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- Introduction
- Immune deficiencies
- Allergies
- Autoimmune disorders
- Cancers of the lymphocytes
Immune system disorder, any of various failures in the body's defense mechanisms against infectious organisms. Disorders of immunity include immune deficiency diseases, such as AIDS, that arise because of a diminution of some aspect of the immune response. Other types of immune disorders, such as allergies and autoimmune disorders, are caused when the body develops an inappropriate response to a substance—either to a normally harmless foreign substance found in the environment, in the case of allergies, or to a component of the body, in the case of autoimmune diseases. Lymphocytes (white blood cells of the immune system) can become cancerous and give rise to tumours called leukemias, lymphomas, and myelomas.
|AIDS (acquired immunodeficiency syndrome)
|Chédiak-Higashi syndrome
|chronic granulomatous disease
|drug allergy
|farmer's lung
|hay fever
|serum sickness
|Addison disease
|diabetes mellitus (type I, insulin-dependent)
|Hashimoto disease
|lupus erythematosus
|multiple sclerosis
|myasthenia gravis
|pernicious anemia
|rheumatic fever
|rheumatoid arthritis
This article discusses various immune deficiencies, allergies, autoimmune disorders, and lymphocyte cancers. For additional information on leukemias, lymphomas, and myelomas, see the article cancer. A discussion of how the immune system works to prevent disease is found in the article immune system.
Immune deficiencies
Immune deficiency disorders result from defects that occur in immune mechanisms. The defects arise in the components of the immune system, such as the white blood cells involved in immune responses (T and B lymphocytes and scavenger cells) and the complement proteins, for a number of reasons. Some deficiencies are hereditary and result from genetic mutations that are passed from parent to child. Others are caused by developmental defects that occur in the womb. In some cases immune deficiencies result from damage inflicted by infectious agents. In others drugs used to treat certain conditions, or even the diseases themselves, can depress the immune system. Poor nutrition also can undermine the immune system. Limited contact with natural environmental factors, particularly with microorganisms found in biodiverse settings, also has been associated with increased risk of allergies, autoimmune disorders, and chronic inflammatory diseases.
Hereditary and congenital deficiencies
Immune deficiencies resulting from hereditary and congenital defects are rare, but they can affect all major aspects of the immune system. Luckily many of those conditions can be treated. In the rare hereditary disorder called X-linked infantile agammaglobulinemia, which affects only males, B lymphocytes are unable to secrete all classes of immunoglobulins. (An immunoglobulin is a type of protein, also called an antibody, that is produced by B cells in response to the presence of a foreign substance called an antigen.) The disease can be treated by periodic injections of large amounts of immunoglobulin G (IgG). The congenital, but not hereditary, T-cell deficiency disease called DiGeorge syndrome arises from a developmental defect occurring in the fetus that results in the defective development of the thymus. Consequently the infant has either no mature T cells or very few. In the most severe cases—i.e., when no thymus has developed—treatment of DiGeorge syndrome consists of transplantation of a fetal thymus into the infant. The group of disorders called severe combined immunodeficiency diseases result from a failure of precursor cells to differentiate into T or B cells. Bone marrow transplantation can successfully treat some of those diseases. The immune disorder called chronic granulomatous disease results from an inherited defect that prevents phagocytic cells from producing enzymes needed to break down ingested pathogens. Treatments include administration of a wide spectrum of antibiotics.
Deficiencies caused by infection
Damage to lymphocytes that is inflicted by viruses is common but usually transient. During infectious mononucleosis, for example, the Epstein-Barr virus infects B cells, causing them to express viral antigens. T cells that react against these antigens then attack the B cells, and a temporary deficiency in the production of new antibodies lasts until the overt viral infection has been overcome. Because antibodies already present in the blood are slowly broken down, failure to make new ones is important only if the infection persists for a long time, as it does occasionally. A much more serious viral infection is that caused by the human immunodeficiency virus (HIV), which is responsible for the fatal immune deficiency disease AIDS. HIV selectively infects helper T cells and prevents them from producing cytokines and from functioning in cell-mediated immunity. Persons with AIDS may be unable to overcome infections by a variety of microbes that are easily disposed of by persons uninfected with HIV. Severe infections by certain parasites, such as trypanosomes, also cause immune deficiency, as do some forms of cancer, but it is uncertain how that comes about. For example, Hodgkin disease, which attacks the lymphatic system, makes the patient more susceptible to infection.
Deficiencies caused by drug therapy
In countries with advanced medical services, immune deficiency often results from the use of powerful drugs to treat cancers. The drugs work by inhibiting the multiplication of rapidly dividing cells. Although the drugs act selectively on cancer cells, they also can interfere with the generation and multiplication of cells involved in immune responses. Prolonged or intensive treatment with such drugs impairs immune responses to some degree. Although the immune impairment is reversible, the physician must seek a balance between intentional damage to the cancer cells and unintentional damage to the immune system.
Medically induced suppression of the immune system also occurs when powerful drugs, which are designed to interfere with the development of T and B cells, are used to prevent the rejection of organ or bone marrow transplants or to damp down serious autoimmune responses. Although use of such drugs has greatly improved the success of transplants, it also leaves patients highly susceptible to microbial infections. Fortunately, most of those infections can be treated with antibiotics, but the immunosuppressive drugs have to be used with great care and for as short a period as possible.
Deficiencies caused by malnutrition
In countries where the diet, especially that of growing children, is grossly deficient in protein, severe malnutrition ranks as an important cause of immune deficiency. Antibody responses and cell-mediated immunity are seriously impaired, probably because of atrophy of the thymus and the consequent deficiency of helper T cells. The impairment renders children particularly susceptible to measles and diarrheal diseases. Fortunately, the thymus and the rest of the immune system can recover completely if adequate nutrition is restored.
Deficiencies associated with limited environmental exposure
The failure of regulatory T cells as a result of reduced exposure to microorganisms in the natural environment during early childhood has been associated with the development of certain allergic conditions, autoimmune disorders (e.g., type I diabetes and multiple sclerosis), and inflammatory bowel diseases. While the mechanism underlying T cell failure in this context remains unclear, it is known that normally harmless microorganisms that coevolved with humans can help prevent the body from generating inappropriate immune responses. This idea was first proposed in the late 1980s by American immunologist David P. Strachan in his hygiene hypothesis. The hypothesis suggested that small family size and increased personal hygiene reduced childhood exposure to infections and thereby resulted in the development of allergic disorders. Building on the hygiene hypothesis, scientists later proposed that the continued increase in the prevalence of allergic disorders and chronic inflammatory diseases in urban populations in the 21st century was linked to diminished contact with biodiverse environments and the microorganisms they contain.
The immune system recognizes and responds to almost any foreign molecule; it cannot discern between molecules that are characteristic of potentially infective agents and those that are not. In other words, an immune response can be induced by materials that have nothing to do with infection. The mechanisms brought into play, though beneficial for eliminating microbes, are not necessarily beneficial when otherwise innocuous substances are targeted. Furthermore, even initially protective mechanisms can cause secondary disorders when they operate on too great a scale or for a longer period than necessary, thereby damaging tissues remote from the infection. The terms allergy and hypersensitivity are commonly used to describe inappropriate immune responses that occur when an individual becomes sensitized to harmless substances. Allergic reactions do not as a rule cause symptoms to arise on the first exposure to an antigen. At the initial exposure reactive lymphocytes are generated that go into action only when the individual is reexposed to the antigen.
The manifestations of a particular allergic reaction depend on which of the immune mechanisms predominates in the response. Based on this criterion, immunologists use the Gell-Coombs classification system to recognize four types of hypersensitivity reactions. Types I, II, and III involve antibody-mediated mechanisms and are of rapid onset. The type IV reaction stems from cell-mediated mechanisms and has a delayed onset. It should be noted that the categorization, though useful, is an oversimplification and that many diseases involve a combination of hypersensitivity reactions.
Type I hypersensitivity
Type I, also known as atopic or anaphylactic hypersensitivity, involves IgE antibody, mast cells, and basophils.
