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V. Rocko, MD
Co-Director, University of the Virgin Islands
Standard Level Goals: Year 2 Describe the neuro-ophthalmic anatomy and physiology (ie cholesterol in raw eggs discount zocor 5mg on-line, the orbit and adnexal structures cholesterol medication starts with a c purchase 10 mg zocor free shipping, the afferent and efferent visual pathways with their intracranial projections cholesterol vegan generic zocor 20 mg without prescription, the sensory and motor anatomy of the face cholesterol reducing foods buy discount zocor 20mg, and the autonomic nervous system, including their blood supplies) as it applies to the eye and visual system. Describe typical and atypical features, evaluation, and management of the most common optic neuropathies (eg, papilledema, optic neuritis, ischemic, inflammatory, infectious, infiltrative, compressive, hereditary optic neuropathies). Describe features, evaluation, and management of the more complex supranuclear and internuclear palsies (eg, progressive supranuclear palsy and subtle internuclear ophthalmoplegia, one-and-half syndrome). List the common causes of an acute versus chronic isolated ocular motor neuropathy and define general management of each. List the common causes of cavernous sinus syndrome and superior orbital fissure syndrome. Describe and differentiate among different forms of acquired nystagmus (eg, downbeat, upbeat, pendular, gaze evoked, rebound, convergence, retraction). List the different mechanism causing nonphysiologic anisocoria and describe characteristics features and evaluation of the less common disorders (eg, mixed sympathetic and parasympathetic denervation of iris, aberrant regeneration in third nerve palsy, pharmacologic miosis). List mechanism and causes of central versus peripheral light near dissociation (eg, Argyll-Robertson pupil, diabetic neuropathy, tonic pupil, Parinaud syndrome). Describe features and evaluation of the less commonly encountered visual field defects (eg, sectoranopia, checkerboard, monocular temporal crescent). Describe more advanced aspects of visual field testing indications, selection, and interpretation (eg, artifacts of automated perimetry, testing, and thresholding strategies). Describe neuro-ophthalmic aspects of common systemic diseases (eg, hypertension, diabetes, thyroid disease, myasthenia gravis, temporal arteritis, sarcoidosis, systemic infections, inflammation). Describe neuro-ophthalmic findings that are common following head trauma (eg, traumatic optic neuropathy, bilateral fourth nerve palsy, traumatic brain injury). Describe evaluation and management of inherited neuro-ophthalmic diseases (eg, Leber hereditary optic neuropathy, autosomal dominant optic atrophy, spinocerebellar degenerations). Describe the typical features, evaluation, and management of urgent neuro-ophthalmic pathologies (eg, giant cell arteritis, cavernous sinus thrombosis, orbital apex syndrome, pituitary apoplexy). Describe the indications for intravenous edrophonium (ie, Tensilon) and prostigmin tests for myasthenia gravis. Perform a detailed cranial nerve evaluation other than the oculomotor nerve evaluation (eg, trigeminal, and facial and acoustic nerve function). Describe the interpretation of neuro-radiologic images (eg, indications and interpretation of orbital tumors, thyroid eye disease, pituitary adenoma, optic nerve glioma, optic nerve sheath meningioma). Describe the evaluation, management, and specific testing (eg, stereopsis, mirror test, red-green testing, monocular prism test) of patients with "functional" (ie, nonorganic) visual loss (eg, recognize nonorganic spiral or tunnel visual fields). Describe the indications for, perform, and list the complications of temporal artery biopsy. Perform basic neurologic screening examination (eg, tandem walk, sensory examination, cerebellar function testing, basic cognitive evaluation). Identify patients with "functional" visual loss (ie, nonorganic visual loss) and provide appropriate approach and follow up. Describe the typical and atypical features, evaluation, and management of papilledema and raised intracranial pressure due to a variety of causes (eg, sinus thrombosis, idiopathic, meningitis). Describe typical features of the most advanced and least common optic neuropathies (eg, chronic recurrent inflammatory optic neuritis, posterior ischemic optic neuropathy, neuromyelitis optica, autoimmune optic neuropathy, toxic/nutritional). Describe typical and atypical features, evaluation, and management of the most complex and least common ocular motor neuropathies and their mimics (eg, patterns of aberrant regeneration). Describe typical and atypical features, evaluation, and management of the most complex and least common forms of nystagmus (eg, spasmus nutans, see-saw nystagmus, periodic alternating nystagmus). Describe typical and atypical features, evaluation, and management of the most advanced and least common pupillary abnormalities (eg, pupil findings in coma, transient pupillary phenomenon). Describe features, evaluation, and management of the most complex and least common visual field defects and recognize pattern mimics (eg, combination of disc-related scotoma plus hemianopia, binasal hemianopia, sectoranopia, bilateral inferior altitudinal loss due to superior occipital lobe lesions and not bilateral anterior ischemic optic neuropathy). Describe, evaluate, and treat the neuro-ophthalmic manifestations of trauma (eg, corticosteroid or surgical therapy in traumatic optic neuropathy). Describe, evaluate, and provide appropriate genetic counseling for inherited neuroophthalmic diseases (eg, hereditary optic neuropathies, chronic progressive external ophthalmoplegia, neurofibromatosis, ataxia syndromes). Describe indications and interpret blood test results for various systemic disorders with neuro-ophthalmic manifestations (eg, thyroid disorders, pituitary disorders, myasthenia graves).
