ref '''periodontology''' '''periodontics''' ancient greek 'around' 'tooth' genitive specialty dentistry studies supporting structures teeth well diseases conditions affect supporting tissues known periodontium includes gingiva gums alveolar bone cementum periodontal ligament periodontist dentist specializes prevention diagnosis treatment periodontal disease placement dental implants periodontium diagram periodontium enamel b dentine c alveolar bone oral

Applied science
Medicine and health
Dentistry
Periodontics


epithelium e attached gingiva f gingival margin g gingival sulcus h junctional epithelium alveolar crest fibres periodontal ligament pdl j horizontal fibres pdl k oblique fibres pdl term ''periodontium'' used describe group structures directly surround support protect teeth periodontium composed largely gingival tissue supporting bone gingivae normal gingiva may range color light coral pink heavily pigmented soft tissues connective fibres cover protect underlying cementum periodontal ligament alveolar bone known gingivae


gingivae categorised three anatomical groups free attached interdental gingiva gingival groups considered biologically different however specifically designed help protect mechanical bacterial destruction ref name clerehugh clerehugh v tugnait genco r j periodontology glance chichester john wiley sons ltd ref free gingiva tissues sit alveolar bone crest considered free gingiva healthy periodontium gingival margin fibrous tissue encompasses cemento enamel junction line around circumference tooth enamel surface


crown meets outer cementum layer root natural space called gingival sulcus lies apically gingival margin tooth free gingiva non diseased healthy gingival sulcus typically mm depth however measurement increase presence periodontal disease gingival sulcus lined non keratinised layer called oral sulcular epithelium begins gingival margin ends base sulcus junctional epithelium attached gingiva begins ref name cope ref attached gingiva junctional epithelium collar like band lies


base gingival sulcus surrounds tooth demarcates areas separation free attached gingiva junctional epithelium provides specialised protective barrier microorganisms residing around gingival sulcus ref name cope collagen fibres bind attached gingiva tightly underlying periodontium including cementum alveolar bone vary length width ref name cope depending location oral cavity individual ref name newman newman takei h klokkevold p r carranza f carranza clinical periodontology th ed st louis elsevier inc ref ref name weinberg weinberg westphal


c froum j palat p schoor r comprehensive periodontics dental hygienist rd ed upper saddle river nj pearson education ref attached gingiva lies free gingival line groove mucogingival junction attached gingiva dissipates functional masticatory stresses placed gingival tissues common activities mastication tooth brushing speaking ref name gehrig gehrig j willmann e foundations periodontics dental hygienist rd ed philadelphia wolters kluwer lippincott williams wilkins health ref health typically pale pink coral pink colour


may present surface stippling racial pigmentation ref name gehrig interdental gingiva interdental gingiva takes space beneath tooth contact point two adjacent teeth normally triangular pyramidal shape formed two interdental papillae lingual facial ref name cope ref name newman middle centre part interdental papilla made attached gingiva whereas borders tip formed free gingiva central point interdental papillae called col valley like concave depression lies directly beneath contact


cementum surrounding alveolar bone composed several complex fibre groups run different directions insert cementum bone via sharpey fibres ref name cope periodontal ligament composed mostly collagen fibres however also houses blood vessels nerves within loose connective tissue ref name weinberg mechanical loads placed teeth mastication external forces absorbed periodontal ligament therefore protects teeth within sockets ref name gehrig alveolar bone periodontal health alveolar bone surrounds teeth forms


bony socket supports tooth buccal lingual plates lining sockets composed thin yet dense compact cortical bone ref name clerehugh within cortical plates dental sockets lies cancellous bone spongy trabecular type bone less dense compact bone ref name weinberg cementum cementum outer layer tooth root overlies dentine layer tooth provides attachment collagen fibres periodontal ligament also protects dentine provides seal otherwise exposed ends dentinal tubules


hard enamel dentine typically light yellow colour ref name gehrig gingival diseases gingivitis common condition affects gingiva mucosal tissues surround teeth condition form periodontal disease however least devastating involve irreversible damage changes periodontium gingiva periodontal ligament cementum alveolar bone commonly detected patients gingival bleeding occurs spontaneously brushing eating also characterised generalised inflammation swelling redness mucosal tissues gingivitis


typically painless commonly result plaque biofilm accumulation association reduced poor oral hygiene factors may increase person 's risk gingivitis including limited systemic conditions uncontrolled diabetes mellitus medications signs symptoms gingivitis reversed improved oral hygiene measures increased plaque disruption left untreated gingivitis potential progress periodontitis related diseases detrimental periodontal general health ref name devries ref periodontal diseases periodontal disease encompasses number diseases periodontal tissues


result attachment loss destruction alveolar bone ref name highfield ref periodontal diseases take many different forms usually result coalescence bacterial plaque biofilm accumulation red complex bacteria eg p gingivalis forsythia denticola gingiva teeth combined host immuno inflammatory mechanisms risk factors lead destruction supporting bone around natural teeth untreated diseases lead alveolar bone loss tooth loss periodontal disease accounted teeth lost patients disease south korea periodontal


caused variety factors prominent dental plaque dental plaque forms bacterial biofilm tooth surface adequately removed tooth surface close proximity gingiva host microbial interaction gets underway results imbalance host bacterial factors turn result change health disease local systemic factors result progress manifestation periodontal disease factors include age socio economic status oral hygiene education diet systemic factors may include uncontrolled diabetes tobacco smoking ref


associated haematological disorders br b associated genetic disorders br c otherwise specified br bone loss periapical xray '''v necrotizing periodontal diseases''' br necrotizing ulcerative gingivitis br b necrotizing ulcerative periodontitis '''vi abscesses periodontium''' br gingival abscess br b periodontal abscess br c pericoronal abscess '''vii periodontitis associated endodontic lesions''' br combined periodontic endodontic lesions br abscessed tooth periapical radiograph '''viii developmental acquired deformities conditions''' br localised tooth related factors modify predispose plaque induced gingival diseases periodontitis br b mucogingival deformities conditions around teeth br c mucogingival deformities


conditions edentulous ridges br occlusal trauma new classification periodontal disease announced determined previous aap classification cater needs patients peri implant diseases conditions new classification periodontal peri implant diseases conditions follows '''periodontal health gingival diseases conditions br ''' periodontal health gingival health br gingivitis dental biofilm induced br gingival diseases non dental biofilm induced br '''periodontitis br ''' necrotizing periodontal diseases br periodontitis br periodontitis manifestation systemic disease br '''other conditions affecting periodontium br ''' systemic diseases


conditions affecting periodontal supporting tissues br periodontal abscesses endodontic periodontal lesions br mucogingival deformities conditions br traumatic occlusal forces br tooth prosthesis related factors br '''peri implant diseases conditions br ''' peri implant health br peri implant mucositis br peri implantitis br peri implant soft hard tissue deficiencies br '''prevention ''' br effective prevention method achieved patient home example using correct tooth brushing technique interdental cleaning aids interdental brushes floss using fluoridated toothpaste also advised patients receive bi annual check ups


dental health provider along thorough cleaning br ref name colgate br '''treatment ''' br along specialist periodontist treatment general dentist oral health therapist dental hygienist perform routine scale cleans using either hand instruments ultrasonic scaler combination practitioner also prescribe specialised plaque removal techniques tooth brushing interdental cleaning practitioner also perform plaque index indicate patient areas plaque removing removed procedure dental prophylaxis ref name colgate peri implantitis periodontology also involves placement maintenance


biofilm formation formation acquired pellicle involves selective absorption salivary gcf molecules electrostatic affinity hydroxyapatite ref name marsh ref bacterial transportation bacteria readily adhere acquired pellicle adhesins proteins enzymes within one two hours ref name marsh reversible interaction electrostatic attraction hydrophobic interaction microorganisms tooth surface ref name marsh irreversible interaction bacterial adhesins recognise specific host receptors pili outer membrane proteins different species bacteria bind together require specific receptors interact pellicle ref name o'toole ref co adehsion natural affinity oral microorganisms


found hard cleanse areas nutrition provided dietary consumption host supra gingival biofilm organisms blood gcf sub gingival biofilm organisms ref name marsh detachment one surface another within biofilm allows colonisation remote sites ref name gurenlian ref bacteria contained within biofilm protected slimy extracellular polysaccharide matrix helps protect outside environment chemotherapeutics agents example chemotherapeutic agent antiseptic chlorhexidine mouth rinse antibiotics thus antibiotics generally used treatment periodontal disease unlike


bacterial infections around body effective way control plaque biofilm via mechanical removal toothbrushing interdental cleaning periodontal debridement performed dental professional ref name gurenlian pathogenesis individual 's host response plays important role pathogenesis periodontal disease even mouth gingiva appear healthy constant low level inflammatory response facilitated host manage constant bacterial load plaque micro organisms leukocytes neutrophils main cells phagocytose bacteria found gingival crevice pocket migrate tissues specialised


changes due increased capillary permeability influx inflammatory cells gingival tissues gingival disease remains established aetiology removed recruitment cells macrophages assist phagocytic digestion bacteria lymphocytes begin initiate immune response pro inflammatory cytokines produced inside gingival tissues escalate inflammation impacts progression chronic systemic inflammation disease result collagen breakdown infiltrate accumulation well collagen breakdown periodontal ligament alveolar bone resorption stage


