ability as an antiepileptic, to lower intraocular pressure in the treatment of glaucoma, lack of toxicity or serious side effects in large acute doses, its neuroprotectant properties, its ability to prevent neurotoxicity mediated by NMDA, AMPA, or kainate receptors; its ability to attenuate glutamate toxicity, its ability to protect against cellular damage, its ability to protect brains from ischemic damage, its anxiolytic effect, and its superior antioxidant activity which can be used in the prophylaxis and treatment of oxidation associated diseases.

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Slide294

Cannabidiol - US patent

On November 17, 2011, the Federal Register published that the National Institutes of Health of the United States Department of Health and Human Services was contemplating the grant of an exclusive patent license to practice the invention embodied in U.S. Patent 6,630,507 to the company KannaLife based in New York, for the development and sale of cannabinoid and cannabidiol based therapeutics for the treatment of hepatic encephalopathy in humans.

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Slide295

Irritable bowel - Comorbidities

Several medical conditions, or comorbidities, appear with greater frequency in patients diagnosed with IBS.

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Slide296

Irritable bowel - Comorbidities

* Neurological: A study of 97,593 individuals with IBS identified comorbidities such as headache, fibromyalgia, and depression. IBS occurs in 51% of chronic fatigue syndrome patients and 49% of fibromyalgia patients, and psychiatric disorders occur in 94% of IBS patients.

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Slide297

Irritable bowel - Comorbidities

* Inflammatory bowel disease: IBS may be a type of low-grade inflammatory bowel disease. Researchers have suggested IBS and IBD are interrelated diseases, noting that patients with IBD experience IBS-like symptoms when their IBD is in remission. A three-year study found that patients diagnosed with IBS were 16.3 times more likely to be diagnosed with IBD during the study period. Serum markers associated with inflammation have also been found in patients with IBS.

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Slide298

Irritable bowel - Comorbidities

* Abdominal surgery: IBS patients were at increased risk of having unnecessary cholecystectomy|gall bladder removal surgery not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications. These patients also are 87% more likely to undergo abdominal and pelvic surgery and three times more likely to undergo gallbladder surgery. Also, IBS patients were twice as likely to undergo hysterectomy.

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Slide299

Irritable bowel - Comorbidities

* Endometriosis: One study reported a statistically significant link between migraine headaches, IBS, and endometriosis.

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Slide300

Irritable bowel - Comorbidities

* Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. The connection between these syndromes is unknown.

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Slide301

Comorbidity

In medicine, 'comorbidity' is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.

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Slide302

Comorbidity

In medicine, the term comorbid can be either medical condition(s) existing simultaneously but independently with another condition; or it can indicate a related medical condition or conditions. In psychiatric diagnoses it has been argued in part that this 'use of imprecise language may lead to correspondingly imprecise thinking', [and] this usage of the term 'comorbidity' should probably be avoided.

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Slide303

Comorbidity - In medicine

In medicine, comorbidity describes the effect of all other diseases an individual patient might have other than the primary disease of interest.

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Slide304

Comorbidity - In medicine

Many tests attempt to standardize the weight or value of comorbid conditions, whether they are secondary or tertiary illnesses. Each test attempts to consolidate each individual comorbid condition into a single, predictive variable that measures mortality or other outcomes. Researchers have validated such tests because of their predictive value, but no one test is as yet recognized as a standard.

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Slide305

Comorbidity - In medicine

# to indicate a medical condition existing simultaneously but independently with another condition in a patient (this is the older and more correct definition)

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Slide306

Comorbidity - In medicine

# to indicate a medical condition in a patient that causes, is caused by, or is otherwise related to another condition in the same patient (this is a newer, nonstandard definition and less well-accepted).

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Slide307

Comorbidity - In medicine

# to indicate two or more medical conditions existing simultaneously regardless of their causal relationship.

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Slide308

Comorbidity - Charlson index

Many variations of the Charlson comorbidity index have been presented, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitoba, and Charlson/D'Hoores comorbidity indices.

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Slide309

Comorbidity - Charlson index

*1 each: Myocardial infarct, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes.

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Slide310

Comorbidity - Charlson index

*2 each: Hemiplegia, moderate or severe kidney disease, diabetes with end organ damage, tumor, leukemia, lymphoma.

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Slide311

Comorbidity - Charlson index

*6 each: Malignant tumor, metastasis, AIDS.

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Slide312

Comorbidity - Charlson index

For a physician, this score is helpful in deciding how aggressively to treat a condition. For example, a patient may have cancer with comorbid heart disease and diabetes. These comorbidities may be so severe that the costs and risks of cancer treatment would outweigh its short-term benefit.

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Slide313

Comorbidity - Charlson index

Since patients often do not know how severe their conditions are, nurses were originally supposed to review a patient's chart and determine whether a particular condition was present in order to calculate the index. Subsequent studies have adapted the comorbidity index into a questionnaire for patients.

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Slide314

Comorbidity - Charlson index

The Charlson index, espescially the Charlson/Deyo, followed by the Elixhauser have been most commonly referred by the comparative studies of comorbidity and multimorbidity measures.

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Slide315

Comorbidity - Elixhauser comorbidity measure

have derived and validated an Elixhauser comorbidity index that summarizes disease burden and can discriminate for in-hospital mortality.

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Slide316

Comorbidity - Elixhauser comorbidity measure

In addition, a systematic review and comparative analysis shows that among various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation.

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Slide317

Comorbidity - Diagnosis-related group

Patients who are more seriously ill tend to require more hospital resources than patients who are less seriously ill, even though they are admitted to the hospital for the same reason. Recognizing this, the diagnosis-related group (DRG) manually splits certain DRGs based on the presence of secondary diagnoses for specific complications or comorbidities (CC). The same applies to Healthcare Resource Groups (HRGs) in the UK.

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Slide318

Comorbidity - Mental health

The Axis II personality disorders are often criticized because their comorbidity rates are excessively high, approaching 60% in some cases, indicating to critics the possibility that these categories of mental illness are too imprecisely distinguished to be usefully valid for diagnostic purposes and, thus, for deciding how treatment resources should be allocated.

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Slide319

Comorbidity - Mental health

It has been argued that because 'the use of imprecise language may lead to correspondingly imprecise thinking', this usage of the term 'comorbidity' should probably be avoided.

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Slide320

Comorbidity - Mental health

Due to its artifactual nature, psychiatric comorbidity has been considered as a Kuhnian anomaly leading the DSM to a scientific crisis and a comprehensive review on the matter considers comorbidity as an epistemological challenge to modern psychiatry.

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Slide321

Comorbidity - Inception of the term

In due course of time after its discovery, comorbidity was distinguished as a separate scientific-research discipline in many branches of medicine.

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Slide322

Comorbidity - Evolution of the term

van den Akker, determining comorbidity as the combination in a patient of 2 or more chronic diseases (disorders), pathogenetically related to each other or coexisting in a single patient independent of each disease’s activity in the patient.

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Slide323

Comorbidity - Psychiatry

Some of the models studied comorbidity as the presence in a person (patient) of more than one disorders (diseases) at a certain period of life, whereas the others elaborated the relative risk, for a person having one disease, of picking up other disorders.

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Slide324

Comorbidity - General medicine

The influence of comorbidity on the clinical progression of the primary (basic) physical disorder, effectiveness of the medicinal therapy and immediate and long-term prognosis of the patients was researched by talented physicians and scientists of various medical fields in many countries across the globe

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Slide325

Comorbidity - Synonyms

* Multifactorial diseases

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Slide326

Comorbidity - Synonyms

* Dual diagnosis, used for mental health issues

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Slide327

Comorbidity - Epidemiology

It is hard not to notice the absence of comorbidity in the taxonomy (systematics) of disease, presented in ICD-10.

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Slide328

Comorbidity - Clinico-pathological comparisons

All the fundamental researches of medical documentation, directed towards the study of the spread of comorbidity and influence of its structure, were conducted till the 1990s. The sources of information, used by the researchers and scientists, working on the matter of comorbidity, were case histories, hospital records of patients and other medical documentation, kept by family doctors, insurance companies and even in the archives of patients in old houses.

