Nancy Padian PhD, MPH
- Adjunct Professor, Epidemiology
https://publichealth.berkeley.edu/people/nancy-padian/
It seems they were really quite content using the eclectic theme- program to address the issues that were most pressing to them polysorbate 80 antimicrobial buy discount cephalexin 500 mg on line. Nonusers infection kidney stones cheap 250 mg cephalexin with mastercard, for example bacteria have nucleus best cephalexin 500 mg, are typically less concerned about the implications of an educational innovation for students than they are based curriculum they had been using for years infection 3 weeks after surgery purchase cephalexin 500 mg on line. She also noted their concern about having to give up a weekend day to attend training. Realizing her enthusiasm for this innovation might be met with a wall of resistance, about what the innovation means to them. Hall and Loucks (1978) believe that by using such an assessment tool, guesswork is removed from the planning process. Research on their instrument shows that the individual and group data generated can be used in various ways: to plan interventions, to evaluate progress, and to spot individual problems (Colette & Russell, 1988; Hall & Loucks, 1978; Hord et al. Based on the results she got from administering the Stages of Concern questionnaire about the High/Scope curriculum, a decision was made to address information and persnnal concerns first. She decided to spend only a portion of the money she had allocated for training and have the trainer provide a half-day overview of the curriculum. After the overview, staff would be given the option to decide if the High/Scope A Final Word Wu (1988) underscores the importance of linking what we know about change to what we know about staff development. If so, additional staff development days would be scheduled for those who wanted to participate. The remaining chapters in this book will provide the tools neces sary to help you, the director, make collaborative change possible. Blueprint for Action 43 Chapter 4 Assessing Organizational Needs Directors often have a kind of global impression that things are either going well or not so well at their centers, but they lack specific informa- lems and generating possible strategies to neutralize the forces that create the problems. Without a the Importance of Assessment Ongoing assessment is important at the organizational level not only because it gives structure to center improvement efforts, but because it also conveys respect for staff and encourages a team approach to problem solving. Staff can be incredibly resourceful at generating solutions to center-wide problems if provided the opportunity to participate in a meaningful way. The nonverbal message that is conveyed through assessment is the responsibility for improving a powerful one clear sense of how the people, structure, and processes of a center interact to produce desired outcomes, directors lack the knowledge of how to ensure that their program will be as effective as possible. The information gleaned from assessing organizational needs helps directors turn those vague or amorphous feelings into more precise data about what aspects of the program can be improved. Assessing organizational needs helps directors identify the issues that are most pressing so they can prioritize their time and resources to address these concerns. When used properly, orga- nizational assessment provides a sound basis for determining the objectives, content, and emphasis of staff development programs. The focus in this chapter will be on tools for assessment at the organizational level. Indeed, the most effective early childhood programs are those where teachers, students, administrators, and parents together engage in problem solving, deck cion making, and implementation of program improvement plans. Clearly, the more perspectives that can be obtained on any relevant issue will ensure that fewer obstacles will be encountered in the change process. The two-way communication that can emerge from assessing organizational issues can lead to a pertaining to the assessment of individual needs. The approach is issue oriented focusing on existing and anticipated prob- collaborative approach to problem solving and establish a precedent for future change. Since change is more likely to occur in work settings in which individuals feel that new ideas are welcome, such data can be used to "unfreeze" existing norms and attitudes. When the information is perceived as Blueprint for Action 45 52 valid, accurate, and unbiased, the description of organizational conditions arrived at through the Pinpointing Problems assessment process can be a potent force in helping bring about needed change (Bowditch & Buono, 1982). Monitoring center outcomes, in particular, is one way to ensure the center stays healthy. Change is bound to get off track if some people see the problem one way but others either do not admit there;s a problem or see it differently. Identifying the problem means achieving some kind of general consensus as to why there is a problem as well as what the problem is.
