X
|
STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
|
Daniel J. Lenihan, MD
For example virus paralysis buy discount tinidazole 500 mg on-line, it is easier to believe that you will eventually find your soul mate when you have yet to have had a serious relationship antimicrobial ipad cover cheap tinidazole 500mg line. It may also be a chance to change directions antibiotics for uti yeast infection tinidazole 1000mg cheap, for those whose lives up to this point have been difficult antibiotics nursing considerations cheap tinidazole 300 mg with amex. The experiences of children and teens are influenced by the choices and decisions of their parents bacteria meaning generic 1000mg tinidazole with amex. They have the chance to transform their lives and move away from unhealthy environments antibiotic resistance from eating meat buy tinidazole 1000 mg otc. Even those whose lives were happier and more fulfilling as children, now have the opportunity in emerging adulthood to become independent and make decisions about the direction they would like their life to take. Consequently, Arnett reviewed results from the 2012 Clark University Poll of Emerging Adults, whose participants were demographically similar to the United States population. Results primarily indicated consistencies across aspects of the theory, including positive and negative perceptions 247 of the time-period and views on education, work, love, sex, and marriage. Two significant differences were found, the first being that emerging adults from lower socioeconomic classes identified more negativity in their emotional lives, including higher levels of depression. Secondly, those in the lowest socioeconomic group were more likely to agree that they had not been able to find sufficient financial support to obtain the education they believed they needed. Overall, Arnett concluded that emerging adulthood exists wherever there is a period between the end of adolescence and entry into adult roles, but acknowledging social, cultural, and historical contexts was also important. Cultural Variations the five features proposed in the theory of emerging adulthood originally were based on research involving about Americans between ages 18 and 29 from various ethnic groups, social classes, and geographical regions (Arnett, 2004, 2016). The rest of the human population resides in developing countries, which have much lower median incomes, much lower median educational attainment, and much higher incidence of illness, disease, and early death. The median ages for entering marriage and parenthood are near 30 in most European countries (Douglass, 2007). Europe today is the location of the most affluent, generous, and egalitarian societies in the world, in fact, in human history (Arnett, 2007). Governments pay for tertiary education, assist young people in finding jobs, and provide generous unemployment benefits for those who cannot find work. Emerging adults in European societies make the most of these advantages, gradually making their way to adulthood during their twenties while enjoying travel and leisure with friends. Like European emerging adults, Asian emerging adults tend to enter marriage and parenthood around age 30 (Arnett, 2011). Like European emerging adults, Asian emerging adults in Japan and South Korea enjoy the benefits of living in affluent societies with generous social welfare systems that provide support for them in making the transition to adulthood, including free university education and substantial unemployment benefits. In contrast, Asian cultures have a shared cultural history emphasizing collectivism and family obligations. Although Asian cultures have become more individualistic in recent decades, as a consequence of globalization, the legacy of collectivism persists in the lives of emerging adults. They pursue identity explorations and self-development during emerging adulthood, like their American and European counterparts, but within narrower boundaries set by their sense of obligations to others, especially their parents (Phinney & Baldelomar, 2011). For example, in their views of the most important criteria for becoming an adult, emerging adults Is your culture one that promotes romantic relationships for in the United States and Europe consistently emerging adults According to Rankin and Kenyon (2008), historically the process of becoming an adult was more clearly marked by rites of passage. However, these role transitions are no longer considered the important markers of adulthood (Arnett, 2001). Economic and social changes have resulted in more young adults attending college (Rankin & Kenyon, 2008) and a delay in marriage and having children (Arnett & Taber, 1994; Laursen & Jensen-Campbell, 1999) Consequently, current research has found financial independence and accepting responsibility for oneself to be the most important markers of adulthood in Western culture across age (Arnett, 2001) and ethnic groups (Arnett, 2004). These findings supported the view that people holding collectivist or more traditional values place more importance on role transitions as markers of adulthood. In contrast, older college students and those cohabitating did not value role transitions as markers of adulthood as strongly. The current trend is that young Americans are not choosing to settle down romantically before age 35. Since 1880, living with a romantic partner was the most common living arrangement among young adults. Another 14% of early adults lived alone, were a single parent, or lived with one or more roommates. The remaining 22% lived in the home of another family member (such as a grandparent, in-law, or sibling), a non-relative, or in group quarters. Comparing ethnic groups, 36% of black and Hispanic early adults lived at home, while 30% of white young adults lived at home. In 2014, 35% of young me were residing with their parents, while 28% were living with a spouse or partner in their own household. Young women were more likely to be living with a spouse or partner (35%) than living with their parents (29%). Additionally, more young women (16%) than young men (13%) were heading up a household without a spouse or partner, primarily because 250 women are more likely to be single parents living with their children. Lastly, young men (25%) were more likely than young women (19%) to be living in the home of another family member, a non-relative, or in some type of group quarters (Fry, 2016). First, early adults are postponing marriage or choosing not to marry or cohabitate. Lack of employment and lower wages have especially contributed to males residing with their parents. Wages for young men (adjusting for inflation) have been falling since 1970 and correlate with the rise in young men living with their parents. The recent recession and recovery (2007-present) has also contributed to the increase in early adults living at home. College enrollments increased during the recession, which further increased early adults living at home. However, once early adults possess a college degree, they are more likely to establish their own households (Fry, 2016). By the time we reach early adulthood, our physical maturation is complete, although our height