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Although we have no evidence of ulators purchase generic lady era online womens health online, and fusion of the hip after failed arthro- an association 100 mg lady era overnight delivery women's health of pasco, two such prominent members of plasty cheap lady era 100mg with visa womens health exercise equipment. He lived to see his technique of anterior the Parisian medical scene hardly could have been spinal correction become accepted throughout unacquainted with one another. He undertook several lecture tours overseas and demonstrated his technique of correction of scoliosis at major centers in Mexico, the United States, Canada, South Africa and Israel. Many orthopedic surgeons visiting Australia came to his hospital, the Mater at North Sydney, to learn his technique. Despite international acclaim, he remained his modest self, untouched by ostentation; he placed no importance on wealth, social status or patron- age. His interests outside medicine were diverse: he read widely and took a special interest in politics. For several years, he was state president of the Democratic Labor Party. He was also a deeply religious man, who, together with his family, found understanding, affection and support within the Catholic Church. During the last months of his illness, he devel- Allan Frederick DWYER oped an equanimity that gave reassurance and 1920–1975 ease to those most dear to him. Allan Dwyer died in Sydney on February 13, 1975, just 9 months Allan Dwyer’s father was a general practitioner after the onset of the illness that caused the tragic and his mother a warm, perceptive and capable end of an inspiring career. From Christian Brothers School at Lewisham, he secured a scholarship in medicine and a bursary of residence at St. He graduated with honors in 1942 and became resident medical officer at St. After war service in Borneo with the Australian Army Medical Corps, he returned to general prac- tice with his father and started as a clinical assis- tant in the orthopedic department of St. This association was to nurture and develop Allan’s life-long enthusiasm for orthope- dic surgery. After obtaining the degrees of FRACS and MS in 1948, he rapidly began to show an outstanding ability for original thought and critical evaluation. His earlier work on the correction of severe defor- mity of the toes gave excellent results and won him countless grateful patients. His more recent work centerd on such formidable problems as scoliosis, the improvement of the rate of spinal 93 Who’s Who in Orthopedics hip resurfacing arthroplasty that he had seen there. This concept, which he developed, became known as the Indiana conservative hip. One of his proudest days was in the summer of 1979, when the American Academy of Orthopedic Surgeons sponsored a course in Indianapolis on resurfacing arthroplasty of the hip. He would internally stabilize intertrochanteric fractures on a standard operating table, using two plain radiographs to verify the correct position after placement of the nail. These nails were not cannulated, and the inferior fin was several millimeters longer than the other two. EICHER lectual stimulation and camaraderie, and traveled 1904–1988 frequently with fellow members to Europe and Canada. Eicher was an associate clinical professor in Berne, Indiana, to Mennonite parents whose of orthopedic surgery at the Indiana University ancestors came from Bern, Switzerland. He was at his fun-loving best attended Indiana University and received his MD with medical students, interns, and residents. After internship at Indianapolis and his wife, Pluma, often entertained students General Hospital, he began the practice of general and house staff in their home, and he greatly medicine, in 1933, in Decatur, Indiana. He repeatedly Had it not been for World War II, he probably insisted that the years of postgraduate training would not have chosen to enter orthopedic train- were the best because of the rapid pace of ing. He joined the United States Army Medical assimilation of knowledge and the absence of Corps in 1942 and served a tour of duty in the the socioeconomic pressures of practice. On returning to the United States, When Pluma died of neoplasia in January he requested assignment to an orthopedic service, 1978, Dr. In even if it meant that he would not receive a 1982, after a bilateral cataract operation, a urinary promotion. He was assigned to the orthopedic tract infection led to a brain abscess. Next came service at Cushing General Hospital, Springfield, a mitral valve replacement and then a mediastinal Massachusetts, of which Nelson Hatt was chief. Hatt for his innovative except the severe visual impairment, which was a ideas. Eicher attained the rank of Major before great setback because of his insatiable reading being discharged, in 1945. In addition to his wife, his oldest son, 1948, strong Hoosier ties brought Dr. A son, Dan, and a his family to Indianapolis, where he practiced daughter, Julie, survive. Eicher’s primary interest, and he