changed determine risk factors disease evidence based research studies needed evidence longitudinal studies giving statistically significant outcomes best reliability determining risk factors risk factors often coexist variables rarely acting alone contribute disease risk factors genetic environmental behavioural psychological demographic nature ref name 'aljehani ' ref many risk factors contribute placing individual higher risk developing gingival periodontal diseases however aetiological factor periodontal disease bacterial plaque biofilm identification one 's risk factors plays


smoking decreases healing abilities oral tissues destroying blood vessels supply preventing essential immune defence organisms penetrating tissues therefore pathogenic bacteria able destruct periodontal tissues rapidly escalate severity disease although clinical signs inflammation less pronounced smokers larger portion sites deep pocketing depths loss clinical attachment compared nonsmokers smoking cessation counselling integral part dental professional 's work periodontal disease patients smoking cessation proven prevent progression periodontal disease


return oral microflora less pathogenic microbial state alcohol consumption research needs conducted form longitudinal studies effects alcohol periodontal tissues however current studies suggest alcohol consumption moderately increases one 's risk progression periodontal disease diabetes mellitus diabetes falls category modifiable risk factors although cannot cured controlled greatly helps periodontal disease control clear two way relationship established blood glucose control directly affecting periodontal disease severity progression vice versa periodontal disease


patients diabetes mellitus also poorer healing abilities without diabetes hence increased risk severe diseases blood glucose control poor healing abilities affected systemic disease ref name pmid obesity vitamin deficiency risk factors periodontal disease go hand hand obesity generally associated decreased consumption fruits vegetables increase foods high fat salt sugar poor diet contributes obesity also results lack essential nutrients including vitamin


c calcium play important roles ensuring healthy immune system healthy oral tissues bone poor oral hygiene plaque aetiological factor periodontal disease poor oral hygiene prominent risk factor initiating progressing determining severity disease performing brushing interdental cleaning perhaps one effective ways removing dental plaque biofilm prevention periodontal diseases cardiovascular disease poor oral hygiene clear relationship increased risk developing cardiovascular disease high concentrations cholesterol


shown oral tissues affected altered pregnancy due decreased immune response increased vascular blood supply volume systemically important note pregnancy cause gingival periodontal diseases may exacerbate inflammatory response pre existing disease also important note pregnancy detract minerals oral tissues teeth previously thought heard old wives' tales existing disease often presents pregnancy due altered oral environment merely due pregnancy causing disease effects


prevented good oral hygiene toothbrushing interdental cleaning risk characteristics must considered conjunction risk factors variables may also contribute increasing decreasing one 's chances developing periodontal disease numerous studies show age gender race socioeconomic status education genetics also strong relationships influencing periodontal disease periodontal disease multifactorial requiring dental oral health professionals clear thorough understanding risk factors mechanisms order implement effective disease management clinical practice ref name 'aljehani ' diagnosis periodontitis associated conditions recognised


intra extra oral examination indices periodontal screening record psr community periodontal index treatment needs cpitn also used making diagnosis order classify severity disease disease identified process full periodontal analysis performed often dental hygienists oral health therapists specialist periodontists involves full mouth periodontal probing taking measurements pocket depths clinical attachment loss recession along relevant parameters plaque bleeding furcation involvement mobility measured gain overall understanding


level disease radiographs may also performed assess alveolar bone levels levels destruction treatment phases periodontal therapy contemporary periodontal treatment designed based trimeric model performed four phases phases structured ensure periodontal therapy conducted logical sequence consequently improving prognosis patient comparison indecisive treatment plan without clear goal phase therapy initial therapy disease control phase non surgical phase non surgical phase initial phase sequence procedures required periodontal


treatment ref name eight phase aims reduce eliminate gingival inflammation removing dental plaque calculus restoration tooth decay correction defective restoration contribute gingival inflammation also known gingivitis ref name eight ref phase consists treatment emergencies antimicrobial therapy diet control patient education motivation correction iatrogenic factors deep caries hopeless teeth preliminary scaling temporary splinting occlusal adjustment minor orthodontic tooth movement debridement ref name eight evaluation phase phase patients seen weeks initial therapy required evaluate steps carried


contours deep craters areas suspected incomplete removal local deposits degree ii iii furcation involvements distal areas last molars expected mucogingival junction problems persistent inflammation root coverage removal gingival enlargement phase iii therapy restorative phase phase defects need restored removable fixed dental prosthesis prosthodontics restoration processes ref name eight phase iv therapy maintenance phase last phase periodontal therapy requires preservation periodontal health phase patients required visit scheduled plan maintenance


care prevent occurrence disease ref name nine maintenance phase constitutes long term success periodontal treatment thus contributing long relationship oral health therapist dentist periodontist patient ref name nine periodontal restorative interface prognosis restorative treatment determined periodontal health goals establishing periodontal health prior restorative treatment follows periodontal treatment managed assure establishment firm gingival margin prior tooth preparation restoration absence bleeding tissue restorative manipulation provides accessibility aesthetic outcome ref name nine


certain periodontal treatment formulated increase sufficient tooth length retention failure accomplish methods prior restorations lead complexity risk failure treatment impression making tooth preparation restoration periodontal therapy follow restorative method resolution gingival inflammation may result repositioning teeth soft tissue mucosal changes ref name nine standard periodontal treatment non surgical therapy golden standard periodontal therapy consists debridement combination oral hygiene instructions patient motivation mainly


focuses elimination reduction putative pathogens shifting microbial flora favourable environment stabilise periodontal disease ref name mordohai ref debridement thorough mechanical removal calculus dental biofilm root surfaces tooth ref name oshman ref debridement basis treatment inflammatory periodontal diseases remains golden standard surgical non surgical treatment initial therapy conducted hand instrumentation curettes scalers ultrasonic instrumentation ref name seventeen requires appointments depending time clinician skills effective removal supragingival subgingival calculus


periodontal pockets involved assist periodontal healing reduce periodontal pocketing changing subgingival ecological environment ref name seventeen prevention periodontal disease maintenance periodontal tissues following initial treatment requires patient 's ability perform maintain effective dental plaque removal ref name seventeen ref requires patient motivated improving oral hygiene requires behaviour change terms tooth brushing interdental cleaning oral hygiene techniques ref name nineteen ref personal oral hygiene often considered essential aspect controlling chronic periodontitis research shown important appreciate


motivation patient behaviour changes originated patient ref name nineteen patients must want improve oral hygiene feel confident skills crucial clinician encourage patient changes educate patient appropriately motivational interviewing good technique ask open ended questions express empathy towards patient role oral health therapist oral health therapist member dental team dual qualified dental hygienist dental therapist work closely dentists


number dental specialists including periodontists common oral health therapist involved treatment gingival periodontal diseases patients scope practice area includes oral health assessment diagnosis treatment maintenance referral necessary also expertise providing oral health education promotion support patient maintain home oral care oral health therapists employed dental team share responsibilities care important asset uniquely specifically trained preventative dentistry risk


minimisation allows dental team work competently effectively dentists manage complex treatments significantly medically compromised patients periodontist periodontist specialist dentist treats patients periodontal related diseases conditions involved prevention diagnosis treatment periodontal disease periodontists receive specialist training periodontics completing dental degree periodontists provide treatments patients severe gingival diseases complex medical histories periodontists offer wide range treatments including root scaling planing periodontal surgery implant surgery complex periodontal procedures ref name aap american academy


postgraduate training program periodontology one must first complete dental degree europe although european country independent system umbrella organisation european federation periodontology efp ability accredit post graduate programs according specific guidelines efp awards certificate specialized training periodontology periodontics implant dentistry every successful european candidate three years full time training accredited post graduate program efp organizes bi annual meetings around europe title europerio many thousands dentists attend sessions featuring one hundred world 's top periodontal speakers


graduate programs approved following university bern sahlgrenska university hospital institute postgraduate dental education j nk ping ucl eastman dental institute university louvain uclouvain university complutense madrid university dublin trinity college university strasbourg france paris diderot university rothschild hospital australia australian programs accredited australian dental council adc three years length culminate either master 's degree mds doctor clinical dentistry degree dclindent fellowship obtained royal australasian college dental surgeons fracds perio canada


canadian programs accredited commission dental accreditation canada minimum three years length usually culminate master msc mdent degree graduates eligible sit fellowship exams royal college dentists canada dentistry regulated profession become licensed dentist canada one must bds dds dmd degree certified national dental examining board canada specialise periodontics accredited dentists required undertake specialty core knowledge examination complete


practitioners periodontists general dentists consultants trainees restorative dentistry clinical academics dental hygienists therapists specialist trainees periodontology many others specialist training periodontics uk either three year full time program four years three days per week end training candidates awarded master clinical dentistry mclindent entered specialist list held general dental council united states ucla school dentistry periodontics graduate clinic american dental association ada accredited programs minimum three years length according american


academy periodontology us trained periodontists specialists prevention diagnosis treatment periodontal diseases oral inflammation placement maintenance dental implants many periodontists also diagnose treat oral pathology historically periodontics served basis specialty oral medicine following successful completion post graduate training periodontist becomes board eligible american board periodontology examination successful completion board certification results diplomate status american board periodontology maintenance periodontal treatment whether surgical non surgical maintenance periodontal therapy essential long term


result stabilization periodontal disease also difference maintenance different types periodontal disease different types gingivitis reversible inflammation gums easily prevented patients removal inflammatory product usually plaque calculus allows gums room heal done patients thoroughly cleaning teeth every day soft bristle toothbrush interdental aid floss interdental brushes whatever preferred patient without patient compliance constant removal plaque calculus gingivitis


