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By G. Dargoth. Le Moyne College. 2018.

Confict between work and familial roles is inevitable at times order altace 10mg visa, whether one or both partners are physicians generic altace 5 mg mastercard. Classically, role Work and family life strain has been more frequently noted among female physi- The issue of deferring intimacy in favour of medical work has cians, but in reality male physicians experience it as well. Half been described in the literature on medical marriages (Myers of married women physicians are married to other physicians 2001 and Gabbard 1989). Dual-physician relationships bring sional advancement over the nurturing of intimate relation- certain challenges, such as complicated schedules and career ships, working long hours at the expense of their home lives. Careers postpone their investment in the “emotional bank account” of can be shaped, reshaped and salvaged more easily than rela- their families or in some cases, avoid admitting that they in fact tionships and families. Paradoxically, however, “the marital interests can be satisfying, which can lead to greater mutual relationship is the main source of coping with the stress of understanding, support and shared parenting (Schrager et al medical practice” (Gabbard 1989). It would seem, however, whether by preference, mutual decision or default, that women physicians continue to take Physicians who enjoy successful intimate partnerships learn more responsibility on the home front than their male counter- early that certain attributes that serve them well at work are parts. For example, while physicians of female physicians being the primary or sole income earner are accustomed to their role as experts and expect to be in in their households. In contrast to Protecting and nurturing our intimate relationships may require most physicians’ experience of medical education, marriage is a re-examination of our professional responsibilities and work non-competitive. As you develop your resident group or consider Relationships, however, do require work in realtime, a sense of your eventual practice setting, keep these questions in mind: humour, and a degree of luck. John Gottman, a respected re- • Does your group discuss shock-absorber systems for searcher in marriage and relationships, stresses the importance parental leaves and urgent family issues? She had speculated that a child would keep geographical triangle: home, school and workplace. Keeping her relationship together, given her partner’s attraction to logistics as simple as possible will beneft your marriage and “more medicine” and achievement. He expresses fear of giving in Raising children together to his feelings lest they derail his career focus. With the For many women physicians, the question of when to plan counsellor’s help, they review their priorities with regard childbearing is especially challenging when training demands to career plans and the timing of child-bearing. Supportive sessions lead to a better understanding of their mutual colleagues and training programs are nearly as important as a objectives, and of the supports available to them to help supportive partner. Furthermore, resi- dency training directors never accompany graduated residents impact on your family, whose sleep is being disturbed by the to the infertility clinic. The concept that it takes a village to raise a child applies to medical families, too. Women physicians are particularly aware Vacations are one of the non-urgent but important elements that the more they work, and the greater number of children of time management. Vacations in which play and fun—and they choose to have, the greater the chance that they will need not perfection—are modelled, where being rather than doing to rely on child care arrangements beyond the family. Many are valued and pleasure for its own sake is enjoyed, are healthy women physicians and dual-career couples fnd live-in help with for the whole family (Maier 2005) regard to child care invaluable. External assistance with regard to other household duties can also be a time-management tool Summary that benefts everyone. Managing the expectations of our partners and others can be problematic in medical relationships. Some of these expecta- Two points to remember when your medical relationship is tions may be fnancial, arising from assumptions about what blessed with children are these: the lifestyles of physicians will be. You do not have to be perfect, but you can be good pectation of concierge service within the health care system. All deserve Although little has been written about the children of physi- refection, good communication and attention to maintaining cians, we do know that children want and deserve their parents’ appropriate and ubiquitous boundaries. Depending on their stage of development, this may mean breastfeeding for the recommended time, taking Relationships go through cycles. Should your medical marriage the maximum possible parental leave, delaying a career move, run into challenges, remember you are not alone. Even if you cannot Myers, through his book Doctors’ Marriages, shares his wisdom always be there, it is important to work with your partner and that face-to-face couples’ therapy works best. Seek professional to communicate with your child so that you are emotionally help through your community resources or your physician involved and up-to-date with what is going on in your child’s health program. In addition, more men than ever before are taking This chapter will advantage of parental leave policies. Thus, traditional gender • describe some of the challenges commonly faced by phy- roles in Canadian culture are clearly undergoing a healthy evo- sician parents, lution. However, these shifts have created new challenges for • summarize supports that programs can use to facilitate training programs as they strive to balance principles of sound sustainability of residents who are parents, and education and training, human rights and responsibilities, and • identify strategies for resident physicians to promote their health care human resource issues. Medical students are watching this transition and may choose not to Case engage in specialty medicine if it is perceived to be adverse to A second-year resident has recently adopted an infant their family-related values and expectations.

