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By: Vinay Kumar, MBBS, MD, FRCPath

  • Donald N. Pritzker Professor and Chairman, Department of Pathology, Biologic Sciences Division and Pritzker School of Medicine, The University of Chicago, Chicago, Illinois


Frequently anxiety ed buy abilify american express, health care is delivered by a network of small clinics-some without doctors or essential analgesics anxiety back pain order abilify in united states online. Even when doctors are available bipolar depression never goes away discount abilify 10mg on-line, for example for surgery depression symptoms after breakup purchase abilify 10 mg mastercard, patients expect pain as an inevitable part of surgical intervention, and despite the high incidence of reported pain, may still rate "pain relief " as satisfactory. Olaitan A Soyannwo postgraduate health care students, and also incorporated into continuing education programs. However, these items must be adapted to be cost effective and culturally appropriate. Inadequate resources Due to staffing, equipment, and financial constraints, facilities for pain services are grossly inadequate or nonexistent in many developing countries. The inadequate resources preclude the organization of acute pain teams and chronic pain clinics, which are widely used in developed countries to provide effective pain control using evidence-based methods, education, advice on difficult pain problems, and research. In the developing world, improvements in acute pain management are most likely to result from effective training programs, use of multimodal analgesia, and access to reliable drug supplies. Lack of knowledge Inadequate knowledge among health care professionals in low-resource countries is one of the major obstacles to effective pain management. Comprehensive pain assessment and multimodal treatment approaches are poorly understood since pain is mostly taught as a symptom of disease rather than an experience with physical, psychosocial, and other dimensions. Lack of training and myths may lead to unreasonable fears of side effects of opioid analgesics and erroneous beliefs about the risk of addiction, even in cancer patients. Patients may also have a poor understanding of their own medical problems, and may expect pain, which they think has to be endured as an inevitable part of their illness. Hence appropriate education is essential for all health professionals involved in pain management, and multidisciplinary teamwork is central to successful pain management. Unfortunately, in many low-resource countries, fears (opiophobia), concerns, and myths about opioid use focus more on tolerance, dependence, and addiction, which should normally not preclude appropriate medical use of opioids. The manual explains the rationale and imperative for the use of opioid analgesics. Lack of government priority National policies are the cornerstone for implementation of any health care program, and such policies are lacking in many low-resource countries. Effective pain management can only be achieved if the government includes pain relief in the national health plan. Policy Obstacles to Pain Management in Low-Resource Settings makers and regulators must ensure that national laws and regulations, while controlling opioid usage, do not restrict prescribing to the disadvantage of patients in need. The public health strategy approach, as pioneered for palliative care, is best for translating new knowledge and skills into evidence-based, cost-effective interventions that can reach everyone in the population. Overcoming health-systems constraints to achieve the Millennium Development Goals. Conclusion Unrelieved pain causes a lot of suffering to the individuals affected, whether rich or poor. All efforts must, therefore, be made to promote effective pain management even for people living below the "breadline. Persistent pain and wellbeing: a World Health Organization study in primary health care. Guide to Pain Management in Low-Resource Settings Chapter 3 Physiology of Pain Nilesh B. Patel Pain is not only an unpleasant sensation, but a complex sensory modality essential for survival. She repeatedly bit the tip of her tongue, burned herself, did not turn over in bed or shift her weight while standing, and showed a lack of autonomic response to painful stimuli. The nervous system mechanism for detection of stimuli that have the potential to cause tissue damage is very important for triggering behavioral processes that protect against current or further tissue damage. This is done by reflex reaction and also by preemptive actions against stimuli that can lead to tissue damage such as strong mechanical forces, temperature extremes, oxygen deprivation, and exposure to certain chemicals. This chapter will cover the neuronal receptors that respond to various painful stimuli, substances that stimulate nociceptors, the nerve pathways, and the modulation of the perception of pain. The term nociception (Latin nocere, "to hurt") refers to the sensory process that is triggered, and pain refers to the perception of a feeling or sensation which the person calls