By C. Tragak. Western State College.
Some proteins buy levitra super active 40mg cheap, such as keratin buy levitra super active 40mg with mastercard, are highly insoluble in water and hence are resistant to digestion buy generic levitra super active 40 mg line, while highly glycosylated proteins discount levitra super active 20 mg with mastercard, such as the intestinal mucins, are resistant to attack by the proteolytic enzymes of the intestine. Amino Acids The amino acids that are incorporated into mammalian protein are α-amino acids, with the exception of proline, which is an α-imino acid. This means that they have a carboxyl group, an amino nitrogen group, and a side chain attached to a central α-carbon (Figure 10-1). Functional differences among the amino acids lie in the structure of their side chains. In addition to differences in size, these side groups carry different charges at physiological pH (e. These side chains have an important bearing on the ways in which the higher orders of protein structure are stabilized and are intimate parts of many other aspects of protein function. Attractions between positive and negative charges pull different parts of the molecule together. Hydrophobic groups tend to cluster together in the center of globular proteins, while hydrophilic groups remain in contact with water on the periphery. The ease with which the sulfhydryl group in cysteine forms a disulfide bond with the sulfhydryl group of another cysteine in a polypeptide chain is an important factor in the stabilization of folded structures within the poly- peptide and is a crucial element in the formation of inter-polypeptide bonds. The hydroxyl and amide groups of amino acids provide the sites for the attachment of the complex oligosaccharide side chains that are a feature of many mammalian proteins such as lactase, sucrase, and the mucins. Histidine and amino acids with the carboxyl side chains (glutamic acid and aspartic acid) are critical features in ion-binding proteins, such as the calcium-binding proteins (e. Some amino acids in protein only achieve their final structure after their precursors have been incorporated into the polypeptide. The former hydroxylated amino acids are critical parts of the cross-linking of collagen chains that lead to rigid and stable structures. Nutritional and Metabolic Classification of Amino Acids Older views of the nutritional classification of amino acids categorized them into two groups: indispensable (essential) and dispensable (non- essential). The nine indispensable amino acids (Table 10-1) are those that have carbon skeletons that cannot be synthesized to meet body needs from simpler molecules in animals, and therefore must be provided in the diet. Although the classification of the indispensable amino acids and their assignment into a single category has been maintained in this report, the definition of dispensable amino acids has become blurred as more infor- mation on the intermediary metabolism and nutritional characteristics of these compounds has accumulated. Laidlaw and Kopple (1987) divided dispensable amino acids into two classes: truly dispensable and condition- ally indispensable. In addition, six other amino acids, including cysteine and tyrosine, are conditionally indispens- able as they are synthesized from other amino acids or their synthesis is limited under special pathophysiological conditions (Chipponi et al. This is even more of an issue in the neonate where it has been suggested that only alanine, aspartate, glutamate, serine, and probably asparagine are truly dietarily dispensable (Pencharz et al. The term conditionally indispensable recognizes the fact that under most normal conditions the body can synthesize these amino acids to meet metabolic needs. However, there may be certain physiological circum- stances: prematurity in the young infant where there is an inadequate rate at which cysteine can be produced from methionine; the newborn, where enzymes that are involved in quite complex synthetic pathways may be present in inadequate amounts as in the case of arginine (Brunton et al. The cells of the small intestine become important sites of conditionally indispensable amino acid, synthesis, with some amino acids (e. However, the quantita- tive requirement levels for conditionally indispensable amino acids have not been determined and these, presumably, vary greatly according to the specific condition. There now appears to be a requirement for preformed α-amino nitrogen in the form of glutamate, alanine, or aspartate, for example (Katagiri and Nakamura, 2002). However, there are now good theoretical reasons to conclude that this is not likely in the human (Katagiri and Nakamura, 2002). The mixture of dispensable and conditionally indispensable amino acids as supplied by food proteins at adequate intakes of total nitrogen will assure that both the nitrogen and specific amino acid needs are met. Nearly half of this protein (about 43 percent) is present as skeletal muscle, while other structural tissues such as skin and blood each contain approximately 15 percent of the total protein (Lentner, 1981). The distribution among the organs varies with developmental age, as the newborn infant has proportionately less muscle and much more brain and visceral tissue than the adult. It is also notable that, despite