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Rice Lake Barron Cameron Prairie Farm Chetek Glenwood City Colfax Bloomer Chippewa Falls Minnesota Menomonie Eau Claire Lakeville Farmington Ellsworth Elmwood Wisconsin Belle Plaine New Prague Elko New Market Mondovi Osseo Le Sueur Lonsdale North eld Cannon Red Wing Montgomery Falls Lake City Alma Spring eld St. Peter Faribault Wabasha Arcadia Mankato Waterville Zumbrota Lamberton Lake Crystal Kenyon Plainview Janesville Owatonna Rochester Holmen Sparta Tomah Waseca St. James Blooming Onalaska New Richland Prairie La Crescent Trimont Truman La Crosse Wells Alden Austin Fairmont Caledonia Adams LeRoy Clinic Sherburn Blue Earth Kiester Albert Lea Mabel Hospital and Clinic Lake Mills Armstrong Decorah Waukon Management Services Agreement Physician Services Iowa Charles City Agreement Prairie The colors on the map represent locations which du Chien operate under the same regional management structure. Rafq Zakaria Campus, Rauza Bagh, Aurangabad- 431001, Maharashtra, India Abstract Nanotechnology is the study of extremely small structures, having size of 0. An application of Nanotechnology in various felds such as health and medicine, electronics, energy and environment, is discussed in detail. Applications of nano particles in drug delivery, protein and peptide delivery, cancer are explained. Applications of various nano systems in cancer therapy such as carbon nano tube, dendrimers, nano crystal, nano wire, nano shells etc. The advancement in nano technology helps in the treatment of neuro degenerative disorders such as Parkinson’s disease and Alzheimer’s disease. Applications of nano technology in tuberculosis treatment, the clinical application of nanotechnology in operative dentistry, in ophthalmology, in surgery, visualization, tissue engineering, antibiotic resistance, immune response are discussed in this article. Keywords: Nano devices; Nano material; Nano medicine; Nano pharmaceutics; Drug delivery Introduction Advancement in the feld of nanotechnology and its applications to the feld of medicines and pharmaceuticals has revolutionized the twentieth century. Nanotechnology is the treatment of individual atoms, molecules, or compounds into structures to produce materials and devices with special properties. Nanotechnology works on matter at dimensions in the nanometer scale length (1-100 nm), and thus can be used for a broad range of applications and the creation of various types of nano materials and nano devices. History of Nanotechnology Te development in the feld of nanotechnology started in 1958 and the various stages of development have been summarized in Table 1. Nano scale and Nanostructures Figure 2: Schematic diagram of various types of pharmaceutical nano systems. Te nano scale is the place where the properties of most common things are determined just above the scale of an atom. Nano scale objects have at least one dimension (height, length, depth) that measures *Corresponding author: Department of Pharmaceutical Chemistry, Y. Rafq Zakaria Campus, Rauza Bagh, Aurangabad- 431001, Maharashtra, India, Tel: +91 9823619992, E-mail: Te brief explanation of pharmaceutical nano system is as follows: annapratimanikalje@gmail. Feynman initiated thought process 1974 The term nanotechnology was used by Taniguchi for the frst time. Feynman Prize in Nanotechnology was awarded for modeling the molecular and electronic structures of new materials and for integrating single molecule 2003 biological motors with nano-scale silicon devices.