pain, and describes variably as irritating, sore, stinging, aching, throbbing, or unbearable. These two aspects, nociception and pain, are separate and, as will be described when discussing the modulation of pain, a person with tissue damage that should produce painful sensations may show no behavior indicating pain. Nociception can lead to pain, which can come and go, and a person can have pain sensation without obvious nociceptive activity. Nociceptors are unspecialized, free, unmyelinated nerve endings that convert (transduce) a variety of stimuli into nerve impulses, which the brain interprets to produce the sensation of pain. The nerve cell bodies are located in the dorsal root ganglia, or for the trigeminal nerve in the trigeminal ganglia, and they send one nerve fiber branch to the periphery and another into the spinal cord or brainstem. The classification of the nociceptor is based on the classification of the nerve fiber of which it is the terminal end. There are two types of nerve fibers: (1) smalldiameter, unmyelinated nerves that conduct the nerve impulse slowly (2 m/sec = 7. The C-fiber nociceptors respond polymodally to thermal, mechanical, and chemical stimuli; and the A-fiber nociceptors are of two types and respond to mechanical and mechanothermal stimuli. It is well known that the sensation of pain is made up of two categories-an initial fast, sharp ("epicritic") pain and a later slow, dull, long lasting ("protopathic") pain. This pattern is explained by the difference in the speed of propagation of nerve impulses in the two nerve fiber types described above. The neuronal impulses in fastconducting A-fiber nociceptors produce the sensation of the sharp, fast pain, while the slower C-fiber nociceptors produce the sensation of the delayed, dull pain. Peripheral activation of the nociceptors (transduction) is modulated by a number of chemical substances, which are produced or released when there is cellular damage (Table 1). These mediators influence the degree of nerve activity and, hence, the intensity of the pain sensation. Repeated stimulation typically causes sensitization of peripheral nerve fibers, causing lowering of pain thresholds and spontaneous pain, a mechanism that can be experienced as cutaneous hypersensitivity. Patel Table 1 Selected chemical substances released with stimuli sufficient to cause tissue damage Substance Potassium Serotonin Bradykinin Histamine Prostaglandins Leukotrienes Substance P Platelets Plasma Mast cells Damaged cells Damaged cells Primary nerve afferents Source Damaged cells Skin Released by tissue damage: Bradykinin K+ Prostaglandins C fibers Histamine A fibers To spinal cord Injury Mast Cell Hypersensitivity may be diagnosed by taking history and by careful examination. Certain conditions may be discriminated: a) Allodynia: Pain due to a stimulus that does not normally provoke pain. With the knowledge of pain pathways and sensitization mechanisms, therapeutic strategies to interact specifically with the pain generation mechanisms can be developed. In addition release of substance-P, along with histamine, produce vasodilation and swelling. Central pain pathways the spinothalamic pathway and the trigeminal pathway are the major nerve routes for the transmission of pain and normal temperature information from the body and face to the brain. Visceral organs have only C-fiber nociceptive nerves, and thus there is no reflex action due to visceral organ pain. In addition, local release of chemicals such substance P causes vasodilation and swelling as well as release of histamine from the mast cells, further increasing vasodilation. This complex chemical signaling protects the injured area by producing behaviors that keep that area away from mechanical or other stimuli. Promotion of healing and protection against infection are aided by the increased blood flow and inflammation (the "protective function of pain"). The A fibers innervate the cells in the marginal zone, and the C fibers innervate mainly the cells in the substantia gelatinosa layer of the spinal cord. Dysfunctions in the thalamic pathways may themselves be a source of pain, as is observed in patients after stroke with central pain ("thalamic pain") in the area of paralysis. Appreciating the complexity of the pain pathway can contribute to understanding the difficulty in assessing the origin of pain in a patient and in providing pain relief, especially in chronic pain. Pathophysiology of pain Pain sensations could arise due to: 1) Inflammation of the nerves. The nerve fibers enter the brainstem and descend to the medulla, where they innervate a subdivision of the trigeminal nuclear complex. From here the nerve fibers from these cells cross the neural midline and ascend to innervate the thalamic nerve cells on the contralateral side. The area of the thalamus that receives the pain information from the spinal cord and trigeminal nuclei is also the area that receives information about normal sensory stimuli such as touch and pressure. From this area, nerve fibers are sent to the surface layer of the brain (cortical areas that deal with sensory information).

