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For many diseases generic top avana 80mg amex, such genetic information will help patients and doctors weigh the risks and benefits of different treatments buy 80mg top avana. In many cases, this advance warning can be a cue to start a vigilant screening program, to take preventive medicines, or to make diet or lifestyle changes that might prevent the disease altogether. For example, those at risk for colon cancer could undergo frequent colonoscopies; those with hereditary hemochromatosis, a common disorder of iron metabolism, could donate blood periodically to remove excess iron and prevent damage to the body. Some women at risk for breast cancer could benefit from tamoxifen; a young person at risk for developing lung cancer may become particularly motivated to quit smoking; those with familial hypercholesterolemia could begin treatment to lower their cholesterol levels and prevent heart attacks and strokes. Unfortunately, our ability to predict a disease sometimes precedes our ability to prevent or treat it. For example, a genetic test has been avail- able for Huntington disease for years, but no treatment is available yet. Testing 10 Gene-base Genetic Medicine 11 Newborn screening A particular form of predictive testing, newborn screening can sometimes help a great deal. In the past, children with the condition became severely mentally retarded, but the screening program identifies children with the enzyme deficiency, allowing them to grow normally on a diet that strictly avoids phenylalanine. Carrier screening For some genetic conditions, people who will never be ill themselves can pass a disease to their children. Some couples choose to be tested for this risk before they marry, especially in commu- nities where a feared childhood disease is particularly common. For example, carrier testing for Tay-Sachs disease, which kills young children and is particularly common in some Jewish and Canadian populations, has been available and widely used for years. Gene therapy Replacing a misspelled gene with a functional gene has long been an appealing idea. Small groups of patients have undergone gene therapy in clinical trials for more than a decade, but this remains an experimental treatment. Gene-based therapy Great medical benefit likely will derive from drug design that’s guided by an understanding of how genes work and what exactly happens at the molecular level to cause disease. For example, the causes of adult-onset diabetes and the resulting complications remain difficult to decipher and, so, to treat. But researchers are opti- mistic that a more precise understanding of the underlying causes will lead to better therapies. In many cases, instead of trying to replace a gene, it will be more effective and simpler to replace the protein the gene would give rise to. Alternatively, it may be possible to administer a small molecule that interacts with the protein—as many drugs do—and changes its behavior. One of the first examples of such a rationally-designed drug targets the genetic flaw that causes chronic myelogenous leukemia, a form of leukemia that mostly affects adults. An unusual joining of chromosomes 9 and 22 produces an abnormal protein that spurs the uncontrolled growth of white blood cells. Scientists have designed a drug that specifically attaches to the abnormal protein and blocks its activity. In preliminary tests, blood counts returned to normal in all patients treated with the drug. And, compared with other forms of cancer treatment, the patients experienced very mild side effects. Instead of having to rely on chance and screening thousands of mole- cules to find an effective drug, which is how most drugs we use today were found, scientists will begin the process of drug discovery with a clearer notion of what they’re looking for. And because rationally designed drugs are more likely to act very specifically, they will be less likely to have damaging side effects. Genomics will hasten the advance of molecular biology into the practice of medicine. As the molecular foundations of diseases become clearer, we may be able to prevent them in many cases and in other cases, design accurate, individualized treatments for them. New drugs, derived from a detailed molecular understanding of common illnesses like diabetes and high blood pressure, will target molecules logically. Decades from now, many potential diseases may be cured at the molecular level before they arise.

