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Differentiation of these two species used to be a problem discount 500 mg methocarbamol mastercard muscle relaxant you mean whiskey, but now they can be distinguished rapidly using low-cost molecular biology techniques (Taylor et al buy methocarbamol 500 mg spasms nose. The larva of this fly (screwworm) is an obligate parasite that can invade the tis- sues of any warm-blooded animal order 500mg methocarbamol overnight delivery spasms near anus. This species and Dermatobia hominis appear to be the principal obligate agents of myiases in Latin America. Animal myiases cause heavy economic losses in terms of cattle, sheep, goats, and equines. The larvae emerge after 11 to 21 hours, penetrate any preexisting wound, and begin to feed on the surrounding tissue. Between four and eight days later, they fall to the ground, bury themselves about 2 cm deep, and turn into pupae. The adult flies emerge a little less than a week afterwards if the weather is warm and humid, or longer if the climate is cooler. The flies mate within three or four days, and in a few more days, the females begin to lay eggs. In summer the entire development cycle can be com- pleted in just over three weeks, so that several generations of flies can be born in a sin- gle season. Females can travel about 50 km from their birthplace under their own power, and they are also car- ried considerable distances by automobiles on which they alight. These facts suggest that eradication programs based on the sterile insect technique need to cover extensive areas in order to achieve a lasting effect. In the temperate zones, myiases occur in the hot season, from the end of spring to the beginning of autumn, whereas in the tropical zones, they occur all year long and are more frequent in summer (Amarante et al. The larvae, which are screw- shaped and measure about 12 mm in length, destroy the tissue in which they lodge and become covered by exudate from the wound. The profuse reddish brown exu- date from the wound stains the skin, fur, or wool, and attracts other flies of both the same and other species, which deposit more eggs or larvae. It has been demonstrated that the larvae can penetrate the intact skin of rab- bits and guinea pigs. Larval invasions are not limited to tegu- mentary wounds; they can also occur in open cavities of the body such as the nos- trils, mouth, eye socket, outer ear, and vagina. If the animals are not treated, contin- uous tissue destruction produces pain and restlessness, which interferes with graz- ing and leads to weight loss. Sometimes prostration and death ensue, and when the flies are very abundant, the fatality rate can be as high as 20%. The most serious clinical pictures are usually seen in sheep, goats, and equines, which often develop secondary infections. Human myiases occur in rural populations, especially in areas and at the times when there is an abundance of C. In addition to the invasion of wounds and ulcers (varicose ulcers of the legs), myiasis also occurs in a furuncular form characterized by a nonmigratory cutaneous nodule. Invasion of the nasal fossae (rhinomyiasis) is most frequent, and it usually occurs as a complication of ozena. To prevent this myiasis, care should be taken to keep domestic animals from giv- ing birth during the season when the flies are abundant. The navel of animals born during the hot season should be treated with fly repellents. In addition, castrations, dehorning, docking, branding, and other interventions that leave tegumentary lesions should be avoided during this season. All accidental wounds, whether affected by myiasis or not, should be cleaned and properly treated as soon as possi- ble and covered with an effective repellent or insecticide. Regional eradication programs based on the sterile insect technique have yielded good results. The technique consists of releasing large numbers of artificially bred males sterilized with gamma rays, which are intended to compete with fertile males in the natural population and mate with the females. Since the females mate only once, they do not become fertilized if they copulate with the sterile males. The first pilot program was initiated in Curacao in 1954 and was successful in eradicating the infestation. The island remained free of the fly until 1975, but then, in the first nine months of that year, there were 261 cases of myiasis, including 14 in humans. For this reason, a joint initiative was undertaken with Mexico in 1972 to establish a barrier of sterile males across the isthmus of Thehuantepec. In 1988, the technique proved to be effective in Africa, when the fly that had appeared in Libya was eradicated (Krafsur and Lindquist, 1996). The technique only works with species that can be bred in the laboratory in massive numbers and are still able to mate despite sterili- zation, and it is only effective when the density of fertile males is low (Reichard, 1999). For this reason, an additional measure has been introduced whereby insecti- cide-saturated bait is distributed to reduce the natural population of C.