Nowadays mood disorder yahoo buy cheap abilify online, that is reserved for women whose cancer has clearly spread to anxiety neurosis discount abilify 20 mg amex the glands there (which can be determined through clinical examination or ultrasound imaging of the glands) depression symptoms after breakup cheap abilify 20 mg overnight delivery. Most women will now go through a selective and accurate sampling of the regional lymph glands anxiety 24 hours a day buy 20mg abilify with amex, called the sentinel lymph node biopsy. The sentinel lymph node is the first lymph gland in the armpit to which cancer spreads. If the sentinel gland is free of cancer then the other glands in the armpit down the line are likely to be as well, in which case there is no need to remove them. If significant numbers of cancer cells are found in the sentinel gland then standard practice is to remove all, or most, of the remaining lymph glands from the armpit or treat them with radiotherapy. Although the armpit is the main route for spread of breast cancer cells, the lymph glands above the collarbone can often be involved as well. These glands are not surgically sampled or removed but are usually treated with radiotherapy. Many of us remember the effects of super doses of radiotherapy that were used in the 1980s in an attempt to cure breast cancer. Such was the severity of the long-term side effects, including arm lymphoedema, that the issue was raised in Parliament. However, until cancer treatment avoids lymph gland removal or radiotherapy, the risk of developing lymphoedema will always remain. There was a time when chemotherapy was considered irrelevant for lymphoedema risk but not any more. Chemotherapy is used most often to reduce the chances of cancer recurring after surgery and radiotherapy. It can sometimes be used before surgery or radiotherapy to increase the chances of cure; or it can be used to treat cancer known to have spread to parts of the body outside the reach of surgery or radiotherapy. It appears likely that taxanes, a widely used chemotherapy agent, increase the lymph load by making blood vessels in the arm release more fluid. This can overwhelm a lymph system already weakened by lymph gland removal and so cause lymphoedema. With a mastectomy, when the whole breast is removed, breast oedema is clearly not a problem. This increases the chance of breast cancer returning, though, so radiotherapy is used on the breast as well. Radiotherapy has an effect like sunburn and causes inflammation of the breast and overlying skin. Lymph flow through the skin is reduced, and that, combined with the removal of lymph glands in the area, causes fluid to build up in the breast. It also makes the breast susceptible to cellulitis, and it leads to a lopsided cosmetic effect, which may be difficult to hide under clothing if the swelling is severe. The good news is that if infection can be prevented and treatment pursued, the breast lymphoedema can eventually resolve. All types of cancer, from gynaecological to skin cancer, are treated in similar ways and so can lead to the development of the condition in the treated area, whether in the arm or leg, or less commonly in the genitals or face and neck (see page 159). A man suffering from filariasis, which is also known as elephantiasis because the swollen leg resembles that of an elephant. A bacterial infection of the lymph vessels or skin can harm vulnerable lymph vessels and disrupt lymph flow, thereby leading to the condition. A vicious circle can therefore become established whereby an infection causes lymphoedema, which leads to further attacks of infection such as cellulitis, which in turn make the lymphoedema worse and so on. The disease, which is also called elephantiasis, affects people living in tropical and sub-tropical climates, and although it is not a life-threatening infection it can cause lasting damage to the lymph system resulting in swelling of the leg or genitalia. Filariasis, although common, is classed as a neglected tropical disease, as is podoconiosis, another form of lymphoedema found in the tropics. The resulting blockage in blood flow causes a sudden rise of pressure in the affected veins so forcing extra fluid out from the blood stream and into the tissues of the leg. Unless the lymph system can cope with this extra fluid then it will lead to acute swelling. Usually this swelling subsides once the clot has been cleared using blood thinners, but it can sometimes persist. When this occurs, it is almost certainly, in part, due to additional damage to the lymph drainage from the thrombosis. Unless the lymph drainage is robust and capable of dealing with this extra fluid, oedema will occur. Because varicose veins usually occur in the legs, the associated swelling usually occurs at its worst in the foot and ankle, where the pressure in the veins is at its highest. The main way to give respite to the affected veins is elevation, which collapses the veins and lowers the pressure within them. You can see this for yourself by sitting down in bare feet and observing the veins around the ankles and tops of feet bulge. If you then lie down and raise your foot above heart level, the veins collapse, meaning that much less fluid is released from the veins into the tissues. This allows the lymph system time to catch up with its fluid drainage responsibilities. Surgery for varicose veins will often reduce the swelling but if it does not then the cause is probably lymphoedema. Furthermore, as lymph vessels are positioned anatomically very close to surface veins in the leg, any surgical treatment of varicose veins can damage the lymph vessels as well: Rita is fifty-three but first noticed varicose veins in her left leg when she was at university. At that time she had the standard treatment, which was to strip out the unwanted varicose veins, but like her mother, who also had treatment for varicose veins, Rita found that the unsightly veins slowly returned. At the age of forty she sought further treatment and had laser destruction of the veins, but again they returned. This time, however, the