African American males are particularly underrepresented in medicine antibiotics for acne make me feel sick order cephalexin 250 mg without a prescription, when compared to African American females and other minority groups antimicrobial towels purchase cephalexin 250mg on-line. In addressing this disparity in education bacteria taxonomy order cephalexin 500 mg with mastercard, a challenge is the medical education "pipeline antibiotic review cephalexin 500mg generic," with minority individuals, particularly African American men accounting for a disproportionately smaller percentage of individuals enrolled in and completing postsecondary education. In addition, minorities have higher attrition rates in all phases of medical education, with attrition rates of 5 to 6. As a consequence, minority representation in some areas in medicine is unchanged of the past four decades. Studies of barriers to pursuit of a medical career by women and underrepresented minorities have found that aspects of the basic science curriculum, particularly chemistry, are perceived barriers for this population. Another barrier at all levels of medical education is the lack of race- and/or gender-congruent mentors and role models. Minority learners and residents also are at higher risk for adverse academic status events, as well as adverse life events that may affect their education. Another common theme in the literature includes the generally lower standardized test scores and general academic achievement for minority learners. Experience of Women and Minority Learners and Faculty Regardless of the type of minority status, including racial/ethnic and sex/gender, members of minorities report "microaggressions" (low-level, covert acts of aggression), "microinsults," and "microinvalidations. Recent studies still who a considerable degree of gender identity concealment for sexual and gender minority students and residents. Although women now make up a sizable proportion of medical students, female students learn how to confront and respond to inappropriate behavior from male patients. However, these students do not feel equipped to respond to the unprofessional behavior of male supervisors, resulting in feelings of guilt and resignation over time that such events would be a part of their professional identity. While women currently make up one-half of medical school graduates, women, along with individuals of color, continue to be underrepresented in leadership positions, with one consequence a lack of leadership role models for women and minority individuals. When women and minority faculty are given leadership positions, these frequently are "minorityfocused," "nurturing" or "advocacy" roles Studies overall have found a lower prevalence of burn out and depressive symptoms in minority students, although minority students are more likely to report that a race-related incident adversely affected their medical school experience, and to cite this as a cause for burn out and low-quality of life. In some studies, minority medical students report a lower sense of personal accomplishment. Minority Physician Contributions to Addressing Health Disparities A constant argument for diversity and inclusion is that healthcare workforce diversity enhances access for minority patients and populations, and that cultural competence is importance to allowing physicians to provide culturally sensitive and appropriate care to all patients, regardless of their minority status. The literature consistently showed a greater contribution by minority physicians to the care of minority patients, and across race and ethnicity, to the care of patients facing challenges with access to care. An interesting sub-theme is whether it is ethical to expect this contribution to the care of underserved patients of this group of physicians. Bias in the Learning and Working Environment There is significant implicit and some explicit bias in the learning environment, which is expressed in implicit white-favoring bias on objectives tests; bias in assessment of women and minority learners; and norming of male stereotypes in the "ideal" learner in some specialties such as emergency medicine. There also is an overrepresentation of minorities in clinical questions in standardized tests to assess medical knowledge, with minority status used as a proxy for genetics, social class or life style factors, which contributes to bias in learners taking these tests. Finally, research shows both attentional blindness to minority members, and implicit bias in children and adults regarding minority individuals perceptions of pain, which extends to health professionals. Articles were reviewed and selected per study eligibility criteria and summarized to answer study research questions. Eight (50%) programs reported longitudinal training; seven (44%) reported block experiences, while one (6. Four (25%) programs required residents to develop and complete a research project, and six (37. Programs vary in curricular elements, using a wide variety of training aims, learner competencies, learning activities, and evaluation methods. This review highlights the need for published reports of educational programs aimed at training residents in health disparities and underserved medicine to include the evidence for effectiveness of various training models. While much has been written, there has not been a systematic review published on this topic. The same criteria were applied to extract evidence-based observations of problems in recruitment and retention for minority faculty. Faculty development programs in 15 different institutions showed mentoring and faculty development for minority faculty could increase retention, academic productivity, and promotion rates for this group. Overall evidence is strong that faculty development programs and mentoring programs increase retention, productivity, and promotion for this group of medical faculty. This paper is a call to action for more faculty development and mentorship programs to reduce the disparities that exist between minority faculty and all other faculty members. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature.