and weight may increase slightly. Those in their early twenties are probably at the peak of their physiological development, including muscle strength, reaction time, sensory abilities, and cardiac functioning. The reproductive system, motor skills, strength, and lung capacity are all operating at their best. Most professional athletes are at the top of their game during this stage, and many women have children in the early-adulthood years (Boundless, 2016). For example, the lens of the eye starts to stiffen and thicken, resulting in changes in vision (usually affecting the ability to focus on close objects). Hair can start to thin and become gray around the age of 35, although this may happen earlier for some individuals and later for others. The skin becomes drier and wrinkles start to appear by the end of early adulthood. This includes a decline in response time and the ability to recover quickly from physical exertion. The immune system also becomes less adept at fighting off illness, and reproductive capacity starts to decline (Boundless, 2016). Obesity Although at the peak of physical health, a concern for early adults is the current rate of obesity. Results from the National Center for Health Statistics indicated that an estimated 70. The current statistics are an increase from the 2013-2014 statistics that indicated that an estimated 35. The average man in his 20s weighs around 185 pounds and by his 30s weighs approximately 200 pounds. The average American woman weighs 162 pounds in her 20s and 170 pounds in her 30s. This translates to 266 million obese men and 375 million obese women in the world, and more people were identified as obese than underweight. Societal factors include culture, education, food marketing and promotion, the quality of food, and the physical activity environment available. Behaviors leading to obesity include diet, the amount of physical activity, and medication use. Rather, research has identified variants in several genes that may contribute to obesity by increasing hunger and food intake. The genes that helped our ancestors survive occasional famines are now being challenged by environments in which food is plentiful all the time. Overall, obesity most likely results from complex interactions among the environment and multiple genes. Additionally, the medical care costs of obesity in the United States were estimated to be $147 billion in 2008. However, the top five causes of death in emerging and early adulthood are non-intentional injury (including motor vehicle accidents), homicide, and suicide with cancer and heart disease completing the list (Heron, & Smith, 2007). Rates of violent death (homicide, suicide, and accidents) are highest among young adult males, and vary by race and ethnicity. Rates of violent death are higher in the United States than in Canada, Mexico, Japan, and other selected countries. Males are 3 times more likely to die in auto accidents than are females (Frieden, 2011). Heavy drinking is defined as drinking five or more drinks on the same occasion on each of five or more days in the past 30 days. Nearly 88,000 people (approximately 62,000 men and 26,000 women) die from alcohol-related causes annually, making it the fourth leading preventable cause of death in the United States. In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31% of overall driving fatalities). This typically occurs after four drinks for women and five drinks for men in approximately two hours. In 2014, 25% of people ages 18 or older reported that they engaged in binge drinking in the past month. Over the long term, frequent binge drinking can damage the liver and other organs," (p. The role alcohol plays in predicting acquaintance rape on college campuses is of particular concern. Krebs, Lindquist, Warner, Fisher and Martin (2009) found that over 80% of sexual assaults on college campuses involved alcohol. Females are more likely to blame themselves and to be blamed by others if they were intoxicated when raped. College students view perpetrators who were drinking as less responsible, and victims who were drinking as more responsible for the assaults (Untied, Orchowski, Mastroleo, & Gidycz, 2012). These include the pervasive availability of alcohol, inconsistent enforcement of underage drinking laws, unstructured time, coping with stressors, and limited interactions with parents and other adults. Due to social pressures to conform and expectations when entering college, the first six weeks of Source freshman year are an especially susceptible time for students. Additionally, more drinking occurs in colleges with active Greek systems and athletic programs. Alcohol consumption is lowest among students living with their families and commuting, while it is highest among those living in fraternities and sororities. Interventions include education and awareness programs, as well as intervention by health professionals. At the college-level, reducing the availability of alcohol has proven effective by decreasing both consumption and negative consequences. Additionally, 25% of those who smoke cigarettes, 33% of those who smoke marijuana, and 70% of those who abuse cocaine began using after age 17 (Volkow, 2004). Emerging adults (18 to 25) are the largest abusers of prescription opioid pain relievers, anti-anxiety medications, and Attention Deficit Hyperactivity Disorder medication (National Institute on Drug Abuse, 2015). For those in college, 2014 data indicate that 6% of college students smoke marijuana daily, while only 2% smoked daily in 1994. For noncollege students of the same age, the daily percentage is twice as high (approximately 12%). Additionally, according to a recent survey by the National Institute of Drug Abuse (2018), daily cigarette smoking is lower for those in college in comparison to non-college groups (see Figure 7. Rates of violent death are influenced by substance use which peaks during emerging Source and early adulthood. Drugs impair judgment, reduce inhibitions, and alter mood, all of which can lead to dangerous behavior. Reckless driving, violent altercations, and forced sexual encounters are some examples. Drug and alcohol use increase the risk of sexually transmitted infections because people are more likely to engage in risky sexual behavior when under the influence. This includes having sex with someone who has had multiple partners, having anal sex without the use of a condom, having multiple partners, or having sex with someone whose history is unknown. Lastly, as previously discussed, drugs and alcohol ingested during pregnancy have a teratogenic effect on the developing embryo and fetus. Because gender is considered a social construct, meaning that it does not exist naturally, but is instead a concept that is created by cultural and societal norms, there are cultural variations on how people express their gender identity. For example, in American culture, it is considered feminine to wear a dress or skirt. However, in many Middle Eastern, Asian, and African cultures, dresses or skirts (often referred to as sarongs, robes, or gowns) can be considered masculine. Similarly, the kilt worn by a Scottish male does not make him appear feminine in his culture.
