In addition medications requiring central line buy generic levaquin 750mg, a new test must have support in the peer-reviewed literature medications and grapefruit interactions discount levaquin 500mg, as well as from relevant specialty societies treatment 4th metatarsal stress fracture purchase levaquin 750mg line. Is the procedure/service for which you are proposing a code change performed nationally? Is the procedure/service for which you are proposing a code change performed by a large number (as a proportion of practitioners within the specialty or subspecialty) of physician or non-physician health professionals? Has the clinical efficacy of the procedure/service for which you are requesting a code change been established and well documented? Is the procedure/service for which you are requesting a code change used as a performance or quality measure by any national organization? Indicate the specific reasons why this code change is necessary (rationale) (avoid non-rationales; reasons like "no code currently available" or "need new code" do not describe the clinical reason why you are requesting a coding revision)? Do many physicians or non-physician health care professionals perform this service across the United States? Please identify the specialties or subspecialties that might perform this procedure/service symptoms 4-5 weeks pregnant order levaquin 750mg mastercard. As such medications used for anxiety cheap levaquin 500 mg fast delivery, this provision may help increase transparency of regulatory and reimbursement processes and encourage greater diagnostics industry involvement symptoms kidney cancer purchase levaquin 750mg overnight delivery. In general, this freeze places further constraints on the financial outlook for the diagnostics industry. Competitive Bidding Demonstration: Competitive bidding is a process in which providers submit price bids and the lowest bid is selected as the payment rate for a particular service. Under this demonstration, contracts are to be re-competed every three years, with multiple winners in each competitive acquisition area. This has financial implications for the diagnostics industry and also influences provider adoption and patient access. Depending on the outcome of this demonstration, Congress may consider competitive bidding in the future with the intent that it will result in cost savings without sacrificing quality. In addition, this provision establishes an accelerated path to payment for technologies involved in diabetes screening once regulatory review has been completed. Implications: Certainly, the fast-track option for regulatory review to payment may have positive impacts on diabetes screening diagnostics, allowing more timely diffusion and patient access. However, for cardiovascular technologies, this provision may raise evidence 703 704 705 706 707 708 Ivor L 2004. Demonstration Project for Competitive Acquisition of Clinical Laboratory Services. Manufacturers may anticipate the impacts of this process on the indications for coverage of these tests and the time that may be required to gain such coverage. Among these are an earlier application deadline of January 3, which lengthens by two months the duration until new codes become effective on the subsequent January 1, yet enables greater time for the new provision for public comment on preliminary coding decisions. Dedicated to developing methods for gathering reliable evidence about existing and emerging technologies, this group also seeks to streamline coding, coverage and payment. Produced in collaboration with the Ethiopia Public Health Training Initiative, the Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. Communicable Disease Control Preface this lecture note was written because there is currently no uniformity in the syllabus and, for this course additionally, available textbooks and reference materials for health students are scarce at this level and the depth of coverage in the area of communicable diseases and control in the higher learning health institutions in Ethiopia. Although, this lecture note is prepared and intended for use primarily for nursing students, other health science students and health professionals can use it. After using this material, students are expected to be able to: describe the epidemiology and scope of communicable diseases in Ethiopia and factors involved in the transmission of communicable diseases; identify the preventive and control measures of each of the communicable diseases; play an active role in the prevention and control of communicable diseases; organize and implement effective health education on communicable diseases, and; participate in teaching junior staff and significant others in health courses on managing patients with communicable diseases. The last chapter has a brief description of nursing principles in the management of communicable diseases. Moreover, each disease has been discussed in terms of its definition, infectious agent, epidemiology, clinical manifestation, diagnostic criteria, treatment, nursing care (for some diseases) and prevention and control methods. I am also indebted to my students, to whom I owe much of what I have learned about teaching the communicable disease control course, and whose interest and participation have sustained my motivation during the arduous writing of this material. Tadesse Anteneh for his advice, encouragement, and support in the preparation of this lecture note. My deep appreciation also goes to Ato Keneni Gutema, Ato Arega Awoke and S/r Addisalem Yilma, for their constructive comments and suggestions on an earlier draft and for taking time out from their busy schedules to read it. I would like to acknowledge Ato Abraham Alano and Ato Yared Kifle, who reviewed the final draft and gave me invaluable comments and suggestions. Last but not least my thanks also go to W/t Yiftusra Abebe and W/t Tigist Ayele who have assisted me in accomplishing all of the secretarial work of this text. C 0 Acid Fast Bacilli Acquired Immuno-Deficiency Syndrome Bacillus of Calmate-Guirein Bies in dies (two times a day) Bachelor of Science degree Degree Celsius Central Nervous System Cerebro-spinal fluid Computerized Tomography Diethylcarbamazin Citrate Directly Observed Treatment Short course Gastro-intestinal Tract Human Immuno-deficiency Virus Immunogloblin M. At the end of this chapter, the student will be able to: Diseases can be classified according to two major dimensions, namely the time course and cause. According to the time course, they are further classified as acute (characterized by a rapid onset and a short duration), and chronic disease (characterized by prolonged duration). However, most of the common diseases in Africa are environmental diseases (infectious) due to infection by living 1 Communicable Disease Control organisms. These are called communicable diseases, because they spread from person to person, or sometimes from animals to people. They occur at all ages but are most serious in childhood and they are to a great extent preventable. In developed countries where they have been prevented, other health conditions such as accidents and degenerative diseases become the most common. Therefore, communicable diseases remain very important in developing countries because: Many of them are very common Some of them are serious and cause death and disability Some of them cause widespread out breaks of disease or epidemics Most of them are preventable by fairly simple means. Poor socio-economic status of the individuals makes them vulnerable to a variety of diseases Low educational status Lack of access to modern health care service 1. This is due to severeal factors including: Immunization 2 Communicable Disease Control Anti-microbial chemotherapy Improved nutrition Better sanitation and housing In less developed countries, however, especially in the tropics, infectious diseases continue to be one of the commonest causes of death, particularly in children. These are: Infectious diseases (communicable diseases) 80% of these can be prevented by simple sanitary measures. Nutritional problems the magnitude of infectious diseases in Ethiopia can be seen from the 1993 E. Accordingly: the top leading causes of outpatient visits were: All types of malaria (10. Some of the components in the definition of epidemiology are: "Populations" Epidemiology focuses on the effects of disease on populations "Disease and health related conditions" Epidemiology indicates that everything around us and everything we do affects our health. The causes of diseases are classified epidemiologically as: Primary causes - Factors that are necessary for a disease to occur, and in whose absence the disease will not occur. Contributing, predisposing, or aggravating factors Risk factors whose presence is associated with an increased probability that disease will occur/develop later. Poverty is the most powerful environmental determinant in the disease occurrence, Habit of cigarette 5 Communicable Disease Control smoking leads to lung cancer. Epidemics - the occurrence of any health related condition in a given population in excess of the usual frequency in that population. Endemic - a disease that is usually present in a population or in an area at a more or less stable level. Sporadic - a disease that does not occur in that population, except at occasional and irregular intervals. Infection - the entry and development or multiplication of an infectious agent in the body of man or animal 7. Infestation  presence of living infectious agent on the exterior surface of the body 9. Infectious agent- an agent capable of causing infection 6 Communicable Disease Control Review Questions 1. How