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By Q. Hogar. Marygrove College.

The tal barriers perceived by people living with spinal cord injury in course of the intervention was 3 months purchase 300mg sinemet otc medications causing dry mouth. Results: 3 months and 18 months after the intervention purchase 110 mg sinemet overnight delivery symptoms vaginitis, the community survey of the Swiss spinal cord injury Cohort study buy 300mg sinemet free shipping medicine pill identification. And the difference is signifcant for statistics ticipation was measured with the Nottwil Environmental Factors (p<0 purchase sinemet 300 mg medicine 48 12. Perceived barriers were compared across people with tal retardation and other sequelae which were caused by perinatal different demographic and lesion characteristics. Multivariable brain damage, and promote the development of movement, cogni- regression modelling applying fractional polynomials was used tive, language, social and other functions. And its mechanism may to evaluate the overall perceived impact of barriers in relation to be related to the promotion of brain development, promoting dam- demographics, spinal cord injury characteristics, and physical in- aged neuronal repair. Results: Most perceived barriers were climatic condi- tions and inaccessibility of public and private infrastructure. Older participants, those with longer time since injury and participants 946 with complete lesions indicated more problems with access. Takahashi5 land experience participation restrictions due to environmental bar- 1 2 riers; in particular women, people with non-traumatic spinal cord Hanno-Seiwa Hospital, Rehabilitation Center, Hanno, Japan, To- injury and limited physical independence. However, our convalescent rehabilitation hospital car- 1Raja Isteri Pengiran Anak Saleha Hospital, Department of Inter- ries out the travel for outpatients as recreation every year. Now we nal Medicine, Bandar Seri Begawan, Brunei report our trial of the trip carried out in Oct, 2013. Material and Methods: 13 patients, 10 patients’ family, 1 doctor, 4 nurses, 1 care Introduction/Background: Geriatric medicine is a new medical sub- worker, 8 therapists and 2 other persons participated. The gender was 4 men and 9 wom- needs of older inpatients is essential for service development and en. Material and Methods: Retrospective review of electron- tients needed assistance in ambulation and activities of daily living. Pre-admission Results: Participants stayed at a hotel with a hot spring in Nikko, function, co-morbidities and input from allied health professionals Tochigi on 2nd and 3rd, Oct 2013. Medical staffs assisted patient’s were classifed under the following categories: medical treatment, toileting in a restroom at each place. Days under other hot spring bathing and a banquet, and events on the second day teams were coded separately. Outcome measures such as length of were sightseeing and shopping in a neighboring park. Results: The karaoke which were held at a banquet deepened the friendship 76 admissions consisted of 63 patients, equal gender proportions. No accidents such as fall oc- 67% with severe functional impairment and 26% with full function. On the other hand, a mattress had to be piled up instead of a More than a third had dementia. Only one-ffth were independent bed because preliminary negotiations with hotel staffs were insuf- with mobility. Conclusion: When stroke patients want to make a trip, it is were referred for physiotherapy input, 25% occupational therapy important to secure safety. Many medical staffs who comprehend input, 60% dietetics and 30% for speech language therapist input. The distribution of bed days in sistance to the stroke patients led to make a good trip. Organizing hospital were classifed as: medical treatment 32%, rehabilitation a trip by medical staffs is useful for improving quality of life of 19%, discharge planning 19%, admission under other teams 25% stroke patients at home. For the remain- ing patients, 5% had a 30 day mortality and 20% were readmitted 947 within a month. A dedicated geriatrics ward is warranted to strengthen comprehensive geriatric assessment and multidiscipli- J. Community sup- 1Switzerland, 2University of Lucerne, Department of Health Sci- port services should also be developed urgently to manage such ences and Health Policy, Lucerne, Switzerland, 3Swiss Paraplegic dependent patients after discharge. Conclusion: Learn- man Social Accident Insurance Institution, provides rehabilitation