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By M. Osmund. Stratford University.

Statistics seek to describe this randomness by telling us how much noise there is in the measurements we make of a system buy 100 mg avana with amex. By filter- ing out this noise order avana 200mg free shipping, statistics allow us to approach a correct value of the underlying facts of interest buy avana 100mg with mastercard. These include techniques for graphically displaying the results of a study and mathematical indices that summarize the data with a few key numbers order avana 50 mg overnight delivery. These key numbers are measures of central tendency such as the mean purchase avana 50 mg visa, median,andmode and measures of dispersion such as standard devia- tion, standard error of the mean, range, percentile,andquartile. In medicine, researchers usually study a small number of patients with a given disease, a sample. What researchers are actually interested in finding out is how the entire population of patients with that disease will respond. Researchers often compare two samples for different characteristics such as use of certain therapies or exposure to a risk factor to determine if these changes will be present in the population. Inferential statistics are used to determine whether or not any differences between the research samples are due to chance or if there is a true difference present. Also inferential statistics are used to determine if the data gathered can be generalized from the sample to a larger group of subjects or the entire population. Visual display of data The purpose of a graph is to visually display the data in a form that allows the observer to draw conclusions about the data. The reader is responsible for evaluating the accu- racy and truthfulness of graphic representations of the data. A lack of a well-defined zero point makes small differences look bigger by emphasizing only the upper portion of the scale. It is proper to start at zero, break the line up with two diagonal hash marks just above the zero point, and then continue from a higher value (as in Fig. This still exaggerates the changes in the graph, but now the reader is warned and will consider the results accordingly. Lack of pro- portionality, a much more subtle technique than lack of a well-defined zero, is also improper. It serves to emphasize the drawn-out axis relative to the other less drawn-out axis. This visually exaggerates smaller changes in the axis that is drawn to the larger scale (Fig. Therefore, both axes should have their vari- ables drawn to roughly the same scale (Fig. This makes the change in mean final exam scores appear to be much greater (relatively) than 80 they truly are. Although the change in mean final exam scores still appears to 80 be relatively greater than they truly are, the reader is notified that this distortion is occurring. This consists of the use of three-dimensional shapes to demon- strate the difference between two groups, usually the effect of a drug on a patient outcome. One example uses cones of different heights to demonstrate the dif- ference between the endpoint of therapy for the drug produced by the company and its closest competitor. Visually, the cones represent a larger volume than sim- ple bars or even triangles, making the drug being advertised look like it caused a much larger effect. This makes it appear as if the change in mean 80 final exam scores occurred over a much shorter time period than in reality. The stem is made up of the digits on the left side of each value (tens, hundreds, or higher) and the leaves are the digits on the right side (units, or lower) of each number. Let’s take, for example, the following grades on a hypothetical statistics exam: Review of basic statistics 97 Fig. In creating the stem-and-leaf plot, first list the tens digits, and then next to them all the units digits which have that ‘tens’ digit in common. This can be rotated 90◦ counterclockwise and redrawn as a bar graph or his- togram. The x-axis shows the categories, the tens digits in our example, and the y-axis shows the number of observations in each category. The y-axis can also show the percentages of the total that each observation occurs in each category. This shows the relationship between the independent variable, in this case the exam scores, and the dependent variable, in this instance the number of students with a score in each 10% increment of grades. As a rule, the author should attempt to make the contrast between bars on a histogram as clear as possible.

