Celecoxib
Gerald Bloomfield, MD
- Associate Professor of Medicine
- Assistant Research Professor of Global Health
- Member in the Duke Clinical Research Institute
https://medicine.duke.edu/faculty/gerald-bloomfield-md
But this alternative interpretation simply cannot handle the observation that when participants in a between-subjects design rated (rather than ranked) the likelihood of only one of these options arthritis knuckles 100 mg celecoxib fast delivery, those evaluating Linda the feminist bank employee offered higher likelihood ratings than those evaluating Linda the bank employee rheumatoid arthritis knee injections buy celecoxib cheap. There is a long tradition of research in social psychology illustrating that people actively construe the meaning of a given task or stimulus (Griffin & Ross arthritis medication that does not affect kidneys discount 200mg celecoxib overnight delivery, 1991) and that their own chronically accessible categories arthritis national research foundation buy generic celecoxib 200 mg online, habits, and experiences powerfully influence their construals (Higgins, King, & Mavin, 1982; Higgins, Rholes, & Jones, 1977; Srull & Wyer, 1979, 1980). When asked whether a given description is likely to belong to an engineer or lawyer, one cannot fail to compute the similarity between the description and each professional stereotype. It happens both inside and outside the laboratory, and, just as one would expect if people were active interpreters of the tasks that confront them, various changes in the presentation of stimuli or the description of the task influence what participants interpret their task to be. Another common accusation against the heuristics and biases tradition is that researchers hold experimental participants to an inappropriately high or even misguided standard of rationality. Second, it brings to the fore the crucial role of axioms in justifying a normative theory. These axioms include the claim that the probability of an eventA and its complementnot-A sum to 1. This is an example of a coherence axiom that constrains the relation between the probabilities of events. In fact, it is the tension between the general agreement with the abstract rules of probability and the violation of those rules in richer contexts that give the heuristics and biases demonstrations their power (a point explored more deeply in Chapters 1, 2, and 22). According to this perspective, probability is defined as the relative frequency of an event in an infinite series. However, as Keynes (1921) argued, a strict frequentist view entails that beliefs about unique events such as the coming of war, the end of a recession, and the outcome of a medical operation cannot be evaluated. And even those who take the frequentist stance in their professional lives act like subjectivists in their day-to-day affairs. An honest frequentist must concede that meaningful probabilistic statements can be made about unique events, such as the Yankees being more likely to win the World Series this year than, say, the Kansas City Royals or Montreal Expos, or that either author of this chapter is likely to lose a prize fight with the reigning champion in his weight class. Such consideration notwithstanding, at some point one is thrown back to the level of axioms: Is one willing, for example, to subscribe to the rule that a set of predictions made with 80% probability should come true 80% of the time. This argument, precisely because it cannot be tested empirically, remains a matter of faith and ideology. This was a bold argument when first introduced and it is even bolder to maintain now. In fact, presenting frequencies rather than probabilities sometimes makes judgment distinctly worse. Critics claim that assessments of single-event probabilities are unnatural, and that only a frequency format is consistent with how the mind works (Cosmides & Tooby, 1996; Gigerenzer, 1991b, 1994; Pinker, 1997). Numerous studies in the heuristics and biases tradition make this clear, any one of which is sufficient to make the point. Here, as in many other studies, the participants were given no information in a probabilistic format nor was a probabilistic response required (or even possible). Nevertheless, even though the actual number of possible committees of 2 and 8 are the same, those estimating the number of 2-person committees gave estimates that were an average two and a half times higher than those estimating the number of 8-person committees (Tversky & Kahneman, 1973). There is clearly more to biased judgment than an inability to handle probabilities. Recent Perspectives As this book demonstrates, the heuristics and biases program has weathered its various critiques and remains a vigorous and still developing perspective on human judgment. Part of its vigor stems from parallel developments in psychology that have both influenced and been influenced by the work on heuristics and biases. Work on the rapid, automatic assessments of the affective system is a good example (Slovic, Finucane, Peters, & MacGregor, Chapter 23; Zajonc, 1980). The idea that a quick, affective, yes/no, approach/avoid reaction precedes extensive cognitive elaboration has certainly been around for a long time and predates the heuristics and biases program. Contemporary research on magical thinking also fits well with the heuristics and biases perspective (see Chapter 11 by Rozin & Nemeroff). This research, like that in the heuristics and biases tradition, highlights the conflict between an initial, reflexive evaluation and a more considered, rational assessment. This work, like the heuristic and biases program, stresses the fact that much of mental life is not the product of deliberate processing, but of quicker, more reflexive processes that are less available to conscious intervention. The advocates of each of these models postulate one set of mental processes that are quick and effortless, and another that are more deliberate and taxing. One advances the claim that people deliberately use less effortful procedures when the judgment is relatively unimportant and motivation is low. The more effortful procedures are reserved for occasions in which the stakes are high.
