睿学教育Wisdome Education

Jennifer M. Gierisch, PhD

• Associate Professor in Population Health Sciences
• Associate Professor in Medicine
• Member in the Duke Clinical Research Institute
• Member of the Duke Cancer Institute

https://medicine.duke.edu/faculty/jennifer-m-gierisch-phd

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The streptococcal M protein is a coiled-coil molecule that extends about 600 nm from the bacterial cell surface women's health clinic san antonio purchase aygestin 5 mg free shipping. The C-terminal region is embedded within the cell wall and the C-terminus is located in the cytoplasmic membrane in the nascent molecule womens health daily magazine discount aygestin. The coding region for the M protein is distributed in repeat blocks designated A–C in which the C-repeat region is conserved among M-protein serotypes breast cancer event ideas discount aygestin 5 mg on line, and the A and B repeats are variable among these serotypes. Pro/Gly designates the region of the M protein that is rich in proline and glycine. Thus, in pharyngeal infection with group A strepto contrast to a conventional peptide anti 4 cocci can stimulate the production of both gen, which stimulates only one in 10 to 8 antibodies. The result is toxins can be powerful stimulators of the a veritable explosion of cytokines result immune response and lead to polyclonal ing in high fever, hypotension, and mul activation of B lymphocytes. Death often occurs within immunoglobulin levels is believed to be 24 hours of the release of these toxins. Instead of binding to atopic dermatitis, psoriasis, Kawasaki the specific antigen receptor known for disease, rheumatic fever, and tuberculosis. There are several ways in which bacteria Antigenic variation or drift is another can survive in the host by evasion of the mechanism whereby bacteria evade the immune defenses. The M protein (the most be briefly summarized here, but the list of important virulence factor of the group A evasive mechanisms used by each bacterial streptococcus) has been shown to exhibit species may be much longer in nature. While antibod bodies kill the bacteria and the fever sub ies can be obtained following immuniza sides. However, some antigenic variants tion with the streptococcal hyaluronic acid, of the bacteria persist, and after five to they are nonprecipitating antibodies and seven days these new variants can cause are not effective in eliminating the organ a relapse in the patient with fever reap ism. Other examples of evasion of the pneumococcus and the meningococcus immune response are bacteria such as N. Some strains teria sequester themselves in nonphago of staphylococci secrete catalase, which cytic cells where they are not exposed to prevents them from being killed inside the immune system. In developed countries, the age is result in an enhanced immune response much later and clinical infection usually to host tissue antigens or a diminished occurs in the age group of 15 to 25 years. In general, viral infections with infectious mononucleosis, which is are self-limited and usually produce long often referred to as the “kissing disease. Thus, paired sera at transmission to occur and no intermediate the time of clinical infection do not help host is involved. Antibodies to early anti To eliminate virions from entering gen appear in about 70 percent of primary noninfected cells and to eliminate virus infections and are usually indicative of an infected cells, two major pathways of acute infection. The the clinical signs of fever, such as humoral response is primarily directed enlarged cervical lymph nodes, and red against virions, while the T-cell response dened pharynx with whitish exudates (also is primarily directed against infected seen with other viruses) are often mistaken cells. For example, the x-linked are herpes simplex in the trigeminal gan lymphoproliferative syndrome that affects glia, which causes recurrent “cold sores,” males from age 6 months to 20 years is in this or herpes zoster in a dorsal root ganglion, category. A second example is antigenic variation Immunosuppressive therapy may or drift in certain viruses. In the former, the change is in certain African countries (especially in minor and accounts for minor epidemics of regions of mosquito-borne disease), where flu during each winter. Antigenic shift is a it represents 90 percent of childhood can major change in the structure of those pro cers in contrast to 3 percent in developed teins, which can cause a major pandemic countries. Since the epidemics in the world but would not be incidence of Burkitt’s lymphoma follows protective against a major antigenic shift. Antibodies the dengue virus can infect macrophages Immunological Aspects of Infection 55 via Fc receptors, and its capacity to enter which has a commensal relationship with the target cell is enhanced if it is bound the lung in the normal host. When the individual is exposed to In contrast to the superficial infections a second dengue virus serotype, the pre of fungi, systemic infections in the immuno existing antibody to the first type binds compromised host have a higher mortality to it but does not neutralize the virus. This category includes Histoplasma cap antibody-enhanced second virus enters the sulatum (pulmonary infection), Coccidiodes macrophage, setting off a veritable explo immitis (acute pneumonitis), and Crypto sion of proteases, lymphokines comple coccus neoformas (meningitis, lung lesions). The result is normal individuals, and the cell-mediated a much more severe disease called dengue immune response is the more important fac hemorrhagic fever, whose mortality rate in tor in control or prevention of them. How areas with poor medical facilities and treat ever, all of these fungal infections (superfi ment may be as high as 50 percent.

