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One half of} the problem is a scarcity of drive towards clear, compelling results; another half is a failure to adequately prepare to plan by workers and different essential members of the organization. Although the environmental assessment additionally be} viewed as mere busywork for the planning workers before real strategic planning begins, it has valid and essential purposes that must be enumerated and highlighted at the start of the assessment. Among them, as the primary activity in the planning process, the environmental assessment largely units the tone for the strategic plan and is an indicator for how relaxation of|the remainder of} the planning process is doubtless to|prone to} unfold by inspecting the next questions: Will the method be complete in scope? Have the outcomes of the strategic planning process been clearly articulated, and will this process drive towards their achievement? As discussed in Chapter 2, many planning efforts get off to a poor begin as a result of|as a end result of} the planning process and activities lack enough advance conceptualization, organization, or clarification to the entire organization. The environmental assessment, if poorly planned and executed, can derail subsequent strategic planning activities. For example, the workers might become enmeshed in data gathering and evaluation, bogging down the entire planning process early-a downside known as as|often identified as} evaluation paralysis. Guidelines and sources for effectively carrying out data gathering-a difficult and controversial task-are provided in displays three. Reviewing latest historical past and analyzing successes and failures is a comforting activity. But little is gained from overanalysis of the past, and whatever momentum and excitement the organization may be able to|could possibly|might find a way to} create on the initiation of strategic planning will likely be lost if historical performance turns into the major focus of the strategic planning process. This chapter examines the two parts of the environmental assessment-the inside and exterior assessments-and the primary outputs they need to} produce to facilitate the remaining activities of the strategic planning process. The evaluation contains an assessment of its current statements (mission, imaginative and prescient, values) and a comparison of those to latest performance. An assessment of program growth and monetary performance can also be|can be} carried out. The structures of governance and administration are evaluated in gentle of the mission, imaginative and prescient, and values assessments and similar organizations; a evaluation of their effectiveness, on the basis of inside data and industry norms where available, completes this task. Analyze Characteristics and Utilization Trends All the packages and services of an organization must be inventoried in the tendencies evaluation task. The high 75 to eighty p.c (as measured by volume or monetary contribution) should have a profile that includes capacity, volumes, and key resource attributes for the past three to 5 years. Profiling low-volume packages and services or people who perform poorly financially may be worthwhile as a prelude to contemplating downsizing or divestiture. Conduct Primary Market Research Market analysis has two primary purposes: (1) to gather pertinent data on the strengths and weaknesses of the organization and its opponents in the marketplace and (2) to involve organization leadership constructively and broadly early in the strategic planning process. This task should begin with a evaluation of any latest (within the past one to three years) primary market analysis. Then, extra analysis could be initiated, together with personal interviews, focus groups, online or written surveys, and phone surveys. Internal analysis targets usually embrace board members, physicians, different health professionals, and higher and center administration workers; in some circumstances, all staff additionally be} analysis targets. Analyze Other Critical Resources Resource evaluation usually focuses on facilities, tools, and workers to establish major property and liabilities. Analyze Financial Performance and Position the past three to 5 years of financial performance for the organization and its major parts must be profiled and industry norms and opponents. If the organization has already prepared future monetary projections for the next three to 5 years, these must be included in the evaluation. The exterior assessment profiles the historical performance and evolution of the marketplace and initiates the method of wanting forward by explicitly contemplating market tendencies and forecasts. Review Demographic, Economic, and Health Status Conditions this task identifies the broadest tendencies and variables which have had and will have an effect on organizational performance. While key community demographic, economic, and health status indicators for the past three to 5 years must be profiled and forecasts provided for the next 5 to ten years, if available, note that minor shifts in these measures are of minimal or no consequence to the strategic planning process. In addition to identifying broad tendencies, this evaluation is often helpful in identifying geographical areas or population segments with strong potential for future cultivation. Forecasts, together with potential various situations, for the next three to 5 years must be recognized and discussed. With predictions that reimbursement constraints will continue to dramatically affect on} hospitals and techniques, this concern deserves specific attention going forward. Technological and pharmaceutical advances should also to|must also} be thought-about among the major environmental influences in the future. Analyze Competitors Analyzing opponents is an important task-and typically essentially the most troublesome one-to full well in the environmental assessment, so substantial effort must be assigned to it. Competitor data in healthcare could be incomplete and outdated, though, more and more, good data could be collected with some hard work and resourcefulness. Some organizations might compete in most or all service classes, whereas others might accomplish that in a single or a few of} choose niches. Conduct Primary Market Research the market analysis task in conducting an exterior assessment parallels that of the interior assessment however focuses on events exterior to the organization. Recent (within the past one to three years) primary market analysis must be reviewed before proceeding with this task. Appropriate analysis might embrace personal interviews, focus groups, online or written surveys, and phone surveys. Assess Market Forecasts and Implications Population adjustments, economic indicators, and healthcare delivery-specific parameters for the community which have have already got been compiled in publicly available forecasts-should be obtained and assessed. If forecasts need to be prepared, at a minimal, projections should use applicable forecasting methods for major health service parts, together with acute, post-acute, and ambulatory care services by major service traces. A brief report with no more than|not more than} ten charts and tables accompanied by modest narration or highlighting of key points should suffice. Competitive Advantages and Disadvantages No specific approach or format for determining and displaying aggressive advantages and downsides is universally accepted. In basic, the two most reliable measures of aggressive advantage or disadvantage are market share and bond rating. Upward historical tendencies in these variables normally indicate a strong aggressive position. Simply focusing on bond rating and market share might, for example, masks major shifts in aggressive position the lagged impact of capital or human investments. As the displays present, objects additionally be} drawn from any class of the interior and exterior assessments, however not every assessment class needs to be represented in the ultimate summary. The purpose of the advantages/disadvantages evaluation is to provide organizational leadership with a transparent assessment of where the organization stands in its aggressive marketplace. Little benefit is derived from applying overly difficult evaluation to achieve the outcomes. Assumptions About the Future Up to this point in its process, the environmental assessment has been involved primarily with the past. The remainder of the assessment and the strategic planning process shifts major target|the major focus} to the longer term run}. The first forward-looking task is to develop an image of the longer term run} surroundings, three to 5 years hence and maybe further, during which the organization will function. The predictions of healthcare futurists and the forecasts from publications and associations that observe rising tendencies can help healthcare organizations formulate their very own assumptions (see the instructed readings on the end of this chapter for examples of accessible resources). Hamel and Prahalad (1994) write that few organizations spend an adequate period of time serious about the longer term run}, noting that "senior managers commit lower than 3%. Our expertise means that to develop a particular perspective concerning the future, senior managers have to be prepared to commit significantly more of their time" (emphasis in original). Historically, healthcare organizations and the general enterprise community have predicated a lot of their planning on one view of the longer term run} environment-usually a linear extrapolation of the past-rather than evaluating broad range|a variety} of possible futures. The upheavals in healthcare and different fields illustrate how this singular view of the longer term run} has led to major errors in organization technique and legitimate concern concerning the knowledge of planning for the longer term run} inside a restricted environmental context. However, this approach is no longer possible and constitutes one of the major variations between modern strategic planning methods and people of even the latest past. To make sure that|be sure that} a broader perspective is adopted, various futures must be outlined and discussed totally. Products of the environmental assessment might need to be revised or finetuned after finishing this task. Many excellent references supply approaches for developing various future situations. Among these, Schoemaker (1995) recommends the next steps in state of affairs growth: 1. Identify key uncertainties Construct initial state of affairs themes Check for consistency and plausibility Develop preliminary situations Identify extra analysis needs 9. Evolve towards a ultimate state of affairs (iteratively, converge towards the state of affairs that might be used) this approach permits organizational leadership to think about and critically analyze diverse various futures and distill a composite state of affairs from this broad view of the longer term run}.