problem affected multiple small surface veins, accompanied by some brown staining in the skin around the ankle and some oedema. So we can see that there are many different causes of lymphoedema, some of which are more easily avoidable than others, and some of which are much more common than others. However, determining the exact numbers of people affected by lymphoedema is not easy. Another problem is the relative lack of research on lymphoedema, which means that studies and statistics are not as readily available or complete as they are for other diseases. Most of the information we do have relates to breast cancer, as that is the area in which most of the studies have been done, but to understand the full burden of lymphoedema in societies we have to look beyond this narrow association. Professor Christine Moffatt is one of the few people in the world to have studied this. Tanya puts on a brave and cheerful face despite the problems the lymphoedema in her left leg causes her. At first sight, this suggests that lymphoedema is more common in Derby than in London. This might well be true for reasons that are not yet known, but a more likely explanation is that methods for identifying patients were more robust in the second study. The study in Derby also confirmed that lymphoedema is more common among the elderly; it found approximately 10 in every 1,000 people aged between sixty-five and seventy-four were affected with lymphoedema, and in those over eighty-five this figure rose to nearly 30. Primary lymphoedema, caused by faulty genes, is uncommon but can be devastating for young people because of the physical and psychological disabilities that result. One in nine women has a lifetime risk of breast cancer, and one in five women treated for breast cancer has a lifetime risk of lymphoedema. So one does not have to be a mathematician to see that breast-cancer-related lymphoedema is relatively common. Lymphoedema in the lower limb from treatment of gynaecological or male urogenital cancers is just as common but has been studied less than breast cancer. Obesity (and/or reduced mobility) was identified as the sole cause in at least 26 per cent of cases, and it was also found to be a contributing factor in other cases. Interestingly, primary lymphoedema (where the failure in the lymph system appears to be built-in from birth) was found in 12 per cent of all cases, making it much more common than generally realised. In another study, all in-patients at a main city hospital and community hospital were examined during a forty-eight-hour period. Of course most were not admitted directly as a result of their condition, but this merely reveals the complex health issues that sufferers of lymphoedema tend to face.

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Settings Apheresis is covered only when performed in a hospital setting (either inpatient or outpatient); or in a nonhospital setting depression quotes about being alone order abilify 20 mg on-line. Ultrafiltration this is a process for removing excess fluid from the blood through the dialysis membrane by means of pressure anxiety in spanish buy generic abilify 10mg line. Ultrafiltration is utilized in cases where excess fluid cannot be removed easily during the regular course of hemodialysis anxiety 025 mg purchase cheap abilify on-line. When it is performed mild depression symptoms yahoo order abilify australia, it is commonly done during the first hour or two of each hemodialysis on patients who. Ultrafiltration is a covered procedure under the Medicare program (effective for services performed on and after September 1, 1979) Predialysis Ultrafiltration While this procedure requires additional staff care, the facility dialysis rate is intended to cover the full range of complicated and uncomplicated nonacute dialysis treatments. Therefore, no additional facility charge is recognized for predialysis ultrafiltration. In unstable patients, the physician may need to be present at the initiation of dialysis, and available either in-house or in close proximity to monitor the patient carefully. In patients who are relatively stable, but who seem to accumulate excessive weight gain, the procedure requires only a modest increase in physician involvement over routine outpatient hemodialysis. Occasionally, medical complications may occur which require that ultrafiltration be performed separate from the dialysis treatment, and in these cases an additional charge can be recognized. However, the claim must be documented as to why the ultrafiltration could not have been performed at the same time as the dialysis. Hemoperfusion this is a process which removes substances from the blood using a charcoal or resin artificial kidney. When used in the treatment of life threatening drug overdose, hemoperfusion is a covered service for patients with or without renal failure. Hemoperfusion generally requires a physician to be present to initiate treatment and to be present in the hospital or an adjacent medical office during the entire procedure, as changes may be sudden. Develop charges for hemoperfusion in the same manner as for any new or unusual service. One or two treatments are usually all that is necessary to remove the toxic compound; document additional treatments. Hemoperfusion may be performed concurrently with dialysis, and in those cases payment for the hemoperfusion reflects only the additional care rendered over and above the care given with dialysis. The effects of using hemoperfusion to improve the results of chronic hemodialysis are not known. Therefore, hemoperfusion is not a covered service when used to improve the results of hemodialysis. There is also a paucity of data regarding its efficacy in treating asymptomatic patients with iron overload. Hemofiltration this is a process which removes fluid, electrolytes and other low molecular weight toxic substances from the blood by filtration through hollow artificial membranes and may be routinely performed in 3 weekly sessions. In contrast to both hemodialysis and peritoneal dialysis treatments which eliminate dissolved