cannot treated completely progress irreversible periodontitis necrotising ulcerative gingivitis nug also acute necrotising ulcerative gingivitis necrotising ulcerative periodontitis type periodontal disease different many periodontal diseases clinical characteristics include gingival necrosis breakdown gums gingival pain bleeding halitosis bad breath well grey colour gingiva punched appearance treated debridement usually local anaesthetic due immense pain maintain treat condition completely chlorhexidine mouthwash recommended patient use twice daily oral health


instruction provided using soft bristle toothbrush electric toothbrush twice day interdental cleaning aid floss interdental brushes cleans areas toothbrush cannot reach patient also educated proper nutrition diet healthy fluid intake smoking cessation occur completely eradicate disease also health patient pain control done ibuprofen paracetamol acetaminophen case immunocompromised patient antibiotics prescribed assessment treatment done hours treatment


continued every months signs symptoms resolved gingival health function restored chronic periodontitis inflammation gums irreversible destruction alveolar bone surrounding structures teeth usually slow progressing bursts local factors explain presence disease diet lack oral hygiene plaque accumulation smoking etc characterised pocket formation recession gingiva shrinkage gums treatment maintenance important stopping disease progression resolve inflammation treatment usually consists scaling root planning


surgical therapy regenerative surgical therapy treatment patient care regular maintenance check ups important completely eradicate disease present recurrence done plaque control removal twice daily toothbrushing daily interdental cleaning chlorhexidine mouthwash also effective patient also present dentist maintenance check ups least every three months office check necessary plaque control aggressive periodontitis aggressive periodontitis involves inflammation gingiva rapid severe destruction periodontal ligament alveolar bone surrounding structures unlike chronic periodontitis often occurs


interdental cleaning necessary maintaining healthy periodontium preventing continuation periodontal destruction regular periodontal check ups also necessary every months periodontitis manifestation systemic disease periodontitis may caused systemic disease currently least systemic diseases linked periodontal disease diabetes mellitus haematological disorders acquired neutropenia leukemia syndrome etc treatment prevention important concepts management maintenance periodontitis manifestation systemic disease treatment consist either surgical non surgical treatment depending


severity treatment patient compliance important includes oral hygiene tooth brushing twice day interdental brushing least day chlorohexidine mouthwash may also helpful see also bone grafting chronic periodontitis dental implant gingival graft gingival recession ''journal periodontology'' periodontitis scaling root planing sinus lift references external links https webarchiveorg web http wwwperioorg consumer ahtml aap directory periodontists https webarchiveorg web http wwwperioorg consumer ahtml american academy periodontology 's aap article periodontal disease http wwwbsperioorguk british society periodontology http wwwcap acpca en search canadian academy directory periodontists http wwwdciindiaorg dental council india http wwwefpnet european federation periodontology https webarchiveorg web http wwwnidcrnihgov healthinformation diseasesandconditions gumperiodontaldiseases defaulthtm national institute cranialfacial research 's article


periodontal disease http wwwperioorgza indexphp south african society periodontology


micrograph showing contraction band necrosis histopathologic finding myocardial infarction heart attack '''histopathology''' compound three greek words ''histos'' tissue ''pathos'' suffering '' logia'' study refers microscopic examination tissue order study manifestations disease specifically clinical medicine histopathology refers examination biopsy surgical specimen pathologist specimen processed histological sections placed onto glass slides contrast cytopathology examines free cells tissue micro fragments cell blocks collection tissues histopathological examination tissues

Natural science
Biology
Pathology
Histopathology


starts surgery biopsy autopsy tissue removed body plant often following expert dissection fresh state placed fixative stabilizes tissues prevent decay common fixative formalin neutral buffered formaldehyde water preparation histology items used submitting specimens biopsy wrap biopsy sponge tissue processing cassette biopsy bag tissue prepared viewing microscope using either chemical fixation frozen section large sample provided eg surgical procedure pathologist looks


tissue sample selects part likely yield useful accurate diagnosis part removed examination process commonly known grossing cut larger samples cut correctly situate anatomical structures cassette certain specimens especially biopsies undergo agar pre embedding assure correct tissue orientation cassette block diagnostic microscopy slide placed plastic cassette rest process chemical fixation addition formalin chemical fixatives


used advent immunohistochemistry ihc staining diagnostic molecular pathology testing specimen samples formalin become standard chemical fixative human diagnostic histopathology fixation times small specimens shorter standards exist human diagnostic histopathology processing water removed sample successive stages use increasing concentrations alcohol ref name mwap ref xylene used last dehydration phase instead alcohol wax used next stage soluble xylene alcohol allowing wax permeate


infiltrate specimen ref name mwap process generally automated done overnight wax infiltrated specimen transferred individual specimen embedding usually metal container finally molten wax introduced around specimen container cooled solidification embed wax block ref name mwap process needed provide properly oriented sample sturdy enough obtaining thin microtome section slide wax embedded block finished sections cut usually placed float waterbath surface spreads


section usually done hand skilled job histotechnologist lab personnel making choices parts specimen microtome wax ribbon place slides number slides usually prepared different levels throughout block thin section mounted slide stained protective cover slip mounted common stains automatic process normally used rarely used stains often done hand ref name mwap frozen section processing second method histology processing called frozen


section processing highly technical scientific method performed trained histoscientist method tissue frozen sliced thinly using microtome mounted freezing refrigeration device called cryostat thin frozen sections mounted glass slide fixed immediately briefly liquid fixative stained using similar staining techniques traditional wax embedded sections advantages method rapid processing time less equipment requirement less need ventilation laboratory disadvantage poor quality final slide


used intra operative pathology determinations might help choosing next step surgery surgical session example preliminarily determine clearness resection margin tumor surgery staining processed histology slides done slides processed chemical fixation frozen section slides see tissue microscope sections stained one pigments aim staining reveal cellular components counterstains used provide contrast commonly used stain histology combination


hematoxylin eosin often abbreviated h e hematoxylin used stain nuclei '''blue''' eosin stains cytoplasm extracellular connective tissue matrix '''pink''' hundreds various techniques used selectively stain cells compounds used color tissue sections include safranin oil red congo red silver salts artificial dyes '''histochemistry''' refers science using chemical reactions laboratory chemicals components within tissue commonly performed histochemical technique perls' prussian blue reaction used demonstrate iron deposits diseases like hemochromatosis recently antibodies used


stain particular proteins lipids carbohydrates called immunohistochemistry technique greatly increased ability specifically identify categories cells microscope advanced techniques include '''in situ hybridization''' identify specific dna rna molecules antibody staining methods often require use frozen section histology procedures also carried laboratory scrutiny precision trained specialist medical laboratory scientist histoscientist digital cameras increasingly used capture histopathological images interpretation histological slides examined microscope pathologist medically qualified


specialist completed recognised training program medical diagnosis formulated '''pathology report''' describing histological findings opinion pathologist case cancer represents '''tissue diagnosis''' required treatment protocols removal cancer pathologist indicate whether surgical margin cleared involved residual cancer left behind done using either bread loafing ccpdma method processing microscopic visual artifacts potentially cause misdiagnosis samples myocardial infarction myocardial infarction heart attack


histopathology seen first minutes possible sign first hours waviness fibres border later however coagulation necrosis initiated edema hemorrhage hours seen karyopyknosis hypereosinophilia myocytes contraction band necrosis margins well beginning neutrophil infiltration days continued coagulation necrosis loss nuclei striations increased infiltration neutrophils interstitium end first week infarction beginning disintegration dead muscle fibres


necrosis neutrophils beginning macrophage removal dead cells border increases succeeding days week also beginning granulation tissue formation margins matures following month gets increased collagen deposition decreased cellularity myocardial scarring fully mature approximately months infarction ref name kumar chapter th edition ref see also anatomical pathology molecular pathology frozen section procedure medical technologist laser capture microdissection list pathologists references external links http wwwpatholuzhch histologiekurs virtual histology course university zurich german english


version preparation http screeningiarcfr atlashistophp histopathology uterine cervix digital atlas iarc screening group https archivetoday http wwwpathuiowaedu virtualslidebox iowa histopathology content index dbhtml histopathology virtual slidebox university iowa anatomical pathology pathology


'''narratology''' study narrative narrative structure ways affect human perception anglicisation french ''narratologie'' coined tzvetan todorov ''grammaire du cam ron'' theoretical lineage traceable aristotle ''poetics'' modern narratology agreed begun russian formalists particularly vladimir propp ''morphology folktale'' mikhail bakhtin 's theories heteroglossia dialogism chronotope first presented ''the dialogic imagination'' history origins narratology lend strong association structuralist quest formal system useful description