Nitrogen balances of 15 Turkish young adults on a safe level of protein intake for 15 days quality altace 2.5 mg. Protein-Energy Requirement Studies in Developing Countries: Results of International Research buy 10mg altace otc. Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults. Protein re- quirements of man: Variations in obligatory urinary and fecal nitrogen losses in young men. Protein requirements of man: Obliga- tory urinary and fecal nitrogen losses in elderly women. Nitrogen balance response in young men given one of two isolated soy pro- teins or milk proteins. Minimum nitrogen require- ment from glandless cottonseed protein for nitrogen balance in college women. Long-term evaluation of the ad- equacy of habitual diets to provide protein needs for adult Thai men. Protein-Energy Requirement Studies in Developing Countries: Results of International Research. Human protein requirements: Obligatory urinary and fecal nitrogen losses and the factorial estimation of protein needs in elderly males. Human protein requirements: Nitrogen balance response to graded levels of egg protein in elderly men and women. Obligatory urinary and faecal nitrogen losses in young Chilean men given two levels of dietary energy intake. Short-term evaluation of the capacity of a Chilean mixed diet to meet protein energy needs of a group of young adult males. Protein-Energy Require- ment Studies in Developing Countries: Results of International Research. Nitrogen balance studies in young men to assess the protein quality of an isolated soy protein in relation to meat proteins. Protein-Energy Requirement Studies in Developing Countries: Results of International Research. Long-term evaluation of the capacity of a Chilean mixed diet to meet the protein energy requirements of young adult males. Protein-Energy Requirement Studies in Developing Countries: Results of International Research. Capacity of the Chilean mixed diet to meet the protein and energy requirements of young adult males. Endogenous nitrogen metabolism and plasma free amino acids in young adults given a ‘protein-free’ diet. Protein requirements of man: Efficiency of egg protein utilization at maintenance and submaintenance levels in young men. Protein require- ments of man: Comparative nitrogen balance response within the submaintenance-to-maintenance range of intakes of wheat and beef proteins. Evaluation of the protein quality of an isolated soy protein in young men: Relative nitrogen requirements and effect of methionine supplementation. Agurs-Collins’ primary research interests include the role of nutrition in cancer and diabetes, nutrition and aging, and disease prevention in minority popula- tions. Agurs-Collins was the president of the District of Columbia Metropolitan Area Dietetic Associa- tion in 1998–1999. She is a member of the Mayoral-appointed Board of Dietetics and Nutrition of the District of Columbia Government, where she developed licensing rules, regulations, and the state nutrition exami- nation. Agurs-Collins was the 1999–2000 recipient of the American Association for Cancer Research, Historically Black Colleges and Universities Faculty Award in Cancer Research and the 1999–2000 Outstanding Dieti- tian of the Year Award, District of Columbia Metropolitan Area Dietetic Association. At the University, he is also codirector of the Program in Food Safety, Nutritional and Regulatory Affairs. Her research interests focus on the associations among nutrition, physical activity, and bone health in women and she has authored over 75 publications. Barr served as vice president of the Canadian Dietetic Association (now Dietitians of Canada) and is a fellow of both the Dietitians of Canada and the American College of Sports Medicine. She is currently a member of the Scientific Advisory Board of the Osteoporosis Society of Canada and the Medical Advisory Board of the Milk Processors Education Program. He also was a research scientist and scientific manager at Health Canada, where he worked in the areas of biochemistry, pharmacology, nutrition toxicology, and toxicology of food-borne and environmental contaminants. He has published over 60 papers and book chapters in the fields of bio- chemistry, toxicology, and risk assessment methodology. His research is intended to elaborate the path- ways and controls of lactic acid formation and removal during and after exercise and to study the integration of carbohydrates, lipids, and amino and fatty acids into the carbon flux sustaining exercise. To study these problems in detail, isotope tracer, biochemical, and molecular techniques have been developed and are used extensively. Additionally, the effects of acute and chronic bouts of exercise, gender, hypoxia, and perturbations in oxygen transport on energy fluxes and associated cellular organelles, membranes, and enzyme systems are under investigation.

