By E. Murat. State University of New York College at Oswego. 2018.

Lacto-ovo vegetarianism The list of famous vegetarians forms an illustrious Definition group generic pilex 60caps on-line prostate cancer knee pain. The ancient Greek philosophers purchase pilex 60caps otc prostate gland problems, including Socrates, Plato, and Pythagoras, advocated vegetarianism. Lacto-ovo vegetarians are people who do not eat Other famous vegetarians include Leonardo da Vinci, Sir meat, but do include dairy products (lacto) and eggs Isaac Newton, the physician Albert Schweitzer, writer (ovo) in their diets. Albert Einstein, although Origins not a strict vegetarian himself, stated that a vegetarian diet would be an evolutionary step forward for the human race. The term vegetarian was coined in 1847 by the founders of the Vegetarian Society of Great Britain, al- Vegetarianism in America has generally consisted of a though vegetarianism as a way of life has existed for small but vocal number of adherents. The founders of the Vegetarian Soci- mid-1800s, when some people began to question accepted ety were lacto-ovo vegetarians. In 1839, Sylvester Graham, One of the central ideas that has motivated vegetari- who invented the “graham cracker” from whole wheat ans is that food choices should not require the death or flour, wrote Lectures on the Science of Human Life. Thus, many vegetarians avoid meat decades later, Ralph Waldo Emerson and Henry David but eat dairy products and eggs (on the grounds that Thoreau both advocated vegetarianism. Some people argue, Williams published The Ethics of Diet, which promoted however, that eating eggs may prevent the life of an ani- vegetarianism and listed all the famous vegetarians mal, so some vegetarians are lacto-vegetarians. In the Christian tradition, the Trappist gained followers in America, although it met consider- 1178 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 able resistance from the meat industry and general pub- have repeatedly shown in studies that a healthy diet con- lic. By the 1960s, the consumption of meat in America sists of plenty of fresh vegetables and fruits, complex had increased significantly from consumption levels at carbohydrates such as whole grains, and foods that are the turn of the century. Meat and dairy foods made up high in fiber and low in cholesterol and saturated fat. Some researchers claimed In alternative medicine, vegetarianism is a corner- that meat was fundamental to health, while a growing stone dietary therapy, used in Ayurvedic treatment, minority of nutritionists began to correlate the meat-cen- detoxification therapies, the Ornish and Wigmore diets, tered American diet with rising rates of heart disease, and in treatments for many chronic conditions including cancer, and diabetes. Up to that time it was believed by American nutritionists Benefits that only meat could supply adequate protein. Lappe ar- gued that by combining particular foods such as rice and Lacto-ovo vegetarianism is sometimes recommended beans, which was done in the diets of older cultures, veg- as a dietary therapy for a variety of conditions, including etarians could obtain proteins that are as complete as heart disease, cancer, diabetes, stroke, high cholesterol, protein derived from meat. The book sold millions of obesity, osteoporosis, hypertension, gout, gallstones, copies, and researchers have since confirmed that vege- kidney stones, ulcers, colitis, hemorrhoids, premen- tarianism provides adequate amounts of dietary protein. Lacto-ovo vegetari- lished Diet for a New America, in which he makes a anism is an economical and easily implemented preven- strong point against the health issues of a meat-centered tive practice. It does, however, require self-education re- diet, and against the cruelty inflicted on animals from garding an adequate diet in those who adopt it. Vegetarianism has been steadily gaining acceptance Preparations as an alternative to the meat-and-potatoes bias of the tra- It is generally recommended that a vegetarian diet ditional American diet. Several factors have contributed to the interest in to help people become vegetarian in stages. Outbreaks of food poisoning icans eat meat products at nearly every meal, and the from meat products, as well as increased concern over first stage of a transition diet is to replace meat in just a such additives in meat as hormones and antibiotics, have few meals a week with wholly vegetarian foods. Then, led some people and professionals to question the safety particular meat products can be slowly reduced and of meat products. There is also an increased awareness eliminated from the diet and replaced with vegetarian of the questionable treatment of farm animals in factory foods. Individuals should be system based on meat production has also been exam- willing to experiment with transition diets, and should ined more closely. Some argue that the raising of live- have patience when learning how to combine vegetarian- stock has been shown to cause soil erosion, water conta- ism with such social activities as dining out. Many vege- mination and shortages, pollution, deforestation, and in- tarian cookbooks are available to help new vegetarians efficient use of natural resources. The growing health consciousness of Americans is The transition to vegetarianism can be smoother for probably the most important reason for the surge of in- those who make informed choices regarding dietary terest in vegetarianism. Sound nutritional guidelines include decreas- convincing evidence that there are major problems with ing fat intake, increasing fiber, and emphasizing fresh the conventional American diet, which is centered fruits, vegetables, legumes, and whole grains while around meat products that are high in cholesterol and avoiding processed foods and sugar. Heart disease, cancer practices include reading food labels and understanding and diabetes, which cause 68% of all deaths in America, such basic nutritional concepts as daily requirements for are all believed to be influenced by diet. Would-be vegetari- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1179 ans can experiment with meat substitutes, foods that are Getting enough vitamin B12 may be an issue for high in protein and essential nutrients. Many meat sub- some vegetarians, although this vitamin is present in stitutes are now readily available, such as tofu and tem- both eggs and dairy products. Vitamin supplements that peh, which are soybean products that are high in protein, contain vitamin B12 are recommended, as are fortified calcium and other nutrients.