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There were no reported barriers to use of the guideline; however those who did not endorse using the guideline cited not having a copy as the reason menstruation every 2 weeks purchase aygestin 5 mg online. Algorithms women's health center vcu order aygestin australia, patient handouts and reference guides were reported as the most frequently used tools; however it was important that tools and resources were created to be more printer friendly women's health clinic rock springs wy order aygestin online. More specifc information regarding pharmacological treatment was noted as an important aspect to include in the updated guideline. Ongoing Update and Review Further feedback from frontline clinicians and their patients during the implementation phase, as well as fndings from an ongoing literature review, will inform the update of these recommendations scheduled for 2021. Procedures for the next update will follow a similar stepwise process to those outlined herein. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Injury Characteristics Date/Time of Injury Reporter: Patient Parent Spouse Other 1. Location of Impact: Frontal Lft Temporal Rt Temporal Lft Parietal Rt Parietal Occipital Neck Indirect Force 2. Symptom Check List* Since the injury, has the person experienced any of these symptoms any more than usual today or in the past day? Y N √ Developmental History √ Psychiatric History Previous # 1 2 3 4 5 6+ Prior treatment for headache Learning disabilities Anxiety Longest symptom duration History of migraine headache Attention-Defcit/ Depression Days Weeks Months Years Personal Hyperactivity Disorder Sleep disorder Family If multiple concussions, less force Other developmental Other psychiatric disorder caused reinjury? Yes No disorder List other comorbid medical disorders or medication usage (e. Disturbance of brain function is related to neurometabolic dysfunction, rather than structural injury, Appendix 1. Concussion results in a constellation of physical, cognitive, emotional, and sleep-related symptoms. Symptoms may last from several minutes to days, weeks, months or even longer in some cases. Obtain description of the injury – how injury occurred, type of force, location on the head or body (if force transmitted to head). Greater forces associated with the trauma are likely to result in more severe presentation of symptoms. Determine whether amnesia has occurred and attempt to determine length of time of memory dysfunction – before (retrograde) and after (anterograde) injury. If present, ask the individuals who know the patient (parent, spouse, friend, etc) about specific signs of the concussion that may have been observed. Ask patient (and/or parent, if child) to report presence of the four categories of symptoms since injury. It is important to assess all listed symptoms as different parts of the brain control different functions. For all symptoms, indicate presence of symptoms as experienced within the past 24 hours. Scoring: Sum total number of symptoms present per area, and sum all four areas into Total Symptom Score (score range 0-22). Clinicians should be aware that symptoms will typically worsen or re-emerge with exertion, indicating incomplete recovery. Overall Rating: Determine how different the person is acting from their usual self. Risk Factors for Protracted Recovery: Assess the following risk factors as possible complicating factors in the recovery process. Concussion history: Assess the number and date(s) of prior concussions, the duration of symptoms for each injury, and whether less biomechanical force resulted in re-injury. Research indicates that cognitive and symptom effects of concussion may be cumulative, especially if there is minimal duration of time between injuries and less biomechanical force results in subsequent concussion (which may indicate incomplete recovery from initial trauma). Headache history: Assess personal and/or family history of diagnosis/treatment for headaches. Research indicates headache (migraine in particular) can result in protracted recovery from concussion.

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Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary breast cancer quiz aygestin 5 mg order without a prescription, the appendices of this book women's health clinic jamaica hospital aygestin 5 mg lowest price, or other resources to define each term women's health center northfield mn safe aygestin 5 mg. Then review the pronunciations for each term and practice by reading the medical record aloud. The medial compartment of the knee showed an inferior surface, posterior and mid-medial meniscal tear that was flipped up on top of itself. This was resected, and then the remain ing meniscus contoured back to a stable rim. Because Lachman and McMurray tests were negative (normal), why was the surgery performed? Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. He complains of pain of more than 1 month’s duration, with persistent symptoms over middle one third of left tibia with resting. The delayed spot planar images demonstrate focal fusiform uptake involving 50% to 75% of the tibial diaphysis width. It is our opinion that with continued excessive, repetitive stress, the rate of resorption will exceed the rate of bone replacement. This will lead to weakened cortical bone with buttressing by periosteal and endosteal new bone deposition. Urinary System • Describe the functional relationship between the Nephron genitourinary system and other body systems. Male Reproductive System • Identify, pronounce, spell, and build words related to Connecting Body Systems–Genitourinary System the genitourinary system. Medical Word Elements • Describe pathological conditions, diagnostic and Pathology therapeutic procedures, and other terms related to Pyelonephritis Glomerulonephritis the genitourinary system. Nephrolithiasis • Explain pharmacology related to the treatment of Benign Prostatic Hyperplasia urinary disorders as well as male reproductive dis Cryptorchidism orders. Acute Tubular Necrosis • Demonstrate your knowledge of this chapter by Oncology completing the learning and medical record Diagnostic, Symptomatic, and Related Terms activities. Nitrogenous wastes are toxic to the body, and must be continuously the male and female urinary systems have similar eliminated or death will occur. In the male, however, some of the uri tration must remain fairly constant for proper func nary structures also have reproductive functions. An excess or Thus, the genitourinary system includes the uri deficiency of electrolytes can have devastating nary system of both the male and female as well as effects. This hormone acts on bone mar Urinary System row to stimulate production of red blood cells when blood oxygen levels are low. The macroscopic struc the purpose of the urinary system is to regulate the tures that make up the urinary system include: composition of the extracellular fluids of the body by removing their harmful substances in the form of • two kidneys urine, while retaining beneficial products. Harmful • two ureters substances, including nitrogenous wastes and • bladder excess electrolytes, are removed by the kidneys and • urethra. Pronunciation Help Long Sound a—rate ¯ e—rebirth¯ ¯ı—isle o—over¯ u—unite¯ Short Sound a—alone˘ e—ever ˘ ˘ı—it o—not˘ u—cut˘ Anatomy and Physiology 311 Renal pyramid (5) Renal artery Inferior vena cava (7) Renal (4) Hilum pelvis (2) Renal cortex (3) Renal medulla (6) Renal vein (8) Ureter Cross section of kidney Adrenal (suprarenal) glands (1) Left kidney (1) Right kidney Inferior vena cava Abdominal aorta (8) Ureters (10) Urinary bladder (9) Ureteral orifice Prostate gland (in males) (11) Urethra (12) Urinary meatus Figure 11-1. The bladder of a fist, are located in the abdominal cavity slight has small folds called rugae that expand as the ly above the waistline. A triangular area at the base of the the peritoneum, their location is said to be bladder called the trigone is delineated by the retroperitoneal. In a frontal section, two the base of the trigone forms the (11) urethra, distinct areas are visible: an outer section, the a tube that discharges urine from the bladder. The (2) renal cortex, and a middle area, the (3) renal length of the urethra is approximately 1. During urination (micturition), hilus), an opening through which the (5) renal urine is expelled from the body through the ure artery enters and the (6) renal vein exits the kid thral opening, the (12) urinary meatus. The renal artery carries blood that contains waste products to the nephrons for filtering. After Nephron waste products are removed, blood leaves the kid Microscopic examination of kidney tissue reveals ney by way of the renal vein.

