Department of Critical Care Medicine, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, Australia
Previously high density cholesterol foods simvastatin 20mg sale, occupational contact with animal faeces cholesterol test price in pakistan simvastatin 5 mg without prescription, living on a farm and contact with cattle have all been described as risk factors for Campylobacter infection [15] cholesterol table buy simvastatin 20mg low cost. Many of the patients who suffer from these gastrointestinal diseases may be receiving long-term treatment with acid suppressants cholesterol and eggs 2012 order simvastatin 20mg line, such as proton pump inhibitors (omeprazole) and H2 antagonists cholesterol in eggs nutrition order simvastatin 40mg with visa. To our knowledge xanthelasma/ cholesterol eyelid deposits cheap simvastatin 10mg line, the independent association between lower bowel problems and campylobacteriosis has not been previously reported. The biological plausibility of this finding is unclear, particularly, as data were not collected on specific diseases of the lower bowel. It is possible that some conditions or their treatment may lead to a prolonged gastrointestinal transit time and slow clearance of the organism. Alternatively, this finding may be due to a bias, as the case ascertainment for campylobacteriosis may have been higher for patients with pre-morbid bowel problems who may be more likely to submit a faecal stool sample. However, more research is needed to clarify this apparent effect and the mechanisms behind it. Protective factors the role of mains water supply as a protective factor is interesting. It has been previously reported that inadequately treated water may cause Campylobacter infection in humans and this pathogen was implicated in several waterborne outbreaks in some countries [3842]. In addition, a recent ecological study in Sweden indicated that water might be an important route of transmission for Campylobacter infection [43]. Water can be contaminated through animal faeces [44] and sewage and some Campylobacter strains can survive for long in untreated water sources [45]. In this study, cases were twice more likely to drink water from a source other than the mains water supply. This association, however, was not statistically significant probably because this exposure was uncommon (reported only by 13 cases and 7 controls). It is possible that the protective effect of the public water supply reflects the association of infection with sources of untreated water. Many of the other protective factors (mainly food items such as beef, turkey and salad vegetables other than lettuce) might indirectly confirm the association with chicken and lettuce as our data suggest that controls, who ate chicken or lettuce less frequently than cases, were more likely to replace those food items with another kind of meat (including poultry) or salad vegetable respectively. It is possible that these individuals may have a healthier life-style and therefore be less prone to infections or may have engaged in some practices, not evaluated in the study, which protect them from Campylobacter infection. Limitations of the study the study only involved campylobacteriosis cases reported through the routine surveillance system, that constitute a subset of all cases occurring in the community. In addition, due to the relatively low response rate and the matched design of the study, cases that were included in the analysis may have not been representative of all reported cases. However, the available demographic data (age and gender), suggest that there were no statistically significant differences between participant and non-participant campylobacteriosis cases reported to the health authorities. All Campylobacter species were included in the case-definition and no information on speciation was collected. Controls were not randomly selected from the source population, which would have assured their representativeness in terms of the exposures, but were case-nominated. Choosing controls among friends, work colleagues and neighbours might lead to over-matching, as cases and controls may be similarly exposed to common risk factors (especially food). In addition, some of the controls may have come from the same household as the cases. This effect, however, may have only reduced the strength of E U R O S U R V E I L L A N C E Vol. We excluded those cases and controls from the analysis, whenever this was evident. As in all case-control studies, cases as a result of their illness may be more able to recall exposures than controls, which may result in recall bias. However, cases that received their questionnaire long after their onset of symptoms in this study (median delay 16 days), may have reported a list of food preferences rather than their definite food exposures. This may have been less of a problem for controls, as exposure period referred to the week prior to their completing the questionnaire, i. Surveillance data have shown increased incidence of Campylobacter infection in rural areas compared to urban areas and studies have suggested that exposure to risk factors may be different for people living in rural compared to those in urban areas [46]. Accurate knowledge of the geographical distribution of cases and controls would have been of added value, and it could have potentially resulted in different guidelines for rural and urban areas. The findings of this study therefore, highlight the need for an improved and more efficient approach to basic food-hygiene measures to prevent campylobacteriosis and other infectious gastrointestinal illnesses in the community. Further measures are needed throughout the food chain from production, transport, retail and catering to reduce the risk of contamination and cross-contamination. Improved catering practice, whether in the domestic or commercial setting, is an important last line of defense in reducing exposure to potentially Campylobacter-contaminated products. In addition, it is essential to raise awareness in the population of the importance of good basic food-hygiene practices, using means of communication easily and readily accessible. Further efforts are needed to identify the defective points in the food chain and enable appropriate measures to reduce the overall burden of this infection in the Irish community. Linkage of epidemiological data with Campylobacter speciation and the development of new molecular diagnostic tests will also provide a greater understanding of Campylobacter infection. Risk factors for domestic sporadic campylobacteriosis among young children in Sweden. Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites. A multicentre prospective case-control study of campylobacter infection in persons aged 5 years and older in Australia. Risk factors for sporadic Campylobacter jejuni infections in rural Michigan: a prospective case-control study. Risk factors for indigenous Campylobacter infection: a Swedish case- control study. Risk factors for campylobacter infection in infants and young children: a matched case-control study. The public health laboratory service national case-control study of primary indigenous sporadic cases of Campylobacter infection. An outbreak of Campylobacter infection associated with the consumption of unpasteurised milk at a large festival in England. A case control study to determine risk factors for campylobacter infection in Christchurch in the summer of 1992-3. A comparative study of thermophilic Campylobacter isolates of clinical, food and pet origin. Campylobacter contamination of raw meat and poultry at retail sale: identification of multiple types and comparison with isolates from human infection. Outbreak of Campylobacter enteritis associated with cross-contamination of food-Oklahoma, 1996. General outbreaks of infectious intestinal disease linked with salad vegetables and fruit, England and Wales, 1992-2000. Risk factors for outbreaks of infectious intestinal disease linked to domestic catering. Update-Outbreak of Salmonella Newport infection in England, Scotland, and Northern Ireland: association with the consumption of lettuce. A study of cross-contamination of foodborne pathogens in the domestic kitchen in the Republic of Ireland. Fluoroquinolone-resistant Campylobacter infections: eating poultry outside of the home and foreign travel are risk factors. Omeprazole as a risk factor for campylobacter gastroenteritis: case-control study. Evaluation of the effect of temperature and nutrients on the survival of Campylobacter spp. A case-cohort study to investigate concomitant waterborne outbreaks of Campylobacter and gastroenteritis in Soderhamn, Sweden, 2002-3. A large outbreak of campylobacteriosis associated with a municipal water supply in Finland. Detection, isolation, and molecular subtyping of Escherichia coli O157:H7 and Campylobacter jejuni associated with a large waterborne outbreak. Factors associated with increased and decreased risk of Campylobacter infection: a prospective case-control study in Norway. Association between environmental risk factors and campylobacter infections in Sweden. Hazards of healthy living: bottled water and salad vegetables as risk factors for Campylobacter infection. Risk factors for sporadic Campylobacter infection: an all-Ireland case-control study. University of Siena, Department of Physiopathology, Experimental Medicine and Public Health 2. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The degree of endemicity is closely related to hygienic and sanitary conditions, the socio-economic level and other development indicators [2]. Nevertheless, Italy is considered to be an area with low/intermediate endemicity of hepatitis A. However, the epidemiological situation varies from region to region within Italy [4]. The practice of consuming contaminated raw seafood still causes outbreaks, especially in southern Italy. Moreover, in 2004 another outbreak, involving 882 cases, was described in Campania [8]. Since 1998, after a large epidemic of hepatitis A, the Puglia region (south-eastern Italy) has introduced a free-of-charge mass vaccination program (the first ever in Italy since safe and highly effective hepatitis A vaccines became available in 1995) for newborns (15-18 months of age) and adolescents (12 years of age), as part of the routine immunisation schedule, in order to reduce transmission [9]. For this reason, since 2001, when the Italian National Health System was decentralised, the regional health authorities have implemented vaccination strategies according to their own judgment. However, the region of Tuscany does not include hepatitis A vaccination in the regional infant and adolescent immunisation calendar. Preventive hepatitis A vaccination, however, is considered, in Tuscany and all other Italian regions, for close contacts of clinical cases as control measure in case of an epidemic. Moreover, although hepatitis A is usually a self-limited disease, the likelihood and severity of symptomatic illness are age-related. In the last decade, in Italy, a progressive reduction of the prevalence of the infection in children, teenagers and young adults has been described. However, the symptomatic/asymptomatic ratio and the percentage of patients with a more severe clinical presentation have progressively increased [15]. Serum specimens were obtained by using leftover serum from specimens taken for diagnostic purposes and submitted to the Laboratory from individuals who received care in the University Hospital of Siena. The sera collected from the two ranges of age were randomly selected from the laboratory stock. Samples were collected anonymously and only the age of the subject and the date of the sample were recorded. A total of 565 sera (283 for the age group 1-5 years and 282 for the age group 15-20 years, approximately 100 samples for each year) were collected and stored at -20°C. Thus, 556 samples were included in the statistical analysis, as the nine giving ambiguous test results were excluded (Table). Serological test Serological testing was performed at the Department of Physiopathology, Experimental Medicine and Public Health of the University of Siena. According to the manufacturer, the test has a sensitivity and specificity of 100%. There also is no way of determining whether the positive test results are due to past infection or due to vaccination. Detection of hepatitis A IgG antibodies indicates either past infection or vaccination. The statistical analysis was performed by Epi Info version 6 program using the chi-squared (2) test, as well as 2 test for trend to evaluate possible tendencies. The nine specimens with equivocal results were eliminated from the statistical analysis. Among these, five were taken from 1-5 years old children (four males, one female) and four were from patients aged 15-20 years (two males, two females). Discussion and conclusion the results of this study showed an increasing trend of the seroprotection rate in children aged 1-5 years with a particularly high antibodies titre in 2004 (2 for linear trend=10. However, this is not enough to support the presumption that there is an increasing trend in the risk of infection in young adults. These results must be considered cautiously because the samples studied cover only three years (1992, 1998 and 2004) during a period of eight years (from 1992 to 2004). In the past few years similar studies have been conducted in Italy but only two described the situation in the whole country. However, direct comparisons with these studies are difficult due to the differences in the age groups considered. The other study performed on sera collected in 1997-1998 showed a prevalence of 34. Other seroepidemiological investigations have only been conducted in specific areas or among certain risk groups. In conclusion, information regarding the current status of hepatitis A immunity, including the seroepidemiological survey described here, is crucial for providing new and timely parameters useful for mathematical modelling, such as the one proposed and investigated for temporal trends in southern Italy [22]. A vaccination program for risk groups, travellers and food handlers would be suitable for the control of this virus at present, however, the current epidemiological situation in Italy does not suggest the need for mass vaccination of newborns and adolescents outside the endemic areas, such as Puglia and Campania. The same is true in other southern European countries, such as Spain, where universal immunisation seems economically uneffective and sufficient evidence for targeted vaccination has not yet been gathered [4]. Determinants of acquiring hepatitis A virus disease in a large Italian region in endemic and epidemic periods. Epidemiological and virological characterization of a large community-wide outbreak of hepatitis A in southern Italy.
