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By: K. Rune, M.B. B.CH. B.A.O., Ph.D.

Vice Chair, University of Tennessee College of Medicine

In many cases pulse pressure and stroke volume purchase norvasc 5 mg with mastercard, the limited evidence in support of many practices drives the use of consensus as the basis for guidelines and improvement blood pressure 60 over 40 order norvasc overnight, while research continues to provide better evidence about effective interventions heart attack man 10 mg norvasc amex. Despite this substantial body of work heart attack questions to ask doctor discount norvasc 10mg, most activities that aim to address health care quality for children and youth have addressed issues other than chronic conditions. Most of the efforts related to chronic conditions have focused on narrowly defined biological outcomes (for example, indicators of diabetes control) rather than on broader measures of disability and functioning. Although improving clinical outcomes has clear value, especially when clinical improvement can be linked with longer-term functioning and improved ability, this article argues for a focus on measures that directly address disability and functioning. Some of these conditions-perhaps especially the high prevalence ones-are appropriate targets for preventive efforts. Quality and improvement activities should address prevention of these conditions and especially the disabilities arising from having them. Childhood chronic conditions provide opportunities for both primary and secondary prevention, that is, preventing the onset of a condition and preventing the consequences of a condition, including disability and dysfunction (see the article by Stephen Rauch and Bruce Lanphear in this volume). Given the dramatic growth in diagnoses of some conditions and the resulting increase in rates of recognized disabilities among children and young adults, public health and welfare systems will face extraordinary demands in the next decade unless greater resources are allocated to prevention. Personal factors secondary prevention of disability focuses on measuring quality of life among children and youth with various chronic conditions, recognizing that these measures provide important indicators of status beyond traditional biological or physiologic assessments. The choice of measures and areas of concern must in part reflect the values of a society or the purposes of study, but researchers also should consider the items or areas that services might be expected to improve. Social and community factors have a major influence on functioning and participation in the activities of everyday life, and this influence may go well beyond the physical impact of a disability. Treating the disease directly may have limited impact on participation or functioning, while targeting functioning or quality of life could lead to a change in chosen interventions. In general, traditional medical treatments may have greater impact on biological measures (for example, blood pressure) but less effect on functioning or participation (such as getting to school or playing games). Improving disability among children and youth thus calls for comprehensive programs with sharply focused goals. These include the scope of the evaluation (whether the measurements are conducted at a single point in time or over a period of longer duration), the area being evaluated (type of disability, functioning, or quality of life), and whether the unit of observation and intervention is the child, the family, or society. Short Term versus Long Term; Cross-Sectional versus Longitudinal Much measurement of child health derives from cross-sectional (that is, point in time) data, a strategy that makes little sense in efforts to measure and improve chronic health conditions and their impact. Although cross-sectional studies allow assessment, for example, of access to or use of services, they do not allow measurement of whether the use of those services is associated with improvements in health and reductions in disability over time. That type of measurement clearly requires following individuals before and after the use of services. Typical preventive services such as those aimed at curbing tobacco use or involving exercise and diet may translate into improved health years or decades later. Nonetheless, some short-term targets merit attention, including the use and efficacy of medications, hospital and emergency department use, and the use and efficacy of specialized treatments such as speech, language, and occupational therapies. The need to improve the evidence base for these treatments and to apply quality-improvement strategies based on solid evidence seems particularly critical in pediatric psychopharmacology. Much pediatric hospitalization today involves children with very complex, often multisystem diseases. How much physical therapy should a child with cerebral palsy receive, how frequently, and for how long? What about behavioral interventions or speech therapy for young people with autism spectrum disorders, again areas where good evidence supports use in general but few data are available regarding scope and duration? It focuses attention on the effects of conditions on mobility and body function and structure, activities and limitations, and social participation, and provides a framework to examine how conditions interact with the environment (including family factors) to affect functioning. Typical Domains of Quality of Life Measures Physical functioning/role performance Psychological/emotional state Social interactions and functioning Education functioning Physical (somatic) symptoms* Disease-specific symptoms* Treatment effects* Other, less common domains: Views of the future Role of the family Source: Author. These measures have the value of applicability across conditions, providing a way to compare degrees of functioning and ability regardless of the specific disorder. They have proven useful in general studies of childhood disability and in assessing improvement. Quality of life measures assess characteristics across a broad spectrum, ranging from general factors (such as relationships, psychology, and participation) and general health-related considerations (for example, how much illness a person experiences or the extent to which illness interferes with important functions) to conditionspecific measures such as abdominal pain in inflammatory bowel disease and joint pain or bleeding in hemophilia.

