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By: John Alexander Bartlett, MD

  • Professor of Medicine
  • Director of the AIDS Research and Treatment Center
  • Research Professor of Global Health
  • Professor in the School of Nursing
  • Affiliate of the Duke Initiative for Science & Society
  • Member of the Duke Cancer Institute

https://medicine.duke.edu/faculty/john-alexander-bartlett-md

Clear evidence of awareness of spelling and punctuation rules medications zovirax 200 mg prometrium overnight delivery, but misformed words may occur in most sentences symptoms kidney pain proven 200 mg prometrium. A2/B1 A2 Is able to medicine 75 yellow purchase prometrium 100 mg online make simple independent sentences with a limited number of underlying structures treatment yellow tongue order 100mg prometrium otc. Vocabulary is made up of very frequent words but has sufficient words and phrases to get across the essentials of the message. A1/A2 Can adapt and build on to a few learnt patterns to make a series of short and simple sentences. This may be a short description or set of related facts on a very familiar personal theme. Can use some words which may resemble L1, but on the whole the message is recognisable to a reader who does not know the L1. A1 Can write a small number of learnt words and fixed phrases in an easily recognisable way. It provides practical advice and materials for carrying out central aspects of formative assessment, such as target setting, self assessment, teacher feedback and sharing learning objectives. This book offers concrete, copy-ready tasks for the assessment of a wide range of aspects of language learning. She gives detailed exemplification and advice on many aspects of assessment, and highlights issues which need further investigation. A conceptual framework of convergent and divergent assessment is offered, with practical classroom implications. R (98) 6 of the Committee of Ministers to Member States Concerning Modern Languages. The assessment of the English ability of young learners in Norwegian schools: an innovative approach. Language learner autonomy and the European Language Portfolio: Two L2 English examples. Its aim is to gauge and advance the learning potential of individual learners and to devise appropriate educational strategies. I will consider some criticisms that have been raised from psychometric perspectives, and I will discuss fundamental differences with similar types of assessment. Vygotsky called for a change from symptomatic assessment, which focuses on present behavior of a particular developmental stage, to diagnostic assessment, which focuses on future behavior and on developing recommendations to foster development (Minick, 1987). He was mostly concerned with qualitative assessment of psychological processes and the dynamics of their development. Since then it has continued to be mainly applied to the assessment of cognitive development potential by psychologists. First, traditional testing may fail to capture the level of cognitive development of learners from dissimilar cultural backgrounds. Second, the focus of assessment should be not only what learners can do now, but also what they may be able to do tomorrow. Third, assessment should be integrated with intervention and should have selecting or modifying intervention as a goal. Any assessment format may be dynamic so long as mediation is included in the assessment procedure (Lantolf and Thorne, 2006). Interventionist studies follow a test­intervene­retest format and thus tend to focus on quantitative results of the intervention while interactionist studies rely on qualitative analysis and interpretation of key features of the interaction blending learning and assessment. Interventionist approaches may be more appropriate when applied to large groups while an interactionist approach may be more useful in a classroom situation. Procedurally, interventionist approaches are carried out following what has been called the sandwich format or the cake format. First, the learner is tested in order to establish the level of independent performance. Second, there is an intervention in the form of teaching what is included in the test. In the final stage, the learner is tested again to assess the degree and the nature of the change. Intervention (second stage) follows a predetermined script and thus the procedure is standardized.