Examination shows increased muscle tone in the upper extremities that is greater on the right than on the left cheap avana 100 mg line. Which of the following is the most likely explanation for this patient’s symptoms? A 47-year-old man comes to the physician because of a 4-week history of increased thirst and urination order avana 50 mg free shipping. Which of the following is the most likely underlying cause of this patient’s increased serum glucose concentration? A previously healthy 39-year-old woman is brought to the physician because of a tingling sensation in her fingers and toes for 2 days and rapidly progressive weakness of her legs cheap avana 200 mg on line. A previously healthy 77-year-old woman who resides in a skilled nursing care facility is brought to the emergency department 6 hours after the onset of acute midback pain that began while lifting a box purchase 100mg avana visa. In addition to treating the pain cheap avana 50mg visa, supplementation with which of the following is most likely to improve this patient’s underlying condition? A 52-year-old woman comes to the physician because of a 3-month history of diarrhea and intermittent abdominal pain that radiates to her back. A 67-year-old woman comes to the physician because of an 8-month history of progressive shortness of breath. The shortness of breath initially occurred only with walking long distances but now occurs after walking ¼ mile to her mailbox. She has had no chest pain, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Breath sounds are decreased, and faint expiratory wheezes are heard in all lung fields. A 22-year-old woman comes to the physician because of a 10-day history of pain in multiple joints. She first had pain in her right elbow, and then her right shoulder, and now has pain, redness, and swelling in her left knee that began 2 days ago. She is sexually active, and she and her partner use condoms for contraception inconsistently. Examination of the left knee shows warmth, erythema, tenderness, and soft-tissue swelling. The remainder of the examination, including pelvic examination, shows no abnormalities. Arthrocentesis of the knee joint yields 10 mL of cloudy fluid with a leukocyte count of 18,300/mm3 (97% segmented neutrophils). Microscopic examination of the leukocytes within the joint fluid is most likely to show which of the following? A 47-year-old woman comes to the physician for a routine health maintenance examination. The most appropriate recommendation is decreased intake of which of the following? A 32-year-old man comes to the physician because of a 12-day history of abdominal cramps and bloating, diarrhea, and flatulence. He says that he started a new exercise program 2 weeks ago and has been consuming a high quantity of yogurt bars, peanut butter, and protein- and calorie-enriched milk shakes to “bulk up. A 22-year-old college student comes to student health services because of a 7-day history of low-grade fever, sore throat, fatigue, and general malaise. One month ago, she had a painless vulvar ulcer that resolved spontaneously; she has been otherwise healthy. She is sexually active and has had three partners since the age of 15 years; she uses an oral contraceptive. Examination shows a rash over the palms and soles and mild cervical lymphadenopathy. D - 96 - Obstetrics and Gynecology Systems General Principles, Including Normal Age-Related Findings and Care of the Well Patient 1%–5% Pregnancy, Childbirth, & the Puerperium 40%–45% Preconception counseling and care Prenatal risk assessment/prevent Supervision of normal pregnancy Obstetric complications Labor and delivery Puerperium, including complications Newborn (birth to 4 weeks of age) Congenital disorders, neonatal Adverse effects of drugs on pregnancy, childbirth, and the puerperium Systemic disorders affecting pregnancy, labor and delivery, and the puerperium Female Reproductive System & Breast 40%–45% Normal processes, female function (eg, ovulation, menstrual cycle, puberty) Breast: infectious, immunologic, and inflammatory disorders Neoplasms of breast Female reproductive: infectious, Immunologic, and inflammatory disorders Neoplasms of cervix, ovary, uterus, vagina, and vulva Fertility and infertility Menopause Menstrual and endocrine disorders Sexual dysfunction Traumatic and mechanical disorders Congenital disorders Adverse effects of drugs on the female reproductive system and breast Endocrine System 1%–5% Other Systems, including Multisystem Processes & Disorders 5%–10% Social Sciences 1%–5% Communication and interpersonal skills Medical ethics and jurisprudence Physician Task Applying Foundational Science Concepts 8%–12% Diagnosis: Knowledge Pertaining to History, Exam, Diagnostic Studies, & Patient Outcomes 45%–50% Health Maintenance, Prevention & Surveillance 13%–17% Pharmacotherapy, Intervention & Management 20%–25% Site of Care Ambulatory 70%–75% Emergency Department 5%–10% Inpatient 15%–20% - 97 - 1. A 57-year-old woman comes to the physician 1 week after noticing a mass in her left breast during breast self-examination.

