By I. Rakus. Haskell Indian Nations University. 2019.

Group A= Shigella dysentraie (most common cause) Group B= Shigella flexneri Group C= Shigella boydii Group D= Shigella sonnei Epidemiology Occurrence- It occurs worldwide discount eriacta master card, and is endemic in both tropical and temperate climates purchase eriacta without prescription. Outbreaks commonly occur under conditions of crowding and where personal hygiene is poor buy eriacta 100mg fast delivery, such as in jails, institutions for children, day care 29 Communicable Disease Control centers, mental hospitals and refugee camps. Two-thirds of the cases, and most of the deaths, are in children under 10 years of age. Reservoir- Humans Mode of transmission- Mainly by direct or indirect fecal-oral transmission from a patient or carrier. Transmission through water and milk may occur as a result of direct fecal contamination. Flies can transfer organisms from latrines to a non-refrigerated food item in which organisms can survive and multiply. Incubation period- 12 hours-4 days (usually 1-3 days) Period of communicability- During acute infection and until the infectious agent is no longer present in feces, usually within four weeks after illness. Diagnosis Based on clinical grounds Stool microscopy (presence of pus cells) Stool culture confirms the diagnosis Treatment 1. Infectious agent Entamoeba histolytica Epidemiology Occurrence- worldwide but most common in the tropics and sub-tropics. Mode of transmission – Fecal-oral transmission by ingestion of food or water contaminated by feces containing the cyst. Reservoir- Humans Mode of transmission- Person to person transmission occurs by hand to mouth transfer of cysts from feces of an infected individual especially in institutions and day care centers. Reservoir- Humans Mode of transmission- by ingestion of food or water directly or indirectly contaminated with feces or vomitus of infected person. Period of communicability- for the duration of the stool positive stage, usually only a few days after recovery. Antibiotics like tetracycline dramatically reduce the duration and volume of diarrhea resulting in early eradication of vibrio cholerae. Infectious agent Hepatitis A virus Epidemiology Occurrence- Worldwide distribution in sporadic and epidemic forms. Infection is common where environmental sanitation is poor and occurs at an early age. Period of communicability- High during the later half of the incubation period and continuing for few days following onset of jaundice. Clinical manifestation Abrupt onset of fever, malaise, anorexia, nausea and abdominal discomfort, followed in few days by jaundice. Public education about good sanitation and personal hygiene, with special emphasis on careful handwashing and sanitary disposal of feces. Proper management of day care centers to minimize possibility of fecal-oral transmission. These infections are acquired through man’s exposure to fecally contaminated soil. Epidemiology Occurrence- The most common parasite of humans where sanitation is poor. Highly prevalent in moist tropical countries Reservoir- Humans; ascarid eggs in soil. Mode of transmission- Ingestion of infective eggs from soil contaminated with human feces or uncooked produce contaminated with soil containing infective eggs but not directly from person to person or from fresh feces. Period of communicability- As long as mature fertilized female worms live in the intestine. Diagnosis Microscopic identification of eggs in a stool sample Adult worms passed from anus, mouth or nose. Reservoir- Humans Mode of transmission- Indirect, particularly through pica or ingestion of contaminated vegetables. Incubation period- Indefinite Period of communicability- Several years in untreated carriers. Infectious agent Entrobius vermicularis 48 Communicable Disease Control Epidemiology Occurrence- Worldwide, affecting all socio-economic classes with high rates in some areas. Prevalence is highest in school-aged children, followed by preschools and is lowest in adults except for mothers of infected children. Reservoir- Human Mode of transmission- Direct transfer of infective eggs by hand from anus to mouth of the same or another person or indirectly through clothing, bedding, food or other articles contaminated with eggs of the parasite. Incubation period- 2-6 weeks Period of communicability- As long as gravid females are discharging eggs on perianal skin. Strongyloidiasis Definition An often asymptomatic helminthic infection of the duodenum and upper jejunum. Infectious agent Strongyloides stercolaris Epidemiology Occurrence- In tropical and temperate areas. Reservoir- Human Mode of transmission- Infective (filariform) larvae penetrate the skin and enter the venous circulation. Incubation period- 2-4 weeks (from skin penetration up to when rhabditi form larvae appear in the feces). Period of communicability- As long as living worms remain in the intestine; up to 35 years in cases of auto-infection. Rhabditiform larvae: - Passed in feces, or - Become filariform larvae in intestine, causing atutoinfection. Reservoir- Humans 53 Communicable Disease Control Mode of transmission- Through skin penetration by the infective