Journalism, media studies and communication


often referred works vladimir propp ref name herman p herman david jahn manfred ryan marie laure https booksgooglecom booksid wwnnbndf uec pg pa ''routledge encyclopedia narrative theory'' pp ref ref name bamberg p bamberg michael g w https booksgooglecom booksid hozldehin c pg pa ''oral versions personal experience three decades narrative analysis special issue journal narrative life history'' p ref jonathan culler describes narratology comprising many strands blockquote implicitly united recognition narrative theory requires distinction story sequence actions events conceived independent manifestation discourse discourse discursive presentation narration events' blockquote


lesser extent film criticism atypical applications narratological methodologies would include sociolinguistic studies oral storytelling william labov conversation analysis discourse analysis deal narratives arising course spontaneous verbal interaction also includes study videogames graphic novels infinite canvas narrative sculptures linked topology graph theory however constituent analysis type narremes considered basic units narrative structure could fall within areas linguistics semiotics literary theory narratology new media digital media theorist professor


janet murray theorized shift storytelling narrative structure twentieth century result scientific advancement book ''hamlet holodeck future narrative cyberspace'' murray argues narrative structures multi narrative accurately reflected post einstein physics new perceptions time process change traditional linear narrative unique properties computers better suited expressing limitless intersecting stories cyberdramas cyberdramas differ traditional forms storytelling invite reader narrative experience interactivity ie hypertext fiction


web soap ''the spot'' murray also controversially declared video games particularly role playing games life simulators like ''the sims'' contain narrative structures invite users create supported idea article game story cyberdrama argued stories games share two important structures contest puzzles electronic literature cybertext development exclusive consumption digital devices interactivity key characteristics electronic literature resulted varying narrative structures interactive media nonlinear narratives serve base many interactive fictions sometimes


used interchangeably hypertext fiction reader player plays significant role creation unique narrative developed choices make within story world stuart moulthrop 's ''victory garden'' one first studied examples hypertext fiction featuring lexias hyperlinks book ''cybertext perspectives ergodic literature'' espen aarseth conceived concept cybertext subcategory ergodic literature explain medium mechanical organization text affects reader 's experience blockquote read cybertext constantly reminded inaccessible strategies


paths taken voices heard decision make parts text others less accessible may never know exact results choices exactly missed ref name ref blockquote narrative structure game worlds cybertexts compared labyrinth invites player term aarseth deems appropriate reader play explore discover paths within texts two kinds labyrinths referenced aarseth unicursal labyrinth holds one single winding path leads hidden center


multicursal labyrinth synonymous maze branching complex path direction chosen player concepts help distinguish ergodic unicursal nonergodic literature multicursal works vladimir nabokov 's ''pale fire'' proven potentially depending path reader takes theorists narratology art critic philosopher arthur danto refers narrative describing two separate events narrative also linked language way story manipulated character display medium contributes story


seen world ref name auto rimmon kenan model neglects medium linguistics language crisis narratology journal narrative technique retrieved september http wwwjstororg stable ref narratology defined shlomith rimmon kenan branch narrative theory concept narratology developed mainly france sixties seventies ref name auto theorists argued long time form context narratology american psychologist robert sternburg argued narratology structuralism variance idea structure basis goes french american belief narratology


logical perversion meaning followed course time seem logical another theorist peter brooks sees narrative designed intent shapes structure story ref name auto felluga dino modules brooks plotting introductory guide critical theory date last update find home page purdue u date accessed site http wwwpurdueedu guidetotheory narratology modules brooksplothtml ref narrative theorist roland barthes argues narratives similar structures every sentence multiple meanings ref name auto barthes sees literature writerly text


need typical plot beginning middle end instead written work multiple entrances exits ref name auto theorist greimas agrees theorists acknowledging structure narrative set find deep structure narrativity however findings greimas says narratology used describe phenomena outside written word linguistics whole establishes connection physical form something language used describe something breaks structural code many theorists base research


ref name auto see also digital storytelling dramatica theory story structure software focalisation narrative narrative criticism narrative structure narreme basic unit structural narratology post structuralism storytelling suspense notes references phelan james peter j rabinowitz companion narrative theory malden blackwell phelan james peter j rabinowitz understanding narrative columbus ohio state university press phelan james david herman brian mchale eds teaching narrative theory new york mla publications phelan james ed reading narrative form ethics ideology columbus ohio state university press phelan james experiencing fiction judgments progressions rhetorical theory


narrative columbus ohio state university press phelan james living tell rhetoric ethics character narration ithaca cornell university press phelan james narrative rhetoric technique audiences ethics ideology columbus ohio state university press phelan james reading people reading plots character progression interpretation narrative chicago university chicago press external links http wwwchassutorontoca epc srb srb musichtml musical narratology william echard review ''a theory musical semiotics'' eero tarasti foreword thomas sebeok https persolimsifr jbb fanifhtml five analyses narrative first got paid https webarchiveorg web http wwwunizares departamentos filologia inglesa garciala bibliographyhtml narrative theory bibliography bibliography


literary theory criticism philology http wwwuni koelnde ame pppnhtm narratology guide theory narrative manfred jahn http wwwericdigestsorg pre storyhtm narratology study story structure https webarchiveorg web http wwwtimbouchercom journal story systemhtml story systems http wwwlhnuni hamburgde living handbook narratology http wwwpumumontrealca revues surfaces vol mcdonaldhtml narrative act wittgenstein narratology henry mcdonald choreography drama film theory literature storytelling


understand mind criminal types psychiatry also deal aspects criminal behavior criminal behavior stated kind antisocial behavior punishable usually law punished norms stated community therefore difficult define criminal behavior fine line could considered okay 's considered considered violation one point time may accepted community article look different roles criminal psychologist key aspects

Social science
Psychology
Criminal psychology


photographs crime conduct interview suspect sometimes formulate hypothesis order assess offender going next broken law question competency stand trial question offender 's current state mind assesses offender 's ability understand charges possible outcomes convicted acquitted charges ability assist attorney defense question sanity insanity criminal responsibility assessment offender 's state mind


walter c langer well renowned psychiatrist draw profile adolf hitler second world war british psychologist lionel haward working royal air force police drew list characteristics high ranking war criminals might display characteristics helped spot high ranking war criminals amongst ordinary captured soldiers airmen renowned italian psychologist cesare lombroso thought one first criminologists attempt formally classify criminals based age gender physical characteristics education geographic region comparing similar characteristics better understood origin


motivation criminal behavior published book called ''the criminal man'' lombroso studied italian inmates based studies suggested three types criminals born criminals degenerates insane criminals suffered mental illness also studied found specific physical characteristics examples included asymmetry face eye defects peculiarities ears unusual size etc ref name kocsis us psychiatrist james brussel drew turned uncannily accurate profile bomber


terrorizing new york city first introduced fbi several classes taught american society crime lab directors public time knew little anything profilers would profile people tv came play later films based fictional works author thomas harris caught public eye profession particular ''manhunter'' ''silence lambs'' fastest development occurred fbi opened training academy behavioral analysis unit bau quantico


offender profiling process linking offender 's actions crime scene likely characteristics used help police investigators narrow prioritize pool likely suspects profiling relatively new area forensic psychology past years developed used described art rigorous science part sub field forensic psychology called investigative psychology criminal profiling based increasingly rigorous methodological advances empirical research criminal profiling process known federal bureau


investigation fbi criminal investigative analysis profilers criminal investigative analysts trained experienced law enforcement officers study every behavioral aspect detail unsolved violent crime scene certain amount psychopathology left scene characteristics good profiler discussed five behavioral characteristics gleaned crime scene described amount planning went crime degree control used offender escalation emotion scene risk level offender victim


psychometric tools order aid assessment assessments help police comparable organizations determine process individual question example psychologist helps find whether individual capable stand trial whether individual mental illness relates whether able understand proceedings '''experimental ''' case task psychologist perform research order inform case involve executing experimental tests purposes illustrating point providing information courts


may involve false memory eyewitness credibility experiments example way involves questions similar likely would witness see object meters could answered '''actuarial ''' role involves usage statistics order inform case psychologist may asked provide probability event occurring example courts may ask likely person reoffend sentence declined '''advisory ''' psychologist may advise police proceed investigation example psychologists help determine


best way interview individual best way cross examine vulnerable another expert witness offender act committing offense education career criminal psychology pursuing career criminal psychology first need bachelor 's degree psychology master 's degree related field master 's degree typically people stop education may get ideal job pay desire typically also need doctorate degree well either phd psyd


addition degrees need take licensing exam required state jurisdiction pursuing kind doctorate degree take five seven years achieve includes various means educational training classroom work practical training research dissertation thesis wish pursue career criminal profiler also need master 's degree doctorate many years experience passing examinations state become licensed psychologist criminal profilers work various


settings including offices courtrooms employed number institutions include local state federal government others self employed independent consultants depending desired field psychology average salary around year criminal psychologist paid different scale types psychologist top paying states forensic psychologists new hampshire washington new york massachusetts california ref name ref forensic psychology careers continuing close gap psychology criminal justice system job opportunities include ref name


correctional counselor jury consultant forensic social worker expert witness forensic psychology professor forensic psychology researcher forensic case manager criminal profiler forensic psychologist correctional psychologist applied criminal psychology effect psychological social factors functioning brain central question forensic criminal psychologists deal due fact seed actions forensic psychiatry main question 'which patient becomes offender' 'which offender becomes patient' another main question asked psychiatrists 'what came


first crime mental disorder' psychologists look environmental factors along genetics determine likeliness profiling particular person commit crime criminal forensic psychologists may also consider following questions mental disorder present present time crime level responsibility offender crime risk reoffending risk factors involved treatment possible reduce risk reoffending accordingly individual psychiatric evaluations resorted measuring personality traits psychological testing


good validity purpose court ref name turvey key studies number key studies psychology especially relevant understanding criminal psychology undertaken include bobo doll experiment bandura ross ross stanford prison experiment philip zimbardo loftus palmer eyewitness study see also forensic psychology moral psychology criminal anthropology antisocial personality disorder psychopathy malignant narcissism sadistic personality disorder references david canter ''criminal psychology'' london hodder education establishments italy italian inventions criminology


active inactive opioid receptors ref name pmid ref '''pain management''' '''pain killer''' '''pain medicine''' '''pain control''' '''algiatry''' branch medicine uses interdisciplinary approach easing suffering improving quality life living chronic pain typical pain management team includes medical practitioners pharmacists clinical psychologists physiotherapists occupational therapists physician assistants nurses dentists team may also include mental health specialists massage therapists pain sometimes resolves quickly underlying trauma pathology healed treated one practitioner drugs analgesics occasionally anxiolytics

