By K. Onatas. DeVry University.
The only assumption between the XML Web service client and the XML Web service is that recipients will understand the messages they receive buy erectafil 20mg low price. As a result buy 20 mg erectafil mastercard, programs written in any language buy erectafil 20mg line, using any component model buy 20 mg erectafil with amex, and running on any operating system can access XML Web services. In such architecture an obvious security choice is to use transport level security mechanisms provided by SSL/TLS or IPSec. However, these mechanisms do not provide complete protection especially for the next generation of Web services, which will be able to run on new protocols and which will include federated applications. In addition to the basic security requirements (confidentiality, integrity and authenticity Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. These security requirements can be met with the use of the emerging XML security technologies (especially XML Signature, “XML-Signature Syntax and Processing”, 2002, and XML Encryption, “Encryption Syntax and Processing”, 2002), which apply security at the message layer of the Open Systems Interconnection (OSI) stack, providing end-to-end security in Web services environments. This specification proposes a standard set of SOAP extensions that can be used when building secure Web services to implement message content integrity and confidenti- ality. The specification is flexible and is designed to be used as the basis for securing Web services within a wide variety of security models including Public Key Infrastruc- ture (PKI), Kerberos, and Secure Sockets Layer (SSL). For example, a PKI can be used to provide authentication, digital signatures, and key distribution. IBM and Microsoft have collaborated to propose a comprehensive Web Services security plan and roadmap for developing a set of Web Service Security specifications that address security issues for messages exchanged in a Web service environment, in a compatible, extensible and interoperable manner. The proposed plan as presented (Security in a Web Services World, 2002) covers a wide range of security issues, namely: WS-Security, WS-Policy, WS-Trust, WS-Privacy, WS-Secure Conversation, and WS-Authorization. Characteristics of Existing HC Information Systems Current HC information systems are built using platform and device specific features, while the health domain concepts are hard-coded directly into the software and database models (Beale, 2002, p. Moreover, they are characterized by limited support of global healthcare standards, the use of obsolete technologies and inflexible architecture design (de Velde, 2000, p. The shortcomings of such practices are especially evident in HC, where the total number of concepts and the observed rate of change are very high. Taking into account that, for example, a medical-classic term set, the SNOMED-CT, codes some 357,000 atomic concepts, one can only imagine the amount of work to be done in order to deliver robust healthcare applications, let alone the boom of cost in case of changes. The inherent inflexibility results in limited application lifespan and overwhelming costs for the maintenance and extension of HC information systems. Current systems are inadequately integrated into the established operational workflows and hospital procedures, minimizing user acceptance and delivered productivity. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The situation becomes even more complicated by the fact that a large number of isolated and incompatible applications are already installed and operational in many healthcare organizations, satisfying specific user needs as Kuhn and Giuse report (2002, p. Several problems contribute to this situation: Questions concerning integration and data input are still unsolved, the market remains volatile and few successful systems have been deployed, it is difficult to demonstrate return on investment while health IT departments lack adequate financial support and there seem to be more failures and concrete difficulties than success stories suggest. The Need for HIS Application Frameworks A crucial challenge for building applications for the health domain is that the number of the concepts that should be covered is very large and that each individual concept can be quite complex, as Beale, Goodchild and Heard identify (2002). Furthermore, health data should be available to process at the semantic level in order to empower decision support and evidence-based medicine. Finally, all these requirements should be satisfied in a cost-effective manner that does not overburden the budget of HC providers. HISA distinguishes three layers within a HIS: the Bitways layer (infrastructure), the Middleware of common services layer and the Applications layer. Such an approach fits nicely with the current situation where many HIS are comprised of many specialized applications or even sub- systems dedicated to specific areas such as outpatient scheduling, billing, ward management, Radiology Information Systems (RIS), Laboratory Information Systems (LIS), and so on. Even if some common services are treated inside a sub system, it is not inhibitory to realize the above HIS architecture, as long as the middleware of common services provides them. Within the Applications layer reside concept-specific applications, providing the necessary interface for the users in order to insert or view data, generate reports, documents, and so on.