do you compare the impact of communicable disease in Ethiopia with that of the developed world? What are some of communicable diseases that create major health problems in Ethiopia? Define the following terms: Epidemiology Epidemics Endemic Pandemic Sporadic Infection and infectious agent 4. Infectious agent: An organism that is capable of producing infection or infectious disease. On the basis of their size, etiological agents are generally classified into: Metazoa (multicellular organisms). Reservoir of infection: Any person, animal, arthropod, plant, soil or substance (or combination of these) in which an infectious agent normally lives and multiplies, on which it depends primarily for survival and where it reproduces itself in such a manner that it can be transmitted to a susceptible host. Man: There are a number of important pathogens that are specifically adapted to man, such as: measles, smallpox, typhoid, meningococcal meningitis, gonorrhea and syphilis. The term "zoonosis" is applied to disease transmission from animals to man under natural conditions. For example: Bovine tuberculosis - cow to man Brucellosis - Cows, pigs and goats to man Anthrax Rabies - Cattle, sheep, goats, horses to man - Dogs, foxes and other wild animals to man Man is not an essential part (usual reservoir) of the life cycle of the agent. Non-living things as reservoir: Many of the agents are basically saprophytes living in soil and fully adapted to live freely in nature. Biologically, they are usually equipped to withstand marked environmental changes in temperature and humidity. Clostridium botulinum etiologic agent of Botulism Clostridium tetani etiologic agent of Tetanus Clostridium welchi etiologic agent of gas gangrene c. Mode of transmission (mechanism of transmission of infection): Refers to the mechanisms by which an infectious agent is transferred from one person to another or from a reservoir to a new host. Direct transmission: Consists of essentially immediate transfer of infectious agents from an infected host or reservoir to an appropriate portal of entry. Direct horizontal Direct touching, biting, kissing, sexual intercourse, droplet spread onto the conjunctiva or onto mucus membrane of eye, nose or mouth during sneezing coughing, spitting or talking; Usually limited to a distance of about one meter or less. Vehicle-borne transmission: Indirect contact through Bedding, toys, handkerchiefs, soiled clothes, cooking or eating utensils, surgical instruments. The agent may or may not multiply or develop in the vehicle before it is introduced into man. Vector-borne transmission: Occurs when the infectious agent is conveyed by an arthropod (insect) to a susceptible host. Mechanical transmission: the arthropod transports the agent by soiling its feet or proboscis, in which case multiplication of the agent in the vector does not occur. Biological transmission: this is when the agent multiplies in the arthropod before it is transmitted, such as the transmission of malaria by mosquito. Air-borne transmission: Dissemination of microbial agent by air to a suitable portal of entry, usually the respiratory tract. Two types of particles are implicated in this kind of spread: dusts and droplet nuclei. Droplet nuclei: Small residues resulting from evaporation of fluid (droplets emitted by an infected host). Portal of entry: the site in which the infectious agent enters to the susceptible host. Susceptible host (host factors): A person or animal lacking sufficient resistance to a particular pathogenic agent to prevent disease if or when exposed. The term "immunity" is used to describe the ability of the host to resist infection. Resistance to infection is determined by non-specific and specific factors: Non-specific factors Skin and mucus membrane Mucus, tears, gastric secretion Reflex responses such as coughing and sneezing. Specific factors Genetic-hemoglobin resistant to Plasmodium falciparum Naturally acquired or artificially induced immunity. Healthy or asymptomatic carriers: these are persons whose infection remains unapparent. For example, in poliovirus, meningococcus and hepatitis virus infections, there is a high carrier rate. Incubatory or precocious carriers: these are individuals or persons who excrete the pathogen during the incubation period. Convalescent Carriers: these are those who continue to harbor the infective agent after recovering from the illness. For example, in a measles patient, fever and coryza occur in the first three days and Koplick spots in the buccal mucosa and characteristics skin lesions appear on the fourth day. Period of communicability: the period during which that particular communicable disease (infectious agent) is transmitted from the infected person to the susceptible host. Primary prevention: the objectives here are to promote health, prevent exposure, and prevent disease. In 16 Communicable Disease Control short it is any intervention that promotes a healthier and happier life. Prevention of exposure:- this includes actions such as the provision of safe and adequate water, proper excreta disposal, vector control, safe environment at home. Prevention of disease:-This occurs during the latency period between exposure and the biological onset of disease. Immunization against an infectious organism does not prevent it from invading the immunized host, but prevents it from establishing an infection. Active immunization means exposing the host to a specific antigen against which it will manufacture its own protective antibodies after an interval of about three weeks (during which the immunized person remains susceptible to the disease). Passive immunization means providing the host with the antibodies necessary to fight against disease. However, for active immunization to be protective, the timing of its administration must be at least three weeks prior to exposure. Passive immunization, on the other hand, 17 Communicable Disease Control is commonly given after exposure has occurred (as in the case of exposure to rabies or tetanus), or shortly before an exposure is expected, as in the administration of immune globulin to prevent viral hepatitis A). Breastfeeding is an example of an intervention that acts at all three levels of primary prevention: Health promotion: by providing optimal nutrition for a young child, either as the sole diet up to four months of age, or as a supplement in later months.
Islam disagrees with jailed women in the home and the valid women with consideration of legal rules participate in all social / cultural and sport filets for more explanting we point to covering subjects and limitation of it in Islam symptoms bladder cancer discount levaquin 750mg line. Tell your wife and girls hide their ornaments in other to be recognized from the servants the God is very generous and kind (ahzab medicine park ok discount 750 mg levaquin,59v) medicine q10 levaquin 250mg low price. In the other narration Imam sadegh said: "Seeing (illegal things) is an arrow of poised arrows of shy tan (Horamoli medicine to stop contractions cheap 750 mg levaquin free shipping,1982) shinee symptoms mp3 order levaquin 250 mg with amex. Because seeing sexual things provide sinful and deadly fields we must prevent from them medicine 834 order levaquin 250 mg on-line. Accord principle between soul and body singleness principle among the persons justice principle Âintentions principle (Ghaemi,2001). If we face with that sport is only related to women we face with social difficulties. The women`s sport is lawful with these principle the principles such non Âmixing principle needs  necessities Âwhen it is enjoyable that must be with goal and based on string then for doing duties and planned responsibilities in future. Sports in Islam, Islamic Propagation Office of Qom Lmy area,press center ofQom,Pp87-88-90. A) Department of Religious Jurisprudence and Islamic law, Karaj branch, Islamic Azad University, Karaj, Iran Email: Amir. In this paper I have tried to discuss about legality reasons of interest termini that prove this right. I can mention Quran as a reason there is no special verse about interests termini and residency, usufruct, custody, and devotion. The second resource that we can refer to it is tradition that there are narrations about interest termini. The third resource is act of companion that companion view interests termini as a legal subject. The fourth resource is totality of wises that they accept interests termini in each manner (Moslem or not). There is total reason about legality of interest termini that jurisprudents use it. But there are a lot of similarities of it in our life then everything that implies to goods can counted as reason of interests termini. Reasons and narratives of interest termini are not coordinated but in some cases like Quran that is a very good reference, we must refer to it. First) Quran There is no verse about residency, usufruct, devotion and gift in Quran but every thing that implies to charity and good works can be a reason for interest termini, like verses bellow that jurisprudents can refer to them. Implication mood In this verse God count good works as best things and alive until the hereafter. So if you abandon your possession it is best thing in God point of view and is a clear reason for interest termini. Implication mood this verse is considerable for Imamieh jurisprudents and knows jihad and donation similar to each other. Even this verse implies to generosity but we can generalize it to interest termini, so this verse is a reason for interest termini. This verse is polestar by means of Imamieh and shafiite jurisprudents (Al-sharbinie Alkhatib, 1958);(Al-sabegh,1971)and malekieh(Ebn anas,1985). Implication