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He has authored over 100 peer- reviewed scientific publications and has served on numerous editorial boards discount atenolol 100 mg line. Cox s honors include election to the Institute of Medicine of the National Academy of Sciences buy atenolol 50 mg low price. Fraser-Liggett is Director of the Institute for Genome Sciences and a Professor of Medicine at the University Of Maryland School Of Medicine in Baltimore, Maryland. Previously she was the President and Director of The Institute for Genomic Research in Rockville, Maryland. She led the teams that sequenced the genomes of several microbial organisms, including important human and animal pathogens, and as a consequence helped to initiate the era of comparative genomics. She has served on a number of National Research Council Committees on counter-bioterrorism, domestic animal genomics, polar biology, and metagenomics. Fraser-Liggett has more than 220 scientific publications, and has served on Committees of the National Science Foundation, Department of Energy and National Institutes of Health. She received her PhD in pharmacology from State University of New York at Buffalo. He is also Co-Director of the Stanford Center for Genomics and Personalized Medicine. Galli s research focuses on the development and function of mast cells and basophils (key players in anaphylaxis, allergies, asthma and many other biological responses), and on developing new animal models to study the diverse roles of these cells in health and disease. Galli serves on the editorial boards of several medical journals and is a co-editor of The Annual Review of Pathology: Mechanisms of Disease. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 86 of a three year elected term, Dr. Galli was the Chair of the Advisory Board to the President and Provost of Stanford University. Goldstein is currently Professor of Molecular Genetics & Microbiology and Director of the Center for Human Genome Variation at Duke University. Goldstein is the author of over 150 scholarly publications in the areas of population and medical genetics. His work focuses on the genetics of human disease and treatment response, with a concentration on neuropsychiatric disease and host determinants of response to infectious diseases. Most recently, he was appointed the co-chair and chair of the Gordon Research Conference meeting on human genetics and genomics for 2011 and 2013. Hunter is currently the Dean for Academic Affairs at the Harvard School of Public Health and the Vincent L. Gregory Professor in Cancer Prevention in the Departments of Epidemiology and Nutrition. His research interests include cancer epidemiology and molecular and genetic epidemiology. Hunter analyzes inherited susceptibility to cancer and other chronic diseases using molecular techniques and studying molecular markers of environmental exposures. Kohane leads multiple collaborations at Harvard Medical School and its hospital affiliates in the use of genomics and computer science to study diseases (particularly cancer and autism). He has developed several computer systems to allow multiple hospital systems to be used as "living laboratories" to study the genetic basis of disease while preserving patient privacy. Among these, the i2b2 (Informatics for Integrating Biology and the Bedside) National Computing Center has been deployed at over 52 academic health centers internationally. Kohane has published over 180 papers in the medical literature and authored a widely used book on microarrays for Integrative Genomics. He has been elected to multiple honor societies including the American Society for Clinical Investigation, the American College of Medical Informatics, and the Institute of Medicine. He is also a practicing pediatrics endocrinologist and father of three energetic children. Manuel Llins is an Assistant Professor of Molecular Biology and a member of the Lewis-Sigler Institute for Integrative Genomics at Princeton University. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease Ph. Llins laboratory studies the deadliest of the four human Plasmodium parasites, Plasmodium falciparum. The focus is predominantly on the red blood cell stage of development, which is the stage in which all of the clinical manifestations of the malaria disease occur. His research has focused on two major areas: the role of transcriptional regulation in orchestrating parasite development, and an in-depth characterization of the malaria parasite s unique metabolic network. These two approaches explore relatively virgin areas in the malaria field with the goal of identifying novel strategies for therapeutic intervention. He is also National Program Director for the Greenwall Faculty Scholars Program in Bioethics, a career development award for bioethics researchers.