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In the PMd 60 caps pilex free shipping prostate journal, SMA 60 caps pilex fast delivery prostate cancer 2, CMAd, and CMAv, the origin of projections to cervical segments did not overlap with the origin of projections to the lumbosacral segments. In the CMAr, the arm and leg representations were not as clearly separated, whereas in the PMv, most of the corticospinal neurons projected only to the upper cervical segments. These results suggest that some of the premotor areas have proximal and distal representations of the arm that are as distinct as those in M1. One measure of the importance of each premotor area in the control of distal versus proximal arm movements is the relative amount of cortex projecting to the lower versus upper cervical segments. This result suggests that the hand representation in M1 is expanded relative to the actual physical proportion of the arm that is occupied by the hand. The expansion of the hand representation has been viewed as a reflection of the special role that M1 retains in the generation and control of highly skilled hand move- ments. Intra- cortical stimulation with microelectrodes has been used to assess the potential of each premotor area to generate movements and to construct a map of the body parts represented in each area. Significantly, intracortical stimulation has evoked move- ment in each of the premotor areas. Typically, the average threshold for evoking movement with intracortical stimulation in a premotor area is somewhat higher than that in M1, and the probability of evoking movement at any given site is lower in the premotor areas than in M1. Electrical stimulation of the SMA generated a complete map of the body with a rostral to caudal orientation of its face, arm, and leg representations (Figure 1. The medial wall is unfolded and reflected upward to display the medial wall in an “upside down” orientation. The boundaries between cytoarchitectonic areas (dotted lines), the fundus of the cingulate sulcus (dashed line), and the lips of the cingulate sulcus (solid lines) are indicated. Movements were evoked by short- or long-train intracortical stimulation in a macaque monkey. ArSs: rostral limit of the superior limb of the arcuate sulcus; Fgc: frontal granular cortex; Skc: somatic koniocortex. Nevertheless, sites within the arm representation of the SMA that evoked movements of distal joints tended to be located ventral to sites where movements of proximal joints were evoked. Intracortical stimulation with parameters that were effective in the SMA did not evoke movement in the preSMA which lies just rostral to the SMA on the medial wall of the hemisphere (Figures 1. Movements elicited in the preSMA were typically slow, involved multiple joints, and resembled natural postural movements. PreSMA neurons often responded to visual but not to somatosensory stimuli, whereas SMA neurons had the opposite characteristics, responding to somato- sensory but not visual stimuli. The intracortical stimulation maps, however, are more fractured, are punctuated with nonresponsive areas, and reflect a lower sampling frequency than in the anatomical experiments. Movements of the arm and leg were elicited in each cingulate motor area, but face movements were evoked only, and infrequently, in the CMAr (Figure 1. Longer pulse trains and higher currents were required to evoke movements within the CMAr. This observation is congruent with the relatively low density of corticospinal neurons found in this area (Figure 1. Thorough exploration of the CMAr was limited to one animal, where arm and leg movements were found to be somewhat intermingled. Systematic mapping of the PMd with intracortical stimulation has been limited to one study,101 although numerous studies have reported the results of partial explorations of this region. These stimulation effects could be mediated directly via corticospinal efferents from each premotor area or indirectly by projections from each premotor area to M1 and henceforth via the corticospinal efferents from M1. Following removal of M1, intracortical stimulation of the SMA could still evoke movements with stimulus currents that were in the range of prelesion values. This observation suggests that electrical activation of corticospinal efferents in the SMA is sufficient to generate muscle contraction. This conclusion reinforces the view that independent and parallel pathways for motor control originate in the SMA and M1. Copyright © 2005 CRC Press LLC RP1 #239 Ar Spur CgS 26 25 27 28 29 30 32 33 34 36 35 Thumb Fingers Wrist Elbow, Shoulder Orofacial Upper Trunk Eye Blink 2 mm No Response FIGURE 1. A cross- section from a macaque brain (Macaca nemestrina) illustrates the location of electrode penetrations and the movements evoked at each stimulation site within the posterior bank of the inferior limb of the arcuate sulcus. Thresholds for evoking movement are indicated by symbol size (large symbols = #15 µA, small symbols = 16–50 µA). Digital photomicro- graphs of spinal cord sections viewed under dark-field illumination with polarized light.

