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Therefore, most of the answer choices will have a sense of normalcy about them that may be fairly obvious and could be answered simply by using common sense. Unfortunately, over analytical test takers will often convince themselves otherwise. Test takers will get thrown off by the new information and if it seems like it might be related, they could choose that answer choice incorrectly. Strategy 11: Narrowing the Search Whenever two answer choices are direct opposites, the correct answer choice is usually one of the two. It is hard for test writers to resist making one of the wrong answer choices with the same wording, but changing one word to make it the direct opposite in meaning. Causes: Obstructive sleep apnea Seizures Cardiac Arrhythmias Brain injury Nervous system dysfunction Lung surgery Causes: Cancer Lung abscesses Atelectasis Emphysema Pneumothorax Tumors Bronchiectasis Drug overdose Prematurity Bronchospasm Encephalitis Choking Ketoacidosis Aspirin overdose Anxiety Pneumonia: viruses the primary cause in young children, bacteria the primary cause in adults. Bacteria: Streptococcus pneumoniae, Mycoplasma pneumoniae pneumoniae (pneumococcus). Respiratory failure Cor pulmonarle Pulmonary emboli: Blood clot of the pulmonary vessels or blockage due to fat droplets, tumors or parasites. General Components and Structure the circulatory system consists of the heart, blood vessels, blood and lymphatics. It is a network of tubular structures through which blood travels to and from all the parts of the body. In vertebrates this is a completely closed circuit system, as William Harvey (1628) once demonstrated. Blood is delivered by the pulmonary veins (two from each lung) to the left atrium, passes through the bicuspid (mitral) valve into the left ventricle and then is pumped into the ascending aorta; backflow here is prevented by the aortic semilunar valves. The aortic arch toward the right side gives rise to the brachiocephalic (innominate) artery which divides into the right subclavian and right common carotid arteries. Next, arising from the arch is the common carotid artery, then the left subclavian artery. As the subclavian arteries leave the axilla (armpit) and enter the arm (brachium), they are called brachial arteries. Below the elbow these main trunk lines divide into ulnar and radial arteries, which supply the forearm and eventually form a set of arterial arches in the hand which give rise to common and proper digital arteries.

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Oshika T, Ohashi Y, Inamura M et al: Incidence of intraoperative floppy iris syndrome in patients on either systemic or topical alpha(1)-adrenoceptor antagonist. Norredam M, Crosby S, Munarriz R et al: Urologic complications of sexual trauma among male survivors of torture. Batista J, Palacio A, Torrubia R et al: Tamsulosin: effect on quality of life in 2740 patients with lower urinary tract symptoms managed in real-life practice in Spain. Mann R, Biswas P, Freemantle S et al: the pharmacovigilance of tamsulosin: event data on 12484 patients. Johnson T, 2nd J, K, Williford W et al: Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. Lowe F, Olson P, Padley R: Effects of terazosin therapy on blood pressure in men with benign prostatic hyperplasia concurrently treated with other antihypertensive medications. Lepor H, Williford W, Barry M et al: the efficacy of terazosin, finasteride, or both in benign prostatic hyperplasia. Amin K, Fong K, Horgan S: Incidence of intra-operative floppy iris syndrome in a U. Blouin M, Blouin J, Perreault S et al: Intraoperative floppy-iris syndrome associated with 1adrenoreceptors Comparison of tamsulosin and alfuzosin. Cantrell M, Bream-Rouwenhorst H, Steffensmeir A et al: Intraoperative floppy iris syndrome associated with alph-adrenergic receptor antagonists. Cheung C, Awan M, Sandramouli S: Prevalence and clinical findings of tamsulosin-associated intraoperative floppy-iris syndrome. Keklikci U, Isen K, Unlu K et al: Incidence, clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin. Takmaz T, Can I: Clinical features, complications, and incidence of intraoperative floppy iris syndrome in patients taking tamsulosin. Bruskewitz R, Girman C, Fowler J et al: Effect of finasteride on bother and other health-related quality of life aspects associated with benign prostatic hyperplasia. Wessells H, Roy J, Bannow J et al: Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia. McConnell J, Bruskewitz R, Walsh P et al: the effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Lowe F, McConnell J, Hudson P et al: Long-term 6-year experience with finasteride in patients with benign prostatic hyperplasia. Vaughan D, Imperato-McGinley J, McConnell J et al: Long-term (7 to 8-year) experience with finasteride in men with benign prostatic hyperplasia. Lam J, Romas N, Lowe F: Long-term treatment with finasteride in men with symptomatic benign prostatic hyperplasia: 10-year follow-up. McConnell J, Roehrborn C, Bautista O et al: the Long-term Effects of Doxazosin, Finasteride and the Combination on the Clinical Progression of Benign Prostatic Hyperplasia.