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Lambert, "The Qualifications of Babylonian Diviners," in Festschrift fьr Rykle Borger zu seinem sixty five. Lambert, "Donations of Food and Drink to the Gods in Ancient Mesopotamia," in Ritual and Sacrifice in the Ancient Near East (ed. Here too, the text deviates from the latter by placing the closing formula (ina ikrib akarrabu, etc. From this we should always|we should always} draw the conclusion that not all prayers of the diviner are ikribus, although they might appear to be so. Die Wettergottgestalten Mesopotamiens und Nordsyriens im Zeitalter der Keilschriftkulturen. Perhaps this familiarity explains the lack of an elaborate hymnic introduction (salutation). Alternatively, one might counsel that ritual acts (and their description in the prayer) function the introductory motif. The diviner shows himself to be ritually prepared to meet with the gods of divination. The pronominal suffix on the verb is a 2ms dative without mimation, as also in strains eight and 54 (compare line 3). Is he tying a chunk of cedar into his hair or is he using a chunk of his hair as a binding? It seems to describe cedar means or the other|by some means}, either as a substantive in construct, a previous adjective, or an appositive. These could indicate that the diviner purified himself before the prayer in preparation to meet with the gods. Washing the arms and mouth as a ritual preparation is found comparatively regularly in the Mesopotamian ritual materials. Does the diviner repeat in line 2 in the course of the prayer the motion that he had already done previous to talking it (recounted here)? As Seux notes (467), Erica Reiner advised the current studying, deriving the verb from sapkum, "to heap up, to pile, to pour on. Goetze (25) suggests the lacking mimation on this ultimate word of the line is because of|as a outcome of} of} the lack of area on the pill. With the verb epsum, "to do, to make," the idiom means "to carry out an extispicy" (Starr, 50). This statement, which seems quite a few occasions all through the prayer, is "an appeal for the manifestation of the oracular verdict" (Starr, 58). In any case, the diviner again invokes Shamash and places pure cedar (see line 15) "to the mouth" of something, as in line 1. Sa, "which," introduces a short relative clause that additional describes the pо qutrnim in line 14. Goetze suggests the lacking mimation on the final noun is just the lack of area on the pill (see 25). The topic of the verb must be understood because the incense talked about in the previous line. As Goetze has advised for line 25, na-si-ku-um stands right here for nasikkum, an apocopated 1cs predicative with 2ms dative suffix. Even if Goetze is appropriate, we do not know why the scribe used this odd orthography in all 4 cases of the verb in this text. Cedar and cypress happen together regularly in rituals of the diviner (see Goetze, 29). Thus, as a substitute of the literalistic "messenger of truth," one may translate the construction as "dependable messenger. It is probably, due to this fact, some sort of liquid concoction comprised of saskы-flour and water that one can drink or pour out as a libation providing. Although the verbs sound descriptive right here, merely telling us what the god is going to do, these phrases are in reality directed at the god. In the gap at the finish of the line, we count on a verb in the subjunctive, as in strains 21 and 43. Samas bl dnim Adad bl ikrib u brim wsib kussо urim kil passur uqnоm turradam takkal tussab ina kussо tadвn dnam ina ikrib akarrabu ina tкrti pusu kittam suknam Line 42: this line begins as strains 19 and 25 did. Since there are still unsolved points with the pronunciation and syntax of numbers, the normalization given right here is an approximation. In different contexts, the word could check with a transverse line or the chord of a circle (in mathematical texts), a part of|part of} a gate, or a region/territory. Lines 51b­53 repeat strains 11­13, the brief version of the fuller formula used in strains 26b­33, 36­41, and 44­49. The verb is derived from itlum (utlu, nilum, nвlu), which in the S stem means "to make someone lie down, sleep, to lay something down. Samas usnlku ibam sa il nuwwur Nisaba Lines 55­57: these strains again repeat the brief formula first present in strains 11­13 and repeated quantity of} occasions all through the prayer. Annum is Anum, god of the sky (see page 217), or, as talked about right here, the abum, "father," of the samыm, "heavens. The phrase bl kakk, "lord of weapons," identifies Nergal fairly appropriately as an professional wielder of weapons. Bltum, "girl," is the female form of blum and implies the same thought of power and authority as that of its masculine type. In the latter, the verb comes first, adopted by the prepositional phrase and topic. The following will give attention to} two particular points only briefly: utilization of} cedar in Mesopotamian and biblical rituals and the idea of humans feeding the gods. And even in these two circumstances cedar is quite of|is type of} secondary, a mere additive to the blood that acts as the real ritual detergent. In truth, Milgrom goes so far as to say that cedar was chosen for these particular rituals because of its reddish colour and thus its affiliation with blood (note also utilization of} a crimson yarn). Our prayer very clearly units up a meal for the gods, round which they gather, eat, after which pronounce judgment. This explicitly anthropomorphic representation of the gods eating a meal has an in depth counterpart in the sacrificial practices depicted all through the Hebrew Bible. Yahweh was supplied a combination of meat, grain, and wine-things that look very very similar to|very like} the elements of a meal-every morning and night (see Exod 29:38­42). The sacrifices and choices prescribed by ritual texts are sometimes called "meals" (. Although there are very vocal statements (that get lots of attention from modern scholars) in opposition to the view (see. For a thorough dialogue of formality purity in the laws of the Hebrew Bible, particularly the pentateuchal Priestly Source, see David P. O Shamash, I lay down for you the abundant yield of the gods, the brilliance of Nisaba. In Enki and the World Order, line 406, she is talked about amongst quantity of} different goddesses as a sister of Enki (Akk. Several Old Babylonian cylinder seal legends and the current letter-prayer indicate that her veneration continued into the second millennium. The language in the opening displays the same sort of social hierarchy as one may find in a letter addressed to royalty by a loyal topic: "your servant" (waradki) writes to "my girl" (bltya). Unlike many different prayers in this quantity that contain lengthy preliminary praise or extensive lamentation and petition, this letter-prayer will get to the point rather shortly (lines 5­7). Ninmug is just asked to intercede on behalf of Ninurta-qarrad, the (male) supplicant, with her husband, Ishum. Apparently the supplicant believes Ishum is the one who has the authority to change his situation. This later deity, whose name is probably to be learn dNin-zadim, played a task in the Ms pо ritual complexes. Giving thanks is each materials and verbal: the supplicant will bring a sacrifice for Ishum and a sheep for Ninmug, but he may even "proclaim the praises" (dall dallu) of each deities. Ishum is the husband of Ninmug and the god with whom she is requested to intercede. The ubiquitous presentation scene on cylinder seals supplies visual affirmation of this description of intercession.