These treatment-related dyskinesias are relatively newly discovered phe- nomena discount erectafil 20 mg with visa, noticed only in the past 20 years when patients have remained on L-dopa therapy for longer periods best erectafil 20 mg. This crossover from a predom- inantly hypokinetic to a predominantly hyperkinetic movement disorder solely due to treatment effects has blurred the traditional distinctions among movement disor- ders discount 20 mg erectafil free shipping. As understanding of the genetic basis of movement disorders increases cheap erectafil 20mg line, a more proper classification scheme for movement disorders may become available. The clinical features of parkinsonism arise in a wide variety of degenerative disorders including striatonigral degeneration, progressive supranu- clear palsy, corticobasilar degeneration, and Shy–Drager syndrome. Parkinsonism may also result from toxins such as carbon monoxide, methanol, mercury or MPTP from stroke or from head injury. It is typically given with the dopamine decarbox- ylase inhibitor carbidopa to prevent degradation of L-dopa in peripheral tissues. After 8 to 12 years of levodopa–carbidopa (Sinemet) therapy, patients may begin to © 2005 by CRC Press LLC experience the long-term side effects of these medications, including dyskinesias, and may be considered for DBS. DBS appears to allow a long-term reduction in Sinemet dosage, reducing the severity of medication- induced dyskinesias. Furthermore, the resistance of many symptoms to both medical and surgical therapy, including speech impairments, abnormal postures, gait and balance problems, autonomic dysfunctions, cognitive impairments, and psychi- atric disturbances provides goals for the development of new forms of treatment. Pathological tremor occurs in a range of 4 to 7 Hz and preferentially affects particular muscle groups, such as distal limbs. Pathological tremor may be subclassified into two main categories: action (or postural) tremor and rest tremor. Such tremor often arises in the second decade of life, may worsen with age, and is most pronounced during attempts to maintain a fixed posture. The tremor is typically worsened with emotion, fatigue, or caffeine and is generally improved with alcohol. Pharmacological thera- pies for essential tremor include the beta-blocker propranolol and the anticonvulsant primidone. Other forms of action tremor may occur with neurological disorders such as multiple sclerosis or meningoencephalitis. The tremor subsides with action such as lifting a cup, but immediately resumes when the hand is still, such as when a cup is held close to the mouth. The tremor may respond to pharmacological therapy with the phenothiazine derivative ethopropazine (Parsidol) or the anticho- linergic trihexyphenidyl (Artane). Manifestations of dystonic conditions may be progressive, initially appearing as mannerisms, and later becoming more persistent. This disorder, termed torsion dystonia of childhood, involves progression from intermittent and focal involuntary movements to persistent contor- tions of the entire body. In some instances, dystonia may be occupationally related, such as spasms of the hand (writers), spasms of the hand and neck (violinists), and spasms of the lip (trombonists). Although L-dopa, bromocriptine, benzodiazepines, and other pharmacological interventions may be helpful in some cases, few dystonia patients generally respond to medical management. In many cases of focal dystonia, therapy consists of transient disruption of muscle function with botulinum toxin. In the past, stereotactic lesioning of the ventrolateral thalamus or the pallidum resulted in substantial improvements in axial symptoms for some patients. Interestingly, such pallidal stimulation requires a considerable period before showing treatment effects. This slow onset suggests that considerable motor circuitry reorganization is required to achieve observable effects. Athetosis refers to a slow, writhing motion resulting from an inability to maintain a fixed position in space. The roles of these multiple, interacting regions to motor control have been roughly delineated,5 but the details of the functioning of these regions, particularly of the basal ganglia, remain highly controversial. In general, physiological studies observed the activities of various parts of the brain during the performance of specific, stereotyped two- and three-dimensional movements.
Intramuscular interferon beta-la for disease progression in relapsing multiple sclerosis generic erectafil 20mg line. Remacemide hydrochloride as an add-on therapy in epilepsy: a randomized purchase erectafil 20mg overnight delivery, placebocontrolled trial of three dose levels (300 erectafil 20mg with mastercard, 600 and 800 mg/day) in a B cheap 20mg erectafil with mastercard. Monotherapy trials with new antiepileptic drugs: study designs, practical relevance and ethical implications. Usefulness of short-term video EEG recording with saline induction in pseudoseizures. Utility and reliability of placebo infusion in the evaluation of patients with seizures. Provocation of non-epileptic seizures by suggestion in a general seizure population. Dementia 1996; 7:293–303 SECTION II: THE USE OF COMPLEMENTARY THERAPIES IN NEUROLOGIC DISEASE 13 Headache Alexander Mauskop Complementary Therapies in Neurology: An Evidence-Based Approach Edited by Barry S. Oken ISBN 1-84214-200-3 Copyright © 2004 by The Parthenon Publishing Group, London The field of headaches has benefited from increased attention from the pharmaceutical industry. The serotonin agonist drugs of the sumatriptan type have revolutionized treatment of migraines and have dramatically improved the lives of millions of people. However, these drugs sometimes do not reach those who need them, do not work for at least 30% of patients, cause unpleasant side-effects in some and have the potential to ® cause serious sideeffects. Other treatments, such as botulinum toxin (Botox ) injections can be very expensive. More than half of migraine sufferers do not even see a physician for their 1 headaches and many turn to a variety of complementary treatments, which are often cheaper, appear and usually are safer and are typically offered by practitioners with good 2 bedside manners. Headache is one of the most common complaints of patients seeing general practitioners and neurologists. The most common type is tension-type headache, which almost everyone experiences intermittently and which usually does not disable or reduce quality of life, unless it becomes chronic. About 18% of women and 6% of men suffer from migraines, which means that over 28 million Americans have this disease. Many migraine sufferers are misdiagnosed as having sinus or tension-type headaches and do not receive appropriate treatment. Some patients have both migraine and tension-type headaches and in some patients the diagnosis is not clear-cut. The general rule is that if a patient is found to have no structural or metabolic cause for her headaches and the headaches interfere with normal functioning, the most likely condition she is suffering from is migraine. Accumulating evidence indicates that genetic factors make people more susceptible to having migraine headaches. This genetic predisposition does not mean life-long suffering, since avoidance of triggers and non-pharmacological treatments can raise the threshold for migraines in the majority of patients and reduce or eliminate the attacks. Many non-pharmacological modalities can help several types of headaches, while others are specific to a certain headache type. Headache 277 MIGRAINE HEADACHES Elimination of triggers Avoidance of triggers can dramatically reduce the frequency of attacks. An excessive amount of caffeine in the diet (for a headache sufferer, more than one drink a day) or in over-the-counter or prescription medications is one of the most common triggers. Some of the foods that can provoke migraine headaches include yogurt, bananas, dried fruit, beans, aged cheese, pickled and marinated foods and buttermilk. Among the alcoholic beverages red wine and beer are more likely to induce a migraine headache than vodka. Nutritional therapies Dietary approaches to the treatment of migraines are widely advocated and are in the category of complementary therapies but have very little scientific evidence. Tyramine- containing foods can trigger migraine headaches in susceptible individuals, as can skipping meals and some food additives and sugar substitutes. Some patients report that their headaches get better with elimination of wheat products, sugar or milk products from their diets. While we do not have scientific proof, it is possible to speculate on why these dietary changes may work.