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If identified, either related to or independent of the glomerular disease diagnosed, treatment should be considered either preceding or concomitant with immunosuppressive therapy, depending on the urgency of the timing of immunosuppression. A recent study demonstrated that four months of rifampin is noninferior to nine months of isoniazid and pyridoxine for treatment of latent tuberculosis. The diagnosis, treatment, and prevention of hyperinfection from Strongyloides has recently been reviewed. Strongyloides may be transformed from an asymptomatic infection to a potentially lethal systemic disease (hyperinfection syndrome) by exposure to as little as a few days of corticosteroid therapy. In patients at risk of harboring asymptomatic Strongyloides in whom corticosteroid therapy is contemplated, screening is advised. In the event that screening is unavailable or delayed in a high-risk patient, some have advocated for empiric treatment with ivermectin or second-line agents if ivermectin is contraindicated or not available. Vaccination with live vaccines (measles, mumps, rubella, varicella, rotavirus, yellow fever) is contraindicated while on immunosuppressive or cytotoxic agents and should be deferred until prednisone dose is <20mg/d and/or immunosuppressive agents have been stopped for at least one to three months. Since these vaccinations may confer only partial protection from meningococcal infection, the Centers for Disease Control recommend consideration of concomitant meningococcal antibiotic prophylaxis. Treatment should be given with zoster immune globulin if exposure does occur, and antiviral therapy with acyclovir or valaciclovir begun at the first sign of chickenpox lesions (See Chapter 4. The live, attenuated Zostavax vaccine is contraindicated in immunosuppressed and 93 immunodeficient patients. The newer recombinant Shingrix vaccine is safe, but immunosuppression may reduce its efficacy. Immunize healthy household contacts with live vaccines to minimize the risk of transfer of infection to an immunosuppressed child but avoid direct exposure of the child to gastrointestinal, urinary, or respiratory secretions of vaccinated contacts for three to six weeks after vaccination. As noted below, prophylactic trimethoprim sulfamethoxazole should be administered during periods of high-dose prednisone therapy to prevent Pneumocystis infection. Strongyloides superinfection should be considered in patients receiving immunosuppression who once resided in endemic tropical environments and who have eosinophilia and elevated serum IgE levels. Prophylactic trimethoprim-sulfamethoxazole should be considered in patients receiving high-dose prednisone or other immunosuppressive agents (rituximab, cyclophosphamide). The other accepted 94 outcome measure for many of these disorders is complete remission, assessed by the complete disappearance of abnormal proteinuria (<300mg per 24 hours). However, most studies rely on other surrogates as predictors of clinical outcomes. Changes in proteinuria A quantitative change in proteinuria (or albuminuria) is presented in most studies. This is often categorized as complete remission, usually defined as proteinuria <0. The variations in these definitions will be discussed in each disease-specific chapter. A percentage decline in proteinuria or albuminuria of >30% is also predictive of protection from progression to kidney failure with moderate reliability. The presumption is that such patients should be excluded from clinical trials since they are expected to be "non-responders" and therefore, may dilute any treatment effect and adversely affect the power of the study.