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Slide329

Comorbidity - Clinico-pathological comparisons

The listed methods of obtaining medical information are mainly based on clinical experience and qualification of the physicians, carrying out clinically, instrumentally and laboratorially confirmed diagnosis. This is why despite their competence, they are highly subjective. No analysis of the results of postmortem of deceased patients was carried out for any of the comorbidity researches.

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Slide330

Comorbidity - Clinico-pathological comparisons

It is the duty of the doctor to carry out autopsy of the patients they treat, said once professor :ru:Мудров, Матвей Яковлевич|M. Y. Mudrov. Autopsy allows you to exactly determine the structure of comorbidity and the direct cause of death of each patient independent of his/her age, gender and gender specific characteristics. Statistical data of comorbid pathology, based on these sections, are mainly devoid of subjectivism.

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Slide331

Comorbidity - Research

The analysis of a decade long Australian research based on the study of patients having 6 widespread chronic diseases demonstrated that nearly half of the elderly patients with arthritis also had hypertension, 20% had cardiac disorders and 14% had type 2 diabetes. More than 60% of asthmatic patients complained of concurrent arthritis, 20% complained of cardiac problems and 16% had type 2 diabetes.

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Slide332

Comorbidity - Research

In patients with chronic kidney disease (renal insufficiency) the frequency of coronary heart disease is 22% higher and new coronary events 3.4 times higher compared to patients without kidney function disorders. Progression of CKD towards end stage renal disease requiring renal replacement therapy is accompanied by increasing prevalence of Coronary Heart Disease and sudden death from cardiac arrest.

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Slide333

Comorbidity - Research

A Canadian research conducted upon 483 obesity patients, it was determined that spread of obesity related accompanying diseases was higher among females than males. The researchers discovered that nearly 75% of obesity patients had accompanying diseases, which mostly included dyslipidemia, hypertension and type 2 diabetes. It is to be noted that among the young obesity patients (from 18 to 29) more than two chronic diseases were found in 22% males and 43% females.

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Slide334

Comorbidity - Research

Fibromyalgia is a condition which is comorbid with several others, including but not limited to; depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, rheumatoid arthritis, migraine, and panic disorder.

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Slide335

Comorbidity - Research

Fortin, based on the analysis of 980 case histories, taken from daily practice of a family doctor, the spread of comorbidity is from 69% in young patients, up to 93% among middle aged people and up to 98% patients of older age groups

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Slide336

Comorbidity - Research

According to Russian data, based on the study of more than three thousand postmortem reports (n=3239) of patients of physical pathologies, admitted at multidisciplinary hospitals for the treatment of chronic disorders (average age 67.8 ± 11.6 years), the frequency of comorbidity is 94.2%. Doctors mostly come across a combination of two to three disorders, but in rare cases (up to 2.7%) a single patient carried a combination of 6–8 diseases simultaneously.

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Slide337

Comorbidity - Research

The fourteen-year research conducted on 883 patients of idiopathic thrombocytopenic purpura (Werlhof disease), conducted in Great Britain, shows that the given disease is related to a wide range of physical pathologies

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Slide338

Comorbidity - Research

Overall the survivability rate of comorbid larynx cancer patients is 59% lower than the survivability rate of patients without comorbidity.

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Slide339

Comorbidity - Research

Except for therapists and general physicians, the problem of comorbidity is also often faced by specialists

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Slide340

Comorbidity - Research

Based on the available clinical and scientific data it is possible to conclude that comorbidity has a range of undoubted properties, which characterize it as a heterogeneous and often encountered event, which enhances the seriousness of the condition and worsens the patient’s prospects. The heterogeneous character of comorbidity is due to the wide range of reasons causing it.

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Slide341

Comorbidity - Causes

* Singular pathogenetic mechanism of a number of diseases

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Slide342

Comorbidity - Causes

* Terminable cause-effect relation between the diseases

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Slide343

Comorbidity - Causes

* One disease resulting from complications of another

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Slide344

Comorbidity - Causes

The factors responsible for the development of comorbidity can be chronic infections, inflammations, involutional and systematic metabolic changes, iatrogenesis, social status, ecology and genetic susceptibility.

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Slide345

Comorbidity - Types

The division of comorbidity as per syndromal and nosological principles is mainly preliminary and inaccurate, however it allows us to understand that comorbidity can be connected to a singular cause or common mechanisms of pathogenesis of the conditions, which sometimes explains the similarity in their clinical aspects, which makes it difficult to differentiate between nosologies.

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Slide346

Comorbidity - Types

* Etiological comorbidity: It is caused by concurrent damage to different organs and systems, which is caused by a singular pathological agent (for example due to alcoholism in patients suffering from chronic alcohol intoxication; pathologies associated with smoking; systematic damage due to collagenoses).

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Slide347

Comorbidity - Types

* Complicated comorbidity: It is the result of the primary disease and often subsequent after sometime after its destabilization appears in the shape of target lesions (for example chronic nephatony resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in patients with type 2 diabetes; development of brain infarction resulting from complications due to hypertension|hypertensive crisis in patients suffering from hypertension).

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Slide348

Comorbidity - Types

* Iatrogenic comorbidity: It appears as a result of necessitated negative effect of the doctor on the patient, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid osteoporosis in patients treated for a long time using systematic hormonal agents (preparations); drug-induced hepatitis resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests).

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Slide349

Comorbidity - Types

* Unspecified (NOS) comorbidity: This type assumes the presence of singular pathogenetic mechanisms of development of diseases, comprising this combination, but require a number of tests, proving the hypothesis of the researcher or physician (for example, erectile dysfunction as an early sign of general atherosclerosis (ASVD); occurrence of erosive-ulcerative lesions in the mucous membrane of the upper gastrointestinal tract in vascular patients).

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Slide350

Comorbidity - Types

* Arbitrarycomorbidity: initial alogism of the combination of diseases is not proven, but soon can be explained with clinical and scientific point of view (for example, combination of coronary heart disease (CHD) and choledocholithiasis; combination of acquired heart valvular disease and psoriasis).

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Slide351

Comorbidity - Structure

There are a number of rules for the formulation of clinical diagnosis for comorbid patients, which must be followed by a practitioner. The main principle is to distinguish in diagnosis the primary and background diseases, as well as their complications and accompanying pathologies.

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Slide352

Comorbidity - Structure

* Primary disease: This is the nosological form, which itself or as a result of complications calls for the foremost necessity for treatment at the time due to threat to the patient’s life and danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason for the patient’s death. If the patient has several primary diseases it is important to first of all understand the combined primary diseases (rival or concomitant).

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Slide353

Comorbidity - Structure

* Rival diseases: These are the concurrent nosological forms in a patient, interdependent in etiologies and pathogenesis, but equally sharing the criterion of a primary disease (for example, transmural myocardial infarction and massive thromboembolism of pulmonary artery, caused by phlebemphraxis of lower limbs). For practicing pathologist rival are two or more diseases, exhibited in a single patient, each of which by itself or through its complications could cause the patient’s death.

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Slide354

Comorbidity - Structure

* Polypathia: Diseases with different etiologies and pathogenesis, each of which separately could not cause death, but, concurring during development and reciprocally exacerbating each other, they cause the patient’s death (for example, osteoporotic fracture of the surgical neck of the femur and hypostatic pneumonia).

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Slide355

Comorbidity - Structure

* Background disease: This helps in the occurrence of or adverse development of the primary disease increases its dangers and helps in the development of complications. This disease as well as the primary one requires immediate treatment (for example, type 2 diabetes).

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Slide356

Comorbidity - Structure

In this case they must be identified as the cause of comorbidity

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Slide357

Comorbidity - Structure

* Associating diseases: Nosological units not connected etiologically and pathogenetically with the primary disease (Listed in the order of significance).

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Slide358

Comorbidity - Diagnosis

There is no doubt in the significance of comorbidity, but how to evaluate (measure) it in a given patient?