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A disease condition that can be fatal menstrual period blood clots aygestin 5 mg buy with visa, rapidly spreads to the entire body women's health center southern pines nc aygestin 5 mg purchase on-line, and is characterized by a very high fever is called breast cancer oakley sunglasses order aygestin on line. Describe theories of alternative and complementary medicine and some healing practices used in these fields. This includes a history of the present illness with a description of symptoms, a past medical history, and a family and a social history. A physical examination, which includes a review of all systems and observation of any signs of illness, fol lows the history taking. Practitioners use the following techniques in performing physicals: • Inspection: visual examination. Vital signs are measurements that reflect basic functions necessary to maintain life and include: • Temperature (T). The skin, hair, and nails provide easily observable indications of a person’s state of health. Such features of the skin as color, texture, thickness, and presence of lesions (local injuries) are noted throughout the course of the physical examination. These may include tests on blood, urine, and other body fluids, and the identification of infectious organisms. Additional tests may include study of the electrical activ ity of tissues such as the brain and heart, examination of body cavities by means of an endoscope. Biopsy specimens can be ob tained by needle withdrawal (aspiration) of fluid, as from the chest or from a cyst; by a small punch, as of the skin; by endoscopy, as from the respiratory or digestive tract; or by surgical removal, as of a tumor or node. The most fun damental imaging method is radiography, which uses x-rays to produce a picture (radiograph) on sensitized film. Radiography is best at showing dense tissues, such as bone, but views of soft tissue can be enhanced by using a contrast medium, such as a barium mixture, to outline the tissue. Other forms of energy used to pro duce diagnostic images include sound waves, radioactive isotopes, radio waves, and magnetic fields. This may consist of counseling, drugs, surgery, radiation, physical therapy, occupational therapy, psychiatric treatment, or a combination of these. During diagnosis and throughout the course of treatment, a patient is evaluated to establish a prognosis, that is, a prediction of the outcome of the disease. Box 7-1 Terminology Evolves With Medical Science the science of medicine never stands still, nor not in use. The genes associated with certain forms of can A generation ago, gene therapy, genetic engi cer and with certain hereditary abnormalities neering, in vitro fertilization, cloning, and stem had yet to be isolated. Anyone who wants to keep current assay, bone density scans for identifying osteo with medical terminology has a lifetime of porosis, and other diagnostic techniques were learning ahead. Surgery may be done through an ex isting body opening, but usually it involves cutting or puncturing tissue with a sharp instrument in the process of incision. Conventionally, this is done using stitches or sutures, but ad hesive strips, staples, and skin glue also are used. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. Some procedures require destruction of tissue by a harmful agent, such as by heat or a chemical, in the process of cautery or cauterization. Some of the purposes of surgery include: • Treatment: For excision (cutting out) of diseased or abnormal tissue, such as a tumor or an inflamed appendix. Surgical methods are also used to repair wounds or injuries, as in skin grafting for burns or realigning broken bones. Surgical methods are used to correct circulatory problems and to return structures to their normal position, as in raising a prolapsed organ, such as the bladder, in a surgical fixation procedure. Exploratory surgery to investigate the cause of symptoms is performed less frequently now because of advances in non invasive diagnostic and imaging techniques. Plastic or reconstructive surgery may be done to accommodate a prosthesis, to restore proper appearance, or for cosmetic reasons. Surgery is done to relieve pain or discomfort, as by cutting the nerve supply to an organ or reducing the size of a tumor to relieve pressure. Surgery may be done in an emergency or urgent situation under conditions of acute danger, as in trau matic injury or severe blockage. Other procedures, such as cataract removal from the eye, may be planned when convenient. Elective or optional surgery would not cause serious consequences if delayed or not done.

