THE EFFECTS OF ALTITUDE ON HUMAN PHYSIOLOGY Changes In Altitude Have A

THE EFFECTS OF ALTITUDE ON HUMAN PHYSIOLOGY Changes in altitude have a profound effect on the human body. The body attempts to maintain a state of homeostasis or balance to ensure the optimal operating environment for its complex chemical systems. Any change from this homeostasis is a change away from the optimal operating environment. The body attempts to correct this imbalance. One such imbalance is the effect of increasing altitude on the body's ability to provide adequate oxygen to be utilized in cellular respiration. With an increase in elevation, a typical occurrence when climbing mountains, the body is forced to respond in various ways to the changes in external environment. Foremost of these changes is the diminished ability to obtain oxygen from the atmosphere. If the adaptive responses to this stressor are inadequate the performance of body systems may decline dramatically. If prolonged the results can be serious or even fatal. In looking at the effect of altitude on b ody functioning we first must understand what occurs in the external environment at higher elevations and then observe the important changes that occur in the internal environment of the body in response. HIGH ALTITUDE In discussing altitude change and its effect on the body mountaineers generally define altitude according to the scale of high (8,000 - 12,000 feet), very high (12,000 - 18,000 feet), and extremely high (18,000+ feet), (Hubble, 1995). A common misperception of the change in external environment with increased altitude is that there is decreased oxygen. This is not correct as the concentration of oxygen at sea level is about 21% and stays relatively unchanged until over 50,000 feet (Johnson, 1988). What is really happening is that the atmospheric pressure is decreasing and subsequently the amount of oxygen available in a single breath of air is significantly less. At sea level the barometric pressure averages 760 mmHg while at 12,000 feet it is only 483 mmHg. T his decrease in total atmospheric pressure means that there are 40% fewer oxygen molecules per breath at this altitude compared to sea level (Princeton, 1995). HUMAN RESPIRATORY SYSTEM The human respiratory system is responsible for bringing oxygen into the body and transferring it to the cells where it can be utilized for cellular activities. It also removes carbon dioxide from the body. The respiratory system draws air initially either through the mouth or nasal passages. Both of these passages join behind the hard palate to form the pharynx. At the base of the pharynx are two openings. One, the esophagus, leads to the digestive system while the other, the glottis, leads to the lungs. The epiglottis covers the glottis when swallowing so that food does not enter the lungs. When the epiglottis is not covering the opening to the lungs air may pass freely into and out of the trachea. The trachea sometimes called the "windpipe" branches into two bronchi which in turn lead to a lung. Once in the lung the bronchi branch many times into smaller bronchioles which eventually terminate in small sacs called alveoli. It is in the alveoli that the actual transfer of oxygen to the blood takes place. The alveoli are shaped like inflated sacs and exchange gas through a membrane. The passage of oxygen into the blood and carbon dioxide out of the blood is dependent on three major factors: 1) the partial pressure of the gases, 2) the area of the pulmonary surface, and 3) the thickness of the membrane (Gerking, 1969). The membranes in the alveoli provide a large surface area for the free exchange of gases. The typical thickness of the pulmonary membrane is less than the thickness of a red blood cell. The pulmonary surface and the thickness of the alveolar membranes are not directly affected by a change in altitude. The partial pressure of oxygen, however, is directly related to altitude and affects gas transfer in the alveoli. GAS TRANSFER To understand gas trans fer it is important to first understand something about the behavior of gases. Each gas in our atmosphere exerts its own pressure and acts independently of the others. Hence the term partial pressure refers to the contribution of each gas to the entire pressure of the atmosphere. The average

When You Feel Overwhelmed... Or Fail - CoSchedule Blog

When You Feel Overwhelmed... Or Fail Blog Marketers (just like you) are overwhelmed. Theres so much to do to be successful. Or is there? The noise is so intimidating: If you write a blog post, you better optimize it for SEO. That content  better be at least 2,500 words long. You have to research everything + back up your claims. It has to  be actionable. It has to be well-designed. You need to build an email list so you can share it. You need to post it on all of your social networks. All of the messages should be optimized for each social media account. You need to publish that blog post, send that email, and post to every social network at the best time. The list goes on and on. ^ And that example is just for writing a blog post. What about writing, designing, publishing, and promoting e-books, hosting webinars, starting your podcast, and beyond? Im sure you see my point. When You Feel Overwhelmed Or FailBut what would your life be like if you were to  focus on doing fewer things extremely well? You will create more effective projects. You will build skills and subsequently boost your efficiency. You will improve  a process you can delegate, and subsequently scale your results. Intense focus on doing work that actually makes a difference will  eliminate the overwhelm. And subsequently, you will fail less frequently. Do one thing well. Then embellish upon it. Do one thing well. Then embellish upon it.A big mentor of mine told me recently: Think of every project in terms of little experiments. via @garrett_moon Nathan Ellering (@njellering) January 31, 2017 If you look at that blog post you want to write as an example here, that means: Write the dang thing. Ship it (imperfections and all). ^  At first, you dont need to optimize it for search engines. It