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Drugs that prolong repolarization Metabolism of adenosine is slowed by dipyridamole pilex 60 caps otc prostate laser treatment, in- also tend to decrease this threshold 60 caps pilex visa prostrate juniper. These changes have dicating that in patients stabilized on dipyridamole the obvious important ramifications for patients with ICDs. Methylxanthines antagonize the effects of thresholds: adenosine via blockade of the adenosine receptors. Magnesium Sulfate No change Increase Decrease Magnesium sulfate may be effective in terminating re- fractory ventricular tachyarrhythmias, particularly poly- Quinidine Amiodarone Sotalol morphic ventricular tachycardia. Digitalis-induced ar- Procainamide Flecainide Dofetilide Disopyramide Lidocaine rhythmias are more likely in the presence of magnesium Digitalis Propafenone deficiency. Magnesium sulfate can be administered -blockers Mexiletine orally, intramuscularly, or, preferably, intravenously, Study Questions 1. The patient is re- she has been receiving ciprofloxacin for a urinary ceiving timolol drops for glaucoma, daily insulin in- track infection. The reason for her appointment to- jections for diabetes mellitus, and an ACE inhibitor day is that she has been having ringing in the ears, for hypertension. She tells you stead of procainamide because of what pharmaco- that she is also having trouble hearing the televi- logical effect of procainamide? The local anesthetic (E) The cholinergic effects of procainamide would activity of procainamide would have no adverse in- aggravate the diabetes. Each of these approaches would reduce the tis- without overt cardiac disease is an example of de- sue calcium concentration and prevent arrhythmias. Agents with ACE inhibitory activity type of arrhythmia is known to often respond well would likewise have no effect on calcium. Class I agents suppress both normal Purkinje (A) -Blocker and ACE inhibitor fiber and His bundle automaticity in addition to ab- (B) Calcium channel antagonist and ACE inhibitor normal automaticity resulting from myocardial (C) -Blocker and ACE inhibitor damage. Class II drugs block -adrenoceptors; class (D) -Blocker and calcium channel antagonist III drugs prolong the membrane action potential by (E) -Blocker and calcium channel antagonist delaying repolarization; and class IV drugs block 4. Phenytoin and lidocaine press abnormal automaticity and permit the sino- are totally synthetic, while digoxin occurs naturally atrial node to again assume the role of the domi- in plants and quinine occurs in the cinchona tree. Drugs that prolong QT interval as an most drugs) are chemically synthesized, some com- unwanted effect: Assessing their likelihood of in- pounds that occur endogenously in humans are ducing hazardous cardiac dysrhythmias. Evolution, mechanisms, and ism and are adverse effects of quinidine and qui- classification of antiarrhythmic drugs: Focus on class nine, constituents of the cinchona tree. The cardiac ion chan- but not the other effects could be associated with nels: Relevance to management of arrhythmias. What niche will newer class III would not be expected with the estrogen replace- antiarrhythmic drugs occupy? Case Study Long QT Syndrome previously healthy 14-year-old athletic girl for developing polymorphic ventricular tachycardia Acomplained to her physician of a 6-day history (torsades de pointe), which may degenerate into of cough, with 2 days of fever, headache, and mild ventricular fibrillation and death. Several of her schoolmates had similar case, a thorough investigation of all her relatives symptoms and were treated with antibiotics. Her should be performed to search for family members physical examination revealed soft crackles at the with abnormal ECGs. A chest radiograph and ICD therapy that was instituted, the patient demonstrated mild interstitial haziness at the bases. A resource for pa- made, and she was given a prescription for 10 days tients with LQTS including a comprehensive list of of erythromycin. On the second day of therapy QT interval prolonging drugs can be found on the while at home, she suddenly lost consciousness internet at Cardiopulmonary resuscitation was initiated and then DC cardioversion was performed with a return to sinus rhythm. LQTS is caused by an abnormality in the function of specific ion channels responsible for myocardial repolarization. This may result from congenital mutations in the DNA en- coding the ion channels (inherited form) or may be acquired from pharmacological therapy or other ill- ness (increased intracerebral pressure, for example). After stopping the erythromycin, she was found to have an underlying long QT interval that was exac- erbated by the erythromycin. A detailed family his- tory confirmed the diagnosis when it was revealed that her mother had fainted on several occasions, and her first cousin (maternal) drowned while swimming in a lake 3 summers previously.