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It is now recog articular facet /ɑ tkjυlə f st/ noun the nised that asbestos dust can cause many lung point at which a rib articulates with the spine diseases menstruation 4 days late buy aygestin 5 mg amex, leading in some cases to forms of articular process cancer womens health questions free aygestin 5 mg purchase without a prescription. Compare antiseptic aseptic technique hook womens health 10k chicago aygestin 5 mg buy with visa, so releasing the amniotic fluid aseptic technique /e septk tek ni ks/ artificial ventilation noun a method of doing something using ster artificial ventilation /ɑ tfʃ(ə)l vent leʃ(ə)n/ noun breathing which is assisted or ilised equipment asexual controlled by a machine asexual /e sekʃuəl/ adjective not sexual, not arytenoid involving sexual intercourse arytenoid / r ti nɔd/ adjective located at asexual reproduction the back of the larynx asexual reproduction /e sekʃυəl ri prə arytenoid cartilage d"kʃ(ə)n/ noun reproduction of a cell by arytenoid cartilage / r ti nɔd kɑ tld / noun a small cartilage at the back of the larynx cloning arytenoidectomy Asian flu arytenoidectomy / r ti nɔd ektəmi/ Asian flu / e (ə)n flu / noun ‘ flu asis noun an operation to remove the arytenoid car asis /əss/ ‘ iasis tilage asleep asbestosis asleep /ə sli p/ adjective sleeping the pa asbestosis / sbe stəυss/ noun a disease tient is asleep and must not be disturbed. Also sleeping deeply called acetylsalicylic acid asparagine assay asparagine /ə sp rəd i n/ noun an amino assay / se, ə se/ noun the testing of a sub acid stance. It is used in the assistant assistant /ə sst(ə)nt/ noun a person who diagnosis of liver disease and heart attacks. After Hans the suicide of someone who is terminally ill Asperger (1906–80), Austrian psychiatrist. Also called tinea pedis asymptomatic atlas asymptomatic / esmptə m tk/ adjective atlas / tləs/ noun the top vertebra in the not showing any symptoms of disease spine, which supports the skull and pivots on asynclitism asynclitism / sŋkltz(ə)m/ noun in child the axis or second vertebra birth, a situation in which the head of the baby atmospheric pressure atmospheric pressure / tməsferk enters the vagina at an angle preʃə/ noun the pressure of the air on the sur asynergia asynergia /s n! Also called nebuliser atonic worrying atonic /e tɒnk/ adjective referring to lack of ataraxic muscle tone or tension ataraxic / tə r ksk/ noun, adjective same atony as ataractic atony / təni/ noun a lack of tone or tension ataxia in the muscles ataxia /ə t ksiə/ noun a failure of the brain to control movements atopen ataxic atopen / təpen/ noun an allergen which ataxic /ə t ksk/ adjective having ataxia, or causes an atopy relating to ataxia atopic ataxic gait atopic /e tɒpk/ adjective referring to condi ataxic gait /ə t ksk &et/ noun a way of tions arising from an inherited tendency to re walking in which the person walks unsteadily act to specific allergens, as in hay fever, some due to a disorder of the nervous system skin conditions and asthma ataxy atopic eczema ataxy /ə t ksi/ noun same as ataxia atopic eczema /e tɒpk eksmə/, atopic atelectasis dermatitis /e tɒpk d! She atria of the heart, which causes an irregular had two attacks of laryngitis during the winter. The right atrium re standing or sitting ceives venous blood from the superior and in attributable risk ferior venae cavae and the left atrium receives attributable risk /ə trbjυtəb(ə)l rsk/ oxygenated blood from the pulmonary veins. The excess atrophic cirrhosis / trɒfk s rəυss/ noun advanced portal cirrhosis in which the risk of bacteriuria in oral contraceptive users liver has become considerably smaller and attributable to the use of oral contraceptives is clumps of new cells are formed on the surface 1,566 per 100,000. Also called hobnail liver being worn away, as may be caused by friction atrophic gastritis Examination showed attrition of two exten atrophic gastritis / trɒfk & strats/ noun inflammation of the stomach caused by sor tendons. Also called vestibulocochlear nerve autogenous /ɔ tɒd ənəs/, autogenic / auditory ossicles ɔ təυ d enk/ adjective produced either in auditory ossicles /ɔ dt(ə)ri ɒsk(ə)lz/ plural noun the three little bones, the malleus, the person’s body, or using tissue from the per incus and stapes, in the middle ear son’s own body an autogenous vein graft Auerbach’s plexus autograft Auerbach’s plexus /aυərbɑ ks pleksəs/ autograft / ɔ tə&rɑ ft/ noun a transplant noun a group of nerve fibres in the intestine made using parts of the person’s own body autoimmune wall [Described 1862. After Leopold Auerbach autoimmune /ɔ təυ mju n/ adjective re (1828–97), Professor of Neuropathology at Bre ferring to an immune reaction in a person slau, now in Poland. In law, automa conscious: A = alert; V = verbal, responding to tism can be a defence to a criminal charge when the accused states that he or she acted verbal commands; P = pain, responding to without knowing what they were doing. Also called post mortem ness of whooping cough during epidemics to encour autosomal age parents to vaccinate children’ [Health Visitor] autosomal / ɔ təυ səυm(ə)l/ adjective refer axial ring to an autosome axial / ksiəl/ adjective referring to an axis autosome axial skeleton autosome / ɔ təυsəυm/ noun a chromosome axial skeleton / ksiəl skelt(ə)n/ noun that is not a sex chromosome the bones that make up the vertebral column autotransfusion and the skull. Also called zidovudine axodendrite / ksəυ dendrat/ noun an ap azo pendage like a fibril on the axon of a nerve azo /ezəυ/ prefix containing a nitrogen axolemma group axolemma / ksə lemə/ noun a membrane covering an axon azoospermia axon azoospermia /ezəυə sp! Pains After Joseph François Felix Babinski (1857– in the back can also be referred pains from gallstones or kidney disease. A backbone pupil of Charcot, he was head of the Neurologi backbone / b kbəυn/ noun a series of cal clinic at Hôpital de la Pitié, 1890–1927. Also called rachis, spine baby background carboxyhaemoglobin level baby / bebi/ noun a very young child who is background carboxyhaemoglobin level not yet old enough to talk or walk Babies / b k&raυnd kɑ bɒksi hi mə &ləυbn start to walk when they are about 12 months lev(ə)l/ noun the level of carboxyhaemoglob old. Some types are permanently ing bald he is beginning to lose his hair present in the gut and can break down food this baldness sue, but many can cause disease. Balkan frame spirochaetes, can move and reproduce very Balkan frame /bɔ lkən frem/, Balkan rapidly. Pearson bed Bactrim ball Bactrim / b ktrm/ a trade name for co-tri ball /bɔ l/ noun 1. After William Morrant teries 37 barrel chest balloon angioplasty barbiturate poisoning balloon angioplasty /bə lu n nd iə barbiturate poisoning /bɑ btʃυrət pl sti/ noun same as percutaneous angi pɔz(ə)nŋ/ noun poisoning caused by an oplasty overdose of barbiturates balloon catheter barbotage balloon catheter /bə lu n k θtə/ noun a barbotage /bɑ bə tɑ / noun a method of tube that can be inserted into a blood vessel or spinal analgesia by which cerebrospinal fluid other body part and then inflated, e. After Gui a group of nerves near the carotid artery and do Banti (1852–1925), Florentine pathologist aortic arch, which senses changes in blood and physician. After Murray Llewellyn barbiturate Barr (1908–95), head of the Department of barbiturate /bɑ btʃυrət/ noun a sedative drug Anatomy at the University of Western Ontario, barbiturate abuse Canada. After Carl Adolph Basedow (1799–1854), barrier method general practitioner in Mersburg, Germany. It involves keeping them away from oth ture of the skin the two layers of skin, the in er patients and making sure that faeces and ner dermis and the outer epidermis 2. Also called greater ves the auditory nerve tibular glands [After Caspar Bartholin (1655– basilic 1748), Danish anatomist] basilic /bə slk/ adjective important or prom basal inent basal / bes(ə)l/ adjective located at the bot basilic vein basilic vein /bə zlk ven/ noun a large tom of something, or forming its base vein running along the inside of the arm basal cell basin basal cell / bes(ə)l sel/ noun a cell from the basin / bes(ə)n/ noun a large bowl stratum germinativum.