doesnt need to be extremely well-edited. You may not need graphics at all. You dont need to optimize it to capture email addresses. Because if you dont focus on doing one thing well at first- and let yourself become overwhelmed with #allthethings  you could do- youre probably spreading yourself too thin. Youre doing many things just alright  without doing one thing extremely well. All of the fringe things that make up a well-rounded  project will come over time. But, as Seth Godin says: If you don’t ship, you actually haven’t started anything at all. At some point, your work has to intersect with the market. At some point, you need feedback as to whether or not it worked. Otherwise, it’s merely a hobby. After you nail the core skill that will make your project successful, you can optimize it further. As you think of projects in terms of little experiments, you  wont waste time  writing an entire strategy around something that is actually a big huge guess. Ship. Learn. Iterate. 9 Things  We Tried  That Didnt Work Out So Well At Least At First And with that here are a number of experiments  the (mostly) marketing team at has tried and failed. Im sharing these stories  so you can implement a similar approach of  testing + agility in your marketing operations. Also learn from our failures so you dont have to experience them yourself. #1: Executing Without A Solid Plan Is Kind Of A Bad Idea (Really Bad, Actually) Last year, I got really excited about launching an editorial strategy course. We had just added a couple new friends  to  the marketing team. So I wanted to refocus my time on something completely new and exciting. I jumped into creating content without telling anyone. The goal, the game plan, the sprints, the tasks- everything existed in my head and was not communicated well with the team. I didnt even ask them for their thoughts on what a great course would look like for the audience. The result? I had to scrap a lot of work and restart. This is why I remind myself: Fail fast. Fail once. Now we have a brainstorming meeting for big ideas like this where I ask the team one question: What would a project like this look like for ? Everyone helps  shape the project. Everyone has  a stake in the strategy. Then I pare down the ideas into realistically achievable sprints. #2: More Meetings Fewer Meetings A lot of people think fewer meetings are  better than  more meetings. Theyre wrong. Our  Product team often uses meetings as a  method to get more work done faster. For example, theyll touch base in the mornings. Then theyll set up another touch point that day in mid-afternoon for a show and tell of what theyve completed so far. This gives the product owners a chance to review the progress and see how things are looking. So if anyone is off track, they can course correct without wasting a lot of time working on  something that would be changed anyway. More touch points like this keep us focused. The key is  these meetings are focused on execution + creating effective work quickly. Theyre like deadlines. And they work because nobody  wants to show up for a show and tell and have nothing to show. #3:  Data-Driven Decisions Assumptions Its easy to let assumptions guide your work. Its another to use data to understand what really works. We tested sending well-designed emails to our audience with the assumption that more people would click through. After testing the designed emails against plain text, the results were not even close. Plain text emails get way more clickthroughs with our audience. But if we hadnt tested, we would have never known. Test. Measure. Learn. Its easy to let assumptions guide your work. Its another to use data to understand what really#4: Plan Way Ahead For Video Content We recently launched #OverheardAt, a new video series. It was a brand new project without a defined process. Snags included sketching, video length, and editing in post-production. ^ Essentially, a better plan + over-communication is the best way to resolve those challenges with video, especially because its really hard to change video content after its been recorded. A big lesson here is that  this was the first time doing it. To build a skill and a solid, repeatable process, you need to start, hone, and optimize. We wont make the same mistakes again. To build a skill and a solid, repeatable process, you need to start, hone, and optimize.#5:  Start + Improve In October 2016, we launched a weekly podcast called The Actionable Content Marketing Podcast. Like any skill you build, I started by first concentrating on finding amazing guests  and sharing helpful  stories other marketers would love. I had to learn a brand new process complete with the foundation/structure + outreach + writing questions + actual interviews + audio quality + promotion + a lot more. My early interviews were a little rocky. The audio could have been better. But Ive gotten a lot more comfortable, and now I just edit out my awkwardness (ha). Now that were covering lots of different marketing topics, weve also changed the name of the podcast to The Actionable Marketing Podcast. Its a matter of focus. And you can listen to my thoughts on that here. The lesson learned here is starting, shipping, iterating. #6: Spend Money To Make Money We started dabbling in AdWords and Facebook Ads to reach a larger audience. At first, I was spending next to nothing and getting next to no results. For projects like paid advertising, you need to invest a significant amount up front because you have no idea what kind of ads will convert (and which wont). Which means, especially as you start, you need to spend some money to understand whats not working to know where you can improve. Ad creative is a big huge guess until you look at the data. Some of my favorite ads never converted while some ads I would have never guessed would do so well are still among our top-performers today. Again, personal opinion should never get in the way of measuring real results. #7: Customers   Traffic + Email Subscribers Profitable customer action. Thats the reason marketing exists, right? To drive profitable customer action. For about