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bulletProfessor of Medicine, Harvard Medical School, Chief, Brigham and Women's/Faulkner Cardiology, Brigham and Women's Hospital, Boston, Massachusetts

https://connects.catalyst.harvard.edu/Profiles/display/Person/26967

Bodnar is a registered dietitian blood pressure kiosk buy discount midamor 45mg on line, a member of the American Dietetic Association pulse pressure and map order 45mg midamor, and a licensed nutritionist arrhythmia with normal ekg cheap 45 mg midamor overnight delivery. She also holds membership in the American Society for Nutrition blood pressure too low midamor 45mg with visa, the Society for Epidemiologic Research, and the Society for Pediatric and Perinatal Epidemiologic Research. His research deals with the genetics of adaptation to exercise and to nutritional interventions as well as the genetics of obesity and its comorbidities. Bouchard is the recipient of many awards and of an honoris causa doctorate in science from the Katholieke Universiteit Leuven. He has been a foreign member of the Royal Academy of Medicine of Belgium since 1996 and was the Leon Mow Visiting Professor at the International Diabetes Institute in Melbourne in 1998. In 2001, he became a member of the Order of Canada as well as professor emeritus, Faculty of Medicine, Laval University. In 2003 he received the Alumnus of the Year Award from Laval University, and in 2004 he received the Friends of Albert J. Bouchard became a knight in the Ordre National du Quebec in 2005 and also received the Earle W. Bouchard is past president of the North American Association for the Study of Obesity and the immediate past president of the International Association for the Study of Obesity. Brown Research Chair on Obesity at Laval University where he directed the Physical Activity Sciences Laboratory for about 20 years. His research has been funded by agencies in Canada and the United States, primarily the National Institutes of Health. She holds membership in the American Society for Nutrition, the Obesity Society, and the Society of Pediatric Research. Catalano also serves on the Management Council and Executive Committee at MetroHealth Medical Center. He has published more than 130 articles in peer-reviewed journals and served on the editorial boards of the Journal of Clinical Endocrinology and Metabolism and Diabetes. He holds membership in the American College of Obstetricians and Gynecologists, the American Diabetes Association, the Perinatal Research Society, and the American Gynecological and Obstetrical Society. Dr Catalano is a member of the Maternal-Fetal Medicine Division of the American Board of Obstetrics and Gynecology. He served his internship at the University of California, San Francisco, and residency and postdoctoral fellowship at the University of Vermont, Burlington. Catalano is certified by the American Board of Obstetrics and Gynecology in maternal and fetal medicine. Gillman directs the Obesity Prevention Program, whose goal is to lessen obesityrelated morbidity and mortality through epidemiologic, health services, and intervention research. He has published widely and has obtained numerous federal and other grants in the areas of developmental origins of health and disease; determinants of dietary and physical activity habits; and interventions to prevent childhood overweight. He is the principal investigator of Project Viva, a prospective cohort study of pregnant women and their children whose goal is to examine pre- and perinatal determinants of offspring health. He served a medicine-pediatrics internship and residency at North Carolina Memorial Hospital. Gillman is a fellow of the American Academy of Pediatrics, American College of Physicians, and the American Heart Association Council on Epidemiology and Prevention. His expertise is improving access to healthcare systems for infants, women, children, and the elderly and improving access to health care for migrant children. He is also active with local, national, and international forums on a variety of health issues. He is a former member of the Board on Children, Youth, and Families and has participated as a member of the Roundtable on Head Start Research. Guerra is recipient of the James Peavey Award from the Texas Public Health Association and the Job Lewis Smith Award from the American Academy of Pediatrics; he is a Kellogg fellow of the Harvard School of Public Health, among many other awards and honors. Her expertise is in disparities in health care for women and minorities and public health efforts to address affordable and healthy foods for low-income populations.

