By R. Kirk. Baker University. 2018.
This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York cheap zocor 40mg cholesterol test kit for sale, Inc buy cheap zocor 20mg cholesterol medication lipidil. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now know or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identiﬁed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. At the most basic level, the successful mapping of the human genome was declared complete in the fall of 2000. Understanding the map of the human genome is as important as understanding the map of genomes of important laboratory species, ranging from the microscopic worms and fruitﬂies used in most classic genetic studies to rodents such as laboratory mice, and eventually to primates, on which much of the research on the aging human brain is done. The genetic maps of all of these species, including our own, does not answer clinical questions, but it does open the door to dramatic, rapid, and efﬁcient answers to questions about the genetic polymorphisms related to diseases in humans. Telomerase is an enzyme responsible for maintaining the telomeres—the redundant DNA portions at the end of chromosomes—whose shortening seems to be linked directly to cell senescence, apop- tosis,and the control over cell death,which,at the level of the individual cell,seems to be linked to the decline of organ function and eventually aging and death within the organ- ism. The potential for genetic manipulations by which telomerase maintains and restores telomere length within individual tissue cultures gives great promise for potential approaches to restoring function lost through degenerative diseases, such as macular degeneration and other disorders related to epithelial aging. In addition, the mainte- nance of telomeres has been intriguingly associated with the malignant immortality of cancer cells,and yet it appears possible to prevent degeneration without creating uncon- trolled growth or malignancy. Understanding this single genetic mechanism may give us clues not only to degenerative neurological and epithelial disease, but also perhaps to cancer,another age-related human disease. Scientists have also discovered that stem cells from embryonic and adult tissues can potentially create new tissues and new organs. Perhaps most excitingly, it appears that brain cells themselves can be replaced through this mechanism. Thus,stem cell research holds promise for treatment of Alzheimer’s and Parkinson’s disease,as well as for potentially growing new functioning organs that could be used for transplantation with much reduced risk of rejection because they are genet- ically fashioned to match the recipient’s immune status. Because of these and many more similar advances, it is more and more important for the practicing clinician to be conversant with the literature of basic science and to stay abreast of such developments. Our patients come to us having read about these developments or having seen television reports, and we should be able to answer their questions and share the excitement. We should also be educating them about the real- istic limits, understanding that many of these developments will not provide imme- diate cures but are promising future developments. We also need to be well informed about the rampant marketing of bogus dreams of anti-aging potions that the marketplace is all too ready to foist onto our patients. The aging of the baby boomers has created a huge and growing market for anti-aging therapies. However, in some instances, such as vitamin supplementation or hormone replace- ment, controversies exist and individual patient decision should be informed by knowl- edgeable and free discussions based on real science. It can also come from internet sources, but internet sources increas- ingly are also are full of inadequate and misleading information and, thus, it becomes even more important for us to be able to relay to our patients legitimate sources of information. Some of the most useful include the following: • On terra ﬁrma, the National Institutes of Health is a complicated maze of 75 buildings. Click on their "Data and Statistics" for CDC health data standards, scientiﬁc data, sur- veillance, health statistics reports, and laboratory information. The website also includes information about grant and cooperative agreement funding opportunities, as well as press releases and current health news. On their "Publications, Software, Products" link, one can order and download brochures, catalogs, publications, soft- ware, slides, and videos. Consumers can browse their "Health Topics" from A (Acan- thamoeba infection) to Z (Zoster), get the latest on health "Hoaxes and Rumors" (i. The goals of the Health- Web project include the development of an interface that provides organized access to evaluated noncommercial, health-related, internet-accessible resources, including those currently available, as well as new resources developed in collaboration with other organizations. The interface integrates educational information so the users has a one-stop entry point to learn skills and use material relevant to their discipline, including geriatrics and gerontology.
A building is in static equilib- rium because its weight is balanced vertically by the upward ground force exerted on it purchase zocor 20mg visa cholesterol test glasgow. A ballerina keeps a delicate balance by positioning her cen- ter of mass on a vertical line that passes through the tip of her feet in con- tact with the floor cheap zocor 20 mg line cholesterol and thyroid. How do we use the equations of static equilibrium to determine some of the unknown forces acting on an object? The symbol SMo denotes the resultant moment acting on B with respect to point O, and Ho is the mo- ment of momentum of B with respect to the same point. According to this equation, the resultant force acting on an object must be equal to the mass of the object times the acceleration of its center of mass. Statics in which r and v denote, respectively, the position and the velocity of the mass element dm, and the integration is over the mass of body B. The acceleration of the center of mass a body is equal to zero when the body is at rest or in constant motion. The balance of ex- ternal forces acting on an object may in certain cases be sufficient to en- sure static equilibrium. For example, the weight of an elevator hanging from a cable is supported by the pull of the cable. If two boys can pull on a rope with the same intensity, they and the rope remain in static equilib- rium. An object, however, is not necessarily in static equilibrium even if the resultant force acting on the object is equal to zero. That is because if there is a resultant moment acting on the object, it will, in accordance with Eqn. Moment of momentum of an object with respect to a fixed point O must be equal to zero as long as the object remains at rest. To assure static equilibrium we must also satisfy the following condition: SMo 5 0 (5. Thus, if the moment of forces acting on an object can be shown to be zero with respect to one point, then it is zero for any other point fixed in an inertial reference frame. When the forces and the moments acting on an object are three-dimensional, the vector equations, Eqns. According to the equations of static equilibrium, if only two forces act on an object, not only that the forces must be equal in magnitude and op- posite in direction but also they must have the same line of action (Fig. The condition of force balance is satisfied when the two forces are equal in magnitude but in opposite direction. The condition of balance of moment of momentum requires that they must have the same line of ac- tion. For this object to be in equi- librium, forces involved must be of same magnitude, opposite sense of direction, and must also share the same line of action. This re- sult has implications on the forces carried by the long bones of the hu- man body. The weight of a bone acts at its center of mass but may be neg- ligible in comparison with the forces acting on the joints. When the tensions in the two strings are large enough, the rod aligns along the tension line as if it were weightless and all the forces acting on it were at its endpoints. Note, however, that in the case of a long bone, muscle forces do not act right at the ends of the bone but have small lever arms. Thus, the assumption that the bone transmits force along the direction of its long axis may not be reasonable under a vari- ety of loading conditions. Another simple result directly derived from the equations of static equi- librium concerns objects under the application of three forces (Fig. If the lines of action of two of these forces intersect each other at some point in space, then the line of action of the third force must also pass through that point. The only way the resulting moment on the object will be equal to zero is if the line of action of the third force also passes through this point. Investigation of static equilibrium requires computations of moments created by external forces. As we have already demonstrated, the mo- ment of a force with respect to point A is defined as MA 5 rP/A 3 F (5. We could determine moment MA by going through the formal procedures of vector multiplication. However, some- times it is easier to adopt an approach that employs only scalar algebra.