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Freshwater marshes and pondshores, ditches, interdune ponds, shores of brackish to freshwater estuarine sounds and rivers. Brackish and freshwater tidal marshes, especially in mud-flats within the intertidal zone. Edges of swamp forests, ditches, seemingly with the ability to spread rapidly; native of Asia. The 3 taxa with "quill-" or "rachis-leaves" are positioned in Tiedemannia, endemic to se. Hill 1756 (Parsley) A genus of about 1-2 species, annual to biennial herbs, of Mediterranean Europe. Commonly cultivated in gardens, not often persistent or weakly escaped; native of Mediterranean Europe. The lowermost leaves (withering prior to fruiting) typically lack leaflets and thus approach in appearance the quill-leaves of Harperella nodosa. It has the potential to be an excellent deal bigger and coarser than another member of the genus, but people will be encountered no bigger than a reasonably robust plant of P. An necessary character is the size of the kinds in relation to the calyx and/or to the bristles on the fruit. In the longer-styled species, the kinds are slender and curved outward, typically enmeshed within the bristles, but distinctly longer than them or than the calyx. In the shorter-styled species, the kinds are straight to slightly curved, shorter than or about as long as|so long as} the bristles, and kind of included within the calyx. In most species the calyx is inconspicuous, but consists of 5 deltoid to narrowly triangular (or even subulate) calyx lobes, zero. Dry-mesic to mesic, sandy forests, usually related to Fagus grandifolia (and southward Magnolia grandiflora). Phillippe, Clustered Sanicle, Clustered Snakeroot, Yellow-flowered Snakeroot, Fragrant Snakeroot. The plant may be very coarse, as much as} 3 m in top and the stem to 5 cm in diameter. Spermolepis Rafinesque 1825 (Spermolepis) A genus of 5 species, herbs, of North America, Argentina, and Hawaii. Since its naming, Taenidia montana has been traditionally separated into a monotypic genus, Pseudotaenidia; Cronquist (1982) has instructed that Pseudotaenidia be submerged in Taenidia. In rocky, dry to dry-mesic forests and woodlands over mafic or calcareous rock, corresponding to diabase, amphibolite, calcareous siltstone, calcareous shale, or limestone. Shale barrens and rocky woodlands over shale, greenstone, calcareous sandstone, and different calcareous and mafic rocks. Identification notes: Because Thaspium and Zizia are sometimes confused when not in fruit, a combined key emphasizing vegetative characters has been supplied; it could even be helpful to use necessary thing} to genera, and if a clear answer is obtained, then use the Thaspium-Zizia combined key, skipping taxa of the "incorrect" genus Leaves 3-4-ternate, the very quite a few final segments 1-3 mm extensive; petals white (fading to yellowish tan in older herbarium material). Thaspium pinnatifidum 1 Leaves simple, 3-foliolate, or 2-3-ternate, the final leaflets or segments > 5 mm extensive; petals yellow, maroon, or pale yellow. Thaspium barbinode 3 Leaflets finely to coarsely serrate, but not lacerate or incised, few if any of the teeth > 2 mm long as measured on the shorter aspect; umbel rays principally both more in number or longer; petals golden yellow. Zizia aurea four Teeth of the leaflets coarse, averaging (1-) 2-3 (-4) per cm of margin, acute to obtuse (the 2 sides making an angle of about ninety degrees); umbel rays 4-10 (-12), the longest to eleven cm long in fruit (some on a plant minimal of|no less than} 5 cm long); basal leaves 3-5 (-7)-foliolate, the leaflets principally rounded to obtuse on the apex; fruit 1-1. Zizia trifoliata 5 Teeth of the leaflets fantastic, averaging 4-10 per cm of margin, the long aspect of most of the teeth zero. Zizia aptera 6 Teeth comparatively obtuse, with a well-developed callous tip and a thickened, translucent border (use 10Ч); decrease portion of stem glabrous, the upper nodes typically minutely roughened; leaf margins glabrous and hyaline; umbel rays 4-10 (-11); flowers maroon or golden yellow. The hispid, purple-tinged leaf sheath is an effective additional character for this species. Forests and woodlands over calcareous rock, corresponding to limestone, dolostone, or calcareous siltstone). The distribution and rarity of this plant is complicated because of confusion with T. Various staff have differed on the characters used to separate two varieties in T. It is presently not clear how two varieties must be separated, or, certainly, if varieties are warranted. Rays reduced or absent, < 5 mm long, the inflorescence due to this fact compact, appearing like a head; inflorescences reverse the leaves, on peduncles 0-1 (-2) cm long; mericarps dimorphic, one with spines, the opposite tuberculate. Nelson (1993) states that regardless of "one thing of a reputation as a rarity," Trepocarpus is "a reasonably successful weed. Koch 1825 (Golden-Alexanders) A genus of about four species, herbs, temperate, of North America. Notes on the disintegration of Polygala (Polgalaceae), with 4 new genera for the flora of North America. Juniperus virginiana within the Serranias del Burro mountains, Coahuila, Mexico: a Pleistocene relict. Taxonomic revision of Geranium sections Batrachioidea and Divaricata (Geraniaceae). The branching of the inflorescence and vegetative shoot and taxonomy of the genus Kummerowia (Leguminosae). The genera of Thelypodieae (Cruciferae; Brassicaceae) within the southeastern United States. The genera of Brassiceae (Crucifrae; Brassicaceae) within the southeastern United States. The genera of Lepidieae (Cruciferae; Brassicaceae) within the southeastern United States. New wool-alien Cruciferae (Brassicaceae) in jap North America: Lepidium and Sisymbrium. The genera of Alysseae (Cruciferae; Brassicaceae) within the southeastern United States. The genera of Arabideae (Cruciferae; Brassicaceae) within the southeastern United States. The genera of Sisymbrieae (Cruciferae; Brassicaceae) within the southeastern United States. The genera of Anchonieae (Hesperideae) (Cruciferae; Brassicaceae) within the southeastern United States. Armoracia lacustris (Brassicaceae), the proper name for the North American lake cress. Parnassia caroliniana, Carolina grass-of-Parnassus, native of southeastern United States. A subspecific revision of North American saltmarsh mallow, Kosteletzkya pentacarpos (L. Big-fruited buckthorn, Sideroxylon macrocarpum (Sapotaceae), a long-forgotten Georgia endemic. A new species of Pediomelum (Fabaceae) from the decrease Piedmont Plateau of Georgia and South Carolina. Taxonomic and nomenclatural notes on South American taxa of Sarcocornia (Chenopodiaceae). Phylogenetic relationships of Cyrillaceae and Clethraceae (Ericales) with particular emphasis on the genus Purdiaea Planch. Phylogeny and floral evolution of the Lysimachieae (Ericales, Myrsinaceae): proof from ndhF sequence data. Population and website traits of a recently found disjunct population of Croton alabamensis (Euphorbiaceae). The delimitation of Bignoniaceae and Scrophulariaceae based mostly on floral anatomy, and the location of drawback genera. The genera of Anthemidae (Compositae; Asteraceae) within the southeastern United States. Notes regarding the nomenclature of Polypodium ptiloton and its correct spelling in Pecluma. Persicaria extremiorientalis (Polygonaceae) is established within the flora of the jap United States of America. Lesser celandine (Ranunculus ficaria): a risk to woodland habitats within the northern United States and southern Canada. Molecular phylogenetic analyses of Tofieldiaceae (Alismatales): household circumscription and intergeneric relationships. Molecular phylogeny of the Magnoliaceae: the biogeography of tropical and temperate disjunctions. Vegetative anatomy and the taxonomic standing of Ilex collina and Nemopanthus (Aquifoliaceae).