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This 86 Research Methodology way we determine which statements consistently correlate with low favourability and which with high favourability menopause 42 years old aygestin 5 mg order. As such it also provides more information and data than does the Thurstone-type scale menstruation 6 weeks postpartum 5 mg aygestin buy. Moreover menstrual workout aygestin 5 mg fast delivery, it has been reported in various research studies* that there is high degree of correlation between Likert-type scale and Thurstone-type scale. One important limitation is that, with this scale, we can simply examine whether respondents are more or less favourable to a topic, but we cannot tell how much more or less they are. There is no basis for belief that the five positions indicated on the scale are equally spaced. The interval between ‘strongly agree’ and ‘agree’, may not be equal to the interval between “agree” and “undecided”. This means that Likert scale does not rise to a stature more than that of an ordinal scale, whereas the designers of Thurstone scale claim the Thurstone scale to be an interval scale. One further disadvantage is that often the total score of an individual respondent has little clear meaning since a given total score can be secured by a variety of answer patterns. It is unlikely that the respondent can validly react to a short statement on a printed form in the absence of real-life qualifying situations. Moreover, there “remains a possibility that people may answer according to what they think they should feel rather than how they do feel. In spite of all the limitations, the Likert-type summated scales are regarded as the most useful in a situation wherein it is possible to compare the respondent’s score with a distribution of scores from some well defined group. Kenney, “A comparison of the Thurstone and Likert techniques of attitude scale construction”, Journal of Applied Psychology, 30, 72–83, 1946. Measurement and Scaling Techniques 87 change or improvement in which case we can use the scales to measure attitudes before and after the programme of change or improvement in order to assess whether our efforts have had the desired effects. We can as well correlate scores on the scale to other measures without any concern for the absolute value of what is favourable and what is unfavourable. All this accounts for the popularity of Likert-type scales in social studies relating to measuring of attitudes. Cumulative scales: Cumulative scales or Louis Guttman’s scalogram analysis, like other scales, consist of series of statements to which a respondent expresses his agreement or disagreement. The special feature of this type of scale is that statements in it form a cumulative series. This, in other words, means that the statements are related to one another in such a way that an individual, who replies favourably to say item No. This being so an individual whose attitude is at a certain point in a cumulative scale will answer favourably all the items on one side of this point, and answer unfavourably all the items on the other side of this point. The individual’s score is worked out by counting the number of points concerning the number of statements he answers favourably. If one knows this total score, one can estimate as to how a respondent has answered individual statements constituting cumulative scales. The technique developed by Louis Guttman is known as scalogram analysis, or at times simply ‘scale analysis’. Scalogram analysis refers to the procedure for determining whether a set of items forms a unidimensional scale. A scale is said to be unidimensional if the responses fall into a pattern in which endorsement of the item reflecting the extreme position results also in endorsing all items which are less extreme. Under this technique, the respondents are asked to indicate in respect of each item whether they agree or disagree with it, and if these items form a unidimensional scale, the response pattern will be as under: Table 5. But a score of 3 would mean that the respondent is not agreeable to item 4, but he agrees with all others. In other words, we must lay down in clear terms the issue we want to deal within our study. Similarly, the number of respondents in a pretest may be small, say 20 or 25 but final scale should involve relatively more respondents, say 100 or more). In a pretest the respondents are asked to record their opinions on all selected items using a Likert-type 5-point scale, ranging from ‘strongly agree’ to ‘strongly disagree’. The strongest favourable response is scored as 5, whereas the strongest unfavourable response as 1.