Always follow your local laws and regulations as they relate to the care of minors altace 10 mg on line. Science Note Most child-related cardiac arrests occur as a result of a hypoxic event such as an exacerbation of asthma order altace 2.5 mg without prescription, an airway obstruction or a drowning. As such, ventilations and appropriate oxygenation are important for a successful resuscitation. In these situations, laryngeal spasm may occur, making passive ventilation during chest compressions minimal or nonexistent. Airway To open the airway of a child, you would use the same head-tilt/chin-lift technique as an adult. However, you would only tilt the head slightly past a neutral position, avoiding any hyperextension or flexion in the neck. Basic Life Support for Healthcare Providers Handbook 27 Table 1-2 Airway and Ventilation Differences: Adult and Child Child (Age 1 Through Adult Onset of Puberty) Airway Head-Tilt/Chin-Lift Past neutral position Slightly past neutral position Ventilations Respiratory Arrest 1 ventilation every 5 to 1 ventilation every 3 seconds 6 seconds 28 American Red Cross Compressions The positioning and manner of providing compressions to a child are also very similar to an adult. Place your hands in the center of the chest on the lower half of the sternum and compress at a rate between 100 to 120 per minute. Compressions-to-Ventilations Ratio When you are the only rescuer, the ratio of compressions to ventilations for a child is the same as for an adult, that is, 30 compressions to 2 ventilations (30:2). However, in two-rescuer situations, this ratio changes to 15 compressions to 2 ventilations (15:2). Apply one pad to the center of the child’s chest on the sternum and one pad to the child’s back between the scapulae. Be sure that the pads will not touch each other if considering a traditional pad placement on the anterior chest. Always follow local protocols, medical direction and the manufacturer’s instructions. Primary Assessment Variations: Infant When assessing the infant’s level of consciousness, you should tap the bottom of the foot rather than the shoulder and shout, “Are you okay? For an infant, check the brachial pulse with two fingers on the inside of the upper arm. The pediatric assessment triangle—Appearance, Effort of breathing and Circulation—can give you a more accurate depiction of an infant’s status. Regardless of what tool is used, the recognition of an unresponsive infant is the priority. Airway To open the airway of an infant, use the same head-tilt/chin-lift technique as you would for an adult or child. However, only tilt the head to a neutral position, taking care to avoid any hyperextension or flexion in the neck. Be careful not to place your fingers on the soft tissues under the chin or neck to open the airway. Table 1-4 illustrates airway and ventilation differences for an adult, child and infant. Basic Life Support for Healthcare Providers Handbook 31 Table 1-4 Airway and Ventilation Differences: Adult, Child and Infant Child (Age 1 Through Infant (Birth to Adult Onset of Puberty) Age 1) Airway Head-Tilt/ Chin-Lift Past neutral position Slightly past neutral Neutral position position Ventilations Respiratory Arrest 1 ventilation every 5 to 1 ventilation every 1 ventilation every 6 seconds 3 seconds 3 seconds Compressions Although the rate of compressions is the same for an infant as for an adult or child, the positioning and manner of providing compressions to an infant are different because of the infant’s smaller size. The firm, flat surface necessary for providing compressions is also appropriate for an infant. However, that surface can be above the ground, such as a stable table or countertop. Often it is easier for the rescuer to provide compressions from a standing position rather than kneeling at the patient’s side. The fingers should be oriented so that they are parallel, not perpendicular to the sternum. Rescuers may use either their index finger and middle finger or their middle finger and fourth finger to provide compressions. Fingers that are more similar in length tend to make the delivery of compressions easier. The ratio of compressions to ventilations is the same as for an adult or child, that is, 30 compressions to 2 ventilations (30:2). The rescuer performing chest compressions will be positioned at the infant’s feet while the rescuer providing ventilations will be at the infant’s head. To provide compressions using this technique: ŸŸ Place both thumbs on the center of the infant’s chest side-by-side about 1 finger-width below the nipple line. While positioned at the infant’s head, the rescuer providing ventilations will open the airway using 2 hands and seal the mask using the E-C technique. With two rescuers, the ratio of compressions to ventilations changes to that of a child, that is, 15 compressions to 2 ventilations (15:2). When applying the pads, place one pad in the center of the anterior chest and the second pad in the posterior position centered between the scapulae.

