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Recentyears have seen droughts with severe impacts on livestock and local livelihoods in parts of Niger and in the East African drylands (Uganda and Kenya) blood pressure medications list purchase lisinopril 17.5mg visa. Deforestation is driven by a number of processes arrhythmia young adults lisinopril 17.5 mg visa, in particular: (i) the continued demand for agricultural land; (ii) local use of wood for fuel blood pressure veins purchase lisinopril 17.5mg on-line, charcoal production and construction purposes; (iii) large-scale timber logging, often without efective institutional control of harvest rates and logging methods; and (iv) population movements and resettlement schemes in forested areas. Socio-economic causes of soil erosion Population expansion: Behind these direct drivers of erosion lies the demographic driver of a continuously growing population (Figure 9. W ith the increase in population comes an increased demand for living space and food which will directly afect soil use in the region. The continent has a long history of rainfall fuctuations of varying lengths and intensities. Drought episodes were generally followed by increasing rainfall levels, but negative trends were observed again from the 1950 onwards, culminating in the droughts of the early 1970s and mid-1980s. Legend Population (%) 3 14 14 26 26 37 37 48 48 57 57 66 66 75 75 84 Figure 9. The most recent continent-wide assessment shows that 494 million ha, or 22 percent of the agricultural land (including rangelands) in Africa, are afected by water erosion (Oldeman, Hakkeling and Sombroek, 1991). The assessment confrms common feld observations that overgrazing is the main cause of soil erosion, followed by inappropriate cultivation techniques on arable land. For the future, the expected intensifcation of use on currently cultivated lands, expansion of cultivation into more marginal areas, reduction in grazing lands and the increasing numbers of livestock are likely to increase vulnerability to erosion. Erosion has assumed a serious dimension in Nigeria, afecting every part of the country. In addition, agricultural practices have contributed to the problems of widespread sheet erosion. Erosion is thus exerting major pressure on soil resources with far-reaching consequences for both the population and the environment (Jimoh, 2000). In the northern areas of Nigeria, erosion is equally serious, especially in places like Shendam and W estern Pankshin in Plateau State, as well as at Ankpa and Okene in Kogi State. Gully erosion is also prominent in Efon-Alaaye, Ekiti State in the western part of the country (Adeniran, 1993). The areas of Nigeria most afected by erosion are the Agulu and Nanka districts of the eastern part of Nigeria, and the Shendam and western Pankshin areas of Plateau State, Nigeria (Udo, 1970; Okigbo, 1977). Elsewhere, the Imo State government has estimated that about 120 000 km2 of land has been devastated by gully erosion. As a result, eight villages have been destroyed and 30 000 people needed to be resettled. Erosion damage in Imo and Anambra states was estimated to cause the loss of over 20 tonnes of fertile soil per annum, at an economic cost of over 300 million naira per annum. Gullies extended to depths of over 120 m and widths up to 2 km wide (Adeleke and Leong, 1980). In 1994, about 5 000 people were rendered homeless due to erosion in Katsina State, Nigeria. Other areas afected by erosion include Auchi in Edo State, Efon Alaye in Ondo State, Ankpa and Okene in Kogi State, and Gombe in Bauchi State. In many areas, erosion has resulted in a physical loss of available land for cultivation. For example, about 1 000 ha of cultivable land has been lost to erosion at the Agulu-Nanka area of Nigeria. Thus the loss of homes and crops, disruption of communication routes, fnancial losses and attendant hydrological problems can all stem from erosion problems. Nearly 90 percent of rangelands and 80 percent of farmlands in the W est African Sahel, Sudan, and northeast Ethiopia are seriously afected by land degradation, including soil erosion. Almost 70 percent of Ugandas territory was degraded by soil erosion and soil nutrient depletion between 1945 and 1990. Status of the Worlds Soil Resources | Main Report Regional Assessment of Soil Changes 256256 in Africa South of the Sahara Considering that over 80 percent of South Africas land surface is covered by natural vegetation, the estimated annual soil loss of 2. These rates of soil loss far exceed tolerance levels and are almost ten times the estimated rate of soil formation, which has been estimated at 0. An estimated 20 percent of the countrys total surface area is potentially highly erodible.