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Finally Kandel was able to hypertension 7101 midamor 45 mg sale show that snails can also learn to blood pressure medication vision order midamor 45 mg without prescription associate two different events and that their nervous systems change in the process hypertension for dummies buy discount midamor 45 mg online. Kandel pre hypertension emedicine 45 mg midamor with mastercard, working with Tom Carew, a physiological psychologist, next showed that the snails could develop both short- and long-term memories. When they touched the gill ten times, in four different training sessions, separated from one another by several hours to one day, the changes in the neurons lasted as long as three weeks. Kandel nest worked with his colleague the molecular biologist James Schwartz and geneticists to better understand the individual molecules that are involved in forming long-term memories in the snails. They showed that in the snails, for short-term memories to become long-term, a new protein had to be made in the cell. The team showed that a short-term memory becomes long-term when a chemical in the neuron, called protein kinase A, moves from the body of the neuron into its nucleus, where genes are stored. The protein turns on a gene to make a protein that alters the structure of the nerve ending, so that it grows new connections between the neurons. Then Kandel, Carew, and colleagues Mary Chen and Craig Bailey showed that when a single neuron develops a long-term memory for sensitization, it might go from having 1,300 to 2,700 synaptic connections, a staggering amount of neuroplastic change. The first, the "template function," allows our genes to replicate, making copies of themselves that are passed from generation to generation. When a gene is turned on, it makes a new protein that alters the structure and function of the cell. This is called the transcription function because when the gene is turned on, information about how to make these proteins is "transcribed" or read from the individual gene. Kandel argues that when psychotherapy changes people, "it presumably does so through learning, by producing changes in gene expression that alter the strength of synaptic connections, and structural changes that alter the anatomical pattern of interconnections between nerve cells of the brain. Susan Vaughan has argued that the talking cure works by "talking to neurons," and that an effective psychotherapist or psychoanalyst is a "microsurgeon of the mind" who helps patients make needed alterations in neuronal networks. Kandel was born in 1929 in Vienna, a city of great cultural and intellectual richness. But Kandel was a Jew, and Austria at the time was a virulently antiSemitic country. In March 1938, when Hitler rolled into Vienna, annexing Austria to the German Reich, he was welcomed by adoring crowds, and the Catholic archbishop of Vienna ordered all the churches to fly the Nazi flag. Austrian Jews were evicted from their homes, and thirty thousand Jewish men were sent to concentration camps the following day. Kandel wrote, "I remember Kristallnacht even today, more than sixty years later, almost as if it were yesterday. When we returned to our apartment a week or so after having been evicted, everything of value was gone, including my toys. It is probably futile, even for someone trained in psychoanalytic thinking as I am, to attempt to trace the complex interests and actions of my later life to a few selected experiences of my youth. Nevertheless I cannot help but think that the experiences of my last year in Vienna helped to determine my later interests in the mind, in how people behave, the unpredictability of motivation, and the persistence of memory. I am struck, as others have been, at how deeply these traumatic events of my childhood became burned into memory. These problems occur when we have powerful internal conflicts in which, as Kandel says, parts of ourselves become radically "dissociated," or cut off from the rest of us. One of his first endeavors was to fuse what he had learned about the brain as a neuroscientist with what he was learning about the mind while treating patients. As a neurologist, Freud quickly became disenchanted with the localizationism of the time, which was based on the work of Broca and others, and realized that the notion of the hardwired brain did not adequately explain how complex, culturally acquired mental activities such as reading and writing are possible. In 1891 he wrote a book titled On Aphasia, which showed the flaws in the existing evidence for "one function, one location," and proposed that complex mental phenomena such as reading and writing are not restricted to distinct cortical areas, and that it made no sense to argue, as localizationists had, that there is a brain "center" for literacy, since literacy is not innate. Rather, the brain in the course of our individual lives must dynamically reorganize itself, and its wiring, to perform such culturally acquired functions. In 1895 Freud completed the "Project for a Scientific Psychology," one of the first comprehensive neuroscientific models to integrate brain and mind, still admired for its sophistication. Here Freud proposed the "synapse," several years before Sir Charles Sherrington, who bears the credit. Freud stated that when two neurons fire simultaneously, this firing facilitates their ongoing association. Freud emphasized that what linked neurons was their firing together in time, and he called this phenomenon the law of association by simultaneity. Free association is based on the understanding that all our mental associations, even seemingly "random" ones that appear to make no sense, are expressions of links formed in our memory networks.