Although the principle of benefcence is in tension with autonomy order 50 mg pletal muscle relaxant menstrual cramps, the physician’s autonomy receives little attention buy 100mg pletal otc spasms around the heart, and the autonomy of medical ethics has come under threat. Pellegrino’s analysis of Beauchamp and Childress’s principles brings him to fve con- clusions: (1) autonomy and benefcence, if rightly understood, turn out to be complementary, not contradictory; (2) in both theory and practice, au- tonomy is not merely a negative but a positive principle as well; (3) the ac- tual content of the principles of benefcence and autonomy is defned in the context of specifc actions and decisions; (4) the physician’s autonomy both as a person and a professional must also be taken into consideration; and (5) medical ethics must maintain its autonomy over against political and socio-economic pressures. The third section of this collection brings together three major essays in which Pellegrino examines the nature of virtue in general, its meaning © 2008 University of Notre Dame Press An Introduction in the medical profession in particular, and moral challenges to the con- science and integrity of physicians. The frst essay, “Character, Virtue, and Self-Interest in the Ethics of the Professions,” confronts the place of pro- fessional virtue and the difculty of contemporary medical professionals recognizing the claims of virtue. Commercialization, competition, gov- ernment regulation, malpractice suits, and advertising, as well as public and media hostility have engendered a profound professional malaise. Pellegrino argues that, though these forces are real and threatening, the major danger is posed by defciencies in medical-professional character and virtue. Medical professionals, in order to maintain their integrity, will need to embrace an ethos of altruism and fdelity that will often be incon- gruent with the dominant, conventional morality. To do this, Pellegrino argues, medical professionals must recognize that professions are moral communities, able to sustain their members if their members sustain their professional moral communities. Success in establishing a sound founda- tion for the professional life requires recognizing (1) the vulnerability of patients, (2) the inequality between physicians and patients, (3) the special fduciary character of the professional in such relationships, (4) the ways in which professional knowledge does not exist for its own sake, (5) the professional relationship as able to bring both help and harm, and (6) the professional relationship as dependent on the professional being a mem- ber of a moral community with its own internal morality. The second of this trio of essays, “Toward a Virtue-Based Normative Ethics for the Health Professions,” invites the reader to confront the mean- ing and foundations of virtue. As Pellegrino reminds us, the classical me- dieval synthesis understood virtue as excellence of character, as a trait appropriately oriented to defning ends and purposes, as an excellence of reason, not emotion, as centered in practical judgment, and as a trait acquired by practice. Pellegrino contrasts this account with Alasdair Mac- Intyre’s account, which regards virtues as dispositions or acquired quali- ties necessary (1) to achieve the internal good of practices, (2) to sustain the communities in which individuals seek the higher good of their lives, and (3) to sustain traditions necessary for the fourishing of individual lives. Despite his defense of virtue ethics, Pellegrino frankly acknowledges the difculties of virtue-based accounts: (1) virtue-based accounts tend to be circular (i. All of this leads Pellegrino to underscore that virtue-based accounts cannot stand alone and must be lodged within a more comprehensive moral phi- losophy, which he acknowledges does not now exist. This problem is com- pounded in medicine, where the Hippocratic tradition is, at best, in dis- array. The practice of medicine is marked by moral pluralism, relativism, and the privatization of morality. In the face of these challenges, Pellegrino calls physicians to an act of profession that can tie them to their engage- ment in healing, so that they can come to appreciate professional virtue in terms of the telos of the clinical encounter: the patient’s good. Pellegrino lists among the virtues that should mark the good physician: fdelity to trust and promise, benevolence, efacement of self-interest, compassion and caring, intellectual honesty, justice, and prudence. Having spoken to professional virtue in the clinical context, Pel- legrino turns in the next essay to challenges to the physician’s moral con- science. His focus is on the conficts engendered as a result of practicing medicine in an often afrmatively secular culture. This tension is rooted in the circumstance that traditional Christians know things about medical morality unrecognized within secular society. In “The Physician’s Con- science, Conscience Clauses, and Religious Belief: A Catholic Perspec- tive,” Pellegrino lays out a geography of some of the resulting moral conficts, giving special attention to the rising reluctance of the state and others to confront honestly what should count as violations of conscience. For example, although religious exemption laws and conscience clauses have protected physicians from being directly coerced to engage in abor- tion or physician-assisted suicide, there is nevertheless often a require- ment that they refer patients to others to do things the Christian physician knows to be immoral (that is, since abortion is equivalent to murder, then referring a woman to an abortionist is equivalent to referring someone to the services of a hit man, even if one will not engage directly in the mur- der oneself). In addition, there are growing constraints on religious insti- tutions, once they receive tax funds, to provide services they would recognize as immoral, though their co-religionists have been forced to pay those very taxes. Among the failures in such public policy approaches is © 2008 University of Notre Dame Press An Introduction not appreciating that institutions, in order to maintain an integrity and commitment to virtue, must preserve the character of their commitments to the particular communities that brought them into existence and sus- tain them. It is through institutions such as sectarian hospitals that indi- viduals realize their concrete lives in moral communities, with the result that the moral integrity of the individual is put at jeopardy if they are not able to protect and maintain the moral character and integrity of their institutions and their moral communities. The last section ofers Pellegrino’s analysis of the ambiguities of hu- manism, the limitations of the Hippocratic Oath, and the challenges to framing a medical ethics for the future. The frst subsection, “Humanities in Medicine,” brings together essays exploring the role of humanism in medicine and medical education. The frst essay, “The Most Humane of the Sciences, the Most Scientifc of the Humanities,” already partially quoted in this introduction, is an early manifesto that in many ways in- spired the development of humanities teaching in medical schools. It in- cludes Pellegrino’s famous synopsis of the relationship of humanities and medicine: “Medicine is the most humane of sciences, the most empiric of arts, and the most scientifc of humanities. Its subject matter is an ideal ground within which to develop the attitudes associated with the human- istic and liberally educated.
