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Year 3: Students who achieve 50% or more in the master’s dissertation will be entitled to graduate with a master’s degree buy serophene 25 mg with mastercard. Individuals who fail to achieve 50% will leave the course with the award of a postgraduate diploma buy generic serophene 100 mg online. Students who achieve a mark of at least 70% on all courses on the programme will be awarded a master’s with distinction. This programme will adopt progression criteria in accordance with the University’s regulation should they change (we understand that these are being reviewed currently and are awaiting formalisation). The 20-credit Science of Medicine course will have double the weighting to the other 10-credit modules. Taking this into account, the assignment marks in each year will aggregated by averaging. Sufficiently high marks must be achieved at the first sitting in the first year (certificate) to allow progression to the second year (diploma) (see above). The diploma will be marked by two Internal Examiners with quality assurance and check-marking by the External Examiner. The provisional marks and marker comments will be discussed by the Board of Examiners and a decision taken as to the mark awarded and feedback to be given to the candidate. Only one submission of a dissertation (or any of the other assignments) is permitted. Note that major correction and resubmission is not permitted under University regulations (see below). Students achieving at least 70% (Grade A) for the dissertation and an average close to 70% for the rest of the assignments will be awarded ‘master’s with distinction’. For those electing to leave the programme after two years with a diploma, an average assignment mark of 70% or more will earn the award of ‘diploma with distinction’. Late work or extensions for study Submission dates You will be given submission dates for coursework at the start of each module. Consideration of late work lies with the Board of Postgraduate Studies and not with the Programme Directors. Normally a penalty of 5% loss of points will be imposed per day of late submission up to the end of the fifth day. Work that is late for some other reason, (“run out of time”, for example) must be accompanied by a letter of explanation of circumstances, and will be considered by the Board of Examiners (BoE). Students suffering from illness during any assessment should obtain a medical certificate from their doctor as soon as possible and report the situation to the course organiser, who should bring evidence of illness or other mitigating circumstances to the attention of the board of examiners. Interruptions of study An interruption of study concession is applicable where a student is unable to work on the thesis for a significant period of time due to circumstances that are largely beyond their own control. Periods of interruption do not count towards the student’s total permitted period of study and do not incur any additional fees or charges. Students should be encouraged to request an IoS as soon as it is apparent that it is justified, rather than waiting to submit a retrospective one at a later date. At the University of Edinburgh, the academic body would normally be the Board of Examiners. Any student wishing to submit an appeal must have legitimate grounds for doing so, namely one or both of the following: (a) Substantial information directly relevant to the quality of performance in the examination which for good reason was not available to the examiners when their decision was taken. For this purpose “conduct of an examination” includes conduct of a meeting of the Board of Examiners. An appeal cannot be lodged until the decision being appealed has been ratified by the appropriate Board of Examiners. There are strict timescales for the submission of academic appeals: Final Year Student / Graduate Continuing Student 6 weeks after results issued 2 weeks after results issued Late appeals may be considered where there are special circumstances in relation to the late submission of the appeal. A subcommittee of the Appeal Committee can consider whether late appeals are allowed to progress. Plagiarism is a serious disciplinary offence and even unintentional plagiarism can be a disciplinary matter. The University of Edinburgh has always taken a strong stand against plagiarism and cheating, and penalties are severe. The University considers the following documents to be essential reading for all students prior to embarking on their studies, and for both staff and students. Student will be expected to be familiar with these regulations in the event of an appeal. Many of the regulations and issues are already covered elsewhere in this handbook, such as the University’s ‘common marking scheme’, but we have highlighted a few pertinent aspects for your attention below. Postgraduate assessment regulations General University-wide regulations relating to all aspects of assessment are available at www. Please use your unique examination number from your matriculation card for assignments, rather than your name or matriculation number. Code of practice for taught postgraduate programmes This in no way supersedes the above University regulations, but acts as a guide to required practice based upon the University’s regulations and reasonable expectations. Their purpose is to enable students to make the most of their programme and to avoid or overcome difficulties. Students should be made aware that approval by a supervisor, and the following of the advice and guidance of the supervisor carries no guarantee of success at examination (of the dissertation).

