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Surveillance approaches Passive or ‘scanning’ disease surveillance: this involves examination of only clinically affected individuals effective 40 mg cialis extra dosage erectile dysfunction treatments that work, with no special effort being made to ‘seek out’ infected or diseased cases cheap 40 mg cialis extra dosage with amex shakeology erectile dysfunction. This may involve the routine gathering of information on disease incidents from the general public, medical or veterinary professionals and laboratories dealing with routine cases. Passive surveillance may lead to significant under-reporting of diseases and should, therefore, be supplemented by active disease surveillance particularly for important animal diseases. Active disease surveillance: this involves proactive examination of individuals to actively seek out infection or disease, and targeted searching for evidence of disease in populations. Programmes may be broad-scale to capture any significant disease occurrences, targeted against specific high-threat diseases (e. International trade may also guide surveillance schemes to establish national and regional disease status, especially where it relates to public health and economic initiatives. For livestock diseases which are spread by the movement of infected animals, areas where animals are moving should be targeted for surveillance (e. The speed of information flow between different components of the disease surveillance system (immediate or routine). The rapidity of response required: immediate investigation of disease incidence or routine and regular analysis of data with subsequent adjustments to control activities when required. For a disease surveillance strategy to act as an early warning system, reporting, decision-making and response must be rapid. However, for endemic diseases, it may be more appropriate to evaluate the routine data collected to adjust or target control activities. National surveillance systems should include an integral approach and accommodate all needs. It may beIt may be possible to link and integrate severalpossible to link and integrate several different surveillance systems. The following functions may supporttions may support surveillance systems: setting of standards (e. The key components of aThe key components of a surveillance and monitoring system. The following tasks are recommended for improving animal disease surveillance:The following tasks are recommended for improving animal disease surveillance: 1. Identify key stakeholders and organisations relevant toIdentify key stakeholders and organisations relevant to the site state or local veterinarian or animal health officer (will most likely be lead person inveterinarian or animal health officer (will most likely be lead person inveterinarian or animal health officer (will most likely be lead person in regional surveillance effort)surveillance effort) public health contact veterinary diagnostic laboratoriesic laboratories. Identify relevant animal diseases for the siteIdentify relevant animal diseases for the site notifiable animal diseasesdiseases wildlife animal diseases zoonoses. Familiarisation with country responses with reference to potential disease outbreaks at the site. Establish standardised report forms for disease surveillance including definitions such as “confirmed” and “suspected”. Identify and collaborate with ongoing animal disease surveillance efforts at other wetland sites and government Ministries or Departments e. Identify efficient and effective communication channels with the relevant health authorities and laboratories and other wetland stakeholders and include opportunities for feedback. Prioritising diseases for surveillance The following factors should be considered when determining which diseases to prioritise for surveillance: Whether the disease is of public health or agricultural importance. Whether the disease is a specific target of a local, regional, national or international control programme. Whether the information to be collected will lead to significant successful human/animal health action. Communicable Disease Management Protocol Manual: Communicable disease surveillance. Climate change and the expansion of animal and zoonotic diseases: What is the Agency’s contribution? Wild birds and avian influenza: an introduction to applied field research and disease sampling techniques. Planning an integrated disease surveillance and response system: a matrix of skills and activities. Concepts for risk based surveillance in the field of veterinary medicine and veterinary public health: review of current approaches. Animal disease surveillance: a framework for supporting disease detection in public health. Identifying a departure from ‘usual’, ‘natural’ or ‘expected’ levels of mortality or morbidity can be complex and measures need to be put in place to help this process. Many of the other sections of this Manual will help in identifying a disease problem [e. Apparently healthy wildlife: identifying when a problem is emerging relies on a good understanding of what constitutes ‘normal’ mortality and morbidity and good early warning systems (Sally MacKenzie). Capacity requirements for identifying disease problems and informing early warning systems A good understanding of the use of the site by wild and domestic animals throughout the year and an understanding of their biology, abundance, behaviour and movements. A reasonable understanding of the epidemiology of particular diseases and of the stressors and other factors associated with disease outbreaks. Robust disease surveillance (both active and passive) in wildlife and livestock at a site.