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The nice gods submit themselves, which is the which means of the kneeling gesture, to his authority. All of this textual data indicates how shuillas probably be} tailor-made to a specific event for a particular individual. Lambert discusses the present passage inside the context of celestial divination in his Babylonian Oracle Questions (Mesopotamian Civilizations thirteen; Winona Lake: Eisenbrauns, 2007), 6. The unspecified "they" in our line should be the good gods or divine assembly of lines 16­17. Piristu, "secret," stands in apposition to tmtu, thereby expressing the common idea that divine revelation is secret-inaccessible to people. This variant speaks in opposition to reading tmittu as tasltu, "celebration, delight, splendor," as some have accomplished (see. For the revelatory significance of model new} moon as described here, see Lenzi, Secrecy and the Gods, 165­66, n. It capabilities as a transition from praise to petition, the next section of the prayer. Shamash-shum-ukin waged a civil warfare for 4 years in opposition to his brother in Nineveh. These are comparable but not similar to the precise directions attested on some of the the} textual witnesses, which range among themselves. The verbs are probably greatest taken as performative utterances, the speaking of which executes the ritual action. It could also be} important to note that simply as the gods kneel earlier than Sin so too does the supplicant. With line 28 the prayer strikes right into a petitionary mode, asking first for a propitious and simply oracular utterance. In a well-balanced line that reveals both grammatical and semantic parallelism, the supplicant expresses their desire for simpler days, which, following because it does on line 30, will need to have} been carefully related to a renewed constructive relationship with their personal deities. GАR = Anzagar is, as the textual content says, the god of goals (ili sa sunti), for whom see Butler, 83­85. Either method, Anzagar is being used here as an intermediary between the supplicant and the deity the supplicant addresses, Sin. For instance, we could examine and contrast the character of the primary deity in this prayer and the Hebrew Bible: Sin is (or is carefully associated with) the moon whereas Yahweh created the moon (Gen 1:14­18). We could also note common ritual gestures and postures: kneeling is a gesture related to prayer and standing earlier than someone typically implies a position of servitude in both our Mesopotamian prayer (lines 11, 27) and the Hebrew Bible. Instead of taking a look at} these in more element, I will turn our consideration to the necessary concept of the divine assembly and the royal image used to depict its leadership. As one can see, this terminology presents us rather sparse data for understanding the divine assembly in the Bible. We due to this fact have to locate passages might be|that could be|which may be} thematically or conceptually related; we need to|we have to} widen the net. Reading these passages collectively, we may piece collectively an image of Yahweh presiding over his divine assembly as a king (see Ps 29, especially v. Like his human counterpart, here Yahweh held courtroom together with his divine retinue (Job 1:6, 2:1), deliberated in regards to the direction of varied human affairs (1 Kgs 22:19­23 1 Chron 18:18­22), sat in judgment on other divine beings (Ps 82:1­8), and commissioned human messengers to ship his phrases (Isa 6, Jer 23:18­22), among other activities. Like a king, Yahweh is presented as the last word|the ultimate word} and ultimate authority in the divine assembly-as Sin is presented in our prayer (lines 11 and 17). In other phrases, Yahweh presided over a divine assembly very the one described in our prayer (and identified from many other Mesopotamian sources), even when he alone was thought-about a god. Because of the evil of a lunar eclipse, which occurred in month so-and-so, on the day so-and-so, 14. O resplendent Sin of Ekur, they inquire of you, and you give the oracle of the gods, 19. The day of model new} moon (is) the day of your oracle, the key of the good gods. The thirtieth day (of the month) is your competition, the day for celebrating your divinity. Later, as Marduk continued to grow in status, his identification with Asallui turned completely confined to such magical contexts. In addition to this, the syncretism is grounded mythologically twice in Enma elis. The connection of Asallui with incantations is quite of|is kind of} sturdy, even in the Sumerian materials (though Abusch points out that even this has been overstated; 543). Early evidence for such a hyperlink between Marduk and magic, however, is considerably extra restricted making this speculation for the syncretism tough to show (Sommerfeld, 16­18). The ancient hermeneutics of name etymology in Akkadian are beyond the scope of this introduction. In addition to this, both dnam-til-la and dnam-ru appear in the same order in the god-lists. This presentation is in no way a important edition, for which one ought to seek the advice of} Maul. This type of prayer, a namburbi, was employed during a prophylactic ritual to avert the possible results of evil portents (see web page 36 in the general introduction). Thus, the relationship between such prayers and the Mesopotamian mantic tradition is significant. The description of the gods is quite of|is kind of} verbose in lines 1­17, and that is indicative of the good "sociological" gap between the supplicant and the high gods. Following the invocation is a listing of those portents (lines 21­22 and into a spot of indeterminate length). These omens range tremendously in number and content by manuscript and are derived from divination literature, particularly the unprovoked sorts, Summa lu (terrestrial omens) and Enma Anu Enlil (celestial omens). No doubt, lost in the lacuna are specific omens inside these general categories or perhaps reference to terrestrial omens. Celestial omens all the time concern the monarchy and the state, by no means private individuals. The gods ought to act in such a method so as to defend him from the portents and their unwell effects. The image is one of winds that blow by-winds are invisible, but those they cross can nonetheless physically feel the results. In one of them, the unidentified scholar relays to the king that he ought to modify the namburbi (as nicely as a prescribed shuilla) by inserting the precise omina in opposition to which the prayer is meant to act. This is the doubtless rationalization as to why this prayer has variant manuscripts by which the reworkings lie completely in the portents section. The textual content of this prayer was thought-about adjustable to a specific ominous state of affairs and this makes it unique among the many extant namburbi-prayers. As is commonly the case in such circumstances, some the textual content picks up after the break on the reverse of the pill after one illegible line. All lines after his line 11 due to this fact should be increased by one (thus, his line 12 is the present line thirteen and the rubric turns into line 14). Der Aufstieg Marduks: Die Stellung Marduks in der babylonischen Religion des zweiten Jahrtausends v. These lines set up sure key ideas (dna dвnu, simta sвmu, uurta uuru and isqta ussuku) for the hymnic section (lines 5­12) of the invocation. The ­ma on attunu is non-coordinating here, putting the emphasis on the pronoun, which brings the opening sentence to completion. Note the shut parallelism between lines 6 and seven, which collectively form a kind of commentary on line 5. The plural by-forms of ittu, idtu and itttu, happen frequently side-by-side in logographic writing Б. The "stars of (the paths) of Ea, Anu and Enlil" check with the stars and constellations which fall into three specific regions of the sky, envisioned as celestial bands running from east to west, and infrequently referred to as arrn st Ea, "Path of Ea," and so on. Erica Reiner and David Pingree understand the Paths of Enlil, Anu, and Ea to be variously defined sections of the horizon over which stars are expected to rise heliacally: Enlil the northern-most, Anu in the heart and closest to the celestial equator, while Ea lies to the south (Babylonian Planetary Omens Part 2: Enma Anu Enlil, Tablets 50­51 [Bibliotheca Mesopotamica 2. In mentioning all three, the author has effectively included all seen astral phenomena involving the mounted stars completely.

