Mark Corson

By A. Steve. Lake Forest College.

Leap motion is newly developed Human-Computer Interac- lines should be developed to link the institution with the community cheap 50mg precose amex. We anticipate free-hand interaction with leap motion will 957 arouse patient’s interest order 25mg precose overnight delivery, it might be an effective and safe therapeu- tic device for neurorehabilitation order precose 25mg fast delivery. Dhakal1 perceived exertion (Borg scale), degree of depression (geriatric de- 1Spinal Injury Rehabilitation Centre, Spinal Unit, Kavre- Banepa, pression score) for effectiveness of treatment, before and after the Nepal study. This requires coordinated efforts and manual function test score of affected side arm was 20. Material and Methods: An account of the experiences and a Barthel index was 70, manual function test score was 24. None of the patients experienced er during the frst four weeks after the earthquake in Nepal. When confronted with a specifc approach based on only one pathology like spina bifda and hydro- J. After closure 1Sichuan University and Hongkong Polytechnic University, Insti- of the meningomyelocoele or shunting for hydrocephalus, these tute for Disaster Management and Reconstruction, Chengdu, China children return to their homestead having a high complication risk. Results: Physical independence of the pa- Introduction/Background: Stroke is a major cause of death and dis- tients varied from severe to mild dependence. Pain and neurogenic ability worldwide, limited information is available about the out- bladder were the most frequently reported medical complications. Aim: To investigate stroke rehabilitation Many of the patients were emotionally unstable and showed mild outcomes, and factors predicting these outcomes in stroke patients. None of the patients had returned Material and Methods: Design: A one-year hospital-based, obser- to work or education although this was a frequently uttered desire. Sample: One hundred and thirty The economic situation of all patients and often their families was nine (139) stroke patients were recruited from two main hospitals considered diffcult and environmental barriers to social participa- in Hebron city. Procedure: Objective assessment, patient interview, tion were also frequently perceived. Rehabilitation measures avail- fle screening and observation of the recruited cases was performed, able to the patients were deemed insuffcient. Sample showed complex medical and psychosocial needs, most of which description: Mean age of the sample was 67. Lower level of functional activity at six months, was pre- dicted by the age patient (B. Rehabilitation response community projects needs to be prioritized assuming these are the basic building blocks of Disaster Rehab response grass root units. Kawate1 them closer, as well there are many grassroots political committees 1Showa University School of Medicine, Rehabilitation Medicine, that this bondage can be utilized in the management of pre disaster Yokohama, Japan rehab programs and post disaster injuries; specifcally during the post disaster periods they can be working as early responders at the Introduction/Background: Acupuncture is used as one of the tech- disaster site. Although Bangladesh is a Muslim majority country; niques for muscle re-education and facilitation to re-establish it has huge number of mosques and other common religious places voluntary control of body movements in patients. Using surface where number of religious leaders are placed to conduct the reli- electromyogram we showed in a previous study that patients with gious works. We have been conducting sessions of training Muslim chronic hemiparesis increased their gait speed signifcantly after leaders (imam and muazzin) to work as the early responder dur- cutaneous acupuncture and showed a trend of modifying mus- ing the cyclones at the coastal districts of Bangladesh following cle hyperactivities. Results: Initial reports of the project were promis- cutaneous acupuncture to hemiparetic gait patterns. Local Methods: Video recordings were taken of sixteen healthy volunteers people can respond disasters earlier. Acupuncture with uninsertable brush shaped J Rehabil Med Suppl 55 Poster Abstracts 281 needles (11 mm diameter, made of resin) on the plaster were ap- Department of Neurology, The Second Affliated Hospital of plied on affected lower extremity, mainly around on Gastrocnemius Chongqing Medical University, Chongqing, China and Achilles tendon. Results: Both, patients and healthy volunteers, did not show any signifcant differences in their gait patterns after Objective: To investigate the effect and mechanism of enriched stimulation. Material and Methods: A total of 30 healthy participants were assigned into group 1 (n=16) and group 2 (n=14). Health, Brunei, Brunei, 3Jerudong Park Medical Center, Jerudong Group 1 and group 2 were provided with low- and high-dose heat Park Medical Center, Brunei, Brunei respectively. Muscle blood fow was measured using Laser Doppler fowmetry (PeriFlux 5000 ®, Sweden) before and after intervention Introduction/Background: In many regions of the world there are in all subjects. Meanwhile, the ranges of neck motion and pressure- isolated physicians who hope to build rehabilitation medicine. Data there is a compelling public health need for more locally trained was collected, recorded and analyzed. However didactic education can be chal- onstrated signifcant improvement in muscle blood fow (p=0. A videoconferencing parisons, there was no statistically signifcant difference between program was established in which the Brunei physician provided the two groups for muscle blood fow (p=0. Results: Sessions clusion: The results indicated that the application of far-infrared were interactive, for example the local speech pathologist co-taught spectrum irradiation combined with ergonomics intervention could swallowing, the Bruneians mimicking various gait patterns for the improve the micro-circulation of neck muscles. Experiential ‘homework’ involved observing gait from a coffee shop and spending a day in a wheelchair. The frst two months of training and Introduction/Background: Ultrasound has proven to be of immense frst on-site visitor have gone well. However, in- cine department of the Ghana College of Physicians are preparing corporating ultrasound into a musculoskeletal practice requires to submit this program for credentialing. Conclusion: The skype overcoming signifcant barriers, including gaining adequate clini- lecture sessions have permitted rapid education and advice over cal training and familiarity with the ultrasound device. The fellowship in the southeastern United States was obtained from the leading ul- also needs accreditation by the Ghana College of Physicians.