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Lieven Ikubwe Emergency Area Nurse Public Innocent Bakunzibake Health Specialist Public Health Dr buy top avana 80 mg with mastercard. Most common cancer is lower lobes w/ pleural broncogenic carcinoma buy generic top avana 80mg line, but incr risk for mesothelioma plaques. Exudative with high hyaluronidase • Patient with kidney stones, Squamous cell carcinoma. High protein and low glucose support • Roommate of the kid bacterial in the dorms who has bacterial meningitis Rifampin!! Staph aureus seeds native valves from bacteremia Subacute Native valve endocarditis- • Most common valve? Trim-sulfa nd Trim-dapsone or primaquine-clinda, or pentamidine • 2 line Treatment? Gram + aerobic branching partially acid fast • Neck or face infection w/ draining Actinomyces! HyperCl Hyperrenin Fludrocortisone Addisons, sickle cell, High urine [Na] even w/ salt Hypoaldo any cause of aldo restriction def. Bladder/Kidney cancer until proven otherwise • “terminal hematuria” + tiny Bladder cancer or hemorrhagic cystitis clots? Ca not reabsorbed by gut (pooped out) • Treatment – Stones <5mm Will pass spontaneously. Just hydrate – Stones >2cm Open or endoscopic surgical removal – Stones 5mm-2cm Extracorporal shock wave lithotropsy So your patient is peeing protein… st • Best 1 test? Membranous- thick cap walls w/ subepi spikes • Assoc w/ heroin use and Focal-Segmental- mesangial IgM deposits. Stop heparin, reverse warfarin w/ vitK, start lepirudin • What to look for in someone w/ unprovoked thrombus? Then valproate or lamotrigine • Generalized seizures begin from both hemispheres @ once. New Onset Severe Headache Things to consider: st • “Worse headache of my life”Subarachnoid hemorrhage. Aminoglycosides & beta-blockers • Urinary retention, Babinski on Multiple Sclerosis. If hematemesis (blood occurs If gross hematemesis If progressive after vomiting, w/ subQ unprovoked in a cirrhotic dysphagia/wgt loss. Esophageal Carcinoma effusion w/ ↑amylase Gastric Varices Squamous cell in Boerhaave’s smoker/drinkers in the If in hypovolemic shock? Lymphocyte predominant • More likely to involve Non-hodgkin’s Lymphoma extranodal sites? We are very pleased you have chosen to take this degree, and we very much hope you will enjoy your time studying with us. You are encouraged to get to know and enjoy working with the other members of the programme, and so build up your own academic network for the future. We would like to emphasise that you are not in competition with one another— there is, for example, no limit on the number of ‘distinctions’ available. Doctors further on in their careers can update their skills and knowledge with teaching from our expert tutors. Disclaimer Some important general aspects covered in this handbook are amplified in the University’s Code of Practice for Taught Postgraduate Programmes, www. This handbook does not supersede the University Regulations, which are available at www. We consider it each student’s responsibility to make themselves familiar with the contents of this handbook and also the Code of Practice for Taught Postgraduate Programmes. The information provided in this handbook is intended to help you avoid unnecessary problems. Programme overview Credits allocation The programme has been divided into a sequence of inter-related modules, a mixture of compulsory and elective options. The first two years contain a series of taught 10 and 20 credit modules and are followed by a dissertation for completion at master’s level. The credit allocation is as follows: 60 points for successful completion of year 1 (6 x 10 credit modules or 4 x 10 credit modules and 1 x 20 credit module), equivalent to a certificate; an additional 60 points for 6 more 10 credit modules to achieve Diploma level; and a further 60 points gained on completion of the dissertation, i.

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Researchers do not yet know how glasses of wine buy discount top avana 80mg, or mixed drinks at one alcohol consumption exacerbates disease progression sitting) purchase 80mg top avana fast delivery, and drink no more than once and interferes with treatment. Alcoholism: Clinical and Experimental tration decreases enhanced ethanol elimination in 19:1083–1087, 1995. Journal of the American compartment model to assess the pharmacokinet- study of ethanol metabolism. Alcoholism: Clinical Alcoholism: Clinical and Experimental Research 32:117–119, 1998. The terms ‘substance’ and ‘drug’ are used interchangeably throughout this handbook. Desmond Corrigan, Chairperson, National Advisory Council on Drugs, for his permission to quote extensively from ‘Facts about Drug Misuse in Ireland’ and for his comments and support for the handbook Dr. The Steering Committee of the Walk Tall Programme (Substance Misuse Prevention Programme) Gerard McHugh Director, Dublin West Education Centre The Management Committee and Staff of Dublin West Education Centre The Department of Education and Science Teacher Education Section, Department of Education and Science Social Inclusion Section, Department of Education and Science Mary Johnston National Support Officer, Walk Tall Programme Susan Dixon Assistant National Support Officer, Walk Tall Programme The Department of Health & Children for its permission to use the photographs contained in the handbook. Joseph’s Academy, Kildare Don Delaney, Director of Communications, South Western Area