Religious involvement may also help to buffer acculturative stress bacteria discovery cephalexin 250mg for sale, which is associated with depression and suicidal ideation (43) antibiotic review cheap cephalexin 500 mg free shipping. The religious belief system itself and the practice of spiritual techniques may also decrease suicide risk by acting as a coping mechanism and providing a source of hope and purpose antibiotic resistance assay order 250mg cephalexin overnight delivery. Assessment and Treatment of Patients With Suicidal Behaviors 43 Copyright 2010 antibiotics for uti otc order cephalexin 250 mg, American Psychiatric Association. Although protective effects can be afforded by religious beliefs, this is not invariably the case. For example, suicide may be more likely to occur among cultures in which death by suicide is a traditionally accepted way of dealing with distress or in religions that deemphasize the boundaries between the living and the dead. Particularly for adolescents, belief in an afterlife may lead to suicide in an effort to rejoin a deceased loved one. Thus, it is important to gain an understanding of the specific religious beliefs and religious involvement of individuals and also to inquire how these religious beliefs relate to thoughts and conceptions of suicide. Although social supports typically include family members or friends, individuals may also receive support from other sources. For example, those in the military and those who belong to religious, community, or self-help organizations may receive support through these affiliations. Individuals who report having more friends and less subjective loneliness are less likely to have suicidal ideation or engage in suicidal behaviors (401). By the same token, if other social supports are not available, living alone may increase suicide risk (149, 385, 402), although this is not invariably true (343, 403, 404). Family discord, other relationship problems, and social isolation may also increase risk (403, 405, 406). Risk of suicidal behaviors may also increase when an individual rightly or wrongly fears that an interpersonal loss will occur (149). A sense of responsibility to family, particularly children, is a commonly cited reason for living that makes suicide a less viable option to escape from pain. The presence of children in the home as well as the number of children appear to decrease the risk for suicide in women (26, 47). Although less well-studied, a smaller effect on suicide potential may also be present in men who have children under age 18 within the home (408). For example, healthy and well-developed coping skills may buffer stressful life events, decreasing the likelihood of suicidal actions (409). Conversely, lifelong patterns of problematic coping skills are common among those who die by suicide (410). Such factors may be particularly important in patients with substance use or personality disorders, for whom heightened suicide risk may be associated with life stressors or interpersonal loss. Although the positive correlation value of individual personality traits with suicide is low, increased suicide risk may be associated with antisocial traits (411) as well as with hostility, helplessness/dependency, and social disengagement/self-consciousness (246). Another key psychodynamic concept is the interpretation of suicide as rooted in a triad of motivations: the wish to die, the wish to kill, and the wish to be killed (415). Other clinicians have conceptualized these motivations as escape (the wish to die), anger or revenge (the wish to kill), and guilt (the wish to be killed). Object relations theories offer important concepts for psychodynamic formulations of suicide. In some cases the wish to destroy the lives of the survivors is a powerful motivator (415, 420). For other individuals, a sadistic internal object is so tormenting that the only possible outcome is to submit to the tormentor through suicide (416, 417). Other important psychodynamic concepts for the clinician to assess are shame, worthlessness, and impaired self-esteem. Early disturbance in parent-child relationships through failure of empathy or traumatic loss can result in an increased vulnerability to later injuries of selfesteem. These patients are vulnerable to narcissistic injuries, which can trigger psychic pain or uncontrollable negative affects.