ing mindfulness based techniques yielded positive results for most in accredited rehabilitation centers. Thus, a pilot project to assess quality of rehabilitation processes and results after musculoskeletal injuries in in- and outpatient medical rehabilitation 951 centers was started in Apr 2015 and is scheduled to Mar 2016. Process quality was assessed by a 9-item-question- Galea 1Royal Melbourne Hospital, Department of Rehabilitation Medi- naire measuring e. Quality of treatment outcome was assessed by generic cine, Parkville, Australia, 2University College Dublin, School of and specifc patient-reported outcomes on admission and discharge. After completion of the pilot rial and Methods: A 14-day extensive workshop program (Sep-Oct phase comprehensive analyses of data records are performed which 2014) was conducted at the University Hospital Antananarivo and will offer more signifcant information until the congress in 2016. Antsirabe, with the Department of Health Madagascar, by rehabili- tation staff from Royal Melbourne Hospital, Australia. Other challenges for basic policies on rehabilita- acquired physical injuries are in need of techniques that help them tion included: access to rehabilitation services, geographical cover- to manage distress and pain. Mindfulness meditation can be defned age, skilled work-force shortages, limited info-technology systems; as a moment-to-moment awareness colored by attitudes such as ac- lack of care-models and facility/staff accreditation standards; lim- ceptance and non-judgement. In best practices it was observed that the 1 2 3 3 key feature was also longer vocational processes, which enabled M. The quality of contacts between 1North Stafforshire Rehabilitation Centre, Physical Rehabilitation Employment service and providers enabled trust and innovative Medicine, Stoke-on-Trent, United Kingdom, 2The Robert Jones solutions with career orientation and active labour market policy & Agnes Hunt Orthopaedic Hospital, Midland Centre for Spinal measures. Employers as the main reasons for success exposed posi- Injuries, oswestry, United Kingdom, 3The Robert Jones & Agnes tive attitudes, potentials, ability to learn, talents, professional atti- Hunt Orthopaedic Hospital, Midlands Centre for Spinal Injuries, tudes and concerns of rehabilitees. It was very interesting that that Oswestry, United Kingdom spoke of good impact on the working culture, when they trained and employed person with disability. Training experience gave them better view adequate measures including prioritising the discharge venue and on their abilities, gathering new knowledge, with constant support care package for these complex patients are carefully planned, we of professional workers. All consecutive patients who have passed away within one year post-discharge were included. Results: Out of 380, 954 15 patients who met the criteria were included in this project. An accessible home and environmental modi- morbidities and complications and were largely unavoidable. Material and Methods: The study followed the interactive approach of qualitative design for search the Impact of modifed home environment. In this study 73% samples were 1University Rehabilitation Institute Soča, Development centre for recruited from different villages and 27% from urban. On the ba- Vocational Rehabilitation, Ljubljana, Slovenia sis on multiple responses, all participants were modifed their liv- ing room, toilet, bathroom and kitchen. Information was gathered through Slovenian vocational proved social relationship and communication though participant rehabilitation network specifc questionnaire. In depth interviews had faced interim economic hardship during way to home modi- analysed information from vocational rehabilitation providers, fcation. Overall more than 65% participants had reported that rehabilitees, rehabilitation counsellors at Employment Service in modifed home environment has a vital role to lead a quality and Slovenia and employers. The integrated plan interventions are more effective to rial and Methods: Qualitative study- retrospective cohort study. Subsequently children 1 have contractures, are incontinent and experience pressure sores. Daejeon Wellness Hospital, Rehabilitation, Daejeon, Republic of Not one program is focusing on the development of the child and Korea, 2Daejeon Wellness Hospital, Medical Oncology, Daejeon, its transition phases. A system of referral to the hospital based on Republic of Korea clinical citeria needs to be installed is most settings.