You may determine you dislike who they are zetia cholesterol medication side effects order zocor 20 mg fast delivery, versus disliking their performance or behaviour what type cholesterol in eggs trusted 5 mg zocor. It takes some purposeful intention to adopt a growth mindset cholesterol symptoms buy discount zocor 10mg online, however normal cholesterol levels new zealand zocor 10 mg line, the benefits of doing so are multifaceted and abundant. One of the best parts about deciding to incorporate growth mindset into your life is that all that is needed to do so is an awareness of the power of the mindset one holds. Interventions show that when students are taught about fixed and growth mindsets, that the information they are given is all that is needed for them to make positive changes and go forward using a growth mindset. Mindsets that promote resilience: When students believe that personal characteristics can be developed. What Factors Promote Resilience and Protect Against Burnout in First-Year Pediatric and Medicine-Pediatric Residents? Clients may be confused, stressed, emotional, they might have financial issues and therefore take it out on frontline staff. This is a scary, volatile time for them, may not truly understand the scope of the situation. Insufficient time (Alexander, Casalino & Meltzer, 2003) When we leave estimate discussions until the end of the conversation, it fragments it. Finances are a key part of the decision-making process for many owners, so it should be discussed from the beginning. Challenges for the Staff & Client the experiences are often parallel to each other: · Sense of identity · Fear of judgment · Emotional Response · Additional stress Theme · "Financial issues are often paired with a perception of caring and compassion. The unwillingness or inability to pay for a private school for a child does not mean that the child is not cared for o Ex. Diamond ring for your partner- does not ensure that they are loved Tools for discussion · · · Rapport building! In some contexts, it is also valuable info to share with the clientele, and general public (family, friends). Verbal & Non-Verbal · Three components of communication o Words o Tone o Body language We focus on words, but in reality, our body and tone are relaying 93% of the message. Not only can we make assumptions of others, we can also make assumptions of how others perceive us. Examples: o A client is afraid to raise concerns about cost of care in case they are perceived as uncaring. Versatility in your workplace- communication is a valuable skill anywhere you go Rapport building is important to your business! A better relationship with clients = better communication, which may in turn decrease the amount of complaints and negative feedback received. Equally important, the life stages described in the guidelines also represent a useful framework for developing and then explaining individualized pet healthcare to the pet owner. Definition and Utilization of Life Stages Puppy From birth through cessation of rapid growth (approximately 6-9 months of age, varying with breed and size) Young adult From cessation of rapid growth until completion of physical and social maturation, which occurs in most dogs by 3 to 4 years of age Mature adult From completion of physical and social maturation until the last 25% of estimated lifespan (breed- and size-dependent) Senior the last 25% of estimated lifespan through end of life End-of-life the terminal stage (length of time depends on the specific pathologies) Physiological and behavioral developmental periods do not start and end abruptly, but phase in and out gradually. Team members should acknowledge the differences in life stages, and adapt the experience at the veterinary hospital to each life stage. Client communication regarding potential hazards will reduce these risks, especially for new dog owners or new dogs at any life stage. This extends to discussions on registration and identification of the dog, and long term planning for care. Nutritional Assessment Nutritional assessment, including evaluation of the body/muscle condition score and nutritional factors, should be a part of every visit to the veterinary practice and should utilize the entire practice team. Screening evaluation should be performed on every animal, with extended evaluations performed as necessary, and should be tailored to life stage. Parasite Control, Zoonoses and Human Safety Parasitism remains common in dogs despite widespread availability of safe and effective treatments. Monitoring for parasitism, year-round broad-spectrum control, and routine treatment prevents both disease in dogs and contamination of the environment. Veterinarians play a crucial role in protecting dogs, their families, and the public from exposure to zoonotic disease. The risk of zoonotic disease must also be considered for the veterinary healthcare team.