As stated by Malo do antibiotics for acne cause weight gain generic cephalexin 250mg without prescription, the King was compared to a house bacteria names purchase 500mg cephalexin with amex, "the chiefs below him and the common people throughout the whole country were his defense access virus purchase 500mg cephalexin otc. The religious laws both organized and stratified Hawaiian society antimicrobial drugs are selectively toxic this means purchase cephalexin 250mg overnight delivery, while the Chiefly laws served to administer governance under and by virtue of the King. According to Hawaiian historian Sheldon Dibble, As a general mark the chiefs were regarded as the only proprietors. They were admitted to own not only the soil but also the people who cultivated it; not only the fish of the sea but also the time, services, and implements of the fisherman. Everything that grew or had life on the land or in the sea; also things inanimate, and everything formed or acquired by the skill or industry of the people was admitted to be owned by the chiefs. Religion constituted the organic law of the country while, administratively, governance resided solely with the King and his Chiefs. Hawaiian Justice Walter Frear noted: the system of government was of a feudal nature, with the King as lord paramount, the chief as mesne lord and the common man as tenant paravail- generally three or four and sometimes six or seven degrees. Each held land of his immediate superior in return for military and other services and the payment of taxes or rent. Under this system all functions of government, executive, legislative and judicial, were united in the same persons and were exercised with almost absolute power by each functionary over all under him, subject only to his own superiors, each function being exercised not consciously as different in kind from the others but merely as a portion of the general powers possessed by a lord over his own. According to tradition and usage, all landed property held by the tenants in chief 19 Walter Frear, "The Evolution of the Hawaiian Judiciary," Papers of the Hawaiian Historical Society (June 29, 1894), 1. Abraham Fornander, Ancient History of the Hawaiian People to the Times of Kamehameha I (Mutual Publishing 1996), 204. Both sides gathered their troops and a great battle ensued on the leeward side of the island in an area called Ke`ei, which came to be known as the Battle of Mokuohai. At the onset of battle, all of the Kona chiefs were engaged except for Kamehameha, who was still performing a religious rite for the occasion with his high priest. It first appeared that Kiwala`o would be victorious, but with the arrival of Kamehameha and his men the battle violently turned against the King. Keawemauhili later escaped and he sought refuge on the windward side of the island. Fornander describes the results of the battle of Mokuohai as: to render the island of Hawai`i into three independent and hostile factions. The district of Kona, Kohala, and portions of Hamakua acknowledged Kamehemeha as their sovereign. The remaining portion of Hamakua, the district of Hilo, and a part of Puna, remained true to and acknowledged Keawemauhili as their Mo`i [sovereign]; while the lower part of Puna and the district of Kau, the patrimonial estate of Kiwalao, ungrudgingly and cheerfully supported Keoua Kuahuula against the mounting ambition of Kamehameha. An alliance would later be established between Keawemauhili and Keoua, and skirmishes took place between Kamehameha and these two Chiefs, but none was decisive enough to alter the equilibrium established after the battle of Moku`ohai. At the close of his last campaign in 1785 against the Ka`u and Hilo forces, Kamehameha returned to Kohala, "where he turned his attention to agriculture, himself setting an example in work and 25 Kamakau, supra note 23, 121. So widespread was the trading, that during this period there are no records of any battles taking place throughout the islands. Fornander explained: To the natives it was an era of wonder, delight, and incipient disease; to the chiefs it was an El Dorado of iron and destructive implements, and visions of conquest grew as iron, and powder, and guns accumulated in the princely storerooms. In 1787, he departed Kaua`i and was the first chief to leave the islands on a foreign trading vessel, the Nootka, accompanying Captain Meares to Canton. On his way to Kauai the following year, he realized he fell into disfavor with Ka`eo and requested that he disembark on the Island of Hawai`i at the court of Kamehameha instead. Kamehameha had also detained two Englishmen, John Young and Isaac Davis31 Both men were skilled in the use of muskets and artillery. He "was anxious to secure foreigners to teach him to handle the muskets which it had been his first object to obtain. Thomas Thrum, "John Young: Companion of Kamehameha, a Brief Sketch of His Life in Hawaii," Hawaiian Almanac and Annual (Thos. Kalanikupule and some of his men escaped capture and fled to O`ahu after the battle. He was forced to abandon his pursuit of complete victory over the Maui kingdom and returned to Hawai`i to deal with his sole remaining archrival for control of Hawai`i island. The islands of Maui and Molokai were later reclaimed without incident by the combined forces of an avenging Kahekili and his brother Ka`eo, King of Kaua`i, Ralph S. The two leeward Kings then prepared to launch an invasion against Kamehameha from Maui.