two years, the Content Marketing team at focused on building traffic. Once the traffic was on our website, we optimized the content to convert that traffic into email subscribers. That is still an approach I recommend starting with. But weve recently made a pivot. What we used to call our Content Marketing team is now the Demand Generation team. Its a matter of focus: To provide the most helpful marketing content on the internet that attracts an audience of marketers who are interested in organizing their marketing execution with . Were using data to understand what content we publish influences the best kinds of customers for our business. Then we learn the  qualities + topics that help us  attract the right audience. And we use that knowledge to  ship more content that aligns among  our best performers. ^ Id definitely recommend doing this for your own marketing. #8: Stop Doing Whats Not Working (RIP #CoChat) For about six months, we hosted a weekly Twitter chat. Six months deep, I wrote a quick survey and shared it with our Twitter chat participants. I really wanted to know if any of them were more likely to buy because of the  chat. The results were a resounding no. Not a single participant was more likely to purchase because of participating in the chat. At least, thats what they told me. Literally. So, as a matter of focus, we shut down #CoChat. It was sucking our resources into a project that was not delivering measurable results to our goals. Stop whats not working to refocus your efforts on what does. Stop whats not working to refocus your efforts on what does.#9: Reward Yourself  For Providing Value concentrates on providing value in every project we ship. When we launched our Headline Analyzer the first time, we  didnt have a way to capture email subscriber leads. When we saw the tool take off, we provided a  content upgrade in exchange for an email address. The tool was valuable for our audience. For free. So we wanted to also have a way to continue to communicate with those folks. Thats fair. Heres another example:  We knew  our audience loved getting free PDFs. Then we started experimenting more: Wouldnt editable spreadsheets, Word docs, and slide decks be even more helpful? And what if we bundled more of those things together so instead of giving one thing away for free, wed give away three, five, or heck, even 10? ^ Every time we gave away more helpful stuff, we converted more people. Every time we gave away more helpful stuff, we converted more people.When you provide something valuable, you, as a marketer, deserve to be rewarded in some way. Think about the conversions, the desirable action. You put in the work, you deserve something out of it. Dont be afraid to make the ask. How To Overcome The Overwhelm (Or Failures) So what  have all of those stories + failures  taught us about overcoming the overwhelm? Plan Your Work. Then Work Your Plan. People who write down goals are more likely to make them a reality. Plan how you will execute a project. Then follow the plan. Leave out the frills and focus. Start With Minimum Viable Tests (Then  Optimize Further) Garrett likes to say: The simplest approach is often the best place to start. Nail a core skill, then optimize further. Doing Less Is Often Doing More You dont have to do everything to be successful. Instead of spreading yourself too thin,  master a 10x project. Then scale it. Being really good at one thing is better than being mediocre at many things. Embrace Frameworks Thought processes are easy to pass along to your team when you embrace easy-to-remember frameworks. For example, the framework that drives our entire Demand Generation strategy is: The right content The right audience The right amount of effort If we do those three things incredibly well, we win.  Everyone on the team can repeat that framework to you if you were to ask. Could your marketing team benefit from a simple framework like that? Ship + Learn + Iterate Dont shoot for perfection. Create something just good enough to produce the desired result. Learn the skill. Then hone it. As you improve your process, optimize it with additional opportunities for growth.

On-line Demand for Products and Services Assignment

On-line Demand for Products and Services - Assignment Example As the growth witnessed in the online shopping arena continues exponentially, various firms are acquiring new wealth focused on new market opportunities for footprint coverage. Therefore, stores are able to subsequently cater to the vast and continuously growing offshore markets in terms of service requirements and market demands. This is because of the growing influence of the Internet where online consumers need both Internet connectivity and valid payment methods to sustain a complete transaction (de Kare-Silver, 2000:48). In most cases, once a particular item has been identified on a website or in another online platform, an online retailer subsequently uses available shopping cart software. These subsequently allow consumers to continue buying products by way of accumulating multiple items, in addition to being able to adjust the quantities acquired. Through the existing ‘checkout’ processes, payment and delivery information is acquired. Here, some stores allow the customers to sign up for permanent online accounts. This is important because of the need for constant information gathering during an online transaction. This involves sensitive information (Sheth, 2003:23). Online accounts are more secure and hence the preferred choice for frequent online shoppers. As such, information should only be entered once. Some of the dominant online accounts include Shopify, Shopgate, and PrestaShop, osCommerce, Magento, and nopCommerce. High-end solutions can also be bought or rented in the version of stand-alone programs (Huang, 2000:339). This may also work as an addition to an existing enterprise program on resource planning. In the event that a transaction is successfully implemented, online shoppers usually receive e-mail notifications. A less sophisticated avenue involves a process where consumers use email or phones to order their products.  