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When human and canine hosts are repeatedly exposed As well as acting as Leishmania spp generic 500 mg methocarbamol amex spasms meaning in hindi. During the proteins: this occurs less frequently and mostly within a range feeding process on the vertebrate host’s skin methocarbamol 500mg free shipping knee spasms at night, the sali- of 43–45 kDa proteins for Lu cheap 500 mg methocarbamol with visa spasms pronunciation. Canine a variety of pharmacologic agents, such as anticoagulants, hosts exposed to Phlebotomus perniciosus bites develop IgG1 © 2012 The Authors Medical and Veterinary Entomology © 2012 The Royal Entomological Society, Medical and Veterinary Entomology, doi: 10. Phlebotomine species of the genus Lutzomyia that act as vectors of New World leishmaniases. Disease in humans Proven or suspected vector species Country∗ Leishmania species Most common Rare Lu. Continued Disease in humans Proven or suspected vector species Country∗ Leishmania species Most common Rare Lu. Elsewhere, the sandfly species is suspected to be a vector on the basis of epidemiological evidence or because it is a proven vector elsewhere. The Bitten hosts also develop strong cellular responses against components promoting infection have been identified in the saliva components. Different © 2012 The Authors Medical and Veterinary Entomology © 2012 The Royal Entomological Society, Medical and Veterinary Entomology, doi: 10. Among the mechanisms pro- tion where susceptible phlebotomine species and mammals posed to explain these effects, the functional alteration of coexist. Traditionally, Old and saliva in some experimental models appears to be protective New World nosogeographical entities have been considered against Leishmania spp. Salivary separately because they involve different parasites (with the gland lysates/sonicates, purified salivary proteins or bites exception of L. In combination, these findings suggest Old World leishmaniases that vaccination against vector antigens may represent a novel method for controlling leishmaniasis. This protective effect, Autochthonous cases of human leishmaniases are currently however, was not shown in a Lu. Given both the large diversity of vector–parasite nature of disease in these countries, the Leishmania species natural associations and the fact that phlebotomine sandfly involved were not determined in nine countries and the species differ in salivary antigens [and that differences may phlebotomine vector species, either proven or suspected, were be present within a species, as recently shown by Rohousova not identified in 16. Cutaneous leishmaniasis shortly before challenge is indeed protective, whereas both infections by this parasite are also found within the same longterm exposures or a long delay prior to challenge after endemic range, where they are usually sporadic, although in short-term exposure are not. This explains the persistence of some foci they may show hyperendemic patterns (Corradetti, severe Leishmania spp. Several vector species are individuals are repeatedly exposed to bites and/or sandfly involved, most of which belong to the subgenus Phlebotomus activity is seasonal. Dogs are the main domestic reservoirs, and saliva may play an important role in the dynamics of clinico- foxes, jackals and wolves represent sylvatic rservoirs (Fig. It is a classical parasite of the Hyracoidea pathogenic for humans, in whom leishmaniases have diverse (e. Procavia capensis) transmitted by the Larroussius species clinical manifestations. However, the presence of mammal reservoirs to mucocutaneous leishmaniasis and pathological sequelae has been indicated in several endemic settings, suggesting following L. In East human social, behavioural and individual factors, such as Africa (Kenya, Ethiopia, Somalia, Sudan and Uganda) and massive migrations, conflict, man-made environmental changes the Arabian peninsula, the distribution of L. As such, the contribution of phlebotomine sandfly dynamics to the spread of disease associated with those of P. In addition, small and discontinuous foci are also affected by leishmaniases in recent conflicts in Sudan, found in northern Africa, Israel, Greece and Saudi Arabia, as Iraq, Afghanistan and, recently, Libya (Amro et al. Finally, climatic changes can be expected to directly affect the density Autochthonous cases of human leishmaniases are currently and dispersion of sandfly species in the Old World (Fischer reported from 21 countries in the Americas. All clinical forms result from zoonotic northernmost limit of leishmaniasis endemicity, demonstrate transmission from either domestic or sylvatic reservoir hosts. The geographical distribution of the disease spans an area This phenomenon was particularly investigated in northern extending from Thexas to Argentina. Visceral leishmaniasis is recorded occurred in patients with no travel history; investigations in as endemic in 12 countries in the New World. There are some other imported to the Americas by infected dogs brought by Iberian examples in Europe which may indicate an expansion in colonizers. In the French Pyrenees, increases in the incidence and have resulted in the first formal description of a new distribution of canine leishmaniasis have been reported in a species from the Lu. Examples of Lutzomyia species that cases were reported annually was attributed to urbanization have participated in this invasion include Lu. That the condition is widely known as ‘ulcera de los chicleros’ (ulcer developed Overview in gatherers of ‘chicle’, a gummy latex from the forest tree Manilkara zapota) in Mexico and is designated ‘guerrilla’s Phlebotomine sandflies are involved in the transmission of sore’ in Venezuela and Colombia reflects the historically close several viral agents, among which the most important are contact of humans with a sylvatic environment that maintains grouped into the Phlebovirus genus (family Bunyaviridae), several species of phlebotomine vectors among wild species of which includes the sandfly fever Sicilian and Toscana viruses, mammalian reservoirs. Hence, hunting, lumbering and mining and the Vesiculovirus genus (family Rhabdoviridae), which activities have been associated with the disease. Since the includes vesicular stomatitis, and the Chandipura and Isfahan 1960s, transmission has increasingly spread to peridomestic viruses.