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Slide359

Comorbidity - Clinical example

Patient S., 73 years, called an ambulance because of a sudden pressing pain in the chest

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Slide360

Comorbidity - Methods of evaluation

There are currently several generally accepted methods of evaluating (measuring) comorbidity:

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Slide361

Comorbidity - Methods of evaluation

This way patients S’s comorbidity in 73 years of age can be evaluated as of moderate severity (23 points out of 56), however it is not possible to evaluate the prognosis of the patient, because of the absence of the interpretation of the acquired results their connection with a number of prognostic characteristics..

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Slide362

Comorbidity - Methods of evaluation

# Cumulative Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to CIRS, but for aged patients, offered by M. D. Miller in 1991. This system takes into account the age of the patient and the peculiarities of the old age disorders.Miller M.D., Towers A. Manual of Guidelines for Scoring the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) // [http://catalogue.iugm.qc.ca/GEIDEFile/CIRSG.PDF?Archive=102955792013File=CIRSG_PDF Pittsburg, Pa: University of Pittsburgh; 1991]

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Slide363

Comorbidity - Methods of evaluation

Using this method patient S’s, age 73, comorbidity can be evaluated as of moderate severity (16 out of 36 points), however its prognostic value is unclear, because of the absence of the interpretation of the overall score, resulting from the accumulation of the patient’s diseases.

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Slide364

Comorbidity - Methods of evaluation

In this case comorbidity of patient S, 73 years of age according to this method, is equivalent to mild state (9 out of 40 points).

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Slide365

Comorbidity - Methods of evaluation

# Modified Charlson Index: R. A. Deyo added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficiency to this index in 1992.

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Slide366

Comorbidity - Methods of evaluation

# Elixhauser Index: The Elixhauser comorbidity measure include 30 comorbidities, which are not simplified as an index. Elixhauser shows a better predictive performance for mortality risk especially beyond 30 days of hospitalization.

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Slide367

Comorbidity - Methods of evaluation

For the evaluation of comorbidity the ICED index suggests to evaluate the patient’s condition separately as per two different components: Physiological functional characteristics

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Slide368

Comorbidity - Methods of evaluation

# Functional Comorbidity Index (FCI): Developed in 2005.

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Slide369

Comorbidity - Methods of evaluation

# Total Illness Burden Index (TIBI): Developed in 2007.

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Slide370

Comorbidity - Methods of evaluation

At the same time due to the inconsistency in approach to the analysis of comorbid state and absence of components of comorbidity in medical universitycourses, the practitioner is unclear about its prognostic effect, which makes the generally available systems of associated pathology evaluation unreasoned and therefore un-needed as well.

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Slide371

Comorbidity - Treatment of comorbid patient

Comorbidity affects life prognosis and increases the chances of fatality

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Slide372

Comorbidity - Treatment of comorbid patient

These side-effects are not always considered by the doctors, because they are considered as the appearance of comorbidity and as a result become the reason for the prescription of even more drugs, sealing-in the vicious circle

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Slide373

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V00-V09 Pedestrian injured in transport accident

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Slide374

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V10-V19 Pedal cyclist injured in transport accident

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Slide375

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V20-V29 Motorcycle rider injured in transport accident

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Slide376

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V30-V39 Occupant of three-wheeled motor vehicle injured in transport accident

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Slide377

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V40-V49 Car occupant injured in transport accident

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Slide378

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V50-V59 Occupant of pick-up truck or van injured in transport accident

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Slide379

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V60-V69 Occupant of heavy transport vehicle injured in transport accident

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Slide380

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V70-V79 Bus occupant injured in transport accident

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Slide381

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*V98-V99 Other and unspecified transport accidents

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Slide382

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*W00-X58 Other external causes of accidental injury

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Slide383

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*W20-W49 Exposure to inanimate mechanical forces

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Slide384

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*W50-W64 Exposure to animate mechanical forces

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Slide385

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*W65-W74 Accidental drowning and submersion

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Slide386

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*W85-W99 Exposure to electric current, radiation and extreme ambient air temperature and pressure

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Slide387

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*X00-X08 Exposure to smoke, fire and flames

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Slide388

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*X10-X19 Contact with heat and hot substances

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Slide389

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*X52, X58 Accidental exposure to other specified factors

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Slide390

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*Y62-Y84 Complications of medical and surgical care

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Slide391

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*Y62-Y69 Misadventures to patients during surgical and medical care

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Slide392

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*Y70-Y82 Medical devices associated with adverse incidents in diagnostic and therapeutic use

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Slide393

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*Y83-Y84 Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure

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Slide394

ICD-10-CM - CHAPTER 20 - External causes of morbidity (V01-Y99)

*Y90-Y99 Supplementary factors related to causes of morbidity classified elsewhere

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Slide395

Depressive personality disorder - Comorbidity with Other Disorders

Many researchers believe that depressive personality disorder is so highly comorbid with other depressive disorders, manic-depressive episodes and dysthymic disorder, that it is redundant to include it as a distinct diagnosis

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Slide396

Depressive personality disorder - Comorbidity with Other Disorders

Comorbidity of mood and anxiety disorders: the rule, not the expception?

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Slide397

Mapping of Unicode characters - Bidirectional Neutral Formatting

Writing direction is the direction glyphs are placed on the page in relation to forward progression of characters in the Unicode string

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Slide398

Mapping of Unicode characters - Bidirectional Neutral Formatting

Some of these characters also have a bidi-mirrored property indicating the glyph should be rendered in mirror-image when used in right-to-left text.

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Slide399

Mapping of Unicode characters - Bidirectional Neutral Formatting

The render-time directional type of a neutral character can remain ambiguous when the mark is placed on the boundary between directional changes. To address this, Unicode includes two characters that have strong directionality, have no glyph associated with them, and are ignorable by systems that do not process bidirectional text:

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Slide400

Mapping of Unicode characters - Bidirectional Neutral Formatting

* Left-to-right mark (U+200E)

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Slide401

Mapping of Unicode characters - Bidirectional Neutral Formatting

* Right-to-left mark (U+200F)

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Slide402

Mapping of Unicode characters - Bidirectional Neutral Formatting

Surrounding a bidirectionally neutral character by the left-to-right mark will force the character to behave as a left-to-right character while surrounding it by the right-to-left mark will force it to behave as a right-to-left character. The behavior of these characters is detailed in Unicode’s Bidirectional Algorithm.

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Slide403

Mapping of Unicode characters - Bidirectional General Formatting

While Unicode is designed to handle multiple languages, multiple writing systems and even text that flows either left-to-right or right-to-left with minimal author intervention, there are special circumstances where the mix of bidirectional text can become intricate—requiring more author control. For these circumstances, Unicode includes five other characters to control the complex embedding of left-to-right text within right-to-left text and vice versa:

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Slide404

Mapping of Unicode characters - Bidirectional General Formatting

* Left-to-right embedding (U+202A)

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Slide405

Mapping of Unicode characters - Bidirectional General Formatting

* Pop directional formatting (U+202C)

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Slide406

Samatha - Nine mental abidings

1998 ISBN 1-55939-106-5 pg 19 Asaṅga delineates the nine mental abidings in his Abhidharmasamuccaya and the Śrāvakabhūmi chapter of his Yogācārabhūmi-śāstra

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Slide407

Samatha - Nine mental abidings

::1. 'Placement of the mind' (S. cittasthāpana, Tib. འཇོག་པ - sems ’jog-pa) occurs when the practitioner is able to place his attention on the object of meditation, but is unable to maintain that attention for very long. Distractions, dullness of mind and other hindrances are common.

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Slide408

Samatha - Nine mental abidings

::2. 'Continuous attention' (S. samsthāpana, Tib. རྒྱུན་དུ་འཇོག་པ - rgyun-du ‘jog-pa) occurs when the practitioner experiences moments of continuous attention on the object before becoming distracted. According to B Alan Wallace, this is when you can maintain your attention on the meditation object for about a minute.[http://wisdompubs.org/Pages/search_results.lasso Wallace, A: 'The Attention Revolution', Wisdom Publications, 1st ed., 2006, p.30]

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Slide409

Samatha - Nine mental abidings

::3

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Slide410

Samatha - Nine mental abidings

::4

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Slide411

Samatha - Nine mental abidings

དུལ་བར་བྱེད་པ - dul-bar byed-pa), by this stage the practitioner achieves deep tranquility of mind, but must be watchful for subtle forms of laxity or dullness, peaceful states of mind which can be confused for calm abiding

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Slide412

Samatha - Nine mental abidings

::6

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Slide413

Samatha - Nine mental abidings

::7. 'Fully pacified attention' (S. vyupaśamana,Tib. རྣམ་པར་ཞི་བར་བྱེད་པ་ - nye-bar zhi-bar byed-pa), although the practitioner may still experience of subtle excitement or dullness, they are rare and he can easily recognize and pacify them.