Suppose that this self-appraisal chronic arthritis in the knee purchase celecoxib 100 mg amex, ego explanation for overconfidence is generally accurate arthritis foods discount 100mg celecoxib. Actually arthritis ease proven 200 mg celecoxib, however arthritis pain behind ear buy celecoxib 200 mg line, there is evidence within the cultural psychology literature that personal modesty really is more common in Asia than in the United States. One way out of this apparent contradiction is to concede that, regardless of its other merits, the conventional view of self-esteem simply does not apply to tasks such as responding to general-knowledge questions. Indeed, the documented high degrees of both general knowledge overconfidence and selfeffacement among the Chinese, for example, could be taken as evidence in and of itself against the self-appraisal account for overconfidence generally. Actually, there have also been numerous other indications that self-appraisals have little to do with general-knowledge overconfidence. Ronis and Yates (1987) reasoned that, if self-appraisals do indeed play a critical role in general-knowledge overconfidence, such overconfidence should be stronger when the respondent personally chooses the focal alternative than when it is picked at random. For each of a variety of items, the respondent was asked to imagine that a random sample of 100 students at his or her university had been selected and that the sample just happened to include the respondent him or herself. The respondent was then asked to imagine that the sample was rank ordered with respect to some focal skill or personal characteristic, such as writing effectiveness, influence on other people, or interest in sports. Next, the respondent was asked to estimate his or her position in the rank ordering. Selfenhancement or overconfidence in this peer comparison task is indexed by the degree to which, on average, such percentile rank estimates exceed 50%. Characteristics in another class of filler items were neutral as far as self esteem was concerned. Perhaps the most important result of the study, however, was that there was almost no correlation between general knowledge over-confidence and peer-comparison overconfidence for any category of skills and characteristics. One conclusion indicated by these findings is that there are at least two different kinds of overconfidence that rest on quite different mechanisms. Another conclusion is that we should expect different patterns of cross-cultural variations in these distinct varieties of overconfidence. A third indication is that, although some forms of overconfidence probably do rest heavily on self-appraisals, others do not. Accounts for general knowledge overconfidence and its cross-cultural variations almost certainly fall into the latter category. Set for Probabilistic Thinking Wright and Phillips (1980) argued that their Asian respondents were especially susceptible to a certainty illusion, a tendency to hold beliefs with absolute certainty. They offered this proposal because of the high frequency with which their Asian respondents reported 100% probability judgments that their chosen answers to general-knowledge questions were correct. The incidence rates for such judgments were generally more than twice as high for their participants in Asia. The rates of 100% judgments for the American and Japanese participants in that study were 22. Wright and Phillips did not attribute the certainty illusion to across-the-board assuredness; instead, they proposed that the illusion is merely one manifestation of a set to view the world in nonprobabilistic terms. In a task discussed more extensively later, Wright and Phillips (1980) asked participants to respond in an open-ended fashion to questions about various issues. Moreover, it raises a variety of interesting additional questions: One concerns how different sets might have arisen in different parts of the world, and another asks how the decision strategies of people with nonprobabilistic sets cope with the actual probabilistic nature of the world. Accuracy Dimension Premiums We noted previously that overall probability judgment accuracy is not a unitary construct. Instead, it has several meaningfully distinguishable dimensions or contributors. We also described instances in which, although two groups might share a common level of overall accuracy, they arrive at that common level via different routes. The Chinese and American participants exhibited the same measure of overall accuracy. It seemed conceivable to us that this might reflect differences in the relative emphases that different cultures place on particular accuracy dimensions, with the Chinese putting more value on discrimination and less on calibration. We tested this idea in a study with participants in Taiwan and the United States, using the methodology used by Yates, Price, Lee, and Ramirez (1996). In essence, that methodology requires the participant to review two collections of judgment-outcome pairs and express a preference for the forecasters (either meteorologists or stock brokers) who rendered the judgments. The collections of judgments were special in that they were identical in terms of overall accuracy but, whereas one was superior in terms of calibration, it was inferior to the other with respect to discrimination. Participants in both sites preferred better discrimination, and the preference was indeed stronger for the Chinese in Taiwan (84% versus 71%), but not significantly so, 2(1) = 1. Thus, there seems to be little reason to believe that differences in premiums on various accuracy dimensions are a major contributor to the kinds of cross-cultural variations that have been observed. Experience and Customary Judgment Demands When we are unfamiliar with a task, we tend to perform it inconsistently. Similar inconsistency was likely to have been a major contributor to the noisiness of the judgments reported by the Chinese participants in Yates et al. There are two avenues by which unfamiliarity-induced inconsistency could degrade the quality of Chinese probability judgments. The first is direct, via the noise dimension of overall accuracy isolated in the covariance decomposition of, as discussed before (Yates, 1982). Several investigators, including Erev, Wallsten, and Budescu (1994), have shown formally how, depending on particular assumptions about the underlying process, inconsistency can contribute to some measures of overconfidence. Is there independent evidence that the expression of uncertainty in terms of probability is relatively uncommon in Chinese cultures. However, there have been several studies using a methodology developed by the Wright and Phillips group that seem to imply this conclusion. The responses are sorted into several categories and key statistics noted, including the number of verbal probability expressions. Repeatedly, the Wright and Phillips group found that their British participants used probability responses more often than their Asian participants and many more different probability responses. More recently, Lau and Ranyard (1999) performed a similar investigation and observed essentially the same pattern. They reported, for instance, that although their Chinese respondents on average used 1. Verbal probability phrases are not the same as numeric probabilities, but if verbal probabilistic expression is relatively uncommon in Chinese discourse, it is hard to imagine that numeric likelihood expression would be common either. Findings like these implicate the roles of customs and norms in cross-cultural variations. There is no reason to expect such differences to rest on immutable, biological foundations.
These two syndromes have different implications for genetic counselling; the former is non-familial rheumatoid arthritis ankle buy celecoxib 100 mg fast delivery, while the second has a strong genetic component arthritis and sports order 100mg celecoxib otc. The typical variety (found in 1 per 90 000 births and usually inherited with an autosomal dominant pattern) consists of absence of both the finger and the metacarpal bone rheumatoid arthritis in feet and hands purchase 200 mg celecoxib with mastercard, resulting in a deep V-shaped central defect that clearly divides the hand into an ulnar and a radial part ultrasound for arthritis in dogs order 100 mg celecoxib otc. The atypical variety (found in 1 per 150 000 births) is characterized by a much wider cleft formed by a defect of the metacarpals and the middle fingers; the cleft is U-shaped and wide, with only the thumb and small finger remaining. Split hand and foot deformities can occur as isolated anomalies, but more commonly they are part of a more complex syndrome. Radial clubhand includes a wide spectrum of disorders that encompass absent thumb, thumb hypoplasia, thin first metacarpal and absent radius. Ulnar clubhand, which is less common, ranges from mild deviations of the hand on the ulnar side of the forearm to complete absence of the ulna. While radial clubhand is frequently syndromatic, ulnar clubhand is usually an isolated anomaly. Postaxial polydactyly (the most common form) occurs on the ulnar side of the hand and fibular side of the foot. Preaxial polydactyly is present on the radial side of the hand and the tibial side of the foot. The majority of conditions are isolated with an autosomal dominant mode of inheritance. Preaxial polydactyly, especially triphalangeal thumb, is most likely to be part of a multisystem syndrome. Central polydactyly, which consists of an extra digit (usually hidden between the long and the ring finger), is often bilateral and is associated with other hand and foot malformations; it is inherited with an autosomal mode of inheritance. Neurological, muscular, connective tissue, and skeletal abnormalities result in multiple joint contractures, including bilateral talipes and fixed flexion or extension deformities of the hips, knees, elbows and wrists. The deformities are usually symmetric and, in most cases, all four limbs are involved. The severity of the deformities increases distally in