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Year 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 Sample N (annual) 2,710 2,759 2,414 2,837 3,514 3,931 3,979 3,702 3,683 3,813 4,379 5,153 5,539 5,725 Under 18 [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] [1] 18-44 25. Year 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 Sample N (annual) 2,093 2,047 1,698 1,869 2,235 2,492 2,545 2,442 2,438 2,369 2,289 2,269 2,198 2,173 Under 18 24. Year 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 All Musculoskeletal 2002-2004 Diseases 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 Condition Sample N (annual) 6,964 7,004 6,025 6,814 8,252 9,166 9,337 8,874 8,947 8,791 8,812 9,181 9,323 9,522 Total 76. Arthritis and Joint Pain [1] 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 2,710 2,759 2,414 2,837 3,514 3,931 3,979 3,702 3,683 3,813 4,379 5,153 5,539 5,725 271. Injuries 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 2,093 2,047 1,698 1,869 2,235 2,492 2,545 2,442 2,438 2,369 2,289 2,269 2,198 2,173 271. Year Total Sample N Population (annual) (in millions) Burden of Musculoskeletal Diseases in the United States, Third Edition page 679 Table 10. Because misclassification for arthritis has been demonstrated in children, reported arthritis for individuals <18 is not included. Spine 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 $581 $515 $606 $635 $672 $574 $649 $678 $709 $580 $592 $792 $919 $971 $255 $238 $349 $486 $348 $381 $496 $436 $360 $420 $410 $404 $223 $401 $84 $97 $94 $120 $142 $174 $188 $191 $234 $285 $309 $250 $181 $87 $21 $85 $96 $89 $35 $39 $93 $136 $169 $164 $123 $111 $68 $80 $934 $858 $1,095 $1,276 $1,111 $1,062 $1,328 $1,453 $1,483 $1,300 $1,264 $1,384 $1,344 $1,496 Burden of Musculoskeletal Diseases in the United States, Third Edition page 688 Table 10. Arthritis and Joint Pain [1] Year 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 Ambulatory $488 $452 $346 $353 $478 $647 $663 $662 $564 $533 $511 $659 $689 $662 Mean Increment (in 2011 $s) Inpatient Prescription -$429 $146 -$238 $168 -$298 $194 -$148 $248 $24 $266 $118 $329 $267 $360 $250 $300 $151 $290 $120 $177 $208 $202 $332 $251 $332 $288 $274 $426 Other $236 $254 $208 $190 $100 $78 $78 $76 $71 $115 $238 $284 $327 $316 All $654 $776 $568 $786 $969 $1,292 $1,476 $1,411 $1,194 $1,117 $1,320 $1,710 $1,821 $1,909 Osteoporosis [2] 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 2009-2011 [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] [2] Burden of Musculoskeletal Diseases in the United States, Third Edition page 689 Table 10. Persons with condition Sample N Total (annual) Population 2011 $s [2] 2011 $s $4,832 $5,037 $5,197 $5,518 $5,883 $6,306 $6,715 $6,924 $6,984 $7,169 $7,306 $7,581 $7,578 $7,768 $273. Because misclassification for arthritis has been demonstrated I children, reported arthritis for individuals <18 is not included. Data smoothing involves the use of an algorithm to remove noise from a data set, allowing important patterns to stand out. Data smoothing can be done in a variety of different ways, and is used to help predict trends. There is also a 4% gap in the probablility of working between persons with and without a musculoskeletal condition. Because persons with a musculoskeletal condition have a low probablility of being in the work force and a lower mean income, the incremental costs are often greated than the raw costs. The Economic Cost section utilized the Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, U. Photos and images were purchased from CanStock Photos for public Internet use in conjunction with Section 4: Permitted Uses. Extensive use was also made of published studies in scientific and epidemiological journals as secondary sources of data. It is important to recognize that no one source of data provides a complete view of the frequency and impact of a disease or condition. Interview surveys, for instance, generally underestimate the frequency of most musculoskeletal diseases.