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Series editors: Heather MacKay (Chair of Ramsar Scientific & Technical Review Panel) purchase 100mg avana free shipping, Max Finlayson (former Chair of Ramsar Scientific & Technical Review Panel) order avana 200mg on line, and Nick Davidson (Deputy Secretary General purchase avana 50mg fast delivery, Ramsar Convention Secretariat) purchase 100 mg avana with visa. Ramsar Technical Reports are designed to publish purchase avana 50 mg with amex, chiefly through electronic media, technical notes, reviews and reports on wetland ecology, conservation, wise use and management, as an information support service to Contracting Parties and the wider wetland community in support of implementation of the Ramsar Convention. When resources permit, they are also published in French and Spanish, the other official languages of the Ramsar Convention. The views and designations expressed in this publication are those of its authors and do not represent an officially-adopted views of the Ramsar Convention. Reproduction of material from this publication for educational and other non-commercial purposes is authorized without prior permission from the Ramsar Secretariats, providing full acknowledgement is given. Where to go for Further Assistance and Advice 309 Appendices 315 iii Foreword Perhaps there are no better settings to illustrate the importance of a ‘One World, One Health’ approach than within wetlands. Well functioning wetlands provide the services, resources and means by which people, livestock and wildlife can remain healthy. The health of these sectors cannot be viewed independently as complex interactions and their interdependence means that the health of one affects the health of the others. This Manual addresses that request and provides wetland managers and other wetland stakeholders with a better understanding of their key role in health management in wetlands. Anada Tiéga Secretary General Ramsar Convention on Wetlands iv Preface When confronted by a disease outbreak in a wetland, a problem analysis almost always tracks back ‘upstream’ and finds an anthropocentric reason – land use, pollution, abstraction, livestock, introduced species, or such like. It becomes easy to see that decisions made about the management of a wetland hold the key to disease prevention and thus that the wetland managers are the holders of this key. They, together with the decision makers, are the ones who can make a difference to health in wetlands. But do these personnel have the understanding of how to do the right thing for disease prevention and control? And do they understand the importance of the complex interactions between humans, their livestock and wildlife when managing health in wetland ecosystems? The request for further guidance on animal diseases in wetlands came from the Tanzanian delegate speaking on behalf of the Africa Region. Coincidence or otherwise, it was a Tanzanian wildlife manager responsible for one of the planet’s high profile protected areas who said, following a taught module on wildlife health, that he “hadn’t thought about wildlife in that way before” and that he would “make practical changes and do things differently”. To try to better understand the nature of guidance needed for wetland health management, we conducted a needs survey of wetland professionals - there was a clear desire for practical guidance. Although designed for wetland managers, it was difficult to know just how to pitch this Manual given the enormous range of personnel responsible for managing wetlands across the world. We hope it is helpful and provides the wetland manager with some insight and a practical manual to help to “do things differently”. The Manual highlights the importance of including disease prevention and control in wetland management plans and provides guidelines on how to 1 do so. This Manual draws on a range of primary sources – interpreting and re-packaging the information for the wetland manager and the wetland policy maker. This Manual is not intended as in-depth technical guidance for dealing with specific disease issues, but as a primer describing the key components of disease prevention and control strategies and directing the reader to the primary sources, where more information can be obtained. The Manual is divided into five chapters accompanied by this Overview and a selection of Appendices ►Figure 0-1. Summary of the contents of each chapter of this Manual 1 Introduction A general introduction to animal diseases in wetlands – what they are and why they are a growing problem. A summary of the impacts of wetland disease on biodiversity, livestock and human health and its economic implications. Management in A look at the disease relationship between wildlife, livestock and Wetlands humans. A summary of current strategies for managing animal diseases in wetlands, including proactive strategies for preventing disease and reactive strategies for controlling disease. An introduction to the role of communication, education, participation and awareness in disease management. Management Guidance on how to incorporate disease management into Practices management plans for wetlands. Case studies: Descriptions and photos of wetland managers’ experiences responding to disease problems. Concern in Key questions to ask when a disease is detected: geographic Wetlands extent, wetland characteristics, host range, seasonality, transmission, field signs and potential impacts.