Sensitization, activation, and effector phases
Type I hypersensitivity can be divided into three phases. The first is called the sensitization phase and occurs when the individual is first exposed to antigen. Exposure stimulates the production of IgE antibodies, which bind to mast cells and circulating basophils. The mast cells are found in tissues, often near blood vessels. The second phase is the activation phase, and it occurs when the individual is reexposed to the antigen. Reintroduction of the antigen causes IgE molecules to become cross-linked, which triggers the mast cells and basophils to release the contents of their granules into the surrounding fluids, initiating the third phase, called the effector phase, of the type I reaction. The effector phase includes all the body's complex reactions to the potent chemicals from the granules. The chemicals include histamine, which causes small blood vessels to dilate and smooth muscle in the bronchial tubes of the lungs to constrict; heparin, which prevents blood coagulation; enzymes that break down proteins; signaling agents that attract eosinophils and neutrophils; and a chemical that stimulates platelets to adhere to blood vessel walls and to release serotonin, which constricts arteries. In addition the stimulated mast cells make chemicals (prostaglandins and leukotrienes) that have potent local effects; they cause capillary blood vessels to leak, smooth muscles to contract, granulocytes to move more actively, and platelets to become sticky.AD!!!!
Type I allergic reactions
The overall result of the type I reaction is an acute inflammation marked by local seepage of fluid from and dilation of the blood vessels, followed by ingress of granulocytes into the tissues. This inflammatory reaction can be a useful local protective mechanism. If, however, it is triggered by an otherwise innocuous antigen entering the eyes and nose, it results in swelling and redness of the linings of the eyelids and nasal passages, secretion of tears and mucus, and sneezing—the typical symptoms of hay fever. If the antigen penetrates the lungs, not only do the linings of the bronchial tubes become swollen and secrete mucus, but the muscle in their walls contracts and the tubes are narrowed, making breathing particularly difficult. These are the symptoms of acute asthma. If the antigen is injected beneath the skin—for example, by the sting of an insect or in the course of some medical procedure—the local reaction may be extensive. Called a wheal-and-flare reaction, it includes swelling, produced by the release of serum into the tissues (wheal), and redness of the skin, resulting from the dilation of blood vessels (flare). If the injected antigen enters the bloodstream and interacts with basophils in the blood as well as with mast cells deep within the tissues, the release of active agents can cause hives, characterized by severe itching. If the antigen enters through the gut, the consequences can include painful intestinal spasms and vomiting. Local reaction with mast cells increases the permeability of the mucosa of the gut, and in many cases the antigen enters the bloodstream and also produces hives. Regardless of whether the allergen is injected or ingested, if it ends up in the bloodstream, it can induce anaphylaxis, a syndrome that in its most severe form is characterized by a profound and prolonged drop in blood pressure accompanied by difficulty in breathing. Death can occur within minutes unless an injection of epinephrine is administered immediately. This type of severe allergic reaction can occur in response to foods, drugs such as penicillin, and insect venom.
Another feature of type I hypersensitivity reactions is that, once the immediate local reaction to the allergen has taken its course, there may occur an influx of more granulocytes, lymphocytes, and macrophages at the site. If the allergen is still present, a more prolonged form of the same reaction—the so-called late-phase reaction, which lasts a day or two rather than minutes—may supervene. This is a feature of asthmatic attacks in some subjects, in whom repeated episodes also lead to increased sensitivity of the air passages to the constrictive action of histamine. If such persons can escape exposure to the allergen for several weeks, subsequent exposure causes much less severe attacks. A prolonged IgE-induced reaction also causes atopic dermatitis, a skin condition characterized by persistent itching and scaly red patches. These often develop at sites where the skin is bent, such as the elbows and knees. The persistence is due to the influx of mast cells stimulated by the continued presence of the allergen, which is often a harmless substance such as animal hair or dander.
Typical type I allergens
Most people are not unduly susceptible to hay fever or asthma. Those who are—about 10 percent of the population—are sometimes described as atopic (from the term atopy, meaning "uncommon"). Atopic individuals have an increased tendency to make IgE antibodies. This tendency runs in families, though there is no single gene responsible as there is in some hereditary diseases such as hemophilia. Although many innocuous antigens can stimulate a small amount of IgE antibody in the atopic individual, some antigens are much more likely to do so than others, especially if they are repeatedly absorbed in very small amounts through mucosal surfaces. Such antigens are often termed allergens. These substances are usually polypeptides that have carbohydrate groups attached to them. They are resistant to drying, but no special characteristic is known that clearly distinguishes allergens from other antigens. Allergens are present in many types of pollen (which accounts for the seasonal incidence of hay fever), in fungal spores, in animal dander and feathers, in plant seeds (especially when finely ground) and berries, and in what is called house dust. The main allergen in house dust has been identified as the excreta of mites that live on skin scales; other mites (those that live in flour, for example) also excrete potent allergens. This list is far from exhaustive. Sensitivities to chocolate, egg whites, oranges, or cow's milk are not uncommon.
The amount of allergen needed to trigger an acute type I hypersensitivity reaction in a sensitive person is very small: less than one milligram can produce fatal anaphylaxis if it enters the bloodstream. Medical personnel should inquire about any history of hypersensitivity before administering drugs by injection, and if necessary they should inject a test dose into (rather than through) the skin to ensure that hypersensitivity is absent. In any case, a suitable remedy should be at hand.
Treatment of type I allergic responses
Several drugs are available that mitigate the effects of IgE-induced allergic reactions. Some, such as the anti-inflammatory cromolyn, prevent mast-cell granules from being discharged if administered before reexposure to antigen. For treatment of asthma and severe hay fever, such drugs are best administered by inhalation. The effects of histamine can be blocked by antihistamine agents that compete with histamine for binding sites on the target cells. Antihistamines are used to control mild hay fever and such skin manifestations as hives, but they tend to make people sleepy. Epinephrine counteracts, rather than blocks as antihistamines do, the effects of histamine and it is most effective in treating anaphylaxis. Corticosteroid drugs can help control persistent asthma or dermatitis, probably by diminishing the inflammatory influx of granulocytes, but long-continued administration can produce dangerous side effects and should be avoided.
Sensitivity to allergens often diminishes with time. One explanation is that increasing amounts of IgG antibodies are produced, which preferentially combine with the allergen and so prevent it from reacting with the cell-bound IgE. This is the rationale for desensitization treatment, in which small amounts of the allergen are injected beneath the skin in gradually increasing quantities over a period of several weeks, so as to stimulate IgG antibodies. The method is often successful in diminishing hypersensitivity to a tolerable level or even abolishing it. However, increased IgG production may not be the complete explanation. The capacity to make IgE antibodies depends on the cooperation of helper T cells, and they in turn are regulated by regulatory T cells. There is evidence suggesting that atopic individuals are deficient in regulatory T cells whose function is specifically to depress the B cells that produce IgE and that desensitization treatment may overcome this deficiency.
Type II hypersensitivity
Allergic reactions of this type, also known as cytotoxic reactions, occur when cells within the body are destroyed by antibodies, with or without activation of the entire complement system. When antibody binds to an antigen on the surface of a target cell, it can cause damage through a number of mechanisms. When IgM or IgG molecules are involved, they activate the complete complement system, which leads to the formation of a membrane attack complex that destroys the cell (see immune system: Antibody-mediated immune mechanisms). Another mechanism involves IgG molecules, which coat the target cell and attract macrophages and neutrophils to destroy it. Unlike type I reactions, in which antigens interact with cell-bound IgE immunoglobulins, type II reactions involve the interaction of circulating immunoglobulins with cell-bound antigens.
Type II reactions only rarely result from the introduction of innocuous antigens. More commonly, they develop because antibodies have formed against body cells that have been infected by microbes (and thus present microbial antigenic determinants) or because antibodies have been produced that attack the body's own cells. This latter process underlies a number of autoimmune diseases, including autoimmune hemolytic anemia, myasthenia gravis, and Goodpasture syndrome.
Type II reactions also occur after an incompatible blood transfusion, when red blood cells are transfused into a person who has antibodies against proteins on the surface of these foreign cells (either naturally or as a result of previous transfusions). Such transfusions are largely avoidable (see blood group: Uses of blood grouping), but when they do occur the effects vary according to the class of antibodies involved. If these activate the complete complement system, the red cells are rapidly hemolyzed (made to burst), and the hemoglobin in them is released into the bloodstream. In small amounts it is mopped up by a special protein called hemopexin, but in large amounts it is excreted through the kidneys and can damage the kidney tubules. If activation of complement only goes part of the way (to the C3 stage), the red cells are taken up and destroyed by granulocytes and macrophages, mainly in the liver and spleen. The heme pigment from the hemoglobin is converted to the pigment bilirubin, which accumulates in the blood and makes the person appear jaundiced.
Not all type II reactions cause cell death. Instead the antibody may cause physiological changes underlying disease. This occurs when the antigen to which the antibody binds is a cell-surface receptor, which normally interacts with a chemical messenger, such as a hormone. If the antibody binds to the receptor, it prevents the hormone from binding and carrying out its normal cellular function (see Autoimmune diseases of the thyroid gland).AD!!!!