the very wide variety of enzymes and proteins within a single organism, almost one half of the total protein content of the human is present in just four proteins (myosin, actin, collagen, and hemoglobin). Moreover, in induced malnutrition, this proportion can rise to 50 percent because of the substantial loss of noncollagen proteins, whereas collagen itself is retained (Picou et al. Even in the adult, when the protein mass of the body has reached a plateau, it can be influenced by a variety of nutritional and pathological factors. Thus, when diets high or low in protein are given, there is a gain or loss of body protein over the first few days, before re-equilibration of protein intake with the rates of oxidation and excretion (Swick and Benevenga, 1977). This phenomenon has led to the concept of a “labile protein reserve,” which can be gained or lost from the body as a short-term store for use in emergencies or to take account of day-to-day variations in dietary intake. Studies in animals have suggested that this immediate labile protein store is contained in the liver and visceral tissues, as their protein content decreases very rapidly during starvation or protein depletion (by as much as 40 percent), while skeletal muscle protein drops much more slowly (Swick and Benevenga, 1977). During this situation, protein break- down becomes a source of indispensable amino acid needs for synthesis of proteins critical to maintaining essential body function (Reeds et al. This labile protein reserve in humans is unlikely to account for more than about 1 percent of total body protein (Waterlow, 1969; Young et al. Thus, the immediately accessible stores of protein (which serve as the source of indispensable amino acids and amino nitrogen) cannot be considered in the same light as the huge energy stores in the form of body fat; the labile protein reserve is similar in weight to the glycogen store. The protein lost during fasting is functional body protein and thus there is no evidence for a protein reserve that serves only as a store to meet future needs. There is a wide range of variation in daily dietary protein intake, from the protein requirement and beyond, to which the body is able to adapt over a period of days, after which no further change in body protein con- tent occurs. However, pathological conditions, such as severe disease states, can cause substantial rates of protein loss due to the increased demand for either amino acids or carbon skeletons to meet local energy demands. If these conditions go unchecked for more than a few days, there may be a serious depletion of the body’s protein mass, which might eventually become life threatening. Although the evidence from short-term changes in diet suggests that the main loss of protein is from the viscera (de Blaauw et al. Although the free amino acids dissolved in the body fluids are only a very small proportion of the body’s total mass of amino acids, they are very important for the nutritional and metabolic control of the body’s proteins. The content of free and protein-bound amino acids in rat muscle is shown in Table 10-2. It can be seen that their ranges are considerable and that their concentrations in the free pool are in no way related to their concentrations in body proteins. In the human, free phenylalanine com- prises less than 2 percent of its total body pool, and corresponds to only about 1. Free glutamate and alanine comprise a larger proportion of their respective body pools, but they could not be considered as reserves for more than a very short time. In human muscle, glutamine has an exceptionally large free pool, containing about 10 to 15 g of nitrogen. After trauma, this pool can become depleted by more than 50 percent (Labow and Souba, 2000); its loss may then make a significant contribution to the total loss of nitrogen. Although the plasma compartment is most easily sampled, the concen- tration of most amino acids is higher in tissue intracellular pools. Typically, large neutral amino acids, such as leucine and phenylalanine, are essen- tially in equilibrium with the plasma. Others, notably glutamine, glutamic acid, and glycine, are 10- to 50-fold more concentrated in the intracellular pool. Dietary variations or pathological conditions can result in substantial changes in the concentrations of the individual free amino acids in both the plasma and tissue pools (Furst, 1989; Waterlow et al. Pathways of Amino Acid Metabolism The exchange between body protein and the free amino acid pool is illustrated by the highly simplified scheme shown in Figure 10-2. Similarly, there is a second pool, consisting of the free amino acids dis- solved in body fluids. The arrows into and out of the protein pool show the continual degradation and resynthesis of these macromolecules (i. The other major pathways that involve the free amino acid pool are the supply of amino acids by the gut from the absorbed amino acids derived from dietary proteins, the de novo synthesis in cells (includ- ing those of the gut, which are a source of dispensable amino acids), and the loss of amino acids by oxidation, excretion, or conversion to other metabolites. Amino Acid Utilization for Growth Dietary protein is not only needed for maintaining protein turnover and the synthesis of physiologically important products of amino acid metabolism but is, of course, laid down as new tissue. Studies in animals show that the composition of amino acids needed for growth is very simi- lar to the composition of body protein (Dewey et al.