The Eboes (Ibos) were called jaundiced antibiotic lyme disease order 300mg tinidazole with mastercard, sickly bacterial skin infection generic 500 mg tinidazole, unattractive antibiotics causing diarrhea purchase 500mg tinidazole with mastercard, superstitious infection 0 mycoplasme proven tinidazole 300mg, lazy homemade antibiotics for acne buy tinidazole 300mg low cost, despondent antibiotic jeopardy tinidazole 1000mg without prescription, and prone to suicide. The profits from some voyages of the slave trade into the port at Charles Town must have been enormous to offset the losses caused by the various hazards, including disease, wars, storms, pirates, and mutinies. Graphic accounts of mutinies especially illustrate the ethnocentric viewpoint of white men and belie the conventional picture of docile black ones. Hundreds of such ads printed in the Charleston newspapers from 1733- 1807, provide one excellent source of data on the number and provenience of slaves imported into Carolina. The British Naval Office, responsible for the loading and unloading of vessels in the ports of the colonies in the eighteenth century, is another valuable source of information. Stationed at Charles Town, Georgetown and Port Royal, their record, in the elegant penmanship of the day, provides a unique insight into the commerce to and from the increasingly important colony of South Carolina. While many ships brought a few blacks from the West Indies, the record shows increasing shipments from "Africa" in large numbers. National Park Service D7 the Records of the Public Treasurers of South Carolina list the duty on blacks imported from 17351774 plus the captain of the ship, the agency or importer, the source of the shipment, and the number of slaves; and the manifests in the Records of the States contains similar information from 1784- 1787. No one source is complete, but through the use of all of them, with attention to dates, ships, captains, and origins, a fairly accurate picture can be constructed of the number of enslaved persons legally transported from eight coastal regions of Africa to Charles Town in three time periods. In the Early Period Angola contributed half of the 22,117 slaves imported, or three- fourths of those of known African origin. The numbers from Senegambia and from the Bight of Biafra are small, and those from other areas are negligible. In the Middle Period, however, when 63,210 people were imported into Charles Town from Africa, Senegambia was responsible for one- third of the slave trade of known origin. The Windward Coast made a substantial contribution at this time followed closely by Angola and then the Gold Coast. While the total trade tripled in this second half of the eighteenth century, the actual number from Angola decreased. The people from Senegambia increased ten fold as rice and indigo cultivation began to flourish in Carolina. The number from the Gold Coast, although half that from Senegambia, saw a thirteen- fold increase over the Early Period. In the four feverish years of the Final Period, the total number of Africans imported - - 29,461 - - far exceeded all those brought in the twenty- eight years of the Early Period, and is almost half the amount in the thirty- nine years of the Middle Period. Angola accounted for over half of the trade, followed by the Windward Coast and then by the Gold Coast, with lesser contributions from other regions. By summing the data of the three time periods, a picture of the total African slave trade to South Carolina alone appears (see "Map 5"). When 23,000, 20 percent of the total, who cannot be assigned to a particular coastal region are omitted, some 39 percent came from Angola which includes Congo, 20 percent from Senegambia, 17 percent from the Windward Coast, and 13 percent from the Gold Coast. The contribution from Sierra Leone is only 6 percent and that from the two Bights and from Madagascar and Mozambique even less. It is of interest to see if this distribution of people imported, 60 percent from West Africa and 40 percent from Central Africa, is reflected in the speech and behavior of the sea islanders. Role of the West Indies One third of the known slave trade between the Caribbean islands and Charles Town took place in the Early Period, two thirds in the flourishing Middle Period, and virtually none in the Final Period. Slaves brought from the British West Indies are important for their impact on the Sea Islands because of their ethnic origins. Although these migrants were already somewhat adapted to the dominant whites by "seasoning" for a few years in the islands, they nonetheless retained the language and customs of their African homeland. Of two million Africans brought to the British Caribbean, Jamaica and Barbados received the bulk; in the eighteenth century they re- exported one- fourth to the mainland. The ethnic composition of Africans imported into Jamaica and Barbados from 1662- 1713 shows emphasis upon the role of the Gold Coast and Benin; as the century progressed, Biafra had a greater share of the trade. Of the known British slave trade from 1700 through 1807, the Bight of Biafra contributed 37 percent and the Gold Coast 13 percent, together just half of the total. While direct importations from the Gold Coast are surprisingly modest in light of the known preference for these people in Carolina, they were thus greatly supplemented by those who came via the West Indies. To an even greater degree bondsmen from the Bights of Benin and Biafra, rare in the D8 Low Country Gullah Culture Special Resource Study direct trade, contributed indirectly via the Caribbean islands. The preponderance of the Bantuspeaking people from Congo and Angola in the Early Period, reinforced by vast numbers in later time, accounts for their influence in Carolina. But Senegambians, preferred by planters and dealers, came in sufficient numbers, especially in the Middle Period, 1749- 1787, to have a lasting effect. People from the Windward Coast also contributed appreciably in that Period as well as in the Final Period from 1804- 1807. The ban on the slave trade to Georgia, imposed with its settlement in 1732, was lifted in 1750, but far fewer Africans entered that colony than neighboring South Carolina. Until 1766 imports to Georgia were from the West Indies and other colonies, especially South Carolina. Of an estimated 6,539 from 1755 to 1798, 2,038, one- third, came from the Caribbean. Of 3,680 from a known region of Africa, 43 percent came from Gambia and 44 percent from Sierra Leone or the Windward Coast. There is much evidence that slaves were smuggled into Georgia illegally, especially from Congo and Angola, but also Ibos from the Bight of Biafra. Even in 1858 the ship Wanderer landed 400 Africans from the Congo, mostly boys between 13 and 18, on Jekyll Island. Many of them and their descendants remained in the area, but 120 were shipped up the Savannah River to Augusta, Georgia. Some, interviewed in 1908, displayed their filed teeth and their houses built of straw, and recalled the crops grown and the slavery and polygamy practiced in Africa. African Americans on the Georgia coast in the 1930s recalled people brought from Africa with "Golla" in their names. Slaves also entered Georgia by a semi- legal route, for Florida remained under the Spanish until ceded to the United States in 1819, and became a state only in 1845. It was thus possible for Africans, transported legally into Spanish Florida, to be brought over the border well after the slave trade officially ended in 1808. Memories of Africa, including recollections of the Moslem religion, survived in Georgia into the twentieth century. African retentions may have been strongest on the Georgia coast because of later reinforcements both directly and indirectly via Florida. The slave trade brought not only people, but also parasites: deadly malignant tertian (falciparum) malaria, yellow