Last but not least blood pressure medication xanax buy 45 mg midamor overnight delivery, in consideration of the many conversations shared and evenings foregone through the production of this book blood pressure very high midamor 45 mg with mastercard, we thank blood pressure 8560 purchase midamor 45 mg fast delivery, for their extraordinary partnership and their patience arrhythmia symptoms discount midamor 45 mg free shipping, Eugene Fidell and Robert Post. Here, we offer sources for additional background, as well as for the quotations and other information presented in the annotations. Additionally, in copying the excerpts, we have corrected spelling errors in the original documents, and made spelling, punctuation and formatting consistent. The paragraph structure of the documents may differ from the originals, and headings within the original documents were not always reproduced in the excerpts. Abortion in America: the Origins and Evolution of National Policy, 1800-1900 (New York: Oxford University Press, 1978) 147-170. The Story of Jane: the Legendary Underground Feminist Abortion Service (Chicago: University of Chicago Press, 1995). Wade," Not June Cleaver: Women and Gender in Postwar America, 1945-1960 (Philadelphia: Temple University Press, 1994) 335. Illegal Abortion as a Public Health Problem For the proceedings of a 1955 conference on abortion organized by Calderone and Planned Parenthood, see: Calderone, Mary Steichen. American Medical Association, Policy Statements on Abortion On the role of the medical profession in enacting laws criminalizing abortion in the nineteenth century, see: Burns, Gene. Clergy Statement on Abortion Law Reform and Consultation Service on Abortion On the Clergy Consultation Service, see: Moody, Howard. Ministers of a Higher Law: the Story of the Clergy Consultation Service on Abortion (1998). Abortion Law Reform in the United States the proceedings of the 1969 California Conference on Abortion are compiled in: Abortion and the Unwanted Child (Carl Reiterman ed. The Pro-Choice Movement, Organization and Activism in the Abortion Conflict (New York: Oxford University Press, 1991). Betty Friedan and the Making of the Feminine Mystique (Boston: University of Massachusetts Press, 1998). The following sources discuss the strike in varying levels of detail: Freeman, Jo. The following unpublished dissertation collects primary source documents from the strike: Bernard, Shirley. Motherhood Reconceived: Feminism and the Legacies of the Sixties (New York: New York University Press, 1996) 46-50. For an overview of the role of women of color in movements for reproductive rights, see: Nelson, Jennifer. Women of Color and the Reproductive Rights Movement (New York: New York University Press, 2003). Feminist as Antiabortionist For background on Sidney Callahan, see: Callahan, Sidney and Daniel Callahan. For the Chicago Daily Defender poll results see: "Blacks Split on Sex," Chicago Daily Defender (February 15, 1971) 1. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Vintage, 1997). Introduction to Population Control For an overview of population control advocacy that ranges well beyond its intersection with abortion reform in the late 1960s, see: Connelly, Matthew. Fatal Misconception: the Struggle To Control World Population (Boston: Harvard University Press, 2008). A Sex Counseling Service for College Students Student Committee on Human Sexuality. Make Love Not War: the Sexual Revolution: An Unfettered History (New York: Routledge, 2000). Desiring Revolution: Second-Wave Feminism and the Rewriting of American Sexual Thought, 1920 to 1982 (New York: Columbia University Press, 2001). The Churches Speak on Abortion: Official Statements from Religious Bodies and Ecumenical Organizations (Gale Group, 1989). Union for Reform Judaism, 49th General Assembly, Montreal, Quebec Rabbinical Council of America. United Methodist Church, Statement of Social Principles United Methodist Church, Methodist Board of Social Concerns. On the Conservative Resurgence, and the history of American Baptists generally, see: Leonard, Bill J.