The signals from the detectors were stored and analyzed mathematically in a computer generic levitra super active 40 mg on-line. Scintillation detectors combined with photomultipliers or photo diodes have been used discount levitra super active 20 mg on line. In order to increase the sensituvity the gas detector is flled with pressurized xenon purchase levitra super active 40mg overnight delivery. The technique has been rapidly developed since the frst scanner presented by Hounsfeld in 1972 order levitra super active 40mg on-line. Both the x-ray tubes, the detector technique as well as the computer presenta- tions with flters etc. You can go to Internet and see a number of excellent pictures; for example see: http://www. These cartoons – given again below – represented a misunderstanding at that time and caused a big smile. The misunder- standing was that some people had the idea that it was possible to take x-ray pictures with refected x-rays – which means that both the x-ray tube and the flm was in the photographer’s box (like an ordinary camera). As a result of this some people feared that you could use an x-ray camera to watch people when they changed into swimming suits inside the small cabins on the beach. A London tailor company advertised therefore that they could make x-ray proof underclothing for ladies. Today with the use of Compton backscattering technique all this is a reality – and in fact in use sev- eral places for security. Today we know that it is pos- sible to use refected x-rays and see through cloths. It Scattered photon is a reaction between the x-ray photon and a free l` or loosely bound electron. With the knowledge of backscattered Compton radiation, equipment have been developed for observ- ing objects. The picture is formed by a pencil-shaped beam of x-rays that is sweeping the object. The energy used is approxi- mately 100 keV (100 – 200 kV tubes) which ensures that the Compton process is dominating. The resolution is (so far) not as good as for ordinary x-rays, but you can easily see objects with an atomic number different from that for tissue. It is possible to use the technique to see the contents of a closed container through the container walls. The technique is excellent for observ- ing hidden objects on people or the cargo in contain- ers – objects that is not possible to observe with the usual metal detectors The most common radioisotope used in diagnosis is technetium-99, but a large number of other isotopes are in use. The thyroid, bones, heart, liver and many other organs can be easily imaged, and disorders in their function revealed. Diagnosis For diagnostic purposes we use radioactive tracers which emit gamma rays from within the body. The isotopes are generally short-lived and linked to chemical compounds which permit specifc physi- ological processes to be studied. For a number of years the g-radiation was observed using a so-called gamma camera. When this nuclide decays, it emits a positron, which promptly combines with a nearby electron resulting in the simultaneous emission of two g-photons in opposite directions. With the isotope F-18 as the tracer, it has proven to be the most accurate noninvasive method of detecting and evaluating most cancers. The reason for this is that F-18 can be added to glucose – and the tumors have an increased rate of glucose metabolism compared to benign cells. Isotopes for diagnosis Let us point out a couple of important requirements for the use of ra- dioisotopes: 1. Due to the requirement of a short half-life mainly or solely artifcially made isotopes comes into question. This implies that the nuclear medicine started when equipment like the cyclotron and neutron sources like the reactor become available in the 1930s and 1940s. Georg de Hevesy and coworkers used Pb-210 (one of the isotopes in the Uranium-radium-series) and studied the absorption and elimination of lead, bismuth and thallium salts by animal organisms. Chieivitz and Georg de Hevesy administered phosphate la- beled with P–32 to rats and demonstrated the renewal of the mineral constituents of bone. George de Hevesy was awarded the Nobel prize in chemis- try for his pioneering work with radioactive tracers. George de Hevesy (1885 – 1966) 1930s in Berkeley He was awarded the Nobel prize in chemistry for 1943. The University of California in Berkeley has played a sig- “for his work on the use of isotopes nifcant role in the start and growth of nuclear medicine. The Lawrence brothers are of Norwegian heritage and Sea- borg is coming from Sweden. Lawrence, the brother of Ernest, made the frst clinical therapeutic application of an artif- cial radionuclide when he used phosphorus-32 to treat leukemia. Also Joseph Gilbert Hamilton and Robert Spencer Stone administered sodium-24 to a leukemia patient. Furthermore, this year Emilio Segre and Seaborg discovered Tc-99m the metastable (excited) Tc-99 isotope. The metastable isotope has a half-life of 6 hours and emit a g-photon with energy 140 keV. Tc–99m is an important isotope and is used in approximately 85 percent Emilio Segrè of diagnostic imaging procedures in nuclear medicine. The development of