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Safety: Findings from all the data collec on methods showed that individuals perceive community safety as a major impact on their health and the health of their community blood pressure medication olmetec generic tenormin 100mg with mastercard. Online survey respondents from all four hardship quar les iden fied safety as a concern and ranked efforts to increase safety as the number one way to make Chicago a healthier place to live (Figure 70) arteria inflamada del corazon purchase tenormin in united states online. Health concern ranking by quar le hypertension 14070 order tenormin line, 2015 (Online Neighborhood Survey) How would you make Chicago a healthier place to live Theme #1: Stress Theme #2: Safety Theme #3: Educa on Theme #4: Social Cohesion Theme #5: Community and Civic Engagement Theme #6: Affordability Theme #7: Availability of Services/Resources Theme #8: Neighborhood Upkeep Theme #9: Transporta on However arteria elastica generic 100 mg tenormin with mastercard, the survey revealed large dispari es between the percep ons of respondents in the highest and lowest hardship quar les in response to ques ons about safety in their neighborhoods (Figure 71). Compared to quar le 4, twice the percentage of respondents in quar le 1 iden fied that they felt safe in their neighborhood and felt that law enforcement was responsive. Conversely, higher percentages of quar le 4 residents iden fied problems of property and violent crime, at more than one-third and two-thirds mes of those living in quar le 1, respec vely. Stress: the central theme men oned consistently in all the data collec on methods was stress. People shared how the stress they experience impacts all levels of their health and quality of life. Research shows that the presence of stress, especially when it is con nuous or frequent, can affect both mental and physical health, including the following condi ons: heart disease, stroke, cancer and func oning of the immune system. Percentage of respondents agreeing to safety ques ons by quar le, 2015 (Online Neighborhood Survey) Survey Ques ons I feel safe in my neighborhood I feel law enforcement is responsive in my neighborhood when needed Property crime is a problem in my neighborhood Violent crime is a problem in my neighborhood Quar le 1 86. Focus group members spoke at length about their mistrust of the police and that community members have been harassed. Three of the five focus groups addressed lack of safety as a barrier to health-a focus that also emerged repeatedly in the oral histories. Focus group par cipants conveyed they feel stress induced by the fear of being shot and being a vic m of violence. Par cipants also shared their feelings that violence in their communi es is at the founda on of inequitable health outcomes and opportuni es. One focus group member described how violence specifically affects her ability to take her child to the park: "they [the gang members] can shoot you or [you will] be caught in crossfire. The Mikva youth group echoed concerns with community violence, saying, "If you want to meet up with someone, you have to be careful what route you take. Many programs and community organiza ons are working to reduce and prevent violence. Focus group members spoke in support of a erschool programs for middle school students as effec ve deterrents. These programs provide at-risk children with posi ve adult support and offer an alterna ve to joining a gang. We need something for these kids to be doing so when they get out [of] school, they can have something to do, instead of just standing outside on the blocks. To address mistrust of police, community members proposed several strategies, including trainings. Both police and community members need to be involved with trainings to build trust and understanding and to help iden fy common goals for a safe neighborhood. Community members also want more neighborhood watch programs that engage residents. Educa on: All of the adult focus groups and the par cipants in the community conversa ons discussed educa on and iden fied ways in which the quality of the educa on and the educa on system itself were both an asset and a barrier to good health. Community members inherently knew that high quality educa on leads to jobs that more likely provide be er health-related benefits and higher salaries, which allow individuals to make healthier choices in housing, food consump on and other factors of daily living. Research also connects higher educa onal status with more prolifera ve social networks and supports. With services provided in the school building, children do not need to be taken out of school and their parents/guardians do not need to miss work to help them obtain care. Focus group and community conversa on members complained that educa onal quality and innova ve learning opportuni es are not equitable throughout the city. Par cipants spoke at length about their concerns over the lack of quality educa on in neighborhoods on the south and integra on of innova ve programming. More voca onal training programs in the high schools would improve student opportuni es to obtain be er paying jobs.