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Since its creation in 1958 purchase 500 mg methocarbamol mastercard muscle relaxant exercises, synthetic thyroid medication (name brand Synthroid) has been the standard treatment for hypothyroidism (Tybout & Hennessy generic methocarbamol 500mg without prescription spasms rectal area, 2013) buy methocarbamol 500mg on line spasms just below sternum. According to Reynold and Olsen (1969), although natural thyroid was the standard treatment at the time Synthroid was created, the pharmaceutical industry needed to “learn how to obtain the effect of desiccated thyroid” via synthetic medication because the demand for natural thyroid medication was too high for the available supply of fresh glands (p. Due to the threat of generic medications, when Boots Pharmaceutical purchased Synthroid from Flint Laboratories in 1986, Boots commissioned a pharmacist to conduct a study with the hopes of proving that Synthroid was superior. However, the results indicated that the generic medications were bioequivalent (Tybout & Hennessy, 2013). According to Tybout and Hennessy, Boots suppressed the results of the study for seven years, at which time a lawsuit was filed on behalf of patients who had overpaid for Synthroid based on the false proclamation that it was superior to other synthetic thyroid medications. I personally believe that the experiences of thyroid patients who do not feel well on synthetic thyroid medication, but are denied an opportunity to try natural thyroid medication, are comparable to the experiences of patients with medically unexplained symptoms. More specifically, as with patients who have medically unexplained 239 symptoms, thyroid patients who require natural thyroid medication to function are often dismissed and do not feel heard, understood, or taken seriously (Peters et al. Considering the many narratives of patients who report not feeling well on synthetic thyroid medication, it is strongly recommended that further research be conducted on the efficacy of natural thyroid medication. Grief and Thyroid Disease Carla’s experience of grief prompted a search of the literature about the relationship between grief and thyroid disease. Although many studies were discovered about the grieving process in relation to other chronic illnesses (e. Research indicates that individuals with chronic illness experience grief over time as a result of loss of health or functioning (Dysvik et al. As such, further research is recommended regarding the experience of grief in individuals with thyroid disease. First, the results will be shared via individual emails with participants who indicated an interest in reading the study. Second, I plan to publish a condensed form of this study in a scholarly journal so that healthcare professionals can utilize the information in practice and future research. Third, I will condense this study to the scope of a conference paper with the intention of presenting the study and its results at appropriate conferences. Finally, I will build upon the findings of this study by conducting further research in the areas of the relationship between thyroid patients’ education levels and doctor-patient communication, thyroid patient self-advocacy behaviors, and the experience of grief as it relates to thyroid disease. Implications for Social Change The results of the current study contribute to positive social change by expanding upon the existing research on women’s health and chronic illness to include thyroid disease, thus enabling medical professionals to better determine and meet the unique needs of female patients with thyroid disease. Based on the results of this study, the processes of diagnosing and treating thyroid disease appear to be influenced by a number of factors, including the nature of the doctor-patient relationship, doctor-patient communication, the structure of the healthcare system and medical education, diagnostic and gender bias, and economics. Additional factors that seem to be intricately related to these processes include patients’ education levels and self-advocacy behaviors. It is recommended that additional research be conducted in these areas in order to further 241 enhance our understanding of thyroid disease and the doctor-patient relationship and ultimately ensure positive health outcomes. The results of the current study indicate a need for doctors who treat thyroid patients to learn how to recognize the communication needs of their patients and match their relational approach to those needs (Briel et al. However, even doctors who wish to work collaboratively with their patients may not have the time or resources to employ patient- centered practices (Celik et al. In order for doctors to provide patient-centered care, policy makers must develop payment models that encourage efforts toward patient involvement, and with regard to care, a focus on quality rather than quantity (Bernabeo & Holombow, 2013; Epstein & Street, 2011; Kerr & Hayward, 2013). With regard to knowledge of how to diagnose and treat thyroid disease, as stated previously, it is important to consider the doctors’ specialties. However, if doctors choose to treat their