nuclear accelerators – in particular the cyclotron – made it possible to enter the feld of nuclear medicine. Two scientists are of utmost importance for the construction of the frst accelerators; Rolf Widerøe and Ernest Lawrence. The development of the cyclotron and the beginning of nuclear medicine is closely connect- ed to California and the Berkeley University. It all started when the oldest of the Lawrence brothers (Ernest) came to Berkeley in 1929. In a linear accelerator charged particles are accelerated in tubes forming a straight line. Lawrence arranged this by letting the particles go in larger and larger circles within a box – kept in place by a magnetic feld. Ernest Lawrence Rolf Widerøe (1901 – 1958) (1902 – 1996) Ernest Lawrence is of Norwegian heritage Rolf Widerøe is Norwegian, born in Oslo. He was He was engaged in the construction of an the father of the frst cyclotrons constructed accelerator, and published these ideas al- in Berkeley. His name is The Radiation Laboratory in Berkeley are connected to important acellerators for radi- named after him. He was an exciting public science center with excit- behind the frst high energy radiation source ing hands-on experiences for learners of all in Norway – the betatron from 1953 at The ages. The above picture is a model of a cyclotron – placed near the entrance of “Lawrence Hall of Science” in Berkeley. The Berkeley University developed a number of accelerators and become the place where new isotopes were produced. The leading scientist in the production of new isotopes and elements was Glenn Seaborg. Glenn Seaborg (1912 – 1999) Glenn Seaborg was a Swedish American (his mother was from Sweden). Seaborg was the prin- cipal or co-discoverer of ten elements: plutonium, americium, curium, berkelium, californium, ein- steinium, fermium, mendelevium, nobelium and element 106, which was named seaborgium in his honor while he was still living. He also developed more than 100 atomic isotopes, like I-131 and Tc- 99m which are important isotopes for medicine. Seaborg was avarded the Nobel prize for Chem- istry in 1951 together with another Berkeley sci- entist Edwin McMillan. He used for the frst time a radioactive isotope in the treatment of a human disease (leukemia). John Lawrence became known as the father of nuclear medicine and Donner laboratory is considered the birthplace of this feld. Hal Anger (also a Donner man) invented in John Lawrence Hal Anger 1958 the gamma-camera – also called Anger (1904 – 1991) (1920 – 2005) camera.
Few levitra super active 40mg fast delivery, if any countries – or their development partners – are undertaking baseline studies prior to commencing interventions or seeking to measure the financial and broader resource cost (including human resources) of scaling up interventions discount 20mg levitra super active overnight delivery, especially to more remote areas levitra super active 20mg for sale. Expanding the evidence base of “what works” order 40mg levitra super active amex, for whom, and at what cost, starting with a few key countries in the Pacific, would be a useful knowledge product and regional public good that policy makers throughout the Pacific could use to improve their resource allocation decision making. The Ministry of Agriculture could more actively promote the farming and marketing of fresh fruit, vegetables, and fish (perhaps by supporting investments in refrigeration at local markets) and restrict the use of land for small-scale tobacco leaf production. The Ministry of Communication could counter the aggressive marketing of unhealthy food and sugar-sweetened drinks, especially those deliberately targeted at children. The economic impacts, such as increased health expenditure, which is a greater proportion of income for the poor, job loss, and reduced productivity, tends to continue the poverty status (Murthy et al. Because high-fat, lower-fiber foods are usually cheaper than healthier alternatives, poorer people are generally more constrained to purchase low-cost food. Dietary choices, more sedentary lifestyles, and genetic factors have led to the obesity problem in the Pacific. As of 2015, just three of the 11 Pacific Possible nations do not meet this threshold. In addition, if diagnosed, poverty reduces the probability of complications being diagnosed early due to the inability to access, or lack of available quality healthcare. The greater diabetes prevalence in females is often due to the more sedentary lifestyle that women lead, causing obesity which is more prevalent among Pacific women than men (Ng et al. Unfortunately, diabetes is further known to precede the onset of heart disease and stroke (Hu, 2013). In the case of Papua New Guinea, the male smoking prevalence is more than double that of females (Eriksen, Mackay, Schluger, Gomeshtapeh, & Drope, 2015). The smoking prevalence of boys and girls in more than half of the world indicates no significant difference across the genders (Warren et al. Future health policies should begin to address the closing gender gap in smoking and identify ways to educate the female population particularly because they are more adversely affected by tobacco use. Designated caregivers often must interrupt their education or withdraw from the workforce which in turn impacts their security and health (Brands & Yach, 2002). Because