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Finally pregnancy vitamin requirements order aygestin 5 mg otc, inspect the macula by asking the patient to look directly into the ophthalmoscope; if the patient finds the light painfully bright menstruation 40 day cycle generic 5 mg aygestin with amex, reduce its intensity women's health center alexandria la discount 5 mg aygestin. The signs and classification of retinopathy depend on the stage of the disease (Table 15. Investigations the diagnosis of diabetes mellitus rests solely on lab oratory blood glucose concentrations (see below). Further investigations may be required in occasional patients in whom it is thought that the diabetes may be secondary to another medical disorder. Tests essential in the further evaluation and longer-term assessment of patients with diabetes are: Figure 15. Thick callus can accumulate at pressure points and erode the underlying healthy skin. Diagnosis and classification of Next, assess for peripheral vascular disease by pal diabetes mellitus pating for the dorsalis pedis and tibialis anterior foot pulses – if these are absent or difficult to find, check Diabetes mellitus is formally diagnosed solely using for the popliteal and femoral pulses and listen for a laboratory blood glucose tests. A further blood sam important to make this distinction, as initial man ple is taken after 2 hours. In a small number of patients, diabetes, with two abnormal results required in those who are asymptomatic. The scheme for diagnosing diabetes Ketonuria (dipstick Common Rare is not entirely intuitive. Weight loss Moderate/severe Nil/moderate Age Any but often Any but often Table 15. If warning symptoms are ary to another condition, drug-induced or due to delayed, absent, not recognized or not acted on, primary disease of the exocrine pancreas. The clas progressive hypoglycaemia will lead to neuroglyco sification of diabetes is summarized in Table 15. A further fall in blood glucose will cause a reduction in conscious level and eventually Hypoglycaemia fitting and/or coma. In normal physiology, a fall in blood glucose concen It is generally not difficult to suspect an episode tration below normal causes a reduction in endog of hypoglycaemia in patients who are known to enous insulin production and a counter-regulatory have diabetes, particularly if they are being treated response with the release of glucagon, adrenaline, with insulin or sulphonylureas. There is also auto caemia not associated with diabetes is much more nomic activation which, together with the increase difficult to recognize. Hypoglycaemia should be con in circulating adrenaline induces a variety of symp sidered in all patients who present with symptoms toms including: suggestive of intermittent sympatho-adrenal activa tion and/or neuroglycopenia (as described above) whether or not they are known to have diabetes. Tremor Present Absent Weight change Weight loss Weight gain Thyroid dysfunction Appetite Increased Decreased There are two serum thyroid hormones. Both the Bowel frequency Increased Decreased total and free (non-protein bound) concentra tions of thyroxine (T4) are higher than those of Temperature Hot/sweaty Cold/dry skin (subjective) the more biologically active tri-iodothyronine (T3). The serum thyroid hormone concentra Mood Hyperactive Depressed tions determine the rate of metabolism. Nerve entrapment can result in carpal tunnel syn G Thyrotoxicosis denotes any excess of thyroid hor drome and pleural or pericardial effusions occasion mones, whereas hyperthyroidism refers more spe ally occur. There is naturally a degree of correlation between G Hypothyroidism denotes thyroid underactivity, the severity of symptoms in thyroid dysfunction and the term myxoedema is generally only used to and the degree of biochemical disturbance. Thyrotoxicosis, in par Presenting symptoms ticular, has several potential causes, the most com mon being: the principal and contrasting presenting symptoms of hyper and hypothyroidism are given in Table G autoimmune Graves’ disease 15. G toxic multinodular goitre Some patients with marked thyroid dysfunction G thyroid adenoma will present with a ‘full house’ of clinical symptoms. G viral thyroiditis However many patients will have only some, or less G post-partum thyroiditis severe, symptoms. Conversely, some elderly in myxoedema coma presenting with inanition (lack patients may have so-called ‘apathetic’ thyrotoxico of energy), hypothermia and a reduced conscious sis, superficially more resembling hypothyroidism. By contrast, nodular thy roid disease is often fairly mild and more stable over time. Physical examination Remainder of the history Patients with thyrotoxicosis from any cause will often Thyrotoxicosis associated with a painful goitre have signs compatible with the symptoms described strongly suggests a diagnosis of viral (de Quervain’s) above including: thyroiditis. Graves’ disease is autoimmune in ori G tachycardia (irregular pulse if in atrial fibrilla gin, and so if you suspect Graves’ disease, find out tion) with increased pulse volume whether the patient has any associated autoimmune G finger tremor disease or whether any close relative is affected.