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People who read this book and make decisions regarding their health or medical care which they believe are based on ideas contained in this book effective 200 mg cialis extra dosage erectile dysfunction reasons, do so as their constitutional right cialis extra dosage 100 mg for sale erectile dysfunction treatment penile injections. Please do not use this book if you are unwilling to assume responsibility for results that arise from the use of any of the suggestions, preparations or procedures in the book. The author and publisher are not responsible for any adverse effects or consequences resulting from the use of any of the suggestions or information contained in the book, but offer this material as information which the public has a right to hear and utilize at their own discretion. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the copyright owner. The extensive medical research findings on this natural medicine have never been compiled and released to the general public before now, but those who have been fortunate enough to hear about this medicine and use it have found that it can produce often astounding healing even when all other therapies have failed. This book tells of the doctors, medical researchers and the hundreds of other people who have used this extraordinary medicine throughout our century to cure a huge variety of common illnesses and to combat even the most incurable diseases. This is the extraordinary untold story of a natural healing substance so remarkable that it can only be called our own perfect medicine. My own experience with this little-known natural medicine began as a result of my search for an answer to many years of serious chronic illnesses that had begun very early in life. When I was young, I suffered through the same measles, mumps, chicken pox and colds that everyone else did. And like other children, I played hard, worked hard, and dreamed of the day when I would become a vigorous, emancipated teenager, just like everyone else. Suddenly, surprised and frightened, I realized I was lying in a dark red pool of blood that was so large it had soaked through even the thick layers of my mattress. Trembling and weak, I pushed myself up out of bed and felt a horrible, wrenching pain tear through my abdomen. But what neither she nor I knew at the time, was that what should have been a natural transition to adolescence and menstruating was, for me, going to become a waking nightmare that lasted almost 30 years. Throughout adolescence, the simple everyday functions of getting up and going to school were an often monumental and utterly exhausting effort for me. Unlike the rest of my family and friends, I had marked periods of extreme exhaustion. I became extremely susceptible to colds and flu and felt bone-chillingly cold all the time – even in the warmest summer weather. By the age of fourteen, the effort of combatting severe chronic pain and fatigue while trying to keep up normal activities became impossible. I collapsed and had to be hospitalized and removed from school for several months. But even after a huge battery of medical tests and innumerable visits with doctors and specialists, no one was able to diagnose what was causing my problems. But by the time I left home for college, the symptoms of bleeding, exhaustion, pain and digestive problems became so bad that I often was unable to even leave my room or to take part in daily activities. I kept up the Demerol injections and codeine for many years and added several other new painkillers and drugs which had been developed for menstrual problems to my regimen. But the problems continued unabated and in the ensuing years I developed a myriad of other serious health problems. I had severe chronic kidney infections, two miscarriages, chronic cystitis, severe candida and external yeast infections along with marked adrenal insufficiency and serious chronic ear and sinus infections for which I was prescribed antibiotics on an ongoing basis for several years. And even though I ate almost nothing because of my extreme food allergies, I actually kept gaining weight, which only added to the discomfort of all the other health disorders I was dealing with. Another big problem was the drug side effects -I felt like a ping-pong ball, bouncing from one drug to another as my doctors kept prescribing more and different drugs to counteract the side effects of the ones I was already taking. By the time I turned 30, the natural health movement was really picking up speed, and, desperate for any solution, I tried out the Adelle Davis nutrition regimen, 7 mega-vitamin therapy, acupuncture, chiropractic care and every herbal preparation and drug-free natural health therapy that I could find. Within two years, my chronic cystitis cleared up and the menstrual pain and bleeding markedly decreased. Unfortunately, in my burst of enthusiasm, I underestimated the impact of pregnancy on my understandably frail health, and the birth that I had so carefully prepared for was a near fatal disaster requiring emergency surgery. For months after the birth, I hounded my gynecologist, complaining of unremitting and severe abdominal cramps, cystitis and horribly painful menstrual periods. A couple of days after the procedure, my doctor sauntered into my hospital room with a conciliatory grin on his face. Sorry you had to go so long without help but, you know, the tests just never turned up anything. And oh, by the way, the pathologist found a little endometriosis in your right ovary. This disease is not uncommon among women, but it is incurable, at least by conventional medical standards.

