Physiological treatments and procedures that result in the same therapeutic effects when performed on the same body region during the same visit or office encounter.
Physiological slurred or rapid speech - trembling hands - persistent rhinorrhea - altered pupil dilation - somnolence - flushed face - red eyes - odor of alcohol - unsteady gait - declining health Behavioral - irritability and mood swings - isolation or avoidance of group work - pattern of absenteeism and tardiness - decreased clinical and academic productivity - fluctuating clinical and academic performance - change in dress or appearance - inappropriate responses - elaborate excuses for behavior - decreased alertness/falling asleep in class - dishonesty The above criteria may be used in determining action. Procedure - student privacy and an opportunity to explain the behavior will be provided - the faculty member may request an immediate urine drug/alcohol screen at the main campus hospital or an affiliating agency - if substance abuse is suspected, the student will not be allowed to drive home and will be escorted to the Emergency Department - the faculty member, student and Xxxx will meet to review the incident(s) - the student will be referred to Occupational Health Services and/or the Employee Assistance Program for follow-up - if the student follows the prescribed treatment, follow-up and monitoring, she/he may return to the program of study without academic consequences - an appeal process is available through the grievance procedure
Physiological. Dynamic Test 6MWT/ISWT/CPET • Height & Weight (BMI) • Heart rate/BP • Resistance • Grip Strength Patient Reported Outcome Measures • EQ-5D (QOL) • EORTC QLQ-C30 (cancer specific) • WHODAS 2.0 (Disability) • IPAQ-SF (Physical Activity) • Self-Efficacy Exercise Scale (SEE) Patient Outcomes • Complications • LOS/Mortailty/90 day hospital free period • Long-term survival Outcome Measures Prehab & Recovery Programme Project Timeline Jan - April 2019 Preparation Service Design Referral process User involvement MDT visits Prehab4Cancer core team / local teams recruitment & upskilling Digital platform incorporated Sept 2018 Aug 2020 LAUNCH Jun 2020 Sept 2019 Apr 2019 Jan 2019 GM Active SLA Sept – Aug 2020 Delivery Phase Full service delivery Ongoing evaluation / data collection / research Version 1 Sept – Dec 2018 Scoping Stakeholder engagement – patient engagement Understanding the evidence base April – Aug 2019 Pilot Phase Service delivery Colorectal, Lung & Upper GI surgical cohorts Monthly performance review meetings Confirm digital platform, evaluation & ethics approval Further stakeholder engagement Chemo / Rad & other tumour groups Sept – Dec 2018 Sustainability Phase Data analysis Business case Agree sustainability & evolution of project / service Revise GM Active service delivery & financial model GM Cancer Prehab and Rehab Surgery Phase – launches 25th April ‘19 600 patients referred to programme Upper GI, Lung, Colorectal >80% attending - Initial results suggest we can improve fitness Planning H and Neck and Transformation 2 GM Cancer PREHAB 01 REHAB MULIT-MODAL PREHAB 2 year mortality PROMS Completion of treatment MDT decision to operate Head and Neck Chemo/Dxt Cancer Surgical Pathway 95% MDT decision to operate 2 week wait 5% Primary Care PREHAB 01 Public Health DIGITAL 10 year survival Prevent CVS events and cancer 2 year survival DIGITAL Prehab4Cancer Xxxxxx Xxxxxxxxx-Xxxxxx Prehab4Cancer Programme Manager Specialist for Manchester Team Structure Xxxxxx Xxxxxxxxx-Xxxxxx Programme Manager Manchester Xxxxxx Xxxxxxxxx Administrator Xxxx Xxxxxx Salford & Xxxxxxxx Xxx Xxxxxx Wigan, Stockport & Tameside Xxxxx Xxxxxxx Xxxxxx & Xxxx
Physiological and pathological roles of proteases Protein degradation is as important for cellular viability as protein synthesis and therefore proteases have been considered as the guardians of cellular homeostasis. In addition to regulating protein turnover, proteases can also modulate protein function irreversibly by limited proteolysis. A number of key cellular functions are controlled by different proteases such as the execution of apoptotic cell death by caspases, degradation and elimination of abnormal proteins by lysosomal proteases or proteasome, and cancer metastasis facilitated by metalloproteases and cathepsins (208). Therefore, dysfunction of proteases could lead to various diseases, including cancer, neurodegenerative disorder, inflammation, and infectious diseases. The importance of properly controlled protease activity in maintaining neuronal function and survival has been recognized. Mitochondrial proteases are important for degrading misfolded proteins and maintaining the homeostasis of mitochondria. As mitochondrial dysfunction plays a key role in neurodegenerative diseases, the importance of mitochondrial proteases in the pathogenesis of neurodegenerative diseases has been under appreciated, especially after the discovery that mutations of a mitochondrial serine protease HtrA2 lead to neurodegenerative disorders (223). Proteasomes and lysosomes, are two major organelles responsible for proteins clearance. Proteases within these two compartments are the final players that execute the degradation of unwanted proteins and are required for carrying out proteasomal or lysosomal dependent protein degradation (247). Deficiency of these proteases have been shown to cause neurodegeneration (62,71,301).