Health Board Contents Section Title Page 1 Introduction 5 2 Defining Drug Terms 7 3 Stages of Drug Use 10 4 Slang Terms 15 5 The Epidemiological Triangle of Drug Use 16 6 Why Do Young People Use Drugs? Hopefully it will enable all teachers to become part of our national prevention effort. It is important that the numbers experimenting with drugs be reduced because in doing so the number of regular users reduces and in turn, the number of problematic and/or dependent users can also be reduced. Despite the fact, as the authors point out, that very few human beings can describe themselves as drug free (how many among us have never taken a medicine, drank tea, coffee or a cola drink containing caffeine? More worrying, sin view of the potential for harm, is the fact that most young people not only experiment with the two most harmful legal drugs – tobacco and alcohol – but use large amounts on a regular basis from quite an early age. This poses a huge challenge to those of us who see prevention, not as a universal panacea for “the drug problem” but as one, albeit essential element in our National Drugs Strategy. Recent research shows that programmes which are properly planned and delivered can have an impact on young peoples’ choices about using chemicals to alter consciousness and reality. Like vaccines, they must be reinforced by booster sessions at home and in the out-of-school environment. Effective interventions, such as those which underpin this handbook, can all too easily be undermined by overt and subconscious messages to young people that chemicals are glamourous, fun, life-enhancing and, above all, risk free. School-based programmes have the potential, if used as directed, to foster an environment among young people which allows them to thrive and develop within a knowledge-based, information-led, technological society. It is doubtful if an individual, who is chemically impaired on a regular basis, can develop their true potential and worth in the modem world we now inhabit. The challenge faced by young people and their educators is how to optimise opportunities to avoid chemical impairment, to strengthen each individual’s ability to assess the value and worth of chemical intoxication in their own lives, thereby maximising outcomes which enhance physical and mental well-being. I have no doubt that the enormous work which has gone into this handbook will successfully help teachers and pupils achieve their goals. Desmond Corrigan Chairperson National Advisory Committee on Drugs Introduction rug use and its impact on society is an emotive issue, particularly D where young people are concerned. Much of the debate which surrounds drug issues in Ireland in both the media and at more local, intimate levels is fuelled by a range of misapprehensions, misunderstandings and misinformation. In this climate it can be challenging for those working in schools to ensure that drugs education is properly seen as part of an integrated, holistic approach to a young person’s development based on educational principles, rather than have it informed by divisive, reactionary responses to wider social issues. The aim of this booklet is to provide you with accurate, evidence-based information to promote your understanding of drugs and drug use. The booklet looks at: y Defining drug terms y The different stages or levels of drug use y The epidemiological triangle y Drug facts y Signs and symptoms of drug use y Responses to drug-related scenarios within the school context y The National Drug Strategy and the development of substance use policy for schools y Guidelines for the use of guest speakers y Useful contacts y Sources for further information 5 Introduction This approach is informed by the understanding that if drugs education is to be effective, it needs to be cognisant of the habits and meanings attached to drug use and specifically differentiate between the levels of use and move away from a myopic focus on dependence at the expense of the type of use young people are most likely to experience, directly or indirectly. In putting this booklet together, we have drawn on the collective experience of members of the Walk Tall National Support Programme and staff of the Addiction Services and Health Promotion Department of the South Western Area Health Board. We have also drawn from the work of primary and post-primary teachers and teacher trainers in substance use to ensure that the information in the booklet meets the needs of working teachers. In our experience, this is an area where schools have the capacity to do enormously significant educational work; however, we would equally acknowledge that if teachers do not have the support of both the school and the wider community in the work they do, developing a healthier response and attitude to drug use will prove difficult. John Williams, National Support Officer, Walk Tall Programme Sheilagh Reaper-Reynolds, Senior Health Promotion Officer, Health Promotion Department, South Western Area Health Board Rory Keane, Education Officer, Addiction Services, South Western Area Health Board Esther Wolfe, Education Officer, Addiction Services, South Western Area Health Board 6 Defining Drug Terms hat is a drug? The following section looks at defining a range W of different drug terms and drug-related behaviours. Drug In the broadest terms, a drug is “… any substance which changes the way the body functions, mentally, physically or emotionally”.