patients for medical conditions in which they do not specialize, it is essential that they continually seek the latest information regarding those conditions. In addition, the undertreatment of thyroid disease results in numerous distressing physical and emotional symptoms and declining functioning (Cappola & Cooper, 2015; Gaitonde et al. Furthermore, as supported by the results of the current study, numerous thyroid patients report not feeling well 243 taking synthetic thyroid medication and describe feeling better with natural thyroid medication. However, the majority of doctors hesitate to prescribe natural thyroid medication because they learn in medical school that synthetic thyroid medication is the only appropriate treatment for hypothyroidism (Dommisse, 2009; Gaby, 2004). In the face of such challenges, a doctor-patient relationship based on mutual trust and collaboration helps to ensure positive treatment outcomes (Crooks et al. Research indicates that patients trust doctors with whom they feel heard, validated, and taken seriously—all of which are positively correlated with the likelihood of considering doctors’ recommendations (Houle et al. Likewise, including patients in the decision making process and responding to patient concerns with empathy encourages authentic communication and patient satisfaction (Barry & Edgman-Levitan, 2012; Gelhaus, 2012a, 2012b; Platanova et al. Patients who do not feel heard, validated, or taken seriously by their doctors are likely to participate in self-advocacy behaviors (e. Research indicates that patients wish to work with their doctors—even patients who seek health information, refuse treatment, and self-treat (Barry & Edgman-Levitan, 2012; McNutt, 2010; Quaschning et al. However, traditionally, doctors have been taught to adopt a position of authority over their patients in order to ensure their patients’ recovery; and patients have been expected to accept a passive role and trust their doctors 244 (Lupton, 2003; Munch, 2004). According to MacDonald (2003), because society has changed and patients want to be active participants in their care, doctors must be willing to surrender some authority (p.

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Community Partnership for Arts and Culture 5 Creative Minds in Medicine Executive Summary The Historical Development of the Arts and Health Field Throughout history purchase 500mg methocarbamol amex muscle relaxant side effects, doctors and medical personnel have provided care of patients and treatment of disease discount 500 mg methocarbamol mastercard zopiclone muscle relaxant. They have worked to apply scientifc methods in light of and sometimes in spite of the different cultural conditions of the period and location in which they work purchase methocarbamol 500mg on-line spasms synonym. The tension between the twin concerns of comfort and science has pulled prevailing medical and social thought frst one way and then another over the years. This has occurred primarily as clinical approaches based in science, diagnosis of disease and observation have competed for favor with more humanistic approaches that emphasize individualized care, compassionate doctor/patient interactions and patient empowerment in healthcare decision-making. The patient-centric approach with its stronger connection to the social sciences has emerged more recently, following a period of stricter emphasis on disease-based, standardized treatment in the vein of natural sciences methodology. Over the past 50 years, greater acceptance of “whole person healthcare” practices, which consider each patient’s unique needs, have created fertile ground for the application of arts and culture activities and expressive arts therapies in health and wellness. Over the course of the 20th century, professional psychologists and educators played an important role in integrating the arts with health more fully. And, from the mid-to late 20th century, greater institutional supports for the arts and health intersection began to develop, while today emphasis is being placed on the production of evidence-based research that demonstrates the multiple values of the intersection. Arts Integration in Healthcare Environments Healthcare facilities can range from small neighborhood clinics to huge hospital campuses. Whatever the type of facility, design considerations are typically focused on creating environments that welcome patients and their families, ease navigation to destinations and facilitate positive general wellness and therapeutic outcomes. Florence Nightingale, the founder of modern nursing, was one of the earliest practitioners of medicine that tied a patient’s environment to his or her health results. In her Notes on Nursing, she pointed out that environmental factors including ventilation, temperature, light, sanitation and noise affect a patient’s recovery and well-being. Discussions about healthcare environments have continued to include the roles of such factors, with growing emphasis placed on the specifc parts that arts and culture can play from two key perspectives: the infusion of works of art and performances into healthcare spaces; and the specifc role the design