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Ten years ago arteria epigastrica inferior discount norvasc 5 mg online, when I last wrote a biography for Oceanography pre hypertension pathophysiology cheap norvasc on line, I was a brand new assistant professor arrhythmia emedicine buy 10mg norvasc with amex. Having a child is a great adventure-one we spent a lot of time preparing for blood pressure 30 year old female discount 2.5 mg norvasc amex, both emotionally and practically. Before my son was born, it was typical for my husband (who is my research technician) and me to spend three or more months of the year at sea together. About a year before we were ready to start our family, I changed the kinds of science I Kelly at the Oregon coast with her husband Chad and their son Kaelan. Our preschooler has also accompanied us on eld e orts, going out on one small boat and spending time at eld sites with hired caregivers while we were out on day-long trips. During these adventures, my son discovered that the ocean can actually be warm enough to swim in and made observations about tidal cycles and waves. I have been fortunate to have resources to facilitate solutions, a supportive professional environment, and a husband who is an equal parent and partner. My doctoral and postdoctoral research focused on the abrupt, large-scale climate and ocean changes of the last deglaciation and associated Heather enjoying some "family sea time" with her youngest daughter Aurelia (now three) at a favorite beach in Woods Hole. Photo credit: Andreas Kuehn Photography feedbacks between the tropics and high latitudes. I became an avid micropaleontologist and sedimentologist with expertise in stable isotope and trace element geochemistry. I have since focused my energy on community building and facilitating the science of others. While at times I miss doing research, I feel equally inspired and impactful by taking the broader view of how it all ts together. I work with federal agency managers and a continually growing network of scientists across a broad range of disciplines to cultivate new research areas and funding opportunities. In this position, I have harnessed my knowledge and talents to build a program and a community that will serve as a legacy for years to come. Each step of my journey has helped prepare me for the next, and I am grateful to many supportive mentors along the way. I always gravitated toward math and science, in part due to the encouragement of dedicated, creative teachers at an early age. I think the grand challenges we face as scientists are the increasing mistrust of science and the diminishing scienti c literacy of our public. Fear of math and science among students necessitates a movement toward more engaging, hands-on learning experiences that foster curiosity and innovation. For me, work-family balance means setting priorities and boundaries, being creative, and sometimes making di cult choices. Rather than dwelling upon missed moments and opportunities in the short term, I tend to focus more on the integration of my choices over time. Currently, I am investigating harmful algal blooms, a worldwide problem, with the aim of providing clues for their management. I had always wanted to study and protect nature, enjoyed terrestrial botany during my undergraduate studies at the University of Barcelona (Catalonia, Spain), then moved to the marine world for graduate work. She o ered me a challenging topic: to understand the underlying mechanisms of the sensitivity of dino agellates to small-scale turbulence. With Marta, I had the great opportunity to interact with the much-loved ecologist Ramon Margalef. I like working in open-minded teams, collaborating, integrating di erent skills and disciplines. Nevertheless, it was a good time for a country that had only recently opened up to democracy and the European Union. Today, a global economic, ecologic, and ethical crisis threatens humanity and science. Science, itself, is a ected by increasing emphasis on competitiveness and decreasing collaboration-one of the original cornerstones of scienti c research. Having a permanent position and management responsibilities in my research center, I feel a special commitment to work for a better future.

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Recent surveys suggest that research universities blood pressure medication vision purchase norvasc now, especially academic medical centers arteriographic embolization purchase norvasc toronto, are increasingly adopting research networking systems (Obeid et al blood pressure chart for child purchase norvasc 2.5mg otc, 2014; Murphy et al hypertension education purchase norvasc cheap. These publicly available data show promise for use in assessing cross-institution research collaborations in future team science research (Obeid et al, 2014). A recent study of implementation at the University of California at San Francisco (Kahlon et al. In response to an online survey, users identified a range of benefits to using the system to support research and clinical work. With the exception of this one study, however, there is little evidence to date that using the tools to guide team assembly results in teams or groups that are more effective than other teams or groups. High diversity of membership (feature #1) is directly addressed by the research in team composition, faultlines, and subgroups summarized above. The finding that task-related diversity is associated with more effective teams is a promising finding for team science projects, which are composed primarily on the basis of task diversity. Deep knowledge integration (feature #2) is actually a result of team composition, given that team science projects often require the integration of knowledge from multiple disciplines and stakeholders. Some of the tools discussed above such as the research networking systems, can potentially help mitigate the communication challenges resulting from this feature by making it possible to learn more about potential teammates in advance of team or group formation. Large size (feature #3) is moderated by the heterogeneity of team or group members such that larger groups have been found to be more productive, but this advantage over smaller teams declines with increased heterogeneity in the disciplines and institutions represented (Cummings et al. Using methods such as cognitive work analysis to carefully analyze the tasks and requirements for team or group members of varying disciplines would help avoid unnecessary challenges of size and diversity. The challenges emerging from goal misalignment with other teams (feature #4) are consistent with the concept of faultlines and subgroups that can be avoided by careful attention to team or group composition. However, science leaders or funding agencies sometimes place additional constraints on composition by requiring that a team or group include certain types of individuals, scientific disciplines, or institutions. Such constraints can inadvertently bring together subteams with multiple and sometimes conflicting goals. In these cases, it may be difficult to avoid the development of subgroups, and leadership and professional development interventions can be directed toward increasing the alignment of all subgroups with the highlevel goals of the larger group. Permeable team and group boundaries (feature #5) has been addressed only recently by research on dynamic team membership that acknowledges that modern teams tend to have fluid boundaries (Mathieu et al. To address these challenges, the authors suggested using team assembly tools, increasing role clarity, developing transportable team competencies, and focusing on team handoffs and transitions. Some research has found that acquaintance among team members and the trust it engenders facilitates effectiveness in cross-instititutional teams or groups (Gulati, 1995; Cummings and Kiesler, 2008; Shrum, Genuth, and Chompalov, 2007). But, as discussed earlier, other studies suggest that membership changes and inclusion of members who are not prior acquaintances can improve the effectiveness of science teams or larger groups (Guimera et al. Geographic dispersion (feature #6) is known to create challenges for team success. Geographically dispersed science team or groups are more likely to be successful if they are assembled so as to avoid faultlines and subgroups known to be problematic. However, if the scientific problem demands inclusion of members who may potentially divide along faultlines, interventions such as those described in Chapter 7 may be warranted. Finally, high task interdependence (feature #7), a feature of many science teams and larger team groups, can generate challenges when interdependence is required across subgroups or faultlines based on disciplinary or translational perspective or demographic factors. Balancing teams at assembly to avoid such faultlines or counteracting them via leadership or other interventions will help facilitate interdependent work. However, task-relevant heterogeneity does seem to be related to team effectiveness with important implications for science teams or groups including multiple discplines. Further research on faultlines and the subgroups that can result from them corroborate the positive influence of task-related heterogeneity and the need to carefully manage demographic heterogeneity. At the same time, emerging research suggests that demographic heterogeneity can sometimes support scientific productivity. The recent research on team assembly is beginning to offer insights into how the process of assembling the team or group and the prior relationships between the members affects the scientific and translational outcomes of team science. Research networking systems show promise for helping individual scientists, university research administrators, funders, and others identify potential team members. Further research on team assembly would be valuable at a time of rapid growth in team science.

