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Dunn and Mulvenon (2009) define summative assessment as assessment "data for the purposes of assessing academic progress at the end of a specified time period. Identifying the purpose or data needed establishes whether a particular assessment is being used formatively Formative Assessment Using formative assessment as a regular part of instruction has been shown to improve student learning from early childhood to university education. It has been shown to increase learning for both lowperforming and high-performing students. Other researchers have shown similar results for students with special learning needs (McCurdy & Shapiro, 1992; Fuchs & Fuchs, 1986). Research also supports the use of formative assessment in kindergarten classes (Bergan, Sladeczek, Schwarz, & Smith, 1991), and university students (Martinez & Martinez, 1992). Formative assessment provides students with information on the gaps that exist between their current knowledge and the stated learning goals (Ramaprasad, 1983). By providing feedback on specific errors it helps students understand that their low performance can be improved and is not a result of lack of ability (Vispoel & Austin, 1995). Studies emphasize that formative assessment is most effective when teachers use it to provide specific and timely feedback on errors and suggestions for improvement (Wininger, 2005), when students understand the learning objectives and assessment criteria, and when students have the opportunity to reflect on their work (Ross, 2006; Ruiz-Primo & Furtak, 2006). Recent research supports the use of web-based formative assessment for improving student achievement (Wang, 2007). A 2009 article in Educational Measurement asserts that teachers are better at analyzing formative assessment data than at using it to design instruction. Research calls for more professional development on assessment for teachers (Heritage, Kim,Vendlinski, & Herman, 2009). Authentic Assessment Generating rich assessment data can be accomplished through the use of an authentic assessment design as well as through traditional tests. Authentic assessments require students to "use prior knowledge, recent learning, and relevant skills to solve realistic, complex problems" (DiMartino & Castaneda, 2007, p. Research on authentic assessment often explores one particular form, such as portfolios (Berryman & Russell, 2001; Tierney et al. Authentic assessment tools can be used to collect both formative and summative data. Resources Rick Stiggins, founder and director of the Assessment Training Institute, provides resources on the practice of assessment at. The National Middle Schools Association provides assessment information through a search for "assessment" at. Stiggins (2007) points out that a variety of quality assessments must be available to teachers in order to form a clearer picture of student achievement of the standards.
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However, per chlor at e was det ect ed in 5 wat er samples, wit h t he highest value of 6. This f inding is consist ent wit h modeling pr oj ect ions and dat a f r om ot her sit es, wit h r espect t o "None Det ect " concent r at ions of per chlor at e in bot h soil and sediment samples, and 10 g/ L t o 100 g/ L concent r at ions of per chlor at e wit hin t he gr oundwat er under lying t he launch and f allout ar eas (given t he expect ed dilut ion wit hin t he sub-dr ain syst em f r om nonimpact ed ar eas). Of addit ional int er est in t he East hampt on st udy is a f inding of low-levels of per chlor at e (appr oximat ely 0. This suggest s an ar ea-wide "backgr ound" level of per chlor at e due t o unknown sour ces in higher r eaches of t he wat er shed. Dar t mout h Fir ewor ks St udy Ar ea the Univer sit y of Massachuset t s at Dar t mout h has host ed one or mor e communit y f ir ewor ks displays in 9 of t he last 10 year s. This is consist ent wit h obser vat ions and st at ement s made by campus of f icials. All wells wer e scr eened at t he wat er t able int er f ace, which was about 5 f eet below gr ade acr oss t he st udy ar ea. Soil condit ions in t he ar ea consist ed of glacial t ill wit h lar ge cobbles and small boulder s. Bedr ock is believed t o be 20 t o 30 f eet below gr ade wit hin t he st udy ar ea. A f ir ewor ks event occur r ed on t he campus on Sept ember 6, 2004, under calm wind condit ions. Accor ding t o r ecor ds pr ovided t o t he local f ir e depar t ment, t he f ir ewor ks pr ogr am consist ed of a t ot al of 1,750 aer ial shells. Pr ior t o t he Sept ember 6 t h event, sur f icial (0-1 inch) soil samples had been obt ained and analyzed f r om t he launch ar ea, along wit h gr oundwat er samples f r om t he 8 monit or ing wells. On t he mor ning of Sept ember 7 t h, f ollowing a clear night wit hout r ainf all, soil samples wer e again collect ed f r om t he same pr e-event locat ions. Addit ional r ounds of gr oundwat er samples wer e obt ained in Oct ober and December of 2004, and Febr uar y of 2005. The locat ion of key sit e f eat ur es and monit or ing point s, along wit h all gr oundwat er dat a, is pr ovided in Figur e 13. As can be seen, f ir ewor ks wer e launched in a 500 f oot by 300 f oot f ield sout hwest of t he campus cent er. Sur f icial soil samples obt ained in t his ar ea pr ior t o t he launch (J une 2004) wer e all N. Sur f icial soil samples obt ained in t his ar ea on Sept ember 7 t h r anged f r om N. Gr oundwat er dat a f or t he 8 monit or ing wells over all sampling r ounds r anged f r om N.