It is actually a link between the nervous and endocrine systems because it regulates the hormonal secretions of the pituitary cholesterol score test simvastatin 40 mg mastercard, the adrenal cortex cholesterol levels pregnancy order 40 mg simvastatin free shipping, the gonads high cholesterol foods healthy cheap simvastatin 40mg line, and the thyroid either by direct or indirect hormonal stimulation ldl cholesterol levels new zealand purchase simvastatin 40mg. The hypothalamus regulates thirst milligrams of cholesterol in shrimp order 5 mg simvastatin fast delivery, hunger cholesterol absorption inhibitor cheap 40 mg simvastatin amex, body temperature, sexual activity, and emotional behavior as well as allergic and immune responses. It relays sensory messages, such as pain, and governs many autonomic functions so that you do not have to think about breathing or regulating your temperature or your blood flow. You can just relax and read your book because you are on automatic pilot with the hypothalamus. If you take one of these human nuclei from the suprachiasmatic nucleus and put it in a petri dish, it will exhibit its own independent electrical firing. But what is really interesting is that it maintains a circadian rhythm, with a periodicity that never deviates more than tiny amounts from the 24-hour cycle (Hastings, 1998). The suprachiasmatic nucleus is our A Review of Classic Physiological Systems 7 biological clock. If we take one of us, put us in total isolation, the suprachiasmatic nucleus will keep going. There is a whole field of chronobiology that has been developed over the past 20 years. The pituitary gland, which is about the size of a pea, hangs on a stalk from the hypothalamus and is controlled by the hypothalamus. Medical students have always been taught that the pituitary gland is the "master gland," but it really is not the master gland. The pituitary stores hormones and secretes them according to instructions given by the hypothalamus. The pituitary and the hypothalamus combined are, however, a major neuralendocrine control center. Until about 240 million years ago, vertebrates had a third eye on the top of their head. This third eye was historically a photosensitive organ, and today it appears in a modified form as the pineal gland, still with photosensitive qualities. Ancient literature refers to the third eye, the pineal gland, as the seat of wisdom or light, which, as we will see in the latter chapters of the book, would make sense. The pineal gland is the "master gland," and in the chapter on the pineal gland (Chapter 10), we will explain in great detail why it is our master gland. The pineal gland lies on top of the third ventricle posterior to the corpus callosum. It regulates neuroendocrine functions, transfers environmental information to the appropriate internal structures, and helps to regulate the immune system. Consisting of scattered but interconnected regions of gray matter, it is our emotional brain. It receives all incoming sensory input and is capable of output to motor, endocrine, and visceral systems. The limbic system is also central to our memory, and as we will see, emotion and memory are integrally related. The limbic system is made up of various processes, including the cingulate gyrus, fornix, and mamillary body. But the processes that we will concern ourselves with here are those of the amygdala, the hippocampus, and the subiculum as well as the thalamus and hypothalamus, which we just reviewed. The amygdala, which means "almond" after its shape, is our center for incoming sensory input for fear, rage, aggression, and sexual feelings. If you were afraid of speaking in front of a lot of people, your adrenal gland would be producing both cortisone and adrenaline. The amygdala says: "Audience, audience in front of you, everyone is looking at you. If so, a fear response, or what was initially described by Walter Cannon in 1914 as the "fight or flight" response, is triggered (Cannon, 1914). Research on the amygdala shows that there is severe impairment in the recognition of fear with patients whose amygdala has been destroyed. Studies reveal that the amygdala is involved in gaze direction and interpretation of facial expressions (Adolphs et al. Scientists at the University of Wisconsin at Madison are carrying out research on the amygdala to learn about its association with negative emotions. They place wire meshes, which are capable of registering the electrical activity of 128 different brain sites, on the heads of subjects. There is evidence that this prefrontal A Review of Classic Physiological Systems 9 portion of the brain has a memory for the representation of elementary positive and negative emotions (Davidson and Irwin, 1999). Children who are depressed produce the same results of right and left frontal cortex variation as well as difficulty with processing the correct affective face as it is presented to them in pictures (Davidson and Slagter, 2000). This research indicates that the young brain is perhaps more vulnerable to the detrimental effects of severe stress than the adult brain. This pattern of reaction inevitably brings hopelessness and despair to the individual. Furthermore, it could well be the physiological setup of the fear conditioning that occurs in posttraumatic stress disorder (Yehuda, 2000; Baker et al. Notably, the prefrontal cortex dominance pattern also is associated with the health of the immune system. The hippocampus, which means "sea horse" after its shape, lies just next to the amygdala. What is crucial to understanding the whole theory of integral physiology is to bear in mind that the hippocampus is a huge filing cabinet for your personal memories. In particular, it stores memories that are associated with trauma and deeply imprints them in the memory. As will be discussed further in Chapter 3 on stress, the subiculum principally serves as an interface for memory and other types of information processing between the hippocampus and the neocortex. It takes a lot of work to change them, and this is the key, in my mind, to the healing process. It is possible, however, to erase traumatic memories or to override them with the cognitive functions of the higher-ordered brain. This synthesis permits it to establish an integrated autonomic, neuroendocrine, and behavioral response to external and internal stimuli. Nerves branch out at each segment of the spinal cord to innervate the various visceral motor organs (see Figure 1. Autonomic means self-regulating, so these organs are all capable of functioning without our conscious thought. However, we are capable of consciously altering certain visceral responses, such as heartbeat rate. What we are seeing here are new pathways, new tracks by which information may be conveyed and by which systems may communicate with one another. The amazing cacophony of intricate neural wiring that will respond to stimuli in the sympathetic nervous system is all regulated by that little walnut-sized hypothalamus. If you tried to perform the same experiment with a heart vessel, no peristaltic reflexive action would occur, so this was an amazing finding. Trendelenburg showed that the gut has a nervous system all its own, yet his work somehow was lost from scientific practice and study. Although, until the past 10 years or so, medical students have rarely been given this information. However, all of this information was recently brought to light by a physician, Dr. The scientific community adheres to the premise that there are two neurotransmitters that run the parasympathetic system: acetylcholine and norepinephrine. In 1981, his colleagues, not being able to deny the results of their own research, finally accepted this fact. Since that time, Gershon and others have determined that serotonin, in addition to being an enteric