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In some cases best 50 mg serophene, non-sterile technique during catheter insertion resulted in serious infections 50mg serophene with mastercard, even leading to limb paralysis. Although we must sign release forms when we undergo any procedure, many of us are in denial about the true risks involved; because medical and surgical procedures are so commonplace, they often are seen as both necessary and safe. Unfortunately, allopathic medicine itself is a leading cause of death, as well as the most expensive way to die. Perhaps the words “health care” confer the illusion that medicine is about health. Thus there is no way of knowing exactly how many people die from a particular procedure. No codes exist for adverse drug side effects, surgical mishaps, or other types of medical error. Until such codes exist, the true mortality rates tied to of medical error will remain buried in the general statistics. The report blames the high cost of American medicine on the medical free-enterprise system and failure to create a national health care policy. We need more research to identify why these injuries occur and find ways to prevent them from happening. In those days, it was common practice to x-ray pregnant women to measure their pelvises and make a diagnosis of twins. Finally, a study of 700,000 children born between 1947 and 1964 in 37 major maternity hospitals compared the children of mothers who had received pelvic x-rays during pregnancy to those of mothers who did not. It found that cancer mortality was 40% higher among children whose mothers had been x-rayed. To obtain useful information, X-rays are taken almost continuously, with minimum dosages ranging from 460 to 1,580 mrem. X-ray radiation accumulates in the body, and ionizing radiation used in X-ray procedures has been shown to cause gene mutation. The health impact of this high level of radiation is unknown, and often obscured in statistical jargon such as, “The risk for lifetime fatal cancer due to radiation exposure is estimated to be 4 in one million per 1,000 mrem. A medical doctor with a PhD in nuclear and physical chemistry, Gofman worked on the Manhattan Project, discovered uranium-233, and was the first person to isolate plutonium. In a nearly 700-page report updated in 2000, “Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population,”(90) Gofman shows that as the number of physicians increases in a geographical area along with an increase in the number of x-ray diagnostic tests performed, the rate of cancer and ischemic heart disease also increases. Gofman elaborates that it is not x-rays alone that cause the damage but a combination of health risk factors that include poor diet, smoking, abortions, and the use of birth control pills. Gofman predicts that ionizing radiation will be responsible for 100 million premature deaths over the next decade. Gofman notes that breast cancer is the leading cause of death among American women between the ages of 44 and 55. Because breast tissue is highly sensitive to radiation, mammograms can cause cancer. Sarno, a well-known New York orthopedic surgeon, found that there is not necessarily any association between back pain and spinal x-ray abnormality. He cites studies of normal people without a trace of back pain whose x-rays indicate spinal abnormalities and of people with back pain whose spines appear to be normal on x-ray. Moreover, doctors often order x-rays as protection against malpractice claims, to give the impression of leaving no stone unturned. It appears that doctors are putting their own fears before the interests of their patients. They concluded that 23% of all admissions were inappropriate and an additional 17% could have been handled in outpatient clinics. Thirty-four percent of all hospital days were deemed inappropriate and could have been avoided. Martin Charcot (1825-1893) was world-renowned, the most celebrated doctor of his time. He became an expert in hysteria, diagnosing an average of 10 hysterical women each day, transforming them into “iatrogenic monsters” and turning simple “neurosis” into hysteria. Only 100 years ago, male doctors believed that female psychological imbalance originated in the uterus. When surgery to remove the uterus was perfected, it became the “cure” for mental instability, effecting a physical and psychological castration. Women are given potent drugs for disease prevention, which results in disease substitution due to side effects. Approximately 4 million births occur annually, with 24% (960,000) delivered by cesarean section. Sakala contends that an “uncontrolled pandemic of medically unnecessary cesarean births is occurring. They also used this argument for tobacco, claiming that more studies were needed before they could be certain that tobacco really caused lung cancer. State journals such as the New York State Journal of Medicine also began to run advertisements for Chesterfield cigarettes that claimed cigarettes are "Just as pure as the water you drink… and practically untouched by human hands.