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Individuals on these therapies may need to ingest some added carbohydrate if pre-exercise glucose levels are,90 mg/dL (5. Hypoglycemia is less common in patients with diabetes who are not treated with insulin or insulin secretagogues, and no routine preventive measures for hypoglycemia are usually advised in these cases. Intense activities may actually raise blood glucose levels instead of lowering them, especially if pre-exercise glucose levels are elevated (157). Decreased pain sensation and a higher pain threshold in the extremities result in an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise. Therefore, a thorough assessment should be done to ensure that neuropathy does not alter kinesthetic or proprioceptive sensation during physical activity, particularly in those with more severe neuropathy. Studies have shown that moderate-intensity walking may not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear (159). In addition, 150 min/week of moderate exercise was reported to improve outcomes in patients with prediabetic neuropathy (160). All individuals with peripheral neuropathy should wear proper footwear and examine their feet daily to detect lesions early. A Results from epidemiological, case-control, and cohort studies provide convincing evidence to support the causal link between cigarette smoking and health risks (163). Recent data show tobacco use is higher among adults with chronic conditions (164) as well as in adolescents and young adults with diabetes (165). Pharmacologic therapy to assist with smoking cessation in people with diabetes has been shown to be effective (172), and for the patient motivated to quit, the addition of pharmacologic therapy to counseling is more effective than either treatment alone (173). Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse (174). Although some patients may gain weight in the period shortly after smoking Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia (161). Cardiovascular autonomic neuropathy is also an independent risk factor for cardiovascular death and silent myocardial ischemia (162). Therefore, individuals with diabetic autonomic neuropathy should undergo cardiac investigation before beginning physical activity more intense than that to which they are accustomed. One study in smokers with newly diagnosed type 2 diabetes found that smoking cessation was associated with amelioration of metabolic parameters and reduced blood pressure and albuminuria at 1 year (177). In recent years e-cigarettes have gained public awareness and popularity because of perceptions that e-cigarette use is less harmful than regular cigarette smoking (178,179).
In this study, mothers and infants were visited three or four times in the first 2 weeks of life and every 2 weeks thereafter until the infant was aged 6 months. Median duration of exclusive breastfeeding was 159 days, and 67% of mothers were still exclusively breastfeeding at 3 months, supporting the notion that with adequate support, exclusive breastfeeding can be achieved. The rate of transmission at 26 weeks in infants who were negative at 6 weeks was 4. Many mothers have access to animal milk at a fraction of the price of formula or can access it for free because of animal ownership. With the simplicity of flash-heat treatment of breast milk, it has been suggested as an option for use during times of increased transmission risk, as during episodes of mastitis or during the transition from exclusive breastfeeding to replacement feeds or the addition of complementary foods. The mother or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant, and, 3. The mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhea and malnutrition, and, 4. The mother or caregiver can, in the first six months, exclusively give infant formula milk, and, 5. Nutritionally, both cohorts did better than the general infant population, as reflected by greater observed Z scores (a measure of nutritional status) in the study populations versus the general infant population. Most clinicians recommend continuing to supplement lactating mothers with multivitamins, particularly given the wellappreciated nutritional stress that breastfeeding puts on mothers. Two other studies from Africa, looking at either vitamin A or multivitamin supplementation, have confirmed these findings. Delivering a comprehensive package of services based on the United Nations four-element strategy, including links between services and integration with maternal, newborn, and child health services 7. Risk factors for in utero or intrapartum mother-to-child transmission of human immunodeficiency virus type 1 in Thailand. Extending the success seen in resource-rich settings to resource-limited locales is both a necessary and urgent ethically sound goal. Pregnancy rates and birth outcomes among women on efavirenz-containing highly active antiretroviral therapy in Botswana. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load. Thus it is vitally important to design, implement, analyze, and continually improve our prevention efforts. These include risk factors for sexual transmission of the virus and specific interventions known to be effective in reducing its spread. This module also provides evidence that prevention programs can be effective and describes essential elements found in most successful interventions.