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However, at ranges present in food and at sensible fortification ranges, zinc absorption seems not to be affected, for example, by iron and copper (21). Isotope research with human topics have identified two factors which along with the total zinc content material of the diet are major determinants of absorption and utilisation of dietary zinc. The first is the content material of inositol hexaphosphate (phytate) and the second is the extent and supply of dietary protein. Phytates are present in whole-grain cereals and legumes and in smaller quantities in different greens. They have a strong potential for binding divalent cations and their depressive effect on zinc absorption has been demonstrated in people (21). The molar ratio between phytates and zinc in meals or diets is a useful indicator of the effect of phytates in miserable zinc absorption. At molar ratios above the vary of 6­10, zinc absorption starts to decline; at ratios above 15 absorption is typically lower than 15 percent (20). The effect of phytate is, however, modified by the supply and quantity of dietary proteins consumed. Zinc absorption from some legume-based diets is comparable with that from animal-protein-based diets regardless of a higher phytate content material within the former. High dietary calcium potentiated the antagonistic results of phytates on zinc absorption in experimental research. The outcomes from human research are much less consistent and any results appear to depend upon the supply of calcium and the composition of the diet (22). Some examples of just lately published absorption research illustrate the effect of zinc content material and diet composition on fractional zinc absorption (Table 53) (19, 23- 25). Thus, approximately twice as much zinc was absorbed from a non-vegetarian or high-meat diet (24, 25) than from a diet in rural China primarily based on rice and wheat flour (20). Data are missing on zinc absorption from typical diets of developing countries, which normally have a excessive phytate content material. The availability of zinc from the diet may be improved by reductions within the phytate content material and inclusion of animal protein sources. Lower extraction charges of cereal grains will end in lower phytate content material however at the identical time the zinc content material is lowered, so that the net effect on zinc supply is restricted. The phytate content material may be lowered by activating the phytase present in most phytate-containing foods or by way of the addition of microbial or fungal phytases. Phytases hydrolyse the phytate to lower inositol phosphates, leading to an improved zinc absorption (26, 27). The exercise of phytases in tropical cereals corresponding to maize and sorghum is lower than that in wheat and rye (28). Germination of cereals and legumes increases phytase exercise and addition of some germinated flour to ungerminated maize or sorghum followed by soaking at ambient temperature for 12­24 hours can scale back the phytate content material substantially (28). Additional discount may be achieved by the fermentation of porridge for weaning foods or doughs for bread making. Commercially out there phytase preparations additionally be|may be|is also} used however may not be not|will not be} economically accessible plenty of} populations. Populations at risk for zinc deficiency the central position of zinc in cell division, protein synthesis, and development makes infants, kids, adolescents, and pregnant ladies particularly at risk for an inadequate zinc intake. Zinc-responsive stunting has been identified in quantity of} research (29), and a more rapid physique weight acquire in malnourished kids supplemented with zinc was reported. A latest metaanalysis of 25 intervention trials comprising 1834 kids underneath thirteen years of age, with a mean duration of approximately 7 months and a mean dose of zinc of 14 mg/day (214 µmol/day), 260 Chapter sixteen: Zinc confirmed a small however important constructive effect of zinc supplementation on peak and weight increases (13). The preliminary presence of stunting was significantly associated with an effect of zinc supplementation on peak, whereas preliminary low plasma zinc concentrations have been associated with a more pronounced effect on weight acquire. Results from zinc supplementation research recommend that a low zinc standing in kids not solely affects development however is also be|can be} associated with an increased danger of extreme infectious illnesses (30). Episodes of acute diarrhoea with shorter duration and fewer severity and reductions in incidence of diarrhoea in zinc-supplemented groups have been reported. Other research point out that the incidence of acute lower respiratory tract infections and malaria may be lowered by zinc supplementation. Prevention of sub-optimal zinc standing and zinc deficiency in kids by an increased intake and availability of zinc may consequently have a significant effect on child well being in developing countries. Positive properly as|in addition to} adverse associations between plasma zinc concentration and foetal development or labour and delivery complications have been reported (31). Interpretation of plasma zinc concentrations in pregnancy is complicated by the effect of hemodilution, and low plasma zinc ranges could reflect different metabolic disturbances (11). Zinc supplementation research of pregnant ladies have been carried out mainly in relatively well-nourished populations, which may be one of the causes for the combined outcomes (31). A latest examine in low-income American ladies with plasma zinc concentrations below the mean at enrolment in prenatal care confirmed that a zinc intake of 25 mg/day resulted in greater infant delivery weights and head circumferences and a reduction in very low delivery weights amongst non-obese ladies compared with the placebo group (12). Table fifty three Examples of fractional zinc absorption from whole diets measured by isotope strategies Subject traits (ref. Experimental zinc repletion research with low zinc intakes have clearly proven that the physique has a pronounced capability to adapt to totally different ranges of zinc intakes by altering the endogenous zinc losses by way of the kidneys, gut, and skin (5-9,33). The normative requirement for absorbed zinc was outlined as the compulsory loss during the early section of zinc depletion earlier than adaptive reductions in excretion take place and was set at 1. To estimate the normative upkeep necessities for different age groups, the respective basal metabolic charges have been used for extrapolation. In rising people the speed of accretion and zinc content material of newly fashioned tissues have been used to acquire the information required for tissue development. Similarly, the retention of zinc during pregnancy and the zinc concentration in milk at totally different phases of lactation have been used to estimate the physiologic necessities in pregnancy and lactation (32). The translation of those estimates of absorbed zinc to necessities for dietary zinc involves quantity of} considerations. Second, the efficiency of absorption of doubtless out there zinc is inversely related to the content material of zinc within the diet. The review of obtainable data from experimental zinc absorption research of single meals or whole diets resulted in a division of diets into three classes ­ excessive, reasonable, and low zinc bio-availability ­ as detailed in Table fifty four (32). It was then discovered that the connection between efficiency of absorption and zinc content material differed for these diets (32). Algorithms have been developed (32) and applied to the estimates of requirements for absorbed zinc to obtain a set of figures for the average particular person dietary zinc necessities (Table 55). The fractional absorption figures applied for the three diet classes have been 50 percent, 30 percent, and 15 percent, respectively. From these estimates and from the evaluation of data from dietary intake research, mean inhabitants intakes have been identified which have been deemed sufficient to ensure a low prevalence of individuals inadequate zinc intake (32). Infants, kids, and adolescents Endogenous losses of zinc in human-milk-fed infants have been assumed to be 20 µg/kg/day (0. For ages 1­10 years the requirements for development have been primarily based on the assumption that new tissue contains 30 µg/g (0. Growth of adolescent males corresponds to an increase in physique zinc requirement of about 0. Lactation Zinc concentrations in human milk are excessive in early lactation, 2-3 mg/l (31-46 µmol/l) within the first month, and fall to 0. From data on maternal milk quantity and zinc content material, it was estimated that the daily output of zinc in milk during the first 3 months of lactation may quantity to 1. In setting the estimated necessities for early lactation it was assumed that half of} this requirement was coated by postnatal involution of the uterus and from skeletal resorption (32). Elderly Requirements for the aged are estimated to be the same as these for different adults. A lower absorptive efficiency has been reported within the aged, which may justify a higher dietary requirement. Because of the suggested position of zinc in infectious illnesses, an optimal zinc standing within the aged may have a significant public well being effect and is an area of zinc metabolism requiring further research. However, the estimates of dietary zinc necessities involve an estimate of absorption. Consequently, variations in absorptive efficiency, not related in relation to estimates of protein necessities, could have to be taken into consideration within the estimates of the total inter-individual variation in zinc necessities. Systematic research of the inter-individual variations in zinc absorption underneath totally different situations are few. In small groups of wholesome well-nourished topics, the reported variations in zinc absorption from a defined meal or diet are of the order of 20­40 percent and appear to be unbiased of age, sex, or diet traits.