We compute the de- scriptive versions when the scores are available: When describing the sample generic sinemet 125 mg without a prescription symptoms pneumonia, we cal- culate S2 and S generic sinemet 125 mg with visa treatment solutions. When the X X X X population of scores is unavailable purchase sinemet 300 mg fast delivery symptoms after conception, we infer the variability of the population based on a sample by computing the unbiased estimators purchase sinemet 300 mg with mastercard medicine gabapentin 300mg capsules, s2 and. With these basics in hand, you are now ready to apply the variance and standard de- viation to research. Thus, the mean from a study might describe the number of times that partic- ipants exhibited a particular behavior, but a small standard deviation indicates that they consistently did so. Or, in a survey, the mean might describe the typical opinion held by participants, but a large standard deviation indicates substantial disagreement among them. We also compute the mean and standard deviation in each condition of an experi- ment. For example, in Chapter 4 we tested the influence of recalling a 5- 10- or 15- item list. By also considering the variability, you would also know that these scores differed from this mean by an “average” of only. In the 15-item condition, however, scores were spread out by almost twice as much, differing from the mean by 1. Therefore, we know that scores were closer to the mean in the 5-item condition, so 3 is a more accurate summary here than 9 is for the 15-item condition. Also, because these recall scores reflect a behavior, we know that memory behavior is more consistent when people recall a 5-item list, with rela- tively large differences in their behavior when recalling a 15-item list. Variability and the Strength of a Relationship Measures of variability also tell us about the strength of the overall relationship that an experiment demonstrates. In an experiment, this translates into everyone in a condition having the same score or close to the same score. In other words, using the terminology of this chapter we would say that a strong relationship occurs when there is little variability among the scores within each condition. This indicates that, as shown, the raw scores within each condition are relatively close to each other. Therefore, the overall relationship between list length and recall scores is rather strong. Therefore, we would describe this as X 3 X 6 X 9 a less consistent, weaker relationship. A third use of variability is that it communicates the amount of error we have when predicting participants’ scores. Variability and Errors in Prediction You know that the mean is the best score to predict as any participant’s score, so, for example, we’d predict a recall score of 3 for anyone in the 5-item condition. To determine our errors when predict- ing unknown scores, we determine how well we can predict the known scores in the data. As in Chapter 4, the amount of error in one prediction is the difference between what someone actually gets 1X2 and what we predict he or she gets (the X). Because some predictions will contain more error than others, we want to find the average error, so we need the “average deviation. Thus, we have a novel way to view S and S2: Because they measure the difference X X between each score and the mean, they also measure the “average” error in our pre- dictions when we predict the mean for all participants. Similarly, the sample variance is somewhat like the average deviation, although less directly. This is too bad because, technically, variance is the proper way to measure the errors in our prediction. This indicates that X when we predict that participants in the 15-item condition scored 9, our “average error”—as measured by the variance—is about 2. Although this number may seem strange, simply remember that the larger the variance, the larger the error, and the smaller the variance, the smaller the error. If the population is known, then we’ll predict anyone’s score is , and our errors in prediction equal σ2. Or, if we must es- X timate the population using the sample, then we’ll use the sample mean to estimate the we predict for everyone, and we estimate that our errors in prediction will equal. Statistics in Published Research: Reporting Variability 103 Accounting for Variance Finally, we have one other use of the term variance. In research reports you will en- counter such phrases as accounting for variance or the variance accounted for. They are used when researchers describe the usefulness of a relationship when we use it to predict scores. Because a relationship shows the particular Y scores that are naturally paired with an X, if we know participants’ X, we know the Y around which they tend to score. Thus, to some extent we can predict when individuals have one Y score and when other individuals have a different Y score. If we compute the variance of all Y scores in a study, this reflects all of the differences in scores that we want to predict, so this is the variance that we want to account