Type III hypersensitivity
Type III, or immune-complex, reactions are characterized by tissue damage caused by the activation of complement in response to antigen-antibody (immune) complexes that are deposited in tissues. The classes of antibody involved are the same ones that participate in type II reactions—IgG and IgM—but the mechanism by which tissue damage is brought about is different. The antigen to which the antibody binds is not attached to a cell. Once the antigen-antibody complexes form, they are deposited in various tissues of the body, especially the blood vessels, kidneys, lungs, skin, and joints. Deposition of the immune complexes causes an inflammatory response, which leads to the release of tissue-damaging substances, such as enzymes that destroy tissues locally, and interleukin-1, which, among its other effects, induces fever.
Immune complexes underlie many autoimmune diseases, such as systemic lupus erythematosus (an inflammatory disorder of connective tissue), most types of glomerulonephritis (inflammation of the capillaries of the kidney), and rheumatoid arthritis.
Type III hypersensitivity reactions can be provoked by inhalation of antigens into the lungs. A number of conditions are attributed to this type of antigen exposure, including farmer's lung, caused by fungal spores from moldy hay; pigeon fancier's lung, resulting from proteins from powdery pigeon dung; and humidifier fever, caused by normally harmless protozoans that can grow in air-conditioning units and become dispersed in fine droplets in climate-controlled offices. In each case, the person will be sensitized to the antigen—i.e., will have IgG antibodies to the agent circulating in the blood. Inhalation of the antigen will stimulate the reaction and cause chest tightness, fever, and malaise, symptoms that usually pass in a day or two but recur when the individual is reexposed to the antigen. Permanent damage is rare unless individuals are exposed repeatedly. Some occupational diseases of workers who handle cotton, sugarcane, or coffee waste in warm countries have a similar cause, with the sensitizing antigen usually coming from fungi that grow on the waste rather than the waste itself. The effective treatment is, of course, to prevent further exposure.
The type of allergy described in the preceding paragraph was first recognized as serum sickness, a condition that often occurred after animal antiserum had been injected into a patient to destroy diphtheria or tetanus toxins. While still circulating in the blood, the foreign proteins in the antiserum induced antibodies, and some or all of the symptoms described above developed in many subjects. Serum sickness is now rare, but similar symptoms can develop in people sensitive to penicillin or certain other drugs, such as sulfonamides. In such cases the drug combines with the subject's blood proteins, forming a new antigenic determinant to which antibodies react.
The consequences of antigen-and-antibody interaction within the bloodstream vary according to whether the complexes formed are large, in which case they are usually trapped and removed by macrophages in the liver, spleen, and bone marrow, or small, in which case they remain in the circulation. Large complexes occur when more than enough antibody is present to bind to all the antigen molecules, so that these form aggregates of many antigen molecules cross-linked together by the multiple binding sites of IgG and IgM antibodies. When the ratio of antibody to antigen is enough to form only small complexes, which can nevertheless activate complement, the complexes tend to settle in the narrow capillary vessels of the synovial tissue (the lining of joint cavities), the kidney, the skin, or, less commonly, the brain or the mesentery of the gut. The activation of complement—which leads to increased permeability of the blood vessels, release of histamine, stickiness of platelets, and attraction of granulocytes and macrophages—becomes more important when the antigen-antibody complexes are deposited in blood vessels than when they are deposited in the tissues outside the capillaries. The symptoms, depending on where the damage occurs, are swollen, painful joints, a raised skin rash, nephritis (kidney damage, causing blood proteins and even red blood cells to leak into the urine), diminished blood flow to the brain, or gut spasms.
The formation of troublesome antigen-antibody complexes in the blood can also result from subacute bacterial endocarditis, a chronic infection of damaged heart valves. The infectious agent is often Streptococcus viridans, normally a harmless inhabitant of the mouth. The bacteria in the heart become covered with a layer of fibrin, which protects them from destruction by granulocytes, while they continue to release antigens into the circulation. These can combine with preformed antibodies to form immune complexes that can cause symptoms resembling those of serum sickness. Treatment involves eradication of the heart infection by a prolonged course of antibiotics.
Type IV hypersensitivity
Type IV hypersensitivity is a cell-mediated immune reaction. In other words, it does not involve the participation of antibodies but is due primarily to the interaction of T cells with antigens. Reactions of this kind depend on the presence in the circulation of a sufficient number of T cells able to recognize the antigen. The specific T cells must migrate to the site where the antigen is present. Since this process takes more time than reactions involving antibodies, type IV reactions first were distinguished by their delayed onset and are still frequently referred to as delayed hypersensitivity reactions. Type IV reactions not only develop slowly—reactions appear about 18 to 24 hours after introduction of antigen to the system—but, depending on whether the antigen persists or is removed, they can be prolonged or relatively transient.
The T cells involved in type IV reactions are memory cells derived from prior stimulation by the same antigen. These cells persist for many months or years, so that persons who have become hypersensitive to an antigen tend to remain so. When T cells are restimulated by this antigen presented on the surface of the macrophages (or on other cells that can express class II MHC molecules), the T cells secrete cytokines that recruit and activate lymphocytes and phagocytic cells, which carry out the cell-mediated immune response. Two common examples of delayed hypersensitivity that illustrate the various consequences of type IV reactions are tuberculin-type and contact hypersensitivity.
Tuberculin-type hypersensitivity
The tuberculin test is based on a delayed hypersensitivity reaction. The test is used to determine whether an individual has been infected with the causative agent of tuberculosis, Mycobacterium tuberculosis. (A previously infected individual would harbour reactive T cells in the blood.) In this test, small amounts of protein extracted from the mycobacterium are injected into the skin. If reactive T cells are present—i.e., the test is positive—redness and swelling appear at the injection site the next day, increase through the following day, and then gradually fade away. If a tissue sample from the site of the positive reaction is examined, it will show infiltration by lymphocytes and monocytes, increased fluid between the fibrous structures of the skin, and some cell death. If the reaction is more severe and prolonged, some of the activated macrophages will have fused together to form large cells containing several nuclei. An accumulation of activated macrophages of this sort is termed a granuloma. Immunity to a number of other diseases (for example, leprosy, leishmaniasis, coccidiosis, and brucellosis) also can be gauged by the presence or absence of a delayed reaction to a test injection of the appropriate antigen. In all these cases, the test antigen provokes only a transitory response when the test is positive and, of course, no response at all when the test is negative.
The same cell-mediated mechanisms are elicited by an actual infection with the living microbes, in which case the inflammatory response continues and the ensuing tissue damage and granuloma formation can cause serious damage. Moreover, in an actual infection, the microbes are often present inside the macrophages and are not necessarily localized in the skin. Large granulomas develop when the stimulus persists, especially if undegradable particulate materials are present and several macrophages, all attempting to ingest the same material, have fused their cell membranes to one another. The macrophages continue to secrete enzymes capable of breaking down proteins, and the normal structure of tissues in their neighbourhood becomes distorted. Although granuloma formation may be an effective method the immune system employs to sequester indigestible materials (whether or not of microbial origin) from the rest of the body, the harm inflicted by this immune mechanism may be much more serious than the damage caused by the infectious organisms. This is the case in such diseases as pulmonary tuberculosis and schistosomiasis and in certain fungal infections that become established within the body tissues rather than at their surface.AD!!!!
Contact hypersensitivity and dermatitis
In contact hypersensitivity, inflammation occurs when the sensitizing chemical comes in contact with the skin surface. The chemical interacts with proteins of the body, altering them so that they appear foreign to the immune system. A variety of chemicals can cause this type of reaction. They include various drugs, excretions from certain plants, metals such as chromium, nickel, and mercury, and industrial products such as hair dyes, varnish, cosmetics, and resins. All these diverse substances are similar in that they can diffuse through the skin. One of the best-known examples of a plant that can provoke a contact hypersensitivity reaction is poison ivy (Toxicodendron radicans), found throughout North America. It secretes an oil called urushiol, which is also produced by poison oak (T. diversilobum), the poison primrose (Primula obconica), and the lacquer tree (T. vernicifluum). When urushiol comes in contact with the skin, it initiates the contact hypersensitivity reaction.