Dining establishments must facilitate easy hand cleaning with soap and water between tables by servers and other staff arrhythmia exam cheap tenormin 100mg visa. This can be done by either: Installation of permanent or portable touchless faucets blood pressure normal newborn purchase tenormin 100mg amex, liquid soap dispenses arrhythmia 29 years old purchase 50 mg tenormin amex, and paper towel dispensers with easy accessibility within dining areas is recommended (this is in addition to existing bathroom facilities) blood pressure 00 order tenormin 100 mg visa. Page 35 Alternatively, simple handwashing stations can be created throughout the dining establishment and dining area through the use of commercially available wet towel bucket dispensers (employing single use paper towels and water) in conjunction with automatic soap dispensers. Wet cloth towels (with water) may also be used as an alternative to paper towels (so long as they are employed as single use). Handwashing stations must be accompanied by nearby touchless trash bins to dispose of used paper or cloth towels. All dining establishments must employ some form of in-dining room handwashing station method that allows staff to wash their hands before and after coming into physical contact with table contents. Hand sanitizers can be used as an additional measure but should not replace handwashing. Face Mask Requirement for all Employees and Third-Party Affiliates All dining establishment employees are considered to be food handlers for the purpose of this document and must wear masks. Food handlers are people who directly touch open food as part of their work, but it also includes staff who may touch food contact surfaces or other surfaces in rooms where open food is handled. The term can, therefore, apply not only to host, managers, servers, bussers, and food runners but also to managers, cleaners, maintenance contractors, delivery workers, and food inspectors. Gloves Glove use is to be reserved to employees involved in direct food preparations as defined by existing industry regulatory standards* (traditionally back of house staff) but also includes bussers and foodrunners. In dining establishments where servers or other staff also act as bussers or foodrunners, glove use should be replaced by handwashing after each physical encountered as described above under "Handwashing". All gloves must be changed frequently, at least every 30 minutes or when changing tasks. Gloves must be changed after carrying out non-food related activities, such as opening/closing doors by hand, and emptying bins. Handwashing is a greater protective barrier to infection than wearing disposable gloves. Page 36 Employee Social Distancing Measures Limit the number of staff in a food preparation area at any one time. Organize staff into working groups or teams to facilitate reduced interaction between groups. Stagger workstations on either side of processing lines, so that food workers are not facing one another. Space out workstations, which may require a reduction in the speed of production lines. Any breach of the 3-foot distance between workers should not exceed 15 consecutive minutes per incident. An individual should be specifically assigned within the kitchen to monitor incidents of close contact Frequency of surface cleaning and sanitizing should be increased. It is recommended that front-of-house staff not enter back-of-house areas where possible. Washing of dishes, silverware, and table linen: o All dishes, silverware, and glassware must be washed and disinfected in a dishwashing machine, including items that have not been used, as they might have been in contact with the hands of guests or staff. Page 37 Customer Experience Customers must wear masks at all times unless seated at a table and actively engaged in eating or drinking. Front door must be operated using one or more of the following: Use electronic self-opening mechanism or employ a door person to open and close doors for customers. Doors must be disinfected and wiped down doors every 30 minutes (self-opening doors do not require this frequency of wiping). Provide wipes/paper towels to customers at entrance and exit for individual use along with trash receptacle. Trash must be disposed of regularly and must be contained in a bin with a touchless lid that opens without the need to touch the lid. Host Stands must be operated as follows: Hand sanitizer must be available at the host stand. Host staff must maintain social distance from the customer as escorting to the table.

These symptoms are highly prevalent blood pressure higher in one arm cheap tenormin 100 mg online, cause significant morbidity blood pressure is highest in the cheap tenormin 50 mg, and can often be effectively treated; their evaluation and treatment usually rest upon knowledge acquired in general psychiatry training programs heart attack jarren benton lyrics cheap tenormin. In terms of the treatment of dementia normal blood pressure chart uk order tenormin in india, interventions to reduce or correct cognitive and functional deficits are expected to gain importance over time as new approaches are developed. Thus, the psychiatrist caring for a patient with dementia should consider, but need not be limited to , the treatments recommended in this practice guideline. Finally, other key tasks include providing critical support for family members and other caregivers and making referrals to social, legal, and other community resources. Recommended assessments include evaluation of suicidality, dangerousness to self and others, and the potential for aggression, as well as evaluation of living conditions, safety of the environment, adequacy of supervision, and evidence of neglect or abuse [I]. All patients and families should be informed that even mild dementia increases the risk of vehicular accidents [I]. Mildly impaired patients should be advised to limit their driving to safer situations or to stop driving [I], and moderately impaired patients should be instructed not to drive [I]. Advice about driving cessation should also be communicated to family members, as the implementation of the recommendation often falls on them [I]. Important aspects of psychiatric management include educating patients and families about the illness, its treatment, and sources of additional care and support. Dementia is usually progressive, and treatment must evolve with time in order to address newly emerging issues [I]. At each stage the psychiatrist should be vigilant for symptoms likely to be present, should identify and treat co-occurring psychiatric and medical conditions, and should help patients and families anticipate future symptoms and the care likely to be required [I]. Psychiatric Management the treatment of patients with dementia should be based on a thorough psychiatric, neurological, and general medical evaluation of the nature and cause of the cognitive deficits and associated