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Demonstrate commitment to using risk-benefit cheap serophene 50 mg on-line, cost-benefit order serophene 100mg online, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for chest pain. Recognize the importance and demonstrate a commitment to the utilization of other healthcare professions in the treatment of chest pain. There are several common etiologies for cough of which a third year medical student should be aware, as well as more clinically concerning etiologies. A proper understanding of the pathophysiology, diagnosis, and treatment of cough is an important learning objective. Symptoms, signs, pathophysiology, differential diagnosis, and typical clinical course of the most common causes cough: • Acute cough: o Viral tracheitis. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history that differentiates among the etiologies of disease, including: • Onset. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Accurately determining respiratory rate and level of respiratory distress. Differential diagnosis: Students should be able to generate a prioritorized differential diagnosis recognizing history, physical exam, and laboratory findings that suggest a specific etiology of cough. Laboratory interpretations: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Laboratory and diagnostic tests should include, when appropriate: • Chest radiograph. Communication skills: Students should be able to: • Counsel and educate patients about environmental contributors to their disease, pneumococcal and influenza immunizations, and smoking cessation. Management skills: Students should be able to develop an appropriate evaluation and treatment plan for patients that includes: • Describing the indications, contraindications, mechanisms of action, adverse reactions, significant interactions, and relative costs of the various treatments, interventions, or procedures commonly used to diagnose and treat patients who present with symptoms of cough. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for cough. Respond appropriately to patients who are non-adherent to treatment for cough and smoking cessation. Demonstrate ongoing commitment to self-directed learning regarding diagnosis and management of cough. Appreciate the impact that an acute or chronic cough has on a patient’s quality of life, well-being, ability to work, and the family. Recognize the importance and demonstrate a commitment to the utilization of other healthcare professions in the treatment of cough. It has a very large number of etiologic possibilities— some benign but many potentially life-threatening. Major organ systems/pathologic states causing dyspnea and their pathophysiology, including: • Cardiac. The symptoms, signs, and laboratory values associated with respiratory failure and ventilatory failure. The alveolar-arterial oxygen gradient and the pathophysiologic states that can alter it. The potential risks of relying too heavily on pulse oximetry as the sole indicator of arterial oxygen content. The common causes of acute dyspnea, their pathophysiology, symptoms, and signs, including: • Pulmonary edema. The common causes of chronic dyspnea their pathophysiology, symptoms, and signs, including: • Congestive heart failure. The utility of supplemental oxygen therapy and the potential dangers of overly aggressive oxygen supplementation in some pathophysiologic states. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history, that differentiates among etiologies of disease, including: • Quantity, quality, severity, duration, ameliorating/exacerbating factors of the dyspnea. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Accurately determining respiratory rate and level of respiratory distress. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to the patient and his or her family. Management skills: Students should able to develop an appropriate evaluation and treatment plan for patients that includes: • A rapid triage approach to the acutely dyspneic patient. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection diagnostic and therapeutic interventions for dyspnea. Recognize the importance of patient preferences when selecting among diagnostic and therapeutic options for dyspnea. Appreciate the impact dyspnea has/have on a patient’s quality of life, well- being, ability to work, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professionals in the diagnosis and treatment of dyspnea. Given the amount of health care dollars that are spent on antibiotic treatment of urinary tract infections as well as the emergence of resistance, it is important for third year medical students to have a working knowledge of how to approach the patient with this complaint, and how to differentiate patients with cystitis from other common causes of dysuria. Presenting signs and symptoms of the common causes of dysuria, including: • Cystitis.

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Similarly trusted 50 mg serophene, intense physical activity and exercising for extended periods while dehydrated purchase serophene 100 mg mastercard, under hot environ- mental conditions, and while fasted may increase the risk of hyperthermia and hypoglycemia. Usually, as pregnancy progresses, women instinctively alter exercise activity patterns. Women also need be aware to change or enhance exercise equipment, such as switching from supine to upright cycling. Historically, concern has been that intense physical activity could result in low birth weight infants and preterm delivery, but this concern needs to be balanced against the need to control body weight during pregnancy and afterward and current evidence that prudent physical activity per- formed at moderate intensities within current guidelines has no adverse effects on fetal development (Mottola and Wolfe, 2000). Exercise prescrip- tions for pregnant women are not dissimilar to those for other adults. Exercise sessions should be preceded