The top-down approach reaching from single cell hetero- geneity in cell systems and tissues down to the molecular level seems suitable for a human cytomics project to systematically explore the molecular biocomplexity of human organisms generic precose 25 mg free shipping. The analysis of already existing data from scientific studies or routine diagnostic procedures will be of immediate value in clinical medicine buy precose 25 mg cheap, for example as personalized therapy by cytomics (Valet 2005) generic 25mg precose with mastercard. Contributions of Nanobiotechnology to Personalized Medicine Nanotechnology is the creation and utilization of materials, devices, and systems through the control of matter on the nanometer-length scale, i. It is the popular term for the construction and utilization of functional structures with at least one characteristic dimension measured in nanometers (a nanometer is one billionth of a meter i. Nanobiotechnology is the application of nanotechnology in life sciences and is the subject of a special report (Jain 2015). Role of Nanobiotechnology in Molecular Diagnostics Application of nanobiotechnology in molecular diagnostics is called nanodiagnos- tics and it will improve the sensitivity and extend the present limits of molecular diagnostics (Jain 2005, 2007). Advances in nanotechnology are providing nanofabricated devices that are small, sensitive and inexpensive enough to facilitate direct observa- tion, manipulation and analysis of single biological molecule from single cell. This opens new opportunities and provides powerful tools in the fields such as genomics, proteomics, molecular diagnostics and high throughput screening. It seems quite likely that there will be numerous applications of inorganic nanostructures in biology and medicine as markers. Given the inherent nanoscale of receptors, pores, and other functional components of living cells, the detailed monitoring and analysis of these components will be made possible by the development of a new class of nanoscale probes. Biological tests measuring the presence or activity of selected substances become quicker, more sensitive and more Universal Free E-Book Store 186 8 Non-genomic Factors in the Development of Personalized Medicine flexible when certain nanoscale particles are put to work as tags or labels. Nanomaterials can be assembled into massively parallel arrays at much higher densities than is achievable with current sensor array platforms and in a format compatible with current microfluidic systems. Currently, quantum dot technology is the most widely employed nanotechnology for diagnostic developments. Cantilevers for Personalized Medical Diagnostics An innovative method for the rapid and sensitive detection of disease- and treatment- relevant genes is based on cantilevers. Short complementary nucleic acid segments (sensors) are attached to silicon cantilevers which are 450 nm thick and therefore react with extraordinary sensitivity. Binding of targeted gene transcripts to their matching counterparts on cantilevers results in mechanical bending that can be optically mea- sured. Differential gene expression of the gene 1-8U, a potential biomarker for can- cer progression or viral infections, can be observed in a complex background. The measurements provide results within minutes at the picomolar level without target amplification, and are sensitive to base mismatches. An array of different gene tran- scripts can even be measured in parallel by aligning appropriately coated cantilevers alongside each other like the teeth of a comb. It could be used as a real-time sensor for continuously monitoring various clinical parame- ters or for detecting rapidly replicating pathogens that require prompt diagnosis. These findings qualify the technology as a rapid method to validate biomarkers that reveal disease risk, disease progression or therapy response. This will have applications in genomic analysis, proteomics and molecular diagnostics. Cantilever arrays have potential as a tool to evaluate treatment response efficacy for personalized medical diagnostics. Nanobiotechnology for Therapeutics Design and Monitoring Current therapeutic design involves combinatorial chemistry and system biology- based molecular synthesis and bulk pharmacological assays. Therapeutics delivery is usually non-specific to disease targets and requires excessive dosage. Efficient therapeutic discovery and delivery would require molecular level understanding of Universal Free E-Book Store References 187 the therapeutics-effectors (e. Characterization of nanocarrier-based drug delivery can enable high efficiency of in vivo or topical administration of a small dosage of therapeutics. Multidimensional atomic force microscopy for drug discovery: a versatile tool for defining targets, designing therapeutics and monitoring their efficacy. Genomics and epigenomics: new promises of per- sonalized medicine for cancer patients. Cytomics, the human cytome project and systems biology: top-down resolution of the molecular biocomplexity of organisms by single cell analysis. Personalized exposure assessment: promising approaches for human environmental health research. A circadian