Fever is Health officials may wish to blood pressure normal low cheap lisinopril 17.5mg on-line give doses of immune an indication of the bodys response to pulmonary hypertension 50 mmhg 17.5mg lisinopril mastercard something heart attack feat thea austin eye of the tiger buy generic lisinopril 17.5 mg line, globulin to children in childcare when cases of but is neither a disease nor a serious problem hepatitis appear. Group A streptococcus: Bacterium commonly Impervious: Not allowing entrance or passage; found in the throat and on the skin that can cause impenetrable. Group care setting: A facility where children Infant: A child between the time of birth and age from more than one family receive care together. Standard precautions: Apply to contact with Parent: the childs natural or adoptive mother or non-intact skin, mucous membranes, blood, all father, guardian, or other legally responsible body fluids, and excretions except sweat, whether person. The general methods of infection prevention are indicated for 135 Childcare Manual all people in the group care setting and designed Virus: A microscopic organism, smaller than a to reduce the risk of transmission of bacterium that may cause disease. Streptococcus: A common bacterium that can cause sore throat, upper respiratory illnesses, pneumonia, skin rashes, skin infections, arthritis, heart disease (rheumatic fever), and kidney disease (glomerulonephritis). Toddler: A child between the age of ambulation and toilet learning/training (usually between 13 and 35 months). Under immunized: A person who has not received the recommended number or types of vaccines for his or her age according to the current national and local immunization schedules. Universal precautions: Apply to blood and other body fluids containing blood, semen, and vaginal secretions, but not to feces, nasal secretions, sputum, sweat, tears, urine, saliva, and vomitus, unless they contain visible blood or are likely to contain blood. Universal precautions include avoiding injuries caused by sharp instruments or devices and the use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear, which can reduce the risk of exposure of the workers skin or mucous membranes that could come in contact with materials that may contain blood-borne pathogens while the worker is providing first aid or care. The Administrative Panel on Biosafety and the Biosafety & Biosecurity Program have revised this document based on the latest government regulatory requirements, guidelines and current professional standards. Safety is a core value at Stanford and the University is committed to continued advancement of an institutional safety culture. Research excellence and safety are inextricably intertwined and the protection of researchers, the environment, and the broader community are an integral part of the responsible conduct of research. The Environmental Health & Safety Ofice, through the Biosafety Manager, is responsible for monitoring individual principal investigators and laboratory facilities for adherence to the practices and procedures described in this manual. However, it is the responsibility of each principal investigator to ensure that all lab workers are familiar with the contents of this manual and that these workers and employees are trained to recognize potential related hazards prior to initiation of the research work. Your cooperation with the Administrative Panel on Biosafety and the Environmental Health & Safety Ofice is essential to comply with the regulatory requirements that our University must follow in order to continue the success of our research endeavors. If you have any questions regarding this document, please call the Research Compliance Administrator at 723-4697 or the Biosafety & Biosecurity Manager at 725-1473. If you have questions regarding this manual, please contact the Biosafety & Biosecurity Program at (650) 725-1473 or email biosafety-owner@lists. Chair, Administrative Panel on Biosafety Lawrence Gibbs Associate Vice-Provost, Environmental Health & Safety Russell Furr Director of Research Safety and Deputy Director, Environmental Health & Safety Ellyn Segal, Ph. Biosafety & Biosecurity Manager, Environmental Health & Safety Chapter 1: Introduction 13 Safe Research at Stanford e As an academic institution, safety culture is part of the educational foundation that will accompany our s students into their future careers, preparing them to + be skilled scientists in academia or industry. Safetys intrinsic value is seen in better reproducibility and productivity of research, as well as preventing tragic lab accidents that cost lives and knowledge. This chapter is part of a larger conversation about shaping and defining a shared cultural approach, which integrates safety and health seamlessly with the work of our laboratories and classrooms. Encourage reporting by members when identifying and reviewing lessons learned afer an incident and using these as Chapter 2: teaching opportunities. Culture of Safety To some degree, as researchers, we all have experienced rules, regulations, compliance What is Safety Culture It is generally As this manual addresses biosafety, it should understood that these are part of an established be stated that a Safety Culture is not a secured research environment. Safety culture is a part experience, it is easy to incorrectly equate safety of organizational culture and is ofen described by rules with safety and come to believe that adhering the phrase the way we do things around here. According to the American Chemical Society, safety In science, researchers think according to the culture at an academic institution is a reflection of principles: mathematical, physical and chemical the actions, attitudes, and behaviors demonstrated laws; biological paradigms. Safety should have led to the realization that ensuring excellence be no diferent. This starts with recognizing that in research requires a strong, positive safety culture safety is a fundamental part of the scientific process, throughout the University.