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The importance of these studies lies not only in the field of human parasitology but also in the more general field of parasitology concerned with the transmission of parasites between different animal species and the importance of predator-prey relationships in such transmission medicine abuse generic 100 mg prometrium overnight delivery. There are good accounts of the history of trichinosis by Bundy and Michael (31) symptoms xylene poisoning prometrium 100mg otc, Foster (89) medications by mail buy prometrium 100mg without prescription, and Grove (105) treatment tracker prometrium 100 mg lowest price. Strongyloides and Strongyloidiasis Humans are hosts to two species of Strongyloides, S. Its life cycle is more complex than that of any of the other nematodes discussed so far and involves both parasitic and free-living generations. Adult parthenogenic female worms in the small intestine lay eggs that hatch within the host to produce first-stage larvae, which are passed out in the feces and adopt a free living existence in the soil. Here they molt to produce infective larvae that penetrate the skin and are carried around the body to the lungs and are swallowed and reach the gut in the same way as hookworms. Sometimes the larvae mature to the infective stage in feces on the skin and reinfect the host through the skin (autoinfection), or the larvae may mature to the infective stage without leaving the gut and penetrate the gut wall. In immunosuppressed individuals, larval stages can be found throughout the viscera. Given the absence of eggs and the small size of the larvae, combined with confusion with other free living species of nematodes, it is not surprising that S. Normond later found adult worms and, not knowing what they were, sent them to Professor Arthur Rene Jean Baptiste Bavay ґ ґ at the French Conseil Superieur de Sante, who realised that ґ ґ they were the adult worms of the larvae that were found in the feces (15). In 1883 the distinguished German parasitologist Karl Georg Friedrich Rudolf Leuckart discovered the alternation of generations involving parasitic and free-living phases (157). The discovery that infection occurred through the skin was made by a Belgian physician, Paul Van Durme, whose studies were based on the work of Looss, mentioned above, who had shown that A. Friedrich Fulleborn, working with dogs in Hamburg, described the pheЁ nomenon of autoinfection and discovered how S. Strongyloides infections and strongyloidiasis are not well covered in the literature, but there is a good account by Grove (105). Dracunculus and Dracunculiasis (Guinea Worm Disease) the best-documented parasitic disease known from the earliest times is undoubtedly that caused by the nematode worm Dracunculus medinensis. Adult worms live in subcutaneous connective tissue, from which the female worm emerges to release thousands of larvae into water, where they are eaten by intermediate hosts, cyclopodid crustaceans, in which they mature into infective larvae that infect humans when the crustaceans are accidentally swallowed with drinking water. The large female worm, up to 80 cm in length, protrudes from the skin, usually of the leg, and causes intense inflammation and irritation, signs that are so unusual and unambiguous that ancient texts can be interpreted with some certainty. This interpretation is widely accepted by most parasitologists (89, 105, 121, 251), but there are difficulties in interpreting this particular text since the word aat may simply mean a swelling (205). Nevertheless, confirmation of the presence of this worm in ancient Egypt comes from the finding of a well-preserved female worm and a calcified worm in Egyptian mummies (205). Because there is reference to "Medina vein" in the Arab literature, some historians have suggested that the Arab physicians may have thought that the worm was actually a rotten vein, but most informed observers now agree that the Arab physicians were fully aware of the worm-like nature of dracunculiasis but not necessarily the actual cause of the disease (105, 251). In 1674, Georgius Hieronymus Velschius initiated the scientific study of the worm and the disease it caused (263), and in 1819, Carl Asmund Rudolphi discovered adult female worms containing larvae (234), a discovery that was followed up in 1834 by a Dane known only as Jacobson (128). Forbes, a British army officer serving in India, found and described the larvae of D. It was not until 1870 that the whole life cycle, including the stages in the crustacean intermediate host, was elaborated by the Russian Alekej Pavlovitch Fedchenko (80, 136). There are more detailed accounts of the history of Dracunculus by Foster (89), Grove (105), and Tayeh (251). Filarial Worms and Lymphatic Filariasis (Elephantiasis) Lymphatic filariasis is caused by infection with the nematode worms Wuchereria bancrofti, Brugia malayi, and B. The discovery of the life cycle by Patrick Manson in 1877 is regarded as one of the most significant discoveries in tropical medicine, but in the context of the history of parasitology it is better perceived as a logical extension of much that had gone before. Like Dracunculus, the adult filarial worms live in subcutaneous tissues, but unlike Dracunculus, the larvae, called microfilariae, produced by the female worm pass into the blood and are taken up by a bloodsucking mosquito when it feeds. After development in the mosquito, the microfilariae are injected into a new host when the mosquito feeds again. One particular form of the disease that must have attracted the attention of our ancestors is elephantiasis, which is characterized by grotesque swellings of the limbs, breasts, and genitals. These deformities appear to have been described and depicted in drawings from the earliest times, but the interpretation of the early records must be viewed with caution (199).

