By I. Bradley. Mt. Sierra College. 2018.

Protein require- ments of man: Variations in obligatory urinary and fecal nitrogen losses in young men clozaril 25mg with mastercard. Is dietary intake of methionine associated with a reduction in risk for neural tube defect-affected pregnancies? Neonatal administration of L-cysteine does not pro- duce long-term effects on neurotransmitter or neuropeptide systems in the rat striatum discount 25mg clozaril with amex. Effect of excess dietary L-histidine on plasma cholesterol levels in weanling rats buy clozaril 100 mg online. Effects of dietary 3- methylthiopropionate on metabolism, growth and hematopoiesis in the rat. Toxicity of protein hydrolysate solutions: Correlation of glutamate dose and neuronal necrosis to plasma amino acid levels in young mice. Effect of aspartame and aspartate loading upon plasma and erythrocyte free amino acid levels in normal adult volun- teers. Plasma methionine levels in normal adult subjects after oral loading with L-methionine and N-acetyl-L-methionine. Plasma and erythrocyte amino acid levels in normal adult subjects fed a high protein meal with and without added mono- sodium glutamate. Plasma and urinary methionine levels in one-year-old infants after oral loading with L-methionine and N-acetyl-L- methionine. Effect of carbohydrate on plasma and erythrocyte glutamate levels in humans ingesting large doses of monosodium L-glutamate in water. Plasma amino acid concentrations in normal adults fed meals with added monosodium L-glutamate and aspartame. Effects of acute aspartame and acute alcohol ingestion upon the cognitive performance of pilots. Catabolism dominates the first-pass intestinal metabolism of dietary essential amino acids in milk protein-fed piglets. L-Tryptophan does not increase weight loss in carbohydrate-craving obese subjects. Evalua- tion of the effect of arginine-enriched amino acid solution on tumor growth. Influence of protein intake and training status on nitrogen balance and lean body mass. Endogenous levels of amino acids in ileal digesta and faeces of pigs given cereal diets. Monosodium glutamate: Acute and chronic effects on rhythmic growth hormone and prolactin secretion, and somatostatin in the undisturbed male rat. Lysine as a prophylactic agent in the treatment of recur- rent herpes simplex labialis. Breeding rats on amino acid imbalanced diets for three consecutive generations affects the concentrations of putative amino acid transmitters in the developing brain. Obligatory nitrogen losses and factorial calculations of protein requirements of pre-school children. Human protein requirements: Nitrogen balance response to graded levels of egg protein in elderly men and women. Obligatory urinary and faecal nitrogen losses in young Chilean men fed two levels of dietary energy intake. The pattern of intestinal substrate oxidation is altered by protein restriction in pigs. New equations for estimating body fat mass in pregnancy from body density or total body water. Qualitative analysis of human milk produced by women consuming a maize-predominant diet typical of rural Mexico. Integumental nitrogen losses of pre-school children with different levels and sources of dietary protein intake. Muscle amino acid metabolism at rest and during exercise: Role in human physiology and metabolism. Experimental phenylketonuria in infant monkeys: A high phenylalanine diet produces abnormalities simulating those of the hereditary disease. Transurethral resection of the prostate, serum glycine levels, and ocular evoked potentials. The assessment of protein nutrition and metabolism in the whole animal, with special reference to man. Homocysteinemia, ischemic heart disease, and the carrier state for homocystinuria.

