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Such needs are particularly focused around symptom management and treatment and end of life decisions symptoms 4 weeks pregnant purchase synthroid 125mcg without prescription. Palliative care medicine grapefruit interaction buy discount synthroid 25 mcg line, with its focus on symptom management symptoms 4dp5dt fet trusted 50 mcg synthroid, should be available to all patients to address these needs medications 4 less canada cheap synthroid 100mcg with mastercard. End-of-life care can be facilitated by aligning the patient and family preferences with the decisions they make and the care they receive. Informatics extends opportunities for facilitating information exchange and decision support that may extend and enhance the patient care and outcomes. Further, we will identify the opportunities for informatics in addressing the challenges of advanced disease, end of life, and bereavement through discussion of critical care issues, examples of existing eHealth applications and discussion of future directions. In this presentation, the most promising theoretical models and behavioral approaches for designing, developing, and evaluating digital health technologies and informatics solutions are highlighted. Examples in clinical care settings are given that illustrate how fundamental behavioral and psychological constructs inform the design and evaluation of clinical decision support systems for tobacco cessation, emotional distress screening and management, physical activity promotion, and for creating automated conversational agents for support and assistance in understanding complex consent forms. The future success of oncology informatics is predicated on drawing from the best available scientific evidence and behavioral informatics, enabled by behavioral medicine research, can serve as a core resource. However, few studies have examined how to best translate research findings into clinical practice of integrated behavioral health providers. Based on feedback obtained during the first phase of this study, we translated the in person workshop into a 90 minute webinar and provided phone based "office hours" following the webinar to provide additional support. They also reported the webinar was an effective platform for learning versus an in-person workshop (M=3. Future research from our group will focus on testing a competency interview that will be tested in the next webinar. Newly trained psychology pre-doctoral interns and postdoctoral fellows represent a substantial portion of the future workforce within this field. There were no significant differences on domain scores between interns and post-docs or those identifying as having a cognitive-behavioral theoretical orientation. Future directions for training improvements and lessons learned in a large healthcare system are discussed. Of particular concern are the effects of insufficient sleep and circadian dysregulation in adolescents on physical. Multiple health risk behaviors have also been linked to chronic sleep loss in adolescents, including alcohol consumption, substance abuse, and serious behavior problems such as violence and delinquency. Given the far-reaching potential for short and long-term adverse consequences and the virtually ubiquitous nature of chronic serious sleep loss in adolescents, the development of strategies targeted towards mitigation of these negative impacts becomes paramount. While implementation of behavioral interventions to increase sleep duration in individual patients may be an important and worthwhile goal in clinical settings, it is likely that a more widespread and far-reaching set of strategies and policies are needed to address this concern as a public health issue. Substantial empirical evidence now supports a healthy school start time for middle and high school students of 8:30a or later as likely to ultimately have one of the most impact on healthy sleep in adolescents. This symposium will focus on two key aspects of the adolescent sleep health crisis: 1) an overview of the biological, environmental and sociocultural etiologies of adolescent sleep loss and the impact of chronic sleep loss on the culture of health in adolescents, and 2) finding solutions, with a focus on the empirical evidence supporting the implementation of healthy school start times as a health policy intervention, including a "real world" example. Croft, PhD One of the most salient and remediable factors impacting adolescent sleep health is that of school start times. Epidemiologic studies in schools have demonstrated the impact of start time policy changes on adverse consequences such as shorter sleep duration, increased sleepiness, difficulty concentrating, behavior problems, and absenteeism. Over the last 15 years a small but growing number of school districts have responded to research regarding insufficient sleep among middle and high school students by implementing healthy school start times. This policy change occurred after an 18-month period of stakeholder input in this large and sociodemographically diverse school district. In the spring of 2015, before the policy change went into effect, ~2200 students and their parents completed online surveys that included selfreport measures on: sleep duration, chronotype (morningness versus eveningness), daytime sleepiness, mood, self-regulation, body mass index, injury, absences, and academic performance. In a subsample of ~300 students, sleep log and actigraphy data were also collected over seven days. These online survey data are being collected again in the spring of 2016 after the policy change goes into effect in the fall of 2015. At baseline, those with longer sleep duration reported having significantly better mood and self-regulation, and these outcomes were also significantly associated with morning chronotype.

