The Guidance takes a rights-based approach that is also focused on gender pulse pressure 32 buy generic isoptin 40mg on-line, and acknowledges that people express themselves differently in all societies blood pressure medication how quickly does it work discount isoptin 40mg visa, sometimes not conforming to gender or social norms, including on the issue of sexual behaviour and sexual orientation or gender identity. It does not endorse or campaign for any particular lifestyle other than promoting health and well-being for all. Equally, they are at the heart of building consensus among the diverse parts of government and civil society that must be involved in developing and delivering sexuality education. National and regional authorities, schools and communities should be engaged, at different stages and to different extents, in the development of national policy; update of curricula; creation of mechanisms and plans for rolling out a new curriculum. Council and committee members can often get involved in sensitization and advocacy efforts; review draft materials and improvements for national curricula and policies; and develop a comprehensive work plan for in-classroom delivery, together with plans for monitoring and evaluation. School level Role of school authority and management: overall, a positive school environment has been shown to facilitate the full implementation of programmes, thus supporting their effectiveness (Picot et al. From a classroom perspective, instructional leadership calls on teachers to lead children and young people towards a better understanding of sexuality through discovery, learning and growth. In a climate of uncertainty or conflict, the leadership abilities among managers and teachers can make the difference between a successful programmatic intervention and a failed one. Community leaders can also provide support for efforts to contextualize the content of the programme. Religious and faith-based organizations play an important role in the lives of many communities. The influence and authority that religious leaders have in communities allows them to speak from a theological foundation of respect for human dignity and wholeness (Religious Institute, 2002). Most religions promote building healthy and loving relationships free from coercion and abuse, and all religions want young people to be healthy and happy. Dialogue can help find the balance between what religion teaches, what scientific evidence proves, and what the lived reality is for local young people. Therefore, the cooperation and support of parents, families, and other community actors needs to be sought from the outset and regularly reinforced. It is important to emphasize the primary concern of promoting the safety and well-being of children and young people that is shared by both schools and parents/caregivers. The chances of personal growth for children and young people are likely to be much better if teachers and parents support each other in implementing a guided and structured teaching/learning process. These outlets are not always concerned with the outcome of their messages, and are occasionally more focused on attracting audiences than on promoting healthy sexuality. It is important for the media to have access to evidence-based information to help communicate accurate messages. Effective sexuality education must take place in a safe environment, where young people feel comfortable to participate and their privacy is respected, where they are protected from harassment and where the school ethos reflects the principles of the content (Pound et al. When developers lack this experience, experts in child and adolescent development and sexuality should be engaged to ensure the appropriate content and context. Learners are not the passive recipients of sexuality education, but rather can, and should, play an active role in organizing, piloting, implementing and improving the content of sexuality education. Experts familiar with this research and knowledge should be involved in developing, selecting and adapting curricula. The needs and assets of young people can be assessed through focus groups and interviews with the young people themselves, as well as with professionals who work with them. These interactions can be complemented with reviews of research data from the target group or similar populations. Quality education on consent should strive to support young people in assessing risks and protecting themselves from situations that may lead to unwanted sexual practices, and should help them develop the knowledge and confidence to seek positive relationships with other individuals. Life skills, such as risk assessment and negotiation abilities are essential for children and young people. Testimonials, simulations and role playing have all been found to be useful complements to statistical and other factual information, helping learners explore the concepts of risk, susceptibility and severity. Negotiation skills are essential for children and young people to be able to put into practice protective behaviours such as delaying the age of sexual initiation; responding to peer pressure to engage in sexual practices; and increasing condom use and use of modern contraception when they do decide to become sexually active. Negotiation skills also provide children and young people with the tools to navigate conversations on sexuality, come to agreements and settle differences with others.