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Slide414

Samatha - Nine mental abidings

::8. 'Single-pointed attention' (S. ekotīkarana,Tib. རྩེ་གཅིག་ཏུ་བྱེད་པ་ - rtse-gcig-tu byed-pa) in this stage the practitioner can reach high levels of concentration with only a slight effort and without being interrupted even by subtle laxity or excitement during the entire meditation session.

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Slide415

Samatha - Nine mental abidings

::9. 'Attentional Balance' (S. samādhāna,Tib. མཉམ་པར་འཇོག་པ་བྱེད་པ་ - mnyam-par ’jog-pa) the meditator now effortlessly reaches absorbed concentration (ting-nge-‘dzin, S. samadhi.) and can maintain it for about four hours without any single interruption.[http://wisdompubs.org/Pages/search_results.lasso Wallace, A: 'The Attention Revolution', Wisdom Publications, 1st ed., 2006, p.99]

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Slide416

Samatha - Nine mental abidings

::(10. śamatha, Tib. ཞི་གནས་, shyiné - the culmination, is sometimes listed as a tenth stage)

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Slide417

Turbidity

'Turbidity' is the cloudiness or haze|haziness of a fluid caused by large numbers of individual Particle (ecology)|particles that are generally invisible to the naked eye, similar to smoke in air. The measurement of turbidity is a key test of water quality.

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Slide418

Turbidity

Fluids can contain suspended solid matter consisting of particles of many different sizes. While some suspended material will be large enough and heavy enough to settle rapidly to the bottom of the container if a liquid sample is left to stand (the Settling|settable solids), very small particles will settle only very slowly or not at all if the sample is regularly agitated or the particles are colloidal. These small solid particles cause the liquid to appear turbid.

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Slide419

Turbidity

'Turbidity' (or haze) is also applied to transparent solids such as glass or plastic. In plastic production haze is defined as the percentage of light that is deflected more than 2.5° from the incoming light direction.[http://www.thermallaminatingfilms.com/haze.php Haze technical definition]

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Slide420

Turbidity - Causes

Certain industries such as quarrying, coal mine|mining and coal recovery can generate very high levels of turbidity from colloidal rock particles.

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Slide421

Turbidity - Causes

The association between drinking water turbidity and gastrointestinal illness: a systematic review

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Slide422

Turbidity - Causes

High turbidity levels can also affect the ability of fish gills to absorb dissolved oxygen

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Slide423

Turbidity - Causes

For many mangrove areas, high turbidity is needed to support certain species, such as to protect juvenile fish from predators. For most mangroves along the eastern coast of Australia, in particular Moreton Bay, turbidity levels as high as 600 Nephelometric Turbidity Units (NTU) are needed for proper ecosystem health.

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Slide424

Turbidity - Measurement

The most widely used measurement unit for turbidity is the Formazin Turbidity Unit|FTU (Formazin Turbidity Unit). International Organization for Standardization|ISO refers to its units as FNU (Formazin Nephelometric Units).

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Slide425

Turbidity - Measurement

The alternatively used Jackson Candle method (units: Jackson Turbidity Unit or 'JTU') is essentially the inverse measure of the length of a column of water needed to completely obscure a candle flame viewed through it

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Slide426

Turbidity - Measurement

For this reason (and the reason that heavier particles settle quickly and do not contribute to a turbidity reading), a correlation between turbidity and total suspended solids (TSS) is somewhat unique for each location or situation.

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Slide427

Turbidity - Measurement

The Secchi disk has the advantages of integrating turbidity over depth (where variable turbidity layers are present), being quick and easy to use, and inexpensive

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Slide428

Turbidity - Measurement

[http://watsanmissionassistant.wikispaces.com/file/view/Turbidity-Myre_Shaw.pdf/360203097/Turbidity-Myre_Shaw.pdf The Turbidity Tube] The turbidity tube condenses water in a graded tube which allows determination of turbidity based on a contrast disk in its bottom, being analogous to the Secchi disk.

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Slide429

Turbidity - Measurement

Turbidity in air, which causes solar attenuation, is used as a measure of pollution. To model the attenuation of beam irradiance, several turbidity parameters have been introduced, including the Linke turbidity factor (TL).HelioClim (Center for Energy and Processes). Paris, France. [http://www.helioclim.net/linke/index.html Linke Turbidity Factor.]

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Slide430

Turbidity - Drinking water standards

Systems that use filtration other than the conventional or direct filtration must follow state limits, which must include turbidity at no time exceeding 5 NTU

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Slide431

Turbidity - Ambient water standards

(States may also publish their own criteria.) Some states have promulgated water quality standards for turbidity, including:

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Slide432

Turbidity - Ambient water standards

* Louisiana. 25, 50 or 150 NTU, or background plus 10 percent, depending on the water body.Louisiana Department of Environmental Quality. Baton Rouge, LA.[http://epa.gov/waterscience/standards/wqslibrary/la/la_6_wqs.pdf Surface Water Quality Standards.] Louisiana Administrative Code (LAC). Title 33, Part IX, Chapter 11. August 6, 2007.

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Slide433

Turbidity - Ambient water standards

* Vermont. 10 NTU or 25 NTU, depending on water body classification.Vermont Water Resources Board. Montpelier, VT. [http://www.nrb.state.vt.us/wrp/publications/wqs.pdf Vermont Water Quality Standards.] January 25, 2006.

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Slide434

Turbidity - Ambient water standards

* Washington (U.S. state)|Washington. 5 NTU over background (when background is 50 NTU or less), or 10 percent increase when background is over 50 NTU.Washington Department of Ecology. Olympia, WA.[http://www.epa.gov/waterscience/standards/wqslibrary/wa/wa_10_chapter173-201a.pdf Water Quality Standards for Surface Waters of the State of Washington.] Washington Administrative Code (WAC). Chapter 173-201A. November 18, 1997.

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Slide435

Turbidity - Analytical methods

Published analytical test methods for turbidity include:

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Slide436

Turbidity - Analytical methods

* ISO 7027 Water Quality: Determination of Turbidity International Organization for Standardization. Geneva, Switzerland.

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Slide437

Turbidity - Analytical methods

[http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=30123 ISO 7027: Water quality -- Determination of turbidity.] 1999.

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Slide438

Turbidity - Analytical methods

* US EPA Method No. 180.1, TurbidityEPA. Environmental Monitoring Systems Laboratory. Cincinnati, Ohio. [http://water.epa.gov/scitech/methods/cwa/bioindicators/upload/2007_07_10_methods_method_180_1.pdf Method 180.1: Determination of Turbidity by Nephelometry; Revision 2.0.] August 1993.

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Slide439

Turbidity - Analytical methods

* Standard Methods, No. 2130B.Clescearl, Leonore S.(Editor), Greenberg, Arnold E.(Editor), Eaton, Andrew D. (Editor). Standard Methods for the Examination of Water and Wastewater (20th ed.) American Public Health Association, Washington, DC. ISBN 0-87553-235-7. This is also available on CD-ROM and [http://www.standardmethods.org/ online] by subscription.

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Slide440

Turbidity - Treatment

Turbidity is commonly treated using either a settling or filtration process. Depending on the application, chemical reagents, will be dosed into the wastewater stream to increase the effectiveness of the settling or filtration process. Potable water treatment and municipal wastewater plants often remove turbidity with a combination of sand filtration, settling tanks and clarifiers.