mood In verses above, God advices to acceleration in good works and interest termini is one of the good works. Because if you think about other people requirements and try to solve them, society going to be without problem. So if you donate your possession to other people, it is kind of progress in good works and we can prove legality of interest termini. Allame tabatabaie view charity in verse 48 of surrah Maede as donation and solve other people problems, but he views it just in financial problems (Altabatabaie, N. In sunny book they view good works as precipitation in Zakat and eliminate other people 745 Life Science Journal 2013;10(1). Implication mood As I told, we can include interests termini as good works and engaged to good doing like when a person leave her/his possession for other people that need it. This is a good doing or like a person who we abandon residency of house for usufruct duration. So we can say possession leaving for other people problems is one of the good doing. Second) Tradition There is no narration about legality of interest termini, but there are total narrations that we can imply them. But there are narrations about legality of interest termini samples like usufruct, residency and devotion and etc. There are several narrations in jurisprudence book of Imamieh and four religions that we try to talk about them. In Imamieh book have written: 1) Profit said: there is no possession that reduces by means of charity, so try to help other people (Almajlesie, 1983). Implication mood So we can understand by means of this narration that if you give money to other people that need money or if you leave your possession for some people, there is no harm in this way, so interest termini is legal. Implication mood We can understand from this narration that people must not with hold their possession form poor people, for example they can devote their possession as residency, usufruct. So we can elicit that interests termini has legality and has positive effects in society. Implication mood this narration also advice you to help other people so interests termini has legality. Implication mood In this narration, charity is heavy for devil then charity for Moslems using is so acceptable and God advice people to donate money to poor people because by means of this act, poor people can solve their own problems so interests termini has legality. Third) Interests termini in companions act Profit adjuncts act is one of the reasons of sunny four religions, so we imply some of them: 1) the last narration is a good example for it. Implication mood In this narration Omar Ebn khatab decides to donate his possession to poor people. Wises of world in each manner or each religion (Moslem or not), accepts interests termini, because it is acceptable in all societies as a good doing. It is like a person who donates his/her possession (garden, farm, etc) for public using permanently or temporary as usufruct, or like a person who devote his possession for satisfying God. Discussion By means of researches that have done about interests termini we considered reasons of legality of this right and conclusions of this research have written beneath: There is question that if interest termini have legality or not? And there are a lot of verses that imply to legality like Surrah kahf verse46, Surrah bagharah verse 195 and surrah Alemran verse92 that they persuade people to do good acts. Other reasons involve adjuncts act and totality of wises, all of them legality of interests termini. Acknowledgement I appreciate of my parents and my dear madders Marziye bigzage that helped me to write this article. S in Microbiology, Zanjan Branch, Islamic Azad University, Zanjan, Iran 2- Department of Microbiology, Faculty of Medical Science, Tabriz Branch, Islamic Azad University, Tabriz, Iran 3- Department of Food Hygiene, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran Email: drhmobaiyen@iaut. Vancomycin is widely used in treating infections created by this organism which increases vancomycin-resistance and the spread of S. Gathering data on the situation of drug resistance - especially vancomycin-resistance of these organisms not only is considered an effective measure to prevent hospital infections but also as one of research priorities. In this study, the frequency of vancomycin resistance and the presence of vanA gene are evaluated in S. The frequency of intermediate vancomycin-resistant strains using agar disk diffusion method and E-test are % 26. VanA- positive strains were far more resistant against antibiotics than vanA- negative. During the present study vanA gene was identified in only one strain of isolated S. Separation of vanA gene in isolated strains rings the alarm for authorities to control infection in the given hospital and other medical centers in Tabriz. Introduction Staphylococcus aureus is one of the most common and important pathogens of nosocomial infections that due to variety of enzymes such as coagulase, hyaluronidase, nuclease, lipase, hemolysin and leukocidin can cause infection anywhere in the body (1). These bacteria are causative agent of wide range of human diseases, including endocarditis, food poisoning, toxic shock syndrome, septicemia, dermal infections, soft tissue infections and bone infections. Because of acquired resistance to drought and increasing resistance to antimicrobial agents, it has been got as a major public health concerns and causes treatment failure in infections due to S. In 2002 and later, similar studies have conducted on resistance to vancomycin strains of S. Genes involved in vancomycin resistance are known van gene which is cause resistant by inducing changes in the cell wall of S. This gene is located on Tn1546 transposons and also can be found on plasmid or chromosome and causes transfer of vancomycin resistant genes from one strain to another or even from one species to another species (12-14). Vancomycin resistant genes can be transferred from Enterococcus faecium to Staphylococcus aureus through the conjugative transposons (15). Vancomycin-resistant Staphylococcus aureus with VanA genotype are known in urinary tract infections, septicemia, and most infections caused by S. This organism has a thick cell wall that vancomycin binds to receptors occupied on the outer cell wall and inhibits its function (19). Materials and methods Sampling and identification of strains: In this study, during an 8-month period from 2011 to 2012, 73 strains of Staphylococcus aureus were isolated from clinical samples of Tabriz Shohada hospital. After collecting the samples, we used blood agar and mannitol salt agar media for isolating and purification of genera, and then were incubated for 24 hours in 37°C (20, 21). We attempted to make coagulase from isolates using human plasma, so, final step of confirmation was made (22, 23). Antibiogram using disk diffusion method Agar disk diffusion test was applied using discs prepared from Mast Co. The antibiotic discs used in this study were linezolid (30 g), vancomycin (30 g), methicillin (5 g), Ceftazidime (30 g), gentamicin (10 g), tetracycline (30 g), ciprofloxacin (5 g), cotrimoxazole (25 g). In this method, antibiotic is placed on the paper tape based on the gradient of concentration (25-27). Then, based on table 1, lysing buffer was added to sediment and was transferred into another microtube and was placed in the thermomixer at 80-85°C for 1 hour. Then was stained by ethidium bromide for 30 minute and the results were read by gel document apparatus (32). Results Results of sampling: Of 1038 samples referred to laboratory, 73 of them were identified as S. Discussion Staphylococcus aureus is one of the important human pathogens that in last decades were as causative agent of community and hospital acquired infections and its resistance is increases against lactams antibiotics and vancomycin (34). There are reports that indicate failure of therapy with vancomycin caused to emerging hetrogenous vancomycin and Intermediate S. Considering that disk diffusion method is used widely in the diagnostic laboratories but it may show false positive and false negative results and also its 750 Life Science Journal 2013;10(1). On the other hands, bacterial load that is inoculated, depth of medium and disks used can affect results (38). In this study, for confirmation we used all of the 12 samples for electrophoresis of vanA gene. Isolating the VanA genes in isolated strains from Tabriz Shohada Hospital was an alert for hospital authorities. Mozaffari pathobiology laboratory, and all persons who helped us in this research. Comparison of two antimicrobial susceptibility tests, disk diffusion and E-test for determining oxacillin and vancomycin susceptibility. Etest synergy testing of clinical isolates of Staphylococcus aureus demonstrating heterogeneous resistance to vancomycin. Emergence of vancomycin-intermediate Staphylococcus aureus in a Belgian hospital, microbiological and clinical features. A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Evaluation of the velogene genomic assay for detection of vanA and vanB genes in vancomycin-resistant Enterococcus Species. Molecular study of vancomycin-resistant enterococci isolated from humans and from food in a cattlerearing area of France. Inhibition of cell wall turnover and autolysis by vancomycin in a highly vancomycin-resistant mutant of Staphylococcus aureus. Staphylococcus, Micrococcus, and Other catalase-positive Cocci that grow aerobically. Clinical and Laboratory Standards Institute, Performance standards for antimicrobial susceptibility testing. Molecular Cloning: a Laboratory Manual Cold Spring Harbor: Cold Spring Harbor Laboratory Press 1982. Colonization frequency of meticillin and vancomycin-resistant Staphylococcus aureus in the nose, Matthew Shohada Hospital Employee of Khorram Abad. Vancomycin in surgical infections due to methicillin-resistant Staphylococcus aureus with heterogeneous resistance to vancomycin. Vancomycin treatment failure associated with heterogeneous vancomycin intermediate Staphylococcus aureus in a patient with endocarditis and in the rabbit model of endocarditis. Prevalence, molecular epidemiology, and clinical significance of heterogeneous glycopeptide intermediate Staphylococcus aureus in liver transplant recipient. Sensitivity of Staphylococcus aureus strains isolated from clinical specimens against vancomycin by using E-test in Tabriz. Emergence of high-level vancomycin-resistant Staphylococcus aureus in the Imam Khomeini Hospital in Tehran. Life Science Journal, the Acta Zhengzhou University Oversea Version registered in the United States, is an international journal with the purpose to enhance our natural and scientific knowledge dissemination in the world under the free publication principle. Any valuable papers or reports that are related to life science in their broadest sense - are welcome. Papers submitted could be reviews, objective descriptions, research reports, opinions/debates, news, letters, and other types of writings. References to standard benefit plan language and coverage determinations do not apply to those clients.
