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The situation for independent variables that represent categories is a bit different and needs careful attention medicine expiration dates keppra 250 mg overnight delivery. A typical example is a variable indicating sex medicine used to stop contractions purchase 250 mg keppra with visa, for which the values could be set at x1 = 1 if male and x1 = 0 if female medications versed order keppra cheap online. In this case, the category for which the value is x1 = 0 is often called the reference group, to which we will compare the category x1 = 1. For linear regression models, the coefficient for this term is: ß1 = μmalesmalesl females that is, the difference between the mean weight, males – females, adjusted for all the other terms in the model. Multiple variables When we have three or more categories, the situation is Blood type x1 x2 slightly more complex; however, this is common and the A 1 0 correct interpretation is important. For this situaO 0 0 tion, we need two independent variables – one less than the number of categories. With this formula, we can compare A and O directly, and B and O directly, but not A and B. The formulation above refers to population values for which estimates would be obtained by fitting such a model to a specific set of data. The first step is to test the hypothesis concerning the full set of ßß s collectively, that is to test: H : 1 k = 0, If this hypothesis is rejected so that there is evidence that at least one of the ßs canßß be considered to be non-zero, then it is reasonable to progress with the testing of the coefficients for the individual terms. If none can be considered to be non-zero, then the model as stated has no meaningful terms and therefore has little value. Logistic regression is a powerful and flexible analytical tool for such situations. Our outcome of interest is typically an odds ratio comparing the odds, (for example, of obesity for males versus females), adjusted for a collection of other factors. The regression model is based on the dependent variable ln(odds) where ln represents the natural logarithmic scale (base ee) and odds are defined as the likelihood p of the event occurring divided by the likelihood of it not occurring, 1 p, sometimesp listed as odds pp /(1/(1/(1 p), So the model becomes ln( ) = 00 ++ 11 xx11 ++ 22 xx22 ++ ++ x +ε or equivalently, ß 00 + 11 x11 + 22 x22 + + k xk + ε odds e where the x are defined as they were for the linear regression model above. For example, for the independent variable, x1 = gender, with x1 = 1 for males and x1 = 0 for females, then the coefficient ß1 is used in the equation: ß1 e males/females and the term is interpreted as the obesity odds ratio for males versus females, adjusted ß1 for the other terms in the model. Basic biostatistics: concepts and tools 79 Survival analyses and Cox proportional hazards models For many situations, we are interested in the time until an event occurs (see Figure 8. For the obesity situation above, suppose that a group of patients had been successfully treated for obesity and they were being followed post-treatment to assess factors that are associated with obesity reoccurrence. In this case, we would be interested in measuring the time from the end of the initial treatment until obesity reoccurrence. The Cox proportional hazards model is an appropriate regression model for such situations. The independent variables can be the same as for the logistic regression example and the regression equation is: ß 1111+ßß2 2 kkx +k ε ht()() h00()()te where Box 4. Censoring h(t) = hazard of the event, having “survived” until time t without an event, Censoring is a process for dealing with follow-up time, when the event of interest doesn’t happen during the h0(t) = baseline hazard rate. This is typically due to dropNote that there is no ß00 to serve as an intercept or scaling out or other reasons for loss to follow-up, but it may factor as this is the role of the baseline hazard rate h0(t). The only complicating issue for this model is that we the follow-up time for an individual participant is said need to account for censoring (Box 4. The term e, obtained from analysing the data, is gression, except that it provides estimates for hazard an estimate of this relative risk. That is, For the independent variable x2 = age, measured in for the independent variable, x = gender, with x = 1 1 1 years, the term has an interpretation similar to that for the for males and x1 = 0 for females, then the coefficient slope in linear regression, this being ß1 is used in the equation: ß2 ß1 e per year increment males females/ the interpretation is similar to that for odds ratios in this example for logistic regression.