females are more likely to assume the caregiving position, the aforementioned relationship is more burdensome for females than males. The correlation between the poor – often women and children – and ill health requires more gender-specific health policies (Brands & Yach, 2002). Growing sea levels and extreme weather events also damage agricultural systems and increase instances of malnutrition. Studies have shown that during heat waves, developing countries have reported increased mortality (Hajat, Armstrong, Gouveia, & Wilkinson, 2005). This increase is mainly due to an “overloading” of the cardiovascular and respiratory systems, and is more common among individuals who already suffer disease or weakness of these systems (Parsons, 2003). Heat waves are also known to increase hospital admissions, and consistently hot, arid climates can increase dehydration amongst the population resulting in the occurrence of kidney stones (Cramer & Forrest, 2006; Knowlton et al. Obese individuals reach higher core body temperatures more rapidly than their non-obese counterparts, initiating the associated symptoms of cardiovascular diseases (Dougherty, Chow, & Kenney, 2009). This problem is exacerbated if much of a country’s production is in primary industry where labor-intensive work is necessary. Growing global temperatures, combined with the Pacific’s humid, tropical environment, will escalate the impacts of obesity in the Pacific Islands (Bridger, 2003). As this report shows, all countries in the Pacific are dealing with the challenges of communicable diseases, reproductive health, and rapid population growth. Unfortunately, the capacity to respond to these growing challenges is constrained because of the already high absolute and relative levels of government expenditure on health. Given generally low or at least volatile economic growth, and limited capacity to increase tax revenue from a nascent private sector, governments have increasingly limited scope to allocate more resources for health in a way that is financially sustainable. The recommendations involve key programs from the Ministry of Health, a wide range of other multisectoral ministries, and stakeholders. Two methods were used to estimate the mortality and morbidity burden using a ‘value of lost output’ and ‘cost of illness’ approach respectively. The following data sources were used for the morbidity burden analysis: The Global Status Report on Noncommunicable Diseases 2014, provided 2014 raised blood glucose prevalence rates - representative of diabetes prevalence rates - for 18-year-olds and over. Additional labor added to the country’s economy from an averted death, has a multi-period effect which is dependent on the age when death was averted. The capital accumulation of a country is restricted when expenditure from savings is diverted to healthcare consumption instead of physical capital accumulation. Initially, the model estimates the number of lives added to the population from averted deaths. This is done by multiplying the number of deaths averted with the survival rate of any other cause of mortality for that year and age group. This figure is also supplemented by the added population from averted deaths in previous years, who survive all other mortality causes year on year. The additional population is multiplied by age-group and country specific employment rates, as well as an experience factor. The savings rate, capital depreciation rate, and capital share are assumed to be constant across years and exogenous to the model. The prevalence of age-standardized adjusted diabetes projections comes from the Global Status Report on Noncommunicable Diseases 2014, which provided the prevalence rate of raised blood glucose for 18 years of age and older in the year 2014. Using the International Diabetes Federation’s diabetes prevalence rates for 2015 and 2040, a constant growth rate gives projections for 2015 through to 2040 with growth rates ranging from 0. The disability prevalence among low- and middle- income countries is estimated to be eight percent (Barcelo, Aedo, Rajpathak, & Robles, 2003). Medical costs are applied to diabetics 15 years of age and over while the loss of income and tax loss are only accounted for 20- to 65-year-old diabetics. The method also assumes that an individual driven to early retirements from diabetes does so at the beginning of the year. A constant growth rate between the two years provides the medical cost associated with all other years of analysis. The loss in tax revenue is calculated as that year’s tax that would have been paid had the individual not been removed from the workforce due to diabetes. This the lost tax revenue is calculated at the average income level tax rate by country. One strong assumption made is that the country-specific tax rate is constant across all years. In order to produce estimates for Kiribati, Marshall Islands, Micronesia, Palau, and Tuvalu, additional assumptions over and above the other six Pacific Possible countries were required. First, the 2015 and 2040 population statistic was disaggregated by age bracket using the average rates from the available six countries; second, prevalence rates by age group from the Global Status Report on Noncommunicable Diseases 2014 began at 18-years-old while the closest sub- population available is from 