Learning Outcomes for Study Session 34 When you have studied this session cheap atenolol 50 mg mastercard, you should be able to: 34 generic 100mg atenolol with mastercard. Both conditions are also classied as diarrhoeal diseases based on the characteristic symptom of diarrhoea. The prevention and control measures against both diseases are the same as for other faeco-oral diseases described previously (refer back to Study Session 32, Section 32. It is endemic in Ethiopia, and research studies have shown a prevalence of amoeba infection ranging from 4% to 19% in the Ethiopian population. Individuals who develop amoebiasis, experience bloody diarrhoea (so the disease is also known as ameobic dysentery), fever and abdominal cramps, sometimes alternating with periods of constipation. Unlike in cases of bacillary dysentery, the blood and mucus is mixed with solid stool and patients are not usually bedridden. Very rarely, amoebiasis can lead to serious complications, including abscesses in the liver, lungs or brain. Another difference between dysentery caused by ameobae and dysentery caused by Shigella bacteria is that amoebiasis mainly affects young adults; it rarely occurs below the age of ve years. By contrast, dysentery in children under ten years is mainly due to Shigella species. Also, amoebiasis does not usually produce epidemics, so an epidemic of dysentery is most probably due to cases of shigellosis. Some amoebae in an infected person s intestines transform and become encased in a round protective membrane called a cyst. They are highly resistant to damage and can be transmitted by direct and indirect faeco-oral routes, mainly via contaminated food or water. They hatch out in the new person and the protozoa rapidly increase in number by cell division. For accurate diagnosis, laboratory identication of the cysts in the patient s stool is necessary to differentiate it from shigellosis. Advise the patient or caregiver that further investigation is needed for diagnosis and that early treatment is important because the disease could lead to serious outcomes. The cysts can be 24 Study Session 34 Intestinal Protozoa, Ascariasis and Hookworm easily transmitted in water contaminated by faeces, from person-to-person through hand-to-mouth transmission and in food. The commonest clinical manifestation of giardiasis is foul-smelling, pale, greasy diarrhoea, without blood or mucus (mucoid). The diarrhoea can be acute and resolve by itself within a few days, or it may be persistent (lasting for more than 14 days). Other symptoms of giardiasis include nausea, vomiting, abdominal cramps and abdominal distension (swelling). You should suspect giardiasis in children if the diarrhoea is persistent, but not bloody or mucoid. For children with mild non-bloody or non-mucoid Details of the specic diarrhoea, the management does not require identication of the infectious management of children with agent; cases are managed with oral rehydration as already described for simple persistent or severe diarrhoea are taught in the Module on the acute watery diarrhoea (refer back to Section 32. If a child has persistent Integrated Management of Newborn or severe diarrhoea, and giardiasis is one of the causes you suspect, treatment and Childhood Illness. In adults, you should suspect a diagnosis of giardiasis in cases with acute or persistent, non-bloody or non-mucoid diarrhoea. However, as other diseases could also have similar manifestations, conrmation of the diagnosis is needed through detection of the parasite in laboratory examination of stool samples. They have complicated lifecycles, and some helminths require transmission between humans and other host animals before they mature. There are three main groups of helminths: the roundworms, the tapeworms and the atworms (or ukes). Here we focus on intestinal roundworms (helminths that are round in cross-section), which live in the person s intestines and exit from the body in the faeces. The two commonest intestinal roundworms in Ethiopia cause the diseases known as ascariasis and hookworm infection. Neither of these conditions is characterised by diarrhoea, so they are not classied as diarrhoeal diseases. Prevention and control measures are similar to those for other faeco-oral diseases, described in earlier study sessions. However, ascariasis requires specic drug treatment based on its symptoms and signs. In Ethiopia, around 37% of the population is estimated to be infected with Ascaris lumbricoides. Adult Ascaris lumbricoides worms in the intestines (1) lay eggs which pass out with the faeces (2). The eggs hatch and lumbricoides), with measuring develop into larvae (immature stage) in the intestines (5). You can make a clinical diagnosis of ascariasis if the patient or the caregiver of a child tells you that long worms have passed with the stool or vomit, or if you are able to see the worms yourself.