system neurotransmitter, is also a signaling molecule that is secreted by specialized, nonnerve cells in the gut lining. Serotonin works within the mucosa to stimulate sensory nerves that carry out peristaltic and secretory reflexes. In addition to serotonin, there are numerous other neurotransmitters that have been identified from enteric neurons. All of this is very interesting when you consider how we refer to our "gut feelings. Similarly, when I do rounds in the hospital, I might say to a nurse or another doctor that I have a gut feeling that the patient in bed number 4 is not going to make it. When we talk about our gut feelings, it is my contention that we are actually referring to our intuition (a far less acceptable term to use in the medical setting). Our gut has a brain of its own that seemingly can facilitate or collaborate with our mind or our intuition. As a result of the work of Gershon and others, the scientific community is beginning to understand that medical problems in the enteric system may actually be localized there. Acceptance of this premise has opened the way to research and discoveries on treatment for gastrointestinal diseases, such as irritable bowel syndrome. We wrote of his theory that the forebrain of humans anatomically and chemically has common features with reptiles, early mammals, and late mammals (see Figure 1. MacLean explains that in the evolutionary transition A Review of Classic Physiological Systems Mammalian (neocortex) 13 Paleomammalian (limbic system) Reptilian figuRe 1. These developmental changes, he theorized, correlated with the evolutionary development of the thalamocingulate division of the limbic system, which does not appear in reptiles and which concerns emotion. In support of this theory, other researchers conducted an experiment that involved damage to the limbic, thalamic, and cingulate portion of female rat brains by seizureinducing injections of lithium and pilocarpine. The first of our triune brains, then, has to do with our reptilian nature, which is controlled by the brainstem. The reptilian response to a stimulus is different from the fright one might experience before giving a lecture. So, even before you feel the nail, the information is transmitted up to the brain. This is the brain that is concerned with feelings and emotions and is much like that of our pet dogs or cats. However, pets have absolutely no sense of time, no sense of prioritized thinking, and no ability to dream of the future. Therefore, animals are not really subject to the acculturation processes that humans are. The third brain is the human brain, which is affiliated with the limbic system, but controlled by the prefrontal neocortex. The human brain is capable of higher cognitive processes, of perceiving time, and of pondering the spiritual self. The triune brain is sometimes inaccurately described as simply an evolutionary process culminating in the human brain. However, our brains should more correctly be thought of as a dynamic interaction of the evolutionary trends of the three. Richard Davidson, PhD, at the University of Wisconsin, Madison states: "We now know that emotion is not all subcortical, and thought or cognition is not all cortical. As we develop as individuals, we have the daunting task of effectively integrating our so-called three minds. Electrical impulses, carried by neurons, move information to various locations, but they communicate with each other in a chemical language via neurotransmitters. In Section 2, entitled "The Endocrine System," we will review more fully the chemical, or hormonal, modes of communication. As already mentioned, the neuron is the basic unit of communication or information processing in the nervous system. Dendrites increase the available area for a neuron to receive incoming information. The axon is wrapped in a fatty coating called a myelin sheath, which is like a coat of insulation that preserves electrical impulses. The sympathetic nervous system is myelinated, and the parasympathetic is unmyelinated. Multiple sclerosis, for instance, occurs when the myelin sheath is disturbed or destroyed, preventing the electrical impulses from being transmitted properly. After processing A Review of Classic Physiological Systems 15 this information, if the brain determines that a motor response is needed, it sends the message via the motor neurons, and your body moves. When a neuron is at rest, there is a steady voltage difference across its plasma membrane. This is a get-up-and-go message, causing a brief reversal in voltage across the plasma membrane. Action potentials arise and move rapidly along sensory and motor neurons because of the myelin sheath. When the action potential reaches the postsynaptic output zone, it either just stops or it may release a neurotransmitter that passes the message along. They can be either excitatory, causing the receiving neuron to continue passing the electrical impulse, or inhibitory, stopping the chain of electrical firings. The neurotransmitter "jumps" between the axon terminal of the presynaptic neuron to the receptor molecules located on the postsynaptic neuron to pass along information. The region of communication between two neurons is called a synapse, which is illustrated in Figure 1. Presynaptic nerve cell Axon Action potential Synapse Neurotransmitter vesicles Diffusion of neurotransmitter Postsynaptic nerve cell figuRe 1. The first nerve cell is called the preganglionic nerve, and the second nerve to receive the message is called the postganglionic nerve. The neurotransmitter for sympathetic and parasympathetic preganglionic and for the parasympathetic postganglionic neurons is acetylcholine.
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Competing interests statement the authors declare competing interests: see Web version for details. This report would not have seen the light of day had it not been for the hard work put in by many of the authors despite having full-time responsibilities in their respective areas of work. In addition to the principal authors, many others provided research support behind the scenes to further enrich the various chapters of the report. This Africa Migration Report has come to fruition under the guidance of an engaged and watchful editorial team who worked to ensure a high-quality product. We are also grateful to the Office of the United Nations High Commissioner for Human Rights and Kenya National Commission on Human Rights for their input in ensuring that the report had a crosscutting human rights perspective. Initial work by Joy Kategekwa of the United Nations Conference on Trade and Development African Union Office on the interlinkages between migration and trade must also be acknowledged. My sincere appreciation goes to colleagues at the African Union Commission, Department of Social Affairs, most especially Sabelo Mbokazi and Evelyne Nkeng-Peh, who tirelessly oversaw all inputs and feedback from the Commission. I wish to also acknowledge the contribution of Corrado Fumagalli, who in addition to being an overall co-editor, was involved in the conceptualization of this endeavour. This report has benefitted extensively from the decades-long experience and migration knowledge of Gervais Appave, who even in retirement, took time out to review some of the chapters of the report. Distribution of international migrants residing in Africa and destinations of migrants from Africa. Child and young migrants as a percentage of the migrant stocks by host region, 19902019. Migration as a topic has today taken centre