For many obese individuals with type 2 diabetes arteria lusoria purchase isoptin 120mg without a prescription, weight loss of at least 5% is needed to produce beneficial outcomes in glycemic control arteria temporalis media buy isoptin 240 mg line, lipids, and blood pressure (70). Therefore, carbohydrate sources high in protein should be avoided when trying to treat or prevent hypoglycemia. Education and awareness regarding the recognition and management of delayed hypoglycemia are warranted. For those who consume sugar-sweetened beverages regularly, a low-calorie or nonnutritive-sweetened beverage may serve as a short-term replacement strategy, but overall, people are encouraged to decrease both sweetened and nonnutritivesweetened beverages and use other alternatives, with an emphasis on water intake. Evidence rating A B B, A, E Energy balance A Eating patterns and macronutrient distribution Carbohydrates E B B A, B B B, A Protein B Dietary fat B B, A Micronutrients and herbal supplements C Alcohol C B Sodium Nonnutritive sweeteners B B clinical benefits of weight loss are progressive and more intensive weight loss goals. Studies have demonstrated that a variety of eating plans, varying in S50 Lifestyle Management Diabetes Care Volume 42, Supplement 1, January 2019 macronutrient composition, can be used effectively and safely in the short term (12 years) to achieve weight loss in people with diabetes. This includes structured low-calorie meal plans that include meal replacements (7274) and the Mediterranean eating pattern (75) as well as low-carbohydrate meal plans (62). However, no single approach has been proven to be consistently superior (76,77), and more data are needed to identify and validate those meal plans that are optimal with respect to longterm outcomes as well as patient acceptability. The importance of providing guidance on an individualized meal plan containing nutrient-dense foods, such as vegetables, fruits, legumes, dairy, lean sources of protein (including plant-based sources as well as lean meats, fish, and poultry), nuts, seeds, and whole grains, cannot be overemphasized (77), as well as guidance on achieving the desired energy deficit (7881). Any approach to meal planning should be individualized considering the health status, personal preferences, and ability of the person with diabetes to sustain the recommendations in the plan. Carbohydrates Studies examining the ideal amount of carbohydrate intake for people with diabetes are inconclusive, although monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose control (82,83). The literature concerning glycemic index and glycemic load in individuals with diabetes is complex, often yielding mixed results, though in some studies lowering the glycemic load of consumed carbohydrates has demonstrated A1C reductions of 0. Studies longer than 12 weeks report no significant influence of glycemic index or glycemic load independent of weight loss on A1C; however, mixed results have been reported for fasting glucose levels and endogenous insulin levels. For people with type 2 diabetes or prediabetes, low-carbohydrate eating plans show potential to improve glycemia and lipid outcomes for up to 1 year (6264,8689). Part of the challenge in interpreting low-carbohydrate research has been due to the wide range of definitions for a low-carbohydrate eating plan (85,86). As research studies on low-carbohydrate eating plans generally indicate challenges with long-term sustainability, it is important to reassess and individualize meal plan guidance regularly for those interested in this approach. There is inadequate research about dietary patterns for type 1 diabetes to support one eating plan over another at this time. Most individuals with diabetes report a moderate intake of carbohydrate (44 46% of total calories) (51). Efforts to modify habitual eating patterns are often unsuccessful in the long term; people generally go back to their usual macronutrient distribution (51). As for all individuals in developed countries, both children and adults with diabetes are encouraged to minimize intake of refined carbohydrates and added sugars and instead focus on carbohydrates from vegetables, legumes, fruits, dairy (milk and yogurt), and whole grains. The consumption of sugar-sweetened beverages (including fruit juices) and processed "low-fat" or "nonfat" food products with high amounts of refined grains and added sugars is strongly discouraged (9092). Individuals with type 1 or type 2 diabetes taking insulin at mealtime should be offered intensive and ongoing education on the need to couple insulin administration with carbohydrate intake. For people whose meal schedule or carbohydrate consumption is variable, regular counseling to help them understand the complex relationship between carbohydrate intake and insulin needs is important. In addition, education on using the insulin-to-carbohydrate ratios for meal planning can assist them with effectively modifying insulin dosing from meal to meal and improving glycemic control (51,82,9396). Individuals who consume meals containing more protein and fat than usual may also need to make mealtime insulin dose adjustments to compensate for delayed postprandial glycemic excursions (9799). For individuals on a fixed daily insulin schedule, meal planning should emphasize a relatively fixed carbohydrate consumption pattern with respect to both time and amount (35). Protein There is no evidence that adjusting the daily level of protein intake (typically 11. Therefore, protein intake goals should be individualized based on current eating patterns. Some research has found successful management of type 2 diabetes with meal plans including slightly higher levels of protein (2030%), which may contribute to increased satiety (58). Those with diabetic kidney disease (with albuminuria and/or reduced estimated glomerular filtration rate) should aim to maintain dietary protein at the recommended daily allowance of 0.