larvae. Incubation period- Symptoms may develop after a few weeks to many months depending on intensity of infection and iron intake of the host. Period of communicability- Infected people can contaminate the soil for several years in the absence of treatment. Larval migration of the skin Produces transient, localized maculopapular rash associated with itching called ground itch. Blood sucking Light infection-no symptoms Heavy infection-result in symptoms of peptic ulcer disease like epigastric pain and tenderness. Further loss of blood leads to anemia manifested by exertional dyspenea, weakness and light-headedness. Reservoir – humans, especially children Mode of transmission- Primarily person-to-person, spread principally through the fecal-oral route. In rare instances, milk, 56 Communicable Disease Control food stuffs and other materials contaminated with feces have been incriminated as vehicles. Incubation period- commonly 7-14 days Period of communicability – not precisely known, but transmission is possible as long as the virus is excreted. Susceptibility and resistance- Susceptibility is common in children but paralysis rarely occurs. Clinical manifestation Usually asymptomatic or non-specific fever is manifested in 90% of cases. Diagnosis Based on clinical and epidemiological grounds 57 Communicable Disease Control Treatment Symptomatic Prevention and control 1. Infectious agent Echinococcus granulosus, a small tapeworm of dog Epidemiology Occurrence – occurs on all continents except Antarctica. Especially common in grazing countries where dogs consume viscera containing cysts.

Because this research area is evolving rapidly order 100mg eriacta visa, online information is more likely to be up-to-date than information in print eriacta 100 mg on-line. Some options include: National Institutes of Health The National Institutes of Health has a number of resources on stem cells cheap 100 mg eriacta free shipping, including: • Current Research http://stemcells. Does not seem Shows a full Shows a good Shows partial Commercial to understand the understanding of understanding of understanding of content stem cell very the stem cell. Student uses Accuracy (of both appropriate Presents accurate Presents accurate Hard to tell if the written notes and sources. Material material 90% to material 75% to student knew the oral presentation) accurate based on 95% of the time. Student is able Student is able Student is able Student is unable to accurately to accurately to accurately to accurately Comprehension articulate the articulate most of articulate part of articulate the topic. Provides a Performs the Provides an complete Provides a simple commercial exceptional Commercial commercial that commercial that in-person for the commercial that quality falls within 30 does not meet the class and/or does meets the time seconds of the time requirements. Before delving deeper into the uses of different types of stem cells, defne the phrase “stem cell. On another sheet of paper make a chart similar to this one but with enough space to record all your fndings. Key Vocabulary • Regenerative medicine • Organ engineering • Scaffold • Bioprinting Time Required • Approximately 90 minutes to research regenerative medicine (may be done outside of class) • Approximately 60 minutes to create regenerative medicine magazine cover (may be done outside of class) • Approximately 90 minutes to present regenerative medicine covers (for class of 30 students) Materials • Computers with Internet access and print materials for research • Rubric Background Information Regenerative medicine holds the possibility of using stem cells to engineer and grow tissues and organs. In the past, if someone had a diseased bladder he or she most likely would develop kidney disease and possibly would die. But in 2001, a young boy was given a new bladder that had been grown for him in the lab. This feld of medicine continues to evolve, thus students must keep up with new advances by reading current research. Depending on student access to the Internet, you may choose to have students do this research in or out of class. After gathering and synthesizing information, the students will create a magazine cover highlighting their favorite advances in regenerative medicine. Safety Students should follow school/district Internet access guidelines to ensure safe browsing. Procedure Begin by watching a video on regenerative medicine, such as Heal, Feed, Sustain: How Biotechnology Can Help Save the World (http://www. Explain that they will be able to answer many of these questions and others after completing this project. Explain that regenerative medicine is a constantly changing feld, thus they will be using online resources to discover current advances. The student will work in groups of two to complete the following Regenerative Medicine: Changing Life handout. In order to move to the next section, the teacher may use the student sheet as a formative assessment. After the students have completed the research, the students will create a magazine cover highlighting a key use of regenerative medicine and details of this use. They should be shared with students in advance and may be developed