the involved limb, with the hands and feet typically being the most severely affected. In the first trimester, a common feature of many chromosomal defects is increased nuchal translucency thickness. In later pregnancy, each chromosomal defect has its own syndromal pattern of abnormalities. Trisomy 21 Trisomy 21 is associated with a tendency towards brachycephaly, mild ventriculomegaly, flattening of the face, nuchal edema, atrioventricular septal defects, duodenal atresia and echogenic bowel, mild hydronephrosis, shortening of the limbs, sandal gap and clinodactyly or mid-phalanx hypoplasia of the fifth finger. Trisomy 13 In trisomy 13, common defects include holoprosencephaly and associated facial abnormalities, microcephaly, cardiac and renal abnormalities (often enlarged and echogenic kidneys), exomphalos and postaxial polydactyly. Triploidy Triploidy, where the extra set of chromosomes is paternally derived, is associated with a molar placenta and the pregnancy rarely persists beyond 20 weeks. When there is a double maternal chromosome contribution, the pregnancy may persist into the third trimester. The placenta is of normal consistency and the fetus demonstrates severe asymmetrical growth retardation. Turner syndrome There are two types of this syndrome, the lethal and non-lethal types. The lethal type of Turner syndrome presents with large nuchal cystic hygromata, generalized edema, mild pleural effusions and ascites, and cardiac abnormalities. The non-lethal type usually does not demonstrate any ultrasonographic abnormalities. These are not associated with an increased prevalence of sonographically detectable defects. Types of abnormalities the following table describes the common chromosomal abnormalities in the presence of various sonographically detected defects. The overall risk for chromosomal defects increases with the total number of abnormalities that are identified. It is therefore recommended that, when an abnormality/marker is detected at routine ultrasound examination, a thorough check is made for the other features of the chromosomal defect(s) known to be associated with that marker; should additional abnormalities be identified, the risk is dramatically increased. Incidence of chromosomal defects in relation to number of sonographically detected abnormalities (Nicolaides et al. The prevalence of these defects is low and therefore the cost implications are small. If the defects are either lethal or they are associated with severe handicap, fetal karyotyping constitutes one of a series of investigations to determine the possible cause and therefore the risk of recurrence. Examples of these defects include hydrocephalus, holoprosencephaly, multicystic renal dysplasia and severe hydrops. In the case of isolated neural tube defects, there is controversy as to whether the risk for chromosomal defects is increased. Similarly, for skeletal dysplasias where the likely diagnosis is obvious by ultrasonography, it would probably be unnecessary to perform karyotyping. If the defect is potentially correctable by intrauterine or postnatal surgery, it may be logical to exclude an underlying chromosomal abnormality, especially because for many of these conditions the usual abnormality is trisomy 18 or 13. Examples include facial cleft, diaphragmatic hernia, esophageal atresia, exomphalos and many of the cardiac defects. In the case of isolated gastroschisis or small bowel obstruction, there is no evidence of increased risk of trisomies. Minor defects or markers For apparently isolated abnormalities, there are large differences in the reported incidence of associated chromosomal defects. It is therefore uncertain whether, in such cases, karyotyping should be undertaken, especially for those abnormalities that have a high prevalence in the general population and for which the prognosis in the absence of a chromosomal defect is good. Since the incidence of chromosomal defects is associated with maternal age, it is possible that the wide range of results reported in the various studies is the mere consequence of differences in the maternal age distribution of the populations examined. In addition, since chromosomal abnormalities are associated with a high rate of intrauterine death, differences may arise from the fact that studies were undertaken at different stages of pregnancy. For example, to determine whether apparently isolated choroid plexus cysts at 20 weeks of gestation are associated with an increased risk for trisomy 18, it is essential to know the incidence of trisomy 18 at 20 weeks, based on the maternal age distribution of the population that is examined. Therefore, we propose that, in the calculation of risks for chromosomal defects, it is necessary to take into account ultrasound findings as well as the maternal age and the gestational age at the time of the scan. Association with maternal age and gestation the risk for trisomies increases with maternal age and decreases with gestation; the rate of intrauterine lethality between 12 weeks and 40 weeks is about 30% for