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One can imagine that urinary incontinence is more of a problem in sports with focus on the individual and where leakage is visible arrhythmia knowledge a qualitative study discount midamor 45mg with amex, for example blood pressure medication dosage too high buy cheap midamor 45 mg line, esthetic sports blood pressure under 50 order 45mg midamor overnight delivery. In some sports such as gymnastics blood pressure chart what do the numbers mean midamor 45mg with amex, lack of focus and concentration during sport can be dangerous. Anal incontinence There is sparse knowledge about anal incontinence during physical activity. Anecdotally, both male and female athletes may pass wind and feces during heavy lifting. One recent study included female students, age 18­40, years from sport, physiotherapy, and nursing in southern France. They found a statistically significant higher prevalence of anal incontinence in those performing intensive sport, defined as training more than 8 hours per week compared with all other subjects (14. As for urinary incontinence, anal incontinence is probably more of a problem in sports where this can be seen or heard. Gymnastics: 67% Tennis: 50% Basketball: 44% Field hockey: 32% Track: 26% Volleyball: 9% Swimming: 6% Softball: 6% Golf: 0% 42% experienced urine loss during daily activities 38% felt embarrassed Former American female Olympians (between 1960 and 1976) participating in gymnastics and track and field compared with swimmers (n = 207) 51. If yes: type of protection worn, leakage duration, and frequency Urinary incontinence: 33. If yes: type of protection worn, leakage composition, leakage duration, and frequency 82 Chapter 8 Pelvic organ prolapse Although there are anecdotal reports of pelvic organ prolapse in young, nulliparous marathon runners and weight lifters, there are few studies on pelvic organ prolapse in exercising women. They were also significantly more likely to have worsening in their pelvic support regardless of initial prolapse stage. However, in the latter study, only 47% of the participants reported high acceptability for tampon use. For smaller leakage, specially designed protecting pads can be used during training and competition. One would assume that the elite athletes would respond in the same way to treatment as other women do. If the pelvic floor possesses a certain "stiffness," it is likely that the muscles could counteract the increases in intraabdominal pressures occurring during physical exertion. The leakage in athletes seems to be related to strenuous highimpact activity, and elite athletes do not seem to have more urinary incontinence than others later in life when the activity is reduced. Preventive devices and absorbing products Devices that involve external urinary collection, intravaginal support of the bladder neck, or blockage of urinary leakage by occlusion are available, and some have shown to be effective in preventing leakage during physical activity. This was supported by a recent study in Bladder training Anecdotally, most elite athletes empty their bladder before practice and competition, which was also reported to be common in young nulliparous women attending gyms. Therefore, it is unlikely that any of them would exercise with a high bladder volume. However, as in the rest of the population, elite athletes may have a nonoptimal toilet behavior, and the use of frequency­volume chart and bladder training regimens may be an important Exercise and pelvic floor dysfunction in female elite athletes 83 first step to become aware of toilet habits and try to make them more optimal. Estrogen the role of estrogen in incidence, prevalence, and treatment of stress urinary incontinence is controversial. Two metaanalyses of the effect have concluded that there is no change in urine loss after estrogen replacement therapy. Estrogen given alone therefore does not seem to be an effective treatment for stress urinary incontinence. A higher prevalence of eating disorders has been found in athletes compared with nonathletes, and these athletes may be low in estrogen. Amenorrheic elite athletes would be on estrogen replacement therapy because of the risk of osteoporosis. Estrogen may have adverse effects such as a higher risk of coronary heart disease and some cancer forms. Cure rates, defined as 2 g of leakage on pad tests, vary between 44 and 70% in stress urinary incontinence. All improved subjectively and showed normal readings on urodynamic assessment after treatment. Elite athletes are accustomed to regular training and are highly motivated for exercise. Therefore, thorough instruction and assessment of ability to contract is mandatory. Because most elite athletes are nulliparous, there are no ruptures of ligaments, fascias, muscle fibers, or peripheral nerve damage. One would expect that the effect would be equal or even better in this specific group of women.