Several types of germs cause infection including discount altace 5 mg overnight delivery; bacteria discount 2.5 mg altace with visa, viruses, fungi, protozoa and parasites. Fungal infections include ringworm and athlete’s foot and parasites include head lice and scabies. Ear infections are caused by germs that are not usually passed from person to person. Chicken pox on the other hand rapidly spreads from person to person and is an example of a highly contagious infectious disease. Once a person comes in contact with an infectious agent or germ, a number of factors infuence whether or not that person becomes ill. These include; the germ itself, the number of germs required to cause infection (i. Other factors depend on us; how strong is our immune system, have we met that germ before, are we resistant to it? Some infections result in lifelong immunity which is why most of us will only develop chicken pox or measles once in our lives, while other infections like the common cold can be caught again and again. Through direct contact, (skin contact, contact with saliva and other body fuids, sexual contact), e. The interval between contact with infection and the time symptoms develop is called the incubation period. For example children with measles are infectious for about 3 days before the appearance of a rash. Spread through the gastrointestinal tract or gut Some diseases are caused by germs which live and multiply in the intestines or gut and are passed out of the body in the faeces. For disease to spread, faeces containing these germs must be carried to the mouth and swallowed. Disease can spread when even very small amounts of faeces, amounts so small that they cannot be seen by the naked eye, contaminate hands or objects and are unknowingly brought to the mouth and swallowed. This is also known as the faecal-oral (faeces to mouth) route of transmission and usually occurs when hands are contaminated after using the toilet. Hands can also contaminate objects such as pencils and door-handles which are then handled, allowing the germs to pass to the next pair of hands and ultimately to the mouth of the next person, and so the infectious chain continues. Gastrointestinal spread is responsible for the spread of most infectious diarrhoea as well as some more generalised infections such as hepatitis A. Spread through the respiratory tract Some infectious diseases are spread by germs that can live and multiply in the eyes, airways (including the nose and mouth), and the lungs. These germs are easily passed from our nose or mouth to our hands and from there to other objects. Some infections are spread by droplets that are expelled by an infected person when they sneeze, cough or talk. Droplet spread usually requires the infected person and the susceptible contact to be relatively close to one another, within about 3 feet. Examples include; common cold, infuenza, meningococcal disease, mumps, rubella and pertussis (whooping cough). Other infections are spread by small aerosol droplets that remain in the air where they are carried on air currents (airborne spread) for some time after they are expelled e. Direct contact A number of infections and infestations (an infestation is when a person is infected with a parasite e. Some infections require only superfcial contact with an infected site for infection to spread e. With others, infection is only passed if there is either direct contact with the infected site or with contaminated objects. All of these infections, as well as many others can also be transmitted by sexual contact. This usually requires a breach in the skin or mucous membranes (the mucous membranes are the delicate linings of the body orifces; the nose, mouth, rectum and vagina). Intact skin provides an effective barrier to these germs and infection following contact with intact skin is extremely unlikely. However, infection can occur if the skin is broken, if someone has open cuts, or if the infected blood is carried through the skin e. It is also possible for infection to occur through sexual intercourse with an infected person. Infection can also be passed from mother-to-infant during pregnancy or at the time of delivery. The potentially serious consequence of acquiring these diseases means that all blood and body fuids must be treated as potentially infectious. This is particularly important because clinical illness is not always obvious in infected individuals.