stage in policy discourse in Africa as in much of the rest of the world, evidenced by the adoption of two global compacts Global Compact on Refugees and Global Compact for Safe, Orderly and Regular Migration (Global Compact for Migration) that seek to deal with human mobility more holistically. The chosen theme of this inaugural edition Challenging the Narrative could not be more fitting given the myriad misconceptions, myths and fears around migration that persist. In recent years, the migration crisis in the Mediterranean has sadly become the poster child for African migration. The desperation that characterizes migration across the Mediterranean has reinforced the perception that African migration is a south-to-north movement, with African migrants taking extreme measures, often at the risk of life and limb, to harvest the promise of Europe. It goes without saying that African migration goes beyond images of the rickety boats on the Mediterranean or conflict-induced displacements that we see in the media. While these certainly have a place in the narrative, the larger frame of the story is as complex and diverse as the people of the continent itself. It is a story that includes subregional, regional and cross-regional aspirations for enhanced integration, and with it, the recognition that migration in Africa today has the potential to drive continental development and transformation. Contrary to conventional belief, the data clearly demonstrates that far more Africans migrate across land borders than cross seas and oceans. This first edition therefore seeks to provide additional perspectives that ensure a more complete understanding of this complex phenomenon, thereby correcting misconceptions regarding African migration. The report provides a status update on the breadth of issues that characterize migration on the continent from which both practitioners and policymakers can draw to inform their actions. The three big white curved lines are like a violent wind enabling the sheets to follow the wind whichever way it blows. The curved sheets on the map of Africa represents the potential in freedom of mobility across borders, the potential free movement has in contributing to safe and protected migratory journeys, and its benefits for continental integration. The shadowed Africa and the meridian-like lines means that African migrants all over bring their identity with them, consciously contributing to the development of the continent. Three reasons are identified for the distortions that characterize the current narrative on African migration: (a) most African migrants are not crossing oceans, but rather crossing land borders within Africa; (b) 94 per cent of African migration across oceans takes on a regular form; and (c) most global migrants are not African. Africa accounts for 14 per cent of the global migrant population, compared, for example, to 41 per cent from Asia and 24 per cent from Europe. These fortify the need to retell the story that is largely about intraAfrican migration, contrary to the horrific sensationalized impression of irregular migration from Africa through the Mediterranean. This chapter sets the tone for other chapters that follow by emphasizing the need to move past the Western approach and amplify African voices in the migration dialogue by providing answers to the following questions: What would an African approach to mobility look like? Although Africa hosts a quarter of the refugee population, only two thirds are nationals of 5 countries out of 54 on the continent. There is a call for a new narrative on contemporary African migration that focuses largely on intra-African migration, as demonstrated in the endless daily border crossings by traders, many of them market women who are simply trying to eke out a living. Contrary to the impression of mediatized horrors of irregular migration from Africa through the Mediterranean, most African migrants are not crossing oceans, but rather crossing land borders. Understanding the various narratives that exist on migration within, to and from the continent, requires a look at the realities in terms of evidence from different countries, the lens through which migration is looked at and the impact the narrative has had on the response to migration at the national, regional and continental levels. Their movement brings advantages to their families and communities, and therefore to their nations. Some reports have suggested that 94 per cent of African migration across oceans takes on a regular form. Looking more closely at voluntary migration, the focus is always on the economic impact and/or role migrants play in their countries of origin and/or host countries. Trade, especially within African States, is motivated by economic opportunities available in each country. Hence, within regions and between countries, there is a lot of cross-border migration on the continent. For instance, the border between Rwanda and the Democratic Republic of the Congo, between the towns of Rusizi and Goma by some estimates, experiences up to 30,000 people a day cross the borders between these two towns. Most are itinerant traders from the Democratic Republic of the Congo bringing bananas, pagne (fabric) and other goods to the markets in Rusizi. There are also Rwandese traders taking finished goods like clothes, small electronics and packaged commodities from further afield across the border. Almost everything will be processed in a matter of minutes before going on their way. Whereas the Beitbridge border post that forms the political border between South Africa and Zimbabwe remains the busiest road border post in Southern Africa. The border post is open 24 hours a day, facilitating daily movement of more than 30,000 people between South Africa and Zimbabwe for trade and other reasons. The cross-border trade is in response to the economic opportunities between the two countries and plays a significant role in servicing consumer needs in both countries by providing low-priced goods and supplementing those that are not available in the market. These border posts illustrate the efforts towards the facilitation of mobility on the continent, notwithstanding the numerous hurdles to human mobility at African border crossing points. The very existence of these border crossings challenges presumptions about human mobility in Africa. It often begins either with the forcibly displaced and their presumed impotence, or with elites frustrated at the impotence of their national passports and assumptions that effective migration policymaking is of necessity and resource intensive. The existing reality of African migration is that Eurocentric approaches to managing migration currently dominate domestic and regional policymaking on human mobility in Africa. The securitization of borders in the Sahel, for example, appears to respond mostly to European security imperatives and not nearly enough on the reality of thousands of years of itinerant trade across the Sahara Desert. However, recent discussions and debates in Europe show a shift in understanding the African migration reality. Bjarnesen (2020) argued that political debates were selective and misleading in terms of the information they had on African migration, which has contributed to the distorted narrative of African migration to Europe. The reality is that African migration in Europe has been constant for over a decade, and the number of arrivals through the Mediterranean has dropped since 2015 and not increased. Whereas within Africa, the demand for passports and