became a pioneer in the develop- ment of the intramedullary stemmed femoral prosthesis. Müller in Saint Gallen, Switzerland, he became interested in the double-cup type of 94 Who’s Who in Orthopedics strengthened by his knowledge of medicine in general, of medical administration, of public affairs and by his ability to assess the characters of other men. Ellis was, above all, a wise man and he possessed the urbanity and detachment that would have made him a good judge or colonial governor. Yet these qualities were not such as to attract the attention of the crowd or even of the profession at large. He was not a brilliant inno- vator or a popular orator, and his talents were con- cealed by a natural reserve that could be a little forbidding. Those who knew him well instinctively sought his opinion, and even his verdict, not only on clini- cal problems but on difficult matters of adminis- tration. It was natural that he found himself on the governing bodies of both of his teaching hospitals and he was chairman of the Medical Committee Valentine Herbert ELLIS of the Royal National Orthopedic Hospital and of 1901–1953 the Academic Board of the Institute of Orthope- dics. His colleagues in the Institute had particular Valentine Herbert Ellis was born in India on reason to be grateful to him; a young postgradu- February 24, 1901, and was the son of Major- ate school is very vulnerable to the influence of General Philip Ellis of the Army Medical Service. He gradu- the great weight of his authority to keep the ated in 1925, became a Fellow of the Royal course steady and the pace even. When he spoke College of Surgeons of England in 1928 and at as treasurer of the British Orthopedic Association, about that time turned his attention to orthope- he was no tame book-keeper but a maker of dics. He would have been one of the associa- National Orthopedic Hospital, was appointed tion’s greatest presidents. He had already served assistant surgeon in 1931 and served the hospital with distinction as president of the Orthopedic faithfully until he died. Ellis was wholly free from self-importance and No happier choice could have been made.
These attacks also exemplified the fact that bioterrorism be shown that particular mutations in the gene confer disease purchase lady era 100 mg amex womens health zone exit health. Agricultural scientists are experimenting with embryo Although the deliberate production and stockpiling of cloning processes with animal embryos to improve upon and biological weapons is prohibited by the 1972 Biological increase the production of livestock trusted lady era 100mg pregnancy after miscarriage. The first successful Weapons Convention (BWC)—the United States stopped for- 75 Bioterrorism WORLD OF MICROBIOLOGY AND IMMUNOLOGY A decontamination crew responds to a possible release of anthrax by terrorists at a United States postal facility in 2001 lady era 100 mg cheap women's health rochester ny. Genetic engineering technologies can be used to of terrorist organizations—including the radical Islamist Al produce a wide variety of bioweapons, including organisms Qaeda terrorist organization—actively seek the acquisition of that produce toxins or that are more weaponizable because state-sponsored research into weapons technology and they are easier to aerosolize (suspend as droplets in the air). More conventional laboratory technologies can also produce There are many reasons behind the spread of biowar- organisms resistant to antibiotics, routine vaccines, and thera- fare technology. Both technologies can produce organisms that cannot tives; some governments may resort to selling bits of be detected by antibody-based sensor systems. In addition, scientists in politi- weapons are those that use smallpox (caused by the Variola cally repressive or unstable countries may be forced to par- virus), anthrax (caused by Bacillus anthracis), and plague ticipate in research that eventually ends up in the hands of (caused by Yersinia pestis). With the advent of ful than a conventional weapon because its effects can be far- vaccines and antibiotics, few U. In 1979, after an accident experience to readily recognize these diseases, any of which involving B. The Somalia in 1977, experts suspect that smallpox viruses may be bacilli multiply rapidly and produce a toxin that causes breath- in the biowarfare laboratories of many nations around the ing to stop. At present, only two facilities—one in the United plies adequate to meet the treatment needs following an attack States and one in Russia—are authorized to store the virus. As on a large urban population would need to be delivered and 76 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioterrorism, protective measures distributed within 24 to 48 hours of exposure. The National BIOTERRORISM, IDENTIFICATION OF Pharmaceutical Stockpile Program (NPS) is designed to MICROORGANISMS • see GENETIC IDENTIFICATION OF enable such a response to a bioterrorist attack. Preparing a strategy to defend against these types of MICROORGANISMS organisms, whether in a