This technique known as "compressed sensing" or "compressive sampling" relies on properties of the sensing matrix such as the restricted isometry property [4] medicine stick buy levaquin 250 mg low cost. When complete information on the signal or image is available this is certainly a valid strategy treatment plan for depression discount levaquin 250 mg. However new medicine levaquin 500mg line, when the signal has to be acquired first with a somewhat costly symptoms ruptured spleen cheap levaquin 750 mg visa, difficult symptoms colon cancer buy discount levaquin 500mg on-line, or time-consuming measurement process medications quit smoking generic 500mg levaquin visa, this seems to be a waste of resources: First one spends huge efforts to collect complete information on the signal and then one throws away most of the coefficients to obtain its compressed version. One might ask whether there is a more clever way of obtaining somewhat more directly the compressed version of the signal. It is not obvious at first sight how to do this: measuring directly the large coefficients is impossible since one usually does not know a-priori, which of them is actually the large ones [4]. Nevertheless, compressive sensing provides a way of obtaining the compressed version of a signal using only a small number of linear and non-adaptive measurements. Even more surprisingly, compressive sensing predicts that recovering the signal from its under sampled measurements can be done with computationally efficient methods, for instance convex optimization, more precisely, 1-minimization [4]. When reconstructing the signal the non-stored coefficients are simply set to zero. This is certainly a reasonable strategy when full information of the signal is available. However, when the signal first has to be acquired by a somewhat costly, lengthy or otherwise difficult measurement (sensing) procedure, this seems to be a waste of resources: First, large efforts are spent in order to obtain full information on the signal, and afterwards most of the information is thrown away at the compression stage. One might ask whether there is a clever way of obtaining the compressed version of the Signal more directly, by taking only a small number of measurements of the signal. It is not obvious at all whether this is possible since measuring directly the large coefficients requires knowing a priori their location. Quite surprisingly, compressive sensing provides nevertheless a way of reconstructing a compressed version of the original signal by taking only a small amount of linear and non-adaptive measurements [5]. Image compression algorithms convert high-resolution images into a relatively small bit streams (while keeping the essential features intact), in effect turning a large digital data set into a substantially smaller one[4]. Wakin proposed Compressive sampling (CoSamp) is a new paradigm for developing data sampling technologies. It is based on the principle that many types of vector-space data are compressible, which is a term of art in mathematical signal processing [1]. Those works explore the inherent security strength of linear measurement provided by the process of compressed sensing. The application of Homomorphic Encryption method on the Cloud Computing security, particularly the possibility to execute the calculations of confidential data encrypted. Homomorphic Encryption systems are used to perform operations on encrypted data without knowing the private key (without decryption), the client is the only holder of the secret key. When we decrypt the result of any operation, it is the same as if we had carried out the calculation on the raw data. In short, practically efficient mechanisms with immediatepractices for secure image recovery service outsourcing incloud are still missing. To reduce the local storage and maintence the data owner later outsource the image samples to the cloud for storage and processing. In this model data users are assumed to possess mobile devices with only limited computational resources. Let f and y be the signal and its compressed samples to be capturedby the data owner. Instead, he outsources an encrypted version y of y and some associated metadata to cloud. Next, the cloud reconstructs an output f directly over the encrypted y and sends f to data users. The user uses the secret key K to recover the original answer g for problem from protectedanswer h of k returned by cloud upon getting input of the secret key K and the answer h of k from cloud. Data: transformation key K and protected answer h of k Result: answer g of original problem Begin 1. The protected image samples shouldsupport image recovery as needed, while the recovered images at cloud should still be in an protected form. BasicRequirements algorithm Algorithm 1: Key Generation Key Generation is a key generation algorithm running at the data owner side, which generates the secret key K upon getting input of some security parameter 1. Specifically we focus on the computational cost of privacy assurance done by the data owner and data users, i. The cloud solves it for the data user, who then performs a decryption process to get the original image data vector and then recover the image. Paul Memorial College of Engineering and Technology, Pondicherry University, India. It was found that overall perceived service quality is determined by three dimensions, which are service quality, information quality, and system quality. The overall service quality will have an impact on customer satisfaction, which will then affect the customer behavioral intention. The study provides insights to researchers and practitioners in the area of mcommerce on the important inter-related dimensions and determinants for measuring service quality. Index Terms- m-commerce, e-service quality, m-commerce service quality, e-service quality measurement, e- service quality factors. Many commercial activities, like sale of goods and services, are now conducted via the Internet. However, e-commerce much depends on the availability of a wired network connection to the Internet. The limitation of wired technology is the lack of mobility, meaning that customers cannot enjoy the luxury of access at anytime and from anywhere; wireless technologies, however, have this advantage. Mobile technologies are not necessary to increase mobility, but they could reduce consumer need to travel about (Mallat, Rossi, Tuunainen, & Oorni, 2009). With this fast evolving trend, users of mobile devices are being looked upon as a large group of potential customers (Aungst & Wilson, 2005). M-commerce studies can be categorized into technology and services, and cover issues such as small screens and multifunctional keypads, reduced power of computation, memory and disk capacity, shorter battery life, complicated mechanisms for text input, data storage and higher risk transaction errors, lower display resolution, less surfability, user unfriendly interfaces, unreliable network connections, and graphical limitations (Lu & Su, 2009; Siau, Lim, & Shen, 2001). Since there seems to be a lack of studies in the m-commerce area, the researcher is motivated to find out what factors enable a high quality m-commerce service in the commercial environment. Another important aspect in m-commerce, as in all other service sectors, is service quality (Lu, Zhang, & Wang, 2009; Turel & Serenko 2006). The mobile device is not merely a communication tool but has increasingly become a tool for online commerce. Therefore, there is an increasing need to focus on the factors that can ensure the service quality of m-commerce (Lu, Zhang, & Wang, 2009; Turel & Serenko 2006). Lu, Zhang, & Wang, 2009; Turel & Serenko 2006) asserted that it is necessary to explore service quality, customer satisfaction, and customer behavioral intentions and their inter-relationship in using mcommerce services in future. It will also enable service providers to benchmark their performance and identify areas that require improvement to ensure continuous usage of the available m-commerce services. This study proposes a service quality model for m-commerce in a commercial environment. Dependent and independent variables as well as their potential relationship are also identified