Software / computer configurations We will ask you to download some free software and to run configurations to ensure your computer is set up to run some of the e-learning resources (e generic 50mg cialis extra dosage amex erectile dysfunction implant. You will be given full details of this prior to commencing the course—see below for further details: Flash player Check you have the latest Flash Player (Version 9 or above) How do I know what version of Flash Player I have? Two ways of doing this discount 50mg cialis extra dosage erectile dysfunction drugs without side effects, either: a) Right-click any flash object in a web browser b) Click on Start> Control Panel >Add/Remove Programs. A dialogue appears that tells you the version of Flash Player currently installed. Wimba Classroom Ensure that your computer is configured to run Wimba (the online tutorial software) before starting the course. Please use the ‘wizard’ to check that your computer and headset are set up for Wimba: edlive. The following are links to demos/videos showing how Wimba Classroom works: Wimba basics: www. Email When you join the University you will get a University of Edinburgh email account and address which will be used for a variety of essential communications. You must access and manage this account regularly as important information from the University will be sent to this address. If you already have a web-based email account and think you are unlikely to check your University email account, it is your responsibility to set up a forward on your University email. Change of details It is vital that you inform Registry Services of any change to details. You are given the opportunity to check and amend your details annually via your Registration Forms, but details can be changed at any time using the online form found here: www. Transkills training Transkills run a range of personal and professional development training courses for students across the University. Course organisers Eleri Williams (Lecturer in Internal Medicine) has responsibility for the day-to- day running of the course, and should be the first point of contact for all students. Associate tutors Associate tutors with specialist expertise will be invited to contribute/run modules in their specialty areas. The programme director is also there to facilitate your orientation and smooth progression through the degree, from initial induction to subsequent course choice, and the transition into the dissertation stage and to the successful completion of the degree. It is your responsibility to inform the programme director immediately of any problems that are interfering with your coursework or progress through the programme, including any religious or medical requirements that might affect your participation in any aspect of the programme. The style of assessment has been chosen to best complement the taught material and learning outcomes. Times New Roman 12pt, Arial 10pt)  With a structure, style and authorial voice consistent with the related literature – i. The thesis will demonstrate the student’s ability to complete a piece of objective research, which may be in the form of an extended clinical audit, a laboratory based project, a systematic review, or similar in any area of internal medicine. The student will be allocated an individual tutor/ supervisor based at the University of Edinburgh, and we would aim to find people with appropriate specialist interest in the areas required. Candidates will however be encouraged to work closely with senior staff in their home institutions, with mutually beneficial fostering of suitable academic links between the University of Edinburgh and medical institutes worldwide. The submission of the thesis (as per University regulations) on an agreed topic must normally be within 36 months of initial registration. Requests for an extension to the period of study must go through the Programme Director as a formal request to the College Postgraduate Studies Committee. Forms for this purpose, and for ‘interruption of studies’ due to special circumstances, are available from the course organizer. The final thesis will be in two forms: a printed document that will be marked and lodged in the university library, and an electronic version which will be set in the course archive for reference by future students. Students must ensure that their submitted dissertation meets the following criteria:  15,000 words or less (excluding references)  A4 portrait format with appropriate margins  Easily-readable font and font size (e. Progression and distinction Candidates gain the given number of credits required for a degree award incrementally in each academic year. Credits required are as set out in the Scottish Qualifications Framework and incorporated into the University’s Curriculum Framework. Progression on the programme is dependent on satisfactory performance at each level of the award. Students may choose to graduate after one year with a postgraduate certificate (60 credit points), or after the second year (120 credit points) entitling them to a postgraduate diploma. Year 1: During the first year, the student is required to complete (to the satisfaction of the Board of Examiners) all compulsory modules (with the option of replacing the Science of Medicine course with two elective modules from year 2). On satisfactory completion of year 1, they can leave the programme with a Certificate in Internal Medicine, or progress to the second year. All students who obtain a mark of greater than or equal to 40% are entitled to progress into the diploma year.