Applied science
Medicine and health
Pain Medicine


effective management chronic long term pain however frequently requires coordinated efforts pain management team effective pain management mean total eradication pain medicine treats injuries diseases support speed healing treats distressing symptoms pain relieve suffering treatment healing dying task medicine relieve suffering three circumstances first painful injury pathology resistant treatment persists second pain persists injury pathology healed finally third circumstance medical


science cannot identify cause pain treatment approaches chronic pain include pharmacological measures analgesics antidepressants anticonvulsants interventional procedures physical therapy physical exercise application ice heat psychological measures biofeedback cognitive behavioral therapy defining pain nursing profession one common definition pain problem whatever experiencing person says existing whenever experiencing person says pain management includes patient communication pain problem ref name consumer reports pain relief april ref define pain problem health care provider likely ask


questions ref name consumer reports pain relief april intense pain pain feel pain anything makes pain lessen anything makes pain increase pain start asking questions health care provider description pain ref name consumer reports pain relief april pain management used address pain ref name consumer reports pain relief april adverse effects many types pain management benefits drawbacks limits ref name consumer reports pain relief


pain relief april sometimes pain management covers problem patient might less aware need treatment deeper problem ref name consumer reports pain relief april physical approach physical medicine rehabilitation physical medicine rehabilitation uses range physical techniques heat electrotherapy well therapeutic exercises behavioral therapy techniques usually part interdisciplinary multidisciplinary program might also include pharmaceutical medicines ref name geertzen jh van wilgen cp ref spa therapy showed positive effects reducing pain among patients chronic


low back pain however limited studies looking approach studies shown kinesiotape could used individuals chronic low back pain reduce pain center disease control recommends physical therapy exercise prescribed positive alternative opioids decreasing one 's pain multiple injuries illnesses diseases ref name ref include chronic low back pain osteoarthritis hip knee fibromyalgia ref name exercise alone rehabilitation disciplines psychologically based approaches positive effect reducing pain ref name


addition improving pain exercise also improve one 's well general health ref name manipulative mobilization therapy safe interventions likely reduce pain patients chronic low back pain however manipulation produces larger effect mobilization specifically chronic low back pain education way brain processes pain conjunction routine physiotherapy interventions may provide short term relief disability pain exercise interventions physical activity interventions tai chi yoga pilates promote harmony mind body total body awareness practices incorporate breathing


relation pain management multiple sclerosis ms ms chronic autoimmune neurological disorder consists demyelination nerve axons disruption nerve conduction velocity efficiency ref name one study electrodes placed lumbar spins participants received treatment twice day time experienced painful episode ref name study found tens would beneficial ms patients reported localized limited symptoms one limp ref name research mixed whether tens helps manage pain ms


pain experience ref name zaghi colleagues found motor cortex stimulated tdcs increases threshold perception non painful painful stimuli ref name although greater need research examining mechanism electrical stimulation relation pain treatment one theory suggests changes thalamic activity may due influence motor cortex stimulation decrease pain sensations ref name relation ms study found daily tdcs sessions resulted individual 's subjective report pain decrease


compared sham condition ref name ref addition study found similar improvement days tdcs session ref name fibromyalgia disorder individual experiences dysfunctional brain activity musculoskeletal pain fatigue tenderness localized areas ref name ref research examining tdcs pain treatment fibromyalgia found initial evidence pain decreases ref name specifically stimulation primary motor cortex resulted significantly greater pain improvement comparison control group eg sham stimulation stimulation dlpfc ref name however effect decreased treatment


ended remained significant three weeks following extinction treatment ref name acupuncture acupuncture involves insertion manipulation needles specific points body relieve pain therapeutic purposes analysis highest quality studies pain treatment acupuncture published january ''british medical journal'' unable quantify difference effect pain real sham acupuncture systematic review reported acupuncture injection therapy effective treatment patients nonspecific chronic low back pain


structures implicated source chronic pain ref name varrassi g paladini ref ref name meglio ref ref name boswell mv trescott ref ref name romanelli p esposito v ref radiofrequency treatment seen improve pain patients facet joint low back pain however continuous radiofrequency effective managing pain pulsed radiofrequency intrathecal pump used deliver small quantities medications directly spinal fluid similar epidural infusions used labour postoperatively major differences much common drug delivered spinal fluid intrathecal rather


epidurally pump fully implanted skin spinal cord stimulator implantable medical device creates electric impulses applies near dorsal surface spinal cord provides paresthesia tingling sensation alters perception pain patient intra articular ozone therapy intra articular ozone therapy seen efficiently alleviate chronic pain patients knee osteoarthritis psychological approach acceptance commitment therapy acceptance commitment therapy act form cognitive behavioral therapy focuses behavior change rather


symptom change includes methods designed alter context around psychological experiences rather alter makeup experiences emphasizes use experiential behavior change methods ref name ref central process act revolves around psychological flexibility turn includes processes acceptance awareness present oriented quality interacting experiences ability persist change behavior ability guided one 's values ref name act increased evidence base range health behavior problems including chronic pain ref name act influences patients adopt tandem process


acceptance change allows greater flexibility focus treatment ref name recent research applied act successfully chronic pain older adults due part direction individual values highly customizable stage life ref name line therapeutic model act significant increases process variables pain acceptance mindfulness also observed study applying act chronic pain older adults ref name addition primary results suggested act based treatment may significantly improve levels physical disability


psychosocial disability depression post treatment three month follow older adults chronic pain ref name cognitive behavioral therapy cognitive behavioral therapy cbt helps patients pain understand relationship pain thoughts emotions behaviors main goal treatment cognitive thinking reasoning remembering restructuring encourage helpful thought patterns target healthy activities regular exercise pacing lifestyle changes also trained improve sleep patterns develop better coping skills pain stressors using various techniques eg relaxation diaphragmatic breathing even biofeedback studies


positive short term effect pain immediately following treatment cbt may also small effect reducing disability potential catastrophizing may associated adult chronic pain benefits appear last long following therapy ref name cbt may contribute towards improving mood adult experiences chronic pain could possibility maintained longer periods time ref name children adolescents review rcts evaluating effectiveness psychological therapy management chronic recurrent pain found psychological treatments effective reducing pain


bringing issues power detect group differences lacking credible controls placebo expectation authors concluded although findings provide support general applicability hypnosis treatment chronic pain considerably research needed fully determine effects hypnosis different chronic pain conditions ref name elkins ref hypnosis reduced pain harmful medical procedures children adolescents ref name accardi ref clinical trials addressing patient groups significantly reduced pain compared treatment non hypnotic interventions ref name apa ref effects self hypnosis chronic


pain roughly comparable progressive muscle relaxation ref name jensen ref hypnosis analgesic painkiller seen relieve chronic pain people may safe effective alternative medications however high quality clinical data needed generalize whole chronic pain population mindfulness meditation meta analysis studies used techniques centered around concept mindfulness concluded mbis mindfulness based interventions decrease intensity pain chronic pain patients review studies brief mindfulness based interventions bmbi concluded bmbi recommended


programs breathworks ref name ref name subject range clinical studies demonstrating effectiveness ref name ref ref name ref ref name ref ref name ref ref name ref ref name ref ref name ref ref name medications world health organization recommends ''pain ladder'' managing pain relief pharmaceutical medicine first described use cancer pain however used medical professionals general principle managing type pain ref name hombrg ref treatment chronic pain three step analgesic ladder provides guidelines selecting appropriate medicine exact medications recommended vary


country individual treatment center following gives example approach treating chronic pain medications point treatment fails provide adequate pain relief doctor patient move onto next step class wikitable sortable colspan style background color cceeee common types pain typical drug management pain type typical initial drug treatment comments headache paracetamol http aeknilcom acetaminophen nsaids ref name bbdchronicpain ref doctor consultation appropriate headaches severe persistent accompanied fever vomiting speech balance problems ref name bbdchronicpain


self medication limited two weeks ref name bbdchronicpain migraine paracetamol nsaids ref name bbdchronicpain triptans used others work migraines frequent severe ref name bbdchronicpain menstrual cramps nsaids ref name bbdchronicpain nsaids marketed cramps nsaid would work ref name bbdchronicpain minor trauma bruise abrasions sprain paracetamol nsaids ref name bbdchronicpain opioids recommended ref name bbdchronicpain severe trauma wound burn bone fracture severe sprain opioids ref name bbdchronicpain two weeks pain requiring opioid treatment


unusual ref name bbdchronicpain strain pulled muscle nsaids muscle relaxants ref name bbdchronicpain inflammation involved nsaids may work better short term use ref name bbdchronicpain minor pain surgery paracetamol nsaids ref name bbdchronicpain opioids rarely needed ref name bbdchronicpain severe pain surgery opioids ref name bbdchronicpain combinations opioids may prescribed pain severe ref name bbdchronicpain muscle ache paracetamol nsaids ref name bbdchronicpain inflammation involved nsaids may work better ref name bbdchronicpain toothache pain dental procedures paracetamol nsaids ref name bbdchronicpain short term use opioids may