gene expression atlas in mammals: implications for biology and medicine. Universal Free E-Book Store Chapter 9 Personalized Biological Therapies Introduction Historically blood transfusion and organ transplantation were the first personalized therapies as they were matched to the individuals. Some cell therapies that use patient’s own cells are considered to be personalized medicines particularly vac- cines prepared from the individual patient’s tumor cells. More recently recombinant human proteins might provide individualization of therapy. The number of biotechnology-based therapeutics introduced in medical practice is increasing along with their use in a personalized manner (Jain 2012). Recombinant Human Proteins There are a large number of therapeutic proteins approved for clinical use and many more are undergoing preclinical studies and clinical trials in humans. Virtually all therapeutic proteins elicit some level of antibody response, which can lead to potentially serious side effects in some cases. Therefore, immunogenicity of therapeutic proteins is a con- cern for clinicians, manufacturers and regulatory agencies.

Also known as winter blues discount 50 mg precose visa, winter depression cheap precose 25 mg without a prescription, and hibernation scoliosis discount precose 50 mg with amex, congenital Lateral (sideways) curv- reaction. For example, func- tional scoliosis can be caused by pain on one side of seborrheic keratosis See keratosis, seborrheic. The causes of structural scolio- Seckel syndrome A rare inherited form of sis include cerebral palsy, polio, muscular dystro- dwarfism and growth delay. Other symptoms and phy, Marfan syndrome, infections of the spine, and features associated with Seckel syndrome include tumors of the spine. Structural scoliosis is different an abnormally small head (microcephaly); varying from functional scoliosis, in which the spine degrees of mental retardation; and/or unusual char- appears to have a lateral curve (scoliosis) but is acteristic facial features including “beak-like” pro- structurally normal. The syndrome is inherited in an autosomal recessive manner and can be due to score, Apgar See Apgar score. Also known as bird-headed dwarfism, microcephalic primordial scrape An abrasion or cut that is caused by some- dwarfism, nanocephalic dwarfism, and Seckel-type thing rubbing roughly against the skin. It can cause the scurvy A disorder that is caused by lack of vita- same illnesses, including lung cancer, that actually min C. Treatment involves including foods secretin A hormone that is made by glands in the that are high in vitamin C in the diet and taking vita- small intestine whose primary function is the stimu- min C supplements if necessary. Also known as petit mal obtained via surgery is usually sectioned (sliced), seizure. The patient does not actually become unconscious, section, longitudinal See longitudinal section. The patient may have section, lower segment caesarean See cae- physical, sensory, and thought disturbances. If sedatives are misused or accidentally seizure, febrile A convulsion that occurs in asso- combined, as in the case of combining prescription ciation with a fever. Febrile seizures are common in sedatives with alcohol, they can dangerously infants and young children and are usually of no last- depress important signals that are needed to main- ing importance. The sed rate measures the rate at which red nerve function that is caused by abnormal electrical blood cells in a test tube separate from blood serum activity in a localized area of the brain. Jacksonian over time, becoming sediment at the bottom of the seizures typically cause no change in awareness or test tube. The type of symptoms and seizures expe- of the brain is affected: One part of the body, or mul- rienced depend on where the abnormal electrical tiple body parts confined to one side of the body, activity takes place in the brain, what its root cause is, may start to twitch uncontrollably. Partial seizures and such factors as the patient’s age and general state may involve head turning, eye movements, lip of health. Seizures can be caused by head injuries, smacking, mouth movements, drooling, rhythmic brain tumors, lead poisoning, maldevelopment of the muscle contractions in a part of the body, appar- brain, genetic and infectious illnesses, and fevers. In ently purposeful movements, abnormal numbness, half of patients with seizures, no cause can yet be tingling, and a crawling sensation over the skin. Partial seizures can also include sensory distur- bances, such as smelling or hearing things that are seizure, absence A seizure that takes the form not there or having a sudden flood of emotions. Also known as focal seizure and can be accompanied by blinking or mouth twitch- local seizure. Deficiency of selenium causes which the body becomes rigid) and the clonic phase Keshan disease. Tonic- clonic seizures may or may not be preceded by selenium deficiency See deficiency, selenium. They may last for mere sec- sella turcica A depression in the base of the onds or continue for several minutes. It was clonic seizure does not resolve or if such seizures called the sella turcica (the Turkish