As sensitizing chemicals diffuse into the skin, they react with some proteins of the body, changing the antigenic properties of the protein. The chemical can interact with proteins located in both the outer horny layer of the skin (dermis) and the underlying tissue (epidermis). Some of the epidermal protein complexes migrate to the draining lymph nodes, where they stimulate T cells responsive to the newly formed antigen to multiply. When the T cells leave the nodes to enter the bloodstream, they can travel back to the site where the chemical entered the body. If some of the sensitizing substance remains there, it can reactivate the T cells, inducing a recurrence of inflammation. The clinical result is contact dermatitis, which can persist for many days or weeks. Treatment is by local application of corticosteroids, which greatly diminish lymphocyte infiltration, and by avoidance of further contact with the sensitizing agent.
Although delayed hypersensitivity can be a nuisance when it produces skin allergies, it is an important part of the immune defense against intracellular parasites, and it may also play a role in the containment of some tumours.


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2:00 – 4:00 p.m.
Talk about wind power!
One of the most popular features on festival day finds kids of all ages building over 200 kites – all under the direction of MN Kite Society former president, Dave Herzig – and flying them together at the south end of the festival grounds.
It's quite a sight!

subset: commoncrawl


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Photo: Stephen Devries
Paprika Pork Chops with Zucchini
Time: 40 minutes
Quick Fix: If you don't have a grill, you can roast the corn ears at 400° for 30 minutes and cook the pork and zucchini in a cast-iron skillet or grill pan.
Serve with Grilled Corn with Lime: Preheat grill to medium-high heat. Combine 1 tablespoon melted butter, 1 teaspoon grated lime rind, and 1 tablespoon fresh lime juice, stirring with a whisk. Place 4 ears shucked corn on grill. Grill 15 minutes or until lightly charred, turning occasionally. Place corn on a serving plate; brush with juice mixture. Sprinkle with ¼ teaspoon kosher salt. SERVES 4 (serving size: 1 ear) CALORIES 114; FAT 4.3g (sat 2.2g); SODIUM 161mg


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|Postmenopausal weight status, body composition and body fat distribution in relation to parameters of menstrual and reproductive history.
MedLine Citation:
|PMID: 10597875 Owner: NLM Status: MEDLINE
|OBJECTIVES: In the present study the association between menstrual and reproductive history patterns and weight status, fat distribution and body composition during postmenopause was tested. METHODS: In 106 healthy postmenopausal women ranging in age from 48 to 58 years (x = 53.7 year) the weight status was classified according to the recommendations of the WHO. Additionally body composition was estimated by dual energy X-ray absorptiometry and fat distribution was calculated using the fat distribution index. Weight status, body composition and fat distribution were correlated with self-reported parameters of menstrual and reproductive history (age at menarche, average cycle length, number of births, age at first and last birth, average pregnancy weight gain, age at menopause). RESULTS: It was shown that number of births, age at first birth and pregnancy weight gain were related significantly to the postmenopausal weight status, body composition and fat distribution. CONCLUSION: An early first birth a low number of births and a high weight gain during pregnancies can be assumed as risk factors for overweight, a higher amount of adipose tissue, android fat patterning and therefore for the development of the metabolic syndrome during postmenopause. In contrast no adverse effect of menstrual and reproductive parameters on postmenopausal bone mass was found.
|S Kirchengast; D Gruber; M Sator; J Huber
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Publication Detail:
|Type: Journal Article
Journal Detail:
|Title: Maturitas Volume: 33 ISSN: 0378-5122 ISO Abbreviation: Maturitas Publication Date: 1999 Oct
Date Detail:
|Created Date: 2000-01-28 Completed Date: 2000-01-28 Revised Date: 2004-11-17
Medline Journal Info:
|Nlm Unique ID: 7807333 Medline TA: Maturitas Country: IRELAND
Other Details:
|Languages: eng Pagination: 117-26 Citation Subset: IM
|Institute for Human Biology, University of Vienna, Austria. firstname.lastname@example.com
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|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
Adipose Tissue
Body Composition / physiology*
Climacteric / physiology*
Middle Aged
Parity / physiology*
Weight Gain / physiology*
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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Steelers' LeBeau says his coaching style has stayed the same
Steelers/NFL Videos
He refuses to spend endless hours during the offseason re-educating himself on the offensive flavor of the month. Chances are what's new to the rest of the league is old news to a man who is in his 55th NFL season as a Hall of Fame player and coach.
"Basically, what was defense in the 1960s is what is defense in 2013," LeBeau said. "Find the ball and get whoever's got it on the ground."
He is in an innovator — the zone blitz defense that reshaped the way defense is played is his creation — but not necessarily an inventor. Inventing effectively requires starting all over again; LeBeau prefers to lean on what is proven to work, then make it better.
"Amazingly enough, we've changed almost nothing from the time we started coaching (in 1973)," LeBeau said. "It even amazes me, to be honest with you."
Last season's copycat zone read offense? It's much like the triple option and veer offenses that swept through college football in the late 1960s and early 1970s. The pistol formation? The 49ers introduced the quarterback lined up in a short punt formation — the shotgun — in the 1960s.
And, to show how the mind of the NFL's oldest coach works — he will be 76 the day after the Steelers open the season Sept. 8 — look at how he defended the Redskins' artful dodger, Robert Griffin III, last season.
LeBeau took out some notes from the 1970s Arkansas defenses, the most successful of their time in defending the option.
"I've been looking at that and writing down notes for 30 years," LeBeau said. "That's not new."
What also isn't new is the Steelers' proven ability to remain an elite defense under LeBeau, no matter the season or the circumstances. In LeBeau's 11 seasons as coordinator, from 1995-96 and 2004-present, the Steelers have finished No. 1 overall five times — including the last two seasons — and No. 2 twice. They were lower than fifth only once.
LeBeau's strategy is no different from any successful coach. Find a weakness and attack. Locate the strength and find a way to defend it. And the Steelers have countless ways of doing this.
Cornerback Ike Taylor said the Steelers' playbook might contain 100 plays for defending a certain strategy. On certain plays, Taylor said LeBeau will make a double call, two different defenses. The defenders adjust to the proper defense once they see the offense line up.
To learn how to play a LeBeau defense — as linebacker Jarvis Jones and safety Shamarko Thomas currently are — players are taught certain techniques they must rely upon. There are certain rules that apply for each defense, too; a defender might not be permitted the same latitude in one defense as another.
But once the basic concepts are learned, LeBeau mostly just tweaks the defense from game to game, adjusting to fit the opponent.
"There are a lot of different ways to do things and, if you find a way that works, I don't mess with it until it's broken," LeBeau said.
He still coaches defensive backs the same way he did with the Eagles 40 years ago.
"What they have to do is exactly what I had to do," said LeBeau, a star cornerback with the Lions for 14 seasons. "The players might seem a little faster, but I played against Bob Hayes, who was the world's fastest human. It's all relative. The fastest person in the world is still the fastest person in the world."
But it's not as if LeBeau is stubborn and resistant to change.
"We're going to keep the same basic philosophy and basic foundation of what we do," LeBeau said. "But we'll always have new stuff every year. In the NFL, you've got the top players in the world, but you've got the top coaches, and they're working, too."
Most seasons, they're working to keep up with Dick LeBeau.
Note: Greater Latrobe Athletic director Mark Mears told the school board Tuesday that despite being called off this year, the annual Steelers night practice at Latrobe Memorial Stadium will return next year.
Despite treatment for disease, the stadium grass wasn't strong enough for the professional players, so the training camp practice — with attractions, music and vendors — was relocated to St. Vincent College on Aug. 2.
Mears said the team, including the Rooney family, told district administrators the practice will return to the stadium in 2014.
Alan Robinson is staff writer for Trib Total Media. Reach him at email@example.com or via Twitter @arobinson_Trib.
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Howdy folks.
The RP3 in my Yeti is bunged, it needs a new air sleeve and rebuild.
The LBS said I should get a full factory rebuild by the fox service centre, which will run to $300.
Or, they can buy a replacement air sleeve and put a new seal kit in for $160.
Or, they can supply me with a new RP23 for around $640 (eek).
I'm leaning towards the $160 option, but it seems steep too. Maybe i should just order the air sleeve and rebuild myself (since they have already gotten it out of the frame - it was stuck in the mounting bolts fused or something).
Trouble with replacement shocks are i need the specific stroke and length, AND tune.. so even if i get the correct size shock, it might not be tuned for the frame.
Any advice?