necessary severe pain ref name bbdchronicpain kidney stone pain paracetamol nsaids opioids ref name bbdchronicpain opioids usually needed pain severe ref name bbdchronicpain pain due heartburn gastroesophageal reflux disease antacid h antagonist proton pump inhibitor ref name bbdchronicpain heartburn lasting week requires medical attention aspirin nsaids avoided ref name bbdchronicpain chronic back pain paracetamol nsaids ref name bbdchronicpain opioids may necessary drugs control pain pain persistent ref name bbdchronicpain osteoarthritis pain paracetamol nsaids ref name bbdchronicpain medical attention recommended pain


pain type pain acute chronic needs considered type pain result different medications prescribed certain medications may work better acute pain others chronic pain may work equally well acute pain medication rapid onset pain inflicted trauma treat post operative pain chronic pain medication alleviating long lasting ongoing pain morphine gold standard narcotics compared semi synthetic derivatives morphine hydromorphone dilaudid oxymorphone numorphan opana nicomorphine


capsules syrups ampules contain oxycontin available making suitable acute intractable pain breakthrough pain diamorphine methadone used less frequently clinical studies shown transdermal buprenorphine effective reducing chronic pain pethidine known north america meperidine recommended pain management due low potency short duration action toxicity associated repeated use pentazocine dextromoramide dipipanone also recommended new patients except acute pain analgesics tolerated inappropriate pharmacological misuse related reasons


countries potent synthetics piritramide ketobemidone used severe pain tapentadol newer agent introduced last decade moderate pain tramadol codeine dihydrocodeine hydrocodone used nicocodeine ethylmorphine propoxyphene dextropropoxyphene less commonly drugs types used help opioids combat certain types pain amitriptyline prescribed chronic muscular pain arms legs neck lower back opiate sometimes without nsaid opiates often used management chronic pain high doses associated


increased risk opioid overdose opioids food drug administration stated according national institutes health studies shown properly managed medical use opioid analgesic compounds taken exactly prescribed safe manage pain effectively rarely causes addiction fda stated abuse misuse products created serious growing public health problem opioid medications provide short intermediate long acting analgesia depending upon specific properties medication whether formulated extended release drug opioid


medications may administered orally injection via nasal mucosa oral mucosa rectally transdermally intravenously epidurally intrathecally chronic pain conditions opioid responsive combination long acting oxycontin ms contin opana er exalgo methadone extended release medication often prescribed along shorter acting medication oxycodone morphine hydromorphone breakthrough pain exacerbations opioid treatment used patients outside healthcare settings oral tablet capsule liquid suppositories skin patches prescribed opioid injection rarely needed patients chronic pain although opioids strong


analgesics provide complete analgesia regardless whether pain acute chronic origin opioids effective analgesics chronic malignant pain modestly effective nonmalignant pain management however associated adverse effects especially commencement change dose opioids used prolonged periods drug tolerance chemical dependency diversion addiction may occur clinical guidelines prescribing opioids chronic pain issued american pain society american academy pain medicine included guidelines importance assessing patient risk


substance abuse misuse addiction factors correlated elevated risk opioid misuse include history substance use disorder younger age major depression use psychotropic medications physicians prescribe opioids integrate treatment psychotherapeutic intervention patient may receiving guidelines also recommend monitoring pain also level functioning achievement therapeutic goals prescribing physician suspicious abuse patient reports reduction pain accompanying improvement function progress achieving identified goals


list consists commonly used opioid analgesics long acting formulations common brand names extended release formulation parentheses oxycodone oxycontin hydromorphone exalgo hydromorph contin morphine eslon ms contin oxymorphone opana er fentanyl transdermal duragesic buprenorphine transdermal butrans tramadol ultram er tapentadol nucynta er methadone metadol methadose hydrocodone bitartrate hysingla er bicarbonate zohydro er nowiki nowiki methadone buprenorphine used treatment opioid addiction analgesics nonsteroidal anti inflammatory drugs major group analgesics nonsteroidal anti inflammatory drugs nsaid work inhibiting release prostaglandins


cause inflammatory pain acetaminophen paracetamol always included class medications however acetaminophen may administered single medication combination analgesics nsaids opioids alternatively prescribed nsaids ketoprofen piroxicam limited benefit chronic pain disorders long term use associated significant adverse effects use selective nsaids designated selective cox inhibitors significant cardiovascular cerebrovascular risks limited utilization ref name munir enany n ref ref name ballantyne jc ref common nsaids include aspirin ibuprofen naproxen many nsaids parecoxib selective


mechanisms vary general effective neuropathic pain disorders well complex regional pain syndrome ref name jackson kc nd ref common anti epileptic drug gabapentin example antidepressant would amitriptyline cannabinoids evidence medical marijuana 's effect reducing pain generally conclusive detailed report institute medicine available evidence animal human studies indicates cannabinoids substantial analgesic effect review study published ''fundamental clinical pharmacology'' various studies cited demonstrating cannabinoids exhibit comparable effectiveness


opioids models acute pain even greater effectiveness models chronic pain analgesics drugs potentiate conventional analgesics analgesic properties certain circumstances called analgesic adjuvant medications ref name ref gabapentin anticonvulsant reduce neuropathic pain also potentiate opiates ref name gabapentin ref drugs anticholinergic activity orphenadrine cyclobenzaprine trazodone given conjunction opioids neuropathic pain orphenadrine cyclobenzaprine also muscle relaxants useful painful musculoskeletal conditions clonidine alpha receptor agonist another drug


found use analgesic adjuvant ref name researchers described novel type pain therapy crispr dcas epigenome editing method repressing na sub v sub gene expression showed therapeutic potential three mouse models chronic pain self management self management chronic pain described individual 's ability manage various aspects chronic pain ref name ref self management include building self efficacy monitoring one 's symptoms goal setting action planning also includes patient physician shared decision making among others ref name benefits self management vary depending self management techniques used


marginal benefits management chronic musculoskeletal pain society culture medical treatment pain practiced greece turkey called '''algology''' greek algos pain hellenic society algology turkish algology pain society relevant local bodies affiliated international association study pain iasp undertreatment undertreatment pain absence pain management therapy person pain treatment indicated consensus evidence based medicine recommendations medical specialty organizations establish guidelines determine treatment pain


health care providers ought offer ref name state pain treatment ref various social reasons persons pain may seek may able access treatment pain ref name state pain treatment health care providers may provide treatment authorities recommend ref name state pain treatment children acute pain common children adolescents result injury illness necessary medical procedures ref name aap ref chronic pain present approximately children adolescents may caused underlying disease sickle cell anemia cystic fibrosis


rheumatoid arthritis cancer functional disorders migraines fibromyalgia complex regional pain could also cause chronic pain children ref name weydert ref young children indicate level pain pointing appropriate face children 's pain scale pain assessment children often challenging due limitations developmental level cognitive ability previous pain experiences clinicians must observe physiological behavioral cues exhibited child make assessment self report possible accurate measure pain self report pain scales involve younger kids matching pain intensity photographs


children 's faces oucher scale pointing schematics faces showing different pain levels pointing location pain body outline ref name ama ref questionnaires older children adolescents include varni thompson pediatric pain questionnaire ppq children comprehensive pain questionnaire often utilized individuals chronic persistent pain ref name ama acetaminophen nonsteroidal anti inflammatory agents opioid analgesics commonly used treat acute chronic pain symptoms children adolescents however pediatrician consulted administering medication ref name ama caregivers may provide nonpharmacological treatment children


adolescents carries minimal risk cost effective compared pharmacological treatment nonpharmacologic interventions vary age developmental factors physical interventions ease pain infants include swaddling rocking sucrose via pacifier children adolescents physical interventions include hot cold application massage acupuncture ref name wente ref cognitive behavioral therapy cbt aims reduce emotional distress improve daily functioning school aged children adolescents pain changing relationship thoughts emotions addition therapy teaches adaptive coping strategies integrated interventions cbt include relaxation technique


american board anesthesiology american osteopathic board anesthesiology recognized aoabos american board physical medicine rehabilitation american board psychiatry neurology provide certification subspecialty pain management following fellowship training fellowship training recognized american board medical specialties abms american osteopathic association bureau osteopathic specialists aoabos field pain medicine grown rapidly many practitioners entered field non acgme board certified ref name pmid ref see also equianalgesic opioid comparison example equianalgesic chart pain catastrophizing


scale pain ladder pain management childbirth pain psychology references reading external links https webarchiveorg web http wwwwhoint medicines areas quality safety guide pain en world health organization treatment guidelines pain palliative care acute pain


'''medical cybernetics''' branch cybernetics heavily affected development computer applies concepts cybernetics medical research practice intersection systems biology systems medicine clinical applications covers emerging working program application systems communication theory connectionism decision theory biomedical research health related questions overview medical cybernetics searches quantitative descriptions biological dynamics ref name jwd jw dietrich http wwwmedical cyberneticsde definitionhtml ''medical cybernetics definition'' medizinische kybernetik released creative commons attribution licence ref investigates intercausal networks