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As a result buy clozaril 100mg visa, traits that increase survival and reproduction—traits that make organisms well suited to their environments and thus enable them to suc- ceed in the struggle for existence—will in general spread in the population order 50mg clozaril fast delivery. In contrast buy discount clozaril 25mg on-line, traits that decrease survival and reproduction, and the alleles that under- lie these traits, will, over time, be eliminated. This is natural selection, which Dar- win defined as “This preservation of favourable variations and the rejection of injurious variations” (Darwin 1859, p. Favorable variations—traits associated with increased fitness—that are preserved by natural selection are known as adaptations. Darwin adopted the term natural selection by analogy with artificial selection, which he called “selection by man. It may be more appropriately understood as a process of nonrandom elimination of organisms, along with their traits and their genes. Darwin rarely used the word evolution, which originally meant unrolling or unfolding. In the 19th century, evolution was commonly used to describe development, which was thought to result from the unfolding of a pre-existing developmental plan. Instead, as mentioned earlier, Darwin referred to evolution as “descent with modification. Since populations of living organisms have these properties, evolution by natural selection is inevitable (Lewontin 1970). Other entities that have these properties, including computer viruses, cultural traits, and artificial organisms, spring 2013 • volume 56, number 2 173 Robert L. Perlman may evolve by selective mechanisms that are analogous to natural selection. Arti- ficial selection, or selection by humans, continues to shape the evolution of domesticated species of plants and animals, as well as the evolution of antibiotic resistance in bacteria and other pathogens. Natural selection may be thought of as a natural law of biology; it is a necessary consequence of the nature of living organisms. Evolution, however, is a historical process, which depends on chance events and historical contingencies as well as on natural selection. For this reason, the course of evolution is not predictive in the way that some physical laws are. As the French biologist Jacques Monod (1971) has written, biological processes result from “chance and necessity. Despite the attention that is understandably given to natural selection, however, we should not forget or minimize the importance of chance in evolution. An important component of natural selection is sexual selection, which results from competition among members of the same sex for access to mating partners and for being chosen by members of the opposite sex (Cronin 1991). The peacock’s tail is the classic example of a trait that arose and is maintained by sexual selection. Large, brightly colored tails attract predators and decrease the survival of peacocks. These large tails evolved because peahens preferred to mate with peacocks who had them, thereby increasing the reproductive success of these peacocks. Many human traits, including patterns of death and disability, are thought to have evolved as a result of sexual selection (Kruger and Nesse 2004). Evolution by natural selection begins with the presence of heritable variations among individual organisms. Organisms that have favorable variations will (rel- ative to organisms without these variations) survive, reproduce, and transmit these traits to their offspring, and so adaptations, traits that increase reproductive success, will spread in a population. Equally importantly, traits that reduce repro- ductive success—Darwin’s “injurious variations”—will decrease in frequency. For the most part, evolution involves the gradual accumulation and summation of many small variations. As a result, the production of adaptations is a slow process, typically taking many, many generations. If two populations of a species evolve in different environments, they will slowly come to differ, both because different traits will enhance fitness and be selected in different environments, and because of chance events that occur in one population but not the other. As these populations diverge to the point that they are recognizably different, they will generally be referred to as different varieties or subspecies. And as they diverge further, organisms from the two populations may no longer mate with one another because of physical, biochemical, or behavioral differences—or, if they do mate, they may not produce viable and fertile offspring. Biologists fre- quently distinguish between microevolution, evolutionary changes within a species 174 Perspectives in Biology and Medicine Evolution and Medicine that lead to the spread of adaptations and the production of distinct varieties or subspecies, and macroevolution, the formation of new species or higher taxa. As Darwin argued, when microevolutionary processes are continued over long time periods, they can eventually lead to macroevolution. The Different Conceptual Bases of Medicine and Evolutionary Biology Medicine and evolutionary biology bring markedly different perspectives to the study of biological phenomena. Physicians are concerned with the health and well-being of their individual patients, and their primary goal is to keep their patients healthy. When their patients do get sick, physicians are interested in diagnosing their patients’ diseases and in understanding how these diseases cause the symptoms that they do, be- cause they wish to restore their patients to health or at least relieve their dis- comfort.