fever, smallpox, and a host of worms. The mosquito- ridden Low Country allowed them to survive and work while whites fled to higher ground from May to October. Respiratory ailments, like pneumonia, hit them hardest, and whooping cough, diphtheria, and measles also took a deadly toll. Members of a homogeneous group who came to an area first and in large numbers had an opportunity to establish their common speech and culture; those who followed in the same area, especially if they came in modest numbers over time, were compelled to adjust to the earlier ethnic group, as well as to whites. Although planters recognized different tribes, they blended them to make a homogeneous work force and obscure these distinctions. Africans who arrived in Carolina and Georgia brought with them attributes of biology, culture, and language that reflected their homeland. What was retained into modern times was dependent not only on the genes, physique, customs, and speech of the areas of Africa from which they came, but also upon the numbers from different tribes, their time of arrival, whom they encountered along the way, and those they met on American shores. Moreover, the prevalence, strength, and utility of different attributes affected their survival. Beliefs, practices, skills, crafts, and speech of the Gullah, like the human body, are more than retention of those traits in Africa, but rather an adaptation over time that led through creolization to a distinctive society on the Sea Islands. By 1740 it was almost 40,000 while the white population was 20,000, a ratio of two to one, fed both by natural increase and the ever- growing slave trade. By the 1770s half of the black population lived on big plantations where they vastly outnumbered whites, further promoting their isolation. From that year to the Civil War, the slave population of the state almost quadrupled to 402,400. The increase in the number of Africans, their concentration in rural area, the severity of slave codes, and the social alienation from whites produced an isolation and bond of brotherhood among the Gullah people. Yet miscegenation did occur, proven by history and by the census data on mulattoes. The rise of "free persons of color," usually mulattoes, made an important contribution to Low Country society. In 1790 there were 1,801; by 1820 they had quadrupled to 6,826, most within the city of Charleston. They made a distinctive minority, talented craftsmen essential to the business of the community. After federal forces took over Beaufort and the neighboring islands, white planters fled and slaves came under the military. Newly emancipated blacks expressed an intense desire to remain in places of their former servitude; many purchased land to which they became emotionally and economically attached. Missionaries and teachers who flocked to the area to help, also reported to a wider world the music, folklore, customs, arts, crafts, beliefs, and language of the Gullah. Their efforts at education proved successful, helped to preserve their culture, and left a continuing legacy. The sea island people continued their isolation and way of life well into the twentieth century. For all of its tragedy, the slave trade did bring with it benefits: useful plants and healing herbs that fed the economy and aided health. Chapter 3 Trans Plants and the Economy "Thank Him who placed us here beneath so kind a sky. The story of agriculture and economics in coastal South Carolina is the story of black labor. Exploration of crops grown and their origin provides one further clue to the source of specific people from Africa, where they went in Carolina, and why. It also dramatically illustrates the adaptation of their work patterns to a different environment, a re- creation of something new that arose in America from the interaction of African and English culture, called creolization, a term borrowed from linguistics. Already acclimated to the heat, humidity, and luxuriant vegetation of subtropical Carolina, blacks were better equipped than whites to face the rigors of the frontier. They used their talents well in fields and streams; one man with gun and net could bring in as much food as five families could eat. From earliest days one natural product was available in abundance to convert into profits, the forest itself. Wood was used for the construction of houses, the building of ships, and the making of barrel staves. The needs of the British navy were also fulfilled in naval stores derived from the plentiful pine trees: tar, pitch, resin, and turpentine. With the clearing of the forests more land was available for another major industry, cattle raising. The mild climate, combined with abundant foliage, caused the multiplication of the animals at a remarkable rate. Soon the leather from cowhides supplemented the skins from deer and other wild animals as valuable exports from the young colony. D10 Low Country Gullah Culture Special Resource Study Here especially the skills of blacks proved vital to the economy, for they were employed in the herding of live stock. Many Africans, especially the Fulani from Gambia, had had experience in tending cattle in their homeland. The term "cow- boy" first came to be used in coastal Carolina at the beginning of the eighteenth century for one who tends cows, just as "house- boy" was used for one who keeps the house. The Africans taught the Englishmen open grazing in contrast to their custom of raising small herds confined to small pastures, although Spanish to the south also influenced the practices of the Carolina settlers. People from specific areas of Africa were preferred for particular occupations, often on the basis of their native skills. Thus, Wolofs and other Senegambians were favored as house servants, along with Yoruba and Dahomeans. Bambara and Malinke from the western bulge and Pawpaws and Coramantees from the Gold Coast area were sought as artisans. Senegambians, thought to have Arabic admixture, were valued as blacksmiths, skilled in the working of both metal and wood. Mande people worked as rowers, transporting supplies and crops along the waterways of Carolina as they had done for ages along the rivers of Senegal and Gambia. The Bantu- speaking Angolans, along with the Ibo and related people of Calabar, were more often employed as field hands. Three crops that thrived in the sandy soil of the Low Country required ever more African laborers and enriched their white masters. Henry Woodward on a ship from Madagascar about 1685, Carolina Gold Rice, a new grain adaptable to wet cultivation, began. By 1700 more rice was produced in the colony than there were ships to transport it. In 1850, 257 plantations along ten rivers of the state produced an astounding 159,930,613 pounds or nearly 80,000 tons of rice. In 1860, nine of the fourteen slaveholders in the United States owning more than 500 slaves were rice planters. In the early years of the colony, rice was grown on inland swamps, a hazardous procedure because the valuable crop could be lost by either too much water or too little. Then planters learned to utilize the timbered swamps that bordered fresh- water tidal rivers such as the Waccamaw, Pee Dee, Santee, Cooper, Edisto, and Combahee, where tides were utilized in the cultivation of the grain. During the first half of the eighteenth century, three to four acres of rice per hand were produced by the older method; after tidal culture became the norm one man could handle up to seven acres. Duncan Clinch Heyward, who grew rice himself along the Combahee River just as his great grandfather had done, wrote of the cultivation of the grain in Seed from Madagascar. He speculated that the manner of cultivation came from China, based on pictures he had seen of rice production there: the plowing of the fields with black water buffalo, the sowing of seed broadcast on the water, and the transplanting of rice by hand in the fields.