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Photo credit: Sinhue Torres-Valdes there were ve women heart attack in 30s discount isoptin 120 mg overnight delivery, and there were no female lecturers in the department-quite a change from the sta scientist role pulmonary hypertension zebra order 120 mg isoptin mastercard. It was to serve as a ing few conferences and meetings, not going to social events, junior science administrator for an international project with and missing all those key meetings that went on a er 5 p. On my rst Now that my children are older, I have returned to my cruise, there were just two women in the 25-strong science favorite part of the job, being at sea making measurements. A couple of years and still work part time and I still miss important meetings, but two more cruises later, I decided to work toward a PhD on the most challenging years have passed and will have lasted the topic of interannual variability of physical properties and for less than a h of my career. Cruises are very di erent circulation in the subpolar North Atlantic, and it has connow: on my 2014 cruise, half the scientists were women, and tinued to be my main area of interest. So, my job morphed on a cruise in 2011, ve of the six-member physics team were in two part-time ones: three days per week coordinating women. I earned my PhD in my greatest achievements may be that my daughter plans to early 2002, having worked on it part time for six years. When I decided to study biology, I ipped through an encyclopedia, found an entry on the Max Planck Institute for Marine Microbiology, and saw dolphins and whales in my future. O I went to study marine biology at the Universities of Bielefeld and Bremen, learned that there is so much more to the ocean than just dolphins and whales, and began to develop a passion for geology and microfossils in particular. During my PhD under the mentorship of Jelle Bijma at the AlfredWegener Institute for Polar and Marine Research, I learned about marine carbonate chemistry and how to culture planktic foraminifers. He introduced me to these analyses, and when I saw my rst boron isotope signal appear on the computer screen, he called me the Queen of Boron-I was hooked. Little did I know then that I had chosen one of the most difcult elements to measure, but Abhijit told me about a seemingly magical mass spectrometer at Stony Brook University, and I had to get to it. So I sent my rst publication to Gary Hemming at Lamont-Doherty Earth Observatory, and half a year later he asked me if I wanted to do a postdoc with him. What was meant to be one year in New York became two, followed by another postdoc at Bremen University, and then I was fortunate to be o ered a faculty position at Columbia University. Even though I am still struggling to overcome the mental toll this dispute has taken on me, I do love my work and all the opportunities that come with it. Now that I am tenured, I am preparing for my rst sabbatical, which will take me to Australia and to more eldwork in Puerto Rico, where we will test foraminifer geochemistry under simulated early Cenozoic seawater conditions. What other job allows you to work in beautiful places and make friends all over the world? Happy finale of a field season in Puerto Rico with my favorite colleagues Steve Eggins (middle) and former graduate student Kat Allen (right). She is a freshman on the high school rowing team and loves being out on the water. In this busy time of life, my husband and I continue to enjoy spending time together. I enjoyed the new challenge of teaching in addition to continuing an active research program. I also started working more closely with graduate students, which has greatly enriched my research. Now, a er eight years, I received tenure and feel that my le was strong because of the extra years of experience that I accumulated. Over these years, I have been involved in a number of exciting research projects, including several large at-sea programs and an on-land seismic study of Newberry Volcano. I really enjoy going to sea and the challenge of leadership and teamwork under di cult conditions. As with most of life, balancing is the most di cult part: balancing work travel with children and family time, and balancing several research projects that currently involve ve graduate students and teaching, all in a half-time job. In addition, I lead the growth and development of our children and family and work hard at this undertaking in addition to my career. All this balance is more straightforward when you keep in perspective that a career is long. Having good colleagues with whom I enjoy working and a husband who greatly admires my abilities have been essential. Lastly, having the courage to take on di erent challenges makes creative work and continued intellectual growth possible.
How the process works: a) the parties identify the witness or evidence that they want produced heart attack arena order isoptin 40 mg with mastercard. Production process for the prosecution: the government shall obtain the presence of witnesses and evidence for the prosecution whose testimony the trial counsel considers to be relevant and necessary arteria 3d buy isoptin 120mg on line. Personal appearance is required only if all of the below are satisfied: (a) the testimony is necessary for consideration of a matter of substantial significance to a determination of an appropriate sentence. If the government will not produce a report, the defense can seek the employment of an expert 11-22 Chapter 11 Discovery & Production [Back to Beginning of Chapter] witness, who can then test the evidence and produce a report. Witness and evidence production lists must be submitted in reasonably sufficient time to give the government a chance to get the witnesses. The military judge may set a date for production requests in the pretrial order, and can grant a continuance if the defense submits a request late in the proceedings. Denials of witnesses/evidence whose production is requested by the defense must be made in writing and must detail the reasons for denial. If the trial counsel contends that the defense requests for witness/evidence production are not required by the rules, then the defense may file a motion to compel production. Whether a witness/evidence shall be produced to testify during the presentencing proceeding is a matter within the discretion of the military judge, subject to the production rules. If the military judge grants a motion to compel production, the trial counsel shall produce the witness or evidence, or the proceedings shall be abated. The standard of review for the denial of a request for production is abuse of discretion. If the military judge abused her discretion, then the test for prejudice is harmless beyond a reasonable doubt. The defense can seek a remedy under this rule even if the government was not at fault when destroying the evidence, or was simply negligent in losing the evidence. The appellate court found that there were adequate substitutes and the evidence did not go to an issue of central importance. The government was unable to locate two unknown witnesses to the fatal traffic accident whom the defense requested, despite efforts that included running ads in German and U. The defense moved to compel their production, or, in the alternative, abate the proceedings until the witnesses could be produced. The court found that these witnesses were unavailable and that other eyewitnesses with unobstructed views of the accident who testified at trial were an adequate substitute for the potential testimony of the unknown witnesses. One witness was the doctor who examined the alleged victim and the other witness was another employee of the hospital who observed her demeanor. No abuse of discretion in abating trial when testimony is "of such central importance to an issue that it is essential to a fair trial. After an autopsy was performed on the victim, the brain and its meninges were stored pursuant to laboratory regulations. Several months later, the specimen container was accidentally discarded when the laboratory was moved to a new location. Unless the government acts in bad faith, failure to preserve potentially useful evidence does not constitute a denial of due process a) Arizona v. The Court stated "unless a criminal defendant can show bad faith on the part of the police, failure to preserve potentially useful evidence does not constitute a denial of due process. Some military cases from the period 1984-1988 refer to Trombetta as the controlling source. The court used the Trombetta test which applied at the time and found no constitutional violation. However, the court stated, "Under Article 46, the defense is entitled to equal access to all evidence, whether or not it is apparently exculpatory. Thus, the better practice is to inform the accused when testing may consume the only available samples and permit the defense an opportunity to have a representative present. The court found no bad faith, and the evidence collected from the car was still available for testing.