Native Guard Poems By Natasha Trethewey Essay Example | Topics and Well Written Essays - 1250 words

Native Guard Poems By Natasha Trethewey - Essay Example The poem profoundly conveys her heart for the blacks in rich voice texture and images of truths concerning the battles not only against slavery for the fellow blacks but even with the unsettled issue of freedom that appears detached from the desired racial equality. â€Å"Native Guard† begins with an epigraph attributed to the 19th century social reformer and statesman Frederick Douglass stating â€Å"... if this war is to be forgotten, I ask in the name of all things sacred what shall men remember?† in reference to the Civil War which Trethewey revitalizes with her literary design. Utilizing ten stanzas each bearing distinct date, the poet pays tribute to one member of the Louisiana Native Guards being â€Å"the first officially sanctioned regiment of black soldiers in the Union Army.† With reference to the first line where the speaker expresses  Ã¢â‚¬ Truth be told, I do not want to forget†, the native guard himself is shown to have gathered to his sen sibility an essential contemplation of the past, adding â€Å"†¦I thought to carry with me / want of freedom though I had been freed, / remembrance not constant recollection†¦Ã¢â‚¬ . ... s and ends with a memory wherein the last line of each sonnet becomes a variant of the subsequent sonnet's opening line, as in a meaningful chronology of historical events. Since â€Å"Native Guard† is a first-person narrative supposedly by an unnamed ex-slave in an all-black regiment of the Union Army, the lines can be observed to possess stately approach to language and structure. Within the poem’s context is the presence of circularity depicting circumstantial shifts as one finds the former slave guarding the imprisoned inside the Union fort at Mississippi’s Ship Island. Comparing his personal life in relation to his professional life as a military officer who look after welfare of the fallen rebels, he states – I now use ink to keep record, a closed book, not the lure of memory — flawed, changeful — that dulls the lash for the master, sharpens it for the slave. For the slave, having a master sharpens the bend into work, the way the sergea nt moves us now to perfect battalion drill, dress parade. Trethewey’s style of writing in â€Å"Native Guard† is characteristic of a speaker’s tone or at least, a sound representative of the way speech is made in the culture or group the narrator has become a part of. Like journal entries, the words are phrased and constructed in a manner that indirectly yet effectively states the type of sentiments involved and along the following lines, the bitterness may be sensed with the drop of the last two words – †¦We’re called supply units - not infantry – and so we dig trenches, haul burdens for the army no less heavy than before. I heard the Colonel call it Nigger work†¦ Often, the work celebrates not only the factual details which history is not made to confront or disclose but also the most excruciating truths that

Electromagnetic radiation (EMR) Term Paper Example | Topics and Well Written Essays - 1000 words

Electromagnetic radiation (EMR) - Term Paper Example Mostly, Electromagnetic Radiation is in the forms of waves. These waves include: Radio Waves, Microwaves, Infrared, X- rays and Gamma-rays (Mattson). The magnetic and electric fields resulting in the electromagnetic waves interact by coming together at right angles to each other and these combined waves move perpendicular to both electric and magnetic oscillating fields and as a result, the disturbance is caused (Nikita , Kevin and Mateo). The resulting electron radiation is released in bundles of light energy which travel at a speed of 299 792 458 m / s, equivalent to the speed of light, as quantized harmonic waves. This electromagnetic waves are grouped according to their wavelength and the this results in the electromagnetic spectrum. The resultant magnetic and electric waves move perpendicularly to each other having certain characteristics which are Amplitude, frequency and wavelength. Features of Electromagnetic Radiation Wavelength The movement of the electromagnetic waves is in form of patterns. The distance that exists between two peaks is the wavelength of the wave. The wavelength of a waveform is measured in meters. This is illustrated in the figure below. Frequency Frequency can be defined as the number of oscillations of the wave per unit time. The frequency of waves is not constant, it varies and the variation greatly depends on the type and nature of the electromagnetic radiation. The frequency of a wave is measured in Hertz. The wave can have high frequency or low frequency as indicated in the diagram below. The frequency is related to the wavelength by the dispersion relation is given by: Where  the wavelength and c is the propagation speed Amplitude Amplitude refers to the characteristic height of the wave. Amplitude is a measure of the intensity of the wave and is measured in meters. The amplitude of an electromagnetic radiation is given by Where  Refers to the electrical amplitude,  is the wavelength and c is the propagation speed. Characteristics of electromagnetic Radiation Interference This is the process in which two waves superposes to form one resultant wave. For interferenc e to occur, the source of the waves must be coherent. If two electromagnetic waves having the same frequency get together i.e. they superpose, it results into a wave which has the resultant magnetic and electric field strength equal to the sum of fields of the two waves. When two strong waves moving that have their fields moving in one direction, i.e. same direction in time and space, the resulting