Purchase tinidazole 300mg online. CHOICE OF ANTIMICROBIAL AGENTS PART-1 USMLE/NEET PG/DNB CET.
Flavonoids (Methoxylated Flavones). Tinidazole.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=97032
Red flags include bacteria you can eat 500 mg tinidazole mastercard, but are not limited to infection years after hip replacement order tinidazole 500mg without a prescription, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected antimicrobial bandages buy tinidazole 1000 mg with mastercard. Imaging of the lower spine before six weeks does not improve outcomes win32 cryptor virus purchase 300 mg tinidazole visa, but does increase costs virustotal purchase tinidazole 1000mg mastercard. Symptoms must include discolored nasal secretions and facial or dental tenderness when touched how quickly do antibiotics for uti work purchase tinidazole 500mg on-line. Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis. There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost. Pap smears are not helpful in women after hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes. Delivery prior to 39 weeks, 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks and 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery. Health care clinicians should discuss the risks and benefits with their patients before considering inductions of labor without medical indications. There is good evidence that for adult patients with no symptoms of carotid artery stenosis, the harms of screening outweigh the benefits. Screening could lead to non-indicated surgeries that result in serious harms, including death, stroke and myocardial infarction. There is adequate evidence that screening women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk provides little to no benefit. The harms include more frequent testing and invasive diagnostic procedures such as colposcopy and cervical biopsy. Abnormal screening test results are also associated with psychological harms, anxiety and distress. The "observation option" refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. To observe a child without initial antibacterial therapy, it is important that the parent or caregiver has a ready means of communicating with the clinician. There is no good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. The potential harms of screening and treating adolescents include unnecessary follow-up visits and evaluations due to false positive test results and psychological adverse effects. Data do not support the necessity of performing a pelvic or breast examination to prescribe oral contraceptive medications. Hormonal contraception can be safely provided on the basis of medical history and blood pressure measurement. The goal was to identify items common in primary care practice, strongly supported by the evidence and literature, that would lead to significant health benefits, reduce risks and harm, and reduce costs. A working group was assembled for each of the three primary care specialties; family medicine, pediatrics and internal medicine. The original list was developed using a modification of the nominal group process, with online voting. The literature was then searched to provide supporting evidence or refute the activities. The field testing with family physicians showed support for the final recommendations, the potential positive impact on quality and cost, and the ease with which the recommendations could be implemented. More detail on the study and methodology can be found in the Archives of Internal Medicine article: the "Top 5" Lists in Primary Care. The goal was to identify items common in the practice of family medicine supported by a review of the evidence that would lead to significant health benefits, reduce risks, harms and costs. For each item, evidence was reviewed from appropriate sources such as evidence reviews from the Cochrane Collaboration, and the Agency for Healthcare Research and Quality. For each item, evidence was reviewed from appropriate sources such as the Cochrane Collaboration, the Agency for Healthcare Research and Quality and other sources. Main E, Oshiro B, Chagolla B, Bingham D, Dang-Kilduff L, Kowalewski L (California Maternal Quality Care Collaborative). Elimination of non-medically indicated (elective) deliveries before 39 weeks gestational age. California Department of Public Health; Maternal, Child and Adolescent Health Division; Contract No: 08-85012. Induction of labour for improving birth outcomes for women at or beyond term (review). Urinary tract infection in children: diagnosis, treatment and long-term management. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence. Feeding tube use in such patients has actually been associated with pressure ulcer development, use of physical and pharmacological restraints, and patient distress about the tube itself. Assistance with oral feeding is an evidence-based approach to provide nutrition for patients with advanced dementia and feeding problems; in the final phase of this disease, assisted feeding may focus on comfort and human interaction more than nutritional goals. Numerous studies-including randomized trials-provide evidence that palliative care improves pain and symptom control, improves family satisfaction with care and reduces costs. Palliative care does not accelerate death, and may prolong life in selected populations. For patients with advanced irreversible diseases, defibrillator shocks rarely prevent death, may be painful to patients and are distressing to caregivers/family members. Currently there are no formal practice protocols to address deactivation; fewer than 10% of hospices have official policies. However, while topical gels are commonly prescribed in hospice practice, anti-nausea gels have not been proven effective in any large, well-designed or placebo-controlled trials. Only diphenhydramine (Benadryl) is absorbed via the skin, and then only after several hours and erratically at subtherapeutic levels. The use of agents given via inappropriate routes may delay or prevent the use of more effective interventions. Considering the potential impact and evidence to support the proposed recommendations, the task force identified seven finalists for which a rationale and evidence base was further developed. Natural history of feeding-tube use in nursing home residents with advanced dementia. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis. Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment. Symptom distress, intervention and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Impact of a palliative care service on in-hospital mortality in a comprehensive cancer center. Palliative care inpatient services in a comprehensive cancer center: Clinical and financial outcomes. Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey. Recurrent headache is the most common pain problem, affecting 15% to 20% of people. Occlusive carotid artery disease does not cause fainting but rather causes focal neurologic deficits such as unilateral weakness. Thus, carotid imaging will not identify the cause of the fainting and increases cost. Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Opioids should be reserved for those with medical conditions precluding the use of migraine-specific treatments or for those who fail these treatments. Interferon-beta and glatiramer acetate do not prevent the development of permanent disability in progressive forms of multiple sclerosis. These medications increase costs and have frequent side effects that may adversely affect quality of life. The cited 3% threshold for complication rates may be high because more recent studies have reported lower stroke rates with improvements in both surgical (Brott, 2010) and medical (Marquardt) management. Members of this group were selected to broadly represent varying practice settings and neurological subspecialties. Neurologists with methodological expertise in evidence-based medicine and practice guideline development were also included. The utility of the electroencephalogram in the evaluation of patients presenting with headache: a review of the literature. The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. La Mantia L, Vacchi L, Di Pietrantonj C, Ebers G, Rovaris M, Fredrikson S, Filippini G. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Carotid endarterectomy: an evidence-based report of the Technology and Therapeutics Committee of the American Academy of Neurology. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. The Academy provides valuable resources for neurologists and neuroscience professionals worldwide who look to the Academy for the most comprehensive professional development, career enhancement, and practice improvement opportunities available. Upright positions and walking have been associated with shorter duration of first stage labor, fewer cesareans and reduced epidural use. Walking during the hospital stay is critical for maintaining functional ability in older adults. Loss of walking independence increases the length of hospital stay, the need for rehabilitation services, new nursing home placement, risk for falls both during and after discharge from the hospital, places higher demands on caregivers and increases the risk of death for older adults. Bed rest or limited walking (only sitting up in a chair) during a hospital stay causes deconditioning and is one of the primary factors for loss of walking independence in hospitalized older adults. Older adults who walk during their hospital stay are able to walk farther by discharge, are discharged from the hospital sooner, have improvement in their ability to independently perform basic activities of daily living, and have a faster recovery rate after surgery. Physical restraints are most often applied when behavioral expressions of distress and/or a change in medical status occur. Studies show sleep deprivation negatively affects breathing, circulation, immune status, hormonal function and metabolism. Sleep deprivation also impacts the ability to perform physical activities and can lead to delirium, depression and other psychiatric impairments. Factors include noise, patient care activities and patient-related factors such as pain, medication and co-existing health conditions. These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse. Severe radiodermatitis can necessitate dose reductions or treatment delays that negatively impact the ability to adequately treat the cancer. The incidence of radiodermatitis can be as high 95% depending upon the population of patients receiving treatment. Studies documenting incidence have primarily occurred in women receiving treatment for breast cancer. Many Internet sites market aloe to individuals for what is commonly termed "sunburn type" reactions from radiation therapy. Research evidence shows that aloe vera is not beneficial for the prevention or treatment of radiodermatitis, and one study reported worse patient outcomes with use of aloe vera. Patients undergoing radiation therapy need to know that aloe vera should not be used to prevent or treat skin reactions from radiation therapy, since it has been shown to be ineffective and has the potential to make skin reactions worse. This can be a significant quality of life issue for patients, affecting functional ability and comfort. In the public realm, numerous Internet sites that sell herbal and dietary supplements have specifically recommended L-carnitine/acetyl-L-carnitine for symptoms of peripheral neuropathy. Evidence not only has shown use of carnitine supplements to be ineffective, but research also has shown it may make symptoms worse. Current professional guidelines contain a strong recommendation against the use of L-carnitine for prevention of chemotherapy-induced peripheral neuropathy. Nurses need to educate patients not to use this dietary supplement while undergoing chemotherapy for cancer. It is the natural tendency for people to try to get more rest when feeling fatigued and health care providers have traditionally been educated about the importance of getting rest and avoiding strenuous activity when ill.