natural or genetically modified state, is difficult. Some of the strategies include the use of bacterial RNA based on structural templates to identify pathogens; Bioterrorism, protective measuresBIOTERRORISM, PROTECTIVE MEASURES increased abilities for rapid genetic identification of microor- ganisms; developing a database of virtual pathogenic mole- In the aftermath of the September 11, 2001 terrorist attacks on cules; and development of antibacterial molecules that attach the United States and the subsequent anthrax attacks on U. Each of government officials, media representatives, and citizens, the these is an attempt to increase—and make more flexible— development of measures to protect against biological terror- identification capabilities. Researchers are also working to counter potential Although the desire to increase readiness and response capa- attacks using several innovative technological strategies. For bilities to possible nuclear, chemical, and biological attacks is example, promising research is being done with biorobots or widespread, consensus on which preventative measures to microchip-mechanized insects, which have computerized arti- undertake remains elusive. These insects can, in a single operation, first half of the twenty-first century, biological weapons will process DNA, screen blood samples, scan for disease genes, surpass nuclear and chemical weapons as a threat to the citi- and monitor genetic cell activity. Defense Advanced Research Project (DARPA) works to rap- Although a range of protective options exists—from the idly identify bio-responses to pathogens, and to design effec- stockpiling of antibiotics to the full-scale resumption of bio- tive and rapid treatment methods. Bees, beetles, and other insects outfitted with Many scientists argue, therefore, that focusing on one specific sensors are used to collect real-time information about the pres- set of protective measures (e. Using fiber optics or electro- against the virus causing smallpox) might actually lower over- chemical devices, biosensors have detected microorganisms in all preparedness and that a key protective measure entails chemicals and foods, and they offer the promise of rapid iden- upgrading fundamental research capabilities. The The array of protective measures against bioterrorism early accurate identification of biogenic agents is critical to are divided into strategic, tactical, and personal measures. Late in 2001, the United States and its NATO (North To combat biological agents, bioindustries are develop- Atlantic Treaty Organization) allies reaffirmed treaty com- ing a wide range of antibiotics and vaccines. In addition, mitments that stipulate the use of any weapon of mass advances in bioinformatics (i. At the tactical level, the United States possesses or virus), the major problem in developing effective counter a vast arsenal of weapons designed to detect and eliminate strategies to bioterrorist attacks involves the breadth of organ- potential biological weapons. For example, researchers are analyzing many pathogens in an effort to identify common options is the use of precision-guided conventional thermal genetic and cellular components. One strategy is to look for fuel-air bombs capable of destroying both biological research common areas or vulnerabilities in specific sites of DNA, facilities and biologic agents. Regardless of whether the pathogens evolve Because terrorist operations are elusive, these large- naturally or are engineered, the identification of common traits scale military responses offer protection against only the will assist in developing counter measures (i. When laboratories capable of producing Biological warfare; Contamination, bacterial and viral; Genetic low-grade weaponizable anthrax-causing spores can be estab- identification of microorganisms; Public health, current issues lished in the basement of a typical house for less than $10,000, 77 Bioterrorism, protective measures WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioterrorist attack on the U. The NPS stockpile is designed to be rapidly extreme of potential military responses, the formal resumption deployable to target areas. For example, in response to poten- of biological weapons programs—even with a limited goal of tial exposures to the Bacillus anthracis (the bacteria that enhancing understanding of potential biological agents and causes anthrax) during the 2001 terrorist attacks, the United weapons delivery mechanisms—is unneeded and possibly States government and some state agencies supplied Cipro, the detrimental to the development of effective protective meas- antibiotic treatment of choice, to those potentially exposed to ures. In addition to increasing funding for the NPS, Biological Weapons Convention to which the United States is additional funds have already been authorized to increase a signatory and which prohibits such research, opponents of funding to train medical personnel in the early identification such a resumption argue any such renewal of research on bio- and treatment