Must Know the updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner Must Know at each level heart attack xi order lisinopril 17.5mg without prescription. Subspecialty Sections the Residency Curriculum consists of the following subspecialty sections: I blood pressure chart and pulse rate buy lisinopril 17.5 mg overnight delivery. Appendix Chair arrhythmia or dysrhythmia 17.5mg lisinopril with visa, Section Chairs, and Committee Members Section Reviewers References D. Specialist training is designed to provide a structured learning program facilitating the acquisition of core competencies as well as specialized cognitive and technical skills at a level appropriate for an ophthalmic specialist who has been fully prepared to begin their career as an independent consultant in ophthalmology. Stratification of Levels Basic Level Goals = Year 1 Standard Level Goals = Year 2 Advanced Level Goals = Year 3 Very Advanced Level Goals = Subspecialist the curriculum is intended to be adaptable and flexible, depending upon the needs of the region. While stratifying the curricula by level (ie, Basic, Standard, Advanced, and Very Advanced) is somewhat artificial, it defines clear milestones for learners to progress up the ladder of expertise acquisition. Differentiating various proficiency levels allows local customization of expectation based upon local resources, ability, and geography. For example, in some locations clinical needs are urgent, and marked abbreviations of the training program will be necessary to provide the region with sufficient numbers of practitioners. Years 1, 2, 3, and Subspecialist Though Years 1, 2, 3, and Subspecialist correspond with Basic, Standard, Advanced, and Very Advanced Level Goals respectively, the listing of years are for clarification purposes only and not as a recommendation for duration of training, which is subject to local requirements and regulations. Very Advanced: Subspecialist Level of Training the Very Advanced level has been included to provide a comparison to the three other levels of training (ie, Basic, Standard, Advanced). Prioritization of Content: Must Know the updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner Must Know at each level. While should know is relevant and important, content defined as should know might be resource dependent or otherwise have some reason for not being learned or taught (eg, we do not see that disease in our particular country). Drafting of Sections and Review Process Drafting of Sections Each committee (referred to by the term Task Force in the 2006 curricula) was responsible for updating their section of the curriculum. If inconsistencies were found, that committee was asked to communicate with the chair or chairs of the relevant sections in order to resolve any discrepancies. Review Process Committee members were asked to identify at least five external colleagues to review their completed draft section. Committee Chairs, Members, and Section Reviewers For a complete list of committee chairs and members, please see the Appendix. Future Updates Ophthalmic curricula worldwide will be improved through the valuable contributions and involvement of global leaders and educators. There are worldwide differences in nomenclature for the general competencies, and the United States version is presented for clarification purposes only. Local customs, practices, resources, and regulatory environments will dictate the application of these competencies for individual programs. Core competencies include: Patient Care Medical Knowledge Practice-based Learning and Improvement Communication Skills Professionalism Systems-based Practice Ophthalmic specialists are expected to: Patient Care Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health; Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families, taking into consideration patient age, gender identification, impairments, ethnic group, and faith community; Gather essential and accurate information about patients; Make informed decisions about diagnostic and therapeutic interventions, based on patient information and preferences, up-to-date scientific evidence, and clinical judgment; Develop and carry out patient management plans; Counsel and educate patients and their families; Use information technology to support patient-care decisions and patient education; Competently perform the medical and invasive procedures considered essential for the area of practice; Provide health care services aimed at preventing health problems or maintaining health; and Work with healthcare professionals, including those from other disciplines, to provide patient-focused care. Medical Knowledge Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (eg, epidemiological and social-behavioral) sciences and apply this knowledge to patient care; Demonstrate an investigatory and analytic thinking approach to clinical situations; and Know and apply the basic and clinically supportive sciences, which are appropriate to ophthalmology. Practice-based Learning and Improvement Investigate and evaluate patient care practices; appraise and assimilate scientific evidence; and improve patient care practices; Analyze practice experience and perform practice-based improvement activities using a systematic methodology; Locate, appraise, and assimilate evidence from scientific studies related to patient health problems; Obtain and use information about regional patient population and the larger population from which patients are drawn; Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness; and Use information technology to manage information, access online medical information, support ongoing personal professional development; and facilitate the learning of students and other healthcare professionals. Communications Skills Demonstrate communication skills that result in effective information exchange and teaming with patients, patient families, and professional associates; Create and sustain a therapeutic and ethically sound relationship with patients; Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills; and Work effectively with others as a member or a leader of a health care team or other professional group. Professionalism Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population; Demonstrate respect, compassion, and integrity; Demonstrate a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development; Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices; and Demonstrate sensitivity and responsiveness to patient culture, age, gender identification, and disabilities. Systems-based Practice Demonstrate an awareness of and responsiveness to the larger context and system of health care and effectively call on system resources to provide care that is of optimal value; Understand how patient care and other professional practices affect other health care professionals, the health care organization, and the larger society, and how these system elements affect their personal ophthalmic practice; Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources; and practice cost-effective health care and resource allocation that do not compromise quality of care; Advocate for high quality patient care and assist patients in dealing with system complexities; and Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care, and know how these activities can affect system performance. Professional attitudes and conduct require that ophthalmic specialists must also have developed a style of care that is: Humane (eg, compassion in providing bad news, management of the visually impaired, and recognition of the impact of visual impairment on the patient and society); Reflective (eg, recognition of the limits of knowledge, skills, and understanding); Ethical; Integrative (eg, involvement in an interdisciplinary team for the eye care of children, patients with long term visual impairment or other disabilities, the systemically ill, the elderly, and with consideration of gender dimensions); and Scientific (eg, critical appraisal of the scientific literature, evidence-based practice, and use of information technology and statistics). Optics and Refraction the general educational objectives are to understand the principles, concepts, instruments, and methods of ophthalmology-related optics and refraction; and to apply these to clinical practice. Define vergence of light, including diopter, convergence, divergence, and vergence formula.