Western performance horses returned to use for a longer duration of time than English performance horses cholesterol what is normal purchase 20mg zocor free shipping, and horses treated with intrasynovial corticosteroids and rest/rehabilitation returned to use for a longer duration than horses treated without rest3 cholesterol is trusted zocor 5mg. Horses presenting with an acute duration of signs typically respond better than horses with chronic lameness average cholesterol by age uk buy zocor 20 mg fast delivery. Injuries to the manica flexoria are reported more frequently in Europe than in North America cholesterol medication sore muscles generic 10 mg zocor otc, possibly due to the over-representation of cobs and ponies in Europe, accounting for 83% of 53 cases in one report from the United Kingdom4. Tears of the manica flexoria occur much more frequently in the hindlimbs (85% of cases)4 and are associated with digital flexor tenosynovitis. Standard ultrasonography does not have a high sensitivity for the detection of manica flexoria tears, and tenoscopic diagnosis is considered the gold standard for definitive diagnosis. To increase the sensitivity of pre-operative diagnosis, the use of both intrathecal analgesia and contrast radiography have been proposed to evaluate digital flexor tendon sheath pathology pre-operatively5. However, even with contrast radiography and dynamic and non-weight bearing ultrasonography, manica flexoria tears may be challenging to diagnose prior to tenoscopy. Superficial Digital Flexor Tendinopathy within the Carpal Sheath In older horses, spontaneous rupture of the proximal superficial digital flexor tendon at the level of the carpal sheath or proximal metacarpus has been reported8, presumably due to stiffening and loss of elasticity with age. Older horses (> 15 years of age) are more likely to show evidence of superficial digital flexor tendonitis within the carpal canal9,10. Because the carpal sheath is a difficult area to evaluate ultrasonographically and lesions may be difficult to diagnose in acute stages, magnetic resonance imaging or surgery may be required to achieve a definitive diagnosis. Conclusions Many tendon and ligament injuries are amenable to diagnosis with diagnostic analgesia and ultrasonography, especially with advances in ultrasound technology and techniques. However, ultrasonography is not sufficient to diagnose all tendon and ligament injuries, especially those in difficult-to-image regions such as the hoof or the carpal and tarsal sheaths. In addition, the sensitivity of ultrasonography for lesions in certain locations, such as manica flexoria tears and marginal tears of the deep digital flexor tendon within the digital flexor tendon sheath, is poor. Deep digital flexor tendon injury within the hoof capsule; does lesion type or location predict prognosis? Accuracy of open magnetic resonance imaging for guiding injection of the equine deep digital flexor tendon within the hoof. Medical treatment of horses with deep digital flexor tendon injuries diagnosed with high-field-strength magnetic resonance imaging: 118 cases (20002010). The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology. Dynamic flexion/extension and non-weight bearing ultrasonography is helpful for identifying manica flexoria tears in horses. Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases. Rupture of the superficial flexor tendon in the forelimb in aged horses: a report of nine cases. Case studies will be used to highlight indications for regenerative medicine approaches. Regenerative Medicine Regenerative medicine broadly refers to the use of agents to help repair, replace or regenerate lost or damaged tissue and organ function. In horses, regenerative medicine is commonly used to treat musculoskeletal injuries affecting the soft tissues, such as tendon and ligament strains, and joint disease. Many of the regenerative therapies currently employed in the field of equine surgery involve the use of biologic agents or stem cells to stimulate the immune system to promote endogenous healing. Regenerative medicine approaches involving tissue engineered constructs or engineered biomaterials have also been applied in the horse for applications such as articular cartilage repair; however, these approaches have been primarily restricted to research studies or small clinical cohorts at academic research hospitals. Regenerative medicine is an active area of ongoing research, and new therapies are emerging on a regular basis. Due to the evolving nature of this field, it is important to stay abreast of the literature as recommendations and regulations governing the use of regenerative medicine approaches continue to change frequently. Biologics can be isolated from a variety of natural sources, and most biologics used in the equine industry are isolated from tissues or body fluids from the animal being treated, including: blood, bone marrow or adipose tissue. Some of the commonly available biologics or regenerative medicine therapies available to equine practitioners will be discussed below. Cell-Based Therapies "Stemness" is a property that refers to an undifferentiated cell capable of self-renewal, or the ability to give rise to indefinitely more "stem" cells, and from which other specialized cell types arise by differentiation. Although allogenic cells have advantages in terms of characterization and off-the-shelf availability, there is evidence that allogeneic stem cells are not completely "immune privileged". However, autologous cells must be culture-expanded to generate a sufficient number of cells for therapeutic applications, and this may delay treatment for 4 to 6 weeks.