from the literature analysis to form the conceptual model. This paradigm has been used to evaluate the level of consumer satisfaction with the chosen product or service, and is operationalized in terms of the comparison between consumer expectation and perceived performance of the product or service. Based on this definition, the quality of a website is to provide sufficient service to customers to shop comfortably and confidently, and to expect fast delivery and reliable service. Davis defined perceived technology ease of use as "the degree to which the prospective user expects the target system to be free of effort". He further perceived technology usefulness as "the degree to which a person believes that using a particular system would enhance his or her job performance". It has also become an important part of the discourse on the web among academics and practitioners, especially those in the service marketing areas (Jensen & Markland, 1996). Therefore, an organization providing higher quality of service can have higher market share and higher returns on investment and, finally, can gain long-term profitability (Buzzell & Gale, 1987; Ghobadian, Speller, & Jones, 1994; Margolies, 1988). In the modern marketing literature, most definitions of quality have focused on consumer perceptions of service, product excellence, and satisfaction of consumer requirements (Ghobadian et al. It is argued that the ease of use of a particular system affects its adoption by customers (Davis, 1989; Davis et al. These criteria are: 1) Information availability, which can help consumers search for any relevant information on any products they are interested in enquiring about; 2) Ease of use/usability, which implies the easiness of using the web site, including downloading speed, design, and organization; 3) Privacy/security, this being the protection of personal information of customers such as hiding their personal information from other websites, shielding identity, and offering informed consent. As far as security is concerned, it refers to protecting users from the risk of fraud and financial loss when they use their credit card or any other financial information. The main concern of the three recovery dimensions is with the problem that needs resolving and requires a "personal service". These recovery dimensions are: 1) Responsiveness  the ability of the company to provide processes that can easily solve problems; 2) Compensation  money-back guarantee, handling costs, and return of shipping; 3) Contact points  the ability of the company to offer live contact and real-time support for the customers through any communication means (online or otherwise). These criteria are: Ease of navigation, Access, Customization/personalization, Efficiency, Responsiveness, Security/privacy, Assurance/trust, Site aesthetics, Reliability, Knowledge on price, and Flexibility. A total of 660 usable questionnaires were collected randomly for the examination of the causal relationship between the three variables mentioned above. The data used in their own study were systematically and randomly collected from 397 churches. They also suggested that quality of product and service are directly related to customer satisfaction, leading to customer loyalty. The literature on customer satisfaction shows that the relationship between customer satisfaction and customer behavioral intention is dependent on the type of satisfaction. There is a strong positive impact on customer behavioral intention by satisfaction manifestation. This is also stronger than that of latent satisfaction on customer behavioral intention (Bloemer & Kasper, 1995; Bloemer & De Ruyter, 1995). This study found that m-commerce in an academic environment is a new area of research and it is very difficult to find related studies, supported by evidence, that focus on service quality, customer satisfaction, and their influences on customer behavior intentions in the mcommerce environment. However, similarities between mobile and e-services can be expected since both are Internet-based. Based upon this suggestion, the present study proposes a multidimensional model of service quality for m-commerce and outlines the relationships between service quality and other significant constructs. To understand and organize the mcommerce services quality in a structured manner, for theoretical purposes, it is organized by dimensions and sub dimensions taking into account that mobile services can be considered a subgroup of electronic services. The sub dimensions adopted in this study are website design, reliability, responsiveness, trust, personalization, perceived risk, perceived cognitive control, content usefulness, content adequacy, ease of use, accessibility, interactivity, and perceived website innovativeness. The overall service quality was determined by three dimensions  service quality, information quality, and system quality  which are described next. The dimensions of service quality are measured using seven subdimensions: website design, reliability, responsiveness, trust, personalization, perceived risk, and perceived cognitive control. The dimension of information quality is measured by two subdimensions: content usefulness and content adequacy. The dimension of system quality is measured by four sub-dimensions: easy of use, accessibility, interactivity, and perceived website innovativeness. In this context, the literature suggests that there is a potential positive relationship between website design and overall customer perceived service quality. This is relevant to m-commerce services as customers are always on the move and often in time-critical situations. Therefore, it can be seen that there is a potential positive relationship between reliability and overall customer perceived service quality. It is also the mechanism that handles returns, and has the capacity to execute arrangement for online guarantees. Subsequently, this can subdue the issue of uncertainty and thus increase the perceived convenience of customers (Gummerus et al. Henceforth, it can be concluded that there is a possible positive relationship between responsiveness and overall customer perceived service quality. Lynch and Lundquist (1996) noted that e-service, with much academic discourse surrounding security, privacy, and confidence, centers on trust. Reichheld and Schefter (2000) pointed out that trust is a significant antecedent of participation in online settings because of the increased ease with which online transaction can behave opportunistically. Therefore, it is proposed that there will is a positive relationship between trust and overall customer perceived service quality. Personalization is a key feature of most e-commerce and mcommerce business models because it offers real values for a customer and creates a perception of high-quality service. At the heart of personalization is satisfying the unique needs of each customer (Huang & Lin, 2005; Riel et al. Therefore, it is possible that there is a positive relationship between personalization and overall customer perceived service quality. As a result, major m-commerce firms have endeavored to address risk associated with security technologies, awareness campaigns, and assurance policy statements (Chang et al. Perceived cognitive control depicts a cognitive state of flow experience and generally refers to the belief that the person has, at his or her disposal, a response that can influence an event (Ajzen, 1991). Among others subtle dimensions of perceived control (Ajzen, 1991), cognitive control is said to be an essentiality. Cognitive control requires a person to predict probable sequences of an event and also understand the implications of those consequences. Cognitive control reduces uncertainty (Imada and Nageishi, 1982), and increases the service value perceived by the customers (Bateson, 1985). Also, it clarifies a situation, particularly regarding the need for service involvement (Botvinick et al. Therefore, it is be concluded that there is a potential positive relationship between perceived cognitive control and overall customer perceived service quality. Delone and McLean (1992) highlighted the importance of relevance, timeliness, and accuracy of information. In the same vein, Doll and Torkzadeh (1988) and Doll, Xia, and Torkzadeh (1994) also emphasized three determinants of user satisfaction: content, accuracy, and timeliness. The dimensions suggested in these two studies and others (Aladwania & Palvia, 2002; Belcher et al. Content usefulness: this refers to the reliability, value, currency, and accuracy of information.