with students. Theachers may adjust this rubric to ft their grading system and to emphasize different aspects of the project as appropriate for their curriculum. Extension This activity may be extended by asking students to research and create a projected timeline for the research and clinical trial process for the new applications of regenerative medicine. Because this research area is evolving rapidly, online information is more likely to be up-to-date than information in print. Shows a complete Shows a good Shows partial Does not seem understanding understanding understanding to understand of a regenerative of regenerative of regenerative regenerative Content from the medicine medicine medicine medicine webquest advancement. All material taken Presents current Presents current Presents little Current nature of from current material 90% to material 75% to to no current sources sources. Creates a Creates a magazine cover magazine cover about regenerative about regenerative Creates a Creates a basic medicine with medicine with magazine cover magazine cover an appropriate an appropriate about regenerative Magazine quality about science with picture and title picture and title medicine with an an appropriate that highlights that highlights appropriate picture picture and title. Occasionally Speaks clearly Speaks speaks clearly Does not speak with correct clearly with with some correct clearly or pronunciation of mostly correct pronunciation of pronounce terms. Maintains eye contact contact because magazine pitch Presents the eye contact most some time but the presentation information in of the time. You will be researching regenerative medicine and the current advancements in this feld. At the end of this process, you will have the opportunity to pitch your magazine cover to the publication board. Whenever this information is used in part or in whole, or when referencing it as part of a report or article, we request that acknowledgment be given to the American Board of Medical Specialties. The anesthesiologist also diagnoses and treats acute, chronic, disease, organ transplantation, or malignancies of the immune system. However, formal special pathways are available for physicians seeking Specialty training required prior to certifcation: Four years dual certifcation in Allergy/Immunology and Pediatric Pulmonology; Allergy and Immunology and Pediatric Rheumatology; and Allergy and Subspecialties Immunology and Adult Rheumatology. Additional information is available To become certifed in a particular subspecialty, a physician must be from the board. Critical Care Medicine An anesthesiologist who specializes in Critical Care Medicine diagnoses and treats patients with critical illnesses or injuries, particularly trauma victims and patients with multiple organ dysfunction who require care over a period of hours, days, or weeks. Hospice and Palliative Medicine An anesthesiologist who specializes in Hospice and Palliative Medicine provides care to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing the physical, psychological, social, and 4 5 spiritual needs of both patient and family. Sleep Medicine Colon and Rectal Surgery An anesthesiologist who specializes in Sleep Medicine has expertise A colon and rectal surgeon diagnoses and treats various diseases of in the diagnosis and management of clinical conditions that occur the small intestine, colon, rectum, anal canal, and perianal area including during sleep, that disturb sleep, or that are affected by disturbances the organs and tissues related with primary intestinal diseases (liver, in the wake-sleep cycle. This specialist is skilled in the analysis and urinary, and female reproductive system). They treat conditions such interpretation of comprehensive polysomnography, and well versed in as hemorrhoids, fssures (painful tears in the anal lining), abscesses and emerging research and management of a sleep laboratory. They also diagnose and treat problems of the intestine and colon such as cancer, polyps (precancerous growths), and infammatory conditions. This Specialty training required prior to certifcation: Four years specialist provides immediate recognition, evaluation, care, stabilization, and disposition of a generally diversifed population of adult and Subspecialties pediatric patients in response to acute illness and injury. To become certifed in a particular subspecialty, a physician must Specialty training required prior to certifcation: Three years be certifed by the American Board of Dermatology and complete additional training as specifed by the board. Subspecialties Dermatopathology To become certifed in a particular subspecialty, a physician must be A dermatopathologist is expert in diagnosing and monitoring diseases certifed by the American Board of Emergency Medicine and complete of the skin, including infectious, immunologic, degenerative, and additional training as specifed by the board. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings, and smears of Anesthesiology Critical Care Medicine skin lesions by means of light microscopy, electron microscopy, and An emergency medicine physician who specializes in Critical Care fuorescence microscopy.