Non-contrast-enhanced T1weighted (T1w) imaging has been under investigation as an alternative cholesterol medication linked to alzheimer's discount zocor 10 mg online. Contrast was sufficient to create 3D volume renderings using cropping and window/level adjustment estimating cholesterol ratio cheap zocor 5mg otc. However cholesterol lowering foods images purchase 5mg zocor visa, the amount of gadolinium enhancement is different for acute and chronic lesions how much cholesterol in shrimp fried rice generic zocor 20mg on-line, and varies with time after injection, making it difficult to predict the chronic extent of lesions from their acute appearance. Lesion volume and transmurality were measured at all time points and all acquisitions. Results: All lesions demonstrated a hyperintense core and hypointense rim with T1w images. Currently, noise-related fluctuations in tracking-coil locations lead to large errors in the motional estimate, leading to image artifacts. Objectives: To improve the performance and robustness of motion-correction methods under realistic (noisy) conditions by implementing a noise-adaptive algorithm. We implemented and tested novel strategies using scanner workflow simulations based on both real and simulated data (Figure 1). To ensure robustness, we made our algorithm adaptive; utilizing a learning time-period to measure the dimensions of the extended tetrahedron and the noise level of each coil, which allowed rejecting data from noisy coils and detecting periods of non-rigid-body motion. Additionally, a set of different filtering methods was analyzed to optimize their performance (Figure 2). We built translational and rotational motional platforms to test the new algorithm features by applying displacements and rotations to a gel phantom which included a 4-microcoil tetrahedron-shaped inclusion. Results: the maximum improvement using the mean filter was 16%, 33%, in translation and rotation, respectively. When noisy coils were included in the system, the rejection filter improved the performance by up to 20%, 50%. Here, we characterize heating of commercial guidewires in configurations relevant to clinical catheterization procedures. Results: the positioning apparatus enabled good repeatability over 3 separate measurements at the tip of a straight guidewire (T= 4. The Nitrex guidewire generated more heating compared to the Glidewire (T Nitrex=5. A second location of increased temperature was observed at contact points in looped configurations (Fig 2). The temperature at both the tip and the loop increased with the number of guidewire loops (Table 1B). Furthermore, temperature at the loop decreased as the loop contact point was separated (T0cm= 2. Conclusions: this work aimed to study guidewire heating in clinically relevant configurations with looping and catheter placement. Looping can occur in the pericardium, in the ventricles, and during prolapse at the valves. In addition, guidewires are used to guide and exchange catheters in clinical procedures. B)T measured simultaneously the guidewire tip and loop connection point (Nitrex) during 2 minutes of connection point for single loop, double loop, triple loop and quadruple loop. Divsion of Cardiovascular Medicine, Department of Medical and Health Sciences, Linkцping University, Linkцping, Sweden, Ostergotlands Lan, Sweden 5. This has shown to be abnormal in adults with dilated cardiomyopathy and low normal ejection fraction. We therefore hypothesised that haemodynamic changes may already be apparent in the ventricle in Fontan patients prior to a decline in ejection fraction. For each individual components the volume was calculated and expressed as percentage of end diastolic volume and the kinetic energy was calculated over the cardiac cycle and measured at end diastole. Results: Ejection fraction was comparable in Fontan patients and healthy volunteers (57% vs 67%).