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The Health Professionals Follow-up Study of men reported a Dietary Fiber intake of 28 cheap cialis extra dosage 50mg otc erectile dysfunction in young men. In the Nurses’ Health Study of women generic cialis extra dosage 50mg with mastercard erectile dysfunction caused by jelqing, the median Dietary Fiber intake at the highest quintile was 22. Taken collectively and averaging to the nearest gram, these data suggest an intake of 14 g of Dietary Fiber/1,000 kcal, particularly from cereals, to promote heart health. Data from the intervention trials are in line with these recom- mendations, as are data from epidemiological studies. The literature on Dietary Fiber intake and glucose tolerance, insulin response, and amelioration of diabetes alone is insufficient at this time to use as a basis for a recommendation (see “Evidence Considered for Estimating the Requirement for Dietary Fiber and Functional Fiber”). However, it should be noted that the positive effects seen in two large prospective studies (Salmerón et al. There is no information to indicate that fiber intake as a function of energy intake differs during the life cycle. Dietary Fiber was present in the majority of fruits, vege- tables, refined grains, and miscellaneous foods such as ketchup, olives, and soups, at concentrations of 1 to 3 percent, or 1 to 3 g/100 g of fresh weight. Nuts, legumes, and high fiber grains typically contained more than 3 percent Dietary Fiber. About one-third of the fiber in legumes, nuts, fruits, and vegetables was present as hemicelluloses. Approximately one-fourth of the fiber in grains and fruit and one-third in nuts and vegetables consisted of cellulose. Although fruits contained the greatest amount of pectin, 15 to 20 percent of the fiber content in legumes, nuts, and vegetables was pectin. The major sources of naturally occurring inulin and oligofructose are wheat and onions, which provide about 70 and 25 percent of these compo- nents, respectively (Moshfegh et al. Isolated inulin provides a creamy texture and is added to replace fat in table spreads, dairy products, frozen desserts, baked goods, fillings, and dressings. Oligofructose is most commonly added to cereals, fruit preparations for yogurt, cookies, dairy products, and frozen desserts. Depending on one’s chosen diet, naturally occurring and manufac- tured resistant starch, as well as that produced during normal processing of foods for human consumption, could make a significant contribution to daily Total Fiber intake. Legumes are the largest source of naturally occur- ring resistant starch (Marlett and Longacre, 1996). In addition, green bananas (Englyst and Cummings, 1986) and cooled, cooked potatoes (Englyst and Cummings, 1987) can provide a significant amount of resis- tant starch. Resistant starch resulting from normal processing of a foodstuff is a more modest contributor to a typical daily intake. Starches specifically manufactured to be resistant to endogenous human digestion are a rapidly growing segment of commercially available resistant starches. This database primarily measures Dietary Fiber intake because isolated Functional Fibers, such as pectins and gums, that are used as ingredients represent a very minor amount of the fiber present in foods. For instance, the fiber content of fat-free ice creams and yogurts, which contain Func- tional Fibers as additives, is much less than 1 g/serving and therefore is often labeled as having 0 g of fiber. Although there is a seemingly large gap between current fiber intake and the recommended intake, it is not difficult to consume recommended levels of Total Fiber by choosing foods recommended by the Food Guide Pyramid. Most studies that assess the effect of fiber intake on mineral status have looked at calcium, magnesium, iron, or zinc. Most studies investigating the effects of cereal, vegetable, and fruit fibers on the absorption of calcium in animals and humans have reported no effect on calcium absorption or balance (Spencer et al. However, some studies described a decrease in calcium absorption with ingestion of Dietary Fiber under certain conditions (Knox et al. Slavin and Marlett (1980) found that supplementing the diet with 16 g/d of cellulose resulted in significantly greater fecal excretion of calcium resulting in an average loss of approxi- mately 200 mg/d. There was no effect on the apparent absorption of calcium after the provision of 15 g/d of citrus pectin (Sandberg et al. Studies report no differences in magnesium balance with intake of certain Dietary Fibers (Behall et al. Astrup and coworkers (1990) showed no effect of the addition of 30 g/d of plant fiber to a very low energy diet on plasma concentrations of magnesium. There was no effect on the apparent absorption of magnesium after the provision of 15 g/d of citrus pectin (Sandberg et al. Magnesium balance was not significantly altered with the consumption of 16 g/d of cellulose (Slavin and Marlett, 1980). A number of studies have looked at the impact of fiber- containing foods, such as cereal fibers, on iron and zinc absorption. These cereals typically contain levels of phytate that are known to impair iron and zinc absorption. Coudray and colleagues (1997) showed no effect of isolated viscous inulin or partly viscous sugar beet fibers on either iron or zinc absorption when compared to a control diet.

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