by a 5- to 15-minute warm-up, and followed by a similar cool-down period. Exercise frequency should be 3 to 5 times per week, and not increase in frequency during first or third trimesters because of fatigue and an evaluation of risks to benefits. Exercise intensity should be moderate and elicit 60 to 70 percent Vo2max, which can be monitored by the maternal heart rate response as shown in Table 12-8. And finally, intensity can be gauged by the talk test, or exercise intensity where lactic acidosis drives pulmonary minute ventilation so that the pregnant woman is out of breath and cannot carry on a conversation. As stated in Chapter 4, the Dietary Reference Intakes are provided for the apparently healthy population, therefore recommended levels of physical activity that would result in weight loss of overweight or obese individuals are not provided. In terms of making a realistic physical activity recommendation for busy individuals to maintain their weight, it is important to recognize that exercise and activity recommendations consider “accumulated” physical activity. It is difficult to determine a quantifiable recommendation for physical activity based on reduced risk of chronic disease. Meeting the 60 minute/day physical activity recommendation, however, offers additional benefits in reducing risk of chronic diseases, for example, by favorably altering blood lipid profiles, changing body composition by decreasing body fat and increasing muscle mass, or both (Eliakim et al. For instance, in a study of Harvard alumni, mortality rates for men walking on average less than 9 miles each week were 15 percent higher than in men walking more than 9 miles a week (Paffenbarger et al. Moreover, in the same study, men who took up vigorous sports activities lowered their risk of death by 23 percent compared to those who remained sedentary (Paffenbarger et al. Similar favorable effects were observed in the Aerobics Center Longitudinal Study as men in the lowest quintile of fitness who improved their fitness to a moderate level, reduced mortality risk by 44 percent, an extent comparable to that achieved by smoking cessation (Blair et al. Results from observational and experimental studies of humans and laboratory animals provide biologically plausible insights into the benefits of regular physical activity on the delayed progression of several chronic diseases. The interrelationships between physical activity and cancer, cardiovascular disease, type 2 diabetes mellitus, obesity, and skeletal health are detailed in Chapter 3. Table 12-9 shows seven prospective studies that associated varying ranges of leisure time energy expenditure (kcal/day or kcal/week) with the risk of chronic diseases and/or associated mortality. Assuming an average of 150 kcal expended per 30 minutes of moderate physical activity (Leon et al. The required amount of physical activity depended on the endpoint being evaluated. The minimum amount of physical activity that provided a health benefit ranged from 15 to 60 minutes/day. The amount of physical activity that provided the lowest risk of morbidity and/or mortality was 60 to greater than 90 minutes/day. This recommendation is also consistent with Canada’s “Physical Activity Guide to Healthy Living” (Health Canada, 1998), and the World Health Organization technical report on obesity (2000). Specifically, recommendation number 3 in Chapter 2 of the Sur- geon General’s report states: “Recommendations from experts agree that for better health, physical activity should be performed regularly. The most recent recommendations advise people of all ages to include a minimum of 30 minutes of physical activity of moderate intensity (such as brisk walking) on most, if not all, days of the week. It is also acknowledged that for most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or of longer duration. Moreover, they showed that more vigorous exercise was associated with an increased degree of protection. Conversely, physical inactivity, noted by prolonged sitting, was shown to be a signifi- cant risk factor for cardiovascular disease. Similarly, reporting on treadmill evaluations of over 6,000 men studied over a 6-year period, Myers and coworkers (2002) concluded that “exer- cise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease. The vast majority of review articles have concluded that acute or chronic aerobic exercise is related to favorable changes in anxiety, depression, stress reactivity, positive mood, self-esteem, and cogni- tive functioning (Anthony, 1991; Craft and Landers, 1998; Landers and Arent, 2001; Mutrie, 2000; North et al. Although one reviewer (Mutrie, 2000) has argued for a causal relationship between exercise and the reduction of clinical depression, others suggest that there are not enough clinical trial studies to support a causal interpretation (Landers and Arent, 2001). Examination of the meta- analyses indicates that the overall magnitude of the effect of exercise on anxiety, depression, stress reactivity, and cognitive functioning ranges from small to moderate, but in all cases, these effects are statistically significant (Landers and Arent, 2001). These results are encouraging, but there is still much to learn before the relationship between physical activity and mental health can be fully understood. Recent reviews on endorphins (Hoffman, 1997), serotonin (Chaouloff, 1997), and norepinephrine (Dishman, 1997) have provided experimental evidence for potential mechanisms by which exercise can produce calming effects and mood enhancements. In general, Vo2max is related to body muscle mass and is a relatively constant value for a given individual but it can be altered by various factors, particularly aerobic training, which will induce a change of 10 to 20 per- cent. Thus, on an absolute basis, bigger individuals tend to have a larger Vo2max (measured in liters of O2 consumed/minute) than do smaller individuals.

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