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HAI Convertable Ceramic 1¼" Flat Iron
- #medium hair
- / #long hair
- / #dry & damaged
- / #fine hair
- / #normal hair
- / #thinning hair
- / #sensitive hair
- / #ceramic
- / #ionic
- / #great value
- / #top 10
- / #bestselling
The HAI Convertable 1¼" ceramic flat iron is an innovative, versatile flat iron that features ceramic heating element technology and replaces old fashioned straightening and curling irons by giving you a variety of styling options with one unique tool. Featuring 1¼" wide by 3½" long ceramic, beveled edge plates, the HAI Classic Convertable is designed to allow you to curl, wave, smooth, or flip your hair with far infrared heat. A rapid heating element provides consistent heat at all adjustable temperature settings, while the superbly balanced, lightweight ergonomic design eliminates styling fatigue. Automatic temperature control is preset at 170ºF and adjusts up to 390ºF in just seconds. The HAI Classic Convertable works well on all hair types and is a great choice if you are looking to create curls in addition to straight styles.
Model#: HAI Convertible /
Guaranteed AuthenticGuaranteed Authentic
Folica is an authorized distributer of this product and guarantees its authenticity.Close
- 1¼" ceramic plates
- Beveled plates for styling flexibility
- Ceramic technology eliminates frizz by locking in moisture and shine
- Negative ions smooth the hair cuticles and reduce static electricity
- Adjustable heat settings from 180ºF to 390ºF
- Far Infrared heating in 10 seconds
- Ergonomic design is easier to press, hold, mold, twirl and curl hair
- PTFC Heaters generate evenly controlled heat and provide quick temperature recovery time
- 1-year warranty
|Cord Length:
|9 Foot
|Max Temperature:
|390 Degrees Fahrenheit
|1 Year(s)
|Min Temperature:
|170 Degrees Fahrenheit
|Cord Type:
|Swivel Cord
|Included Bonus:
|Technology :
|Ionic, Infra-red
|Plug Type:
|Plate Size:
|1-1/4 Inch
Folica's Warranty
Folica stands behind every product we sell and we honor all manufacturers' warranties. For all electrical appliances we offer complete protection. If you experience any problem with an item purchased from us and it's still under the warranty period, all you have to do is fill out our Warranty Replacement form, send us the items plus a small shipping and handling fee and we will take care of the rest. We'll repair or replace your item with a new product or a Folica Certified Refurbished product. It's that simple.
You May Also Like
#top 10 / #great value
The Solia 1¼" flat iron has features to ensure true silky straight hair.New Price:
#thick hair / #titanium
Turbo Power Nano Black Titanium 1½" Flat IronNew Price:
#normal hair / #ceramic
The HairArt Ceramic Straightening & Curling Iron is a verstile styling tool that is both a curling iron and a flat iron, allowing you to create as many styles as you desire.New Price:
My Precious Baby Died After Four Amazing Years :(Yes, it died. BUT I will gladly purchase another one! In fact, I have been switching off between two straighteners over the last three years: this product, and the CHI 2-inch turbo. Let me tell you -- the CHI gets it straight, but dries my hair out. This HAI product REALLY does seal in moisture. It did break, though. Just like so many other ladies are saying, the cord on mine got loose. BUT -- I admit, every day when I finished using it, I let the cord hang from my bathroom counter top. I would recommend making sure that when its not being used, the cord and base of it are lying on a flat surface. Gravity was never good for anything! Also, my hair type is thick, coarse and wavy. It stayed straight even in the humid, gulf-coast environment I live in.Dec 16, 2008Hai Enthusiast / Houston
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Good But I Like The Chi BetterI think this is a good straightening iron but it does not seem to be as efficient as my old Chi. It does seem to dry out the hair and not have that much of a "smoothing" effect. I would not reccomend it to someone with very curly/wavy/frizzy hair.Dec 2, 2008Lindsey / Long Beach, CA
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Dies OutIve had this flat iron for a 1.5 years. It worked really good at first and I loved it. But only after six months, I noticed my hair had a lot of damage (I dont wash my hair everyday) and was bummed because this was supposed to have that magic cermaic technology. In the last six months it has also really died out. It takes more effort with this iron to get my hair straight. I think if youre going to spend some money on a flat iron, get a really good one, like a GHD. Make it last!!Nov 25, 2008Holly
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I'm A Hairdresseri have used all the big name flat irons, and this is by far my favorite! every hairdresser friend that has tried it- buys one, and all of my clients love it! plus you cant beat the price!Nov 13, 2008Nicole / Dalton, Ga
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Lasts A Long Time!I have had this one FOREVER (probably around 7 years) and still hasnt died. It works great... I would highly recommend it!!Nov 8, 2008Ali / CA
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Awesome... Unless You Have Thin HairI love using my moms HAI because we both have super thick hair. If you have thin hair DON"T USE IT YOU SHOULDN"T BEUSING ANYTHING THAT 300-400 degrees! My sister fried her hair so badly with this because she has super thin blonde hair. So buy it only if you hve thick or super curly hair!Nov 2, 2008EwfjkwhfkjwfdHAIR TYPECurly Hair
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Well Worth The Money1 1/4" ceramic coated, "floating" plates allow for quick & easy straightening or for a little flick out or under at ends. You can even use the iron to give you curls (more like feathering curls that curling iron curls). You really dont need to spend any more than this amount on a good flat iron. I have a lot of hair, with a natural wave to it....I can flatten it out & make it look sleek & sexy in minutes. Temperature control allows you to decide how hot the iron should be (up to about 400 degrees) and the swivel cord allows for you to place it down in any position and turn it around in your hand without tangling up the cord. DONT wrap the cord around the flat iron, though because youll ruin the delicate wires inside. If you straighten your hair every day, youll be able to get about 1 good year out of any flat iron. Very durable, but dont iron your hair in a room with ceramic tiles, b/c, should you drop it, the plates will most likely break/fall out & youll need to get a new flat iron! I know from personal experience! Has nothing to do with brand, but the fact that plates are also ceramic.Nov 2, 2008Lauren / PA
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It's Good But The Cord Sucks!!!I have had two of the exact kind.. Its awesome straightner.. But i have had both of mine for about two years and the cord on both of them has decided to not work.. So now i am on number three.. If i even buy one.. I wish they would make the cord better... and i would have given it 5 stars!!!!Sep 18, 2008Sara
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Great Product!!I have had my Hai straightener now for over 5 years, so I feel lucky, based upon the other reviews that I read. It just bummed out on me last week, so I of course came back to the same product. It doesnt burn my hair or cause split ends, it just leaves me with this nice silky smooth head of hair without chemicals and expensive trips to the salon. If you do the math, $80/5 = $16 a year, waaaaaaaay less expensive than going to a salon even once!Aug 31, 2008Kim G
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From A Salon's Senior Receptionist's Pov - Great Buy!!This is a terrific steal - I am Senior Receptionist at a hair salon and would definitely recommend the HAI Convertible! I have fine, wavy, frizzy hair that was difficult to straighten, and for years I was using the irons that were not getting hot enough. I have had the iron for over a year and have never had any second thoughts about getting a different one...I had gone through about 3 irons previously! The iron is used by stylists in our salon and is a great recommendation for all types of hair. The adjustable heat setting lets users determine their necessary heat levels, and the width of the plates are just right. I would recommend this iron to girls with medium (hair an inch above the shoulders) to long hair - the iron plates may still be too wide for girls (like me!) with short hairs in the back of their head that are hard to straighten. For that, use the HAI Twig....Overall, AWESOME buy and FANTASTIC deal!!!! BUY HERE FROM FOLICA!Aug 25, 2008Kristina / OC, CA
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text:
In addition to the spraying being conducted Friday, the Pennsylvania Department of Environmental Protection's West Nile Program will conduct a truck mounted ultra-low volume larval mosquito control operation in part of Hanover Wednesday and Thursday, July 17 at 18, beginning at 3:30 a.m.
The spray will encompass all parts of the borough, south of Elm Avenue. The treatment is being done to control the larval stage of the Asian Tiger mosquito.
The Truck mounted ULV spray will be conducted by DEP. The application material has a very low toxicity profile to mammals and is safe for the environment.
Weather conditions and other unexpected events could delay or cancel this spray operation.
This pilot project, aimed at controlling the Asian Tiger mosquito (ATM), will be carried out throughout the remainder of the season. If these efforts are successful, this strategy will be employed in other ATM infested areas of the state.


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Bobby Smith Spinners, R&B music has lost another legend. Co-founder and co-lead singer of the legendary R&B group, 'The Spinners', died Saturday, March 16, 2013 of complications from the flu and pneumonia, according to his family. It's been reported that Smith was diagnosed with lung cancer last year.
According to USA Today, "The funeral will take place Monday in Detroit, where Smith will be interred, said the group's Jessie Peck……examiner.
The Spinners were initially part of the Motown Records machine in the 1960's, however; their huge success came in the 1970's when they signed with Atlantic Records.