waveform is twice that of each individual waveform (Encyclop?dia Britannica Online). This results in constructive interference. However, the superposition of a wave having an electric field in one direction in space and with another electromagnetic radiation wave which has the same frequency but with an electric field in the opposite direction in space and time results in cancellation and a result, there is no formation of a waveform (Encyclop?dia Britannica Online). This implies that the two waves are not in phase. The resultant effect is termed as destructive interference. In summary, s uperposition of waves results in destructive, constructive or partial interference considering the magnitude of the waves being superposed. If two monochromatic waves described by And Then The value is responsible for the interference process. If then the resultant interference is constructive If Then  If Then the interference is a destructive interference. Diffraction When electromagnetic waves come onto obstacles, they are diffracted. Diffraction is the process by which the waves bend around obstacles. This can be illustrated as in the diagram be

Mesotherapy Strategies and Techniques

Mesotherapy Strategies and Techniques MESOTHERAPY INTRODUCTION Mesotherapy is an art of injecting small quantities of various medicinal preparations such as vitamins, minerals and other conventional drugs directly into the mesoderm to treat pathological conditions locally. It involves the administration of intradermal or subcutaneous injections of compounds to treat a variety of medical conditions and avoiding systemic adverse effects due to drugs. It appears to be a novel technique to administer medicines local to the pathology while the skin serves as a natural time- release system. BACKGROUND OF MESOTHERAPY The term mesotherapy (derived from Greek mesos. â€Å"Middle† and therapeia to treat medically) denotes injection of substances into middle layer of skin ( mesoderm) for medical purposes. Historical aspects[1] Mesotherapy was originally used to treat painful conditions using local procaine injections. Michael Pistor who coined the term mesotherapy is considered the father of mesotherapy. In his original article,he described treating deafness, tinnitus, vertigo and headaches using local injections of procaine. Earlier to this in 1884, Koller an ophthalmologist used local cocaine to relieve pain. In 1925 Lerich used intradermal injections in the intercostal spaces. In 1937 Aron studied the use of intradermal injections to have an analgesic effect. Albert Lemaire, a Belgian physician used procaine injections to treat trigeminal neuralgia. In 1952, Michel Pistor a French physician popularized mesotherapy to treat various conditions in dermatology,sports,traumatology and vascular disease chiefly as a pain-relieving therapy. He defined mesotherapyas a techniquethat was used to treat mesoderm,(primary germ layer that develops into connective tissue, muscle and the circulatory system). In 1953, Dr .Mario Lebel invented a 3mm length needle that could be used precisely for injection of substances into the dermis. In 1964, the French society of Mesotherapy was founded by Michel Pistor and use of mesotherapy was extended to treat cosmetic conditions. The American influence was evident after Dr. Lionel Bissoon popularized the technique in North America. Despite the fact that mesotherapy is gaining popularity in aesthetic medicine especially for localized cellulite reduction, it continues to be a controversial topic and therefore requires cautious approach. The safety and efficacy of these mesotherapy remain ambiguous to patients and physicians alike. [2] Applied basic science [1, 3] The concept that led to discovery of mesotherapy is quite interesting. Pistor saw recovery of chronic hearing loss while treating a patient with procaineinjections for an asthma attack. Subsequent intradermal injections of this product into the mastoid region proved this effect to be true. However the depth of injection was considered important. This led the researchers to the fact that at a depth of 1.5 to 2mm the local activity of the product would last longer due to a persistent reservoir with weak local diffusion in the dermis whereas products injected into dermis would dissipate to greater distances.A product when injected intradermally acts in two ways. Firstly, by stimulating dermal receptors in situ and secondly, over long distances by reaching other organs via circulation. A concept of meso-interface exists which is the surface of contact established between the injected products and the tissue injected. The more the multiple punctures are made and the more fragmented produc ts are delivered in small quantities, the greater the meso-interface and proportionately greater numbers of dermal receptors get activated.Pistor has always described this technique as follows. â€Å"A little volume, a few times and in the right place†. The idea was that by placing these products in the dermis, the skin acts as a reservoir for drugs to diffuse slowly via microcirculation to activate dermal receptors. A general mechanism of action (based on the target site, dermis) and a specific mechanism of action (based on the ingredients used) has been proposed to explain the concept of mesotherapy. The dermis is considered to be common denominator for circulatory, neurological and immunological functions; and the general mode of action is believed to occur by correction of these altered functions. Individual drugs or agents target the specific indication of mesotherapy. EQUIPMENTS The various equipments used in mesotherapy are Mesogun (Fig 1) Mircromesotherapy device Needleless Mesotherapy Mesogun Mesogun is a syringe infusion pump that is capable