Like most developmental research the answer is more complicated than a simple yes or no bacteria 1000x magnification discount tinidazole 300mg with visa. Chess and Thomas (1987) antibiotic resistance hand sanitizer cheap tinidazole 300mg online, who identified children as easy antibiotics for chronic acne cheap tinidazole 1000 mg fast delivery, difficult antibiotic resistance chart discount 1000 mg tinidazole with mastercard, slow-to-warm-up or blended antibiotic zone reader tinidazole 300mg online, found that children identified as easy grew up to became well-adjusted adults antibiotics side effects buy tinidazole 500 mg without prescription, while those who exhibited a difficult temperament were not as well-adjusted as adults. Kagan (2002) studied the temperamental category of inhibition to the unfamiliar in children. Infants exposed to unfamiliarity reacted strongly to the stimuli and cried loudly, pumped their limbs, and had an increased heart rate. Research has indicated that these highly reactive children show temperamental stability into early childhood, and Bohlin and Hagekull (2009) found that shyness in infancy was linked to social anxiety in adulthood. An important aspect of this research on inhibition was looking at the response of the amygdala, which is important for fear and anxiety, especially when confronted with possible threatening events in the environment. Recall from our discussion on epigenesis or how environmental factors are thought to change gene expression by switching genes on and off. Additionally, individuals often choose environments that support their temperament, which in turn further strengthens them (Cain, 2012). In summary, because temperament is genetically driven, genes appear to be the major 274 reason why temperament remains stable into adulthood. In contrast, the environment appears mainly responsible for any change in temperament (Clark & Watson, 1999). Everybody has their own unique personality; that is, their characteristic manner of thinking, feeling, behaving, and relating to others (John, Robins, & Pervin, 2008). Personality traits refer to these characteristic, routine ways of thinking, feeling, and relating to others. Consequently, there are signs or indicators of these traits in childhood, but they become particularly evident when the person is an adult. They are also likely to have books on a wide variety of topics, a diverse music collection, and works of art on display. Individuals who are conscientious have a preference for planned rather than spontaneous behavior. Conscientiousness A tendency to show selfdiscipline, act dutifully, and aim for achievement Extraversion the tendency to experience positive emotions and to seek out stimulation and the company of others A tendency to be compassionate and cooperative rather than suspicious and antagonistic toward others; reflects individual differences in general concern for social harmony the tendency to experience negative emotions, such as anger, anxiety, or depression; sometimes called "emotional instability" Extroverts enjoy being with people. They are generally considerate, friendly, generous, helpful, and willing to compromise their interests with those of others. Neuroticism Those who score high in neuroticism are more likely to interpret ordinary situations as threatening and minor frustrations as hopelessly difficult. They may have trouble thinking clearly, making decisions, and coping effectively with stress. Adapted from John, Naumann, and Soto (2008) Five-Factor Model: There are hundreds of different personality traits, and all of these traits can be organized into the broad dimensions referred to as the Five-Factor Model (John, Naumann, & 275 Soto, 2008). Longitudinal studies reveal average changes during adulthood in the expression of some traits. Longitudinal research also suggests that adult personality traits, such as conscientiousness, predict important life outcomes including job success, health, and longevity (Friedman et al. The Harvard Health Letter (2012) identifies research correlations between conscientiousness and lower blood pressure, lower rates of diabetes and stroke, fewer joint problems, being less likely to engage in harmful behaviors, being more likely to stick to healthy behaviors, and more likely to avoid stressful situations. Conscientiousness also appears related to career choices, friendships, and stability of marriage. Lastly, a person possessing both self-control and organizational skills, both related to conscientiousness, may withstand the effects of aging better and have stronger cognitive skills than one who does not possess these qualities. I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, love partners want me to be more intimate than I feel comfortable being. I want to merge completely with another person, and this sometimes scares people away. Hazan and Shaver developed three brief paragraphs describing the three adult attachment styles. Adults were then asked to think about romantic relationships they were in and select the paragraph that best described the way they felt, thought, and behaved in these relationships (See Table 7. Attachment-related anxiety refers to the extent to which an adult worries about whether their partner really loves them. Those who score high on this dimension fear that their partner will reject or abandon them (Fraley, Hudson, Heffernan, & Segal, 2015). Attachment-related avoidance refers to whether an adult can open up to others, and whether they trust and feel they can depend on others. Those who score high on attachmentrelated avoidance are uncomfortable with opening up and may fear that such dependency may limit their sense of autonomy (Fraley et al. According to Bartholomew (1990) this would yield four possible attachment styles in adults; secure, dismissing, preoccupied, and fearfulavoidant (see Figure 7. Adults with a dismissing style score low on attachment-related anxiety, but higher on attachment-related avoidance. They trust themselves, but do not trust others, thus do not share their dreams, goals, and fears with others. They do not depend on other people and feel uncomfortable when they have to do so. Such adults are often prone to jealousy and worry that their partner does not love them as much as they need to be loved. Adults whose attachment style is fearfulavoidant score high on both attachment-related avoidance and attachment-related anxiety. These adults want close relationships, but do not feel comfortable getting emotionally close to others. They have trust issues with others and often do not trust their own social skills in maintaining relationships. Those high in attachment-related anxiety report more daily conflict in their relationships (Campbell, Simpson, Boldry, & Kashy, 2005). Some studies report that young adults show more attachment-related avoidance (Schindler, Fagundes, & Murdock, 2010), while other studies find that middle-aged adults show higher avoidance than younger or older adults (Chopik et al. Young adults with more secure and positive relationships with their parents make the transition to adulthood more easily than do those with more insecure attachments (Fraley, 2013). Young adults with secure attachments and authoritative parents were less likely to be depressed than those with authoritarian or permissive parents or who experienced an avoidant or ambivalent attachment (Ebrahimi, Amiri, Mohamadlou, & Rezapur, 2017). When people are asked what kinds of psychological or behavioral qualities they are seeking in a romantic partner, a large majority of people indicate that they are seeking someone who is kind, caring, trustworthy, and understanding, that is the kinds of attributes that characterize a "secure" caregiver (Chappell & Davis, 1998). However, we know that people do not always end up with others who meet their ideals. Are secure people more likely to end up with secure partners, and, vice versa, are insecure people more likely to end up with insecure partners The majority of the research that has been conducted to date suggests that the