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In contrast blood pressure medication name brands discount 10mg norvasc visa, people with no college degree normal blood pressure chart uk purchase 2.5mg norvasc with amex, ideologically conservative blood pressure medication ramipril cheap 10mg norvasc visa, and Republican supporters tend to be less tolerant blood pressure medication yellow teeth generic norvasc 10 mg otc. These tendencies do not, of course, take into account individual variations in attitudes. Women are somewhat more tolerant toward homosexuality than men, but the opinion gap is not considerable: slightly more than 50 percent of women accept homosexuality as opposed to slightly more than 40 percent of men (Shiraev and Sobel, 2006). Betzig (1989) found that cross-culturally, adultery and sterility (inability to conceive a child) were the most common reasons for divorce. There are some aspects of interpersonal male­female attractiveness that are also consistent across cultures. For example, characteristics such as kindness, understanding, intelligence, good health, emotional stability, dependability, and a pleasing disposition are considered to be cross-culturally attractive in women. Men everywhere react more negatively than women do when their partners share sexual fantasies about having sex with others. Women everywhere are more distressed than men are when their partner is kissing someone else (Rathus et al. For instance, courting and flirtation patterns are similar across many cultures and performed for the specific purpose of mate selection and reproduction (Aune & Aune, 1994). Touching may be viewed as a normal act of communication between two strangers in Mediterranean countries, but it could be totally inappropriate in the United States. A study conducted across 33 countries showed similarities in preference for mate characteristics between men and women who ranked "kind and understanding" first, "intelligent" second, "exciting personality" third, "healthy" fourth, and "religious" last. Despite the overall cross-cultural gender similarity, there were some differences in preference. According to the survey, men almost universally prefer "good looks" in women, whereas women choose "good earning capacity" as the most important characteristic of the partner of the opposite sex (Buss, 1994). Compared to Hispanic and white young males, ages 14­21, black youth are more sexually active. More than 35 percent of blacks report six or more sexual partners over their life. However, if social class differences are taken into consideration, there were no differences between the two groups. Data gathered across a large number of countries in Africa, Asia, South America, and Europe (Neto et al. According to the Global Study of Sexual Attitudes and Behaviors, men and women around the world experience similar sexual problems related to aging. The study, based on in-person and telephone interviews with 27,500 men and women in 30 countries worldwide, found that among men, the most common problem is erectile dysfunction, which increases with age. Among women, among the most common problems were lack of interest in sex and inability to experience orgasm (Laumann, 2002). The way we see ourselves and other people is often based on a starting point from which we make our judgments. Both are foreign college exchange students, both are juniors, and both of them will study at the City University of New York. Men and women believe that sexual experiences reduce their energy and are bad for their health. After a couple marries, the husband and wife are allowed to have sex once a week, at night, and as quickly as possible. Children on this island, both boys and girls, are taught about sex as early as at the age of 7. Chapter 7 Motivation and Behavior 193 At the age of 13, the boys undergo a special ritual that initiates them into adult sexual life. Every young man and woman at this age has an adult sexual partner of the opposite sex, who teaches them proficiency in sex. After a year of training, the students are allowed to have sex without supervision. After spending a month in the United States, Teak and Teal decided to write letters to some close friends in their home countries about their experiences with sex culture in the United States. Many interesting and valuable ideas about the nature of human motivation appear in classical works of prominent social scientists. Theories of sociobiology claim that general biological laws of evolution are perfectly suitable as a fundamental explanation of human motivation.

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