Children acquire the ability to internally represent the world through language and mental imagery medicine q10 buy synthroid overnight delivery. Adolescents can think systematically medicine hat news buy cheap synthroid 150 mcg, can reason about abstract concepts medications 3 times a day order generic synthroid pills, and can understand ethics and scientific reasoning symptoms night sweats buy discount synthroid 25mcg on-line. Object permanence Preoperational Theory of mind; rapid increase in language ability Concrete operational 7 to 11 years Conservation Formal operational 11 years to adulthood Abstract logic Piaget has been criticized for overemphasizing the role that physical maturation plays in cognitive development and in underestimating the role that culture and experience plays. Looking across cultures reveals considerable variation in what children are able to do at various ages. Research has shown considerable overlap among the four stages and that development is more continuous. Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s, but whose work was not discovered by researchers in the United States until the 1960s and became more widely known in the 1980s (Crain, 2005). His sociocultural theory emphasizes the importance of culture and interaction in the development of cognitive abilities. Vygotsky differed with Piaget in that he believed that a person not only has a set of abilities, but also a set of potential abilities that can be realized if given the proper guidance from others. Vygotsky developed theories on teaching that have been adopted by educators today. Information Processing is not the work of a single theorist, but based on the ideas and research of several cognitive scientists studying how individuals perceive, analyze, manipulate, use, and remember information. This approach assumes that humans gradually improve in their processing skills; that is, cognitive development is continuous rather than stage-like. The more complex mental skills of adults are built from the primitive abilities of children. At the same time, interactions with the environment also aid in our development of more effective strategies for processing information. Urie Bronfenbrenner (1917-2005) developed the Ecological Systems Theory, which provides a framework for understanding and studying the many influences on human development (Bronfenbrenner, 1979). Bronfenbrenner recognized that human interaction is influenced by 21 larger social forces and that an understanding of these forces is essential for understanding an individual. The input of those is modified by the cognitive and biological state of the individual as well. This relates to the different generational time periods previously discussed, such as the baby boomers and millennials. Taking into consideration all the different influences makes it difficult to research and determine the impact of all the different variables (Dixon, 2003). Consequently, psychologists have not fully adopted this approach, although they recognize the importance of the ecology of the individual. Explain research involving time spans Explain ways to conduct ethical research An important part of learning any science, including psychology, is having a basic knowledge of the techniques used in gathering information. The hallmark of scientific investigation is that of following a set of procedures designed to keep questioning or skepticism alive while describing, explaining, or testing any phenomenon. Science involves continuously renewing our understanding of the subjects in question and an ongoing investigation of how and why events occur. The scientific method is the set of assumptions, rules, and procedures scientists use to conduct research. A research design is the specific method a researcher uses to collect, analyze, and interpret data. Psychologists use three major types of research designs in their research, and each provides an essential avenue for scientific investigation. Descriptive research is research that describes what is occurring at a particular point in time. Correlational research is research designed to discover relationships among variables and to allow the prediction of future events from present knowledge. Experimental research is research in which a researcher manipulates one or more variables to see their effects. Each of the three research designs varies according to its strengths and limitations. Descriptive Research Case Study: Sometimes the data in a descriptive research project are based on only a small set of individuals, often only one person or a single small group.

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Gail Dubrow medicine x topol 2015 purchase 200 mcg synthroid amex, "Deviant History medicine to increase appetite generic synthroid 100mcg without prescription, Defiant Heritage symptoms 5dp5dt purchase synthroid visa," the Friends of 1800 website symptoms 5th week of pregnancy buy discount synthroid 200mcg on-line, 2002, accessed June 5, 2016. Harris and preservationists have enriched the American historical narrative, and have identified historic places tied to African Americans, including historic places that many would not automatically consider African American historic places. Racism and economic disparities, both social and structural, have certainly contributed to this circumstance. As Professor of Rhetoric Charles Nero noted in his study tracing the development of the Faubourg Marigny neighborhood of New Orleans into a "gay ghetto," this racialized social and physical segregation was often by design: "Exploiting personal and friendship networks that had been established because of shared sexual-and racial and gender-identities was crucial. Mumford notes that "[m]any of the best and most important studies have avoided further investigation into the meanings of race for the gay past. While the women I have written about are among the most compelling characters in this saga, men gradually became my principal focus-because their story is also mine. It was a straight bar, but there were a lot of gay people from downtown, and there were a lot of Black gay guys there. Shane Vogel, the Scene of Harlem Cabaret: Race, Sexuality, Performance (Chicago: University of Chicago Press, 2009), 4. It was here where Wallace Thurman sought contributions from other young artists for a publication made for them, as opposed to being targeted to