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Slide441

Turbidity - Treatment

This method is commonly used at coal mines and coal loading facilities where stormwater collection ponds have seasonal issues with turbidity

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Slide442

Turbidity - Reagents

Reagents available for treating turbidity include aluminium sulfate or alum (Al2(SO4)3.xH2O), ferric chloride (FeCl3), gypsum (CaSO4.2H2O), poly-aluminium chloride, long chain acrylamide-based polymers and numerous proprietary reagents.Earth Systems, Clear Solutions newsletter - Focus on Turbidity [http://www.earthsystems.com.au/wp-content/uploads/2012/02/ClearSolutions_No1_2003.pdf] 2003

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Slide443

Turbidity - Reagents

The dosing process must also be considered when using reagents as the flocs may be broken apart by excessive mixing.

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Slide444

Morbidity and Mortality Weekly Report

, the journal's editor-in-chief is Ronald Moolenaar.[http://www.cdc.gov/mmwr/staff/staff.html Morbidity and Mortality Weekly Report Staff], Centers for Disease Control and Prevention

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Slide445

Morbidity and Mortality Weekly Report

As noted in the sequel, some single reports have evoked media interest also outside health and medical contexts

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Slide446

Morbidity and Mortality Weekly Report - Notable articles

* The spread of Hepatitis A among attendees of jam band concert tours (September 2003).[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5235a5.htm Public Health Dispatch: Multistate Outbreak of Hepatitis A Among Young Adult Concert Attendees --- United States, 2003] (MMWR 52(35), September 5, 2003)O' Neil, John

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Slide447

Morbidity and Mortality Weekly Report - Notable articles

* Low concerns for risks of elevated blood levels of lead in Washington, DC (April 2004).[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5312a6.htm Blood Lead Levels in Residents of Homes with Elevated Lead in Tap Water --- District of Columbia, 2004] (MMWR 53(12), April 2, 2004) The article was notable and later criticized for not emphasizing the risks, and now is available together with two amending notices to the readers by CDC from 2010.

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Slide448

Morbidity and Mortality Weekly Report - Notable articles

* Several dozen deaths in teens participating in what is called the choking game (February 2008)via Associated Press. [http://query.nytimes.com/gst/fullpage.html?res=9A05E6DF1E38F936A25751C0A96E9C8B63 NATIONAL BRIEFING | SCIENCE AND HEALTH; Count Of 'choking Game' Fatalities], The New York Times, February 15, 2008. Retrieved July 24, 2009.

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Slide449

Morbidity and Mortality Weekly Report - Notable articles

* A report about the elevated death rate among fisherman in the Pacific Northwest (April 2008)Bakalar, Nicholas. [http://www.nytimes.com/2008/05/13/health/13stat.html Northwest Fishery Posts Highest Fatality Rate], The New York Times, May 13, 2008. Retrieved July 24, 2009.

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Slide450

Morbidity and Mortality Weekly Report - Notable articles

* Improvements in public health after the implementation of municipal smoking bans (January 2009)Bakalar, Nicholas. [http://www.nytimes.com/2009/01/13/health/research/13prev.html Smoking Ban Improves a City's Health], The New York Times, January 12, 2009.

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Slide451

Morbidity and Mortality Weekly Report - Notable articles

* The initial reports of a novel swine flu virus which led to the 2009 flu pandemic (April 24, 2009)[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5815a5.htm Swine Influenza A (H1N1) Infection in Two Children --- Southern California, March--April 2009], Morbidity and Mortality Weekly Report, April 24, 2009

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Slide452

Morbidity and Mortality Weekly Report - First report of AIDS

[http://www.cdc.gov/mmwr/PDF/wk/mm4534.pdf Pneumocystis Pneumonia — Los Angeles], Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, August 30, 1996 / Vol

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Slide453

Morbidity and Mortality Weekly Report - Background

Between 2001 and 2003, various tests showed that the lead content in drinking water in Washington DC more often than not was higher than 15 PPM (parts per million), which was the action level fixed by U.S

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Slide454

Morbidity and Mortality Weekly Report - Background

Lead is well known to have toxic effects, especially for embryos and small children. Even in small doses, Lead poisoning#Chronic poisoning|lead poisoning may lead to e.g. permanent intelligence deficiencies and concentration difficulties.

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Slide455

Morbidity and Mortality Weekly Report - Report details

On March 30, 2004, an MMWR dispatch, Blood Lead Levels in Residents of Homes with Elevated Lead in Tap Water --- District of Columbia, 2004 was made available on the MMWR web site

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Slide456

Morbidity and Mortality Weekly Report - Report details

The report concludes that the high amounts of lead in the drinking water may have led to a slight rise of the blood levels; however, it claimed that no children were identified with Blood lead level|BLLs ref name=salonref name=salon/ref name=salon/ref name=salon/ref name=wapo-underrepref name=wapo-underrep/ref name=wapo-underrep/ref name=wapo-cdc-mislead/ref name=wapo-cdc-mislead/

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Slide457

Morbidity and Mortality Weekly Report - Response to the criticism

The CDC did not withdraw the report, but in 2010 amended it with two notices to the readers, with the following explanations

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Slide458

Human parainfluenza viruses - Morbidity and mortality

Mortality caused by hPIV in developed regions of the world remains rare. Where mortality has occurred, it is principally in the three core risk groups (very young, elderly and immuno-compromised). Long term changes can however be associated with airway remodelling and are believed to be a significant cause of morbidity. The exact associations between hPIV and diseases such as chronic obstructive pulmonary disease (COPD) are still being investigated.

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Slide459

Human parainfluenza viruses - Morbidity and mortality

In developing regions of the world, the highest risk group in terms of mortality remains pre-school children. Mortality may be as a consequence of primary viral infection or secondary problems such as bacterial infection. Predispositions, such as malnutrition and other deficiencies may further elevate the chances of mortality associated with infection.

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Slide460

Human parainfluenza viruses - Morbidity and mortality

Overall, LRI's cause approximately 25–30% of total deaths in pre-school children in the developing world. hPIV is believed to be associated with 10% of all LRI cases, thus remaining a significant cause of mortality.

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Slide461

Cervical cerclage - Morbidity and mortality rates

Approximately 1-9% of women will experience premature labor after cerclage. The risk of chorioamnionitis is 1-7%, but increases to 30% if the cervix is dilated greater than 1.2 in (3cm). The risks associated with premature delivery, however, are far greater. Babies born between 22 and 25 weeks of pregnancy are at significant risk of moderate to severe disabilities (46-56%) or death (approximately 10-30% survive at 22 weeks, increasing to 50% at 24 weeks, and 95% by 26 weeks).

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Slide462

HIV/AIDS in the United States - Mortality and morbidity

Invariably, HIV is a silent disease when first acquired, and this period of latency varies. The progression from HIV infection to AIDS varies from 5–12 years. In the past, most individuals succumbed to the disease in 1–2 years after being diagnosed with AIDS. However, since the introduction of potent anti retroviral drug therapy and better Post-exposure prophylaxis|prophylaxis against opportunistic infections, mortality rate|death rates have significantly declined.

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Slide463

Sakıp Sabancı Museum - The World of Abidin Dino

Between November 24, 2007 through January 27, 2008, the museum hosted works and documents of the renowned Turkish painter Abidin Dino, a multi-faceted artist and man of culture, who died in 1993. The comprehensive exhibition comprised his drawings and writings

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Slide464

Sakıp Sabancı Museum - The World of Abidin Dino

along with photographs and documents chronicling the various periods throughout his 80 years in Turkey, France and other countries.[http://muze.sabanciuniv.edu/exhibition/exhibition.php?lngExhibitionID=66bytLanguageID=2 Sakıp Sabancı Museum Web Site - Past Exhibitions - The World of Abidin Dino]

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Slide465

Anhedonia - Comorbidity

Anhedonia is present in several forms of psychopathology.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision

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Slide466

List of organizations designated by the Southern Poverty Law Center as anti-gay hate groups - Abiding Truth Ministries

Abiding Truth Ministries is a Christian fundamentalism|conservative Christian organization located in Temecula, California

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Slide467

List of organizations designated by the Southern Poverty Law Center as anti-gay hate groups - Abiding Truth Ministries

Along with Kevin E

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Slide468

Rubidium oxide

The final product of oxygenation of Rb is principally RbO2, rubidium superoxide:

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Slide469

Rubidium oxide

This superoxide can then be reduced to Rb2O using excess rubidium metal:

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Slide470

Rubidium-87

'Rubidium' ('Rb') has 32 isotopes, with naturally occurring rubidium being composed of just two isotopes; 85Rb (72.2%) and the radioactive 87Rb (27.8%). Normal mixes of rubidium are radioactive enough to fog photographic film in approximately 30 to 60 days. Standard atomic mass is 85.4678(3) unified atomic mass unit|u.