noncognitive symptoms, in the context of a solid alliance with the patient and family [I]. It is particularly critical to identify and treat general medical conditions, most notably delirium, that may be responsible for or contribute to the dementia or associated neuropsychiatric symptoms [I]. Ongoing assessment includes periodic monitoring of the development and evolution of cognitive and noncog- 2. Specific Psychotherapies and Other Psychosocial Treatments In addition to the general psychosocial interventions subsumed under psychiatric management, a number of specific interventions are appropriate for some patients. Few of these treatments have been subjected to double-blind Copyright 2010, American Psychiatric Association. Behaviororiented treatments are used to identify the antecedents and consequences of problem behaviors and attempt to reduce the frequency of behaviors by directing changes in the environment that alter these antecedents and consequences. These medications have similar rates of adverse effects and have been shown to lead to modest benefits in a substantial minority of patients. Special Concerns Regarding Somatic Treatments for Elderly Patients and Patients With Dementia Medications are effective in the management of some symptoms associated with dementia, but they must be used with caution in this patient population [I]. Because age may alter the absorption, distribution, metabolism, and elimination of many medications, elderly individuals may be more sensitive to their effects. General medical conditions and use of more than one medication may further affect the pharmacokinetics of many medications. In addition, patients with dementia may be more likely to experience certain medication adverse effects, including anticholinergic effects, orthostasis, sedation, and parkinsonism. Finally, symptoms of dementia may alter medication adherence in ways that are unsafe. Consequently, when using pharmacotherapy in patients with dementia, low starting doses, small increases in dose, and long intervals between dose increments may be needed, in addition to ensuring that a system is in place that can enhance proper medication adherence [I]. Treatment of Psychosis and Agitation Psychosis, aggression, and agitation are common in patients with dementia and may respond to similar therapies. When deciding if treatment is indicated, it is critical to consider the safety of the patient and those around him or her [I]. A careful evaluation for general medical, psychiatric, environmental, or psychosocial problems that may underlie the disturbance should be undertaken [I]. Treatment of Cognitive Symptoms Three cholinesterase inhibitors-donepezil, rivastigmine, and galantamine-are approved by the U. If this does not resolve the symptoms, and if they do not cause significant danger or distress to the patient or others, such symptoms are best treated with environmental measures, including reassurance and redirection [I]. The use of such agents should be reevaluated and their benefit documented on an ongoing basis [I]. These medications have also been shown to provide modest improvement in behavioral symptoms in general [I].

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Smart StepS Provide activities and resources to promote the health Rationale and well-being of staff Health promotion services for all staff members can improve their members blood pressure food purchase tenormin 50 mg with mastercard. Connecting staff members to health promotion programs helps staff members heart attack one direction lyrics tenormin 100mg with visa, children and their families heart attack at 25 generic tenormin 100 mg visa. Resources Resources on staff wellness can be found in Staff Wellness in section 10 blood pressure medication voltaren effective 50 mg tenormin. They promote nutrient-rich foods, healthy food preparation methods, good nutrition practices and include enjoyable, developmentally appropriate and culturally relevant participatory activities. For information on nutrition education for families, see Engaging Families in section 8. For information on nutrition education for staff members, see Professional Development in this section and Food Service Personnel Qualifications and Training in section 5. Educational materials that are consistent with state or national standards provide relevant sciencebased nutrition information that is developmentally appropriate and focused on developing skills for healthy eating. By providing positive food experiences, child care programs help children to develop an awareness of good nutrition and develop healthy eating habits for a lifetime. Helping children to make healthy food choices can promote consumption of a balanced diet; achievement of optimal growth and intellectual development; increased physical performance; maintenance of healthy weight; and decreased risk of nutrition-related diseases. Smart StepS Provide weekly nutrition education activities for children that focus on developing healthy behaviors. Materials with corporate logos or advertising contain commercial messages and expose children to product marketing. Department of Health and Human Services and Connecticut Department of Public Health. For licensed child care centers that serve meals, the registered dietitian consultant can assist with this process. The early childhood education consultant can help to evaluate the appropriateness of education materials regarding state early childhood education standards. Smart StepS Integrate nutrition education activities throughout the curriculum and into daily routines. Rationale An integrated approach to nutrition education is more effective than teaching nutrition only as a discrete unit, since it is ongoing and continually reinforces what children are learning. When nutrition education is linked with other content areas, children have daily exposure to nutrition concepts and messages. Nutrition concepts are easily integrated into a variety of content areas such as language and literacy development, mathematics, science and music. They can also be incorporated into daily routines such as mealtimes and transitions. The interdisciplinary approach to nutrition education should complement and not replace sequential nutrition education lessons within a comprehensive health education curriculum. Older children can learn to read food labels and compare the nutritional value of foods. Older children can create a healthy menu based on the local food preferences of a specific country or ethnic group. Resources Michigan Team Nutrition Booklist, Michigan State University, 2006. Changing Lives, Saving Lives, A Step-by-Step Guide to Developing Exemplary Practices in Healthy Eating, Physical Activity and Food Security in Afterschool Programs, Center for Collaborative Solutions, 2010. Rationale Promoting nutrition throughout the child care environment provides consistent health messages for children and families.