During the early years of Atlantic Records, Philippe Wynne, with the suggestion of his cousin G.C. Cameron who was previously a lead singer of 'The Spinners', joined the group. Smith and Wynne shared leads on several songs. However; it was hard to distinguish the difference between the two of them because they sounded similar.
It was to the point where fans assumed that Wynne sang lead on every hit released by 'The Spinners' in the 1970's.Although Wynne sang lead on the hit song, "Rubberband Man" and on songs like "How Could I Let You Get Away"; Smith sang lead on "I'll Be Around", "Could It Be I'm Falling In Love" and the Dionne Warwick duet, "Then Came You". For years, many assumed that these songs were led by Wynne.
Bobby Smith was born in Detroit, Michigan. According to USA Today, the last surviving original member of 'The Spinners', Henry Fambrough remembers, "Bobby was a regular, down-to-earth, good-natured person, the kind of guy who'd give you his shirt…."


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The police commander serving the 24th District in Rogers Park will rely on his gang expertise to thwart a growing problem in the neighborhood.
David Sobczyk, a Chicago native and 25-year veteran of the city police department, was named the new Commander of the 24th District by Superintendent Jody Weis, who announced several leadership changes within the department.
Sobczyk's former post at the Deployment Operations Center will be assumed by Commander Steve Caluris, Weis says.
"He'll be a tremendous asset with his years of experience and expertise, especially in gang intelligence and other areas of homeland security, which will be an added benefit to the daily responsibilities of a district commander," says Deputy Chief Brian Murphy of the Deployment Operations Center in reference to Sobczyk.
As Sobczyk transitions into his role, his first priority will be to listen to what the residents of Rogers Park about their concerns.
"My goal is to keep my ears open and hear from the people who live and work here," says Sobczyk.
Next, he will respond to the needs of his officers so they are better able to fight an increase in crime, especially violent crime. Crimes were up 2.9 percent citywide in 2008, according to statistics on the Chicago Police Department website, after a steady 16-year decline.
Murders were up 15.7 percent and 46.3 percent of the motives were gang-related.
Sobczyk has years of experience under his belt, especially with gangs and counter terrorism and intelligence, which will be useful in helping the Rogers Park community battle such problems. His previous assignments in diminishing gang activity took place in Cabrini Green and Humboldt Park, which Sobczyk calls a "challenging learning experience."
Members of the Rogers Park community came together during a recent town meeting, expressing concerns about crime in the neighborhood.
Sheli Lulkin, retired executive director of the Edgewater Chamber of Commerce, lives on the boundary of the 20th and 24th districts and gets to compare the two. Lulkin says she has witnessed gang activity on numerous occasions and says Rogers Park in comparison to Edgewater "tends to be much worse, crime-wise."
Courtney Owen, commercial district planner for the DevCorp North says that the community needs more beat cops.
"I think people just want to feel safe in their own neighborhood and that goes for any neighborhood. Police need to focus their efforts on hot spots," Owen says.
Police spokeswoman Monique Bond says Sobczyk was named Rogers Park commander because of his experience as a gang specialist.
"Commander Sobczyk has bedrock credibility when it comes to gang violence and intelligence," Bond says. "His policing skills go beyond gang intelligence. He has the ability to motivate his people and deploy the resources where they are needed most."
Sobczyk holds a bachelor's degree in criminal justice from the University of Illinois at Chicago and an M.A. in public administration from the Illinois Institute of Technology. He is also a graduate of the FBI National Academy.
He began his career in the 11th District and later worked in public housing, gang crimes, vice control, patrol division administration and the gang intelligence sections.
One of Sobczyk's bigger accomplishments has been designing the Crime Prevention and Information Center (CPIC), which addresses both crime prevention and homeland security issues. It uses advanced technology and shared databases all over Chicago to reduce crime and prevent terrorist acts. This fusion center, which began in April 2007, is described as groundbreaking and has become a national model.
"I've been blessed throughout my career not only with the breadth of experience, but the richness of the people I've been surrounded by and that kind of exposure helped me to advance," says Sobczyk.


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Like many graduating high-schoolers, I will be applying for post-secondary education this year. In fact, compared to some of my colleagues, I am already one of the late ones to apply. This rush to grab available spots in universities is perhaps why one of the newest articles in Maclean's magazine has caught my eye. The title is exactly that: Too Asian?
Let us look at the academic world around us as objectively as possible for a moment, especially in high schools. Living in Canada, you probably know people in your school that are of Chinese, Korean or Japanese descent. And out of those people, you probably know quite a few who are deemed to be academically superior than most, receiving marks that are of the upper echelon in your school.
Such notions are not rare in most high schools in Canada, yet in the past 25 years we have seen more and more Asian students taking spots in premier universities and some people are starting to feel that this might not be the best thing.
Frankie Mao, a 22-year old student at the University of British Columbia remembers his graduation clearly. It was the day when he would shed his high-school like and enter a life that was never before familiar to him. It was also the day when a Caucasian mother of another student confronted him and told him that her son didn't receive a spot in the university because of immigrants like him taking them up. "I knew it was wrong, being generalized in this category," he says, "But f–k, I worked hard for it."
Of course Frankie worked hard for entrance into the university. In fact, statistics show that in general, Asian students do work harder than most other people in academics. The assumption is that they lack in extracurricular activities and are all book nerds, but that is a myth that has long been demonstrated to be false.
Universities in North America are meritocratic, meaning if you've got what it takes, you will be considered equally to others for a chance. Unfortunately this means that Canadian universities are now seeing a large proportion of their student body composed of Asians, particularly at the University of British Columbia, Toronto, and Queens. Of course I don't mean that this is a bad thing academically. We should give higher education to those who earn it. Yet there are certain social repercussions that could follow this phenomena, which has been a growing concern in Ivy League schools in America for quite some time and the issue has just recently attracted attention from Canadians.
Universities should be meritocratic, especially in a free country like Canada. Unlike some American schools, we haven't raised admission requirements significantly for Asian students in comparison to other ethnic groups. But can you imagine a Canada, claiming to be multicultural, to have its educated population be comprised solely of people of Asian descent? It could have a huge impact on racial relationship, immigration policies, and affect what it means to be truly Canadian. But what's clear from this issue is that we don't have the perfect multi-racial society we would like to think we have. We are, like the title to sociologist Thomas Espenshade book, "No Longer Separate, Not Yet Equal." And it's probably unlikely that we will ever reach that utopic vision of a world. So the ball is in our court; as the next generation, how will we deal with issues such as this one? And being of Chinese descent myself, how different would the future be for my children in this country?
Information source: Maclean's
Latest posts by tonny (see all)
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5 Responses to Canadian Universities: Too Asian?
Well those are facts. They involve a slight distortion of statistics. Due to the baby boom, a large percentage of every province's population is significantly over the age for university. Therefore, taking that into account, there is only about a 10% discrepancy in population percentages.
Now, I honestly don't think it is a viable problem. Of course, this is personal opinion. I think arbitrary attempts to equalize will only limit freedom. Why do more Asians go to UBC or U of T? Because more Asians apply to those universities and they work hard to be admitted. Because they are interested in the majors offered there. Trying to adjust racially only limits the potential of those Asians just because they are Asian.
For example, the Asian concentration in arts schools is below the expected average. Is that a problem as well? Would it be reasonable to limit the chances of hardworking white citizens in order to accommodate less qualified Asians?


text:
|Using color to guide debridement.
MedLine Citation:
|PMID: 23151765 Owner: NLM Status: In-Data-Review
|ABSTRACT: Chronic wounds are typically halted in the inflammatory stage of wound healing secondary to a prolonged inflammatory response of the body to bacterial colonization, as planktonic bacteria and biofilm and senescent cells present at the wound's edges. Surgical debridement of these wounds is a critical step taken by the treating physician to attain complete healing. In order for debridement to successfully reset the stages of wound healing, residual biofilm and senescent cells must be removed. Despite the importance of complete and thorough debridement, few methods exist, and even fewer articles have been written describing techniques to ensure that all portions of a wound are equally addressed with each procedure. Using methylene blue dye to color the wound allows the surgeon to address and debride all portions of the wound adequately. In addition, the surgeon must be very familiar with what the normal tissue colors are following removal of the methylene blue-dyed tissue. Getting to tissue with those colors provides an end point to the debridement and helps prevent removal of excess healthy tissue. This article describes the primary author's technique for staining tissues with methylene blue dye prior to wound debridement, as well as the colors to look for to signal completion of surgery. In addition, a review of biofilm and senescent cells is presented as both are targeted but frequently missed when wounds are incompletely debrided.
|Matthew Endara; Christopher Attinger
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20583395 - Short-term results of repeat valve replacement: a predictive factor analysis.