an outside audience. Despite its historical significance, the building was not landmarked before its demolition. Their former rooming house stood here until 2002, when New York City sold the peaked roofed brownstone, one of six in a matching row, to an investor in Rye, N. The home came down, and a new one, no bigger, was built in its place, its most distinguishing feature being a driveway. Chaban, "Much to Save in Harlem, but Historic Preservation Lags, a Critic Says," New York Times, February 29, 2016. The "267 House/Niggerati Manor" (now demolished) was located at 267 West 136th Street, New York City, New York. Twenty-one year old Richard Bruce Nugent was a self-conscious decadent who had shortened his name to Richard Bruce to allay maternal embarrassment about his homosexuality. The Rockland Palace, which hosted some of the most legendary of drag balls during the Harlem Renaissance, is gone. The Dark Tower (now demolished) was located at 108-110 West 136th Street, New York City, New York. This is now the location of the Countee Cullen Branch of the New York City Public Library. Du Bois: the Fight for Equality and the American Century, 1919-1963 (New York: Henry Holt & Company, 2000), 224-225. There are efforts to improve the pace of designations in Harlem generally, but they remain slow going. See Springate, Archeology (this volume) for a discussion of the archeological potential of places where standing structures are no longer extant. When in New York City, Locke often stayed at the Hotel Olga, 42 West 120th Street. He participated in the famed "Saturday Nighters" salon in the home of the writer Georgia Douglas Johnson in the period before the start of the Harlem Renaissance (Figure 4). In many ways, ragtime/jazz artist Antonio "Tony" Jackson, and blues artists Gladys Bentley and Gertrude "Ma" Rainey were pioneers in visibility and openness. There were the poets Waring Cuney, Mae Miller, Sterling Brown, Angelina Grimke, and Albert Rose. Writers like Jean Toomer and Alice Dunbar-Nelson (former wife of Paul Laurence Dunbar), and philosopher-critic Locke came regularly to enjoy the train of famous and to-be-famous visitors. She was one of the earliest blues artists to record her performances, earning her the title of "Mother of the Blues. Jackson performed at the Beaux Arts Cafй on the second floor of the Pekin Theater (now demolished), 2700 South State Street, Chicago, Illinois.

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Almost everyone has some hair loss with aging symptoms 6 days after conception cheap synthroid 150 mcg mastercard, and the rate of hair growth slows with aging medicine zofran buy discount synthroid. Male-pattern baldness is related to testosterone and is identified by a receding hairline followed by hair loss at the top of the head treatment glaucoma order 125 mcg synthroid with visa. Women can also develop femalepatterned baldness as their hair becomes less dense and the scalp becomes visible (Martin sewage treatment order synthroid 100mcg mastercard, 2014). Source Skin: Skin continues to dry out and is prone to more wrinkling, particularly on the sensitive face area. As we get older, our skin dries and loses the underlying layer of fat, so our face no longer appears smooth. Loss of muscle tone and thinning skin can make the face appear flabby or drooping. Although wrinkles are a natural part of aging and genetics plays a role, frequent sun exposure and smoking will cause wrinkles to appear sooner. Dark spots and blotchy skin also occur as one ages and are due to exposure to sunlight (Moskowitz, 2014). Sarcopenia: the loss of muscle mass and strength that occurs with aging is referred to as sarcopenia (Morley, Baumgartner, Roubenoff, Mayer, & Nair, 2001). Sarcopenia is thought to be a significant factor in the frailty and functional impairment that occurs when older. The decline of growth and anabolic hormones, especially testosterone, and decreased physical activity have been implicated as causes of sarcopenia (Proctor, Balagopal, & Nair, 1998). This decline in muscle mass can occur as early as 40 years of age and contributes significantly to a decrease in life quality, increase in health care costs, and early death in older adults (Karakelides & Nair, 2005). Exercise is certainly important to increase strength, aerobic capacity, and muscle protein synthesis, but unfortunately it does not reverse all the age-related changes that occur. The 308 muscle-to-fat ratio for both men and women also changes throughout middle adulthood, with an accumulation of fat in the stomach area. Thinning of the bones with age can change the shape of the rib cage and result in a loss of lung expansion. Age related changes in muscles, such as the weakening of the diaphragm, can also reduce lung capacity. Both of these changes will lower oxygen levels in the blood and increase the levels of carbon dioxide. In middle adulthood, these changes and their effects are often minimal, especially in people who are non-smokers and physically active. However, in those with chronic bronchitis, or who have experienced frequent pneumonia, asthma other lung related disorders, or who are smokers, the effects of these normal age changes can be more pronounced. Sensory Changes Vision: A normal change of the eye due to age is presbyopia, which is Latin for "old vision. When we look at something far away, the lens flattens out; when looking at nearby objects tiny muscle fibers around the lens enable the eye to bend the lens. With age these muscles weaken and can no longer accommodate the lens to focus the light. They are most noticeable if you are looking at the sky on a sunny day, or at a lighted blank screen. Floaters occur when the vitreous, a gel-like substance in the interior of the eye, slowly shrinks. As it shrinks, it becomes somewhat stringy, and these strands can cast tiny shadows on the retina. In most cases, floaters are harmless, more of an annoyance than a sign of eye problems. However, floaters that appear suddenly, or that darken and obscure vision can be a sign of more serious eye problems, such a retinal tearing, 309 infection, or inflammation. During midlife, adults may begin to notice a drop in scotopic sensitivity, the ability to see in dimmer light. By age 60, the retina receives only one third as much light as it did at age 20, making working in dimmer light more difficult (Jackson & Owsley, 2000).