Physiological role of the lymphatic system The lymphatic system carries out the vital function of draining proteins and cells from the interstitium of tissues which are too large to be absorbed by the blood capillary network. The majority of peripheral organs and tissue contain lymphatic vessels through which fluid containing cells and proteins can drain and be transported back to the blood circulation in a uni-directional flow. Lymph from the lower half of the body and the left upper half drains directly into the thoracic duct which empties into the blood at the junction of the left jugular vein and left subclavian vein; whereas lymph from the right upper half of the body drains into the right lymph duct which enters the blood at the right jugular and right subclavian vein. As well as draining proteins and cells from peripheral tissues, the lymphatic system plays a role in nutrient absorption in the gut, particularly the absorption of dietary fats. The rate of lymph flow from the periphery is controlled by the rate of leakage of proteins from the blood network into the interstitium. As the interstitial protein concentration increases, the osmotic force causes fluid to move from the blood into the tissue. This increase in fluid pressure causes the lymphatic capillaries to open at the junctions between lymphatic endothelial cells to allow fluid to enter the vessel. The pressure inside the capillary then increases causing the junctions to close and lymph to flow away from the tissue. Therefore, eventually the transport of fluid away from the tissue by the lymphatics balances out the effect of leakage from the blood vessels, and homeostasis of extracellular fluid concentration is achieved (104).
Physiological damp and mould growth • excess cold • excess heat • asbestos and manufactured mineral fibre • biocides (e.g. damp and timber treatment products) • carbon monoxide and fuel combustion products • lead • radiation • uncombusted fuel gas • volatile organic compounds. Psychological: • crowding and space • entry by intruders • lighting • noise Infection: • domestic hygiene, pests and refuse • food safety • personal hygiene, sanitation and drainage • water supply for domestic purpose Accidents: • falls associated with baths • falling on level surfaces • falling associated with stairs and steps • falling between levels • electrical hazards • fire • flames and hot surfaces • collision and entrapment • explosions • position and operability of amenities • structural collapse and failing elements The HHSRS is a technical system and is best used by persons with a technical health and safety or building construction background. The HHSRS is available at: xxx.xxxxxxxxxxx.xxx.xx/xxxxxxxxx/xxxxxxx/xxx/000000.xxx. There are a number of landlord guides to the HHSRS available through the internet that provide an understanding of HHSRS without going into its full details. One such guide provided by the Government, is entitled Housing Health and Safety Rating System – Guidance for Landlords and Property-related Professionals available at xxx.xxxxxxxxxxx.xxx.xx/xxxxxxxxxxxx/xxxxxxx/ housinghealth In practice it is very challenging for landlords to acquire the skills necessary to use the HHSRS to accurately risk-assess hazards as category 1 or 2. To help landlords to identify potential category 1 hazards and prioritise them for action a simple guide to risk-assessing hazards is provided below: The risk from a hazard is a combination of: • the likelihood of a hazard, over a 12-month period, causing harm sufficient to require some medical attention and • the potential seriousness of harm from that hazard, should harm occur. A risk assessment of a hazard that indicates high likelihood of harm, and high potential seriousness of that harm, means that the hazard may potentially be high risk and therefore in need of remedial action to reduce the risk to a more acceptable level. Step 1 Familiarise yourself with the 29 HHSRS hazards, especially the most commonly occurring.