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The common causes of eosinophilia are drug effect women's health vs fitness magazine cheap aygestin 5 mg with amex, allergy or parasitic infestation of the gut womens health orlando aygestin 5 mg overnight delivery. The differential diagnosis includes: • Allergic disorders • Parasitic colonisation – hookworm 6272 menopause generic aygestin 5 mg with amex, flaria, hydatids, toxocara • Drug administration • Skin disease, e. Epilim (Valproate) Specimen: Serum – Gel Suggest trough level collected just before next dose. Epstein–Barr Virus is the causative agent in infectious mononucleosis which is characterised by lymphadenopathy, pharyngitis, fever, variant lymphocytosis in the blood flm and transient heterophile antibodies in serum. Clinical features include splenomegaly, an increase in thrombotic risk and bleeding of varying severity. Ethosuximide (Zarontin) Specimen: Plasma – Lithium heparin Trough level is taken before next oral dose ( within one hour). After pulling the lower lid down roll the swab across the inner part of the lower lid. In neonates, conjunctivitis can be due to gonococci or Chlamydia trachomatis transmitted from mother to baby during birth. When testing for Chlamydia remove any purulent exudate before collecting conjunctival epithelial cells by rubbing the small Chlamydia swab over the everted palpebral conjunctiva. Bacterial conjunctivitis outside the neonatal period is most commonly caused by Staph. A negative bacterial culture usually indicates a viral or allergic conjunctivitis. Normal Factor V, which promotes normal clotting, is inhibited physiologically by Activated Protein C. Addition of oral contraceptives increased the risk a further 3–5 times in heterozygous individuals. Faeces, for Clostridium Diffcile Toxin Specimen: Faeces Note any antibiotic therapy. Reference Range: Not detected Faeces, for culture and microscopy Faeces Examination for Microbiology Specimens should be fresh and submitted contained in the brown top faeces jar. Optimum sensitivity in stool examination is provided by the permanent fxed smear which is routinely performed at Capital Pathology. Microscopy and culture is performed on specimen one and microscopy alone is performed on specimen two. If a specimen of faeces is unobtainable, a rectal swab may be used (in transport medium). Patient Information leafets are available from the Client Services Department on 02 6285 9802 or at any Collection Centre. Capital Pathology Handbook – Interpretation of Laboratory Tests Faeces, for Occult Blood Specimen: Special diet required – please contact Collection Centre for information leafets. Indications When done properly, a positive result (even one) increases likelihood of gastrointestinal blood loss, especially from lower bowel. Types of test/dietary advice Nonspecifc guaiac tests These, the most commonly used tests, detect the peroxidase activity of haem whether of human or animal origin. They can give false positives with high meat diets, peroxidase–containing foods such as horseradish or turnip, or sometimes with iron supplements. Specifc immunochemical tests Most of these detect intact human Hb but others are based on human haem, porphyrin or even albumin. Although these tests avoid dietary false positives, there is still the large problem of positives due to minor benign bleeding. Faeces, for pH and Reducing Substances Specimen: Faeces Require same day specimen. Filariaria Antibodies Specimen: Serum – Gel Reference Range: Supplied with report Filariasis occurs in Africa, Latin America, Asia and the Pacifc Islands where the most common cause is Wuchereria bancrofti. Lymphatic flariasis occurs when host infammation and fbrosis lead to lymphatic occlusion and in patients heavily and repeatedly infected, elephantiasis may develop. Treatment with diethyl carbamazine or ivermectin clears microflaria from the blood. The complication rate is low, with local haematoma formation and bruising the most commonly occurring complications.

Konrad, 21 years: The most common presenting usually quite large, spheroidal, replacing most of the feature is a palpable abdominal mass in a child. Occasionally there is some intermittent polyphonic wheeze but Bronchiectasis and cystic fibrosis the wheeze is not usually that prominent. G sexual history and risk factors G painless erosions/ulcers on genitals, perianal region or in mouth – the primary lesion (appears after incubation for 3–30 days) is transient and may be unnoticed. She was Food Intolerance referred to an endocrinologist and did True allergic reactions (IgE mediated) to well on therapy, which had nothing to food must be differentiated from food intol do with an allergic diathesis.

Hengley, 62 years: Com bination of mercaptopurine with xanthine oxidase inhibitors such as allopurinol can again result in bone marrow toxicity, but is sometimes used deliberately to increase the immunosuppressive effect. Despite the excit ing and rewarding nature of research, deciding to conduct a research study can be intimidating for both inexperienced and experienced researchers alike. Population Two key terms that you must be familiar with are “sample” and “popula tion. Headaches, blurred cataract is treated in the same manner as age-related vision, and dull pain in the eye may also be pres cataract.

Gorok, 26 years: Also ensure that they can practically be answered within the scope of the project, as is the case here. Available details of previous treatments and the patient’s re sponse to those treatments will be delineated as part of the history of present illness. Bronchial breathing, reduced chest movements, reduced breath sounds, tachypnoea, crackles and percussion dullness. Miscellaneous and exceptional items, if any, should be usually placed in the last row of the table.

Karlen, 25 years: The national population census Census data offer a reference-standard population estimate for analysis of population trends and are used to provide essential statistical information for epidemiology, to enable planning and funding of public services, and to support research and business. This form is relatively difficult to develop and the statements may not say exactly what the respondent would like to express. Syringomyelia and by the arachnoid villi present along the dural venous sinuses syringobulbia are characterised by development of a syrinx. Manifestations may range from mild unsteadiness to complete inability to stand and walk, with accompanying incoordination and dysarthria.

Cobryn, 29 years: The reason being that these tests do not use all the available information but rather use groupings or rankings and the price we pay is a loss in efficiency. Both drugs bind to different immunophilins, thereby inhibiting the phosphatase calcineurin. Intraepithelial T lymphocytes present in the skin and gastrointestinal tract can respond to the encountering pathogens. There is delayed 7-10 days after exposure, catarrhal stage begins which is the accumulation of polymorphs and macrophages.