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On the total integration of Sicily into the much larger world of Muslim and Jewish Notes to Pages –  Mediterranean culture cheap top avana 80mg on line, see also Abraham Udovitch cheap 80 mg top avana with mastercard, ‘‘New Materials for the History of Islamic Sicily,’’ in Giornata di Studio: Del Nuovo sulla Sicilia musulmana (Roma,  maggio ) (Rome: Accademia Nazionale dei Lincei, ), pp. Giorgio (–) (Salerno: Archivio di Stato, ); the document regarding the infirmary dates from  (pp. Amarotta, Salerno romana e medievale: Dinamica di un insedia- mento, Società Salernitana di Storia Patria, Collana di Studi Storici Salernitani,  (Sa- lerno: Pietro Laveglia, ). Among those granted permis- sion to use the baths at Santa Sofia were the nuns of the neighboring house of S. The monastery of Santa Sofia became a female house in the thirteenth century; see Galante, Nuove pergamene,p. Citarella, ‘‘Amalfi and Salerno in the Ninth Century,’’ in Istituzioni civili e organizzazione ecclesiastica nello Stato medievale amalfitano: Atti del Congresso inter- nazionale di studi Amalfitani, Amalfi, – luglio  (Amalfi: Centro di Cultura e Storia Amalfitana, ), pp. For the twelfth century, see Donald Matthew, The Norman Kingdom of Sicily (Cambridge: Cambridge University Press, ). Drell, ‘‘Family Struc- ture in the Principality of Salerno During the Norman Period, –,’’ Anglo- Norman Studies: Proceedings of the Battle Conference  (): –; and ‘‘Marriage, Kinship, and Power: Family Structure in the Principality of Salerno under Norman Rule, –’’ (Ph. For their part, however, men could not alienate their female relatives’ property without the woman’s permission. Katherine Fischer Drew (Philadelphia: University of Pennsylvania Press, ), esp. Evidence concerning the general legal and social history of women in southern Italy in the central Middle Ages has only recently begun to be collected. See in particular the essays of Patricia Skinner, ‘‘Women, Wills and Wealth in Medieval Southern Italy,’’ Early Medieval Europe  (): –; ‘‘The Pos- sessions of Lombard Women in Italy,’’ Medieval Life  (spring ): –; ‘‘Disputes and Disparity: Women at Court in Medieval Southern Italy,’’ Reading Medieval Studies  (): –; ‘‘Women, Literacy and Invisibility in Southern Italy, –,’’ in Women, the Book and the Godly: Selected Proceedings of the St Hilda’s Conference, , ed. Drell notes some shifts in the role of mundoalds (men who held a woman’s mundium) over the course of the twelfth century (pp. Copho, for example, distinguishes special remedies for noble people at least six times. See Copho, Practica, in Rudolf Creutz, ‘‘Der Magister Copho und seine Stellung im Hochsalerno: Aus M. The essays collected by Judith Bennett and Amy Froide in Singlewomen in the European Past, – (Philadelphia: Universityof Pennsylvania Press, ) have laid out many new avenues for research. Muhammad ibn Ahmad ibn Jubayr, The Travels of Ibn Jubayr, being the chronicle of a mediaeval Spanish Moor concerning his journey to the Egypt of Saladin, [etc. It is not clear whether the reference to noble- women in ¶, which was added later in the development of the Trotula ensemble, comes out of a Salernitan context. David Nirenberg, Communities of Violence: Persecution of Minorities in the Middle Ages (Princeton: Princeton University Press, ), pp. For example, the polymath Adelard of Bath and several English or Anglo- Norman physicians are known to have studied in Salerno; some Salernitan physicians also emigrated to England. Moreover, some of the earliest extant manuscripts of Con- stantinian and Salernitan writings come from England. Burnett, The Introduction of Arabic Learning into England, Panizzi Lectures,  (London: British Library, ), pp. On the specific significance of this English connection to Treatments of Women, see below. The definitive studyof the institutional historyof the school remains Paul Oskar Kristeller, ‘‘The School of Salerno: Its Development and Its Contribution to the His- tory of Learning,’’ Bulletin of the History of Medicine  (): –; reprinted in Ital- ian translation with further revisions as Studi sulla Scuola medica Salernitana (Naples: Istituto Italiano per gli Studi Filosofici, ). See also Vivian Nutton, ‘‘Velia and the School of Salerno,’’ Medical History  (): –; and ‘‘Continuity or Rediscovery: The City Physician in Classical Antiquity and Mediaeval Italy,’’ in The Town and State Physician in Europe from the Middle Ages to the Enlightenment, ed. My thanks to Francis Newton for informing me of his findings on the early date of Alfanus’s translation of Nemesius (personal communication, June ). His reli- gion of birth is of less import for this story than his native language. On Constantine and his oeuvre, see Bloch, Monte Cassino, : –, –, and : –; and most recently the essays in Constantine the African and ‘Alī ibn al- ‘Abbās al-Magˇūsī: The ‘‘Pantegni’’ and Related Texts, ed. On the intellectual culture of Monte Cassino, see Newton, Scriptorium and Library. Green, ‘‘Constantinus Africanus and the Con- flict Between Religion and Science,’’ in The Human Embryo: Aristotle and the Arabic  Notes to Pages – and European Traditions, ed. Wack, Lovesickness in the Middle Ages: The ‘‘Viaticum’’ and Its Commen- taries (Philadelphia: University of Pennsylvania Press, ); Gerrit Bos, ‘‘Ibn al-Jazzār on Women’s Diseases and Their Treatment,’’ Medical History  (): –; and idem, Ibn al-Jazzār on Sexual Diseases and Their Treatment, Sir Henry Wellcome Asian Series (London: Kegan Paul, ).

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