trisomy 21, and 80% for trisomies 18 and 13 (Appendix 1). Turner syndrome is usually due to loss of the paternal X chromosome and, consequently, the frequency of conception of 45,X embryos, unlike that of trisomies, is unrelated to maternal age. The prevalence is about 1 per 1500 at 12 weeks, 1 per 3000 at 20 weeks and 1 per 4000 at 40 weeks. Polyploidy affects about 2% of recognized conceptions but it is highly lethal and it is very rarely observed in live births; the prevalence at 12 and 20 weeks is about 1 per 2000 and 1 per 250 000, respectively. Type of defect If there are minor defects, the risk for trisomy 21 is calculated by multiplying the background (maternal age and gestation-related risk) by a factor depending on the specific defect. For the following conditions, there are sufficient data in the literature to estimate the risk factors. Nuchal edema or fold more than 6 mm this is the second-trimester form of nuchal translucency. However, it is sometimes associated with chromosomal defects, cardiac anomalies, infection or genetic syndromes. For isolated nuchal edema, the risk for trisomy 21 may be ten-times the background risk. The commonest cause is intra-amniotic bleeding, but occasionally it may be a marker of cystic fibrosis or chromosomal defects.
Much improvement in the workers health protection has been made in developed countries in the field of industrial hygiene and safety arthritis diet primal blueprint purchase cheap celecoxib online, and occupational medicine arthritis in the back causes generic celecoxib 200mg mastercard. Developing and setting mandatory occupational safety and health standards involves determining the extent of employee exposure to hazards and deciding what is needed to control these hazards to protect workers arthritis feet physical therapy buy cheap celecoxib 100mg line. Industrial hygienists are trained to anticipate arthritis pain throughout body discount 100mg celecoxib mastercard, recognize, evaluate, and recommend controls for environmental and physical hazards that can affect the health and well-being of workers. Industrial hygienists analyze, identify, and measure workplace hazards or stresses that can cause sickness, impaired health, or significant discomfort in workers through chemical, physical, ergonomic, or biological exposures. Labor regulation Talking about labor Law in Ethiopia means to basically review the history of the last 40-50 years. Until recently, the main source of labor law, the Labor Proclamation, Proclamation No. The new statute represents an important tool for unions and employers to participate in all labor matters. The innovation concerns the right of workers, without distinction whatsoever, to form organizations of their own choosing and the right of these organizations to organize their activities without interference by the public authorities and not to be dissolved by administrative authority (Article 114 (1), (2) and (7)). They should be distributed evenly, but may be even calculated over a longer period of time (Articles 63 and 64). Overtime Any work exceeding the normal working time of 48 hours a week is overtime. Paid leave Annual, uninterrupted leave with pay shall be a minimum of 14 working days, plus one working day for every additional year of service (Article 77). Additional leave is granted for employees engaged in particularly hazardous or unhealthy work. Furthermore, the Ethiopian Labor Proclamation provides one part (Part Six) to the Working Conditions of Women and Young Workers. Other leave entitlements Articles 85 to 86 provide for an entitlement to sick leave after the completion of the probation period. An employee is entitled to a maximum of 6 months of sick leave within 1 year of service. An employer will only be obligated to grant paid sick leave for the first months, whereas the wage is reduced to 50 % for the second and third month, and reduced to zero for the third to the sixth month of sick leave within a year. For any absence for longer than one day the employee has the obligation to produce a valid medical certificate. Moreover, Article 81 to 84 of the Proclamation provide for special leave for family events, union activities and other special purposes, such as for hearings before bodies competent to hear labor disputes, to exercise civil rights, and for training purposes according to collective agreements or working rules. Beyond the age of 14 years, no person may employ a child for work that is inappropriate or that endangers his or her life or health (Article 89 (2) and (3)). Work performed under the regime of a vocational training course is exempted from this protection (Article 89 (5)). Equality the Constitution guarantees the right to equality in employment, promotion, pay and the transfer of pension entitlement (Article 35 (8) of the Constitution). In Article 41 of the Constitution, it is stated that the State shall, within available means, allocate resources to provide rehabilitation and assistance to the physically and mentally disabled, the aged, and to children who are