They frequently adhere in tight clusters hypertension powerpoint tenormin 50 mg with amex, forming syncytial sheets or mulberry-like aggregates (morulae) prehypertension stage 1 stage 2 generic tenormin 100 mg free shipping, best detected at the periphery of the aspirate smear blood pressure chart images tenormin 100 mg low cost. Within a given sample pulse pressure cardiac output cheap 100mg tenormin with mastercard, the tumor cells may be polymorphous, varying in cell size and shape. Likewise, nuclei are round, spindle-shaped, or pleomorphic; and multiple nuclei of unequal size and shape may be present. The nuclear chromatin usually is finely reticulated, often with prominent parachromatin spaces. Rapidly proliferating tumors can show many mitotic forms and many small apoptotic cells with nuclear pyknosis or karyorrhexis. The amount of cytoplasm is variable and is scant in small cell tumors (eg, small cell carcinoma, neuroblastoma, retinoblastoma, rhabdomyosarcoma, and Ewing sarcoma), and plentiful in others, particularly adenocarcinoma. The cytoplasm may be intensely basophilic and may contain granules, fine to large vacuoles, or bluish cytoplasmic debris. The cytoplasm often appears frayed on the aspirate smear due to pulling apart of cohesive tumor cells. Nonhematopoietic malignant cells are frequently not aspirable ("dry tap") due to associated marrow fibrosis; thus tumor cells may not be detected in marrow smears. Immunohistochemistry are useful in distinguishing metastatic neoplasia from hematopoietic malignancy and in determining tumor origin. The presence of a leukoerythroblastic reaction (ie, immature granulocytes plus nucleated red blood cells blood in the blood is associated with involvement of bone marrow by metastatic tumor. Mitotic Figure A cell containing a mitotic figure is variable in size; it may or may not be larger than the surrounding cells. The cytoplasm has color and granulation characteristic of the resting 56 the College of American Pathologists 2019 Hematology, Clinical Microscopy, and Body Fluids Glossary Bone Marrow Cell Identification cell. Instead, the nucleus appears as a dark, irregular mass, often with a clear central zone. Rarely, the anaphase or telophase of mitosis may be seen, with two separating masses of chromosomes forming two daughter cells. A mitotic cell can be distinguished from a degenerating cell by a relatively compact nucleus (or nuclei); a degenerating cell often displays a pyknotic nucleus that has been fragmented into numerous purple, roundish inclusions. Although the bone marrow is normally a rapidly dividing tissue, only small numbers of mitoses are found in normal marrow aspirates. Niemann-Pick Cell, Foamy Macrophage Niemann-Pick disease is an inherited deficiency of the lysosomal enzyme sphingomyelinase, leading to extensive accumulation of sphingomyelin in a variety of tissues, including the bone marrow. The Niemann-Pick cell is a sphingomyelin-laden histiocyte of variable size (20 to 90 m in diameter) with abundant cytoplasm (N:C ratio less than 1:10). Some variants of Niemann-Pick disease have mixtures of foamy macrophages and sea-blue histiocytes, representing breakdown of the stored sphingomyelin to ceroid. Blood lymphocytes and monocytes also may display cytoplasmic vacuoles containing sphingomyelin. Although foamy macrophages characterize Niemann-Pick disease, they may be seen in other conditions. These include inherited deficiencies in the metabolism of lipid materials (eg, gangliosidoses, Fabry disease, and lactosyl ceramidosis) or excess accumulation of lipid material in bone marrow macrophages (eg, hyperlipidemias, thalassemias, rheumatoid arthritis, sickle cell anemia, thrombocytopenic purpura, infectious mononucleosis, chemotherapy-induced marrow aplasia, hepatitis, and chronic renal failure). The foamy macrophages in these disorders differ slightly from Niemann-Pick cells in that their vacuoles may be larger and more irregular. Osteoblast the osteoblast is a bone-forming cell, producing bone matrix (osteoid), that when mineralized becomes lamellar bone. The cytoplasm is abundant, stains blue-gray, and may have an indistinct, streaming border. A prominent clear zone (hof) is usually evident a small distance away from the nucleus. Although osteoblasts resemble plasma cells, they may be distinguished by their larger size (at least twice as large as plasma cells), elliptical shape, lightly basophilic cytoplasm, prominent clear zone away from (rather than next to) the nucleus, fine reticular chromatin, and one or more nucleoli.