In coordinating centre blood pressure over 160 cheap lisinopril 17.5 mg line, including a contact person and either case blood pressure medication withdrawal lisinopril 17.5 mg generic, these persons would be included in a when they are available arteria rectal inferior generic lisinopril 17.5 mg without prescription. A third commonly used strategy is the review of Provide information about the importance of the death certificates. It is important to antici neurologists, neuropathologists, and laboratories pate where bias will be introduced if subnational conducting diagnostic tests, public health depart surveillance is conducted. It under study has differential access to physicians, is essential that participant neurologists and neuro laboratories or specialized diagnostics is important. This can be avoided by of the study population will be identified by the having a policy of acknowledging the reporting surveillance system, and consequently in order to clinician, and by including all reporting clinicians permit extension of epidemiologic conclusions to the (both those who report cases and those who report population of the region or country. This is that they have no cases) in national activities and particularly important in any country where geo publications. A surveillance system protein and clinical capacity to assist in differential should count its referrals; if the number of referrals diagnosis. Surveillance systems are well persons under 50 years of age in relation to the advised to prepare information sheets describing population. No national report must allow the identi to data analysis (correct spelling, use of appropriate fication of an individual. In addition, the time between onset of reporting is valuable in identification of missed cases symptoms and reporting to relevant national (thereby aiding in estimations of reporting complete authorities must be calculated from the surveillance ness), identification of clinicians not participating in data. This is referred to as reporting delay and is the surveillance efforts, and in determining whether essential to both evaluate the surveillance systems the proper diagnosis is being reported on death timeliness and to provide the required information certificates. It is important that the extent of data systems will aid in this process, in many countries this special knowledge is recognized by the surveil the number of reports may be sufficiently small that lance system and that it provides nationally appro electronic data management is not required. One goal of and determine the exact requirements for informed this manual is to collect together the relevant infor consent. A slightly elevated protein content tau; beta-amyloid 1-42, 1-42; ubiquitin; the (0. Until recently, standar dized criteria for a typical tracing had not been widely agreed. The dorsomedial nuclei of the thalamus (93% of cases), giving a characteristic hockey-stick appearance (Figure 9. Although macroscopic examination Japanese Nipositu encephalitis of the brain may be unremarkable, cortical or Wernicke encephalopathy cerebellar atrophy is often found, and may vary greatly Bithalamic glioma from case to case and within the various regions of Thalamic infarction the cortex in each individual. Typically, the hippo Post-infectious encephalitis campus is preserved, even in the presence of severe brain atrophy. In longstanding cases severe spongiform for genetic testing is considered mandatory in many change, neuronal loss, and astrocytosis may occur, countries but may be culturally unacceptable in leading to status spongiosis with collapse of the others. However, should be offered before any PrP gene analysis, burnt-out damage may show only prominent reactive with an emphasis on the autosomal-dominant astrogliosis without apparent spongiform change. It is recommended, diagnostic, and the differential diagnosis would however, that genetic analysis should be offered only include those diseases listed in Figure 9. This will reduce the risk of a false diagnosis1 due to possible technical difficulties diffuse Lewy body disease focal changes from performing the test infrequently. If re-use from advances in PrP staining through immuno is unavoidable, instruments must be immersed in 1N cytochemistry (see Figure 9. Based on the published data, tonsil biopsy different brain regions is required in order to perform cannot be recommended as a routine diagnostic an adequate histopathological evaluation. Brain biopsy with fixed and frozen tissue retained due to the large number of germinal centres (Figure 5. Lymphoreticular tissue biopsy post-mortem with candidate is spleen tissue; if spleen is unavailable, then fixed and frozen tissue retained peripheral lymph nodes can be sampled.
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References:
- https://atriumhealth.org/-/media/newsroom/Documents/2018-Annual-Report.pdf
- http://www.rioleo.org/docs/katzung.pdf
- http://www.cdc.gov/NCHS/data/series/sr_11/sr11_220.pdf