of disease caused by the most likely pathogens. Nonethless, advocates of increased research capabilities develop protective measures against biological attack. Such argue that laboratory and hospital facilities must be expanded plans allow for the maximum flexibility in terms of effective and improved to provide maximum scientific flexibility in the response to a number of disease causing pathogens. For example, In addition to increased research, preparedness pro- the Centers for Disease Control and Prevention (CDC), based grams are designed to allow a rapid response to the terrorist in Atlanta, Georgia, has established a bioterrorism response use of biological weapons. One such program, the National program that includes increased testing and treatment capac- 78 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioterrorism, protective measures ity. The CDC plan also calls for an increased emphasis on epi- ment facilities. Environmental Protection Agency demiological detection and surveillance, along with the devel- (EPA) has increased monitoring and working with local water opment of a public heath infrastructure capable of providing suppliers to develop emergency response plans. For example, the list of those biological agents most likely to be used on its web public has been specifically discouraged from buying often pages. As of July 2002, the CDC identified approximately 36 antiquated military surplus gas masks, because they can pro- microbes including Ebola virus variants and plague bacterium, vide a false sense of protection. In addition to issues of that might be potentially used in a bioterrorist attack potency decay, the hoarding of antibiotics has is also discour- Other protective and emergency response measures aged because inappropriate use can lead to the development of include the development of the CDC Rapid Response and Advanced Technology Laboratory, a Health Alert Network bacterial resistance and a consequential lowering of antibiotic (HAN), National Electronic Data Surveillance System effectiveness. Following the September 11, 2001 terrorist attacks on More specific response plans and protective measures the United States, additional funds were quickly allocated to are often based upon existing assessments of the danger posed enhance the United States Department of Health and Human by specific diseases and the organisms that produce the dis- Services 1999 Bioterrorism Initiative. For example, anthrax (Bacillus anthracis), botulism of the Bioterrorism Preparedness and Response Program (Clostridium botulinum toxin), plague (Yersinia pestis), small- (BPRP) increases the number and capacity of laboratory test pox (Variola major), tularemia (Francisella tularensis), and facilities designed to identify pathogens and find effective viral hemorrhagic fevers (e. Although these biogenic agents share the common previous funding for bioterrorism research. CDC has of experts to evaluate changes in research in order to effec- tively anticipate and counter potential terrorist threats. As a adopted a position that, in the absence of a confirmed case of result, research into smallpox, anthrax, botulism, plague, smallpox, the risks of resuming general smallpox vaccina- tularemia, and viral hemorrhagic fevers is now given greater tion far outweigh the potential benefits. CDC has also accelerated production of a biological weapon attack could overburden medical infra- smallpox vaccine. It is also possible days) convey at least some protection from the ravages of the that an effective biological weapon could have no immediate disease. A number of former agreements of an anthrax vaccine used primarily by military personnel.
Syndromes
You will need to devise a cataloguing system as soon as you start your note-taking purchase lady era 100mg mastercard menstrual ultrasound. Journals cheap lady era 100 mg without prescription women's health dumbbell workout, newspapers cuttings and other resource materials are best stored in box files buy lady era with a visa women's health lichi. Make a note of any cross-references between your resource materials and your filed notes. You can also use colour coding to organise files, for example so that your box file is the same colour as its related ring binder. Clearly mark each set of notes with information that will identify its source. For lectures, this will be the title, name and designation of the lec turer, along with the date. It might also be useful to make a note of the module under which the lecture was scheduled. Notes taken from articles, books or audiovisual material need to have sufficient information to allow you to locate the original material at a later date. Write these as questions and find out by reading or talking with peers or lecturers. Assimilate in formation gleaned from other sources into your lecture notes at the appro priate place. For example, notes from clinical practice, where you have seen a chronic asthmatic, might be filed along with your lecture notes on respi ratory diseases. Start with programmes that give