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Taxonomy of Stenaria (Rubiaceae: Hedyotitideae), a brand new} genus together with Hedyotis nigricans. Relationships of Houstonia prostrata (Rubiaceae) of Mexico and Arizona and a evaluate of Houstonia subgenera and sections. Recharacterization of Dichondra (Convolvulaceae) and a revision of the North American species. Taxonomic status and relationships of bracken ferns (Pteridium: Dennstaedtiaceae) of Laurasian affinity in Central and North America. Thlaspi alliaceum (Brassicaceae) naturalized in Georgia, Missouri, and North Carolina. Phenetic evaluation of morphological variation in the Lobelia cardinalis complicated (Campanulaceae: Lobelioideae). Morphometric evaluation of the Trillium pusillum Michaux complicated (Trilliaceae) of the southeastern United States. The morphology and anatomy of Hydrastis (Ranunculales): systematic reevaluation of the genus. Proceedings of an international symposium, Royal Holloway, University of London, Egham, Surrey, U. A new species of Boltonia (Asteraceae) from the Ridge and Valley physiographic province, U. Genetic insights into the biogeography of the southeastern North American endemic, Ceratiola ericoides (Empetraceae). Hill cane (Arundinaria appalachiana), a brand new} species of bamboo (Poaceae: Bambusoideae) from the Southern Appalachian Mountains. Identity of natualised exotic Wisteria (Fabaceae) in the south-eastern United States. Horticulture, hybrid cultivars and exotic plant invasion: a case research of Wisteria (Fabaceae). Genetic range and differentiation of Taxodium in the south-eastern United States using cleaved amplified polymorphic sequences. Nomenclature, distribution, chromosome numbers, and fruit morphology of Oxypolis canbyi and O. Systematic reassessment of the North American Physalis viscosa complicated (Solanaceae). Systematic research of the Altissimae and Giganteae species groups of the genus Vernonia (Compositae). Youngia thunbergiana (Crepidinae, Cichorieae, Asteraceae), a species missed in the North American flora. Recently discovered populations of small whorled pogonia (Isotria medeoloides) in Virginia. Molecular phylogenetics of Thymelaeaceae, with particular reference to African and Australian genera. Potential and actual gene exchange amongst three sympatric species of Vaccinium § Cyanococcus in Highlands County, Florida. Systematics, distribution, and nomenclature of the polymorphic Vaccinium angustifolium. The taxonomic status of Vaccinium pallidum, the hillside blueberries together with Vaccinium vacillans. The circumscription of Croton section Crotonopsis (Euphorbiaceae), a North American endemic. An assessment of the varieties of Croton glandulosus (Euphorbiaceae) in the United States. Revisiуn taxonуmica de las especies americanas del gйnero Bothriochloa (Poaceae: Panicoideae: Andropogoneae). New mixtures in Cenchrus (Paniceae, Poaceae) in Europe and the Mediterranean space. Neotypification of Trifolium psoralioides Walter (Fabaceae) and its transfer to Orbexilum. Crossing relationships amongst North American and eastern Asian populations of Agastache sect. Phylogenetic relationships in Buxaceae based mostly on inner transcribed spacers and plastid ndhF sequences. A phylogenetic classification of tribe Poranthereae (Phyllanthaceae; Euphorbiaceae sensu lato). Michigan flora: a information to the identification and incidence of the native and naturalized seed-plants of the state. Hiemobotrychium, a brand new} section of Botrychium subgenus Sceptridium from the southeastern United States. First data of alternate-leaved spleenwort, Asplenium Чalternifolium, in the New World. Lipochaeta and Melanthera (Asteraceae: Heliantheae subtribe Ecliptinae): establishing their natural limits and a synopsis. Evidence of inhabitants bottleneck in Astragalus michauxii (Fabaceae), a narrow endemic of the southeastern United States. Contrasting allozyme range between northern and southern populations of Cypripedium parviflorum (Orchidaceae): implications for Pleistocene refugia and taxonomic boundaries. Phylogeny and classification of Ranunculales: evidence from four molecular loci and morphological data. Rediscovery of Sisyrinchium corymbosum Bicknell (Iridaceae), lost for 100 years. A case of disputed orthography: is it Echinochloa colona; or is it Echinochloa colonum (Gramineae). A nomenclatural historical past of southeastern filiferous Yucca, with choice of a neotype for Y. Silene catesbaei, somewhat than Silene polypetala, the proper name of the endangered fringed catchfly. The hidden abundance of Lepuropetalon spathulatum (Saxifragaceae) and its first reported incidence in Florida. Discovery of tree-form gopher apple (Licania michauxii Prance), with implication of an arboreous ancestor. Genetic fruit polymorphism in North American Valerianella (Valerianaceae) and its taxonomic implications. A new Phemeranthus (Portulacaceae) from the Piedmont of Virginia and North Carolina. Substrate adaptation in rock outcrop vegetation: eastern United States Talinum (Portulacaceae). Evidence for a species-level distinction of two co-occurring asters: Aster puniceus L. Population genetics and origin of the native North American agricultural weed waterhamp (Amaranthus tuberculatus; Amaranthaceae). Electrophoretic and cytogenetic evidence for allopolyploid origin of Marshallia mohrii (Asteraceae). Morphometric and genetic variation in Eriocaulon koernickianum Van Heurck & Muller-Argoviensis (Eriocaulaceae): a disjunct plant species of the southeastern United States. Recognition of three taxa of eastern North American "Waldsteinia," and their appropriate names when integrated into Geum (Coluriae; Rosaceae). A new species of Marshallia (Asteraceae, Helenieae, Marshalliinae) from mafic woodlands and barrens of North Carolina and Virginia. New mixtures, rank adjustments, and nomenclatural and taxonomic comments in the vascular flora of the southeastern United States. Character significance and generic similarities in the Paniceae (Poaceae: Panicoideae). Taxonomy of the native North American species of Saccharum (Poaceae: Andropogoneae). Marbleseeds are gromwells ­ Systematics and evolution of Lithospermum and allies (Botaginaceae tribe Lithospermeae) based mostly on molecular and morphological data. The present status of Cypripedium kentuckiense (Orchidaceae) together with a morphological evaluation of a newly discovered inhabitants in eastern Virginia. A preliminary report on the varieties of Maianthemum canadense in northern Michgan. Systematics and biogeography of the Aralia ­ Panax complicated (Araliaceae) [abstract]. A phylogenetic and biogeographic research of Hamamelis (Hamamelidaceae), an eastern Asian and eastern North American disjunct genus.