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Problems following discharge Topreventanaemiaofprematurity,additionalironas supplementationorinpretermformulaisgivenuntil6 months corrected age, when iron becomes available fromsolidfoods. It becomes increas inglyevidentwhentheindividualchildiscomparedto their peers at nursery or school. Agreaterproportionhave refraction errors and squints and therefore require glasses. It may occur when the level of unconjugated bilirubin exceeds the albumin bindingcapacityofbilirubinoftheblood. The neurotoxic effects vary in severity from transient disturbance to severe damage and death. In severecases,thereisirritability,increasedmuscletone causingthebabytoliewithanarchedback(opisthot onos), seizures and coma. Infants who survive may develop choreoathetoid cerebral palsy (due to damagetothebasalganglia),learningdifficultiesand sensorineural deafness. Kernicterus used to be an important cause of brain damage in infants with severerhesushaemolyticdisease,buthasbecomerare since the introduction of prophylactic antiD Figure 10. The birth of a severely affected infant,withanaemia,hydropsandhepatosplenomeg aly with rapidly developing severe jaundice, has become rare. Antibodies may develop to rhesus anti gens other than D and to the Kell and Duffy blood groups,buthaemolysisisusuallylesssevere. Jaundice <24 h of age Jaundice starting within 24h of birth usually results fromhaemolysis. Thisisparticularlyimportanttoiden tify as the bilirubin is unconjugated and can rise very rapidlyandreachextremelyhighlevels. Breast milk jaundice Jaundice is more common and more prolonged in breastfedinfants. The cause is multifactorial but may involve increasedenterohepaticcirculationofbilirubin. Dehydration In some infants, the jaundice is exacerbated if milk intake is poor from a delay in establishing breast feeding and the infant becomes dehydrated.

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First, orally administered proteolytic enzymes are efficiently absorbed by the gastrointestinal tract into the systemic circulation168 to then provide a clinically significant anti-inflammatory benefit as I reviewed recently. Fourth, proteolytic enzymes degrade microbial biofilms and increase immune penetration and the effectiveness of antimicrobial therapeutics. For patients with gastrointestinal and genitourinary dysbiosis, supplementation with Bifidobacteria, Lactobacillus, and perhaps Saccharomyces and other beneficial strains is mandatory. The wide-ranging and well-documented benefits seen with probiotic supplementation provide direct and indirect support for the importance of microbial balance in health and disease. Supplementation with probiotics (live bacteria) is the best option, however prebiotics (such as fructooligosaccarides), and synbiotics (probiotics + prebiotics) may also be used. Synbiotic supplementation has been shown to reduce endotoxinemia and clinical symptoms in 50% of patients with Nutritional Perspectives: Journal of the Council on Nutrition of the American Chiropractic Association January 2006 19 Reducing Pain and Inflammation Naturally Part 6 minimal hepatic encephalopathy176, and probiotic supplementation safely ameliorated the adverse effects of bacterial overgrowth in a clinical study of patients with renal failure. Additionally, oral glutamine in doses of six grams three times daily can help normalize intestinal permeability, enhance immune function, and improve clinical outcomes in severely ill patients. Numerous experimental studies in animals have shown that circulating IgA immune complexes are taken up by hepatocytes and then secreted into the bile for elimination. A 1929 clinical study with human patients published in Archives of Internal Medicine provided irrefutable radiographic documentation that therapeutic enemas safely and effectively stimulate bile flow for 45-60 minutes following administration63, and this finding, along with the obvious quantitative reduction in intestinal microbes induced by such "cleansing", helps explain the reported benefits of colonics/enemas in patients with systemic illness40,61,62,64 and other immune-complex associated diseases such as cancer. Furthermore, this directly supports the naturopathic concept of "treating the liver" in patients with systemic disease by the use of dietary and botanical therapeutics that stimulate bile flow, such as beets, ginger206, curcumin/turmeric207, Picrorhiza208, milk thistle209, Andrographis paniculata210, and Boerhaavia diffusa. Constipation must absolutely be eliminated; there is no place for constipation in patients being treated for dysbiosis of any type. Patients with severe or recalcitrant dysbiosis can start the day with a laxative dose of ascorbic acid. The goal here is purgative physical removal of enteric microbes; in high concentrations, ascorbic acid has a direct antibacterial effect. Magnesium in elemental doses of 500-1,200 mg also helps soften stool and promote laxation. For the majority of patients in outpatient clinical practice, the location of their dysbiosis is the gut, which is easily assessed with specialized stool testing and parasitology examinations, and which is easily treated with oral botanical antimicrobials and dietary modification. In my own clinical practice, I consider stool testing extremely valuable and estimate that 80% of parasitology examinations return with at