Manila: Republic of the Philippines treatment kidney stones cheap levaquin 500mg free shipping, Thirteenth Congress of the Philippines; 2004 [cited 2011 June 28] symptoms syphilis purchase levaquin 250 mg line. Direction Generale des Impots et des Domaines du Sйnйgal; 2011[cited 2011 June 28] withdrawal symptoms buy levaquin 500mg with mastercard. Annex A-2: tax changes for businesses: general tax changes for businesses [Internet] medicine rash purchase 250 mg levaquin with amex. Specific excise duties on locally manufactured or on imported goods of the same class or kind [Internet] treatment breast cancer order levaquin 500mg mastercard. Custom Tariff medications qd buy levaquin 250 mg line, chapter 24; tobacco and manufactured tobacco substitutes [Internet]. Bangkok: Mahidol University, Tobacco Control Research and Knowledge Management Center; 2008. Trinidad and Tobago: second (five year) implementation report: annex 1: taxation rates. Import tariff guides, chapter 24: tobacco and manufactured tobacco substitutes [Internet]. Chapter 6 Changing Smokeless Tobacco Products and Marketing Practices by Industry 185 Blank page. Smokeless Tobacco and Public Health: A Global Perspective Introduction Cigarette markets are declining in high-income economies such as North America and Europe due in large part to effective tobacco control policies. Societal pressures discouraging cigarette use may impel smokers to use other forms of tobacco, for example. Such changes have precedent, as over time different forms of tobacco have seen changes in popularity among users. This chapter will not address product variety and contents in depth, but will focus on data on marketing practices available mostly from high-income countries. For example, introduction of snus products in the United States or South Africa would be considered novel, but emergence of new Swedish snus brands in Sweden probably would not fit this description. Reynolds purchased Conwood, manufacturer of Grizzly and other popular moist snuff products, in 2006. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Table 6-1. No No No No No No No No No No Yes No No No No No Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes * Star Scientific discontinued its dissolvable products in early 2013. Note: this table is intended as an overview of novel products introduced; it is not necessarily comprehensive as there is no formal mechanism on a global scale for reporting new smokeless tobacco products. Product the characteristics and performance of a product can greatly influence its overall attractiveness. Smokeless tobacco products can be differentiated from one another most clearly in terms of product design, which may be tailored to achieve chemosensory effects and nicotine delivery targets and paired with marketing to appeal to varied subpopulations (women, youth, African Americans, people of low socioeconomic status). The tobacco in individual products can range from simply dried, cured tobacco leaves cut or torn in various ways, to moistened, fermented tobacco strips, to finely powdered dry tobacco. In both countries, loose product dominates, though portioned forms are growing in popularity. Portioned pouch products were introduced in Sweden in the 1970s and in the United States with Skoal Bandits in 1983. These products were explicitly developed to be easier to use, neater, and more appealing to novice users. In 2009, Reynolds American introduced three dissolvable tobacco products, Camel Orbs (a lozenge), Camel Sticks (a thin, 4-inch stick), and Camel Strips (a thin, rectangular sheet). Such products have attracted considerable concern because of their physical similarity to confectionary products and the ease with which use can be concealed, potentially making them attractive to youth. For example, in the United States, moist snuff is typically packaged in approximately 1. In 2010, disclosures of product-level data for sales of snus and dissolvables were required. Change in smokeless tobacco sales by weight class, 2002Â2010, United States Source: U. One study of Ariva found that it was preferred by smokers over a pure pharmaceutical nicotine lozenge. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Stonewall), smokers rejected General snus, and showed no significant preference for any of the other products. When the smokers quit smoking, those using Camel Snus reported greater relief of cravings and withdrawal symptoms compared to those using other oral products. Interestingly, in the 2011 relaunch of Camel dissolvables, Reynolds American offered a variety pack containing all three versions of the product, presumably so consumers could try all three with less investment to find a type that suited them. The form of the product may have distinct effects on the form of nicotine (bound vs. A prime example is the manipulation of acid/base chemistry to affect the proportion of free nicotine in the mixture, which impacts systemic absorption. Manufacturers can use buffering agents and salts to raise pH and thereby raise the level of free nicotine in a product (or use these agents to lower pH and lower the amount of free nicotine). Makers of custom-made products also manipulate the pH of their products when they add alkaline substances such as punk ash and slaked lime (calcium hydroxide) to products such as iqmik (used by Alaskan Natives), South African custom-made snuff, betel quid, and mawa. Fant and colleagues42 and Kotlyar and colleagues32 showed that product pH appeared to relate to the level of nicotine absorbed. Subjective measures of product strength and satisfaction also followed a similar pattern. Yet a separate study shows that products with higher nicotine levels may be more likely to be misused or cause dependence. In North America, traditional chewing tobacco is either unflavored or incorporates some sweetener. Moist snuff traditionally was available unflavored or with the addition of wintergreen (methyl salicylate). In Sweden, common Swedish snus flavorants include mint/wintergreen, licorice, juniper berry, and eucalyptus. The flavors used in snus products in South Africa include coffee, tropical fruits, mint, and eucalyptus. Emerging dissolvable tobacco products have been marketed with flavors including mint and coffee. Chemical analysis of Camel dissolvables identified flavorants such as coumarin, vanillin, and cinnamaldehyde, along with sweeteners such as sorbitol and xylitol. For example, coumarin, identified in Camel Mellow Orbs,46 is banned as a food additive due to its liver toxicity. Promotion Advertising and promotion are the most visible methods for fostering the growth of a market and attracting new customers, often through creating a specific brand image. At the time, the median age of Swedish snus users was over 40 years, but new product development and intensive promotion by Swedish Match increased snus use among young Swedish men, so that by 1973 the median age of Swedish snus users had declined to 30 years. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products snus and cigars. Product marketing in the 2000s sought to expand beyond these traditional groups and attract more upscale, urban, and female users. Smokers One potential user group of interest is current cigarette smokers, who are already familiar with tobacco use (and addicted to nicotine). Smokeless tobacco manufacturers, at least in the United States, have been targeting smokers for the past few decades. Some manufacturers accomplished this through the development of line extensions. The original test markets for snus-like products (such as Camel Snus, Taboka) occurred in cities that had recently enacted smoke-free regulations. In branding, the name carries with it a set of associations beyond the product characteristics, implying a certain level of quality and conveying a certain image. In Scandinavia, product developers have been explicitly targeting women with product innovations and attractive packaging since 2008, which may have contributed to an upward trajectory for Swedish snus use among women compared to stable levels among men. According to DiFranza and colleagues,72 adolescent snuff users report levels of dependence similar to those of cigarette smokers with comparable histories of use; more than 50% of adolescents with less than 100 lifetime uses of either product reported at least one dependence symptom, whereas over 90% of those with more than 100 lifetime uses reported at least one symptom. Swedish youth report similar patterns, as well as particularly high dependence and withdrawal among dual users. Regarding snus, attractive advertising and packaging have been a particular concern; for dissolvables, an additional issue has been their similarity to confections. Data from one survey indicate that 29% of young adult men (aged 18Â25 years) living in test market cities had tried snus. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Of particular concern is whether novel products could initiate adolescents to nicotine use, leaving them more likely to try and eventually adopt cigarette smoking. As Rosendahl and colleagues note,86 parental modeling of tobacco use can also be important. In Sweden, where more men use snus and more women smoke, adolescent smoking was predicted by parental smoking but not parental snus use, whereas adolescent snus use was predicted by parental snus use. In the United States, smoking is far more common and remains more socially accepted; however, snus use as a precursor of smoking is a potential concern. Mejia and Ling56 note that, whereas earlier messaging for traditional moist snuff was directed toward men and emphasized rugged masculinity, messaging for novel snus products centers on enjoyment of indoor activities where smoking is prohibited and is couched in imagery that emphasizes trendiness, urbanity, and sophistication for both men and women. Timberlake and colleagues88 confirmed this in a content analysis of Camel Snus advertising during the years 2007 to 2010. They noted that in 2009, themes of temporary substitution were supplanted by the "Break Free" campaign, which provided more ambiguous messages tied to freedom, independence, and behavior change. In 2011, Reynolds American launched a 7-day switching challenge, suggesting that the company may begin to encourage full substitution of snus for cigarettes (Figure 6-3). Reynolds American and Star Scientific have employed similar themes for their dissolvable tobacco products. Example of smokeless tobacco messaging emphasizing using smokeless tobacco when smoking is prohibited Figure 6-3. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Packaging as Marketing Packages can serve as key aspects of tobacco marketing, both by reinforcing brand imagery communicated through other media, and by serving as a communication vehicle at the point of sale. Packaging innovations can also play a role in the appeal of a product,60 especially in high-income countries. For example, Camel Snus has come in three different packaging configurations over time: originally a round tin, later an oblong tin, and finally an embossed metal tin with a design incorporating the newly required front-of-package health warning (Figure 6-4). Smokers may have been more explicitly considered in the design of Marlboro Snus, which comes in both round tins and cardboard sleeves (containing fewer sachets) that can be carried along with cigarettes (Figure 6-5). Reynolds American has also encouraged consumers to engage with the company in creating attractive packaging for both cigarettes and smokeless tobacco. In India, for example, the gutka industry promotes a packaged, ready-to-use product based on a traditional custom-made product. Evolution of Camel Snus packaging, 2006Â2011 Source: Photos courtesy of Maansi Bansal-Travers, Roswell Park Cancer Institute. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Figure 6-5. Evolution of Marlboro Snus packaging, 2007Â2011 Source: Photos courtesy of Maansi Bansal-Travers, Roswell Park Cancer Institute. Universal product code designs on Camel dissolvables, 2011 Source: Photo courtesy of Maansi Bansal-Travers, Roswell Park Cancer Institute. In the last decade, stealth marketing has become an important strategy to increase product awareness. Other emerging strategies include viral marketing (a marketing technique that uses pre-existing social networks and technologies to increase product sales and brand awareness through self-replicating, much like the spread of a virus), celebrity endorsements, product placements, and "brand pushers," all of which try to "catch people at their most vulnerable by identifying the weak spot in their defensive shields. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products Freeman and Chapman93 have noted that such activities have the potential to erode the impact of advertising restrictions on tobacco products. Accumulating evidence points to an increasing Web presence by tobacco companies, as well as consumers sharing user-generated content that is pro-tobacco (which may or may not be spurred on by the tobacco industry). In the past, website users have been asked to design new signature flavors and packages for Camel cigarettes,93 and a 2011 website feature allows users to custom design a snus tin. In many countries, including the United States, doing so would require manufacturers to go through a pharmaceutical approval process and provide strong evidence of their effectiveness for cessation. However, Ariva was packaged in pharmaceutical-type blister packaging and was sometimes shelved behind pharmacy counters near nicotine replacement products. Increasing Availability and Access Another marketing approach is to increase the availability of products, making access to them much easier. It is thus not possible to extrapolate the patterns of tobacco use from one country where oral tobacco is available to other countries. Changing Smokeless Tobacco Products and Marketing Practices by Industry Smokeless Tobacco Products traditional products. Although there are no published data on consumer perceptions or snus usage estimates, a national survey in 2007 showed that only 1. These few events and findings point to the need for greater monitoring and more research on marketing practices in low- and middle-income countries. Price Monetary Costs Cost is often a significant factor in whether consumers will be interested in using a product. Tax is not the only driver of effective price paid by consumers; manufacturers can also influence product price. Another way tobacco companies can alter the monetary cost to consumers is to offer tiers of products at different price points. This became an established practice in the cigarette market in the 1980s, primarily in response to increasing tobacco taxes,119 and discount brands appear to be used most by more-dependent smokers of lower socioeconomic status. Premium brands tend to be most commonly used by adolescents, whereas discount brand users tend to be older.
Based on next-generation sequencing technology medications john frew discount 250 mg levaquin with amex, these tests simultaneously analyze a set of genes that are associated with a specific family cancer phenotype or multiple phenotypes symptoms low potassium generic 500 mg levaquin amex. Patients who have a personal or family history suggestive of a single inherited cancer syndrome are most appropriately managed by genetic testing for that specific syndrome symptoms 5 weeks 3 days cheap levaquin 250 mg otc. When more than one gene can explain an inherited cancer syndrome medications 2355 buy levaquin 750mg without a prescription, then multi-gene testing may be more efficient and/or cost effective treatment wasp stings best levaquin 250 mg. There may be a role for multi-gene testing in individuals who have tested negative (indeterminate) for a single syndrome medicine dictionary order 500 mg levaquin with mastercard, but whose personal or family history remains suggestive of an inherited susceptibility. As commercially available tests differ in the specific genes analyzed (as well as classification of variants and many other factors), choosing the specific laboratory and test panel is important. For many of these genes, there are limited data on the degree of cancer risk and there are no clear guidelines on risk management for carriers of pathogenic/likely pathogenic variants. Not all genes included on available multi-gene tests are necessarily clinically actionable. As is the case with high-risk genes, it is possible that the risks associated with moderate-risk genes may not be entirely due to that gene alone, but may be influenced by gene/gene or gene/environment interactions. In addition, certain pathogenic variants in a known pathogenic/likely pathogenic variant alone to assign risk for relatives. It is for these and other reasons that multi-gene testing is ideally offered in the context of professional genetic expertise for pre-and post-test counseling. One or more first-degree relatives[B] diagnosed with colorectal cancer or Lynch syndrome related tumor[A] before age 50 years iii. One or more first-degree relatives[B] with colorectal or endometrial cancer, and another synchronous or metachronous Lynch syndrome-related cancer iv. Two or more first-degree[B] or second-degree[C] relatives diagnosed with colorectal cancer or Lynch syndrome-related tumor, [A] with at least 1 diagnosed before age 50 years v. Histology that is suggestive of the need to perform microsatellite instability testing includes tumor infiltrating lymphocytes, Crohn-like lymphocytic reaction, mucinous or signet ring differentiation, or medullary growth pattern 2. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. The neurostimulator includes a lead set with surface electrodes and a needle electrode, which produces an adjustable electrical pulse that travels to the sacral nerve plexus via the tibial nerve. The sacral nerve plexus then regulates the bladder and the pelvic floor functionality. The complaint by the individual who considers that he/she voids too often during the day. The complaint that the individual has to wake at night one or more times to urinate. The complaint of a sudden compelling desire to pass urine, which is difficult to defer. Failure/intolerance/contraindication to pharmacotherapy with 2 overactive bladder medications such as an anticholinergic and/or 3 agonist administered for 4Â8 weeks Limitations/Exclusions 1. Response is defined as 50% improvement in voiding symptoms (based on documentation such as patient voiding diaries). Implantable tibial nerve stimulation not considered medically necessary due to insufficient evidence of therapeutic value. The indication of failure/intolerance/contraindication to pharmacotherapy with 2 anticholinergic medications and/or smooth muscle relaxants was clarified to include overactive bladder and 3 agonist medications. Applicable Procedure Codes 64566 Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming Posterior Tibial Nerve Stimulation for Voiding Dysfunction Last review: Jan. Nonsurgical treatments for urinary incontinence in adult women: diagnosis and comparative effectiveness. Rhinoplasty Last Review Date: March 13, 2020 Medical Guideline Disclaimer Property of EmblemHealth. All of the aforementioned entities are affiliated companies under common control of EmblemHealth Inc. Performed in conjunction with a septoplasty for nasal airway obstruction when the nasal deformity contributes to the airway obstruction and septoplasty criteria are met. Performed as part of reconstruction for severe deformity when documented obstructive breathing symptoms secondary to any of the following are present: · Excision of a nasal abscess. Documentation of care by 1 the Plan must receive substantiating documentation that demonstrates the presence of nasal obstruction as a prerequisite to a medical necessity evaluation by a Medical Director. Vestibular stenosis for prolonged nasal obstruction which is moderate to severe, separate from obstruction caused by deviated septum or turbinate hypertrophy, and causing problems such as breathing difficulty, bleeding, or sinusitis Limitations/Exclusions Rhinoplasty is not covered when any of the following are applicable: 1. Performed solely to change appearance in the absence of any signs or symptoms of functional abnormalities or nasal defects, as this would be considered cosmetic. Applicable Procedure Codes 30124 30125 30400 30410 30420 30430 30435 30450 