left without parents or guardian. Purpose of the Proclamation the Right of Disabled Persons to Employment Proclamation No. In paragraph 3 of the preamble it is stated that the objective of the Proclamation is to stop such discriminations and protect the rights of disabled persons to compete for and get employment on the basis of their qualifications. Scope of the Proclamation Article 2(1) of the Proclamation defines a "disabled person" as a person who is unable to see hear, or speak or suffering from injuries to his limbs or from metal retardation due to natural or man made causes provided however that the term does not include persons who are alcoholics, drug addicts and those with psychological problems due to socially deviant behaviors. Disabled person having the necessary qualifications shall, unless the nature or the work dictates otherwise, have the right to compete and to be selected for. Working Groups were formed for each country to identify what needs to be done in each case to improve the impact of national laws. The common problems encountered in the development of occupational health service include: 1. Lack of awareness among workers, employers, health planners, policy makers, health professionals and public at large. Inadequate, inaccessible, and inequitably distributed health service institutions. Lack of multidisciplinary staff, absence of field-testing equipment for conducting environmental and biological monitoring of the work place and the health of the workers. Insufficient budget for carrying out regular inspections, conducting research activities. The characteristics of the workers, the majorities are poor, illiterate or poorly educated. Unfavourable climatic condition and heavy load of endemic disease: such as bilharzia, onchocerciasis, malaria, leishhuhumaniasis, and trypanosomiasis. Absence of integration of occupational health and safety with general health service Principles of occupational Health and Safety the basic principles for the development of occupational health and safety services are as follows: a) the service must optimally be preventive oriented and multidisciplinary. Scope of occupational health and safety Factory management spends large amount of expenses for health insured workers. The workers compensation expenses include medical payments (hospital and clinic treatment); partial, temporary, and permanent disability costs; death benefits; and legal costs. The cost claims may steadily rise up if the employers do not take measure to intervene the problem. The role of occupational health and safety, therefore, lies in designing ways and means for cost reduction through workers proper health service provision. Occupational diseases, accidents, and death prevention are the issues to be addressed. The causes of these problems may be chemical, physical, biological, psychological, and ergonomical environments. The second scope includes evaluation of the recognized problem, which encompasses mainly data collection, analysis, interpretation, and recommendations. Finally, the third scope involves the development of corrective actions to eliminate or limit the problem. Generally, the work frame of occupational health and safety is wide and needs multidisciplinary approach. It requires the knowledge of physics, biology, chemistry, ergonomics, medicine, 29 Occupational Health and Safety engineering, and related sciences. It also requires public health management skills for proper communication and decision making. Elements of the work environment the basic elements in an occupational setting such as a manufacturing plant, industry, or offices are four. The work environment 1 the worker In developing countries like Ethiopia, the work force has several distinct characteristics: 1. Most people who are employed to work in the informal sectors, mainly in agriculture, or in small-scale industries, such as garages, tannery and pottery. In huhumany developing countries the rates of unemployment and under employment is increasing each year. In general, workers are at greater risk of occupational hazards for a variety of reasons because of low education and literacy rates; unfamiliarity with work processes and exposures, inadequate training, predisposition not to complain about working conditions or exposures because of jobs, whether or not they are hazardous, are relatively scarce; high prevalence 30 Occupational Health and Safety of endemic (mainly infections) diseases and malnutrition; inadequate infrastructure and human resources to diagnose, treat, and prevent work related diseases and injuries. Women, who make up a large proportion of the work force in many developing countries and often face significant physical and psychosocial hazards in their work. Children, who account for a significant part of the work force in many developing countries, often undertake some of the most hazardous work. In many of these countries, primary education is not required and there are no legal protections against child labor.
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