of injecting the desired substance at a required amount, speed and depth using the injector and needle. Syringes varying from 2cc-10cc and needle lengthsvarying in size from 4mm to 13mm can be used based on the indication, and desired depth of injection. A device known as guide is used to keep the needle at a constant depth. Once the parameters are chosen, the product can be injected by one of the following modes. Continuous – Min 3cc/min Max 10cc/min. Mircrodose – Max0.1cc/trigger. Standard dose – Max 0.3cc/trigger. Mesoperfusion – Max 0.3cc/trigger. Nappage – 0.1cc/trigger. Advantages of Mesogun Good comfort level for patient and physician Procedure is faster and relatively painless Accurate delivery system Versatality – Ability to perform various modes such as nappage, continuous, mesoperfusion in dosimetry. Syringes used in Mesogun: Generally 1ml, 5ml, 10ml and 20ml syringes with luer lock system is used based on the indication. MesoNeedles (Fig2 a): Mesoneedles or â€Å"Lebel needles† are commonly used in mesotherapy.The John Screw needles have an adjustable length.The recommended parameters for needles are based on the site of injection: Face and neck – 4mm 30G mesoneedles Fat and cellulite – 6mm 30G mesoneedles,  ½ inch 30G needles. Multi-injectors and plates (Fig2 b): These accessories help to cover larger areas in a short time facilitating faster and easier procedure for the injector. There are sterile circular and linear multi-injectors with needles ready to be used for any body part. Micromesotherapy Device Micromesotherapy is an evolution of conventional mesotherapy. Usually mesotherapy uses needles to deliver drugs in deep dermal layer. Here a reverse cone shaped device has ultrafine needle 32Gx2mm by which drugs are injected into the superficial layer of dermis therebyminimizing incidence of bruising, pain and scarring. Needle-Less Mesotherapy or No Needle Mesotherapy This is a needle free device that pushes mesotherapy products painlessly through the skin using electrical waves known as isophoresis. The main features of needle less mesotherapy are: Less painful and less traumatic Uses ultrasound/electroporation technology. Probably around 20% efficiency compared to traditional mesotherapy as there is no neocollagenesis or neo angiogenesis reactions that occur with needle micro injury. This may be an option if mesotherapy is not allowed in the country. It has been discussed in details in Chapter 12. MESO SOLUTIONS (Fig6[VG1] The basic requirements of meso products is that it should be approved and skin-compatible.Systemic administration (intravenous, intramuscular, subcutaneous or intradermal) should be safe and known pharmacological actions to be effective. The ingredients used in mesotherapy products should be water soluble, isotonic and non-allergenic. The mesoproducts vary with the indications chosen for treatment. [4] [ Figure 3]Products used for mesotherapy involves combination of products some of which are main ingredients known as principals as they have high grade of evidence in the treatment of each indications and complementary agents that have been approved for treatment of each indications. For a mixture to be effective it should contain 2 – 3 principals for any given indication. Therefore the ingredients in mesosolutions are broadly classified into main categories: Principal (P) / Major Complementary (C) / Minor. The main targets for mesotherapy are skin, hair, fat and cellulite. (Table 11.1). Table 11.1 Principal and Complementary ingredients in meso solutions in various indications INDICATION PRINCIPAL/MAJOR COMPLEMENTARY/MINOR SKIN REJUVENATION Mesolift Hyaluronic Acid5 DMAE Organic silicum Fibronectin + Vegetal Proteins Vitamin C Glycolic Acid Xadenal Vitamin A Growth Factors Stem Cells Mesoglow Hyaluronic Acid Siloag Vitamin C Xadenal Taurine Meso lightening Kojic Acid Azalaic Acid Vitamin C Glutathione Tretinoin Glycolic Acid Striae or stretch marks Stretch Marks Organic silicum Centella Asiatica Vegetal Proteins + Fibronectin DMAE Vitamin C Idebenone Hair Loss Androgenetic Alopecia Minoxidil Finasteride Dutasteride Dexenol Biotin Amino acids Peptides Zinc Azelaic Acid Stem Cells Telogen effluvium Biotin Dexapanthenol Pyridoxine Multi Vitamins Trace Elements Cellulite and Fat Meso Cellulite Caffeine Carnitine Aminophylline DMAE Rutin Artichoke Yohimbine Procaine Vitamin C Fat deposits Body Sculpting, localized fat, Cellulite PPC Deoxy cholate L – Carnitine Aminophylline Pentoxifylline DMAE -Dimethylaminoethanol ; PPC Phosphatidylcholine TECHNIQUES FOR MESOTHERAPY INJECTIONS The mesoproducts can be injected into the skin by various injection techniques to reach desired depth.The commonly used techniques and the desired depth reached are summarized in Table 11.2and Illustration 11.1 Table 11.2: Techniques and depth in mesotherapy injections Technique Depth Intraepidermal 1mm Papular 2mm Nappage 2-4mm Point by point 4mm Mesoperfusion > 4mm The salient features of various techniques are outlined below: Intra-epidermal This is one of the most superficial of the techniques described by Perrin. Depth: 1mm within the epidermis Painless, no bleeding Simple and large surface covered Ideal for patients with low pain threshold Ideal for facial rejuvenation, mesoglow Papular Depth:2mm dermoepidermal junction Painful Useful in mesobotox Ideal treatment of wrinkles Nappage(French for ‘covering’) Also known as picotage is the classic injection technique in mesotherapy. (Illustration 11.2) It is the most widely used technique in aesthetic dermatology. The syringe is held obliquely and the physician applies constant pressure on the plunger flicks the wrist to infuse a drop of the solutioninto the dermis(Fig 4). The injections are 2-2.5mm deep and 1cm