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human biology medical decision making information processing structures living organism approaches medical cybernetics include systems theory medical sciences scope systems theory medical sciences searching modelling physiological dynamics intact diseased organism gain deeper insights organizational principles life perturbations ref name jwd focus medical application field also referred systems medicine medical information communication theory motivated awareness information essential principle life application communication theory biomedicine


aims mathematical description signalling processes information storage different physiological layers ref name jwd connectionism connectionistic models describe information processing neural networks thus forming bridge biological technological research ref name jwd medical decision theory mdt goal mdt gather evidence based foundations decision making clinical setting ref name jwd see also related fields biocybernetics complex systems cybernetics systems theory prosthetics systems biology systems medicine related scientists uri alon william ross ashby claude bernard valentin braitenberg walter cannon stephen grossberg humberto maturana warren mcculloch related scientists walter pitts arturo rosenblueth


robert trappl felix tretter francisco varela frederic vester kevin warwick paul watzlawick list biomedical cybernetics software list medical cybernetics schools colleges universities https mohammeddockratwixsitecom medicalcyberneticsco medical cybernetics college bradford uk support office lenasia johannesburg rsa principal mohammed dockrat medical cyberneticist references reading vv parin introduction medical cybernetics ''nasa technical translation'' nof f national aeronautics space administration ca muses aspects crucial problems biological medical cybernetics ''progress biocybernetics'' external links http wwwaimeduniwienacat institute medical cybernetics artificial intelligence medical university


vienna austria http open siteorg science mathematics applied cybernetics k applied cybernetics medical medical cybernetics open encyclopedia project http wwwmedizinische kybernetikde portal server medizinische kybernetik medical cybernetics http biocybcsuclaedu ucla biocybernetics laboratory los angeles ca usa biomedical cybernetics


sample scene taiping rebellion saladin guy lusignan battle hattin '' 'religious war''' '''holy war''' war primarily caused justified differences religion modern period debates common extent religious economic ethnic aspects conflict predominate given war according ''encyclopedia wars'' known recorded historical conflicts religion primary cause ref name axelrod vol ref matthew white 's ''the great big book horrible things'' gives religion

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Religious war


primary cause world 's deadliest atrocities ref name white ref several conflicts including israeli palestinian conflict syrian civil war wars afghanistan iraq religious elements overtly present variously described fundamentalism religious extremism depending upon observer 's sympathies however studies cases often conclude ethnic animosities drive much conflicts ref name omar scholars argue termed religious wars largely western dichotomy modern invention past centuries arguing wars classed religious secular economic political ramifications ref


name cavanaugh ref name great ref ref name jeffrey russell similar opinions expressed early seven years' war widely recognized religious motivation noting warring factions necessarily split along confessional lines much along secular interests ref name p john entick ''the general history later war'' volume https booksgooglecom booksid psaaaacaaj pg pa dq religious war hl en sa x ei cooaurognogj ask hyaq redir esc v onepage q religious war f false p ref according jeffrey burton russell conflicts may rooted strictly religion religion may also contributing factor warfare alongside ethnic social political economic issues ref name jeffrey russell ref history concept religion


modern word ' 'religion'' comes latin word ' 'religio'' ancient medieval world etymological latin root ' 'religio'' understood individual virtue worship never doctrine practice actual source knowledge ref name harrison territories modern concept religion abstraction entails distinct sets beliefs doctrines recent invention english language since usage began texts th century due splitting christendom protestant reformation prevalent colonization globalization age exploration involved contact numerous


foreign indigenous cultures non european languages ref name harrison territories ref th century concept religion received modern shape despite fact bible quran ancient sacred texts concept religion original languages neither people cultures sacred texts written ref name nongbri ref example greek word ''threskeia'' used greek writers herodotus josephus found texts like new testament sometimes translated religion today however term


understood worship well medieval period ref name nongbri quran arabic word ' 'din'' often translated religion modern translations mid translators expressed ' 'din'' law ref name nongbri even first century ad josephus used greek term ''ioudaismos'' translate judaism today even though used ethnic term one linked modern abstract concepts religion set beliefs ref name nongbri th century terms buddhism hinduism taoism confucianism first emerged ref name harrison territories


ref name invention japan ref throughout long history japan concept religion since corresponding japanese word anything close meaning american warships appeared coast japan forced japanese government sign treaties demanding among things freedom religion country contend western idea ref name invention japan according philologist max ller th century root english word religion latin ' 'religio'' originally used mean reverence god gods careful pondering


divine things piety cicero derived mean diligence max ller characterized many cultures around world including egypt persia india similar power structure point history called ancient religion today would called law languages words translated religion may use different way word religion example sanskrit word dharma sometimes translated religion also means law throughout classical indian subcontinent study law consisted


concepts penance piety ceremonial well practical traditions medieval japan first similar union imperial law universal buddha law later became independent sources power precise equivalent religion hebrew judaism distinguish clearly religious national racial ethnic identities one central concepts halakha meaning walk path sometimes translated law guides religious practice belief many aspects daily life ref name whitefordii ref criteria classification crusades muslim expansion th


century recognized holy war ''bellum sacrum'' later writers th century early modern wars ottoman empire seen seamless continuation conflict contemporaries term religious war used describe controversially time known european wars religion especially ongoing seven years' war least mid th century ''encyclopedia wars'' authors charles phillips alan axelrod document notable wars world history wars religious


wars category index ref name axelrod vol note th century much reasons conflicts explained lens religion time wars explained lens wars way sovereign interests ref name axelrod alan axelrod alan phillips charles ''encyclopedia wars'' vol facts file november pxxii wars always arisen arise today territorial disputes military rivalries conflicts ethnicity strivings commercial economic advantage always depended depend today pride prejudice


coercion envy cupidity competitiveness sense injustice much world th century reasons war explained justified least participants religion around middle th century europeans began conceive war legitimate means furthering interests individual sovereigns ref commentators concluded wars wars fundamentally originated religious motivations ''the encyclopedia war'' edited gordon martel using criteria armed conflict must involve overt religious action


concludes wars listed encyclopedia labelled religious wars william cavanaugh ''myth religious violence'' argues termed religious wars largely western dichotomy modern invention arguing wars classed religious secular economic political ramifications ref name cavanaugh ref similar opinions expressed early seven years' war widely recognized religious motivation noting warring factions necessarily split along confessional lines much along secular interests ref name p


evident religion one aspect people 's cultural heritage may serve cultural marker ideological rationalisation conflict deeper ethnic cultural differences specifically argued case troubles northern ireland often portrayed religious conflict catholic vs protestant faction fundamental cause conflict fact ethnic nationalistic rather religious nature ref name mcgarry j mcgarry j o'leary b ''explaining northern ireland broken images'' oxford blackwell ref since native irish mostly catholic


later british sponsored immigrants mainly protestant terms become shorthand two cultures inaccurate describe conflict religious one ref name mcgarry j according irfan omar michael duffey 's review violence peacemaking world religions note studies supposed cases religious violence often conclude violence strongly driven ethnic animosities ref name omar ref concept holy war individual religious traditions early empires could described henotheistic ie dominated single god ruling elite marduk babylonian empire assur


protestants early christianity st augustine 's concept war ''bellum iustum'' widely accepted warfare regarded virtuous activity ref name peters first ref name usna ref expressions concern salvation killed enemies battle regardless cause fought common ref name peters first according historian edward peters th century christians developed concept holy war ''bellum sacrum'' whereby fighting might considered penitential spiritually meritorious act ref name peters first ref ref name levine war ninth tenth centuries multiple


holy land muslims support besieged christian byzantine empire muslim seljuq expansion asia minor europe proper later crusades launched targets either religious reasons albigensian crusade northern crusades political conflict aragonese crusade council clermont pope urban ii raised level war ''bellum iustum'' war ''bellum sacrum'' holy war th century france succession wars roman catholics protestants huguenots primarily known french wars


religion first half th century german states scandinavia sweden primarily poland beset religious warfare thirty years war roman catholicism protestantism figured opposing sides conflict though catholic france take side protestants purely political reasons battle ''reconquista'' ''cantigas de santa maria'' battle las navas de tolosa known arab history battle al uqab took place july important turning point ''reconquista''


medieval history spain forces king alfonso viii castile joined armies christian rivals sancho vii navarre pedro ii aragon afonso ii portugal battle berber muslim almohad conquerors southern half iberian peninsula islam muslim conquests military expansion unprecedented scale beginning lifetime muhammad spanning centuries ottoman wars europe th century muslim conquests less coherent empire


caliphate mongol invasions expansion continued fronts iberia lost reconquista another half millennium final collapse mughal empire east ottoman empire west onset modern period also number periods infighting among muslims known term fitna mostly concern early period islam th th centuries ie collapse caliphate emergence various later islamic empires fulani jihad


states africa c technically millennium muslim conquests could classified religious war applicability term questioned reason notion religious war opposed secular war result western concept separation church state division ever existed islamic world consequently cannot real division wars religious non religious islam normative tradition pacifism warfare integral


part islamic history defense spread faith since time muhammad formalised juristic definition war islam continues hold normative power contemporary islam inextricably linking political religious justification war normative concept known ''jihad'' arabic word meaning strive struggle viz way god includes aspect struggle sword first forms military jihad occurred migration hijra muhammad small group followers


medina mecca conversion several inhabitants city islam first revelation concerning struggle meccans quran happened many times throughout history beginning muhammad 's battles polytheist arabs including battle badr battles uhud khandaq mecca hunayn judaism judaism expression ''milkhemet mitzvah'' hebrew commandment war refers war obligatory jews men women wars limited territory within borders land israel geographical limits


israel conflicts surrounding nations detailed tanakh hebrew bible especially numbers ezekiel due jewish diaspora jews scattered world living almost entirely outside land israel concept religious war absent jewish thought approximately last years assert may reemerged factions zionist movement particularly revisionist zionism earliest days israel 's existence people holy war sacred institution undertaken cultic act