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At the end of the sessions medicine ball exercises cheap prometrium 100 mg with visa, the initial assessment was given to symptoms in early pregnancy purchase 100mg prometrium with mastercard the learners followed by two transcendence assessments that required learners to treatment concussion buy 200mg prometrium visa transfer and to medications and mothers milk cheap prometrium 200mg visa apply the concepts learned to different tasks. Mediation during transcendence sessions demonstrated differences between learners that were not apparent in assessment sessions, thus providing a richer picture of the level of development attained by the learners in the study. As illustrated below, one of the learners ("D"onna) had internalized her conceptual understanding of tense/aspect, through previous interactions, to a degree that allowed her to function almost independently in the transcendence session. Transcendence occurred not only in the performance of different tasks but also from one linguistic feature to another. In this particular case, the learner was able to transfer internalization of tense/aspect differences between passй composй and imparfait to the past perfect. During the intervention section, mediation revealed two main problems in comprehending the oral test. One was the inability to recognize words that they knew and could use in oral production. Learners encountered phonological, lexical, and cultural difficulties in different degrees. Learners required different degrees of mediation in terms of the number of times they needed to listen to the text as well as the number and explicitness of hints required. Thus, even when learners are seemingly at the same level, mediation uncovers important differences in their abilities and potential for learning. Instead, implicit strategies increased in use, for instance, eliciting student answers and comprehension checks. First, following Aljaafreh and Lantolf (1994), learners revised their compositions individually albeit in the presence of the evaluator. Further revisions were allowed by consulting cultural artifacts such as a dictionary and a grammar reference. Finally, learners were able to ask the evaluator specific questions about their compositions. Interestingly, independent revisions as well as revisions mediated by cultural artifacts were common and equally effective in improving the quality of the writing. Those students who were unable to improve their compositions with the mediational tools available would call attention to themselves as needing more explicit mediation. During one section of the oral assessment, a story narration, the evaluator intervened providing opportunities to make corrections and to add details. Qualitative analysis of the interaction between the examiner and the learner during the narrative task revealed important differences among learners regarding their control of verbal tense and aspect, which had not been apparent during the initial independent narration. The results of the diagnostic assessment are presented qualitatively, in addition to a numerical score, and future recommendations for improvement, derived from the qualitative assessment report, are provided for each learner. Students complete the exam one page at a time providing an individual response, a pair response and a group response, the two last responses involving negotiation among learners. Points are assigned for each, and students receive a combined score for their individual and negotiated responses with 113 Marta Antуn Table 7. Si hay un verbo que no recuerdas estб bien (Do you want to try again using the past? Bueno, ellos estaban en Toledo, ellos estaban mirando la casa del Greco, y probablemente compraban. However, there were remaining concerns regarding the ability to assess state standards at the individual level, time restrictions regarding individual assessment, and mediating sessions. Motivated by the question of how the teacher may organize the social environment of learning and concerned with the feasibility of conducting mediation sessions within the classroom, Guk and Kellogg (2007) proposed that learners trained by the teacher act as mediators during group work learning tasks. These differences point at an asymmetrical scaffolding orientation in the construction of grammar in teacher-student interaction as opposed to an orientation towards the co-construction of discourse in student-student interaction. Central to this idea is the view of the class, not as an aggregate of individuals, but a socially constructed entity. An important point made in this study is that cohesion is not a characteristic of the group itself; rather, it is a feature of an activity. Cohesion emerges in a particular activity when the goals, orientation and responsibilities of individuals come together. In the examples of classroom interaction provided in the study, one of the teachers showed intentionality by planning her feedback and keeping track of the degree of explicitness provided to learners during whole-class interaction. Lund (2008) argued in favor of shifting "the locus of assessment from the individual to the intersection of the individual and the collective, mediated by cultural tools" (p.