apart. This technique can also be used for injections using a mesogun. (Fig 5) Depth 2-4mm Less pain and less bleeding Ideal for rejuvenation and scalp treatments Point by Point(Fig 6) Depth 4mm Perpendicular injection Ideal for fat reduction Mesoperfusion Depth > 4 mm Mesosolution is injected slowly over a priod of 10 minutes Not commonly used in dermatology PRACTICAL ASPECTS OF MESOTHERAPY Indications and contraindications for mesotherapy are listed in box 11.1 and box11.2. Box 11.1 Indications for mesotherapy Box 11.2 : Contraindications for mesotherapy Related to patient Unrealistic expectations Body mass index greater than 30 Pregnancy / Lactation H/O strokes, recent cancer. H/o multiple meds for heart disease H/o allergy to ingredients e.g. Soy proteins, lignocaine. Autoimmune disorders Epilepsy Insulin dependent diabetes Related to product Aminophylline – Known hypersensitivity to drug, active peptic ulcer, Pentoxiphylline, aminophylline- recent cerebral retinal bleed L. carnitine – history of seizure disorder Phosphatidyl choline relative contraindications with antiphospholipid antibody syndrome Caffeine – arrhythmias, anxiety, insomnia hypotension Mannitol – pulmonary edema, renal disease. Patient selection Selecting the patient with a valid indication for mesotherapy is the key to success. Care should be taken to avoid patients with active skin diseases, too elderly and patients with history of sensitive skin. For androgenetic alopecia better results are seen in patient with Grades 1 – 3. Counseling and preparing the patient A proper counseling is essential before starting mesotherapy. Patients with body dysmorphic disorders and those with unrealistic expectations should not be treated. Alternate procedures should be discussed sufficiently as mesotherapy is still in the controversial stage. A written informed consentis mandatory in the present medical scenario. A good before and after clinical photograph is needed to evaluate results following the procedure. Procedural aspects The area to be treated is marked and thoroughly cleaned with an antiseptic solution. For anesthesia, a local anesthetic cream may be applied or ice-anesthesia can be used to numb the treatment area. Patients are preferably injected in a lying down position. The required quantity of ingredients is drawn into the syringe using an 18Gx11/2needle. The injection is given either manually or using a device to deliver by the papular, nappage or point by point technique. A gentle massage is given after the treatments. Fresh normal saline and a mositurising cream can be applied to the treated area and massaged gently. [9]. The procedure takes about 20 – 30 minutes depending on the indication and area to be treated. There is no downtime after the procedure and the patient will be able to return to normal activities immediately. Good results are seen with mesotherapy done for skin rejuvenation, cellulite and double chin. [Fig 7, 8, 9] Post procedure care and counseling for follow up There may be mild pain, pinpoint bleeding, itching, burning or erythema after the injection which will subside spontaneously. Bruising and hematoma can appear occasionally and can be managed symptomatically. Mild swelling at site of injection may require anti-inflammatory agents for few days. The patients need to be counseled on the following aspects: Avoid sun exposure and smoking for next 48 hours Loose fitting clothes to be worn especially after lipolytic injections. The area to be treated is generally massaged after 72 hours and continued daily till disappearance of nodules if any. Follow up: Generally treatments are given once every 1-2weeks for 6 sessions, then once a month for 5months. Maintenance sessions are to be done once or twice a year. This protocol may be altered depending on the indication, patient’s lifestyle, financial position and response to previous treatments. Complications Though there are few evidence based studies on the efficacy of mesotherapy, there are documented reports on various complications. [10-17] The complications can be classified as local and systemic complications. (Box 11. 3) Box 11.3: Complications Local Bruising Burning or itching Pain, Tenderness, swelling Urticaria [10] Skin necrosis, Ulcers [11] Abscess [12] Hyper pigmentation Atypical mycobacterial infection [13] Rare – granulomatous panniculitis [14,15], koebnerisation, granuloma annulare, Oleoma [16] Systemic Anaphylaxis Nausea Vasovagal shock Hepatic toxicity Nerve demyelination Allergy to specific ingredients Thyrotoxicosis Ischaemic colitis [17] Management of Complications: Bruising:  It is a common but preventable complication. Always advice patient to stop aspirin or NSAIDs at least 2 weeks prior to the day of procedure. While injecting be slow and gentle. It is advisable to avoid mesotherapy during menstruation. Burning/Itching:  Burning can be overcome by adding lignocaine to the products if compatible. A mesomask applied immediately following procedure can also minimize burning and itching as it has a soothing effect. Pain/Tenderness: Procedural pain can be minimized by using adequate topical anaesthesia. Immediate post treatment pain can be alleviated by cold compresses with ice. Other methods that help to minimize pain are by pinching the skin for point by point injections or by stretching it when giving a nappage. Change needles after every few pricks to reduce the pain caused by blunt injecting needles Urticaria:  Urticaria can be avoided by a careful history to avoid products that would provoke an allergic reaction. E.g. phosphatidyl choline in individuals with history of allergy to soy proteins. Skin necrosis:  Skin necrosis occurs usually with phosphatidyl choline when the injections are given superficially