Publication Detail:
|Type: Journal Article
Journal Detail:
|Title: Advances in skin & wound care Volume: 25 ISSN: 1538-8654 ISO Abbreviation: Adv Skin Wound Care Publication Date: 2012 Dec
Date Detail:
|Created Date: 2012-11-15 Completed Date: - Revised Date: -
Medline Journal Info:
|Nlm Unique ID: 100911021 Medline TA: Adv Skin Wound Care Country: United States
Other Details:
|Languages: eng Pagination: 549-55 Citation Subset: N
|Matthew Endara, MD, is a Resident at the Department of Plastic Surgery, and Christopher Attinger, MD, is Chairperson/Professor, at Center for Wound Healing, Department of Plastic Surgery; both at Georgetown University Hospital, Washington, DC.
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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Did you know that metacafe pay 2$ for every 1000 views for your videos?
I was surprised when I saw this:
WoW, if Youtube would do this.. than it would be insane I hardly use metacafe
Would it be allowed to use PTC websites for it? As I know some PTC's that have a rate of $0,50 per 1000 uniques so.. And I still have credits there for ads, but not enough for payout...
|Nico Lawsons
Is that per video? For each 1000 views up to 500,000.
What does the fine print state?
#1 SEO Keyword Software Leave a Comment @ ➡Make Money Online
Funny Signs..SEO
5 million views on youtube would be extremely hard (but possible) but I can't imagine how hard it would be on metacafe (much less traffic). I would give it a go but it only starts paying out after 20,000 views (my best on youtube is 200 )
The views must come from US. They pay for only US views. And like GameOver said, after 20 000 international views.
I have 100k plus views on Youtube with some crappy vids, but I could hardly manage that on Metacafe, plus it would be a complete waste of time.


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Occupational Therapy Equipment Catalogs
Chinese Herbology – Wikipedia, The Free Encyclopedia
Chinese herbology is the theory of Chinese herbal therapy, which accounts for the majority of treatments in Chinese medicine (TCM). The term herbology is misleading in so far as plant elements are by far the most commonly, but not solely used substances; animal, human, and mineral products are … Read Article
Discovering New Possibilities With Assistive Therapies
catalogs for unfamiliar equipment and then struggling to erect the device in your home only to find that it's Occupational Therapy. Upon request, an occupational therapist and a rehabilitation engineer from CI visit patients' homes to … Read Here
Appropriate and sufficient equipment and supplies must be provided by the institution for student use and for the catalogs, handbooks, Occupational Therapy Code of Ethics, Core Values and Attitudes of Occupational Therapy Practice, … Read More
THE UNIVERSITY OF TENNESSEE – UT Knoxville | College Of Arts …
Occupational therapy is the art and science of helping people • designing and constructing adaptive equipment • conducting research to measure the effectiveness of catalogs of those institutions to determine the specific … Fetch Doc
38224 20273 Material, Equipment For Educational Technology …
STATE AGENCIES & CONTRACTORS38224- MATERIALS AND EQUIPMENT FOR OCCUPATIONAL TRAINING Purchasing Officer I (518) 474-1912 . firstname.lastname@example.com . CONTRACT PERIOD: Catalogs and price lists provided must reflect all products excluded from the resultant … Read Full Source
Sensory Room Development Ideas For Creating And Furnishing A …
Ve additional equipment such as bubble lamps, a vibroaoustic chair, soun Many of these items are available in catalogs and at stores such as Bed and other discount stores. Stores such occupational therapy supervisor, worked closely with … Content Retrieval
OTA 250 Henshaw 03-30-07-4d
OTA 250 OCCUPATIONAL THERAPY ADMINISTRATION 3 cr. (3-0) time management, equipment and supply inventory, and record maintenance. 26. Understand the ongoing professional responsibility for providing fieldwork and are described in the college catalogs and college student … Content Retrieval
Chapter Ten: Introduction To Occupation-Based Practice …
Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated. Dimension Probes Analysis • Adaptive equipment catalogs • Flip chart, black board, or white board Instructions: • Individually: … Retrieve Document
For the Occupational Therapy Assistant Page 1 Adequate space must be provided to store and secure equipment and supplies. A.2.21. catalogs, handbooks, and Web sites—must accurately reflect the program offered. A.4.2. … Read Full Source
Diving Cylinder – Wikipedia, The Free Encyclopedia
Shallow decompression stops in technical diving or for in-water oxygen recompression therapy. (Occupational Safety and Health Administration and Compressed Gas Association The J-valve got its name from being item number J in one of the first scuba equipment manufacturer catalogs. … Read Article
Occupational therapy is the art and science of helping people • designing and constructing adaptive equipment • conducting research to measure the effectiveness of catalogs of those institutions to determine the specific … Doc Viewer
Arthritis: Physical And Occupational Therapy Part 6 – YouTube
Your therapist can show you catalogs that have a wide variety of assistive devices. 2:10 Occupational Therapy Month 2010 by sandyzk1 524 views; 3:45 How to Use Adaptive Equipment for Moving Around in the Kitchen by whitehallboca 2,928 views; … View Video
One Person\'s Stripper Pole Is Another\'s Therapeutic …
I\'ve given my son aquarium tubing to chew on because the stuff out of therapy catalogs is so much pricier. I am an occupational therapy assistant and I have studied Sensory Integration and visited some great SI Equipment; Therapies; Special Needs Adoption; Respite; Children With Special … Read Article
Occupational Therapy
Occupational Therapy Major Adviser: Melinda A. Cozzolino, Chair of Graduate Program, email@example.com Development of specialized equipment and methods of adapting equipment and physical space. Environmental adaptation includes time, space, … Get Document
Therapist\'s Specialty Is Functional Skills
Adaptive equipment, catalogs. Therapists may instruct in wrapping the residual limb with ace bandages, or in applying stump The occupational therapy training period is a time when client and caregivers should ask questions, gain … Return Document
Occupational Therapy Education,a part of the KU School of Allied Health on the University of Kansas Medical Center campus. Kan., training clients in food-preparation skills and use of kitchen equipment while preparing low-cost dinners for seniors. Advising and Mentoring … Retrieve Doc
Occupational Therapy Sample Reports – Sitemason
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text:
ACP-EU Fisheries Research Initiative.
Refereed StatusNon-Refereed
MetadataShow full item record
This report presents the proceedings of a five day scientific conference on "Placing Fisheries in their Ecosystem Context", held on 4-8 December 2000, at the Charles Darwin Research Station, Puerto Ayora, Galápagos Islands. The conference was hosted by the Charles Darwin Foundation for the Galápagos Islands and co-organized by Instituto de Ecologia Aplicada, Universidad San Francisco de Quito, Ecuador; the Charles Darwin Research Station, Ecuador; and the North Sea Centre, Denmark. The conference as made possible through support from the European Commission's INCO-DC Concerted Action programme ERBIC18CT97175. The conference was based on the recognition that the sustainability of fisheries worldwide depends on the maintenance of the ecosystems in which they embedded. The negative impact of fisheries on ecosystems, and thus on the sustainability of both the fisheries and the ecosystems, is becoming more and more obvious and must be addressed. This conference brought together p.....
JournalProceedings of the INCO-DC Conference Placing Fisheries in their Ecosystem Context
Series;NrACP - EU Fisheries Research Report, 12
Document Languageen
Conference NameProceedings of the INCO-DC Conference Placing Fisheries in their Ecosystem Context
Conference PlaceGalápagos Islands, Ecuador
Conference Date4-8 Dec 2000
CitationChristensen, V. & Reck, G. & Maclean, J.L. (Ed.) Proceedings of the INCO-DC Conference Placing Fisheries in their Ecosystem Context. p. 1-88
- Miscellaneous [667]


text:
|Morphological characteristics of placentas associated with idiopathic intrauterine growth retardation: a clinicopathologic study.
MedLine Citation:
|PMID: 20627398 Owner: NLM Status: MEDLINE
|OBJECTIVES: To investigate histopathologic findings, placental diameters and characteristics of syncytial knots in the placentas from idiopathic intrauterine growth retardation (IUGR) pregnancies, and to compare them with a normal birth weight group.