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This allows the pharmacist to screen products for their suitability for individuals with known sensitivities 9 medications that can cause heartburn generic synthroid 50 mcg without a prescription. Over-the-counter medications and cosmetics also contain a qualitative listing of their ingredients medicine garden synthroid 25mcg line. The pharmacist thus has access to critical information he or she needs to safeguard patients relative to their known hypersensitivity symptoms 3dp5dt order synthroid 125 mcg with visa. Woodburne symptoms juvenile rheumatoid arthritis order synthroid without prescription, Essentials of Human Anatomy, Oxford University Press, New York, 1965, p. Rothman, Physiology and Biochemistry of the Skin, University of Chicago Press, Chicago, 1954, p. Skin SensitivityРA Specic Toxicological Concern One further problem of topical formulations associated with many ingredients and of special concern with preservatives is the development of skin sensitivity [81]. Haptens (chemicals like urushiol found in poison ivy) are absorbed through the skin and, while in the local tissues, chemically react with local proteins. Langerhans cells, the local cells involved in immunological surveillance, identify these now denatured proteins as foreign (nonhost). The Langerhans cells then leave the dermis by way of the lymphatics and enter the draining lymph node, where they complete the sensitization process by passing the allergen message on to resident lymphocytes (antigen presentation). Once sensitized, subsequent contact with the oending chemical (hapten) leads to inЇammation and skin eruption. Many of the preservatives used in pharmacy are phenols and comparably reactive substances, compounds that have a high propensity to sensitize susceptible individuals. The pharmacist should be alert to this possibility and prepared to recommend discontinuing therapy and physician referral when allergic outbreak is evident or suspected. Moreover, the pharmacist should be ready to recommend alternative products that do not contain an allergically oending substance once it has been identied, assuming of course that therapeutically suitable alternatives exist. Flynn, in Percutaneous Absorption: Mechanism Р Methodology Р Drug Delivery, 2nd ed. Hagen, Physicochemical Study of Hydrocortisone and Hydrocortisone n-Alkyl-21-Esters, thesis, University of Michigan, 1979. Smith, An Inquiry into the Mechanism of Percutaneous Absorption of Hydrocortisone and its n-Alkyl Esters, thesis, University of Michigan, 1982. Redelmeier, Skin Barrier Р Principles of Percutaneous Absorption, Karger, Basel, 1996, pp. Jones, Excipient eects on topical drug delivery paper presented at the Industrial Pharmaceutical Technology Section Symposium, 121st Annual Meeting of the American Pharmaceutical Association, Chicago, Abstracts, Vol. Chapter 9 Disperse Systems Wandee Im-Emsap and Juergen Siepmann Freie UniversitaИt Berlin, Berlin, Germany Ornlaksana Paeratakul Srinakharinwirot University, Nakhonnayok, Thailand I. Various pharmaceutical systems are included in this denition, the internal and external phases being gases, liquids, or solids. This chapter describes the basic principles involved in the development of disperse systems. Emphasis is laid on systems that are of particular pharmaceutical interest, namely, suspensions, emulsions, and colloids. Theoretical concepts, preparation techniques, and methods used to characterize and stabilize disperse systems are presented. The term ``particle' is used in its broadest sense, including gases, liquids, solids, molecules, and aggregates. The reader may nd it useful to read this chapter in conjuction with Chapters 8, 12, and 14, since they include some of the most important applications of disperse systems as pharmaceutical dosage forms [1]. Classication based on the physical state of the two constituent phases is presented in Table 1. The dispersed phase and the dispersion medium can be either solids, liquids, or gases. An emulsion is a liquid=liquid dispersion in which the two phases are either completely immiscible or saturated with each other. Another classication scheme is based on the size of the dispersed particles within the dispersion medium (Table 2). The particles of the dispersed phase may vary considerably in size, from large particles visible to the naked eye, down to particles in the colloidal size range, and particles of atomic Copyright © 2002 Marcel Dekker, Inc. Generally, three classes are distinguished: molecular, colloidal, and coarse dispersions.

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