substances via diffusion across semipermeable membranes, hemofiltration mimics the filtration process of the normal kidney. The procedure is most advantageous when applied to high-risk unstable patients, such as older patients with cardiovascular diseases or diabetes, because there are fewer side effects such as hypotension, hypertension or volume overload. These pretransplant transfusions are covered under Medicare without a specific limitation on the number of transfusions, subject to the normal Medicare blood deductible provisions. Routine costs will continue to be covered as well as other items and services provided as a result of coverage of these specific trials in this policy. Aprepitant (Emend) is the first Food and Drug Administration-approved drug of its type. Aprepitant has been proposed to function in combination with other oral antiemetics for a specified population of Medicare patients receiving highly emetogenic chemotherapy and/or moderately emetogenic chemotherapy. Nationally Noncovered Indications the evidence is adequate to conclude that aprepitant cannot function alone as a full replacement for intravenously administered antiemetic agents for patients who are receiving highly emetogenic chemotherapy and/or moderately emetogenic chemotherapy. Medicare does not cover under Part B for oral antiemetic drugs in antiemetic drug combination regimens that are administered in part, via an oral route and in part, via an intravenous route. Medicare does not cover under Part B aprepitant when it is used alone for anticancer chemotherapy related nausea and vomiting. General An estimated 230,000 new cases of prostate cancer occurred in the United States during 2004. Treatment options vary once the disease is diagnosed depending on age, stage of the cancer, and other individual medical conditions. Hormonal therapy, chemotherapy, and radiation (or combinations of these treatments) are used for more advanced disease. Continued use of the drug is not reasonable and necessary if the hemoglobin rises <1g/dl (hematocrit rise <3%) compared to pretreatment baseline by 8 weeks of treatment. See the Medicare Benefit Policy Manual, chapter 11, section 90 and chapter 15, section 50. General Prostate cancer is the most common non-cutaneous cancer in men in the United States. In 2009, an estimated 192,280 new cases of prostate cancer were diagnosed and an estimated 27,360 deaths were reported. The National Cancer Institute states that prostate cancer is predominantly a cancer of older men; the median age at diagnosis is 72 years. Once the patient has castration-resistant, metastatic prostate cancer the median survival is generally less than two years. The posited mechanism of action, immunotherapy, is different from that of anti-cancer chemotherapy such as docetaxel. This exposure "trains" the white blood cells to target and attack the prostate cancer cells. Clinically, this is expected to result in a decrease in the size and/or number of cancer sites, an increase in the time to cancer progression, and/or an increase in survival of the patient. Most such anti-cancer therapies are manufactured and sold by a biopharmaceutical company and then purchased by and dispensed from a pharmacy. In contrast, once the decision is made to treat with sipuleucel-T, a multi-step process is used to produce sipuleucel-T. Sipuleucel-This made individually for each patient with his own white blood cells. Hematopoietic stem cells are multi-potent stem cells that give rise to all the blood cell types; these stem cells form blood and immune cells. A hematopoietic stem cell is a cell isolated from blood or bone marrow that can renew itself, differentiate to a variety of specialized cells, can mobilize out of the bone marrow into circulating blood, and can undergo programmed cell death, called apoptosis - a process by which cells that are unneeded or detrimental will self-destruct. When bone marrow or peripheral blood stem cell transplantation is covered, all necessary steps are included in coverage. When bone marrow or peripheral blood stem cell transplantation is non-covered, none of the steps are covered. These disorders are varied with regard to clinical characteristics, cytologic and pathologic features, and cytogenetics. In addition, the clinical study must adhere to the following standards of scientific integrity and relevance to the Medicare population: a. The research study protocol specifies the method and timing of public release of all pre-specified outcomes to be measured including release of outcomes if outcomes are negative or study is terminated early. However a full report of the outcomes must be made public no later than 3 years after the end of data collection. Outcomes should be measured and compared among pre-specified subgroups within the cohort. The principal purpose of the study is to test whether the item or service meaningfully improves health outcomes of affected beneficiaries who are represented by the enrolled subjects. The study design is methodologically appropriate and the anticipated number of enrolled subjects is sufficient to answer the research question(s) being asked in the National Coverage Determination. The study is sponsored by an organization or individual capable of completing it successfully. All aspects of the study are conducted according to appropriate standards of scientific integrity. The study is not designed to exclusively test toxicity or disease pathophysiology in healthy individuals. The research study protocol specifies the method and timing of public release of all prespecified outcomes to be measured including release of outcomes if outcomes are negative or study is terminated early. The results must include number started/completed, summary results for primary and secondary outcome measures, statistical analyses, and adverse events. Final results must be reported in a publicly accessibly manner; either in a peer-reviewed scientific journal (in print or on-line), in an on-line publicly accessible registry dedicated to the dissemination of clinical trial information such as ClinicalTrials.