Often the illness is short lived and does not require a visit to a doctor or specifc identifcation of the germ responsible buy discount pletal 50 mg on line spasms foot. However if someone is very sick pletal 100 mg online muscle relaxer sleep aid, has bloody diarrhoea, if symptoms persist for more than a few days, or if there is a signifcant outbreak within a school then a specifc diagnosis should be sought. To do this the doctor will request that a sample of faeces is sent to the laboratory for analysis. While the causes are varied, strict attention to personal hygiene is important to reduce the spread of disease. The most important ways to reduce spread of gastroenteritis are hand washing and exclusion. Pupils should be encouraged to wash hands after toileting, before eating, after contact with animals, after sporting or play activities, and after any contact with body fuids. All staff and pupils who have had gastroenteritis should be excluded while symptomatic and the 48 hours since their last episode of diarrhoea and/or vomiting. Environmental cleaning is also very important in limiting the spread of gastroenteritis. Most germs that cause gastroenteritis are very infectious and for that reason pupils or staff members who have had diarrhoea and/or vomiting should be excluded until 48 hours have elapsed since their last episode of diarrhoea and/or vomiting. More specifc advice regarding exclusion may be given by the Department of Public Health where necessary. Exclusion: Staff or pupils who have had Salmonella campylobacteriosis should be excluded while Salmonella is a bacterial infection; it is usually caught symptomatic and for 48 hours after their frst formed from contaminated food, especially chicken, other faeces. It may be Precautions: Preventive measures include care in passed on by contact with animals and through the way food is stored and prepared, cooked, and by contaminated water supplies. Strict attention Precautions: Strict attention to hand hygiene is to hand hygiene is essential to reduce spread. Preventive measures also include careful supervision of pupils Exclusion: Staff or pupils who have had salmonellosis during farm visits and hand washing after touching should be excluded for 48 hours after their frst formed animals. If a school’s water is supplied from a Resources: Useful information on salmonella can be private supply they should ensure the quality of this found at http://www. Exclusion: Staff or pupils who have had cryptosporidiosis should be excluded for 48 hours after Shigella (Dysentery) their frst formed faeces. Cases should avoid using Shigellosis (or bacillary dysentery) is a bacterial swimming pools for two weeks after their frst formed infection that is usually spread from person-to person. The shigella bacteria picked up in tropical Resources: Useful information on cryptosporidium countries tend to be more severe with bloody diarrhoea can be found at http://www. Precautions: Strict attention to personal hygiene and hand washing is important to reduce spread. Norovirus (Winter vomiting bug) Norovirus causes short lasting outbreaks of vomiting Exclusion: Staff or pupils who have had shigellosis and diarrhoea. The virus is very contagious and should be excluded for 48 hours after their frst formed extremely common. Fortunately, most cases infection, it is recommended that the case should recover fully without complication. Environmental cleaning is also critical as norovirus can survive on surfaces such as door handles, Resources: Useful information on shigella can be light switches desks etc for a number of weeks. A signifcant proportion mononucleosis is an illness caused by the Epstein Barr of cases have no symptoms. The virus is spread from person-to-person via saliva, usually through kissing or being in close contact with a In Ireland, the infection is most commonly associated case or carrier. About a ffth of those who are infected with untreated water sources and with person to become long-term carriers, being infectious for more person spread. Infection may also be acquired after contact Precautions: Frequent hand washing and avoiding with the faeces of farm animals and visiting petting sharing of utensils will further reduce the risk of farms. Precautions: Preventive measures include care in Exclusion: Generally not necessary. Those involved in the way food is stored, prepared, and cooked, and by high risk body contact/collision sport should be excluded attention to basic hygiene in food handlers, affected from full team participation for 4 weeks (see Chapter 8 people, and those in contact with them.