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From which of the next cell types is the cell with the bilobed nucleus derived? A 6-month old boy is famous at his well-child visit to have very poor progress and weight gain since his last visit. His mother states that he was hospitalized for pneumococcal pneumonia, and has had several of} unhealthy colds with purulent nasal discharge since he was born. His physician suspects an immunodeficiency, and laboratory outcomes indeed reveal deficiency of a complement protein. Which of the next antibodies capabilities in the identical manner as the lacking complement protein on this child? A 29-year-old intravenous drug person has suffered from recurrent pneumonias, fungal infections in the axillae, and a recent ear infection. Cells with which of the next markers are most probably to be poor on this patient? Patients who share related medical signs and illness pathology might however current in a different way|in another way} primarily based on age at illness onset. How does the presentation of the illness evident in the image differ between juvenile and adult-onset disease? A 2-year-old lady with a lifelong history of malabsorptive and foul-smelling diarrhea, weakness, and common failure to thrive has simply undergone a small gut biopsy (see image). Her dad and mom believe her problems started at 6 months of age, when she started eating strong meals, but have significantly worsened over the previous few months. The only recent change in her diet is that she eats a bowl of cereal each morning with her dad and mom before they go to work. A 26-year-old woman presents to the clinic with joint ache in her arms and wrists, problem breathing, and redness over her cheeks and nostril. She additionally notes that her fingertips change color from white to blue to pink when she is chilly. A clinician is concerned that an Rh-negative mother pregnant with an Rh-positive fetus. The potential pathology that the clinician is concerned about is classed as which of the next immune reactions? Over the previous year, the patient has suffered from erysipelas properly as|in addition to} a previous bout of pneumococcal pneumonia; both have been treated efficiently with antibiotics. Which of the next laboratory abnormalities is most probably to even be present? A 30-year-old woman presents to the emergency department with a right-sided facial droop and bilateral swelling on the face near the angles of the mandible. On additional questioning she says that for the previous few weeks she has been feeling short of of|wanting} breath and tired, and has had a dry cough. Physical examination reveals pink, tearing eyes; easy, nontender bulging of both cheeks; a right-sided drooping of the mouth; cervical nodes; and bilateral dry rвles. A 58-year-old man presents to his physician because of fatigue, edema, and worsening kidney perform. After intensive laboratory work-up, his physician decides to perform a kidney biopsy. The pathologist notes numerous greencolored, proteinaceous deposits when he uses polarized light microscopy to view the pattern. A 7-year-old boy introduced to|is delivered to|is dropped at} the physician by his dad and mom because of recurrent sinus infections. The dad and mom state that the boy additionally has had quantity of} lung infections and intermittent diarrheal infections since start. Which of the next forms of hypersensitivity response is being tested, and which cells could be expected to mediate a positive check result? A 24-year-old, previously wholesome woman presents to the outpatient clinic with a two-week history of drooping eyelids and problem rising from a chair. Stimulation with a reversible acetylcholinesterase inhibitor leads to the decision of her signs. A 3-year-old boy introduced to|is delivered to|is dropped at} his pediatrician because of worsening cough and rhinorrhea. His dad and mom state that he has had quantity of} related episodes over the previous year with two brief hospitalizations for pneumonia. What different illness is most carefully correlated with the identical kind of autoantibodies as current on this patient? A hyperacute rejection is mediated by pre-formed antibodies to the transplanted organ. Acute rejection can occur at any time but is most probably in the first three months after transplantation. It is because of|as a end result of} of} human leukocyte antigen discrepancies between host and graft, and is more common in highly vascular organs such as the liver or kidney. Finally, chronic rejection is a sluggish course of that leads to fibrosis of the transplanted tissue elevated fibroblast exercise. Plasma cells are answerable for antibody manufacturing and subsequently could be the offender in hyperacute rejections. Fibrocytes leave the bloodstream and differentiate into fibroblasts in the transplanted organ. This defect in early stem cell differentiation leads to an absence of T and B lymphocytes. Without T and B lymphocytes, sufferers are at significantly elevated threat of bacterial, viral, and fungal infections. Failure of the third and fourth pharyngeal pouches to descend identified as|is called|is named} DiGeorge syndrome, and leads to no thymus or parathyroid glands. Tetany from hypocalcemia and viral and fungal infections are common the shortage of T lymphocytes, while normal B lymphocytes are current. An X-linked tyrosine kinase defect causes Bruton agammaglobulinemia, resulting in decreased ranges of all immunoglobulin molecules. Infections start to occur after the maternal IgG antibodies decline, typically after six months of life. This patient has indicators and signs of rheumatoid arthritis, a dysfunction of immune dysregulation. Kupffer cells are tissueresident macrophages; the image depicts a Langerhans cell. Langerhans cells are specialized, tissue-resident dendritic cells, not macrophages. As maternal IgG freely crosses the placenta, any subsequent Rh-positive fetus is at risk for hemolytic illness. Thus, the oblique Coombs check is a vital laboratory tool to monitor for Rh incompatibilities that will complicate fetal health. The check end result given on this question signifies that the patient possesses anti-Rh antibodies in her serum. Therefore, it will be logical for the clinician to suspect previous pregnancy with an Rh-positive fetus. Vancomycin can cause two forms of hypersensitivity reactions: anaphylaxis, which is a sort I hypersensitivity response, and the "pink man" syndrome Immunology Answer B is inaccurate. Tumor necrosis factor-b has capabilities just like tumor necrosis factor-a in that it helps mount an acute-phase response. Dendritic cells come up from both myeloid and lymphoid bone marrow precursors after which establish websites of residence within the peripheral tissues. By contrast, a vancomycin-induced anaphylactic response includes histamine release from mast cells and basophils without binding of preformed IgE antibodies to Fc receptors. Examples include autoimmune hemolytic anemia, Goodpasture syndrome, rheumatic fever, and Graves illness. Type I hypersensitivity reactions are mediated by pre-formed IgE antibodies that bind a particular antigen to which the patient has already been exposed. Binding of the antigen-IgE complexes to Fc receptors on mast cells leads to degranulation and release of vasoactive substances corresponding to histamine. Examples include polyarteritis nodosa, immune advanced glomerulonephritis, lupus, rheumatoid arthritis, serum illness, and the Arthus response (local advanced deposition). This youngster is affected by acute epiglottitis, attributable to Haemophilus influenzae kind B (HiB). The incidence of this illness has decreased drastically because of immunization efforts.