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Patients receiving the diagnostic testing did significantly better in terms of their short-term 75 disability and satisfaction with care buy 60 caps pilex with amex prostate inflammation symptoms. In a systematic review of placebo-controlled trials for ulcerative colitis pilex 60 caps without prescription prostate joe theismann, subjects in the placebo arms had significantly higher clinical, endoscopic and histological improvement rates when they were in studies seen more than three times by the clinician compared 76 with studies where they were seen three or fewer times. Clinicians who provide too many negative details of an intervention may elicit a nocebo effect. For example, in a small study of 28 subjects prior to lumbar puncture, of 15 subjects told they may expect to have a headache, seven did have a headache, while 77 only one of the remaining 13 who were not told about a headache reported a headache. In contrast, another study of 200 patients receiving new prescriptions for angiotensin- converting enzyme inhibitors, trimethoprim-sulfamethosoxazole, or non-steroidal anti- inflammatory drugs (NSAIDs) found no increased incidence of side-effects in the group receiving verbal and written information about the three most common side-effects 78 compared with a usual-care control group. TRIAL DESIGNS AND THE PLACEBO EFFECT Inert pills referred to as placebos are often used in double-blind randomized drug trials. The use of a placebo in such drug trials as well as other interventional trials has an effect on outcomes in part related to informed consent and subjects being aware of the possibilities. In routine clinical practice when patients are given a known drug, the effectiveness of the drug is a combination of a non-specific placebo effect and the biologically active effect. In double-blind placebo-controlled trials the effect of the drug is thought to be just the direct biological effect. However, since the placebo effect is not simply additive to the biological effect and the subject is aware that they are in a Complementary therapies in neurology 256 doubleblind trial, conclusions from double-blind placebo-controlled trials are not 1,79 straightforward. In a double-blind trial, informed consent may alter the effectiveness of the placebo compared with the active agent in comparison to a situation where agents 80 are administered without patients being given information concerning the study. Doubleblind administration of decaffeinated coffee produced different effects on alertness and blood pressure than deceptive administration of decaffeinated coffee when 81 subjects were told they were receiving regular caffeinated coffee. There was a systematic review of trials in which NSAIDs were used in comparison with another active drug or in comparison to a placebo for treatment of pain in osteo- or rheumatoid 82 arthritis. In the trials in which the NSAID was being compared to a placebo, there was a significantly greater dropout rate related to ineffectiveness compared to the same NSAID being tested in an active drug comparison. On the other hand, patient dropouts were greater for adverse events in the trials in which the NSAID was compared to another drug than in placebo-controlled trials. Thus, given the same active NSAID, subjects had different experiences based solely on whether the other arm of the trial was a placebo arm or an active drug arm, despite the fact that the patient was not in that other arm but simply knew about it. In a smaller study where pain medications were given in a single clinical setting, there was a significantly greater benefit of the same NSAID when the drug was given as part of an active treatment-controlled study compared with a placebo- 83 controlled study. There are some data to suggest that placebo effects are greater for psychological and 27 selfrated measures than other objective measures of disease activity. A study that evaluated patients in placebo arms of rheumatoid arthritis drug trials found essentially no change over 6 months on the erythrocyte sedimentation rate but there was a significant 84 improvement in articular index and morning stiffness. While placebo responses may be generally greater for self-ratings, one study evaluating pain following bilateral third molar extraction found decreases in swelling and C-reactive protein following placebo ultrasound treatment (machine intensity set to zero) similar to the decreases found in self- 85 reports of pain. Another study observed elevation of liver enzymes in multiple dose trials during placebo treatment and attempted to determine predictors for those 86 elevations. Objective changes in pulmonary function in asthmatic adults have been 87,88 observed following expectation of receiving an inhaled bronchoconstrictor and these changes were reversed with expectation of receiving an inhaled beneficial drug. The placebo effect has sometimes been considered as unfortunate noise while performing and analyzing data from randomized double-blind trials (see