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Anaemic children fail to grow properly and their school performance will be negatively affected purchase atenolol 50 mg with amex. Haemoglobin is the red order atenolol 100mg with visa, iron-rich protein that gives red blood cells their colour and enables them to pick up oxygen and transport it around the body. In the next study session, we turn to the largest single cause of mortality among children under the age of ve years: acute respiratory tract infections. Summary of Study Session 34 In Study Session 34, you have learned that: 1 Parasitic infection of the intestines could be due to protozoa or helminths. Amoebic dysentery is rare in children, in contrast to shigellosis (bacillary dysentery) which mainly affects young children. For persistent or severe cases in children, and all adults with suspected giardiasis, start rehydration and then refer them for laboratory diagnosis and treatment. Cases present with abdominal discomfort and you may see the passage of live worms with the faeces or vomit. Treat cases with albendazole or mebendazole according to the schedule in Table 34. Refer suspect cases for laboratory conrmation and educate the community on shoe wearing, use of latrines and proper disposal of faeces. Which diseases do you suspect, if he describes the diarrhoea as: (a) Bloody with mucus? The respiratory tract (or airways ) includes all the parts of the body that enable us to breathe. The upper respiratory tract consists of the airways from the nostrils to the vocal cords in the larynx (voice box), and includes the pharynx (back of the throat) and part of the internal structure of the ear (the middle ear). The lower respiratory tract refers to the continuation of the airways below the larynx and the branching airways throughout the lungs. They are transmitted from one person to another by oh-tiy-tiss ; pharyngitis is airborne droplets spread through coughing or sneezing. First, we discuss acute otitis media and then pharyngitis, both of which can cause severe complications in children. In each ear, the middle and inner ear are connected to the upper respiratory tract by a tube called the Eustachian tube, which leads to the pharynx. You can sometimes hear a soft pop in your ears when you swallow as the pressure wave created by swallowing travels up the Eustachian tubes. Upper respiratory tract infection in the pharynx and tonsils can reach the middle ear if the infectious agents spread upwards along the Eustachian tubes. If infection reaches the middle ear, the lining becomes red and inamed, and it leaks sticky tissue uid (mucus) into the ear. As the infection builds up, white blood cells crowd into the area to ght the infectious agents and the middle ear becomes lled by pus a thick whitish-yellowish uid, formed by mucus packed with living and dead bacterial cells and debris from damaged tissue in the ear. The infection in the new host usually begins with a common cold, sore throat or measles. As a health worker in the community, you should check the following symptoms in children with upper respiratory tract infections:. Ear pain, often manifested by irritability (the child is easily upset) and occasionally holding or tugging at the ear. Symptoms associated with upper respiratory tract infection, such as a runny nose and sneezing typical of the common cold. Hearing loss, which may manifest as changes in speech patterns; however, this often goes undetected if hearing loss is mild or in one ear only, especially in younger children. These include chronic otitis media, manifested by pus discharging from the ear for more than two weeks, which can lead to permanent deafness. The dose of these antibiotics in tablets or syrup preparations depends on the age or weight of the child, as given in Table 35. These dosages also apply to the treatment of pneumonia, which will be discussed in Section 35. Age (weight) Co-trimoxazole (give twice per day for ve days) Amoxicillin (give three times per day for ve days) Adult tablet Paediatric tablet Syrup Syrup(125mg/5ml) (80 mg trimethoprim + (20mgtrimethoprim+ (80mgtrimethoprim+ 400 mg 100 mg 400 mg sulphamethoxazole) sulphamethoxazole) sulphamethoxazole /5 ml) 2 12 months tablet 2 tablets 5 ml (1 teaspoon) 5 ml (1 teaspoon) (4 10 kg) 12 months to 5 1 tablet 3 tablets 7. If the pus continues to discharge from the ear after ve days, refer the child to a health centre for further assessment and treatment. In most cases, the tonsils are affected and become inamed and ulcerated (tonsillitis). In this section, we will describe the clinical manifestations, complications and treatment of pharyngitis. A better understanding of these points will help you to identify a child with pharyngitis and know that you should refer them to a higher level health facility.