You have looked at nutritional problems of public health importance in Ethiopia and the role you can play as a Health Extension Practitioner in identifying and recording nutrition problems in your community and how can you advise and support the individuals you work with to find effective nutrition solutions treatment type 2 diabetes purchase keppra online now. As you’ve learned symptoms 3 days after conception purchase keppra 500mg online, the nutrition information you generate at the kebele level can be used to monitor nutrition indicators and to inform decision making at different levels treatment integrity checklist buy line keppra. As a Health Extension Practitioner you are in the ideal position to collect and process information about your community. These indicators are useful to assess progress towards achieving the Millennium Development Goals and assessing programme performance in particular. Nutritional indicators also help in planning community-based nutrition intervention programmes. As a Health Extension Practitioner you need to maintain the quality of all information generated from a community-based nutrition programme and timely reporting. Write your answers on your Study Diary and discuss them with your Tutor at the next study support meeting. You can check your answers with the Note on the Self-Assessment Questions at the end of the Module. So she needs to make sure that, in addition to carbohydrates, her family also eats some fats, some proteins and some micronutrients every day. Pregnant and lactating women is 4800 ´ 4/100 = 192 Therefore, the number of children under two years in Afeta is 384, while the number of under-fives is 701. Mrs X could tell her family that without rest and plenty of food she risks the baby being born with low birth weight. And low weight babies grow up with more chance of being ill, may do less well at school and may grow into adults who are unable to work effectively. However, very little meat is needed, and if food like beans, nuts and dairy products are included in the diet then a family can have a balanced diet, without including meat. Then you need to advise her about eating foods that contain vitamin A, iron and iodine, and making sure she has enough energy. She needs to eat a well-balanced diet but there is no need for expensive additional foods. Finally you need to know if she received a dose of vitamin A shortly after giving birth and if she is now eating food containing high amounts of vitamin A. Small children have a higher basal metabolic rate than older people so need more nutrients. Adolescents experience a growth spurt at the age of 15/16 so need a large intake of all kinds of nutrients during this time. However, at the moment, many babies are not exclusively breastfed and many infants are given complementary food too early or too late. Therefore, it is important they receive more information and advice, and as a Health Extension Practitioner you are in a good position to be able to do this. In addition, the fat in breastmilk has been found to be very important for the development of the brain. Breastfed children show better intelligence compared to bottle or formula fed ones. It has contraceptive and uterinecontracting effects that help the mother to space pregnancies and prevent postpartum haemorrhage, respectively. And it is also readily and freely available, and saves household expenditures for feeding the baby. So the working mother should express her breastmilk and get the baby fed by the caregivers when she is at the work. And you should also tell her that if she has any difficulties she should ask you how to overcome these.

Dosing regimen CrCl >60 ml/min >60 ml/min 40 60 10 40 <10 ml/ ml/min ml/min min Patient age <65 yrs ≥ 65 yrs All patients Dose 5 mg/kg 5 mg/kg 4 mg/kg 3 mg/kg 2 mg/kg Take levels 18-24 hrs 1818-24 hrs 18-24 hrs 48 hrs post post 1st dose 24hrs post post 1st post 1st dose 1st dose 1st dose dose Timing of 24 hrs post 1st Await levels < 1 mg/L before re-dosing 2nd dose dose 5) Give 2nd dose without waiting for levels in patients <65 yrs with good renal function medicine nausea cheap keppra 250mg amex. Await levels <1mg/L before re-dosing in elderly patients and those with renal impairment 6) Adjust maintenance dose according to level result (see Table 2 below) 98 Table 2 symptoms 6 days before period due purchase 250mg keppra amex. Exclusions:  If vancomycin therapy is required for Clostridium difficile infections bad medicine order keppra 500mg amex, use the oral route. Levels must be taken 0-60 minutes pre-dose with the sampling time documented on the blood form. Trough level interpretation & maintenance dose adjustment when levels 10-15mg/L are required Pre-dose (trough) level Maintenance dose adjustment (table 2) Less than 5mg/L Contact pharmacy 5 to 6. Repeat trough levels every 3 days in haemodynamically stable patients with stable renal function whose last level was in range. It follows the principles and concepts of essential medicines so as to simplify the management of medicines supply and support a streamlined logistics system. This set of tools is meant to be a guide for quick reference and its recommendations are valid for most presentations of the conditions covered. Nevertheless, clinical judgment and experience will always prevail for adjustment of treatment in individual cases when necessary. It is my hope that all health workers in Tanzania will find this document a useful tool in management of patients’ illinesses. It is anticipated that, the guidelines will be useful as tools for health professionals. The Ministry acknowledges all those who were involved in the development of the document and appreciates a sincere contribution of: Mr. Most chapters start with a title, a brief description of the topic, common clinical signs and symptoms of each disease, the diagnosis and differentials, investigations, treatments and supportive care. The medicines will be used to treat the majority of public health problems and they should be available to health facilities at all time. The guideline also makes provision for referral of patients to higher health facilities. The indices for all medicines used are found at the back of the guide book, together with the information on how to report the adverse drug reactions. The guideline also, makes provision for referral of patients to higher health facilities see the referral form. The last pages of the guideline contain annexes, references as well as the Essential Medicines List. Comments that aim to improve these treatment guidelines will be appreciated all the time and the form for that purpose is appended. Any pain of moderate or higher intensity is accompanied by anxiety and the urge to escape or terminate the feeling. In nonor pre verbal children, facial expression is the most valid indicator of pain; therefore use faces pain scale to assess severity. Children A: Paracetamol 15 mg/kg/dose 4–6 hourly when required to a maximum of 4 doses per 24 hours; 1|P a g e 1 | P a g e 1. They have the broadest range of efficacy, providing the most reliable and effective method for rapid pain relief. Adults : C: Tramadol tablets or injection 50-100mg every 6 hours or until pain is controlled.