Then training in one work- space should result in the rotation of PDs by a certain amount cheap 20 mg erectafil with mastercard, and translation of the arm to a new workspace should result in an additional rotation by an amount approximately equal to the rotation in the shoulder joint cheap 20 mg erectafil overnight delivery. At the new workspace generic erectafil 20mg visa, despite the fact that no prior training had taken place there cheap erectafil 20mg without prescription, an effect of the training elsewhere should be observed, i. However, it is certainly not the case that all M1 cells are “muscle-like” in their tuning properties. In many instances, experiments have demonstrated that a signif- icant portion of cells in M1 code for parameters of reaching movements in extrinsic coordinates. Therefore, our hypoth- esis assumes that M1 cells that have more muscle-like properties — i. For example, consider adaptation to a force field described by = B1˙, where f is a force vector acting on the hand, x˙ is a hand velocity vector, and B1 = [–11, –11; –11, 11] N·sec/m. If the right arm is near the horizontal plane and the shoulder is flexed so that the hand is at a “left” workspace (meaning that reaching movements are performed in a flexed posture for the shoulder), the PD of the triceps is about 90°. When a subject trains in the field, one observes a 30° clockwise rotation in the PD of the triceps. Now imagine that there are cells in the motor cortex that also rotate their PD by an amount similar to this. Furthermore, we would expect that on average, the 90° clockwise rotation in the shoulder joint should cause the PD of these cells to rotate by an average of 90°. So for a motor cortical cell that was “muscle-like” and had a PD of, say, 180° at the left workspace, adaptation to the field at that workspace should cause the PD to change to 150° (i. If the subject had not practiced movements in the field, this cell would have a PD of 90°. Therefore, the effect of training at the left workspace should be observable in terms of the behavior of the hand at the right workspace if the “memory cells” that rotated their PD at the left workspace maintain their relative rotation at the right workspace. In terms of forces, this corresponds to a field where the relative rotation of the muscle PDs is maintained as a function of the shoulder angle. One can approximate such a force field by transforming forces on the hand at the “left” workspace to joint torques, and then transforming the torques back to hand forces at the “right” workspace. This theoretical result means that the force field described by B1 should be generalized to –B1 at the right workspace. We were intrigued by this prediction because we had observed earlier that if one adapts to field B and then is given field –B in the same workspace, performance in –B is absolutely terrible. In fact, perfor- mance in –B for these subjects is far worse than performance of naïve subjects in the same field. The property of activity fields that is relevant in this case is the change in PD as a function of shoulder angle. Alternatively, how does one infer the shape of the activity fields from the patterns of behavioral generaliza- tion? We need to advance beyond a description of the input–output variables that are encoded by internal models (sensory state of the arm and force, respectively) and consider how the transformation from input to output might take place. That is, we must first consider how the central nervous system might compute internal models. While the idea of using populations of neurons to code variables of interest is old,19 it has become a compelling tool since it was combined with a simple decoding strategy called a population vector to reconstruct the direction of reaching move- ments from cells in M1. Therefore, w is a two-dimensional vector that might point in any direction about a unit circle. In a given trial, imagine that the movement direction is θ, and each cell i discharges by amount ri. The second term is noise ni that we might encounter at any given trial i: r ()θ (11. Experiments show that the tuning curve is typically a cosine-like function of movement direction and has a half-width at half-height value of approximately 56°. Experiments suggest that this noise term (for neurons in the visual cortex) is often normally distributed with a variance that is proportional to the mean value of the tuning function.