answer is "yes. One important question is whether these findings exist because (a) secure people are more likely to be attracted to other secure people, (b) secure people are likely to create security in their partners over time, or (c) some combination of these possibilities. For example, when people have the opportunity to interact with individuals who vary in security in a speed-dating context, they express a greater interest in those who are higher in security than those who are more insecure (McClure, Lydon, Baccus, & Baldwin, 2010). For example, in a longitudinal study, Hudson, Fraley, Vicary, and Brumbaugh (2012) found that, if one person in a relationship experienced a change in security, his or her partner was likely to experience a change in the same direction. This kind of work suggests that secure adults are more likely to describe their early childhood experiences with their parents as being supportive, loving, and kind (Hazan & Shaver, 1987). A number of longitudinal studies are emerging that demonstrate prospective associations between early attachment experiences and adult attachment styles and/or interpersonal functioning in adulthood. For example, Fraley, Roisman, Booth278 [Image: skeeze] LaForce, Owen, and Holland (2013) found in a sample of more than 700 individuals studied from infancy to adulthood that maternal sensitivity across development prospectively predicted security at age 18. Simpson, Collins, Tran, and Haydon (2007) found that attachment security, assessed in infancy in the strange situation, predicted peer competence in grades one to three, which, in turn, predicted the quality of friendship relationships at age 16, which, in turn, predicted the expression of positive and negative emotions in their adult romantic relationships at ages 20 to 23. It is easy to come away from such findings with the mistaken assumption that early experiences "determine" later outcomes. To be clear, attachment theorists assume that the relationship between early experiences and subsequent outcomes is probabilistic, not deterministic. Having supportive and responsive experiences with caregivers early in life is assumed to set the stage for positive social development, but that does not mean that attachment patterns are set in stone. In short, even if an individual has far from optimal experiences in early life, attachment theory suggests that it is possible for that individual to develop well-functioning adult relationships through a number of corrective experiences, including relationships with siblings, other family members, teachers, and close friends. Relationships with Parents and Siblings In early adulthood the parent-child relationship has to transition toward a relationship between two adults. One of the biggest challenges for parents, especially during emerging adulthood, is coming to terms with the adult status of their children. This problem becomes more pronounced when young adults still reside with their parents. Arnett (2004) reported that leaving home often helped promote psychological growth and independence in early adulthood. Yet, there is little research on the nature of sibling relationships in adulthood (Aquilino, 2006). What is known is that the nature of these relationships change, as adults have a choice as to whether they will maintain a close bond and continue to be a part of the life of a sibling. Siblings must make the same reappraisal of each other as adults, as parents have to with their adult children. Research has shown a decline in the frequency of interactions between siblings during early adulthood, as presumably peers, romantic relationships, and children become more central to the lives of young adults. Aquilino (2006) suggests that the task in early adulthood may be to maintain enough of a bond so that there will be a foundation for this relationship in later life. Those who are successful can often move away from the "older-younger" sibling conflicts of childhood, toward a more equal relationship between two adults. Siblings that were close to each other in childhood are typically close in adulthood (Dunn, 1984, 2007), and in fact, it is unusual for siblings to develop closeness for the first time in adulthood. Intimate relationships are more difficult if one is still struggling with identity. Achieving a sense of identity is a life-long process, as there are periods of identity crisis and stability. These intimate relationships include acquaintanceships and friendships, but also the more important close relationships, which are the long-term romantic relationships that we develop with another person, for instance, in a marriage (Hendrick & Hendrick, 2000). A major interest of psychologists is the study of interpersonal attraction, or what makes people like, and even love, each other. Similarity: One important factor in attraction is a perceived similarity in values and beliefs between the partners (Davis & Rusbult, 2001). We can feel better about ourselves and our choice of activities if we see that our partner also enjoys doing the same things that we do. Having others like and believe in the same things we do makes us feel validated in our beliefs. This is referred to as consensual validation and is an important aspect of why we are attracted to others. Source: Self-Disclosure: Liking is also enhanced by self-disclosure, the tendency to communicate frequently, without fear of reprisal, and in an accepting and empathetic manner. Friends are friends because we can talk to them openly about our needs and goals and because they listen and respond to our needs (Reis & Aron, 2008). If we open up about our concerns that are important to us, we expect our partner to do the same in return. Proximity: Another important determinant of liking is proximity, or the extent to which people are physically near us. Research has found that we are more likely to develop friendships with people who are nearby, for instance, those who live in the same dorm that we do, and even with people who just happen to sit nearer to us in our classes (Back, Schmukle, & Egloff, 2008). Proximity has its effect on liking through the principle of mere exposure, which is the tendency to prefer stimuli (including, but not limited to people) that we have seen more frequently. The effect of mere exposure is powerful and occurs in a wide variety of situations. Infants tend to smile at a photograph of someone they have seen before more than they smile at a photograph of 280 someone they are seeing for the first time (Brooks-Gunn & Lewis, 1981), and people prefer sideto-side reversed images of their own faces over their normal (nonreversed) face, whereas their friends prefer their normal face over the reversed one (Mita, Dermer, & Knight, 1977). This is expected on the basis of mere exposure, since people see their own faces primarily in mirrors, and thus are exposed to the reversed face more often. We have an initial fear of the unknown, but as things become familiar, they seem more similar and safer, and thus produce more positive affect and seem less threatening and dangerous (Harmon-Jones & Allen, 2001; Freitas, Azizian, Travers, & Berry, 2005). Familiar people become more likely to be seen as part of the ingroup rather than the outgroup, and this may lead us to like them more. Zebrowitz and her colleagues found that we like people of our own race in part because they are perceived as similar to us (Zebrowitz, Bornstad, & Lee, 2007). Friendships In our twenties, intimacy needs may be met in friendships rather than with partners. This is especially true in the United States today as many young adults postpone making long-term commitments to partners, either in marriage or in cohabitation. The kinds of friendships shared by women tend to differ from those shared by men (Tannen, 1990). Friendships between men are more likely to involve sharing information, providing solutions, or focusing on activities rather than discussion problems or emotions. Men tend to discuss opinions or factual information or spend time together in an activity of mutual interest.