least one clinically-relevant abnormality. Testing for and treating dysbiosis is an absolutely essential consideration in patients with gas, bloating, alternating constipation/diarrhea, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, severe allergies, arthritis, and autoimmunity. In addition to hundreds to thousands of years of traditional use, many botanical medicines have modern peer-reviewed clinical and experimental research supporting their role in the eradication of acute and chronic infections. Beyond the use of antimicrobial herbs, other treatments such as diet therapy, immunonutrition, hepatobiliary stimulation, probiotics, and proteolytic enzymes clearly have a role in the treatment of patients with musculoskeletal inflammation secondary to dysbiosis. Additional details for testing and treatment of all major autoimmune disorders are provided in Integrative Rheumatology. Alex Vasquez is a licensed naturopathic physician in Washington and Oregon, and licensed chiropractor in Texas, where he maintains a private practice and is a member of the research team at Biotics Research Corporation. As the author of "Integrative Orthopedics: the Art of Creating Wellness While Managing Acute and Chronic Musculoskeletal Disorders" available from OptimalHealthResearch.


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Constipation was another problem that was not only miserable, but which also promoted the persistence of the dysbiosis and which was caused by the gut-paralyzing effect of H2S. Additively and synergistically, the elevated fecal betaglucuronidase was deconjugating whatever little cytochrome p450 detoxification was taking place, leading to the inability to clear and thus the accumulation of ambient chemicals and internal toxins that could not be oxidized for conjugation; notice the dual effect of endotoxin-mediated blockade of cytochrome p450 along with increased enterohepatic recycling due to the elevated fecal beta-glucuronidase. The folate deficiency and resultant lymphopenia are presumed due to a combination of malabsorption and increased utilization; at this time I also had an increased lactulose:mannitol ratio and dramatically elevated caffeine clearance with horrid benzoate conjugation. During this time, I gained personal physician heal thyself experience with practically innumerable nutrients, botanicals, and a few antimicrobial drugs; I also appreciated-and was ultimately cured by-my (in)famous vitamin C purge: firstmorning consumption of two cups of coffee (peristalsis stimulant) and ~30 grams of vitamin C with the resulting osmotic laxative and exaggerated migratory motor complex providing gastrointestinal housecleaning par excellence. Conclusions With the compilation of personal experiences and ongoing research from thousands of clinicians and basic scientists, we collectively have the knowledge and tools available to assess and alleviate dysbiotic illnesses in their various forms. The twilight of the idiopathic era and the dawn of new possibilities in health and healthcare continue to be progressively illuminated. Mitochondrial Medicine and Mitochondrial Nutrition in Primary and Specialty Care 3. Multifocal dysbiosis: Pathophysiology, relevance for inflammatory and autoimmune diseases, and treatment with nutritional and botanical interventions. Nutritional and Botanical Treatments Against "Silent Infections" and Gastrointestinal Dysbiosis, Commonly Overlooked Causes of Neuromusculoskeletal Inflammation and Chronic Health Problems. International Journal of Human Nutrition and Functional Medicine 2014;v2(q1);p1 ow. Musculoskeletal disorders and iron overload disease: comment on the American College of Rheumatology guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. Idiopathic versus Multifactorial: Twilight of the Idiopathic Era and the Dawn of New Possibilities in Health and Healthcare. Page i 1 Patient Assessments, Laboratory Interpretation, Clinical Concepts, Patient Management, Practice Management and Risk Reduction: this chapter introduces/reviews/updates patient assessments, laboratory interpretation, musculoskeletal emergencies, healthcare paradigms; the common and important conditions hemochromatosis and hypothyroidism are also included in this chapter since these need to be considered on a frequent basis in clinical practice 2. Wellness Promotion & Re-Establishing the Foundation for Health: Reviewed here are diet, lifestyle, psychosocial health, and-given the pervasiveness of persistent organic pollutants and their increasingly recognized clinical importance-an introduction to environmental medicine 187 3. Basic Concepts and Therapeutics in (Nondrug) Musculoskeletal Care and Integrative Pain Management: Nonpharmacologic management of musculoskeletal problems is preferred over pharmacologic. The Major Modifiable Factors in Sustained Inflammation: Major components of the "Functional Inflammology Protocol" are reviewed here, from concepts and molecular biology to an emphasis on practical clinical applications 1) 2) Food & Basic Nutrition Infections: Dysbiosis* / Viral** *This section specific to bacterial dysbiosis was also published separately as a clinical monograph titled Human Microbiome and Dysbiosis in Clinical Disease (Discounted Black and White Printing. Details regarding the local services provided within your Region can be obtained by telephoning the following numbers.