saddle) follow each other in rapid succession, the patient because of its resemblance to a saddle used by the needs emergency help. The fluid comes from the prostate, seminal seizure disorder One of a great many medical vesicles, and other sex glands. The sperm are man- conditions that are characterized by episodes of ufactured in the testicles. The seminal fluid helps uncontrolled electrical activity in the brain transport the sperm during orgasm. Some seizure disorders are hereditary, contains sugar as an energy source for sperm. Seizure dis- semen analysis A laboratory test that measures orders are more likely to develop in patients who the amount of semen a man produces and deter- have other neurological disorders, psychiatric con- mines the number and quality of sperm in the ditions, or immune system problems than in others. A semen analysis is usually one of In some cases, uncontrolled seizures can cause the first tests done to help determine whether a man brain damage, lowered intelligence, and permanent has a problem fathering a child (infertility). The seminal vesicles ally involves use of medication, although in difficult contribute fluid to the ejaculate. For exam- ple, raloxifene (brand name: Evista) prevents bone sensory integration dysfunction A neurologi- loss and lowers serum cholesterol as estrogen does, cal disorder in which there is impaired perception but it has been used, like tamoxifen, to block the or processing of sensory input to the brain. In sen- action of estrogen on breast cells and is given to pre- sory integration dysfunction, the processing of infor- vent breast cancer in some high-risk populations. Symptoms range from very mild to debilitating and may involve mutism; mutism; social phobia. It selective serotonin reuptake inhibitor See is most commonly diagnosed in children. Also known of selenium include seafoods; some meats, such as as sensory processing disorder. Sepsis may be associ- ated with clinical symptoms of systemic illness, such septum, interatrial See septum, atrial. Sepsis can be a serious situ- septum, interventricular See septum, ation, a life-threatening condition that requires ventricular. Treatment depends on the type of infection but usually begins with septum, nasal The dividing wall that runs down antibiotics or similar medications. Also known as the middle of the nose, creating two nasal passages, blood poisoning and septicemia.

When following the debate from its in- ception until late antiquity discount precose 50 mg visa, one gets the impression that the differences manifest themselves precisely in these three areas cheap 50mg precose. Whereas the doctors of the Hippocratic Corpus were mainly interested in the question of the location of the mind in so far as they felt a need for a treatment of psycho- logical disorders based on a theory of nature discount 50mg precose amex, later the situation changed and medical-physiological data were no more than one of the possible (but by no means decisive) factors to build arguments for one of the positions taken on. In the section below I will pay particular attention to the early phase of the debate (fifth and fourth centuries bce), concentrating on the main authors of the Hippocratic Corpus, Aristotle and Diocles, with brief references to Plato. Secondary literature on this issue usually distinguishes between the encephalocentric, cardiocentric and haematocen- tric view on the seat of the mind. A selection from the extensive range of literature on this subject: Bidez and Leboucq (1944); Byl (1968); Di Benedetto (1986) 35–69; Duminil (1983); Gundert (2000); Hankinson (1991b); Harris (1973); Manuli (1977); Pigeaud (1981b) 72; Pigeaud (1980); Pigeaud (1987); Revesz (1917); Rusche (¨ 1930); B. Heart, brain, blood, pneuma 125 taken by the fifth-century medical writer Alcmaeon of Croton (South Italy), who was thought to be the first to discover the existence of the optic nerve, by the author of the Hippocratic work On the Sacred Disease, and by Plato (in the Timaeus). The cardiocentric view was represented in the Hippo- cratic writings On Diseases 2 (fifth century bce), On the Heart (end of the fourth/start of the third century bce) and by Aristotle, Diocles of Carystus and Praxagoras of Cos (fourth century bce). The haematocentric view was taken by Empedocles and the authors of the Hippocratic writings On Dis- eases 1 and On Breaths (all fifth century bce). Although this division may be largely appropriate in terms of the period concerned, it is already too much a product of the schematisation mentioned above, which became characteristic of the debate in later doxography. Strictly speaking, only the authors of On the Sacred Disease and On the Heart express an opinion on the location of what they consider the highest psychic faculty, the former choos- ing the brain, the latter the heart. Apart from this, the division into three areas presents the matter in too static a way: most of the authors mentioned appear to regard psychic activities mainly as processes, in which some parts of the body are more involved than others, but which are in principle based on the interaction between a number of anatomical and physiological factors. It would be better