Closer to our subject quality pletal 100 mg muscle relaxant lactation, complex software devel- opment in healthcare often takes ﬁve years or more from the gleam in the software architect’s eye to a ﬁnished generic pletal 50mg on line muscle relaxant 2mg, debugged, and installed product. To develop the software and supporting infrastructure for the important applications discussed in this book will require tens of billions of dollars in investment. The challenge for investors is simply that this ﬁeld is unfolding at what seems like a glacial pace, given the metabolism of large, complex health enterprises and markets. In our technologically obsessed society, it is almost inevitable that we overestimate the short-run impact and market signiﬁcance of new technologies when they are introduced (in a wave of hype). There follows a similarly inevitable disillusionment when one realizes that the technologies are not “ﬁnished” and need reﬁnement to be truly useful. If the disillusionment is pervasive enough, a technology becomes unloved and unﬁnance- able. The key to becoming indispensable is for vendors and their engineering and marketing staffs to develop strong feedback loops with their customers and users and rewrite and rescope their products until they solve a real problem or meet a real need. Having the patience to recognize the ultimate value of a technology and to tolerate the ﬁddling is necessary to make it truly useful. Successful investors will understand 184 Digital Medicine that this process requires patience and conﬁdence in the managers and scientists they support. Healthcare applications require “warm” money—returns in the high teens and time frames of seven to ten years and the patience to retest assumptions about what actually works in the ﬁeld. On the other hand, technology changes lives in ways one cannot anticipate or control. Technology has a funny way of morphing into an end in itself unless it is wielded and controlled by a strong, purposeful hand. Americans (and people in other countries as well) have paid the price for this lag in absurd paperwork burdens, exces- sive administrative costs, delayed or unresponsive decision making, burned-out caregivers and managers, a consumer-unresponsive and unfriendly healthcare experience, and an unacceptably high risk of adverse events. Emerging information technologies can change all these things with the right combination of patience, ﬁnancing, and intolerance of excuses and poor performance. The key to achieving a more intelligent, responsive, and safer health system is to raise collective expectations of how the health Making an Effective Digital Transformation 185 system performs. All of us, in our roles as consumers, practitioners, managers, trustees, capital funders, and policymakers, can inﬂuence the pace of transformation. Thoughtful application of these powerful new tools can create a better healthcare experience and improved health. See Computed tomography Computerized interpretation, 24 Cunningham, Rob, 159 Computer(s), 2–3; clinical laboratories Customers. See General Electric outsourcing, 30; savings, 129 Gelernter, David, 40 Health Care Financing Administration. See Picture archiving and commu- Moore, Gordon, 22 nication system Moore’s Law, 22, 171 Palm. Record-keeping systems, 75 versus United Kingdom, 73–74; Referrals, 168 wealth of, 67; younger versus older, Registration, in physician ofﬁces, 76 71 Regulatory barriers, 86–87 196 Index Remote computing: applications, 75; Spielberg, Alissa, 70 transparency of, 62 Spinal cord: infection, 100; stem cells and, Remote medicine, 24–28 21 Remote monitoring, 25–26 Standardization, 161–65; consideration of, Remote servers, 8 164–65; funding, 163–64 Research studies, 36 Start-up companies, 58 Results reporting, 181 Stem cells, 21 Reuters Business Insight, 15 Stevens, Rosemary, 47, 85 Rheingold, Howard, 29; on virtual Stock market, 182 communities, 103 Stowers Institute of Medical Research, 15 Ridley, Matt, 14 Stroke damage, 22 Risk minimizing, 127–30 Subscriber enrollment, 120 Rivalries, 55 Subscription services, 113; health payment, Robotics, 27 165–69 Rufﬁn, Marshall de Graffenried, Jr. He has taught health policy and manage- ment at the University of Chicago Graduate School of Business, the Wharton School at the University of Pennsylvania, and other lead- ing universities. Goldsmith received his doctorate in sociology from the University of Chicago in 1973. He worked for the governor of Illinois as a policy analyst and the dean of the Pritzker School of Medicine at the University of Chicago, where he was responsible for planning and government affairs for the Medical Center. Goldsmith is a member of the board of directors of the Cerner Corporation, a healthcare informatics ﬁrm, and Essent Healthcare, an investor-owned hospital management company, and he is a member of the board of advisors of the Burrill Life Sciences Capital Fund, which invests in biotechnology innovation. He is also an advisor to Cain Brothers, an investment banking ﬁrm that works exclusively in healthcare. Goldsmith’s principal activity is forecasting technological and economic trends in the health system. He has consulted widely for ﬁrms spanning the health system spectrum, including hospital systems, health plans, medical device and product ﬁrms, pharma- ceutical companies, and multispecialty physician groups. Some counties hold household hazardous waste collection days, where prescription and over-the-counter drugs are accepted at a central location for proper disposal. Mix drugs with an undesirable substance, such as cat litter or used coffee grounds.
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