biometrics at Namanga and Lunga Lunga in East Africa obscures the reality of a Maasai population that are a nomadic community spread between Kenya and the United Republic of Tanzania, and of a Swahili kingdom that once spanned the East African coastline between Mogadishu and Biera. This is the reality of how Africa moves, not in response to colonial borders but to local and regional histories and imperatives. There is a need to recognize these historical movements that were not governed by any policy and law prior to colonialism and still exist in practice today. Yet the media is sometimes awash with misleading stories and images of stranded African migrants, even when these are mostly asylum seekers from war-ravaged regions of the Middle East. While both extrapolate existing data based on reported evidence on migration, there is limited specialized media reporting to research the truth behind the numbers. Landau, the media is lazy and often report data as they are reported without undertaking specialized reporting. Second, there are few journalists who take up specialized reporting within the continent, which is affecting the way media reports on migration in Africa (Harber, 2015). Western media, on the other hand, tends to focus on mostly stories of displacement, especially refuges and irregular migrants bound for Europe, giving the impression that a large population of African migrants are bound for Europe. There is an imbalance of stories on economic contributions of migrants within the continent and beyond. This first African Migration Report presents an opportunity to challenge existing distortions of African migration. Firstly, and probably most prominently, migration as an academic discipline is not well established in academic institutions of higher learning on the continent. Currently, there are three well-established academic institutions in Africa offering training on migration studies. These include the Centre for Migration Studies housed at the University of Ghana, African Centre for Migration Studies at the University of Witwatersrand in South Africa and the Centre for Migration Studies at the American University in Cairo. Consequently, most people who write about African migration are from the West due to the paucity of African scholarship related to migration, African security and development, among others. The result is that their perspectives on migration sometimes tend to be transposed onto Africa, compelling the continent to view migration and mobility in Africa through a prism of a problem to be fixed rather than the reality of life that it is, and a reality that if well managed, could benefit both sending and receiving countries, including the benefits that accrue to the migrants themselves. The few African researchers on migration are in turn also largely influenced by the thinking of the dominant academic views on the topic, consequently influencing the outlook and direction of African policymakers. Recently, there is evidence of upcoming researchers challenging the existing migration narrative attempting to decolonize migration research. This has roused calls from global scholars demanding for a different narrative and highlighting the needs for voices from African scholars. In other words, to adopt a different narrative on migration, we must change our way of thinking and knowing about a phenomenon and be open to different "systems of knowing" on migration. This is critical as historically, information and experiences within African settings were transmitted through a local dialect and through oral traditions. Understanding cultures, norms and values of a community that will help to understand migration behaviours requires one to understand the meanings without it being lost in interpretation. Aside from the policy thinking and academic work, migration initiatives on the continent are yet to be truly driven by African aspirations, as they are often oriented towards addressing concerns of donor countries. These concerns are rightly associated with African migration that makes it to and across the Mediterranean, which as it is known today but a fraction of African migration. Irregular migration is a complex and dynamic issue that overlaps several issues concerning security. The drivers of irregular migration are vast, as people are driven by lack of economic opportunities at their country of origin to conflict. Recent discussions aiming to define irregular migration by the Legatum Institute are focused on unpacking this complex concept that can assist policymakers to address the issue more effectively. Recent statistics on irregular migration, however, put this as low as 15 per cent of overall African migration, and yet it is this migration that dominates policy discussions on African migration rather than the 85 per cent that are actively trading across borders such as Rusizi and Goma on a daily basis, thereby positively impacting the economic fortunes of their countries despite the immense hurdles they face. The over-focus on irregular migration, however, distracts the discussions at the African Union on the potential economic opportunities that can be developed and/or strengthened between and among member States in Africa. Secondly, there is a chasm between African Union policies and practice on the ground by its member States. The policies that the African Union has put out over the course of the past two decades depict a continental political body that is fairly progressive in its thinking and outlook on migration. The policy frameworks and positions on migration adopted by the African Union are showing some permeation through policy reforms and practice at the national level. While the signals for the proliferation of African Union migration policy positions and propositions are reflected in the national policies on migration, such as Ghana, Kenya, Malawi, Nigeria and Zambia, among others, the domestication is not occurring at a desirable pace. Arguably, if the full body of policy frameworks and positions on migration-informed policy and practice at national level as they should, the reality of how African migration is viewed and characterized would begin to change. At present, there are few policy frameworks being implemented at national or regional level, which is limited by the available resources and capacities. Further, the African Union developed a 10-year plan of action that could lead to the successful development and implementation of the framework by 2030. The concerns are related to the slow pace of signatures and ratification, which is linked to the buy-in and support to member States to implement this protocol. In addition, the restrictive and prohibitive nature of the national laws and policies hinder the impact of the Free Movement Protocol. Third, and this is despite the existence of myriad migration dialogue and interState cooperation mechanisms on the continent eight by recent count there is not much by way of active, ongoing cooperation and information-sharing between countries on migration. This in turn impedes the collection and collation of any meaningful, comparable data that could inform policymakers of continental trends and by so doing, help ensure continued relevance and applicability of policy decisions at continental and regional levels to national realities. There is some evidence of benchmarking exercises adopted between countries (such as Ghana and Kenya) to gain ideas of best practices in migration governance, with some countries receiving additional support from African migration experts to strengthen their knowledge and policies to align with existing policy frameworks. There is tremendous progress Africa has made since the institution of migration dialogues on the continent starting in 2000. However, there is a need to put more effort in ensuring that the already existing migration dialogue platforms are better coordinated to bring together African migration policymakers for sustained deliberations, aimed at practical cooperation and founded on a culture of information and data-sharing.