for. How well a relationship helps us to predict the different Y scores is the extent that it “explains” or “accounts” for the variance in Y scores. However, the rela- tionship with list length tends to group similar scores together. Therefore, we know when participants score around 3 (when they recall a 5-item list) and when they pro- duce a different score of, say, 9 (when they recall a 15-item list). By considering list length, our predictions seem very close to each person’s actual score, so we seem to be close to predicting many of the differences among the nine scores. Therefore, in our lingo, we would say that the variable of list length seems to “account for” a sizable portion of the variance in recall scores. However, we still have some error in our pre- dictions because not everyone scored exactly the score we’d predict. Therefore, some differences among scores are not predicted, so we say that some of the variance in re- call scores is not accounted for. On the other hand, consider when a relationship is weaker, such as the relationship between someone’s gender and his or her height. We would predict the average man’s height for any man and the average woman’s height for any woman. However, there is a wide range of women’s and men’s heights, so our predictions each time may not be very close to someone’s actual height. Therefore, this relationship is not all that much help in predicting someone’s exact height, and so it would be described as accounting for little of the variance in height. As these examples illustrate, more consistent relationships account for a greater amount of the variance. Chapters 8 and 12 discuss ways to precisely measure the amount of variance accounted for. For example, recall that the symbol for the sample mean is M, so in a report of our list-length study, you might see this: “The fewest errors were produced when recalling 5-item lists (M 3. With this information, you are largely finished with descriptive statistics because you know the important characteristics of the sample data and you’ll be ready to draw inferences about the corresponding population. Later we will compute the mean and standard deviation in each con- dition of an experiment as part of performing inferential statistics. Measures of variability describe how much the scores differ from each other, or how much the distribution is spread out. The variance is used with the mean to describe a normal distribution of interval or ratio scores. The standard deviation is also used with the mean to describe a normal distribution of interval/ratio scores. It can be thought of as somewhat like the “average” amount that scores deviate from the mean. Transforming scores by adding or subtracting a constant does not alter the standard deviation.

Historically buy sinemet 110 mg fast delivery symptoms heart attack women, paint and gasoline were major sources of lead exposure and still can be found in the environment order 300mg sinemet mastercard medications 10325. Other sources of inorganic lead include ‘‘home crafts’’ such as pottery and jewelry making purchase sinemet 300 mg with mastercard medicine rocks state park. Inorganic metallic lead oxides and salts are slowly absorbed through all routes except the skin purchase 125mg sinemet mastercard treatment depression. Inorganic lead binds to hemoglobin in erythrocytes, with the remainder distributing to soft tissues such as the brain and kidney. Through redistribution, it later accumulates in bone, where its elimination half-life is 20–30 years. Chronic exposure results in the inhibition of d-aminolevulinic acid dehydratase and a block in the conversion of d-aminolevulinic acid to porphobilinogen (see Fig. Early signs of poisoning include vertigo, ataxia, headache, restlessness, and irritability; wristdrop is a common sign of peripheral neuropathy. Projectile vomiting, delirium, and seizures may occur with the progression of encephalopathy with lead concentrations >100 lg/dL. Intestinal spasm with severe pain (lead colic) may become evident in advanced stages of poisoning. Organic lead poisoning is increasingly rare due to phased elimination of tetraethyl and tet- ramethyl lead (antiknock components in gasoline). Both agents are highly volatile and are absorbed through the skin and respiratory tract, often from sniffing gasoline. Properties and mechanism of action (1) Inorganic arsenic can be found in coal and metal ores, herbicides, seafood, and drinking water. Acute poisoning (1) Symptoms include severe nausea, vomiting, abdominal pain, laryngitis, and bronchitis; capillary damage with dehydration and shock may occur. The skin often appears pale and milky (‘‘milk and roses’’ com- plexion) because of anemia and vasodilation. Skin pigmentation, hyperkeratosis of the palms and soles, and white lines over the nails may be observed after prolonged exposure. Treatment is primarily supportive after acute poisoning and involves emesis, gastric lavage, rehydration, and restoration of electrolyte imbalance. Organic arsenicals are excreted more readily and are less toxic than inorganic