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Shell:-Thick symptoms valley fever buy cheap prometrium 200 mg on line, Smooth symptoms quit drinking cheap prometrium 100 mg on-line, brown medicine to induce labor generic prometrium 200mg overnight delivery, radially straited (embryophore) Content: - A round granular mass enclosed by a fine membrane with six hooklets Stains red (acid fast) in Ziehl-Neelsen staining technique medications removed by dialysis prometrium 100mg with mastercard, this character helps to differentiate from T. Egg(hexacanth embryolarva(Cysticercus bovis) Adult Parasitology 119 Man acquires infection from raw or under cooked infected meat. Following ingestion, the larvae become attached to the wall of the small intestine with its suckers. Proglottides are formed from the neck region and the larvae grow into a long adult tapeworm. When fully developed the gravid segments become detached and the eggs are discharged only after the gravid segments have been separated from the worm. Gravid segments containing eggs and eggs from ruptured segments are passed in the faeces. The embryos escape from the eggs and pass through the intestinal wall into a blood vessel. Through the blood circulation they are carried to muscles and develop into infective cystic larvae called cysticercus bovis. TheScientific Book Center, Cairo) Parasitology 120 Pathogenicity: - Causes taeniasis Major symptoms are loss of appetite, weight loss, hunger, acute intestinal obstruction, eosinophilia, and discomfort by the crawling of segments through the anus. Avoid eating raw or insufficiently cooked meat which may contain infective larvae. Identifying gravid segments and scolex recovered from clothing or passed in faeces. Owing to the inherent problem of missing many infections during routine stool examination. Estimates made by different investigators of the prevalence Parasitology 121 of taeniasis in Ethiopia vary widely, from 2% -16% to over 70% (Kloos H et al, 1993, Yared M et al 2001). Taeniasis is so common in the country and the tradition of self-treatment is so well developed that most people do not use the health services for diagnosis and treatment. Instead, Ethiopians use about dozens of traditional plant medicines, including Kosso (Hagenia abyssinica). Enkoko (Embelia schimperi), and Metere (Glinus lotoides) upon noticing proglottids in the feces or when experimenting abdominal discomfort, usually every 2 months (Shibru T, 1986). Taenia solium (Pork tape worm) Geographical Distribution:-Widely distributed where human faeces reach pigs and pork is eaten raw or insufficiently cooked. Habitat: Adult: In the small intestine of man Larva: In muscular tissues of pig Egg: In the faeces of man and in gravid segment. Larvae:Known as Cysticercus cellulosae Found in skeletal and muscular tissues of pig Has four sucers, rostellum and two raws of hooklets Egg (embryophore): -morphologically identical with the egg of T. Size: - 31-43 (m Shape: -Round Colour:- Shell-dark yellowish-brown, content light yellowish gray. Shell: -Thick, Smooth, brown, radially straighten (embryophore) Content: - A round granular mass enclosed by a fine membrane with 6 hooklets. Does not stains red (acid fast) in Ziehl-Neelsen staining technique Life Cycle: the life cycle of T. Egg(hexacanth embryo) larva(Cysticercus cellulosae) Adult Parasitology 123 Man acquires infection from eating raw or under cooked pork that develops into adult in the intestine or from contaminated food or drink with faeces containing the eggs and develops into larval stage in visceral organs. Mode of Transmission can be Eating raw or under cooked pork meat Eggs in food or drink Internal autoinfections Pathology: Taeniasis and cysticercosis Major symptoms are as a result of the adult worm. These include abdominal pain, loss of appetite, and infection with larvae cause cystic nodules in subcutaneous and muscles. Treating infected person, providing health education and adequate sanitary facilities Laboratory Diagnosis 1. Detecting eggs in the faeces which is morphologically indistinguishable from the egg of Taenia saginata. Parasitology 124 Relevance to Ethiopia the parasite has not been reported from Ethiopia. Habitat: Adult: small intestine of man, rat and mice Cysticercoid larvae: in the intestinal villi of man, rat and mice. Eggs: In the faeces of man, rat and mice Morphology: Adult Size: 10-44 mm Scolex with 4 suckers, short retractile rostellum with single crown of hooklets. Stroblia: 100-200 proglottides, the size is inversely proportional to the number of worms present in the intestine of their host.