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Slide471

Rubidium-87

See rubidium-strontium dating for a more detailed discussion.

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Slide472

Rubidium-87

82Rb is used in some cardiac positron emission tomography|PET scans to assess Myocardial perfusion scan|myocardial perfusion. It has a half-life of 1.273 minutes. It does not exist naturally, but can be made from the decay of 82Sr.

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Slide473

Rubidium-87

Even though rubidium-85 is more abundant, rubidium-87 has a positive scattering length, which means it is mutually repulsive, at low temperatures

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Slide474

Rubidium-87

Rubidium-87 has an atomic mass of 86.9091835 u, and a binding energy of 757,853 keV. Its atomic percent abundance is 27.835%, and has a half-life of .

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Slide475

Rubidium-87 - Notes

* Geologically exceptional samples are known in which the isotopic composition lies outside the reported range. The uncertainty in the atomic mass may exceed the stated value for such specimens.

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Slide476

Rubidium-87 - Notes

* Values marked # are not purely derived from experimental data, but at least partly from systematic trends. Spins with weak assignment arguments are enclosed in parentheses.

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Slide477

Rubidium-87 - Notes

* Uncertainties are given in concise form in parentheses after the corresponding last digits. Uncertainty values denote one standard deviation, except isotopic composition and standard atomic mass from IUPAC which use expanded uncertainties.

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Slide478

Cutaneous horn - Mortality/Morbidity

The lesion at the base of the keratin mound is benign in the majority of cases. Malignancy is present in up to 20% of cases, with Squamous-cell carcinoma|squamous cell carcinoma being the most common type. The incidence of Squamous-cell carcinoma|squamous cell carcinoma increases to 37% when the cutaneous horn is present on the penis. Tenderness at the base of the lesion is often a clue to the presence of a possible underlying Squamous-cell carcinoma|squamous cell carcinoma .

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Slide479

List of ICD-9 codes 780–799: symptoms, signs, and ill-defined conditions - Ill-defined and unknown causes of morbidity and mortality (797–799)

* () Sudden infant death syndrome

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Slide480

List of ICD-9 codes 780–799: symptoms, signs, and ill-defined conditions - Ill-defined and unknown causes of morbidity and mortality (797–799)

* () Other ill-defined and unknown causes of morbidity and mortality

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Slide481

List of ICD-9 codes 780–799: symptoms, signs, and ill-defined conditions - Ill-defined and unknown causes of morbidity and mortality (797–799)

** () Anxiety|Nervousness

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Slide482

Misophonia - Prevalence and comorbidity

The prevalence of misophonia is unknown, but groups of people identifying with the condition suggest it is more common than previously recognized. Among patients with tinnitus, which is prevalent in 4–5% of the general population, some surveys report prevalence as high as 60%, while prevalence in a 2010 study was measured at 10%.

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Slide483

Misophonia - Prevalence and comorbidity

The Dutch study published in 2013 of a sample of 42 patients with misophonia found a low incidence of psychiatric disorders, with the exception of Obsessive-Compulsive Personality Disorder (52.4%).

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Slide484

Misophonia - Prevalence and comorbidity

It has been suggested that there is a connection between misophonia and synesthesia, a neurological condition in which stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway.Cytowic, Richard E

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Slide485

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

* () Fetus or newborn affected by material conditions which may be unrelated to present pregnancy

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Slide486

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

** () Noxious influences affecting fetus or newborn via placenta or breast milk

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Slide487

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

*** () Exposure to narcotics, perinatal

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Slide488

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

* () Fetus or newborn affected by complications of placenta, Umbilical cord|cord, and Biological membrane|membranes

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Slide489

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

** () Other compression of umbilical cord affecting fetus or newborn

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Slide490

List of ICD-9 codes 760–779: certain conditions originating in the perinatal period - Maternal causes of perinatal morbidity and mortality (760–763)

* () Fetus or newborn affected by other complications of Childbirth|labor and delivery

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Slide491

Pancreaticoduodenectomy - Morbidity and mortality

Pancreaticoduodenectomy is considered, by any standard, to be a major surgical procedure.

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Slide492

Pancreaticoduodenectomy - Morbidity and mortality

Even at high-volume hospitals, morbidity has been found to vary by a factor of almost four depending on the number of times the surgeon has previously performed the procedure.[http://www.patienteducationcenter.org/aspx/HealthELibrary/HealthETopic.aspx?cid=L0409b The Whipple Procedure] Pri-Med Patient Education Center, Harvard Health Publications

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Slide493

Pancreaticoduodenectomy - Morbidity and mortality

de Wilde et al. have reported statistically significant mortality reductions concurrent with centralization of the procedure in the Netherlands.De Wilde, R.F. et al., 2012. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. The British journal of surgery, 99(3), pp.404–410.

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Slide494

Pancreaticoduodenectomy - Morbidity and mortality

One study reported actual risk to be 2.4 times greater than the risk reported in the medical literature, with additional variation by type of institution.

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Slide495

Rubidium hydroxide

'Rubidium hydroxide' (RbOH) is a strong Base (chemistry)|basic chemical and alkali that is formed by one rubidium ion and one hydroxide ion.

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Slide496

Rubidium hydroxide

Rubidium hydroxide does not appear in nature. However it can be obtained by Chemical synthesis|synthesis from rubidium oxide. In addition, rubidium hydroxide is commercially available in form of an aqueous solution from a few suppliers.

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Slide497

Rubidium hydroxide

Rubidium hydroxide is highly corrosive, therefore suitable protective clothing, gloves and eye-face protection are required when handling this material.

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Slide498

Rubidium hydroxide - Synthesis

Rubidium hydroxide can be synthesized from rubidium oxide by dissolving the oxide into water:

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Slide499

Rubidium hydroxide - Synthesis

Rubidium hydroxide is also commercially available from a certain number of chemical suppliers in form of 50% or 99% water|aqueous solution at multiples of 5 gram|g.

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Slide500

Rubidium hydroxide - Uses

Rubidium hydroxide is rarely used in industrial processes because potassium hydroxide and sodium hydroxide can perform nearly all the industrial functions of rubidium hydroxide in a less violent and hence safer way.

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Slide501

Rubidium hydroxide - Uses

Rubidium hydroxide is used in scientific research. It is often used sparingly to prevent waste of the expensive element rubidium. For example, it is used to give fireworks a violet color in place of pure rubidium.

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Slide502

Rubidium hydroxide - Uses

Despite the fact that rubidium hydroxide is rarely used in normal industrial processes, it is notable that the synthesis of nearly all rubidium compounds involves rubidium hydroxide as an intermediate. Natural rubidium oxide is added to water, and the resulting reaction forms soluble rubidium hydroxide as a product.

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Slide503

Rubidium hydroxide - Hazard prevention

Rubidium hydroxide is a corrosive compound that causes immediate Burn (injury)|burns to the skin on contact. Ultimate care must be carried out when handling this chemical.

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Slide504

Rubidium hydroxide - Hazard prevention

In the laboratory, protective clothing, gloves, and eye-face protection made from alkali-resistant materials are to be worn to prevent injury caused by accidental Leakage (chemistry)|leakage of rubidium hydroxide onto human skin.

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Slide505

Rubidium hydroxide - Hazard prevention

:wikt:dilution|Dilution of this strong alkali must be done by adding the hydroxide slowly into the beaker of water.

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Slide506

Rubidium hydroxide - Hazard prevention

In addition, chemical experiments on this compound must be performed with caution to prevent the great amount of heat released in an exothermic reaction from causing the solution to boil-over or damage the vessel.