10 mg simvastatin otc. Cell membrane overview and fluid mosaic model | Cells | MCAT | Khan Academy.
Although this session is a favorite among trainees cholesterol test reliability buy cheap simvastatin 10mg line, there is broad appeal to all clinical providers cholesterol medication not statin purchase simvastatin 20mg. Pediatric Clinical Chest Rounds consists of 4 clinical cases selected from the case reports submitted to the Pediatrics Assembly and focuses on challenges in diagnosis and management good cholesterol ratio calculator discount simvastatin 5 mg visa. They will also identify gaps in our knowledge and discuss future directions for research cholesterol ratio 2.6 buy 5mg simvastatin. Emerging data spanning diverse scientific disciplines have established the dynamic and pleiotropic role of mitochondria in cellular homeostasis cholesterol test machine price in india discount simvastatin 10mg fast delivery, function cholesterol in eggs amount trusted simvastatin 40mg, stress/injury, inflammation, senescence and repair responses. Our understanding of the maternally-inherited genetic programming of mitochondria, which possess a genome, proteome, and metabolome that are distinct from host cells, expands as mitochondrial-specific assays, imaging techniques and targeting become feasible. This session will highlight the critical physiologic and pathophysiologic roles of mitochondria in acute and chronic lung diseases as well as in systemic syndromes, such as sepsis and critical illness. This session aims to provide a vocabulary to aid in discussion of multi-omics integration; engender familiarity with literature on multi-omics technologies; and concretize conceptual and technical approaches to integration of multi-omics-derived data sets in lung health and disease. The explosion of large data sets derived from high-throughput multi-omics technologies holds great promise for answering fundamental questions in lung health and disease. The integration of data sets generated by different technologies-such as combining epigenetic profiling with transcriptional the information contained in this program is up to date as of April 16, 2018. The focus on relieving symptom burden, illness related distress, and improving quality of life complements disease directed treatment throughout the course of illness. Keynote presentations from two visionary thought leaders in pulmonary focused palliative care will bookcase brief presentations of innovative implementation strategies from clinician scientists who are working in outpatient pulmonary palliative care. Assemblies on Pediatrics; Environmental, Occupational and Population Health; Pulmonary Infections and Tuberculosis 2:15 p. The greatest impacts are likely to be on respiratory health due to worsening air quality and increases in the information contained in this program is up to date as of April 16, 2018. Current climate change initiatives will be futile if present population increases continue. This session will present the latest projections of relationships between climate change, environmental threats and increasing population how these will affect the future respiratory health of children. Annamalay, PhD, Perth, Australia the Effect of Climate Change on Respiratory Disease in Developing Countries R. Public Advisory Roundtable; Assemblies on Clinical Problems; Sleep and Respiratory Neurobiology 2:15 p. The growing recognition of sleep apnea by clinicians and health systems, has led to the realization that sleep apnea is a chronic and complex disease with a wide range of phenotypic manifestations and morbidities. Furthermore, it has prompted observations that it may co-occur in the context of other respiratory diseases, and that such concurrent presence of sleep apnea and a lung disease may mutually alter their clinical presentation and course, as well as modify the response to treatment. This session will explore the current state of the art in the context of sleep apnea Target Audience Basic scientists, clinicians, students and postdoctoral trainees Objectives At the conclusion of this session, the participant will be able to: · gain knowledge in the use novel systems to model human lung development to accelerate mechanistic studies; · learn new paradigms about temporal and spatial regulation of Wnt signaling in development and tissue homeostasis and approaches to study of developmental pathways; · highlight new advances in stem cell therapeutics and clinical translation. This session will present new approaches to study of human lung development, recent progress made in deciphering the signaling pathways and mechanisms underlying human lung development, and the therapeutic potential for stem cell therapies and corrective technologies. C93 Assemblies on Clinical Problems; Environmental, Occupational and Population Health; Drug/Device Discovery and Development Committee 2:15 p. This session will provide a forward looking discussion around concepts of disease modification and future opportunities to change the course of chronic respiratory disease. It will bring forth new treatment paradigms that will ultimately impact the goals of therapy. There will be a review of the current landscape of disease progression and modification in respiratory medicine. Additionally, we will identify considerations required for conducting clinical research such as relevant clinical end-points (including technological approaches. Speakers will describe the clinical recommendations formulated by the guideline panels, discuss the rationale for each, and critically review the evidence supporting each recommendation. Speakers will also describe how the guidelines provide the foundation for improving care. A5905 Variability in Early Sedation and Analgesia Practices for Patients with Acute Respiratory Failure/S. A5906 Identifying States of Strain ("Risky States") in Intensive Care Units Associated with Preventable Patient Harm/J. Oral Presentations 2:30 Distinct Protein Expression Profiles Are Associated with Cross-Sectional Clinical Phenotypes and Disease Progression in Former and Current Smokers/Y. A5900 the Medicaid Expansion and Health Insurance in Survivors of an Alcohol-Related Critical Illness: an Interrupted Time Series Analysis/B. A5901 National Trends in Intensive Care Unit Admissions Among Medicare Beneficiaries in the United States, 2007 - 2013/G. A5920 Development and Efficacy of a Novel Nebulized Antibiotic Formulation for the Treatment of Mycobacterium Abscessus Pulmonary Infections/T. A5921 3:30 3:30 3:45 3:45 Featured Speaker 4:00 Alternative Trial Designs for Complex Infections/B. A5916 Macrolide Resistant Mycobacterium Avium Complex Lung Disease Treated with Bedaquiline/J. A5917 Treatment Regimens Prescribed for Pulmonary Mycobacterium Abscessus Infections Among Hospitalized Patients in the United States, 2000-2015/E. A5922 A Comparison of Micro Computed Tomography to Histology in Idiopathic Pulmonary Fibrosis/N. A5924 Dynamic Contrast-Enhanced Magnetic Resonance Imaging for the Evaluation of Perfusion Heterogeneity in Idiopathic