religious community according reuven firestone holy war western concept referring war fought religion adherents religions often order promote religion conversion specific geographic limitation concept occur hebrew bible whose wars fought religion order promote rather order preserve religion religiously unique people relation specific limited geography shinto buddhism formally introduced japan missionaries kingdom baekje adherents


native shinto religion resisted spread buddhism several military conflicts broke starting soga mononobe conflict pro shinto mononobe clan pro buddhist soga clan religious conflict modern period israeli palestinian conflict demolished home balata second intifada israeli palestinian conflict viewed primarily ethnic conflict two parties one party often portrayed singular ethno religious group consisting jewish majority ignores non jewish minority israeli citizens varying levels support zionist state especially druze circassians


example volunteer higher numbers idf combat service represented israeli parliament greater percentages israeli jews well israeli arabs samaritans various christians negev bedouin party sometimes presented ethnic group multi religious although numerously consisting muslims christians religious groups including samaritans even jews yet despite multi religious composition parties conflict elements sides often view religious war jews muslims religious tensions


muslim jewish palestinians jews praying wailing wall led palestine riots ref name segev ref including hebron safed ethnic cleansings jews un decided partitioning mandate palestine led creation state israel jordan annexing west bank portion mandate since region plagued conflict palestinian exodus also known ''nakba'' occurred approximately palestinian arabs fled expelled homes arab israeli war civil


war preceded exact number refugees matter dispute though number palestine refugees unsettled descendants registered unrwa million ref name crenshaw ref causes remain subject fundamental disagreement palestinians israelis jews palestinians make ethnic historical claims land jews make religious claims well pakistan india india muslim league aiml formed dhaka muslims suspicious hindu majority indian national congress complained muslim members


rights hindu members number different scenarios proposed various times fuelled british policy divide rule tried bring upon every political situation among first make demand separate state writer philosopher allama iqbal presidential address convention muslim league said separate nation muslims essential otherwise hindu dominated subcontinent dissolution british raj british india partitioned two new sovereign states dominion india


amharic ''gra '' meaning left handed came close extinguishing ancient realm abyssinia forcibly converting surviving subjects islam intervention european crist v da gama son famous navigator vasco da gama attempted help prevent outcome killed al ghazi however polities exhausted resources manpower conflict allowing northward migration oromo present homelands north west addis ababa many historians trace origins hostility somalia ethiopia war


historians also argue conflict proved use sides value firearms matchlock musket cannons arquebus traditional weapons nigerian conflict inter ethnic conflict nigeria generally religious element riots igbo north said sparked religious conflict riots igbo north said inspired radio reports mistreatment muslims south military coup d' tat led lower middle ranking officers


igbo overthrew npc ncnc dominated government prime minister balewa along northern western government officials assassinated coup coup considered igbo plot overthrow northern dominated government counter coup launched mostly northern troops june july mass exodus ibo north west million ibo fled neighboring regions order escape persecution anti ibo riots increased aftermath anti ibo riots led many believe security could gained separating north


uprising period civil military unrest south vietnam largely focused corps area north country central vietnam country buddhist majority estimated percent ref name time ref ref name pentagonpapers ref diem ruled strong religious bias member catholic vietnamese minority pursued pro catholic policies antagonized many buddhists chinese conflict dungan revolt panthay rebellion hui also set racial antagonism class warfare rather mistaken assumption


uyghur population grew percent dramatic increase hui population led inevitably significant tensions hui uyghur muslim populations old uyghurs kashgar remember hui army battle kashgar massacred uyghurs caused tension hui moved kashgar parts china hui criticize uyghur separatism generally want get involved conflicts countries islam fear perceived radical ref name van wie davis ref hui uyghur live apart


praying separately attending different mosques lebanese civil war war damaged buildings beirut consensus among scholars triggered lebanese civil war however militarization palestinian refugee population along arrival plo guerrilla forces sparked arms race different lebanese political factions however conflict played along three religious lines sunni muslim christian lebanese shiite muslim druze considered among shiite muslims argued antecedents war traced back conflicts political compromises reached end


lebanon 's administration ottoman empire cold war powerful disintegrative effect lebanon closely linked polarization preceded political crisis arab israeli war exodus palestinian refugees fled fighting expelled homes arrived lebanon palestinians came play important role future lebanese civil conflicts establishment israel radically changed local environment lebanon found lebanon promised independence achieved november free french troops invaded lebanon


rid beirut vichy french forces left country christians assumed power country economy confessional parliament created muslims christians given quotas seats well president christian prime minister sunni muslim speaker parliament shia muslim march parliament passed amnesty law pardoned political crimes prior enactment amnesty extended crimes perpetrated foreign diplomats certain crimes referred cabinet higher


judicial council may militias important exception hezbollah dissolved lebanese armed forces began slowly rebuild lebanon 's major non sectarian institution violence still occurred late december car bomb estimated carry pounds tnt exploded muslim neighborhood basta least people killed wounded including former prime minister shafik wazzan riding bulletproof car yugoslav wars croatian war bosnian war viewed religious wars orthodox catholic


muslim populations former yugoslavia respctively serbs croats bosniaks ref name radelji topi ref ref name boylesheen ref traditional religious symbols used wars notably foreign muslim volunteers came bosnia wage ''jihad'' thus known bosnian mujahideen sudanese civil war second sudanese civil war described ethnoreligious conflict muslim central government 's pursuits impose sharia law non muslim southerners led violence eventually civil war war resulted independence south sudan six years war ended sudan muslim south sudan


christian timeline africa americas asia europe see also odium theologicum references bibliography nigel cliff ''holy war vasco da gama 's epic voyages turned tide centuries old clash civilizations'' harpercollins roger crowley '' holy war constantinople clash islam west'' hyperion reuven firestone ''holy war judaism fall rise controversial idea'' oxford university press sohail h hashmi ''just wars holy wars jihads christian jewish muslim encounters exchanges''


oxford university press james turner johnson ''the holy war idea western islamic traditions'' pennsylvania state university press dianne kirby ''religion cold war'' palgrave macmillan reprint steven merritt miner ''stalin 's holy war religion nationalism alliance politics '' univ north carolina press christian hling ''die europ ische debatte ber den religionskrieg konfessionelle memoria und internationale politik im zeitalter ludwigs xiv'' ver ffentlichungen des instituts f r europ ische geschichte mainz g ttingen vandenhoeck ruprecht david new ''holy war rise militant christian jewish islamic


fundamentalism'' mcfarland vivek swaroop sharma makes conflict 'religious' ''the national interest'' march april full text available http nationalinterestorg feature makes conflict religious external links http wwwlepgorg warshtm wars religion http wwwmapsofwarcom ind history religionhtml maps war history religion https apholtcom counting religious wars encyclopedia wars counting religious wars encyclopedia wars https apholtcom religion worst atrocities history religion worst atrocities history wars type war


benefit adverse effects pharmacodynamics sometimes abbreviated pd pharmacokinetics pk especially combined reference example speaking pk pd models pharmacodynamics places particular emphasis dose response relationships relationships drug concentration effect one dominant example drug receptor interactions modeled chem l r lr chem ''l'' ''r'' ''lr'' represent ligand drug receptor ligand receptor complex concentrations respectively equation represents simplified model reaction dynamics studied mathematically tools free energy maps ref align right width

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recipient exchanging replacing substances accumulating form reserve ex glycogen storage direct beneficial chemical reaction free radical scavenging direct harmful chemical reaction might result damage destruction cells induced toxic lethal damage cytotoxicity irritation molecular mechanisms pharmacological agents desired activity desired activity drug mainly due successful targeting one following cellular membrane disruption chemical reaction downstream effects interaction enzyme proteins interaction structural proteins interaction carrier proteins interaction ion channels ligand binding receptors hormone receptors


bind receptors determine cellular effects upon drug binding receptors elicit normal action agonist blocked action antagonist even action opposite normal inverse agonist principle pharmacologist would aim target plasma concentration drug desired level response reality many factors affecting goal pharmacokinetic factors determine peak concentrations concentrations cannot maintained absolute consistency metabolic breakdown excretory clearance genetic factors may exist would alter metabolism drug action patient 's immediate status may also affect indicated dosage undesirable


effects undesirable effects drug include increased probability cell mutation carcinogenic activity multitude simultaneous assorted actions may deleterious interaction additive multiplicative metabolic induced physiological damage abnormal chronic conditions therapeutic window therapeutic window amount medication amount gives effect effective dose amount gives adverse effects desired effects instance medication small pharmaceutical window must administered care control eg frequently measuring blood concentration drug since easily loses effects gives adverse effects


duration action ' 'duration action'' drug length time particular drug effective ref name pmid ref duration action function several parameters including plasma half life time equilibrate plasma target compartments rate drug biological target ref name pmid ref receptor binding effect binding ligands drug receptors governed ''law mass action'' relates large scale status rate numerous molecular processes rates formation un formation used determine equilibrium concentration


explains called ' 'receptor reserve'' phenomenon ie concentration producing occupancy typically higher concentration producing maximum response precisely receptor reserve refers phenomenon whereby stimulation fraction whole receptor population apparently elicits maximal effect achievable particular tissue simplest interpretation receptor reserve model states excess receptors cell surface necessary full effect taking sophisticated approach receptor reserve integrative measure response inducing capacity agonist