forms; poi- soning is rare. The effects are severe hemoly- sis and subsequent renal failure; symptoms include jaundice, dark urine, and severe ab- dominal pain. Properties and mechanism of action (1) Inorganic mercury occurs as a potential hazard primarily because of occupational or indus- trial exposure. Acute poisoning and treatment (1) Mercury vapor poisoning produces chest pain, shortness of breath, nausea, vomiting, and a metallic taste. Treatment involves removal from exposure, supportive care, and chelation therapy with di- mercaprol, unithol, or succimer. Chronic poisoning (1) Mercury vapor poisoning may lead to a fine tremor of the limbs that may progress to choreiform movements, and neuropsychiatric symptoms that may include insomnia, fa- tigue, anorexia, and memory loss, as well as changes in mood and affect. Exposure of the fetus to methylmercury in utero may result in mental retardation and a syn- drome resembling cerebral palsy. Metal-chelating agents usually contain two or more electronegative groups that form stable coordinate-covalent complexes with cationic metals that can then be excreted from the body. The greater the number of metal–ligand bonds, the more stable the complex and the greater the efficiency of the chelator. Dimercaprol is an oily, foul-smelling liquid administered intramuscularly as a 10% solution in peanut oil. Dimercaprol interacts with metals, reactivating or preventing the inactivation of cellular sulfhydryl-containing enzymes. This agent is useful in arsenic, inorganic mercury, and organic mercury poisoning (and lead poisoning). The adverse effects of dimercaprol include tachycardia, hypertension, gastric irritation, and pain at the injection site. Succimer (Chemax) is a derivative of dimercaprol that can be taken orally and is approved for use in children to treat lead poisoning. The adverse effects of succimer are generally minor and include nausea, vomiting, and anorexia. Unithol (Dimaval) is another analogue of dimercaprol over which it has advantages (few adverse effects) for treatment of mercury, arsenic, and lead poisoning. This agent is used primarily to chelate excess copper in individuals with Wilson disease. Penicillamine is also used for copper and mercury poisoning and as an adjunct for the treat- ment of lead and arsenic poisoning. Allergic reactions and rare bone marrow toxicity and renal toxicity are the major adverse effects. Deferoxamine is a specific iron-chelating agent that on parenteral administration binds with ferric ions to form ferrioxamine; it also binds to ferrous ions. Deferoxamine can also Chapter 13 Toxicology 319 remove iron from ferritin and hemosiderin outside bone marrow, but it does not capture iron from hemoglobin, cytochromes, or myoglobin. Deferoxamine is metabolized by plasma enzymes and excreted by the kidney, turning urine red. Deferoxamine may cause allergic reactions and rare neurotoxicity or renal toxicity. Defer- oxamine therapy is contraindicated in patients with renal disease or renal failure. More than a million cases of acute poisoning occur each year in the United States, many in children and adolescents. The symptoms of most drug and chemical poisonings are extensions of their pharmacologic properties. Measures to support vital functions, slow drug absorption, and promote excretion are generally sufficient for treatment. Comatose patients may die as a result of airway obstruction, respiratory arrest, or aspiration of gastric contents into the tracheobronchial tube. Induction of vomiting with ipecac orally is no longer recommended for routine use at home, and is con- traindicated in children under 6 years. Urinary excretion can be enhanced by the admin- istration of agents such as sodium bicarbonate, which raises urinary pH and decreases renal reabsorption of certain organic acids such as aspirin and phenobarbital. Hemodialysis is an efficient way to remove certain low molecular weight, water-soluble tox- ins and restore electrolyte balance. Salicylate, methanol, ethanol, ethylene glycol, paraquat, and lithium poisonings are effectively treated this way; hemoperfusion may enhance the whole-body clearance of some agents (carbamazepine, phenobarbital, phenytoin). Drugs and poisons with large volumes of distribution are not effectively removed by dialysis. Antidotes (see respective agents) are available for some poisons and should be used when a specific toxin is identified. Some examples include naloxone, acetylcysteine, physostigmine, metal chelators (see above), atropine, pralidoxime, and ethanol. What treatment would be appropriate in a 3- What is the most appropriate agent to adminis- year-old boy with a dramatically elevated blood ter at this point? A 56-year-old chronic alcoholic is brought to gency room because he recently ingested the emergency room with altered mental status numerous ‘‘iron pills’’ his mother was taking for and complains of not being able to see. The child now has severe abdomi- reports running out of ‘‘whiskey’’ and ingesting nal pain, bloody diarrhea, nausea, and vomit- wood alcohol (methanol).