Nerusul, 22 years: Description: Transient and localized stabs of pain in the head that occur spontaneously in the absence of organic disease of underlying structures or of the cranial nerves. Another ear preparation, Colymycin S Otic, containing colistin, which has the same spectrum of antibacterial activity as polymyxin, is currently the most widely used topical preparation for Pseudomonas otitis externa. Learning Activities 383 Learning Activity 12-3 Building Medical Words Use gynec/o (woman, female) to build words that mean: 1. Also Opportunistic mycobacteria, Goodpasture’s syndrome, aspergilloma, mitral valve stenosis (if on warfarin), other endobronchial tumours (including benign lesions), hereditary haemorrhagic telangiectasia, endobronchial amyloid, any cause of systemic clotting abnormality.

Jaroll, 59 years: A longitudinal study of compensation-seeking and return to work in a treated mild traumatic brain injury sample. The sample was drawn from the electoral roll and Figure 1 provides numbers progressing through each stage. Pes cavus Suggested and confrmed by: accentuated foot arches normal variant, and other neurological disorders, e. Patch: A large (>2 cm) flat lesion with a color different from the surrounding skin.

Mufassa, 35 years: Symptomatic approach to posttraumatic headache and its possible implications for treatment. The probability distribution represents the probability of all possible events (no heads, one head and two heads), and therefore the total probability is 1. It may develop either from in the retina, atrophy of the papillae of the tongue, rectal lowered haemoglobin content (e. This results in inflammation, thrombosis, tissue present with recurrent attacks of severe abdominal pain at damage and haemorrhages found in acute haemorrhagic intervals of months to years.

Marcus, 50 years: To determine the energy of ascorbyl disproportionation, we simply invert the first reaction and accordingly the sign of its potential. A complete history including nutritional, social and growth monitoring is essential. Fat/cell ratio : 50:50 Myeloid/erythroid (M/E) ratio : 2-4:1 (mean 3:1) the nucleus at this stage is coarse and deeply basophilic. The adjective for the operative time span from decision for surgery to placement on the operating room table is.

Sanford, 34 years: Approximately 15-20% of in back-to-back arrangement without intervening stroma nodular hyperplastic prostates harbour carcinoma. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Identify and use the roots pertaining to the cardiovascular and lymphatic systems. The lining rests on middle (small intestinal) and lower (melaena) is a major vascularised subserosal fibrous tissue.

Tragak, 52 years: This test is frequently used but the problem of validity still remains a major problem of this test. Materno-foetal transmission in congenital syphilis if the can be easily demonstrated in the mucocutaneous lesions. Clinical history 111 tract, but is normal in up to 25 per cent of cases with G Visceral: a dull poorly localized pain in the upper gastrointestinal bleeding. Diabetic nephropathy on immunofluorescence are positive for IgG; sometimes encompasses 4 types of renal lesions in diabetes mellitus: also for IgA or IgM, and C3.

Baldar, 55 years: The spreading wet gangrene generally Wet gangrene occurs in naturally moist tissues and organs lacks clear-cut line of demarcation and may spread to such as the mouth, bowel, lung, cervix, vulva etc. Malignant cells frequently have a sections they are seen as a dark band of dividing chromatin prominent nucleolus or nucleoli in the nucleus reflecting at two poles of the nuclear spindle. Deoxygenated leaves the left ventricle through the largest artery of blood takes on a characteristic purple color. This refects your problem and defnes the scope of the study (the general objectve).

Merdarion, 33 years: If born alive, the features similar to severe Rh α-thalassaemia trait may occur by the following molecular haemolytic disease are present (page 340). Diagnosis: G Gummatous syphilis: G Occurs 3–15 years after untreated primary G Serology strongly positive in secondary syphilis infection. These seizures resemble epileptic seizures, with the presence of a sudden burst of tonic contractions. Macrophages 27) Results in increasing the number of binding sites on the surface of a microbe to make it easier to phagocytize L.

Corwyn, 24 years: Morphologically, mitochondrial interferes in generation of phospholipids from the cellular changes are vacuoles in the mitochondria and deposits of fatty acids which are required for continuous repair of amorphous calcium salts in the mitochondrial matrix. Ambiguity in the genitalia is defined as external genita lia that are neither entirely female nor entirely male in appearance. Similarly, the accuracy of tabulation may be checked by having a sample of the tables re-done. You may elicit pain as you do, lobe of the liver towards the right iliac fossa, can be so watch the patient’s face.

Arokkh, 36 years: The pathologic changes consist of other rare types such as due to inherited abnor vary depending upon whether the obstruction is sudden mality of enzyme metabolism e. The disease is more common in young and thyroid parenchyma and a less prominent lymphoid middle-aged women and may present clinically with painful infiltrate. For given donor organs, recipient waiting lists are searched for the best match, but in a typical case, this match is only partial. Enlargement of the thymus or failure to involute produces Secondary tumours occur late in the course of disease thymic hyperplasia.

Bengerd, 47 years: Through these processes, immunodeficiency to be described in 1952 memory B cells are generated within by Colonel Ogden Bruton. However, most case-control studies are retrospective, and since many of the most important design issues we need to be concerned about arise from retrospective data collection, we will concentrate on this time perspective. They each carry urine are nitrogenous wastes, the end products of pro in peristaltic waves to the bladder. Like other antibodies, each IgE antibody is specific; one acts against oak pollen, another against ragweed.

References

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• Mery GM, Reardon MJ, Haas J, Lazar J, Hindenburg A. A combined modality approach to recurrent cardiac sarcoma resulting in a prolonged remission: a case report. Chest 2003;123:1766-1768.