simple, straightforward advice, then try documentaries and debates that give opposing arguments. Try to record these programmes so you can compare the information contained in your notes with the original source. Use different note-taking styles to record information from the same programme. How do the different sets of notes compare – do they each contain the same key points and examples? The above material can be used to discuss different styles of note-taking. Each person makes a list of two things about his or her note-taking that are good, and two things he or she would like to improve. Talk about your list with your friend, and set a date when you think you will have achieved them. Arrange to 166 WRITING SKILLS IN PRACTICE meet up again to check out your lists. Your list might include things like improving accuracy, filing notes and keeping your index up to date or trying a different way of recording information. Regularly reading through them will help you remember information and improve your understanding. Try to actively recall the main points or summaries at regular intervals. Summary Points ° Notes are both a learning tool and a study aid for revision. These as signments demand an enormous amount of time and effort from both the student and the examiner. However, they are essential in helping tutors gauge the level of each individual’s performance. Essays provide students with the opportunity to demonstrate to the tu tor their ability to: ° recall the pertinent facts of a subject ° select and organise information ° understand the relationship between ideas ° express ideas in a coherent and logical manner ° formulate opinions and convey convincing arguments to support their views ° discuss the practical application of theories. As well as demonstrating these abilities to their tutor, it will also give the students feedback on how well they understand the subject. As well as being part of the assessment process, the task of preparing and formulating essays is in itself a learning process. First, the obligation to write such papers is a useful catalyst in encouraging them to read more broadly and in depth about the subject matter in question. Second, the stu dents’ thinking about the subject is developed through the process of se lecting and organising information into a cohesive account. Studying in 167 168 WRITING SKILLS IN PRACTICE this way aids the retention of information for use in formal examinations and, more importantly, in clinical practice. Some students have had little experience of essay writing before they start their training. Other students, who may have returned to education after working for several years, may feel they need to revise their composi tion skills. If this applies to you, the following section gives advice on how to plan, write and understand the assessment of essays. It will help you to: ° understand the breadth and depth of the task ° refine your research task ° organise your notes ° select information relevant to your essay title ° structure your essay. Establishing the terms of reference Find out from your tutor any specific instructions regarding your set essay. What are the guidelines about the format in which the essay must be submitted? Analysing the essay title Always start by reading the title very carefully. Any mistakes in your inter pretation of the assignment will lose you marks or might even cause you to fail. Essay titles are phrased as questions, instructions, or statements on which you will be asked to comment. Start by identifying the main com ponents of the title by underlining all the keywords. These words will tell you both the topic and the approach your tutor wants you to take in the es say. For example: Outline the principles of the Data Protection Act (1998) and give examples of how these can be applied to record keeping in a community setting. You can now decide which of the keywords tells you ‘what’ or ‘who’ is the subject of the essay. Outline the principles of the Data Protection Act (1998) and give examples of how these can be applied to record keeping in a community setting. Look at the question again and see how the examiner has further de fined the subject area by asking for the ‘principles’. The question is not ask ing for information about the background to the Act or how it is enforced. Each subject area will have a wealth of information that would be far too much to include in one essay. Therefore, questions usually set one or more parameters within which you must restrict your answer. These often refer to: ° time periods, for example, ‘since the 1940s’, ‘in the twentieth century’, ‘in the last decade’ ° specific regions or nations, for example, ‘European’, ‘in the Third World’, ‘inner city’ 170 WRITING SKILLS IN PRACTICE ° specific sectors of the health service, for example, ‘community care’, ‘hospice’ and ‘acute’ ° specific aspects of health care, for example, ‘record keeping’, ‘moving a client’ or ‘type of therapy’. The parameters will help you to identify what is of relevance and impor tance to include in your answer.