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Observational studies have found that other behavioural modifications buy clozaril 25mg with amex, in particular cessation of smoking buy 50mg clozaril with visa, are associated with a reduction in cardiovascular disease mortality (108–112) buy generic clozaril 100mg on line. In men in the United Kingdom, a healthy lifestyle and increased physical activity have been shown to reduce the chances of developing cardiovascular disease (113). While interventions targeted at individuals could be expected to bring about behavioural changes if they are implemented in a supportive environment, evidence for this view is not strong (106–114). However, fiscal interventions and legislation on smoking in public places are capable of bringing about widespread and useful reductions in smoking prevalence. Appropriate policies might address: agricultural subsidies for fruits and vegetables; food pricing and avail- ability; labelling of food; public transport; pedestrian- and cyclist-friendly road planning; school health education; and tobacco control measures, including prohibition of advertising and price control. The overall objective should be to make it easy for the population to make healthy choices related to diet, physical activity and avoidance of tobacco. Evidence There is a large body of evidence from prospective cohort studies regarding the beneficial effect of smoking cessation on coronary heart disease mortality (116). However, the magnitude of the effect and the time required to achieve beneficial results are unclear. Some studies suggest that, about 10 years after stopping smoking, coronary heart disease mortality risk is reduced to that of people who have never smoked (109, 110, 117, 118). It has also been shown that cigarette smokers who change to a pipe or cigar (119), and those who continue to smoke but reduce the number of cigarettes, have a greater mortality risk than those who quit smoking (112). A 50-year follow-up of British doctors demonstrated that, among ex-smokers, the age of quitting has a major impact on survival prospects; those who quit between 35 and 44 years of age had the same survival rates as those who had never smoked (120). The benefits of giving up other forms of tobacco use are not clearly established (121–124). General recommendations are therefore based on the evidence for cigarette smoking. Recent evidence from the Interheart study (31) has highlighted the adverse effects of use of any tobacco product and, importantly, the harm caused by even very low consumption (1–5 cigarettes a day). The benefits of stopping smoking are evident; however, the most effective strategy to encourage smoking cessation is not clearly established. All patients should be asked about their tobacco use and, where relevant, given advice and counselling on quitting, as well as reinforcement at follow-up. There is evidence that advice and counselling on smoking cessation, delivered by health profession- als (such as physicians, nurses, psychologists, and health counsellors) are beneficial and effective (125–130). Several systematic reviews have shown that one-time advice from physicians during routine consultation results in 2% of smokers quitting for at least one year (127, 131). Similarly, nicotine replacement therapy (132, 133) can increase the rate of smoking cessation. Nico- tine may be administered as a nasal spray, skin patch or gum; no particular route of administration seems to be superior to others. In combination with the use of nicotine patches, amfebutamone may be more effective than nicotine patches alone, though not necessarily more effective than amfebutamone alone (135, 136). Nortriptyline has also been shown to improve abstinence rates at 12 months compared with a placebo. Both agents have appreciable discontinuation rates because of side- effects (135–137). Data from observational studies suggest that passive cigarette smoking produces a small increase in cardiovascular risk (138–140). Whether reducing exposure to passive cigarette smoke reduces cardiovascular risk has not been directly established. The interventions described above targeted at individuals may be less effective if they are imple- mented in populations exposed to widespread tobacco advertising, sponsorship of sporting activities by the tobacco industry, low-cost tobacco products, and inadequate government tobacco control policies. There is evidence that tobacco consumption decreases markedly as the price of tobacco products increases. Bans on advertising of tobacco products in public places and on sales of tobacco to young people are essential components of any primary prevention programme addressing noncommunicable diseases (140). The cholesterol-raising properties of saturated fats are attributed to lauric acid (12:0), myristic acid (14:0), and palmitic acid (16:0). Stearic acid (18:0) and saturated fatty acids with fewer than 12 carbon atoms are thought not to raise serum cholesterol concentrations (146, 147). The effects of different saturated fatty acids on the distribution of cholesterol over the various lipoproteins are not well known. Trans-fatty acids come from both animal and vegetable sources and are produced by partial hydro- genation of unsaturated oils. Metabolic and epidemiological studies have indicated that trans-fatty acids increase the risk of coronary heart disease (145, 152, 153). It has also been demonstrated that replacing saturated and trans-unsaturated fats with monounsaturated and polyunsaturated fats is more effective in preventing coronary heart disease events than reducing overall fat intake (145, 153, 155). Current guidelines recommend a diet that provides less than 30% of calories from dietary fat, less than 10% of calories from saturated fats, up to 10% from polyunsaturated fats, and about 15% from monounsaturated fats (86, 88, 148). Metabolic studies have shown that dietary cholesterol is a determinant of serum cholesterol concentration (156–158).