Symptoms include increasing thirst sinemet 125mg mastercard symptoms uti in women, dry mouth cheap sinemet 300 mg with mastercard medicine 4839, weakness or lightheadedness delta cell cheap 300 mg sinemet mastercard treatment 2nd degree heart block, pancreatic A type of cell located in (particularly when it worsens on standing) sinemet 125 mg line 909 treatment, and a tissue that is called the islets of Langerhans in the darkening of or decrease in urination. Delta cells make somatostatin, a hor- dration can lead to changes in the body’s chemistry, mone that inhibits the release of numerous hor- kidney failure, and death. It contracts to move the arm up from out a prescription as a “nutritional supplement. Although most people have ment, language, motor and spatial skills, and func- experienced this feeling at one time or another, in tion. By definition, dementia is not due to major some people sensations of déjà vu are part of a depression or schizophrenia. Alzheimer’s disease is seizure or migraine aura; in others, the sensations the most common cause of dementia. Toothache can be caused by a problem that does not originate demulcent An agent that forms a soothing, pro- from a tooth or the jaw. For example, mucilage and oils dentin The hard tissue of the tooth that sur- are demulcents that can relieve irritation of the rounds the central core of nerves and blood vessels bowel lining. Demyelination exposes these fibers and appears to cause problems in nerve impulse Depo-Provera A contraceptive that is injected conduction. It contains the hormonal dendrite A short, arm-like protuberance from a compound medroxyprogesterone acetate. Depression is not the same as a ervation include disease, chemical toxicity, physical passing blue mood. It is not a sign of personal injury, or intentional surgical interruption of a weakness or a condition that can be wished away. Without treatment, dengue fever An acute mosquito-borne viral ill- symptoms can last for weeks, months, or years. The presence of depression include loss of interest in activities that fever, rash, and headache (the “dengue triad”) is were once interesting or enjoyable, including sex; characteristic. Dengue fever is endemic throughout loss of appetite, with weight loss, or overeating, with the tropics and subtropics. Also called breakbone weight gain; loss of emotional expression (flat fever, dandy fever, and dengue. Victims of dengue affect); a persistently sad, anxious, or empty mood; fever often suffer temporary contortions due to the feelings of hopelessness, pessimism, guilt, worth- intense joint and muscle pain. Other cal problems such as headaches, digestive disor- symptoms are bleeding with easy bruising, blood ders, or chronic pain that do not respond to spots in the skin, vomiting of blood, blood in the treatment, and thoughts of death or suicide or sui- stool, bleeding gums, and nosebleeds. Most called major depression, dysthymia, and bipolar deaths occur in children and infants are at particu- disease (manic-depressive disease). The disease tends to be associated with obesity and is dermatome 1 A localized area of skin that about five times more frequent in females than in receives its sensations via a single nerve from a sin- males. The fatty tumors are most often located on zoster) typically affects one or several isolated der- the trunk and limbs. The purpose of dermabrasion is with patches of slightly raised reddish or scaly rash. Chemical skin peels are an alterna- When inflammation of the muscle (myositis) occurs tive to dermabrasion. Dermatitis most common symptom is muscle weakness, usu- has many causes, including direct contact with an ally affecting the muscles that are closest to the irritating substance; allergic reaction to an inhaled, trunk of the body (proximal). Trouble with swal- ingested, or injected allergen; eczema; or underly- lowing may occur. Some patients develop include redness, itching, and in some cases, blister- hardened bumps of calcium deposits under the ing. Other treatments include detergents, especially those with perfumes; including immunosuppressing drugs, such as aza- chemicals used in photo development; ammonia thioprine and methotrexate, may