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Congenital Aniridia page 426 page 427 In this rare anomaly treatment gout trusted prometrium 100 mg, there is almost complete absence of the iris symptoms kidney disease buy 200mg prometrium amex. This defect results from an arrest of development at the rim of the optic cup during the eighth week medicine 3604 pill buy prometrium 100 mg low cost. These cells lengthen considerably to medications similar to vyvanse prometrium 100mg cheap form highly transparent epithelial cells, the primary lens fibers. Although secondary lens fibers continue to form during adulthood and the lens increases in diameter, the primary lens fibers must last a lifetime. Figure 18-10 Photomicrograph of a sagittal section of the eye of an embryo (Г-50) at Carnegie stage 23, approximately 56 days. The part of the hyaloid artery that supplies the tunica vasculosa lentis disappears during the late fetal period. The former site of the hyaloid artery is indicated by the hyaloid canal in the vitreous body (see. It is composed of vitreous humor, an avascular mass of transparent, gel-like, intercellular substance. Persistent Pupillary Membrane Remnants of the pupillary membrane, which covers the anterior surface of the lens during the embryonic period (see. Very rarely the entire pupillary membrane persists, giving rise to congenital atresia of the pupil; surgery is needed in some cases to provide an adequate pupil. Sometimes the hyaloid artery remnant may appear as a fine strand traversing the vitreous body. Congenital Aphakia Absence of the lens is extremely rare and results from failure of the lens placode to form during the fourth week. Congenital aphakia could also result from failure of lens induction by the optic vesicle. After the lens is established, it induces the surface ectoderm to develop into the epithelium of the cornea and conjunctiva. This imbalance may result from abnormal development of the scleral venous sinus (see. Many lens opacities are inherited, dominant transmission being more common than recessive or sex-linked transmission. The lenses are vulnerable to rubella virus between the fourth and seventh weeks, when primary lens fibers are forming. Cataract and other ocular abnormalities caused by the rubella virus could be completely prevented if immunity to rubella were conferred on all women of reproductive age. Treatment of cataracts requires surgery, typically at a very early age (younger than 4 months), to remove the damaged lens. More than 70% of patients with bilateral congenital cataracts can attain reasonable visual acuity. Extended treatment with refractive correction and additional surgery may be required. Figure 18-13 Bilateral congenital cataracts resulting from the teratogenic effects of the rubella virus. The cornea is formed from three sources: the external corneal epithelium, derived from surface ectoderm the mesenchyme, derived from mesoderm, which is continuous with the developing sclera Neural crest cells that migrate from the lip of the optic cup and differentiate into the corneal endothelium Integration link: Cornea - histology Edema of the Optic Disc the optic nerve is surrounded by three sheaths that evaginated with the optic vesicle and stalk; consequently, they are continuous with the meninges of the brain. The relationship of the sheaths of the optic nerve to the meninges of the brain and the subarachnoid space is important clinically. This occurs because the retinal vessels are covered by pia mater and lie in the extension of the subarachnoid space that surrounds the optic nerve. The sclera develops from a condensation of mesenchyme external to the choroid and is continuous with the stroma (supporting tissue) of the cornea. Toward the rim of the optic cup, the choroid becomes modified to form the cores of the ciliary processes, consisting chiefly of capillaries supported by delicate connective tissue. The first choroidal blood vessels appear during the 15th week; by the 23rd week, arteries and veins can be easily distinguished.

References:

  • https://books.google.com/books?id=S0usnJnJKjUC&pg=PA108&lpg=PA108&dq=Larynx+Cancer+.pdf&source=bl&ots=yx5350OmNb&sig=ACfU3U2ts60AvBgiZ_cEgwxQieFQuo4BHg&hl=en
  • http://www.rlandrews.org/pdf_files/handbk_of_enteralfeeding.pdf
  • https://diagnostics.roche.com/content/dam/diagnostics/Blueprint/en/resource-center/cps/Brochure%20HbA1c_scientific_discussion_paper_AND_variant_study.pdf