Physiological drug targeting strategies for brain drug delivery Physiological drug delivery strategies aim to use endogenous transport mechanisms at the BBB, such as adsorptive-mediated, carrier-mediated or receptor mediated transcytosis. The advantage of the vascular route is the widespread diffusion of the infused drug across the whole brain (1) (figure 7A). This can be explained by the large surface area of the human BBB (approximately 20 m2). In addition, approximately each neuron has its own brain capillary for oxygen supply as well as the supply of other nutrients. This means that the vascular route is a very promising one for drug targeting and delivery to the brain. For small drug molecules drug delivery via carrier-mediated transcytosis is possible. Glycopeptide drugs, such as a glycosilated analogue of Met5-enkephalin are transported via the hexose transporter GLUT1 (21, 53). In addition, glycosilation of a linear opioid peptide resulted in an improved BBB transcytosis, as well as an improved metabolic stability (54). The best known example of carrier-mediated drug delivery is the transport of L-dopa, a precursor of the neurotransmitter dopamine, in the treatment of Xxxxxxxxx’x disease by the neutral amino acid carrier (16, 55). The disadvantage of carrier-mediated drug delivery is that a drug should mimic an endogenous nutrient (50). Adsorptive-mediated transcytosis (AMT) is triggered by an electrostatic interaction and can transport larger drug molecules to the brain. The best known compound that is targeted to the brain via this mechanism is cationised albumin (21, 56). An example of a drug transported by AMT is Ebiratide, a synthetic peptide analogue of adrenocorticotropic hormone for the treatment of Alzheimer’s disease (57, 58). Ebiratide is positively charged and is resistant to metabolism during the transcytosis across the BBB. AMT is not very specific, but the higher capacity of AMT, compared to receptor-mediated transcytosis, is a favourable property for the delivery of peptides to the brain (4, 21). A more specific delivery of larger drug molecules or drug carrying particles to the brain can be reached through receptor-mediated transcytosis. Upon receptor-ligand internalisation clathrin-coated vesicles are formed (59). These clathrin-coated vesicles are approximately 120 nm in diameter (60). In this thesis the focus is on the TfR, but also the insulin receptor or the scavenger receptors at the BBB can be used for drug delivery. For the human insulin...
Physiological predisposition has also been explored by other studies, including a review article by Xxxxxx Xxxxxxx on the role of viral infections in SIDS [52]. Though he did not test them, Xxxxxxx hypothesized that an interaction between infant smoke exposure, breastfeeding, and viral respiratory infections may put infants at risk for SIDS. Such a model would also explain the fact that SIDS has historically been most common in the winter months, and why SIDS appears to be related to exposure to cigarette smoke [52]. A comprehensive literature review and policy statement by the Task Force on Sudden Infant Death Syndrome in 2005 summarized the significant risk factors for SIDS and made a series of recommendations to reduce risk [40]. The study found 2.5 times greater risk for SIDS among black infants compared to their white counterparts. Additionally, black infants were almost twice as likely as white infants to be placed to sleep in the prone position (21% vs. 11%). The study also concluded that the prone sleep position, overheating, sleeping on a soft surface, maternal smoking, young maternal age, low birth weight, and male gender were significantly associated with SIDS. Interestingly, the study also identified a lack of prenatal care as a risk factor. According to the task force, as incidence of prone sleeping falls in the United States, interventions targeting these and other modifiable risk factors (such as maternal smoking) will become increasingly important [40].
Physiological data collection. Portions of the course are an ongoing research project being conducted in conjunction with the Center for the Study of Non-Symbolic Consciousness and the Transformative Technology Lab at Sofia University. As part of the study you will be required to wear physiological monitoring equipment during some of the exercises or at other times. This equipment may include but is not limited to: galvanic skin response sensors, heart rate sensors, and brainwave sensors. You must have an approved cellphone to participate in the course. This cellphone must have reliable Internet access. All physiological devices will connect to your cellphone via Bluetooth or wired connection. You will be required to run an app on your phone in a designated way, and at designated times. This app will connect to the devices and stream their data into our cloud-based data storage system.