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Realistc interest in medicine; life skills; wide range of interests; acts of Personal statement altruism and voluntary work; communicaton and interacton skills buy generic eriacta on-line. Applicants may be eligible for a contextual ofer if applying from a school or college ranked in the botom 40% in any of the following categories: average score per A level entry; average score per A level entrant; percentage of students applying to higher educaton buy line eriacta. Widening partcipaton Contextual ofers are usually two grades lower than the standard ofer generic eriacta 100 mg visa. For internatonal baccalaureate this may be 32 points overall with 16 at Higher Level, including 6 at Higher Level in Chemistry and 6 at Higher Level in another lab-based science. Applicants must have A level passes in Chemistry and two of Biology/Human Biology, Physics, Mathematcs. Personal statement Personal statement is reviewed prior to interview but not scored. The medical school is not prescriptve about how this is obtained and recognises the widely difering opportunites available. General Studies, Highers Critcal Thinking and Further Mathematcs are not accepted. Minimum of 19 points must be achieved in Higher level Internatonal Baccalaureate subjects. Non-academic criteria assessed; medical motvaton and awareness of the career, sense of responsibility, evidence of a balanced approach to life, Personal statement evidence of self-directed learning and extracurricular actvites, caring ethos and a sense of social awareness, referee’s report. The university recognises that opportunites for work experience will vary according to individual circumstances. Applicants are to showcase Work experience an appreciaton of the length of the training programme and the career structure. The academic and non-academic atainment of a candidate will be reviewed against educatonal performance data and socio-economic background to provide an overview of an applicant’s potental. The medical Widening partcipaton school will consider this informaton when deciding whether to call a candidate for interview. Subjects Internatonal Baccalaureate at Higher level should include Chemistry and another science. Personal statement Personal statement is reviewed prior to interview but not scored. Reviewed informally during selecton for interview process, but focus of Personal statement interview staton. Students are required to discuss ‘two experiences that informed decision to Work experience study medicine’ at interview. The medical school runs the Medical Aspiratons Programme, supportng Widening partcipaton Year 12 students on their path to study medicine. Chemistry and one other Internatonal Baccalaureate science (Biology preferred) at Higher Level. Career exploraton, non-academic achievements and personal qualites are Personal statement assessed and scored. Graduate and mature Interview method applicants, if short-listed, are invited for interview. Refecton on their experiences with the diseased, disadvantaged Work experience and disabled is assessed. Applicants from a widening partcipaton background are subject to diferent minimum academic requirements. Work experience Work experience is not outlined as part of the entry requirements. On receipt of an applicaton, contextual informaton is fagged for Widening partcipaton consideraton, including but not exclusive to care leavers, extenuatng circumstances, neighbourhood partcipaton and school performance. Total score of 38 to include Chemistry at a score of 6 at Higher level, Biology at a score of 6 at Higher level and either Maths or Physics at Higher level Internatonal Baccalaureate (if it is not possible to sit Maths or Physics at Higher level, then Standard level will be considered at 6 points). Experience in a medical setng is not necessary but it is expected that candidates will have at least spoken to a doctor about a career in medicine or have found out about a medical career through reading. An awareness Work experience of current issues facing the medical profession is also expected. Candidates must show an interest which can be demonstrated through voluntary/paid work in a community setng. Widening partcipaton candidates are identfed immediately afer submission of applicaton. Candidates not on widening partcipaton Widening partcipaton programmes can check eligibility directly with the university. Applicants must have Internatonal Baccalaureate 6,6,5 in three Higher level subjects, including Biology and Chemistry. No prescribed experience required but applicants should try to obtain a realistc understanding of the demands of medical training and practce. Work experience Applicants may fnd it useful to get some experience in a range of caring situatons, observing or working alongside healthcare staf, in either a voluntary or paid capacity. Evidence of motvaton to study medicine, understanding of medicine as a Personal statement career, community actvites, leadership qualites, ability to work in a team and general interests. Widening partcipaton candidates are fagged at applicaton stage and this Widening partcipaton may be a factor at short-listng stage. A minimum of 35 points from six academic subjects, including Chemistry or Biology plus a second science at Higher Level. Grades of 6,6,6 at Higher Internatonal Baccalaureate Level and 6,6,5 at Standard Level usually required. Applicants are required to complete a post-applicaton roles Personal statement and responsibilites form. This may involve work with customers or clients requiring support, assistance Work experience or service. Experience in caring role is preferred if the applicant has had opportunites to undertake this. Experience in a health-related setng which is verifed in the personal Work experience statement. Biology and Chemistry plus one other subject at Higher Internatonal Baccalaureate level (minimum of 6 in each Higher level subject) plus three subjects at Standard level (minimum of 5 in each Standard level subject). Specifc work experience not required though applicants must showcase evidence of research into a career in medicine. Insight is more important Work experience and voluntary placements in hospices, residental homes etc, where there is interacton with vulnerable people, is just as valuable as shadowing doctors. Those who atend the summer school and impress medical school staf are made a guaranteed interview if they meet the academic entry requirements. Biology taken with Human Biology and Maths taken with Further Maths are not accepted. Six subjects at minimum grade B including English Language, Maths, Double/Additonal Science or Chemistry and Biology. Overall score of 35 points with a mark of 6 in three Higher level subjects one of which must be Chemistry.