Affecting water quality by causing oxygen depletion from respiration and bacterial degradation order avana 200mg amex, and blocking of sunlight purchase avana 50 mg. This may appear in conjunction with occurrence of a marine reddish/orange tide or freshwater bloom (which initially appear green and may later turn blue sometimes forming a scum/foam in the water) generic avana 50mg mastercard. Signs such as irritation of the skin avana 100mg otc, vomiting discount avana 200 mg on line, paralysis, lethargy and loss of muscle co-ordination may be observed in birds. Not all toxic algal blooms are visibly noticeable and so a sample of organisms from the bloom may be useful or necessary for diagnosis. Recommended action if Contact and seek assistance from animal and human health professionals suspected immediately if there is any illness in birds, fish, marine mammals and/or people. Diagnosis Confirmative diagnosis is difficult and relies on circumstantial evidence and supportive clinical and pathologic findings. There are also currently no established toxic thresholds for wildlife species and even when these exist it may be difficult to assess their significance. Collect samples during the die-off event as soon as possible after carcases are found. Contact a diagnostic laboratory for advice on appropriate sample collection and transport. Plants such as reeds and willow, and constructed treatment wetland systems can remove sediments and pollutants especially in places which release high volumes of nutrients, such as animal and human sewage outlets. Monitoring and surveillance Careful monitoring and early detection of potentially toxic algal blooms could allow time to initiate actions to prevent or reduce harmful effects e. Monitor for changes in nutrient load of water discharges, particularly sewage discharges (including septic tanks and cesspits) and agriculture. Patrol to observe and map discoloured water or dead fish for early detection of potentially toxic algal blooms. Humans Do not fish in an algal bloom/discoloured water and never eat fish which are dead when caught. When swimming, look for warnings of algal blooms and avoid swimming if you cannot see your feet when the water level is at your knees. Ingestion of toxin may not cause mortality but have other less obvious physiological effects such as affecting immune, neurological and reproductive capability. Effect on livestock Mostly not harmful unless ingested through eating contaminated seafood/fish, drinking contaminated water or licking their coats following exposure to the skin. Effect on humans Mostly not harmful unless ingested through eating contaminated seafood/fish or drinking contaminated water. Some organisms irritate the skin and others release toxic compounds into the water and, if aerosolised by wave action, these compounds may cause problems when inhaled. Economic importance May have significant economic impacts on freshwater and marine aquaculture industries, fisheries and coastal tourism. In: Field manual of wildlife diseases: general field procedures and diseases of birds. Harmful algal blooms in coastal waters: options for prevention, control, and mitigation. Instituto Español de Oceanografía, Centro Oceanografico de Vigo, Cabo Estay-Canido, 36390 Vigo, Spain. Lead poisoning arises through the absorption of hazardous levels of lead in body tissues. Lead is a highly toxic poison which can cause morbidity and mortality in humans, livestock and wildlife. Waterfowl, birds of prey and scavenging birds are at greater risk of exposure to lead than other bird species and mammals due to feeding habits that involve ingesting lead gunshot as grit or consuming prey animals that have been shot with lead ammunition. Lead poisoning in waterbirds is a very serious and large-scale environmental problem. Birds can die from lead poisoning throughout the year but mortality is more likely after waterfowl hunting seasons. Lead exposure may also cause a variety of health effects in humans, particularly for children, foetuses and pregnant women. Species affected Many species of birds, particularly waterbirds, birds of prey, scavenging birds, and mammals. Any species using an area where shooting with lead ammunition occurs or has occurred previously is at some risk of exposure and, potentially, poisoning. Lead-based paint, mine wastes, lead contaminated industrial effluents and other objects provide additional sources of contamination.

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