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The Expert Panel endorsed the approach of the project and content of the outcomes framework 25mg clozaril mastercard. The fnal report and outcomes framework were presented to the European Commission in January 008 generic clozaril 100 mg amex. This process of discussion and agreement was at the heart of the Tuning (medicine) project 25mg clozaril otc. For example, “Ability to provide evidence to a court of law“ was rated very low by respondents as a core outcome and so was removed as a Level outcome. The original draft included the following Level outcomes: • Ability to design research experiments • Ability to carry out practical laboratory research procedures • Ability to analyse and disseminate experimental results These were rated very low by respondents in terms of importance for all graduates as core outcomes of the primary medical degree. The conclusion was that under the Level 1 outcome ‘Ability to apply scientifc principles, method and knowledge to medical practice and research’, no specifc Level outcomes should be included. Similarly, “Research skills”, with no further specifcation, is included as an outcome under Medical professionalism. This leaves it open to individual countries, schools or students to decide how to prioritise practical research experience, in keeping with their profle, educational philosophy or career intentions. Individual schools can also select additional learning outcomes in order to develop or preserve a distinct educational profle – for example, a specifc emphasis on research-related experience and skills - without compromising the essential competence of their graduates and their ftness to care for patients. The structure of the outcomes framework has been chosen to be useful to those involved in planning and designing new undergraduate medical degree programmes. The Level 1 outcomes describe domains of teaching, learning and assessment that lend themselves to becoming “curriculum themes”, with defned academic leadership and dedicated resources. The Level outcomes can help to defne the content of such themes in terms of teaching, learning and assessment. The Professionalism outcomes are relevant when addressing the personal and professional development and ftness to practise of medical students. In future work we aim to document best practice in learning, teaching and assessing these outcomes. Meantime useful information on outcome-based assessment can be accessed through the Scottish Doctor website (http://www. Mobility It seems likely that schools which share a common set of graduating learning outcomes will fnd it much more straightforward to exchange students and staf, particularly in the later parts of the curriculum. Similarly, assurance that graduates have achieved the necessary learning outcomes is likely to facilitate mobility of doctors in Europe and provide reassurance to employers and patients. Quality enhancement and quality assurance Consideration of a medical school’s graduating outcomes in relation to an agreed framework should be an integral part of quality assurance and accreditation, sitting alongside evaluation of education process and infrastructure. Recently developed methodologies permit systematic mapping of one outcomes framework against another, so that a school’s learning outcomes could simply be cross-referenced against the European framework (Ellaway, R et al, 007). Although it is likely that national systems of quality assurance and accreditation will continue to predominate in Europe, the Tuning outcomes can support a developing European dimension in medical education as part of a harmonisation process. European Ministers of Education (1999) Joint declaration of the European Ministers of Education convened in Bologna on the 19th of June 1999 [The Bologna Declaration]. Joint Quality Initiative informal group ( 004) Shared ‘Dublin’ descriptors for Short Cycle, First Cycle, Second Cycle & Third Cycle Awards. Ensuring global standards for medical graduates: a pilot study of international standard-setting. Association of American Medical Colleges (1998) Learning objectives for medical student education: Guidelines for medical schools. Medical Teacher, 007; 9:636-641 3 Appendix A: Knowledge Outcomes Although not formally part of Tuning methodology, the web-base questionnaire survey also sought opinion about important areas of knowledge for medical graduates. In general, the highest scores and rankings related to knowledge of traditional scientifc disciplines which underpin medical practice, such as physiology, anatomy, biochemistry, and immunology, together with clinical sciences such as pathology, microbiology and clinical pharmacology. The lowest ranking related to knowledge of “diferent types of complementary / alternative medicine and their use in patient care”. Graduates from medical degree programmes in Europe should be able to demonstrate knowledge of: Basic Sciences Normal function (physiology) Normal structure (anatomy) Normal body metabolism and hormonal function (biochemistry) Normal immune function (immunology) Normal cell biology Normal molecular biology Normal human development (embryology) Behavioural and social sciences Psychology Human development (child/adolescent/adult) Sociology Clinical Sciences Abnormal structure and mechanisms of disease (pathology) Infection (microbiology) Immunity and immunological disease Genetics and inherited disease 4 Drugs and prescribing Use of antibiotics and antibiotic resistance Principles of prescribing Drug side efects Drug interactions Use of blood transfusion and blood products Drug action and pharmacokinetics Individual drugs Diferent types of complementary / alternative medicine and their use in patient care Public Health Disease prevention Lifestyle, diet and nutrition Health promotion Screening for disease and disease surveillance Disability Gender issues relevant to health care Epidemiology Cultural and ethnic infuences on health care Resource allocation and health economics Global health and inequality Ethical and legal principles in medical practice Rights of patients Rights of disabled people Responsibilities in relation to colleagues Role of the doctor in health care systems Laws relevant to medicine Systems of professional regulation Principles of clinical audit Systems for health care delivery 5 Appendix B: Clinical Attachments and Experiential Learning Although not formally part of Tuning methodology, the web-base questionnaire survey also sought opinion about which areas of clinical medical practice were most important to be included as part of the core undergraduate medical school programme. In general, the highest rankings related to acute medical and surgical care settings, with community and primary care also ranking highly. The lowest rankings related to areas of specialised surgical and medical practice. If your curriculum vitae is in a different format but still provides all of the information shown on the model curriculum vitae below, you may submit it with your application. You can modify it to reflect your individual circumstances, eliminating sections that do not pertain to your activities. There should be no gaps since medical school graduation, domestic or international, as this may cause a delay in processing your application. List membership on editorial boards, position as scientific reviewer for medical journal, etc. These activities relate to service in other medical societies or volunteering in free clinics for the indigent, as well as to service in the lay community, such as coaching little league teams or participating on local school boards, etc.

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