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Does not discriminate b/t fibrin-based clots= bleeding & stroke problems arise 33. Captopril/ Enalapril Cause renal failure = use w/ caution in the elderly contraction rate & drive via 1. Theophyline) Favored for the Txt of Reentrant Supra Ventricular Tachycardia Low molecular weight heparin = Oral anticoagulant sixty three. Txt lennox gestaut seizures in children Butyrophenone Atypical D4 Flumazenil Methylphenidate Phenytoin Thiopental Carbamazepine Atypical D4-r Pimozide Risperidone Thioridazine Haloperidol 10. Can be used in combo w/ Fentanyl for neuroleptoanalgesic effect Neuroleptic tranquilizer. Has gentle alpha block Can be used on combo w/ Droperidol for neuroleptoanalgesic effect Used transdermally for continual pain Pre anesthetic. Accumulates in keratinized layers of the pores and skin = used in dermatomycoses infections fifty five. Aka infiltrative cardiomyopathy that stiffens the center Due to amyloidosis in the elderly Due to , additionally see schaumann & asteroid bodies in younger (<25 yoa). Petehial hemorrhages are seen on kidney surfaces = Flea-Bitten floor = younger black males 146. Hemosiderin (pigment w/ Fe3-) lined macrophages which were pahgocytised 166. Tapeworm an infection inflicting megaloblastic anemia by consuming great amount of vit B12 in the host 229. Zones of medial necrosis +/- slitlike cysts = Medial Cystic Necrosis of Erdheim 241. Complicaitons: pleural effusion; atelectasia; fibrinous pleuritis; empyema; fibrinous pericarditis; otitis media 250. Permanent dilatation of the bronchi ­ predisposed by continual sinusitis and post nasal drip 251. Associated w/ Emphysema = "Bleb" = outpouching - If it ruptures causes Pneumothorax 256. Lytic lesions of flat bones ("salt & pepper lesions") = vertebrae, ribs, skull; Hypercalcemia; Bence-Jones protein casts 264. Malignant neoplasm of the lymph nodes inflicting pruritis; fever = appears like an acute an infection 265. Celiac disease due to of} a gluten-induced enteropathy = small intestine villi are blunted 270. Infiltrating Duct Carcinoma w/ fibrosis ­ most common type of breast carcinoma 282. Retrolental Fibroplasia = reason for bindness in premies due to of} high O2 concentrations 284. Pt has recurrent infections & diarrhea w/ respiratory tract allergy & autoimmune ailments 285. Letter Siwe syndrome; Hand Schuller Christian Disease; Eosinophilic Granuloma 303. Anemia; splenomegaly; platelets > 1 million = extensive extra-medullary hematopoiesis 306. Nearly all the time related w/ death due to of} damage to the important facilities in these areas 317. Predilection for lenticulostriate arteries = putamen & internal capsule hemorrhages 318. Tabes Dorsalis = joint position sensation, pain sensation, ataxia, Argyl Robertson pupils 320. Cri di Chat: mental retardation; small head; broad set eyes; low set ears; cat-like cry 323. Osteoporosis: Albers-Schonberd Disease = inspite of d bone density, many fractures = osteoclasts 358. Lysosomal storage disease L Iduronidase ­ Heparan/Dermatan Sulfate accumulation 379. Exs: Tuberculin reaction; Contact dermatitis; Tumor cell killing; Virally infected cell killing 412. Incomplete fusion of lateral palatine course of w/ each other & median nasal prominence & medial palatine prominence 416. Pituitary tumor - usually calcified Inolved in Vision relay Involved in Hearing relay Glandular: 5-17 fetal weeks Canalicular 13-25 fetal weeks Terminal Sac 24 weeks to birth Alveolar period birth-8yoa 21-22 days Mouth! Common Bile Duct - provided by Celiac Artery Duodenum, slightly below Common Bile Duct! Splenic flexure of the Colon provided by Superior Mesenteric artery Splenic Flexure! Transfers lactate to the liver to make glucose which is distributed back into the muscular tissues for vitality use Ouabain [(-) K+ pump] Vanadate [(-) phosphorylation] Digoxin [heart contractility] "Citric Acid Is Krebs Starting Substrate For Mitochondrial Oxidation" Citrate! Seen @ third week: Ecto, Meso & Endo @ 2nd week: varieties the primitive streak, from which Meso & Endo come from. Mycobacterium; Cryptosporidium; Nocardia (partially); Legionella micdadei; Isospora 56. Serratia ­ purple (can trigger pseudohemoptysis) Pseudomonas A ­ piocyanin blue/green Staph Aureus ­ yellow ­ Protein A Mycobacteria ­ photo/scoto chromogenic ­ caritinoid ­ yellow/orange Corneybacterium D ­ black/gray ­ pseudomembrane plaque in throat Bacteroides (Porphyromonas) melaninogenicus ­ black (heme) E. Treponema palidum & Pneumocystis Carinii (cannot be cultured on inert media however can be found extra cellularly in the body) 91. Mycoplasma pneumoniae has fried egg colonies on Eaton agar (needs cholesterol) 94. P1 protein inhs ciliary action Fried egg colonies Atypical pneumonia ­ younger adults Fungal media Sabrands Malassazia furfur ninety nine. Target formed pores and skin lesions w/ a black middle and purple ring surrounding the lesion 114. Pyogenes (pharyngitis; Scarlet fever; cellulitis; impetigo; Rheumatic fever)) 123. Alcoholics Aspiration pneumonia Abscesses in the lungs Vibrio Cholera: metabolic acidosis 146. Appears in blood soon after an infection, earlier than onset of acute sickness Disappears w/in 4-6 months after the beginning of scientific sickness Appears early acute part, signifies higher danger of transmitting the disease Disappears earlier than HbsAg is gone Present in starting of scientific sickness Seen in the "window part" Actinomycetes = Nocardia; Actinomyces; Streptomyces 176. Replicates, differentiates and releases elementary bodies to infect other cells 183. Ixodes scapularis transmits Nantucket Protozoa Infection by Reduviid Bug Infection by TseTse Fly Infection by Sandfly Infection by Ixodes Tick Infection by Anopheles Mosquito Trophozoites w/ "Face-Like" Appearance Nonseptate Hyphae Histoplasmosis Geography Coocidioidomycosis Geography Blastomycosis Geography 202. States east of Mississippi River Page 31 Paracoccidioidomycosis Geography Roseola Infection, aka Herpangina Orthomyxovirus 209. Encephalitis viruses: Alphaviruses: Eastern (more severe) and Western Equine Encephalitis 223. Vivax Ovale Malariae Falciparum Cysts Cysts Cysts Cysts Trophozoites Diagnosis Trophozoites or cysts in stool Trophozoites or cysts in stool Acid quick oocysts Trophozoites or cysts in stool Motile trophozoites Enlarged Host Cell Oval/Jagged Crescent Fever Fever Spike 48h 48h 72hrregular Benign 3 levels Benign 3 levels four levels of Malarial Malignant 3 levels Miscellaneous 1. Bordetella pertussis (Whooping Cough) elicits lymphocytosis rather than granulocytosis eight. Bronchioalveolar carcinomas develop with out destroying the conventional structure of the lung 9. It permits similar devices on the network to be grouped collectively into one broadcast area, irrespective of their physical position in the network. A switch only sends visitors to a given port if the visitors has to go to that port. So switches have the effect of decreasing congestion at workstations, by stopping the workstations from seeing all of the visitors from the opposite ports of the switch. A easy switched network, although, still needs routers to set the boundaries of the place broadcasts are despatched (referred to as "broadcast containment"). This referred to as a collision area, as a result of|as a result of} when a device is attempting to ship a packet, it could possibly} only collide with packets despatched by other devices on the identical segment. This became limiting when many users had laptops, and wished to in a position to|be capable of|have the power to} transfer between buildings, however still have the identical network surroundings wherever they plugged in. At about the identical time, hubs became much less popular and have been largely replaced by L2 switches. It seems that users are usually more excited about accessing company-wide assets (file servers, printers, and so on. However, it initially had one massive draw back: it required a elementary change to the format of the Ethernet header.

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