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Slide507

Morbidity and mortality conference

'Morbidity and mortality' (MM) 'conferences' are traditional, recurring conferences held by medical services at academic medical centers, most large private medical and surgical practices, and other medical centers

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Slide508

Morbidity and mortality conference

Morbidity and Mortality conferences have long been part of the practice of medicine, having originated in the early 1900s with Dr

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Slide509

National Comorbidity Survey

The 'National Comorbidity Survey: Baseline' (NCS-1) was the first large-scale field survey of mental health in the United States

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Slide510

National Comorbidity Survey

The 'National Comorbidity Survey: Reinterview' (NCS-2) was a follow up study conducted between 2001 and 2002. The participants in NCS-1 were re-interviewed with the aim to collect information about changes in mental disorders, substance use disorders, and the predictors and consequences of these changes over the ten years between the two surveys.

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Slide511

National Comorbidity Survey

In conjunction with the NCS-2, two other surveys were done. The 'National Comorbidity Survey Replication' (NCS-R) was a study done with 9,282 new participants. And the 'National Comorbidity Survey: Adolescent Supplement' (NCS-A) was a study done between 2000 and 2004 with 10,000 adolescents.

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Slide512

National Comorbidity Survey - Most notable findings

-Comorbidity: Of the people who experience mental illness in their lifetime (48% of pop), 27% will experience more than one. The resulting average is 2.1 mental disorders per (disordered) person.

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Slide513

Ureterostomy - Morbidity and mortality rates

The outcome and prognosis for ureterostomy patients depends on a number of factors. The highest rates of complications exist for those who have pelvic cancer or a history of radiation therapy.

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Slide514

Ureterostomy - Morbidity and mortality rates

In one study, a French medical team followed 69 patients for a minimum of one year (an average of six years) after TUU was performed

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Slide515

Binge eating disorder - Comorbidities

Individuals who have binge eating disorder commonly have other psychiatric comorbidities such as major depressive disorder, personality disorder, bipolar disorder, substance abuse, body dysmorphic disorder, kleptomania, irritable bowel syndrome, fibromyalgia, or anxiety disorder

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Slide516

Binge eating disorder - Comorbidities

Binge eating disorder is similar to, but distinct from, compulsive overeater|compulsive overeating

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Slide517

List of languages by writing system - Nsibidi

*Ekoid languages|Ekoi

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Slide518

List of languages by writing system - Nsibidi

*Igbo language|Igbo

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Slide519

List of languages by writing system - Nsibidi

*Ibibio language|Ibibio

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Slide520

Incidence matrix - Signed and bidirected graphs

It is the incidence matrix of any bidirected graph that orients the given signed graph

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Slide521

Sensory processing disorder - Other comorbidities

Various conditions can involve SPD, such as schizophrenia, succinic semialdehyde dehydrogenase deficiency, primary nocturnal enuresis, prenatal alcohol exposure, learning disability|learning difficulties and autism, as well as people with traumatic brain injury or who have had cochlear implants placed

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Slide522

Morbid obesity - Morbidity

Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic syndrome, a combination of medical disorders which includes: diabetes mellitus type 2, hypertension|high blood pressure, hypercholesterolemia|high blood cholesterol, and hypertriglyceridemia|high triglyceride levels.

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Slide523

Morbid obesity - Morbidity

Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle. The strength of the link between obesity and specific conditions varies. One of the strongest is the link with type 2 diabetes. Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women.Seidell 2005 p.9

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Slide524

Morbid obesity - Morbidity

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of fat cells (diabetes mellitus|diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease)

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Slide525

Gene promoter - Bidirectional promoters (mammalian)

Transcription factor binding and modified histones in human bidirectional promoters

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Slide526

Supercentenarian - Morbidity

Research on the morbidity of supercentenarians has found that they remain free of major age-related diseases (e.g., stroke, cardiovascular disease, dementia, cancer, Parkinson’s disease and diabetes) until the very end of life when they die of exhaustion of organ reserve, which is the ability to return organ function to Human_homeostasis|homeostasis

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Slide527

List of Dragon Ball characters - Bobbidi

Bobbidi is voiced by Jōji Yanami in the original series and by Bin Shimada in Kai, Terry Klassen in the Ocean dub, and Duncan Brannan in the Funimation dub.

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Slide528

Hantaan River virus - Morbidity and mortality

In hantavirus induced hemorrhagic fever, incubation time is between two to four weeks in humans before symptoms of infection present

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Slide529

Bidi Bidi Bom Bom

'Bidi bidi bom bom' is a song by American Tejano music|Tejano pop singer Selena from her album Amor Prohibido|Amor prohibido (1994). The album's second single, Bidi bidi bom bom was written by Selena and Pete Astudillo. It was produced by A.B. Quintanilla|A.B. Quintanilla III– Selena's brother– and Bebu Silvetti. It was released on 13 August 1994 in the United States. It was picked up by Tejano, rhythmic contemporary and Contemporary Latin#Music|Contemporary Latin radio stations.

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Slide530

Bidi Bidi Bom Bom

Bidi bidi bom bom received mixed to positive review from contemporary music critics.

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Slide531

Bidi Bidi Bom Bom

Bidi bidi bom bom has been covered by many artists since its release.

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Slide532

Bidi Bidi Bom Bom - Background and production

Bidi bidi bom bom, one of the first songs composed for Selena's fifth studio album Amor Prohibido|Amor prohibido (1994), is regarded as Selena's signature song

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Slide533

Bidi Bidi Bom Bom - Background and production

with writing the song, while Selena's widower Chris Perez helped gather Rock fusion and guitar solos into Bidi bidi bom bom

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Slide534

Bidi Bidi Bom Bom - Background and production

Selena had done takes for Bidi bidi bom bom at Q-Productions

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Slide535

Bidi Bidi Bom Bom - Composition and lyric content

Her heart would palpitate (Bidi bidi bom bom) every time he walks near her

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Slide536

Bidi Bidi Bom Bom - Critical reception

Ilan Stavans and Harold Augenbraum reviewed Amor prohibido and stated that Bidi bidi bom bom, No me queda más, and Techno Cumbia are the key hits of the album

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Slide537

Bidi Bidi Bom Bom - Critical reception

Diosdada Sagarra Díaz of Adelante (newspaper)|Adelante highly praised Bidi bidi bom bom's mixing styles and the addicting rhythms of the song

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Slide538

Bidi Bidi Bom Bom - Critical reception

Bidi bidi bom bom was highly liked by children and was covered in various children compilation albums after Selena's death.

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Slide539

Bidi Bidi Bom Bom - Background and development

The music video for Bidi bidi bom bom was filmed from 28–30 April 1994 and was directed by Cecilia Miniucchi.

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Slide540

Bidi Bidi Bom Bom - Background and development

The video was shot in Santa Monica, California at the Santa Monica Pier

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Slide541

Bidi Bidi Bom Bom - Background and development

Meanwhile, she begins to sing the song Bidi Bidi Bom Bom

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Slide542

Bidi Bidi Bom Bom - Reception

Fuegues editor, François Petit, said, The music video for 'Bidi Bidi Bom Bom' was astonishing and greatly appreciated among French gays for its grooves and addicting lyrics, in nightclubs across Canada

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Slide543

Bidi Bidi Bom Bom - Credits and personnel

All credits were taken from the albums liner notes.

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Slide544

Bidi Bidi Bom Bom - Credits and personnel

*Pete Astudillo – writer

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Slide545

Bidi Bidi Bom Bom - Credits and personnel

*List of music arrangers|Roger Emerson – music arranger

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Slide546

Bidi Bidi Bom Bom - Credits and personnel

*Brian Red Moore – audio mixing (recorded music)|audio mixer

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Slide547

Bidi Bidi Bom Bom - Covers

Bidi Bidi Bom Bom was also included in a lesbian pride event in Long Beach, California|Long Beach, California.

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Slide548

Bidi Bidi Bom Bom - Covers

Puerto Rican boy band, Tick Tock (band)|Tick Tock, covered the song, as well as creating a music video to promote the song in 2004

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Slide549

Australian Shepherd - Morbidity

Based on a sample of 48 still-living dogs, the most common health issues noted by owners were eye problems (red eye, epiphora, conjunctivitis, and cataracts). Dermatological and respiratory problems also ranked high.