However blood pressure medication and hair loss purchase isoptin 120 mg without prescription, abnormal manifestation with sex chromosome aberration usually appears at maturity and potential disorders may be suspected infrequently blood pressure levels vary order 120mg isoptin with mastercard. Locus specific horse primers were designed and used for amplifying genomic exon 2 sequences in all species studied. Next-generation and Sanger sequencing combined with cloning were used for assessing the genomic sequence variation. Distl, Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover Foundation, Hannover, Niedersachsen. The Shetland pony represents a particularly small horse breed with a characteristically large head and strong built often accompanied by thick mane and tail hair and a general robustness. This study aimed at investigating whole genome sequencing data from Shetland ponies for potential signatures of selection and deleterious variants in these highly selected regions, which might be responsible for the expression of a reduced body size and a Shetland pony specific shape. In one of these variants the homozy- gous mutant genotype was only present in Shetland ponies smaller than 87. In conclusion, our study revealed two Shetland pony specific variants of which one variant was private for Miniature Shetland ponies and potentially fixed by targeted selection of this specific pony type during domestication. Thus, these investigations add further two candidate genes to the genetically complex development of body size and shape in horses. Ropka-Molik1, 1National Research Institute of Animal Production, Department of Animal Genomics and Molecular Biology, Krakow, Poland; 2University of Agriculture, Department of Horse Breeding, Krakуw, Poland. Polish horse breeding industry is well known from Arabian horse breeding tradition. Balanced selection is based on preserving traits combining unquestionable appearance and utility. Genetic screening for heritable disorders in Arabians is an extremely important step for population management to avoid the production of affected offspring, reducing the incidence of carriers and preventing economic losses. The genetic background of causative mutations responsible for each conditions has been previously described (Brault et al. Analysis included 448 healthy horses that were introduced into Polish Arabian Stood Book. Although the carriers of the mutant alleles do not show clinical signs and there is a lack of reports describing negative consequences for health and athletic performance in heterozygous individuals, further monitoring of active population is essential. Due to limited sequence read coverage and technological issues with Sanger data, some functional genes that are highly conserved in other mammals are not present in EquCab2. Based on a comparison of mammalian protein-coding gene lists, we identified 1,430 protein-coding genes present in other mammals but not listed in EquCab2. We used tblastn to search for these genes in EquCab3 and found that the new reference assembly incorporates 758 of these genes. Finally, the distances between these transcripts and their nearest 5 gaps tended to be longer in EquCab3 than in EquCab2, suggesting that missing 5 regulatory regions of these genes had been captured in the new reference. Gao, Institute of Animal Science, Chinese Academy of Agriculture Science, Beijing, China. To explore genetic diversity and population structure in Chinese indigenous cattle, we conducted population genetic analysis at both individual and population level, and performed genome-wide selection signatures. We genotyped 572 samples from 20 Chinese indigenous cattle breeds and downloaded the published data for worldwide breeds. And Chinese indigenous cattle were clustered into two groups- Southern breeds and Northern breeds- with the Central breeds branched at an intermediate position. TreeMix with four migrations events and f3 statistic results provided the evidence of admixture history between Southern breeds and Northern breeds. According to the proportion of descent, we found the natural barrier Qinling Mountain and Taihang Mountain to gene admixture. In selection signatures analysis, 48 genes are annotated, some of which associated with production traits, participated in immune response, nervous system development, and other biological process. The results revealed the population structure and levels of admixture among Chinese indigenous cattle, shedding light on the origin and evolutionary history of these breeds.
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