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The present monograph assesses the medical and biological studies that have been performed depression disease order abilify 15mg with amex, and shows why they are deficient relative to bipolar depression definition generic 15mg abilify otc safety key depression test means purchase genuine abilify. However depression symptoms za cheap abilify online amex, even in the absence of the real-life missing components (which tend to enhance the adverse effects of the wireless radiation), the literature shows there is much valid reason for concern about potential adverse health effects from both 4G and 5G technology. The studies reported in the literature should be viewed as extremely conservative, underestimating the adverse impacts substantially. The electromagnetic spectrum encompasses the entire span of electromagnetic radiation. The spectrum includes: ionizing radiation (gamma rays, x-rays, and the extreme ultraviolet, with wavelengths below ~10-7 m and frequencies above ~3x1015 Hz); non-ionizing visible radiation (wavelengths from ~4x10-7 m to ~7x10-7 m and frequencies between ~4. Because of present concerns about the rapid expansion of new communications systems without adequate safety testing, more emphasis will be placed on the communications frequencies in this document. Now, many varieties of artificial light (incandescent, fluorescent, and light emitting diode) have replaced the sun as the main supplier of visible radiation during waking hours. In the last two or three decades, the explosive growth in the cellular telephone industry has placed many residences in metropolitan areas within less than a mile of a cell tower. Future implementation of the next generation of mobile networking technology, 5G, will increase the cell tower densities by an order of magnitude. There are three main reasons the laboratory tests do not reflect real-life exposure conditions for human beings. First, the laboratory tests have been performed mainly on animals, especially rats and mice. Because of physiological differences, there have been continual concerns about extrapolating small animal results to human beings. Additionally, while inhaled or ingested substances can be scaled from small animals to human beings relatively straight-forwardly, radiation may be more problematical. While 50% of the studies employing simulated exposures do not find any effects, studies employing real-life exposures from commercially available devices display an almost 100% consistency in showing adverse effects". These effects may be exacerbated further with 5G: "with every new generation of telecommunication devices. This contradicts real-life exposures, where humans are exposed to multiple toxic stimuli, in parallel or over time. Thus, almost all of the laboratory tests that have been performed are flawed with respect to showing the full adverse impact of the wireless radiation. Either 1) non-inclusion of signal information or 2) using single stressors only 3) tends to underestimate the seriousness of the adverse effects from non-ionizing radiation. Excluding both of these phenomena from experiments, as was done in the vast majority of cases, tends to amplify this underestimation substantially. The epidemiology studies typically involved human beings, who had been subjected to myriad known and unknown stressors prior to (and during) the study. I believe the inclusion of real-world effects in the cell tower studies accounted for the orders of magnitude exposure level decreases that were associated with the increased cancer incidence. Thus, the laboratory tests were conducted under very controlled conditions not reflective of the real-world, while the epidemiology studies were performed in the presence of many stressors, known and unknown, reflective of the real-world. The exposure levels of the epidemiology studies were, for the most part, uncontrolled. Extensive reviews of these wireless radiation biological and health effects have been published, including [Kostoff and Lau, 2017; Panagopoulos, 2019; Belpomme et al, 2018; Desai et al, 2009; Di Ciaula, 2018; Doyon and Johansson, 2017; Havas, 2017; Kaplan et al, 2016; Lerchl et al, 2015; Levitt and Lai, 2010; Miller et al, 2019; Pall, 2016, 2018; Panagopoulos, 2019; Panagopoulos et al, 2019; Russell, 2018; Sage and Burgio, 2018; Van Rongen et al, 2009; Yakymenko et al, 2016; Bioinitiative, 2019]. Penetration depths for the carrier frequency component of 5G radiation will be on the order of a few millimeters. At these wavelengths, one can expect resonance phenomena with small-scale human structures [Betzalel, 2018], as well as resonances with insects/insect components. However, there is evidence that biological responses to millimeterwave irradiation can be initiated within the skin, and the subsequent systemic signaling in the skin can result in physiological effects on the nervous system, heart, and immune system [Russel, 2018]. This is one of many translations of articles produced in the Former Soviet Union on wireless radiation (also, see reviews of Soviet