15+-years-old. The economic costs is the difference in income between employment and unemployment. The summation of these economic burdens gives the lower bound estimate of total economic burden due to diabetes morbidity. The diabetes morbidity burden is scaled up to the four non-communicable diseases using relationships derived in the mortality analysis. The projections for all other years is then scaled back to 2015 by 6 Where disability benefit information is available, disability benefit should also be considered to be an economic burden to the economy. An implicit assumption that results from this method is that those countries with higher diabetes morbidity costs will also have higher cardiovascular diseases, chronic respiratory disease, and cancer prevalence rates. A particularly interesting outcome of a reduction in diabetes prevalence is that the cost curve associated with diabetes morbidity can be bent. The first scenario reduces the diabetes prevalence, beginning at the year 2015, by three percent on the status quo prevalence, with this three percent discounted by five percent each year. Furthermore, the reduction is compounded so that the reductions in one year is added to the proportion of reduction in every year following. The second scenario uses the same method, however, the initial reduction begins at six percent. It is well known that disease is not impartial and that the less educated are encumbered by more than their equal share of the disease burden. The less educated tend to earn lower wages while the assumption states that an individual cured of a disease would on average earn the expected wage of an economy.
The basic framework of medicines management—internationally 40mg levitra super active with visa, nationally and locally—should be appreciated buy 20mg levitra super active free shipping. Course description This programme aims to ensure that practitioners have a sound anatomical and physiological basis for treatment of common medical conditions encountered in adult acute and general medicine buy levitra super active 40mg overnight delivery. Intended learning outcomes On completing this course the candidate should understand the anatomy cheap levitra super active 20mg free shipping, physiology and pathological processes that are important for the common diseases encountered in general medicine. Existing University of Edinburgh anatomy, physiology and pathology online e-learning tools will be utilised in combination with core reading (available in e-book format) as well as external resources to guide students through the various body systems. Course description This course aims to ensure that practitioners have a sound understanding of the laboratory techniques used to aid in the diagnosis of common general medical problems. Key clinical cases will be used to improve understanding in each of the disciplines; microbiology, haematology and biochemistry. Students will discuss how to interpret a blood film, diagnose coagulation disorders, make a microbiological diagnosis and conduct simple biochemistry assays. This module will also cover hospital-acquired infection, resistance patterns, lipid metabolism, porphyrias and some of the more unusual diagnoses requiring clinical biochemistry input. It will cover common clinical pitfalls and will be largely taught by way of problem-based learning using clinical scenarios. Intended learning outcomes On completing this course the candidate should have a basic understanding of the techniques used in laboratory medicine to aid in the diagnosis of clinical conditions. Course description This course aims to ensure that the candidate will have a good understanding of the principles and practice of clinical radiology. They will gain understanding about the physical properties and risk of x-rays, and discuss the benefits and disadvantages of the various modalities and techniques used in medical imaging. They will gain experience in the interpretation of clinical radiology images through the use of clinical case scenarios. This will focus on conditions encountered in the acute and general medical setting. Intended learning outcomes On completing this course the candidate should have an understanding of the principles and various techniques involved in imaging patients in a modern healthcare environment. They should be able to interpret x-ray images to diagnose the common conditions encountered in acute and general medicine using clinical case scenarios. The student should: Understand how x-rays work, the physical principles and the risks. Elements of therapy and research methods have been introduced through the pharmacology and introductory courses. Year 2 will allow the students to develop increasing generic skills essential for good clinical care, diagnosis and clinical management. Students will now also be introduced to increasingly complex clinical problems based in specialty areas. While some specialty courses are compulsory, there will also be options for elective modules thus allowing students to develop deeper knowledge in areas where they may wish to sub-specialise in their future careers. Study will now focus more on the diagnosis of the illness or condition and ongoing management including recognised treatment options. Each course will cover current concepts of prevention, treatment and rehabilitation where