- Renal carcinoma, familial
- Dementia with Lewy bodies
- Osteosclerosis autosomal dominant Worth type
- Potter disease, type 3
- Fetal and neonatal alloimmune thrombocytopenia
- Cri du chat
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The vast majority of medications do not damage the salivary glands, but the likelihood of decreased unstimulated salivary flow rates increases in the presence of numerous diseases and medications. Although patients receiving multiple xerostomic medications tend to have more severe dry-mouth symptoms,22,23 the effects of xerostomic medications on patients can be highly variable. Over-the-counter medications associated with xerostomia include those used to treat allergic conditions, congestion, motion sickness and diarrhea. Some medications, such as those prescribed for overactive bladder disease, irritable bowel syndrome and Parkinson disease, are used specifically for 6 their anticholinergic properties. These medications directly inhibit salivary flow and often are associated with dry-mouth symptoms. Dehydration, mouth-breathing and neurological or psychological disorders (such as depression or anxiety) may add to the perception of oral dryness. In one study, investigators found that dehydration as a result of abstaining from food and liquids for 24 hours reduced unstimulated parotid salivary flow by approximately 90 percent. Salivary gland hypofunction can disrupt homeostasis of the oral cavity, may increase susceptibility to oral infection and dental disease, and can compromise quality of life. Traumatic lesions may be visible on the buccal mucosa and the lateral borders of the tongue. Inspection and palpation of specific salivary glands may reveal swelling, discomfort, a cloudy or purulent discharge (pus), or a complete absence of clinically evident secretions. A positive response to any of the following questions has been associated with reduced saliva, even in patients who have not expressed complaints of xerostomia39: Does the amount of saliva in your mouth seem to be too little? A comprehensive head and neck examination-both extraoral and intraoral-is important in identifying the presence or absence of pooled saliva, as well as in providing an initial assessment of the quantity and quality of saliva. The clinician should inspect and palpate major salivary glands to identify masses, swelling or tenderness. Minor salivary gland biopsy is a useful diagnostic tool for identifying underlying pathological changes associated with salivary gland dysfunction, especially when the clinician is attempting to identify the underlying etiology of salivary dysfunction as it relates to systemic diseases. In most individuals, Candida albicans is part of the normal oral flora, but patients with xerostomia often exhibit recurrent oral candidiasis. Patients should receive detailed information about the potential causes of dry mouth and the potential sequelae of impaired salivary secretion, including dental caries, candidiasis and mucosal complications. Preventive oral health care should be strongly emphasized, along with oral hygiene instruction stressing the importance of effective plaque removal and of regular dental visits to promote oral health.
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Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Thus, insulin requirements in the immediate postpartum period are roughly 34% lower than prepregnancy insulin requirements (87). In women taking insulin, particular attention should be directed to hypoglycemia prevention in the setting of breastfeeding and erratic sleep and eating schedules (88). Metabolic control and progression of retinopathy: the Diabetes in Early Pregnancy Study. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control. Cost-benefit analysis of preconception care for women with established diabetes mellitus. Associations of mid-pregnancy HbA1c with gestational diabetes and risk of adverse pregnancy outcomes in high-risk Taiwanese women. Refa erence intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Risk of macrosomia remains glucose-dependent in a cohort of women with pregestational type 1 diabetes and good glycemic control. Glycaemic control throughout pregnancy and risk of pre-eclampsia in women with type I diabetes. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and metaanalysis of randomized clinical trials on maternal and newborn outcomes. Pharmacokinetics, efficacy and safety of glyburide for treatment of gestational diabetes mellitus. Effect of glyburide vs sube cutaneous insulin on perinatal complications among women with gestational diabetes: a randomized clinical trial. Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. Prospective parallel randomized, double-blind, doubledummy controlled clinical trial comparing clomiphene citrate and metformin as the firstline treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome.