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Slide550

Australian Shepherd - Morbidity

Collie eye anomaly (CEA) is rare in the breed, but it and cataracts are a concern in Aussies

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Slide551

Australian Shepherd - Morbidity

Some Australian shepherds (as well as collies, German Shepherd|German shepherds and many other herding dogs) are susceptible to a genetic mutation of the MDR1 gene. Dogs with the mutation can suffer toxicity from anti-parasitics such as Ivermectin in high doses, and other drugs. A test is available to determine if a particular dog carries the mutated gene.

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Slide552

Dobrava-Belgrade virus - Morbidity and Mortality

The fatality rate is 12%, making Dobrava virus the most life-threatening hantavirus disease in Europe. Variant DOBV genotypes have different degrees of pathogenicity.Papa A.Dobrava-Belgrade virus: phylogeny, epidemiology, disease.Antiviral Res. 2012 Aug;95(2):104-17. doi: 10.1016/j.antiviral.2012.05.011. Epub 2012 May 30.

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Slide553

Dragon Ball Z Collectible Card Game - Babidi saga

Another Booster only set, Babidi Saga expanded upon the Majin (Dragon Ball)|Majin mechanic

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Slide554

Dragon Ball Z Collectible Card Game - Babidi saga

The Personality cards in this set included Son Goku (Dragon Ball)|Goku, Son Gohan|Gohan, Android 18, Mr. Satan|Hercule, Videl, List of Dragon Ball characters#Kaioshin, East|Supreme Kai, Babidi|Majin Babidi, Dabura|Majin Dabura, List of Dragon Ball characters#Pui-Pui|Majin Pui-Pui, List of Dragon Ball characters#Yakon|Majin Yakon, and Vegeta|Majin Vegeta.

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Slide555

Dragon Ball Z Collectible Card Game - Babidi saga

The 6-star Ultra Rare cards printed in this set were Majin Vegeta, Level 1 and Majin Vegeta, the Malevolent, Level 5.

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Slide556

Law Abiding Citizen

'Law Abiding Citizen' is a 2009 American Thriller (genre)|thriller film directed by F. Gary Gray from a screenplay written by Kurt Wimmer and stars Jamie Foxx and Gerard Butler. The film takes place in Philadelphia and tells the story of a man driven to commit multiple murders while targeting not only his family's killer but also a corrupt criminal justice system. Law Abiding Citizen was released theatrically in North America on October 16, 2009.

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Slide557

Law Abiding Citizen

The film was nominated for a Saturn Award as the Best Action/Adventure/Thriller Film of the year, but lost to Inglourious Basterds, and the film also garnered NAACP Image Awards nominations for both Jamie Foxx (Outstanding Actor in a Motion Picture) and F. Gary Gray (Outstanding Directing in a Motion Picture).

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Slide558

Law Abiding Citizen - Plot

In a 1999 Philadelphia violent home invasion, Clyde Shelton (Gerard Butler) is forced to witness the rape and murder of his wife and young daughter, by Clarence James Darby (Christian Stolte) and his accomplice Rupert Ames (Josh Stewart)

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Slide559

Law Abiding Citizen - Plot

Ten years later, Ames's time on death row is up

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Slide560

Law Abiding Citizen - Plot

As he leaves the interrogation room, Rice receives a phone call from his wife, and learns that Shelton had sent a copy of the snuff film of Darby's demise to his house, traumatizing his young daughter

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Slide561

Law Abiding Citizen - Plot

Once in jail, Shelton demands a porterhouse steak lunch be delivered to his cell by a specific time, in return for disclosing where to find Darby's lawyer, who they then discover was reported missing three days earlier

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Slide562

Law Abiding Citizen - Plot

Cantrell arranges a meeting with a CIA contact and takes Rice along

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Slide563

Law Abiding Citizen - Plot

Rice discovers that Shelton owns an auto garage right next to the prison

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Slide564

Law Abiding Citizen - Plot

Shelton returns to his garage after planting the city hall bomb, then returns to his cell

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Slide565

Law Abiding Citizen - Cast

* Colm Meaney as Detective Dunnigan

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Slide566

Law Abiding Citizen - Cast

* Bruce McGill as Jonas Cantrell

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Slide567

Law Abiding Citizen - Cast

* Emerald-Angel Young as Denise Rice

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Slide568

Law Abiding Citizen - Cast

* Annie Corley as Judge Laura Burch

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Slide569

Law Abiding Citizen - Production

Filming began in August 2008 and took place in and around Philadelphia. Filming locations included Philadelphia's City Hall and the old Eastern State Penitentiary.

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Slide570

Law Abiding Citizen - Production

The film was edited after being threatened with an Motion Picture Association of America film rating system|NC-17 rating for violence, with the full version released unrated on Blu-ray.

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Slide571

Law Abiding Citizen - Soundtrack

The Law Abiding Citizen (soundtrack)|score to Law Abiding Citizen was composed by Brian Tyler (composer)|Brian Tyler, who recorded his score with a 52-piece ensemble of the Hollywood Studio Symphony at the Sony Scoring Stage with help from Kieron Charlesworth

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Slide572

Law Abiding Citizen - Soundtrack

The tune at the end for closing credits is Sin's A Good Man's Brother by Grand Funk Railroad.

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Slide573

Law Abiding Citizen - Release

The film was released theatrically on October 16, 2009. The first theatrical trailer was released on August 14, 2009 and was attached to District 9.

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Slide574

Law Abiding Citizen - Release

The premiere was held on November 15, 2009 at the Cineworld complex in Glasgow - hometown of Gerard Butler. Many British tabloids have labeled this event as the Homecoming Premiere, in reference to the Homecoming Scotland celebrations.

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Slide575

Law Abiding Citizen - Reception

Law Abiding Citizen received negative reviews from critics. Review aggregation website Rotten Tomatoes gives it a 25% score, with an average rating of 4.3/10 based on 155 reviews. The site's critical consensus states that Unnecessarily violent and unflinchingly absurd, Law Abiding Citizen is plagued by subpar acting and a story that defies reason. http://www.rottentomatoes.com/m/law_abiding_citizen/

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Slide576

Law Abiding Citizen - Reception

In his review for the Chicago Sun Times, Roger Ebert said, Law Abiding Citizen is the kind of movie you will like more at the time than in retrospect. He then went on to say, Still, there's something to be said for a movie you like well enough at the time. Ebert rated the film 3 out of 4 stars.http://www.rogerebert.com/reviews/law-abiding-citizen-2009 Roger Ebert

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Slide577

Alaskan Malamute - Morbidity

The most commonly reported health problems of Alaskan Malamutes, in the 2004 UK Kennel Club survey (based on a sample size of 64 dogs) were musculoskeletal (Hip dysplasia (canine)|hip dysplasia), and hereditary cataracts. There are additional health issues in the breed whose origins are unknown at this time including varied seizure disorders found in young puppies as well as adults, Epilepsy, congenital heart problems, kidney problems and skin disorders.

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Slide578

Alaskan Malamute - Morbidity

Other health issues in Malamutes include Elbow dysplasia, Polyneuropathy in dogs and cats|inherited polyneuropathy, chondrodysplasia, heart defects, and eye problems (particularly cataract and progressive retinal atrophy).http://www.alaskanmalamute.org/Health/health.asp Alaskan Malamute Club of America Health Committee Retrieved July 10, 2007 A growing problem among arctic dog breeds, including the Alaskan Malamute, but especially their cousin, the Samoyed, is canine diabetes with onset occurring typically in middle age (5 to 7 years)[http://www.adrtc.org/canine-diabetes/ Arctic Dog Rescue and Training Center » Canine Diabetes]

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Slide579

Ernest Shackleton - Biding time

In the period immediately after his return, Shackleton engaged in a strenuous schedule of public appearances, lectures and social engagements

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Slide580

Ernest Shackleton - Biding time

Any future resumption by Shackleton of the quest for the South Pole depended on the results of Scott's Terra Nova Expedition, which left from Cardiff in July 1910

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Slide581

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