feld plays in healthcare environments from structural, aesthetic and practical viewpoints. Over time, arts and culture have come to be valued for more than their decorative uses and are increasingly being integrated with healthcare environments for therapeutic ends. With key partnerships developing between Cleveland’s wealth of arts and culture organizations and its healthcare institutions, more visual artworks and performances are appearing in healthcare settings such as the Cleveland Clinic, MetroHealth and University Hospitals. Additionally, design considerations are directly infuencing health and well-being with medical products shaped by organizations including Nottingham Spirk and Smartshape; biomedical art and game applications from students at the Cleveland Institute of Art; specially designed fashion from businesses such as Downs Designs; and architectural elements in facilities like the Hospice of the Western Reserve. Research has shown that arts integration in healthcare environments can yield lower levels of stress and the use of pain medication among patients; reduce medical errors and work-related injuries among staff; and yield cost reductions, lower rates of staff turnover, and enhanced public perceptions of healthcare institutions/facilities. Community Partnership for Arts and Culture 6 Creative Minds in Medicine Executive Summary Participatory Arts and Health The inherent ability of arts and culture to connect, inspire and engage at both individual and community levels has direct implications for the roles it can play when intersecting with the health and human services feld. For individuals undergoing medical treatment, participation in arts and culture activities has been shown to play an important role in boosting confdence, alleviating stress and improving clinical outcomes. Expressive arts therapists are trained healthcare professionals who apply the disciplines of visual art, music, dance, literature and theater to alleviate or treat specifc diseases or disabilities for the health benefts of participants. For example, visual and literary arts help grieving children and adolescents express their emotions following loss; music therapy decreases pain, anxiety, depression, and shortness of breath, and it improves mood in palliative medicine patients; dance allows military veterans to tell their stories nonverbally and cope with post-traumatic stress disorder; writing and reciting poetry assists those with Alzheimer’s disease and related dementia to recall memories; and drama therapy lifts mood and reduces pain levels for dialysis patients undergoing treatment. Expressive arts therapies have also yielded measurable outcomes such as stress reduction, pain management and improved motor and social functioning for groups such as military veterans, autistic youth and stroke survivors. As the role of arts in healthcare has shifted over time, from more aesthetic use to practical applications, individual artists have also become more involved in healthcare facilities. Artists are sharing projects and engaging others in their work through arts-by-the-bedside programs and as artists-in-residence. Arts-by-the-bedside programs bring customized performances directly to patients’ bedsides. Artist-in-residence programs bring artists into healthcare settings in a more structured way for specifed periods of time, allowing for the artist to become more integrated into the hospital environment and deepen relationships with those they serve. Whereas expressive arts therapies work toward treating the physical and psychological reactions associated with disease, the interaction of the artist with a patient or the interaction of the patient with a particular artistic medium are seen as ends in themselves. Cleveland’s healthcare institutions use a wide variety of expressive arts therapies to bring about positive clinical outcomes for patients, as do arts and culture organizations like Art Therapy Studio, Beck Center for the Arts and the Music Settlement. Cleveland’s wealth of educational programs focused on the expressive arts therapies offered through sources like the Cleveland Music Therapy Consortium and Ursuline College, as well as the city’s historic role in the development of the feld, set it apart as an expressive arts therapy leader. In addition to expressive arts therapies, general arts and culture activities are also being used to empower individuals in the creation of artwork and are well-suited to meet the emotional, physical and social needs of specifc groups like older adults through Judson, Malachi House, McGregor and Menorah Park. Collectively, Cleveland’s expressive arts therapists and individual artists are key champions of promoting the role arts and culture have to play in the medical feld’s broader movement toward more patient-centered care. Arts and Health Integration with Community Development, Public Health and Human Services Within their communities, individuals participate in arts and culture activities as observers, creators, facilitators and supporters. Whether through formal or informal outlets, engagement in arts and culture has been shown to mediate greater civic engagement and effcacy among participants.