Ulcers:  Ulcers can due to infection or irritant nature of the drugs. Irritant induced ulcers can be prevented by minimizing the number of drugs used in the cocktail to 4 or 5. Infective ulcers can be avoided by disinfecting the treatment area thoroughly and by wearing sterile gloves and using sterile equipment and materials. Hyper pigmentation:  This can be avoided by advising the patient photo protection for 48 hours after the procedure and by addition of topical skin lightening agents in patients with a history of post inflammatory hyper pigmentation. COMBINING MESOTHERAPY WITH OTHER TECHNIQUES Mesotherapy can be combined with other techniques to enhance results.Soon after injection of mesotherapy products, ultrasound, radiofrequency or electroporation may be applied to help in better diffusion of the injected products. The techniques are discussed in chapter 12. Mesomasks can be applied immediately after the injections to minimize bleeding points and to overcome the discomfort that follows injections.It is a 150 g of powder to be mixed with water to form a paste which is applied for 15minutes as a mask over gauze. This allows all products to penetrate deeper in the skin to give a better effect. These masks contain a mixture of calcium sulfate, talc and orange oil. Other procedures such as chemical peels, fillers and neurotoxins can be carried out between the mesotherapy sessions. In countries where mesotherapy is not practiced, mesotherapy products can be used following cosmetic skin needling. By using a dermaroller in the area to be treated, it is possible to create micro perforations that will be used as channels to deliver a product deeply into the skin. CLINICAL STUDIES Mesotherapy has been in history for a long time and there are proponents who have been successfully using it in practice for the benefits of their patients. However there are few indexed studies about the safety and efficacy of mesotherapy but many about its complications, hence it only natural to distrust proponents in relation to this technique Hence adequate controlled studies are needed to establish the value of mesotherapy in aesthetic dermatology. [18] Mesotherapy for skin rejuvenation, treatment of local fat deposits, body sculpting have been assigned Evidence Level C, whereas cellulite treatment has been assigned Evidence Level D [18]. Few recent studies have shown promising results for mesotherapy in various aesthetic indications. A study by Larruba et al showed good results with hyaluronic acid mesotherapy on photoaging and assessed by ultrasound techniques. [5] A study by Savoia etal showed promising [VG1] An excellent compilation with evidence for few of them are given in these two articles from IJDVL Sarkar R, Garg VK, Mysore V. Position paper on mesotherapy. Indian J Dermatol Venereol Leprol 2011;77:232-7 Konda D, Thappa DM. Mesotherapy: What is new?. Indian J Dermatol Venereol Leprol 2013;79:127-34 Another review of various indication s of mesotherapy is in this article by Dr. premlatha 3.Latha P. and Vandana K.R. / International Journal of Advanced Pharmaceutics / 1 (1), 2011, 19-29 ( full text available of all three) The meso solutions can be tabulated in the format below Indication Product Mechanism of action ( should include original intention versus intention in mesotherapy e.g. aminophylline was originally used for brochodilation. In mesotherapy it is used for vasodilatation etc Evidence grade ( wherever available)

Buckley / Ericsson :: essays research papers

Buckley / Ericsson   Ã‚  Ã‚  Ã‚  Ã‚  In their essays both Buckley and Ericsson analyze the different ways we use lies to help and hurt our self in our every day lives, and how this effects American culture. Ericsson shows the way lies can , as she puts it, â€Å" lubricate the daily machinery of living†(128). Buckley, on the other hand uses examples of lies as a way to deny himself; and do exactly the opposite of Ericsson. But they both show how we as Americans use lies these ways and others so much that most of us may not realize it.   Ã‚  Ã‚  Ã‚  Ã‚  Ericsson’s essay was obviously about The Ways We Lie, mostly about the way we lie to other people to make their or your own life easier. Buckley’s essay is not so obviously about lying, but if you read deeper into the text you can see how Buckley makes his life harder by lying to himself. When Ericsson is describing the white lie; she use the example of a friend telling another friend she looks good when the truth is she doesn’t. This is exactly how we use lies to lubricate daily living, we avoid confrontation. â€Å" The liar deciding what is best for the lied to† (Ericsson 121). When Buckley describes the amount of discomfort he endured from the heat on the train, he imagines what would happen to the conductor in an age of more violence. â€Å"The passengers would seize the conductor and strap him down on a seat over the radiator to share the fate of his patrons† (64). He has strong feelings toward the conductor, because someth ing has not already been done. When the conductor approaches Buckley; he has intensions of making the conductor aware of the problem, but the simple stare of his neighbor drives him to ignore the plain facts. Even though Buckley notices, â€Å"the car was flecked with the white shirts of the passengers†; he uses the stare as a way to dilute the truth into believing that his idea of turning the heat down would not be the consensus of the rest of the car (64).   Ã‚  Ã‚  Ã‚  Ã‚  The way lies have become a part of are daily life as Americans, and the way this has effected our culture is what both Ericsson and Buckley express in their essays. I think Buckley clearly stated his essay’s purpose when he said, â€Å" what has happened to the American people.