30460 30462 30465 Excision dermoid cyst, nose; simple, skin, subcutaneous Excision dermoid cyst, nose; complex, under bone or cartilage Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip Rhinoplasty, primary; including major septal repair Rhinoplasty, secondary; minor revision (small amount of nasal tip work) Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) Rhinoplasty Last review: Mar. Join a research e ort with one million or more people nationwide to create a healthier future for all of us. The articles written herein are a snapshot in time of an evolving, all-consuming worldwide pandemic, and we hope they are still accurate and relevant as you read them. Protests, most peaceful, some less so, have been raging in this and many other cities since the brutal killing of yet another unarmed black citizen by agents of the state. The protests were certainly triggered by police brutality, but have come to be infused, inevitably, with a much broader outcry against systemic racism. They could just as easily be about the staggering disproportionate effect of the coronavirus outbreak on black communities, where the mortality rate is about two and a half times higher than white Americans. Many of the changes to healthcare systems that we are witnessing now will likely be an engrained part of care delivery long term. You can read more about the registry here in this issue, and we hope you will participate. The grant allows reimbursement of related expenses to be dated back to January 20, as well as throughout the rest of the year. Applications are due by July 10, 2020, with an anticipated project start of September 1, 2020. Health networks can be an effective strategy to help smaller rural health care providers and health care service organizations align resources, achieve economies of scale and efficiencies, collaboratively address challenges, and create impactful, innovative solutions. The kit is then mailed back to the lab with test results returned to the clinician who acts on results accordingly. Such a long-acting prevention method may offer an easier, discreet option that may be more desirable for some people. Most participants in the cabotegravir group (80%) reported pain or tenderness at the injection site, compared to only 31 percent of those in the Truvada group, who received placebo injections. All study participants, including those who initially received Truvada, will be offered long-acting cabotegravir as soon as it can be made available. Two-thirds of study participants were under 30 years of age, and 12 percent were transgender women. Half of the participants in the United States identified as black or African American. Participants were randomly assigned to receive either injections of cabotegravir and placebo oral tablets or placebo injections and daily oral Truvada tablets. Neither the participants nor the study team knew who was receiving which medication. Supreme Court announced that it would review the decision from the Fifth Circuit Court of Appeals, which ruled that the individual mandate was unconstitutional and indicated in remanding the case that it likely cannot be severed from important aspects of the rest of the law. Oral argument is expected to take place in the Fall of 2020 and a decision would likely happen by the end of the term in the summer of 2021. As a country, we must ensure access to health insurance and comprehensive, affordable care. California, led by Texas on behalf of that state, Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, and West Virginia. Lambda Legal Senior Attorney and Health Care Strategist Omar Gonzalez-Pagan, Counsel Gregory R. It includes a patient-facing app, a provider-facing app, a web portal for providers, and an on-line training system. It provides important tools that support self-monitoring, care coordination, and social support-all in a secure mobile app. They also permit "texting"-like messaging in a health system-approved environment that allows for the flexibility and efficiency of texting. Ingersoll and their team have documented the impact of PositiveLinks in a demonstration project with the first 77 enrollees. These positive results have now been extended to 24 months, as reported in a recent publication. Caceres opened his private practice integrating computer technology into the day-to-day real world of medical practice. Alozie attended medical school at the University of Benin Medical School in Benin, Nigeria. His education in the developing world was public health-focused and centered on issues like water, malaria and tuberculosis. Alozie recalls, "Truthfully, I really had no idea how Ryan White funding mechanisms worked, what 340B was, or how to grow a team and clinic. Alozie recalls, "As I began my career, initially my desire was to become a cardiologist. Of their total patients, 88 percent are male, 12 percent are female, which has remained consistent over the years. Alozie is driven by public health and epidemiology and is constantly analyzing data to improve systems of care. They leverage technology to engage patients and ensure they have access to care, particularly with newer populations of young `digital natives. They had been put on hospice care, other physicians told them they were going to die so their families had given up. We must stay dedicated to continue to look for ways to improve the systems and educate, educate, educate! For the last two years, he has volunteered and worked with friends to set up public health and eye exam fairs in areas within Nigeria. I am dedicated to educating the next generation, being available for them to ask questions and learn from my speeches and presentations. It was organization that conducted continuing education and outreach, which is what piqued my interest, and I became drawn to it. Determining the exact prevalence is difficult for several reasons: Trichomonas is not a reportable infection, there is a low sensitivity of wet mounts, and many infections are asymptomatic. Factors that were associated with Trichomonas vaginalis were younger age at sexual debut, greater number of sex partners, and a history of Chlamydia infection in the past year. Other clinical manifestations include vulvovaginal itching, burning, dyspareunia, dysuria, post coital bleeding, lower abdominal discomfort. Although several flagellate genera parasitize humans, only four, Trichomonas, Giardia, leishmania, and Trypanosoma, commonly induce disease. Three members of the genus trichomonas parasitize humans but only one, Trichomonas vaginalis, is an established pathogen. Trichomonas vaginalis is oval and measures 7um by 15um and has five flagella that arise anteriorly (Figure 1). Trichomonas can be isolated in the vagina, cervix, urethra, bladder, Bartholin glands, and Skene glands where they replicate by binary fission. The organism is commonly isolated from vaginal secretions in women and symptoms can range from none to pelvic inflammatory disease. Women often present with an abnormal vaginal discharge which may be purulent, the most common method for diagnosing Trichomonas vaginalis is by a wet mount because it can be done in the office by obtaining a swab of vaginal secretions, looking under the microscope, and making a quick diagnosis; however, the sensitivity from vaginal secretion is very low 51Â65 percent. In addition, the sensitivity declines over time and is decreased by 20 percent within 1 hour after collection. If you are relying on this test, you are most likely missing the diagnosis of Trichomoniasis. It has a sensitivity of 75 percent to 99 percent and a specificity of up to 100 percent. However, it requires that you have the culture medium, Modified Diamonds Medium or other media formulated to support the growth of Trichomonas vaginalis, readily available in your office and it needs to be inoculated immediately. Modified Diamonds Medium has been found to be an effective medium for the culture of this organism. In addition, women who present with vaginal complaints should be tested for Trichomonas vaginalis. Patients were randomly assigned to treatment with metronidazole 500 mg twice daily for 7 days or with metronidazole 2g in a single dose and the seven day treatment group had a lower rate of positive cultures 6 to 12 days after treatment completion (8. Providers need to be familiar with Trichomonas and its clinical presentation, diagnostic dilemmas, treatment considerations, and complications. Prevalence of Trichomonas vaginalis among civilian, noninstitutionalized male and female population aged 14 to 59 years: United States, 2013 to 2016. Fox) who is thrown back 30 years into the past when an experiment by his eccentric scientist friend Doc Brown (Christopher Lloyd) goes awry. Marty recognizes that he must ultimately return to his own time, using what has been learned and achieved in order to save a life. For certain, the two pandemics have a number of important similarities as well as differences. Modern electronic media offer means for more efficient communication and data sharing. Denial, a very human initial defense mechanism when coping with a new and frightening reality, can become extremely dangerous when it hampers a prompt and effective response to that reality. It also justified the policies of some nations which would not sustain the cost and effort to make treatment available, resulting in countless additional infections and lives lost. Li, who subsequently contracted and died of the infection, was initially discredited by his government. This may take the form of public advocacy, by means of financial and/or volunteer support for healthcare organizations, political activism.
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