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This may indicate that the population of intermittent stayers may be more disabled than the others, which is further bolstered by the fact that clients in this group had more temporary departures to medical and psychiatric hospitals during their first 12 months in the Housing First program. Prior Living Situation Clients who entered the Housing First program from the streets were most likely to leave the program within 12 months (n = 9, 69 percent) and were also most likely to experience temporary program departures (n = 12, 36 percent). The clients with the highest levels of housing stability were those who entered the program from shelters, jail or a psychiatric hospital, or some other or unknown location, including crisis houses and living with friends. Prior Living Situation, by Level of Housing Stability (N = 34 for stayers, N = 33 for intermittent stayers, N = 13 for leavers) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 69% (9) 36% 30% (12) (10) 29% 26% 26% (10) (9) (9) 18% (6) 15% 18% (5) (6) 23% (3) 8% (1) 0% Stayers Streets Shelter Intermittent Stayers Psychiatric Hospital/Jail Leavers Other/Unknown One client entered the Housing First program from jail and was included with the group of clients who came from psychiatric hospitals-both living situations were fixed, controlled, and institutional environments. Clients who left the Housing First program permanently during the first 12 months were slightly more likely than other clients to experience co-occurring psychiatric diagnoses and histories of substance abuse (n = 10, 77%). The remainder of clients-approximately one-quarter of stayers (n = 9) and leavers (n = 3) and 18 percent (n = 6) of intermittent stayers-had a diagnosed psychiatric disorder only. Co-Occurring Disorders, by Level of Housing Stability Co-Occurring Disorders N Stayers (N = 34) % Intermittent Stayers (N = 33) N % Leavers (N = 13) N % 77% 23% 0% 0% 0% 100% 69% 15% 15% 23% 8% 15% 54% 38% Total (N = 80) N 55 18 5 2 7 73 52 18 3 20 15 9 36 34 % 69% 23% 6% 3% 9% 91% 65% 23% 4% 25% 19% 11% 45% 43% Disorders Axis I diagnosis and substance abuse 22 65% 23 70% 10 history Axis I diagnosis only 9 26% 6 18% 3 Substance abuse history only 1 3% 4 12% 0 No axis I diagnosis or substance 2 6% 0 0% 0 abuse history Psychiatric diagnoses No axis I diagnosis 3 9% 4 12% 0 Has axis I diagnosis 31 91% 29 88% 13 Schizophrenia, psychotic disorders 25 74% 18 55% 9 Mood disorders 5 15% 11 33% 2 Other disorders 1 3% 0 0% 2 History of substance abuse None 11 32% 6 18% 3 Alcohol 4 12% 10 30% 1 Drugs 4 12% 3 9% 2 Alcohol and drugs 15 44% 14 42% 7 Prior substance abuse treatment 14 41% 15 45% 5 Data source: Baseline Data Collection Instrument Note: Other disorders include oppositional-defiant disorders and personality disorders. All leavers in the sample, and most stayers and intermittent stayers, had an axis I diagnosis. Mood disorders include depressive disorders, bipolar disorders (characterized by depressive and manic episodes), and substance-induced mood disorders. Studies have found that homeless mentally ill clients with mood disorders, rather than schizophrenia, have a higher success rate in housing (Lipton et al. In addition, intermittent stayers were most likely to have a history of substance abuse and were more likely to use alcohol alone than other clients. Further, intermittent stayers also received prior substance abuse treatment more frequently than other clients-45 percent (n = 15) of intermittent stayers received treatment compared to 41 percent (n = 14) of stayers and 38 percent (n = 5) of leavers. Baseline Levels of Impairment Clients in the study sample with higher levels of impairment related to psychiatric symptoms and substance use at baseline had lower levels of housing stability. Eighty-five percent of intermittent stayers (n = 28) and leavers (n = 