be prescribed. Physical therapy is usually Treatment involves identifying and avoiding sub- recommended to preserve muscle function and stances that cause attacks and, during attacks, using avoid muscle atrophy. Dermatitis herpetiformis is asso- ciated with a disorder of the small intestine called dermatophytic onychomycosis See ony- celiac sprue. For example, when the rash of measles descending aorta starts after the arch of the aorta fades, desquamation occurs. The most important stage of human devel- opment occurs before birth, as tissues and organs designer drug A drug, typically a psychoactive arise from differentiation of cells in the embryo. An brain-based abilities such as speech and hand–eye example of a designer drug is the street drug coordination, and learns. Interruptions in any of “ecstasy,” which is an analogue of methampheta- these processes can result in developmental delay. Also known as selective estrogen-receptor modula- development, fetal See prenatal development. For example, raloxifene (brand name: Evista) is classified as a designer estrogen because, developmental delay A condition in which a like estrogen, it prevents bone loss and lowers child is behind schedule in reaching milestones of serum cholesterol; however, it does not stimulate early childhood development. Desmoid tumors occur most often in young adults, and they developmental disorder One of several disor- usually involve the limbs or trunk, but they can also ders that interrupt normal development in child- arise in the abdomen or thorax. A developmental disorder may affect a single are very difficult to remove because they adhere area of development (specific developmental disor- tenaciously to surrounding structures and organs. Radiation therapy and limited developmental disorders can be accommodated chemotherapy have also been used. Early intervention is absolutely tumor is also called aggressive fibromatosis because essential for pervasive developmental disorders, it is locally aggressive and fibrous, like scar tissue. See also autism; cerebral palsy; develop- desmoplasia The growth of fibrous or connec- mental disorder, pervasive; developmental tive tissue anywhere in the body. The formation of scar tissue (adhesion) social interaction, imaginative activity, and verbal http://www. See also ple, dysgraphia is a specific developmental disor- dextroposition of the heart; Kartagener syndrome. Dextroposition occurs when the con- tents of the left side of the chest shove the heart to developmental dyspraxia A pattern of delayed, the right, or when the contents of the right side of uneven, or aberrant development of gross or fine the chest are reduced (for example, by collapse of motor skills during childhood development. Treatment is via early intervention, using physical dextrose Glucose, a simple sugar. Di Ferrante syndrome is an device, assistive Any device that is designed, autosomal recessive genetic disorder. For example, canes, crutches, walkers, wheelchairs, and shower chairs are all assistive devices. See also dia- Prefix meaning through, throughout, or com- assistive technology; augmentative communica- pletely, as in diachronic (over a period of time), tion device; device, medical. In insurance parlance, med- ical device is usually synonymous with assistive diabetes, type 2. Medical as a result of damage to the pancreas from iron dep- devices are not covered by most insurance policies, osition of hemochromatosis. See also diabetes mel- although they may be available through supplemen- litus; hemochromatosis. Symptoms include increased urine output, appears during pregnancy and usually goes away increased appetite and thirst, unexplained weight loss after the birth of the baby. Gestational diabetes first treated with weight reduction, a diabetic diet, can cause birth complications. When these measures fail to control the macrosomia, in which the baby is considerably larger elevated blood sugars, oral medications are used. If than normal due to large deposits of fat; such a baby oral medications are still insufficient, insulin medica- can grow too large to be delivered through the tions are considered.

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