Cytogenetics 41 mental disabilities medications given during dialysis purchase keppra 500 mg on-line, spontaneous abortion medicine definition order 500 mg keppra, premature death depending on the chromosome involved medicine 100 years ago buy 500 mg keppra fast delivery. The best known interstitial deletion affects the long arm of chromosome 15: del15(q11-13). This is one of the causes of Prader-Willi or Angelman syndrome (see Chapter 4, epigenetics and genomic imprinting). In the former case paternal deletion, in the latter one maternal deletion is found. Also interstitial, but small, so-called microdeletions are in the background of Williams and DiGeorge syndromes (del7q11. In both cases the repetitive sequences occurring in the affected region may explain the "slipping" of the replication apparatus or the non-exact pairing of the non-homologous chromosomes (skipping). Like deletions, duplications are also used to identify the chromosomal location of a gene or group of genes, so to map a gene. Translocations For the formation of translocations more than one, usually 2 or 3 breaks are needed. Depending on the origin of the broken piece or on the number of fragments translocated there are different sub-groups of the translocations. Reciprocal translocations At least two breakpoints are expected in the reciprocal translocations, which may be in two homologous chromosomes or in two completely different non-homologous ones. This phenomenon can be explained by just changing the position of the affected genes, not the genes themselves. Breakpoints are usually in noncoding regions, as the proportion of the coding regions of the human genome is <2%. In cases where the breakpoint is within a gene, following the translocation the gene itself is affected, so the abnormal product with different function, activity or amount, or perhaps unable to function is responsible for the appearance of pathological traits, e. The best example of reciprocal translocations leading to the formation of the Philadelphia chromosome (Ph1), is between 9 and 22 chromosomes, its cytogenetic abbreviation is t(9;22)(q34;11). If three instead of two breakpoints occur, insertional translocation or insertion takes place. Then one piece of the broken chromosome (2 breaks) is incorporated, inserted to the other chromosome (one break). Since human chromosome set consists of 46 chromosomes, and any piece of any of these chromosomes may change places, so it is obvious that the number of translocations is almost infinite. The special case of translocations is the Robertsonian translocation or centric fusion (Figure 3. In these structural chromosomal abnormalities only acrocentric chromosomes can be involved so in humans only one of the 13, the 14, the 15, the 21 and the 22 chromosomes. Not only the types of chromosomes involved, but the breakpoints are strictly determined: a break is always in the centromere or near to centromere. In this way abnormal fusion chromosomes can be formed, one of which initially can contain two centromeres (dicentric), but ultimately only one centromere remains active, the other is without a centromere, therefore it is lost during the subsequent divisions and thus the number of chromosomes is reduced. If the break is exactly in the centromere, a two centromeric, although rearranged chromosome is formed. As the result of the rearrangement from the initial acrocentrics two different sized, a larger and a smaller metacentric or submetacentric chromosome is created. Cytogenetics 43 the centric fusion not only results in an abnormal chromosome structure, but the chromosome number is reduced from 45 to 46.

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