STUDY DESIGN: Based on strict eligibility criteria, this prospective case-control study included 52 term placentas from idiopathic IUGR pregnancies and 69 term placentas from normal birth weight pregnancies. The study was carried out at the Clinical Hospital Centre, Split, where all placentas were collected and examined. For each placenta, diameters were measured and the following histopathologic findings were recorded: infarction, intervillous thrombosis, abruption, villous branching and maturation, chorioamnionitis, decidual vasculopathy and hemorrhagic endovasculitis for each placenta. In addition we assessed quantitative (number of syncytial knots and number of syncytial nuclei per syncytial knot) and qualitative (density and surface area) characteristics of syncytial knots in each placental sample. Statistical significance was tested using chi(2)-test, Student's t-test and Mann-Whitney U-test. Statistical significance was set at P< or =0.05.
RESULTS: There was no difference in investigated histopathologic findings between idiopathic IUGR placentas and control group placentas. Placental diameters correlated significantly with neonatal birth weight (r=0.64; P<0.01); with higher birth weight there is an increase in placental diameters. Syncytial knots from idiopathic IUGR had significantly smaller surface area (Z=2.637; P=0.008) and higher density (Z=3.225; P=0.001) compared with the control group, while there is no difference in number of syncytial knots per individual villus, total number of syncytial knots in each placenta sample or number of syncytial nuclei per syncytial knot.
CONCLUSIONS: The investigated histopathologic findings in idiopathic IUGR placentas are incidental, with no higher frequency than in placentas from uncomplicated pregnancies, and should not be considered as possible causative factors for idiopathic IUGR. The demonstrated qualitative changes of syncytial knots in placentas associated with IUGR could represent a compensatory mechanism.
|Sandra Zekic Tomas; Damir Roje; Ivana Kuzmic Prusac; Ivica Tadin; Vesna Capkun
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Publication Detail:
|Type: Journal Article
Journal Detail:
|Title: European journal of obstetrics, gynecology, and reproductive biology Volume: 152 ISSN: 1872-7654 ISO Abbreviation: Eur. J. Obstet. Gynecol. Reprod. Biol. Publication Date: 2010 Sep
Date Detail:
|Created Date: 2010-08-23 Completed Date: 2010-12-13 Revised Date: -
Medline Journal Info:
|Nlm Unique ID: 0375672 Medline TA: Eur J Obstet Gynecol Reprod Biol Country: Ireland
Other Details:
|Languages: eng Pagination: 39-43 Citation Subset: IM
Copyright Information:
|Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
|School of Medicine University Split, Soltanska 2, 21000 Split, Croatia. email@example.com
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
Birth Weight
Case-Control Studies
Fetal Growth Retardation / pathology*
Giant Cells / pathology
Infarction / pathology
Middle Aged
Placenta / pathology*
Prospective Studies
Purpura, Schoenlein-Henoch / pathology
Young Adult
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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text:
Yesterday, when Chinese state broadcaster CCTV ran its annual "Academy Awards for business" ceremony (think Forbes 500 but on TV), the old guard of China's electronics industry butted heads with the country's hottest tech hero in the name of good television – and RMB 1 billion (about $164 million).
During a discussion led by network host Chen Weihong, Dong Mingzhu, President of China's Gree Electric, and Lei Jun, CEO of smartphone maker Xiaomi, traded barbs over the business models of each other's companies. Dong accused Xiaomi of relying on price point and marketing to push its product, while Lei singled out Gree's customer service strategy as an area of weakness.
The jabs ultimately led to a bet: if in five years Xiaomi's revenue exceeds that of Gree's, Dong will pay Lei RMB 1 billion. And if it doesn't, Lei will have to cough up for Dong.
If you're keeping track: last year Gree brought in RMB 99.3 billion in annual revenue (about $16.3 billion). Xiaomi, meanwhile, brought in RMB 13.27 billion in revenue (about $2.16 billion) for the first half of 2013, and expects that figure to double by the end of this year.
While the debate probably made for great TV, there's no doubt that Dong and the TV host missed a great opportunity to put Lei on his toes, if that was ever their intention.
One angry man, one angry woman
The CCTV host made it clear what was about to unfold when he invited Wang Jianlin, chairman of the Dalian Wanda Group, and Jack Ma, chairman and founder of Alibaba, to take the stage alongside Dong and Lei. The former two figures made a similar bet at the previous year's event.
After introducing the Dong and Lei, both of whom received awards that night, the host ask Lei if he could foresee Xiaomi surviving for 23 years – the current lifespan of Gree Electric. Lei replied affirmatively as he described Xiaomi's business model, which followers of the company are certainly familiar with by now.
The most important element of Xiaomi's business model is that it's asset-light. First of all, it has no factories of its own, so it can utilize the world's best factories. Second, it has no sales channels or physical retail outlets, so it can use the internet's e-retailers to sell directly to consumers. Since it needs no capital for sales and storefronts, it's more efficient. Third – and most importantly – since it has no factory, and since it has no physical retail outlets, it can put its energies towards the user and the product. As a result, out of Xiaomi's 4,000 employees, 2,500 [are responsible for] communicating with users, and 1,400 do research. So it can focus all of its energies on product development and service for the user.
Dong then went in for some low blows, noting that probably 99 percent of the audience didn't own a Xiaomi phone, and arguing that since Xiaomi simply markets devices that are manufactured by others, the company has less control over its products (bear with us). When the host egged her to make a bet with Lei on Xiaomi's fortunes, Dong continued to argue against the company's fortunes, saying:
Even though you sell online, you say you want to be competitive on price. But Gree isn't competitive on price, it's competitive on quality. We also have outstanding service, and that's because we have tens of thousands of professional retailers. If we collaborate with Jack Ma, will we not take over the world? You don't have a factory that can make the best products […] My products don't need after-sales service, and who out there isn't buying them?
After Dong expressed doubt that Xiaomi could grow as fast as Gree had in the past year, Lei then again turned back to the alleged advantages of Xiaomi's business model as a means to respond to her critiques.
Let me summarize quickly. First Gree is a company I have the utmost respect for, and Dong is an entrepreneur whom I have the utmost respect for. She does traditional manufacturing and traditional marketing very well. But these days, the era of harnessing the internet's DNA to completely change consumer goods has already arrived. Xiaomi is a classic example of this trend. Where are it's advantages? It is close to its userbase and emphasizes user experience and word-of-mouth marketing. Second, since it's asset-light, it can grow quickly. And third, we have a service team of 2,500 members, 1,300 of which are available 24 hours a day, seven days a week. Finally, as for whether Xiaomi's business model will overtake Gree's business model, we'll have to wait five years. So everyone, bear witness: within five years, if our revenue beat's Gree's, Dong Mingzhu can owe me RMB 1 billion and that would be fine.
What's missing here?
We're talking about television here, so we ought to take this event with a grain of salt. Moreover, Dong also makes some ludicrous arguments that ought to call into question the authenticity of the entire debate. For one thing, by outsourcing its production to manufacturers, Xiaomi places itself firmly in the majority of hardware brands, rather than in the minority. Accusing it of ceding quality control would be to accuse Apple of the same thing. And of course, to say that Xiaomi competes merely on price point also reflects a misunderstanding of the company's business model. It's true that the company sells phones at nearly the cost of production, but it doesn't compete just on price point. New Asian brands brands like, Coolpad, Gionee, and Zopo – those are brands that undercut big names and compete on price-point, and aim to make slim profit margins at high volumes. But Xiaomi hedges its bets on its customizable MIUI skin – built on top of Android – and its theme store, book store, app store, and its other services to help bring in profits. Successful software monetization will likely also depend on volume, however, Xiaomi's software isn't a commodity like a piece of hardware, or an air conditioner.
So why are we talking about this in the first place then? CCTV probably succeeded in creating some quality entertainment (this writer has only read the Chinese transcript, full disclosure), with the symbolic old guard of China's industry sitting beside the symbolic great hope for Chinese innovation (this is not at all to discount the innovative efforts of other Chinese tech firms).
The missing component from the televised dialogue mirrors the component that's missing from most of the discussion about Xiaomi in general – namely, the software-and-services side Xiaomi, rather than the hardware side of Xiaomi. Xiaomi's executives have correctly compared the company to Amazon's Kindle division, which puts affordable hardware in consumers hands with the hope that it benefits from app-store purchases and the like. And the big question surrounding Xiaomi as it grows outside the US ought not just be "Will units of the cheap Chinese phone with the cute mascot bring in revenue outside of China?" but "Will this company make profits by selling apps and services to consumers who opt to buy a cheap phone?"
That, right there, is the RMB 1 billion question.
(Editing by Steven Millward and Paul Bischoff)
(Image fia Flickr user hand-nor-glove)