As a result purchase zocor 40mg amex cholesterol ratio 4.2, has evolved in response to ﬁnancial purchase 20mg zocor mastercard cholesterol medication nightmares, technologic, and most of today’s CGA programs bear little resemblance cultural forces. Nevertheless, comprehensive geriatric assessment and then traces the reviewing the basic principles of CGA provides an under- evolution of the next generation of health service deliv- standing of both the evolution of this method of health ery innovations that are derived from CGA. Finally, I care delivery and the framework for CGA-like interven- speculate on the future of CGA-like interventions. Such team care recommendations; and (3) implementation of recom- requires a set of operating principles and governance. First among these principles is an process is to be successful at achieving health and func- understanding of the roles of each member of the team tional beneﬁts. Within this broad conceptualization, CGA and mutual respect among the different professions. The has been implemented using many different models in team must also establish rules for process of care includ- various health care settings. Although such teams have been embraced in Most CGA programs have used some type of identiﬁca- principle by health care systems, in practice they often tion (targeting) of high risk parents as a criterion for run counter to the training of health professionals. The purpose of such selection ticular, physicians have had little training in working with is to match health care resources to patient need. For health care teams, and their basic training emphasizes a example, it would be wasteful to have multiple health medical model. Rather, the intensive (and expensive) members evaluate all patients; whereas extended team resources needed to conduct CGA should be reserved for members are enlisted to evaluate patients on an "as- those who are at high risk of incurring adverse outcomes. Most frequently, the core team consists of Such targeting criteria have included: a physician (usually a geriatrician), a nurse (nurse prac- titioner or nurse clinical specialist), and a social worker. Frequently, the constituency of the team failure) is determined more by the local availability of profes- • Expected high health care utilization sionals with interest in CGA than by programmatic Each of these criteria has been shown to be effective in needs. However, none of extended team is gradually yielding to a strategy that these criteria are effective in identifying patients who relies on ﬂexibility in team composition so that patients would beneﬁt from all geriatric assessment and manage- are assessed by only those providers who are likely to ment programs. In this model, the only consistent ria should be matched to the type of assessment and member of the team would be the primary care provider. For example, Brief screens, as described in Chapter 17, might identify a geriatric evaluation and case management program which providers need to conduct further assessment and might focus on persons at high risk of health care uti- therapy. Conversely, a preventive program might rely patient brieﬂy to determine whether a more in-depth solely on age (e. The overriding approach of this strategy is that each patient receives the only the amount of assessment that is necessary. Assessment and Development Regardless of the composition of the team, a key of Recommendations element is the training of the team. Such training should Once patients have been identiﬁed as being appropriate serve several purposes: (1) to ensure that team members for CGA, the traditional model of CGA invokes a team have an adequate understanding of the CGA process; (2) approach to assessment. Such teams are intended to to raise the level of expertise of team members in their improve quality and efﬁciency of care of needy older speciﬁc contribution to the team; (3) to develop standard persons by delegating responsibility to the health profes- approaches to problems that are commonly identiﬁed sionals who are most appropriate to provide each aspect through CGA; (4) to deﬁne areas of responsibility of indi- 18. Comprehensive Geriatric Assessment and Systems Approaches to Geriatric Care 197 vidual team members; and (5) to learn to work effectively The process of management of clinical disorders can as a team. When new members of the team are added, tations of such protocols have frequently met with con- they should receive the basic components of the initial siderable resistance or have been ignored in clinical team training. Nevertheless, common approaches to these If CGA is to be effective, the following six components problems that span across providers participating in the of the process of care must be addressed: CGA team are important to ensure that a similar inter- vention is being rendered to all patients. Implementation of the treatment plan In inpatient settings where the assessment team has 5. Monitoring response to the treatment plan primary care of the patient, generally implementation of 6. Revising the treatment plan as necessary recommendations is not a problem, provided that there The approach to gathering clinical data is changing. However, prehensive geriatric assessment has been conducted by patients may refuse to participate in diagnostic or thera- all team members during the course of one long visit, peutic plans. This scheduling has traditionally tive services, the link between recommendations and been to accommodate the health care providers sched- implementation is less certain. In outpatient settings, the ules but must be balanced with considerations of poten- implementation of CGA recommendations is particu- tial patient fatigue. As a result, there has been increasing larly tenuous because the process can fail at several ﬂexibility in scheduling outpatient CGA so that is more points, including lack of implementation of CGA recom- convenient for patients and their families. In inpatient mendations by primary care physicians (in consultative and home settings, different providers usually conduct CGA models) and poor adherence to CGA recommen- their assessments over the course of several days before dations by patients.
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