11) had some impairment related to psychiatric symptoms upon entering the Housing First program, while 76 percent of stayers (n = 25) were impaired. The levels of impairment related to drug and alcohol use were higher for intermittent stayers and leavers than for stayers. While only 9 percent (n = 3) of stayers experienced impairment related to drug use, 36 percent (n = 12) of intermittent stayers and 46 percent (n = 6) of leavers were impaired as a result of drug use. Similarly, only 12 percent (n = 4) of stayers experienced impairment related to alcohol use, while 48 percent (n = 16) of 73 Chapter 5: Housing Tenure intermittent stayers and 23 percent (n = 3) of leavers were impaired. In addition, intermittent stayers were much more likely than other groups to use alcohol.

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Histopathology performed in 11/22 cases showed focal segmental glomerulosclerosis. Recognition of additional prothrombotic state risk may help to lower the incidence of neurological complications. Results: the Nephrology risky huddle commenced in June 2018 and has directly successfully identified 60 clinical and 20 non-clinical near miss incidents, leading to the development of a specific renal druggle to focus on medication safety. The huddle is attended by with valuable input from the multi-disciplinary team including Consultants, Management, Nursing staff, Pharmacist, nurse specialists, Medication safety officer and Clinical risk management. Feedback from staff indicates an increased workload, however this creates a positive culture to discuss incidents openly. Communication and team building developing, and coordination of services and events has improved. Conclusion: the value of the Nephrology Risky huddle in incident reporting and discussion of near misses and adverse medication events can be used to identify the root cause of patterns of events. Empowerment and shared leadership across health care teams facilitates transparency, respect, compassion for patients, families and colleagues. The Nephrology risky huddle continues to identify learning opportunities creating a safer culture. Case: A 14-year-old girl was found to have anemia at school medical checkup and referred to our hospital. She had no disorders in other organs, including uveitis, lymph nodes swelling, and pulmonary diseases. Renal biopsy revealed interstitial fibrosis with inflammatory cells in 20-30% of stroma with multi-layered renal tubular basement membrane and 50% of collapsed glomeruli. One month later, she presented significant edema, and serum creatinine elevated to 2. The success of the nephrology safety culture is a journey not a project, dependent on planning resources and a sense of drive and passion within the nephrology service. The vision is to improve and safeguard the wellbeing of service users, their families and employees, minimize the hazards related with the delivery of care, avoid conflicting events, minimize their influence and learn from events. Modelling culture of safety behaviour: Safety huddles empower employees, ensuring accountability and foresee and deal with safety issues effectively. The Nephrology risky huddles facilitates discussion using the themes, Incidents- clinical and non-clinical, clinical practice, medication administration and educational opportunities. The most common 57kb deletion in Caucasian patients, has not been frequently found in other populations. The impact of the variants on the protein function was verified using in silico prediction tools. The score of severity was based on age of onset, and type and severity of manifestations.


  • https://ijrap.net/admin/php/uploads/2188_pdf.pdf
  • https://www.scienceopen.com/document_file/319b0561-e6ab-4b52-a21c-84e14871e01c/PubMedCentral/319b0561-e6ab-4b52-a21c-84e14871e01c.pdf
  • https://link.springer.com/content/pdf/10.1007%2F978-3-642-00966-2.pdf