research on this topic by McRee [1979, 1980]). Not only was skin impacted adversely, but also heart, liver, kidney, spleen tissue as well, and blood and bone marrow properties. These results reinforce the conclusion of Russel (quoted above) that systemic results may occur from millimeter-wave radiation. Thus, the expected real-world results (when human beings are impacted, the signals are pulsed and modulated, and there is exposure to many toxic stimuli) would be far more serious and would be initiated at lower (perhaps much lower) power fluxes. What national security concerns caused it (and the other papers in the linked pdf reference) to be classified in the first place, and then kept classified for 35 years until declassification in 2012? It appears that we have known about the potentially damaging effects of millimeter-wave radiation on the skin (and other major systems in the body) for over forty years, yet the discourse today only revolves around the possibility of modest potential effects on the skin and perhaps cataracts from millimeter-wave radiation. Alternatively, in this specific example, the carrier signal and the information signal could be viewed as a combination of potentially toxic stimuli, where the adverse effects of each component are enabled because of the synergistic effects of the combination. If these results can be extrapolated across species, then human beings could exhibit different responses to the same electromagnetic stimuli based on their genetic predispositions. For example, studies have shown that industry-funded research of wireless radiation adverse health effects is far more likely to show no effects than funding from non-industry sources [Huss et al, 2007; Slesin, 2006; Carpenter, 2019]. Unfortunately, given the strong dependence of the civilian and military economies on wireless radiation, incentives for identifying adverse health effects from wireless radiation are minimal and disincentives are many. These perverse incentives apply not only to the sponsors of research and development, but to the performers as well. Even the Gold Standard for research credibility - independent replication of research results - is questionable in politically, commercially, and militarily sensitive areas like wireless radiation safety. Suppose there are two research groups (funded by the same government agency) who both arrive at the same conclusion that just coincidentally coincides with what the government sponsor wanted. Or, these two research groups received funding from different agencies of the government. Given the broad support exhibited today by the government, military, and industry for the rapid implementation of 5G, all these organizations have to present a united front in declaring 5G (and previous generations of mobile networking technology) to be safe. Even reporting of conflict-of-interest on wireless radiation research papers or evaluation panels leaves much to be desired. Currently, potential conflicts of interest of the research performers are identified by listing of funding sources in the published papers, or other formal documented evidence of conflicts of interest. Unfortunately, there is a large body of data from laboratory and epidemiological studies showing that previous generations of wireless networking technology have significant adverse health impacts. When real-world considerations are added, such as 1) including the information content of signals along with 2) the carrier frequencies, and 3) including other toxic stimuli in combination with the wireless radiation, the adverse effects are increased substantially. Superimposing 5G radiation on an already imbedded toxic wireless radiation environment will exacerbate the adverse health effects shown to exist. Far more research and testing of potential 5G health effects is required before further rollout can be justified. Thermal and nonthermal health effects of low intensity non-ionizing radiation: An international perspective. BioInitiative Report: A Rationale for Biologically-based Public Exposure Standards for Electromagnetic Radiation at Extremely low frequency electromagnetic fields and cancer: How source of funding affects results. Pathophysiology of cell phone radiation: oxidative stress and carcinogenesis with focus on male reproductive system. Electromagnetic fields may act via calcineurin inhibition to suppress immunity, thereby increasing risk for opportunistic infection: Conceivable mechanisms of action. Source of Funding and Results of Studies of Health Effects of Mobile Phone Use: Systematic Review of Experimental Studies. Modified health effects of non-ionizing electromagnetic radiation combined with other agents reported in the biomedical literature. Tumor promotion by exposure to radiofrequency electromagnetic fields below exposure limits for humans. Biological effects from exposure to electromagnetic radiation emitted by cell tower base stations and other antenna arrays. Soviet and Eastern-European research on biological effects of microwave-radiation.

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