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If the total cost is more than your budget order 100mg eriacta with amex, the best approach is to decide which of the ‘not so essential’ items you can do without purchase eriacta cheap. Section 2 Procurement and management of supplies and equipment 17 Freight and insurance charges for imported goods Freight charges vary enormously purchase eriacta from india, depending on the volume and weight of the items ordered, the type of goods (for example, hazard or heat-sensitive goods), mode of transport (sea, land or air) and distance. The value of freight is based on the weight or volume of the goods rather than on the value of the goods. Hazardous or heat-sensitive goods can cost considerably more to transport and may be restricted to particular modes of transport. For example, laboratory reagents, which are flammable, require special packing and documentation, and vaccines, which must be kept cold during transport, require an effective cold chain. A freight contract that includes insurance is more expensive, but insuring goods against loss or damage is very important. If you insure goods, you can make a claim if they are lost or damaged during freighting. When you are putting together a budget add approximately 20-30% of the cost of the order to cover the cost of freight and insurance. Ask your supplier or freight forwarders for estimates of freight and related insurance costs before placing the order. You need to check current procedures with your national customs department, as well as with your supplier. The prices charged by international suppliers may seem to be lower, but imported products often have additional costs, such as import duties, freight, handling and insurance. Whenever possible, obtain quotations (a request for a price) from at least three suppliers so that you can compare prices. Although equipment may be supplied with a guarantee or warranty, check that the manufacturer or supplier is liable for repairs and maintenance. If there is no authorised agent or representative in your country, you may find you have to send the item back to the manufacturer and this could be very costly. After you have selected a supplier, monitor their performance to ensure that they continue to provide good service. Certain conditions may be attached to funding for equipment and supplies from donor agencies. Some health facilities use requisition forms or books for ordering supplies from district or national stores. When placing an order or re-ordering: • Check the stock records to find out the stock balance and decide what items and how much of each item you need to order. If you are ordering from a catalogue, write down the catalogue code number for each item. For example, if you need 34 rolls of crepe bandage and a pack contains 12 rolls, order 3 packs. 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Use the same format as an order form, but state clearly that it is a quotation request. Also ask for a pro-forma invoice, which provides a complete breakdown of costs and which also makes ordering easier. Provide as much detail about requirements and specifications as possible to avoid supply of incorrect items or quantities or delays in filling your order. For other suppliers, you may not need to fill out the form as long as you provide the relevant information. Section 2 Procurement and management of supplies and equipment 21 Handling donations Procurement also includes donation of drugs, supplies and equipment. Donated goods can be of great value to health facilities with limited resources, but donations are not always useful or totally ‘free’. For example, recipients may have to pay for customs clearance, storage, insurance and transport. There are also costs associated with staff time to organise arrangements and sort out what is and is not useful, and with disposing of inappropriate items. Health facilities with limited resources are often worried about refusing or complaining about donations. Do not feel obliged to accept donations unless the goods being offered are appropriate to your needs. Establish and use donation guidelines and policies, or use the practical tips in the box to help you manage donated supplies. Practical tips for receiving donations ● Decide what supplies and equipment are needed and in what quantities, and prioritise the list of items you plan to request. Confirm who will be responsible for covering the costs of transport, freight, insurance, import duties and customs clearance. If the supplies include drugs or sterile supplies, check that these will have an adequate expiry date (at least a year or half the shelf life if the expiry date is less than a year). Donor organisations have a responsibility to make sure that they donate appropriate medical supplies, equipment and drugs. For example, equipment should be in full working order and supplied with all technical documents and enough consumables and spare parts for 2 years. Donors should only provide donations in response to requests, and should know or find out about the recipient, confirm the need for the donation, and check their capacity to handle donations. It is important to ensure that the recipient provides clear specifications of the items required. If offering alternatives, donors should check with the recipient that these alternatives are acceptable. Before sending donations, it is essential to obtain consent from the recipient and to agree who will cover the costs of international and local transport, freight and insurance, warehousing, clearance, storage and handling. Finally, donors should confirm what items are being sent and when these will arrive so that the recipient can plan to receive them. Proper storage conditions are important to protect stock from deterioration and damage.

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