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Toxicological testing of pure chemicals at varying dosages successfully flagged certain chemicals in the environment that caused overt toxicity arrhythmia associates buy 45 mg midamor with visa, cancers heart attack early symptoms cheap 45 mg midamor with mastercard, and death blood pressure unstable discount midamor 45mg with amex. For example blood pressure of 120/80 buy midamor 45mg visa, rather than the old toxicological method of a single-exposure, doseresponse approach using pure compounds, it is vital that new risk assessment procedures simulate more closely what occurs in nature. Rather than single compounds, we need to know the effects of combinations of compounds or mixtures. These endogenous chemicals, first from the mother, the placenta, and from the developing fetus itself, circulate in very low concentrations, typically in the part-per-trillion to part-per-billion range. As complexity builds, the ever-changing mixture of natural hormones ensures normal development; too little or too much leads to disease and pathology. Early life, especially the fetus and infant, is a period of vulnerability, when any disruption to natural processes may change, sometimes irreversibly, the structure and/or function of a physiological system. The timing of release, in addition to the amount of hormone, is absolutely crucial to normal development. This research has since been extended to environmental influences such as cigarette smoking, pollution, and environmental chemicals. Certain cancers, especially reproductive cancers, seem to have their origins in early life. While the manifestation of disease or disorder may not be apparent at birth, following a latent period the results of these exposures become evident, often in adolescence, adulthood or aging. The timing of exposure is key to understanding which organ or tissue may be affected, as the development of different parts of the body occurs at different rates. Thus, an organ that is developing during the time of the harmful exposure is more likely to be affected than an organ that has already completed development. The outcomes of exposures during vulnerable periods may be physical malformations, functional defects, or both. Another very real and complex aspect of the windows of vulnerability concept is that the same exposure can have different effects depending on when in development the exposure occurred. Some disturbances in hormone levels may not cause obvious structural changes, but may still lead to functional changes, disease, or dysfunction, later in life. Children are also at greater risk of exposures than adults for a number of reasons including that: 1) they are exposed to many fat-soluble contaminants in breast milk or in formula; 2) they put their hands and objects in their mouth far more often than adults; 3) they live and play close to the ground; and 4) they have greater skin area relative to their body weight than adults allowing for more absorption of chemicals (55). The harm of exposures to children is thus due to differences in the ways they may be exposed, their developmental vulnerability, and a longer life expectancy with a much longer horizon for exposure to manifest as disease. Furthermore, they have limited understanding of danger, and are politically powerless to avoid exposures. Traditional toxicological testing invokes the concept that "the dose makes the poison" (Table 4). In the tests to determine a safe threshold, different concentrations of a single chemical are administered. Toxicity is usually established in a two-year chronic study in rodents (usually adults) that determines the dosage at which one-half of the animals die or develop the target disease (usually a cancer). From this point studies establish the highest dose that has no observable toxicity (again, the endpoint is usually cancer or organ failure). For chemicals that have received little testing, an additional factor of 10 (leading to a safety factor of 1000) might be utilized. Without actually looking for perturbations in an endpoint that is not as obvious as death, it is not possible to know if hormone levels are being affected, and whether/how that might change 28 the predisposition to develop a disease. Considering that the consequences of some endocrine disorders may not be observed for weeks, months, or years, the inability of toxicological testing to quantify such non-observable outcomes is a serious limitation of this approach to determining risk. The "safe exposure threshold" approach began to be questioned in the 1980s as scientists began to better understand how natural hormones work in the body, how precisely the synthesis and release of hormones is regulated by our endocrine glands and how the body changes during development. The development of accurate risk assessments of safety has been hindered by the cost of biological testing in animals. In the red-eared slider turtle, it is the temperature during the mid-trimester of development that determines whether the individual will develop as a male or a female, similar to how the X and Y chromosome determine sex in humans. To understand this, recall that estrogen is a natural hormone that affects an organism at very low concentrations. One issue revolves around the difficulty in understanding how very low dose exposures are biologically relevant.

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References:

bullethttps://www.amc.edu/patient/services/neurosciences/spine_surgery/lumbar_spinal_stenosis.pdf
bullethttp://www.jd.mps-al.org/UserFiles/Servers/Server_396542/File/For%20Students/Forms/Teacher/chap01.pdf
bullethttps://www.navsea.navy.mil/Portals/103/Documents/SUPSALV/Diving/US%20DIVING%20MANUAL_REV7.pdf?ver=2017-01-11-102354-393
bullethttps://www.seas.upenn.edu/~amyers/SpecRel.pdf
bullethttps://www.childrensmn.org/downloads/2015/11/carespecialties.cancerblood.contraceptioncancer.pdf