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Although we demonstrate that observer ratings of personality predict future health order atenolol 100 mg mastercard, we do not rule out the potential of self-report measures to provide equally valuable inferences order atenolol 50mg without a prescription. Thus, although the association between Neuroticism and health appears less robust than Conscientiousness, the extent to which self-reports of Neu- roticism predict objective health remains an open question. First, we did not collect self-reports of Big Five personality and thus could not directly compare the predictive utility of observer ratings with self-report ratings. Rather, we relied on a substantial literature demonstrating links between self-reported personality and health to serve as the reference point for our examination of observer-reported person- ality and health. Second, the personality effects we report are small, but these should be evaluated relative to other well-established risk factors for poor health. Adding However, all of the clinical indicators reported here are well personality measures to electronic infrastructures of health records characterized and have prognostic utility as early warning mea- could provide an invaluable data resource for researchers to ex- sures for morbidity and mortality (Blair et al. Randomized controlled trials should be dimensions (Benet-Martnez & John, 1998; McCrae & Terrac- conducted in which health care providers either have access to ciano, 2005) suggests that findings from New Zealand should personality information or not. There is countries where healthcare is less accessible and accessing it ongoing debate about how to address behavioral risk factors for requires greater conscientious effort. Our findings suggest that interventions requiring effortful Next Steps planning, self-control, and strict adherence are less likely to be effective for segments of the population in which these psycho- Healthcare reform in the United States is leading to a substantial logical resources are in shortest supply (i. This rapid increase presents a timely opportunity for health- individuals low in Conscientiousness may increase the appeal of care professionals to encourage young adults to supplant the health health-promotion communication, and the effectiveness of health- risk behaviors of youth with health-promoting habits for midlife. Self-reports have known social desirability biases, and such effects may be com- pounded if patients were to complete personality questionnaires References knowing that the outcome could affect the type of medical treat- ment they would receive. Intelligence, personality, and ratings were not guaranteed, would reporters self or other be interests: Evidence for overlapping traits. Personality structure: Emergence of the five-factor cultures and ethnic groups: Multitrait-multimethod analyses of the Big model. Conscientiousness and health-related behaviors: A meta-analysis of the leading behavioral contributors to British Journal of Health Psychology, 17, 85 102. Is personality associated with health care use by older Evidence and implications for a personality trait marker of health and adults? The disease-prone person- s12160-012-9454-6 ality : A meta-analytic view of the construct. Conscientiousness and longevity: An examination of possible personality-targeted prevention program for adolescent alcohol use and mediators. Neuroticism, somatic complaints, agreement of personality judgments at zero acquaintance. Self-rated health and mortality: A disease: Prospective study and updated meta-analyses. Personalized genetic prediction: Too limited, too as predictors of illness and death: How researchers in differential psy- expensive, or too soon? The Big Five trait taxonomy: History, Actual causes of death in the United States, 2000. Archives of Pediatrics and Adolescent Medicine, 166, 240 integrated guidelines for cardiovascular health and risk reduction in 247. The power of personality: The comparative validity of person- traits from the observer s perspective: Data from 50 cultures. Impact of psycho- quality, scaling assumptions, and reliability across diverse patient logical factors on the pathogenesis of cardiovascular disease and impli- groups. Personality and health: Advan- physical health: A life-span perspective with emphasis on the separabil- tages and limitations of the five-factor model. The Journals of of arterial thickening: Women with antagonistic traits have similar Gerontology Series B: Psychological Sciences and Social Sciences, 59, carotid arterial thickness as men. Personality predictors of longevity: Activity, emo- defined population of older persons. Revision received October 15, 2013 Changes in periodontal disease experience from 26 to 32 years of age in Accepted December 17, 2013. His response was, defined by the Study Committee on Postgraduate Medical Why don t you do that and I will help. The asked me during his office visit with me, What are you going mentor achieves this by listening or talking in confidence to to do next in your career and professional life? Mentors are especially helpful that I had been a history major and had thought I would be a when they share personal knowledge, advice, and experi- history professor. There were better prepared than you think, and if you want to pursue that no physicians in my family, but I was fortunate to find men- path I will help. There is much overlap in these functions, and it is impor- I have been fortunate to have had many excellent tant to recognize that good mentors are all of these things, mentors during my academic career who helped and that they change their techniques and functions over time me through many important experiences and based on the needs of those they mentor. Commit to mentoring Offer guidance and direction Have a clear understanding of regarding professional goals and Professionals must first acquire knowledge and the skills of your motivation to mentor issues their profession through study and experiential learning. Mentor based on a realistic Provide timely, clear, and But true professional expertise comes through practice and assessment of your skills and comprehensive feedback to constant feedback, often from a mentoring relationship with questions leadership abilities a senior colleague.