Pulmonary Fibrosis/N. A5926 2:30 2:45 2:30 3:00 2:45 3:15 3:00 the information contained in this program is up to date as of April 16, 2018. A5929 3:45 3:45 Characteristics of Upper Airway Collapse Assessed During Drug-Induced Sleep Endoscopy Predict Response and Deterioration Under Mandibular Advancement Device Therapy/S. A5936 Increases in Heart Sound Intensity Following Respiratory Events Are Positively Correlated with Drops in Oxygen Saturation During the Events/M. A5933 Circulating Plasma Exosomes May Signal Circadian Clock Misalignment to Peripheral Tissues/A. A5934 Quantifying the Severity of Pharyngeal Airflow Obstruction Using Polysomnography/D. A5935 2:45 2:30 3:00 2:45 3:15 3:00 3:30 3:15 3:45 3:30 4:00 the information contained in this program is up to date as of April 16, 2018. A5954 House Dust Mite-Derived Protease Allergen Sensing by Lung Endothelial and Proangiogenic Cells Induces Asthma/K. A5957 Time Series Fluctuation of Clinical and Molecular Markers in Healthy and Asthmatic Subjects Before and After Rhinovirus Inoculation/A. A5958 Fevipiprant, a Selective Prostaglandin D2 Receptor 2 Antagonist, Potently Inhibits Chemotaxis and Cytokine Production by Group 2 Innate Lymphoid Cells/L. A5961 Improvements in Asthma-Related Quality of Life Observed Within 4 Weeks of Treatment with Tezepelumab/J. A5945 Genetic Variation in Surfactant Protein-A2 Differentially Modulates Resolution of Eosinophilia During Allergic Airways Inflammation/A. A5949 Secreted Phospholipase A2 Group X Regulates Type-2 Cytokine Expression in Mast Cells/R. A5950 Dehydroepiandrosterone Supplementation May Benefit Certain Women with Asthma: A Pilot Study/N. A5951 Interleukin-25 and Eosinophils Progenitor Cell Mobilization in Allergic Asthma/W. A5953 413 402 403 414 404 415 416 405 406 417 407 418 408 409 419 the information contained in this program is up to date as of April 16, 2018. A5964 Gut Microbiome Patterns in Adults Differentiate Asthma and Asthma-Related Clinical Features/Y. A5966 Understanding Heterogeneity in Severe Asthmatics Using High Dimensional Analysis of Cellular Phenotypes/M. A5968 Age-Specific Associations Between Circulation of Viral Pathogens and Asthma Health Services Utilization/L. A5969 204 Structured Smoking Exposure Variability in the Electronic Health Record Hurts Lung Cancer Screening Practices/D. A5973 Assessing the Implications of Average Household Income on Adherence to Lung Cancer Screening Recommendations/F. A5977 A Qualitative Study of Clinician Views of Lung Cancer Screening: the Role of Uncertainty/A. A5978 "I Just Wanna Know": A Qualitative Study of Patients Offered Lung Cancer Screening/S. A5979 Evaluating the Effectiveness of Lung Cancer Screening in Patients with Chronic Obstructive Lung Disease/M. A5980 Patient and Clinician Perspectives on Smoking Cessation in Three Lung Cancer Screening Programs/S. A5981 Identifying Eligibility for Lung Cancer Screening in Hospitalized Smokers: An Opportunity to Improve Screening Rates/D. A5982 Health and Quality of Life Assessment in Four Groups of Lung Cancer Patients: Low Dose Computed Tomography Screened, Chest X-Ray Detected, Incidentally-Found, and Routinely Diagnosed/D. A5983 Disparities in Early Stage of Lung Cancer Treatment According to Hispanic Origin A Population-Based Study/M. A5985 Assessing Effectiveness of a Group Education Class on Lung Cancer Screening/L. A5970 Potential Barriers to Lung Cancer Screening: Clinico-Socioeconomic Characteristics of Participants and Non-Participants/S. A5987 Incidental Pulmonary Nodule Characterization in Primary Care Progress Notes/J. A5988 No Stone Unturned: Nodule Net, an Intervention to Reduce Loss to Follow-Up of Pulmonary Nodules/H. A5990 E-Consult Management of Lung Nodules: Do Primary Care Providers Follow Recommendations? A5998 Evaluation of a Sepsis Care Bundle and Care Coordination for Timely Antibiotic Administration and Improving Hospital Outcomes/E. A6000 Focusing on Earlier Antibiotics and Fluid Support to Achieve a More Effective and Efficient Sepsis Performance Measure that Improves Survival: A Systematic Review and Meta-Analysis/D. A6001 Frequency of Surviving Sepsis Campaign Bundle Compliance for Hospital-Acquired Sepsis/S. A6003 the Association of Intravenous Sodium Bicarbonate with Mortality in Patients with Lactic Acidosis Caused by Sepsis/N. A6004 Prognostic and Therapeutic Value of Subtyping Shock Following Out-of-Hospital Cardiac Arrest/J. A6005 Magnitude of Fluid Positive Balance on Post-Shock Day 1 Correlates with the Number of Subsequent Ventilator Days/S. A6007 Incidence of Diabetes Insipidus After Cessation of Vasopressin Infusion for Treatment of Shock/H. A6009 A Phase 2a Randomized Controlled Trial of Echocardiogram-Guided Resuscitation in Early Septic Shock/R. A5994 the Product of Pulse Pressure and Heart Rate, an Early Indicator of the Presence of Sepsis/D. A5996 715 716 702 703 704 717 718 the information contained in this program is up to date as of April 16, 2018. A6012 the Predictive Accuracy of Variations in Inferior Vena Cava Diameter, Pulse Pressure, and Central Venous Pressure with Respiration in Determining Volume Status of Critically Ill Patients/K. A6013 Association Between Timing of Appropriate Antibiotics and Mortality in Sepsis Is Not Influenced by Source of Infection/E. A6015 Rate of Mechanical Ventilation in Septic Shock Patients with Severe Malnutrition/A. A6017 603 Anxiety in Patients Receiving Non-Invasive Ventilation for Acute Respiratory Failure: Prevalence, Risk Factors and Prognostic Impact/A. A6021 Efficacy of Low Dose Prophylactic Quetiapine on Delirium Prevention in Critically Ill Patients: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study/Y. A6022 Outpatient Psychoactive Medication Usage and Post-Operative Delirium After Major Surgery/T. A6026 Tracking Physical Activity Levels in Critically Ill Patients During Intensive Care Unit and Ward Admission/T. A6028 Physical Rehabilitation Interventions in the Intensive Care Unit: A Scoping Review of 96 Prospective Studies/J. A6031 614 602 the information contained in this program is up to date as of April 16, 2018. A6032 Prevalence of and Risk Factors for Frailty After Hospitalization for Critical Illness/N. A6033 Frailty Subphenotypes and Functional Recovery in Older Survivors of Acute Respiratory Failure/M. A6036 Charlson Comorbidity Score Is Not Predictive of Neurologic Outcomes in Cardiac Arrest Following Hypothermia/J. A6045 Impact of Dexmedetomidine for the Treatment of Alcohol Withdrawal Syndrome Upon Intensive Care Unit Length of Stay/E. A6047 Critically Ill Caucasian Patients Admitted for Alcohol Withdrawal Have a Longer Hospital Length of Stay and Receive Higher Doses of Benzodiazepines/N. A6048 Treatment of Alcohol Withdrawal Syndrome with Benzodiazepines or Phenobarbital in the Medical Intensive Care Unit, a Retrospective Comparison/J. A6049 Trends Over Time in Drug Administration During Adult In-Hospital Cardiac Arrest/A. A6050 Early High Glycemic Variability Was Associated with an Increased 30-Day Mortality in Patients with Sepsis/Y. A6051 Role of Admission Glycated Hemoglobin in Critically Ill Patients with Pneumonia/C. A6053 Challenging Dogma - Early Endoscopic Intervention Is an Option for Necrotizing Pancreatitis Resulting in Significant Improvement in Organ Failure/P. A6054 Prevalence and Outcomes of Clostridium Difficile Infection Among Hospitalized Adults with Cystic Fibrosis/K. A6041 515 516 502 the information contained in this program is up to date as of April 16, 2018.
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