to ask in which terms ancient doctors from the fifth and fourth centuries bce thought about these matters, and which types of arguments they used to substantiate their views. The following categories can be discerned: faculties (thought, perception, feeling, etc. It is not always immediately obvious to what extent the medical authors made a distinction between ‘mental’ processes as such and physiological processes. Mental faculties are given a more independent role in the Hippocratic writing On the Sacred Disease, in which the function of the brain is char- acterised as ‘interpreting’ (hermeneus¯ ) what is derived from the air outside. This is in many respects a key text, not least because of the author’s polemic stance to rival views: For these reasons I believe that the brain is the most powerful part in a human being. So long as it is healthy, it is the interpreter of what comes to the body from the air. The eyes, ears, tongue, hands and feet carry out what the brain knows, for throughout the body there is a degree of consciousness proportionate to the amount of air which it receives. As far as understanding is concerned, the brain is also the part that transmits this, for when a man draws in a breath it first arrives at the brain, and from there it is distributed over the rest of the body, having left behind in the brain its best portion and whatever contains consciousness and thought. For if the air went first to the body and subsequently to the brain, the power of discerning thinking would be left to the flesh and to the blood vessels; it would reach the brain in a hot and no longer pure state but mixed with moisture from the flesh and from the blood so that it would no longer be accurate. The diaphragm (phrenes), however, does not have the right name, but it has got this by chance and through convention. I do not know in virtue of what the diaphragm can think and have consciousness (phronein), except that if a man suddenly feels pleasure or pain, the diaphragm leaps up and causes throbbing, because it is thin and under greater tension than any other part of the body, and it has no cavity into which it might receive anything good or bad that comes upon it, but because of the weakness of its structure it is subject to disturbance by either of these forces, since it does not perceive faster than any other part of the body. Rather, it has its name and reputation for no good reason, just as parts of the heart are called auricles though they make no contribution to hearing. Some say that we owe our consciousness to our hearts and that it is the heart which suffers pain and feels anxiety. But this is not the case; rather, it is torn just like the diaphragm, and even more than that for the same reasons: for blood vessels from all parts of the body run to the heart, and it encapsulates these, so that it can feel if any pain or tension occurs in a human being. Moreover, it is necessary for the body to shudder and to contract when it feels pain, and when it is overwhelmed by joy it experiences the same. Yet neither of these parts has any share in consciousness; rather, it is the brain which is responsible for all these. Heart, brain, blood, pneuma 127 This passage is part of a rather complicated explanation of epilepsy (for details on this see the next paragraph). The brain plays a pivotal role in this explanation as it is the point from where bodily and psychic faculties are co-ordinated, but also because it is particularly sensitive to harmful influences from the environment, such as climate and season (‘so long as it is healthy’). These influences can therefore be additional factors that contribute to the course the disease takes. The author emphasises this crucial role of the brain as part of his polemic against two rival factions which consider the diaphragm or the heart to be the central organ that is the source of consciousness. He dismisses the etymological argument of the first faction (phrenes – phronesis¯ ) as invalid, and accommodates the empirical fact that both factions put forward – the heart’s leaping in case of sudden gladness or sadness – into his own theory, which is also based on empirical observations (namely the delicacy of the diaphragm and the veins going to the heart). In a previous chapter he employed an empirical argument to support his conviction that the disease is caused by an accumulation of phlegm in or around the brain. He claimed that if one were to open the skull of a goat that died as a result of an epileptic fit, one would find a large amount of fluid (phlegm) around the brain. In this context phronesis¯ clearly means more than ‘thinking’ or ‘intelligence’, as the word is commonly translated. It means ‘having one’s senses together’ and refers to a universal force by which a living being can focus on its surroundings and can un- dertake activities; it also implies perception and movement. Another thing that is striking is that the author is of the opinion that the brain is also the source of feeling – although he admits that the heart and diaphragm take part in this as well. A text in which mental phenomena are even more clearly classified as a separate category is the Hippocratic writing On Regimen.