Recent studies suggest it may also be the predominant pathway in the G2/M-phases of the cell cycle after compaction of the chromatin antimicrobial business opportunity cheap 250 mg cephalexin free shipping, but further studies are needed to clarify this infection 2 cure race buy 250mg cephalexin. They undergo an illegitimate union resulting in a bridge-like structure during anaphase of mitosis due to the inability of the sister chromatids to separate normally how quickly do antibiotics for uti work cheap cephalexin 500 mg mastercard. Dicentric chromosomes result from breaks induced in two chromosomes in which the two broken chromosomes possessing the centromere join antibiotic resistance questionnaire buy cheap cephalexin 250mg line, resulting in a dicentric chromosome. An acentric fragment is produced following the breakage of a chromosome or chromosomes in which a portion of the chromosome that does not include the centromeric region is detached from the remainder of the chromosome. C the minimum whole body dose that can be detected through measurement of dicentric chromosomes in peripheral blood lymphocytes is approximately 0. Usefulness and limits of biological dosimetry based on cytogenetic methods, Radiat Prot Dosimetry, 115:448-454, 2005. A A terminal deletion is produced when a single chromosomal break results in deletion of a portion of the chromosome, that is, a "one-hit" aberration. An acentric ring results from two chromosomal breaks within the same arm of a chromosome. A dicentric results from breaks in two different chromosomes, while an inversion is produced by two breaks in the same chromosome. B the formation of a dicentric chromosome is most likely to trigger the events during mitosis that lead to mitotic catastrophe and the death of the cell (although it should be noted that some dicentrics are stable and long-lived). The other chromosomal aberrations listed are not as likely to result in cellular death (for example, inversions, translocations and insertions do not produce acentric fragments) although they could play an important role in carcinogenesis if the portion of the chromosome altered results in the inactivation of a tumor suppressor gene or activation of an oncogene. C the most reliable approach to estimate dose one month following a radiation exposure is to karyotype peripheral blood lymphocytes to detect chromosomal aberrations, particularly dicentric chromosomes, which are normally not found in unirradiated people. C Chromatid type of chromosome aberrations are caused by chromatid breaks in S or G2 phase. Comet assay measures strand breaks in agarose but not metaphase chromosome aberrations. A the number of dicentric chromosomes in X-irradiated cells follows a linear-quadratic function of dose. E Pimonidazole detects hypoxic cells, whereas all the other assays listed would be useful for the identification of apoptotic cells. The Annexin V Assay, a classical technique for detecting apoptosis, is the most commonly used method for detecting apoptosis by flow cytometry. This dye could be used to assess the nuclear morphology of normal versus apoptotic cells by fluorescence microscopy. A the most appropriate approach to assess cellular survival to radiation for an actively dividing population of cells is to determine what fraction of the irradiated cells is capable of clonogenic survival (colony formation). Division delay would measure the amount of cell cycle perturbation caused by radiation, but occurs in all actively dividing cells regardless of whether they ultimately live or die. Apoptosis is just one form of death, and can occur at many different times after irradiation. The formation of giant cells with multiple nuclei is a manifestation of cells undergoing mitotic catastrophe following the formation of chromosome aberrations, but is not the only mechanism of radiation-induced cell death. Likewise, detection of necrotic cells would only provide the fraction of cells that undergo this form of cell death, and would not give an overall sense of cellular lethality that could also occur through either apoptosis, autophagy, mitotic catastrophe or senescence. C Mitotic catastrophe is caused by the mis-segregation of genetic material into daughter cells resulting from radiation-induced chromosome aberrations and/or damage to the replication machinery of the cell. Apoptosis is a form of programmed cell death and can occur in response to initial radiation induced damage. However, this is rare and limited to specific tumor types such as low-grade lymphoma. In this case mitotic catastrophe is the reason for cell death, and apoptosis is just the mode of cell death. The generation of ceramide through the action of sphingomyelinase plays a role in the intrinsic pathway leading to apoptosis, and may be important in endothelial cells, but is not a major mechanism for the lethality of irradiation in solid tumors.
Buy 250mg cephalexin with mastercard. Microbiology Techniques: Testing antimicrobials.
References
- Popper HH, Wirnsberger G, Juttner-Smolle FM, Pongratz MG, Sommersgutter M. The predictive value of human papilloma virus (HPV) typing in the prognosis of bronchial squamous cell papillomas. Histopathology 1992;21:323-30.
- McDonnell TJ, Troncoso P, Brisbay SM, et al: Expression of the protooncogene bcl-2 in the prostate and its association with emergence of androgenindependent prostate cancer, Cancer Res 52:6940n6944, 1992.
- Brott T, Thalinger K, Hertzberg V. Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986;17:1078.
- Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40:994-1025.
- Martinez MA, Rincon A, Desviat LR, et al. Genetic analysis of three genes causing isolated methylmalonic acidemia; identification of 21 novel allelic variants. Mol Genet Metab 2005;84:317.
- Apostolidis A, Popat R, Yiangou Y, et al. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol 2005; 174: 977-82; discussion 82-3.
- Munoz Maniega S, Cvoro V, Chappell FM, et al. Changes in NAA and Lactate following ischemic stroke. A serial MR spectroscopic imaging study. Neurology 2008;71:7.
- Bolton-Maggs PHB, Pasi KJ. Haemophilias A and B. Lancet 2003; 361: 1801n9. Resnick D. Bleeding disorders. In: Resnick D. Diagnosis of Bone and Joint Disorders, 4th edn. Saunders, 2002; 2346n73.