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Before the use of the term instantaneous physiologic death is considered, all of the procedures listed in Table I should have been applied, and no positive findings of significance should have resulted. After the death has been thoroughly investigated, eliminating all apparent causes of death, then some attempt must be made to find "historical" clues which might suggest instantaneous physiologic death. Vasovagal reflex (inhibition) In this situation, a history of a precipitating event will be developed and possibly a history of vasovagal episodes of lesser degree may be elicited from relatives and friends of the deceased. Since the flood of reflex activity of this nature is initiated by an "external cause," the precipitating event (if the death was witnessed) will likely be recalled. Ventricular fibrilation No precipitating event is necessary although there may be one. Such may have occurred when the individual was very tired and under great emotional strain. A combination of the two, vasovagal reflex and ventricular fibrillation, may be possible in theory and may actually take place. But in such an instance, a disease process would be noted at the time of autopsy, and the diagnosis of instantaneous physiologic death would be unnecessary. The type of the instantaneous physiologic death m a y be well enough defined so as to state on the death certificate: 1. Fatal ventricular fibrillation (when there is a history of preceding syncope due to arrhythmia). M a n y d e a t h s, h o w ever, are not witnessed, a n d despite a negative autopsy, etc. I f y o u desire s o m e fascinating reading the following b i b l i o g r a p h y is offered as an i n t r o d u c t i o n. None Cause None Precipitating present* Precipitating present* None Certification tendency to certify: 2. Minor cardiac "cause of death-undetermined" tendency to certify: "death due to diseasem natural causes" D 4. Minor cardiac * May be pressure to put precipitating cause on the death certificate and certify as an accident An overview of different methods (philosophies) of certifying the cause of death in instances where disease is absent or present in minimal (apparently sublethal) amounts. Brod, J, Fencl, V, Hejl, Z, et al: Circulatory changes underlying blood pressure elevation during acute emotional stress (mental arithmetic) in normotensive and hypertensive subjects. Simonson, E, Baker, C, "Burns, N, et al: Cardiovascular stress (electrocardiographic changes) produced by driving an automobile. This syndrome claims approximately three babies of every 1,000 live births, with a slight preponderance of males and a higher frequency occurring in lower socioeconomic groups. The peak incidence is in ages 2 to 4 months and 75 percent of the deaths are of infants less than 6 months old.
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Clinical trials are also underway to test the oral topical application of an engineered tobacco plant secretory IgA specific to a surface protein and other recombinant products on strep mutans ability to adhere to dental enamel (46, 52). In denture wearers, a form of oral candidiasis, characterized by petechial lesions on the palate, may be visible only after the removal of the dentures. Contributing Factors to Dry Mouth Nasal dryness, sinus blockage by tenacious secretions and associated "mouth breathing" - Nasal dryness should be considered in conjunction with xerostomia, since blocked nasal passages increase mouth breathing and exacerbate oral dryness. In many patients, the use of humidifiers followed by gentle nasal lavage to remove encrusted secretions may be helpful (Table 10). Additional causes of nasal blockage, including nasal polyps and sinus infection, should be sought and treated appropriately. At our clinic, we have found that "nasal lavage" may prove helpful in treatment of dry nose as well as dry mouth (Table 10). The patients may irrigate their sinuses using a nasal syringe or use more automated methods of sinus lavage commercially available ( The general procedure is to first achieve humidification of the sinus (either a warm shower or use of a cool mist humidifier), followed by nasal lavage and then a topical corticosteroid spray. Also of use are products for the dry nose such as Ayr Saline Nasal Gel, Breathe Right Saline Nasal Spray, Ocean Nasal Spray (and the newly available Ocean Plus), Pretz Spray, and Xlear Nasal Wash with Xylitol. Many patients with these complaints have acid reflux that results in laryngotracheal irritation, that stimulates vagal responses that mimic sinusitis. If reflux and laryngotracheal irritation are not suspected, and treatment with antibiotics is initiated for sinusitis, the result is likely to be oral candidiasis. Treatment approaches for laryngotracheal irritation due to acid reflux include twice daily use of a proton pump inhibitor, three times daily use of liquid alginate (Gaviscon), and avoidance of late night meals and caffeine. In some patients, promotility agents may be required and the assistance of an otolaryngologist with experience in distinguishing sinusitis and tracheal reflux is helpful in both diagnosis and therapy. In some of these individuals, it has been proposed that they have a local neuropathic process termed "burning mouth syndrome. In recent years, the distinction of this pain amplification has been distinguished from depression although the same types of medication used for depression or diabetic neuropathy have proven helpful. It is worth noting that the mainstay of neuropathy is tricyclic agents, which will exacerbate dryness due to their anticholinergic side effects (Table 12). Thus, "fibromyalgia" or "central sensitization" is the "elephant in the exam room. Gynecologic and Obstetric (Table 14)- Vaginal dryness often leads to painful intercourse (dyspareunia) (53, 54).