Kaptchuk for 1 further discussion ). The response rate in placebo arms of 117 ulcer studies has varied from 0 to 100%, much more variable than the cimetidine or ranitidine response rates in 89 the same systematic review. In addition, there is often a significant correlation between 89 drug and placebo healing rates across clinical trials, although this has not been 90,91 completely consistent. Some clinical trials in neurology have even begun excluding subjects if they demonstrate improvement in outcome measures during a placebo wash-in 92 period. However, there are many reasons for it to be beneficial to understand the placebo effect better, rather than simply ignoring it and excluding placebo responders from clinical trials. It would be beneficial to be able to define individual characteristics that correlate with the placebo effect; thus treatment arms in a randomized trial could be Placebo effect: clinical perspectives and potential mechanisms 257 better matched, improving the power of the study to determine the active treatment effect.

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Detailed issues which have surfaced as in need of consideration include: • Differences in practice between different agencies pilex 60caps otc prostate oncology 77030, and different members of the same agency pilex 60caps on-line prostate 5lx 120 softgels. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Exchange and Sharing of Caller Information 227 Cultural issues are most problematic in the Fire Service, where there is direct evidence of considerable resistance to change which is a matter of public record available in reports and on web sites (see: The Future of Fire Service Control Rooms and Communications in England and Wales, HM Fire Service Inspectorate, 2000; Cleveland FBU Web Site on The Ambulance service, whilst often overstretched, has a desire to collaborate with other services; the Police service appears willing to consider any relevant initiatives. Technical Feasibility The technical systems are so disparate as to be functionally incompatible: from informa- tion gathered, it would appear that the only directly compatible systems among the services studied are the IT and radio systems used by both Police Forces. This view was particularly reinforced by visits to suppliers of equipment, visits to other sites, and technology session attended by Barfordshire Police, and the Ambulance and Paramedic Service. The issues raised as important include, for example, a recognition that not all information can be computerised—much resides as knowledge, implicit or explicit, with the people undertaking the work. The issues raised as important are: • A need to provide real-time shared information. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Government intervention is a significant driver where new technology is concerned, and brings its own problems. Risks: Structural, Organisational and Technical Project Risks A Risk Log compiled in January 2000 represented an assessment of the risks seen to be most threatening at that time. Most of these risks were realised to a greater or lesser degree in respect of the Fire Service. The outcome has been to confirm the ability of the Police and Ambulance Service to work more closely together, whilst the Fire Service has effectively withdrawn from any operational involvement in the study. This is not to apportion any blame, but merely to state the facts, a point which is confirmed by an assessment of Risk No. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Exchange and Sharing of Caller Information 229 • Who is responsible when things go wrong? Information security standards need to be set across participating organisations, embracing technological and non-technological issues. Other legal obligations (not specifically determined as part of this study) must be complied with. Any technological and organisational “solutions” need to enable only the sharing that is allowed. Technology The general view, supported by the participative session on technology, is that “anything is possible technologically”, but developments will be constrained by money, time, and other resources. Technology needs to be treated as an enabler, supporting the information needs of the business. There is an implied need to combine call-centre and emergency control technologies. Visits to the Call Centre Conference and Barfordshire Connect have helped with preliminary understanding of these, and this needs to be continued. Emergency Control: Two main suppliers of control systems, Intergraph and Fortek, have been visited. As outlined in the “risks” above, call-centre technology may be relevant to non- emergency calls; control-centre technology and procedures to emergency calls. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. It is expected that they will maintain involvement in any longer term developments. As this is a feasibility study, it is assumed that further studies and initiatives will be undertaken to build on these findings.

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