relevant. Course description This course aims to ensure that the candidate understands how to examine patients appropriately and thoroughly and will make use of virtual examination resources such as virtual stethoscope. The theory underpinning good communication with patients will be discussed and described (as well as shown on video) using examples of good and bad consultations. Common ward-based medical procedures that middle grade doctors need to be familiar with will be covered using interactive tools to demonstrate the anatomy and clinical risks associated with these procedures. Intended learning outcomes On completing this course the student should know how to examine a patient competently and understand what makes a good patient consultation. The student should: Understand the theory behind good communication with patients. Online assessment (discussion boards and group work wikis) will constitute the other 10% of their overall course grade and is taken to represent a formative assessment of learning throughout the programme. Course description This course aims to ensure that the candidate understands how to manage the majority of common emergency medical admissions and will be taught using clinical case scenarios. Clinical decision making is an important but often neglected part of healthcare provision today. Psychologists have studied the process of decision making for over half a century and identified a number of theoretical frameworks that could explain the behaviours employed by physicians. This research can be applied to everyday clinical situations to analyse the effect on the level of patient care. Intended learning outcomes On completing this course the student should have a broad knowledge of how to diagnose and treat common medical emergencies. They should be able to recognise and assess the sick patient, know how to perform advanced life support and how to implement ongoing care. Students should understand the main philosophical theories and processes that are relevant to clinical decision making. Patient safety will be discussed more broadly and there will be an examination of how clinical processes could be improved. The student should: Understand how to diagnose and treat common emergency medical presentations. Elective Modules Students will choose one module in each of the four elective module blocks. Online assessment incorporating a variety of activities (participation in discussion groups/ wikis, online presentation/ review of journal articles, submission of literature appraisal forms, etc. This is also taken to represent a formative assessment of learning throughout the programme. Individual specialty tutors will use increasingly complex clinical case studies to broaden knowledge. Tutors will guide students to appropriate seminal publications in the specialty and encourage them to present and review recent journal article in a group setting (online journal club). Online publication review forms will be used to assess literature evaluation skills. Historically important, controversial, topical and novel papers will be discussed. Students’ writing skills will be developed through formative assessments (a case report or review article) which should contain an appropriate review of the literature in the specialist area. Intended learning outcomes On completing the course students should have a deeper knowledge and understanding of these specialty areas of medicine through discussion of complex clinical cases. They will also develop generic skills in literature evaluation, presentation, writing and publishing. The student should: Understand the presentation, management and treatment of the common conditions encountered in a specialist area of medicine. Online assessment (discussion boards and group work wikis) will constitute the other 30% of the overall course grade and is taken to represent a formative assessment of learning throughout the programme. In the post-genomic era there is rapid advancement in understanding biological mechanisms, especially at the molecular and biochemical level. New biological and clinical tools and technologies, coupled with bioinformatic approaches, are heralding a global and comprehensive analysis of fundamental molecular and cellular processes. This course describes the spectrum of scientific and clinical measurements required in Translational Medicine research for the identification and definition of disease. Investigators have access to a research ‘toolbox’ containing an increasingly wide range of technologies for high throughput molecular and cellular readouts. As well as identifying specific gene targets, these technologies are used to generate molecular ‘signatures’ or ‘barcodes’, which permit sophisticated analysis of underlying biological pathways and networks. In addition, genomic and proteomic signature patterns are also important for the definition of biomarkers which are utilized for monitoring pathogenesis and treatment of disease. These biomarkers are increasingly employed by the pharmaceutical industry in drug discovery and development strategies. Nevertheless, full definition of disease requires manipulation and measurement of biological processes at all levels in the hierarchy. The role of genomic, proteomic, cellular and imaging technologies will be covered in relation to translational medicine.