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Hang out in the emergency department 909 treatment cheap 100mcg cytotec otc, where the doctors will teach you how to medicine 5000 increase order cytotec 200mcg visa suture wounds and perform other minor procedures medicine disposal order cytotec cheap online. The time you spend with specialists in different areas of medicine may ultimately give you the necessary exposure to help make a final decision in the next year. Moreover, you will begin to get to know physicians who may write letters of recommendation in support of your residency applications. There are lots of options from which to choose-giving tours to prospective applicants, teaching elementary school students about how the heart works, or coordinating the delivery of medical supplies to third-world countries. To help you to figure out what specialty might be the best match (before you head out on the wards in third-year), consider taking part in a specialty interest group as one of your extracurricular activities. The purpose of these unique and valuable groups is to bring together medical students, residents, and faculty physicians who share the same interest in that specialty. As a member, you can set up time to shadow physicians, attend special lectures, get ideas and make contacts for research projects, meet with clinicians outside of the hospital in social situations, perform services for the local community, and much more. This educational resource provides time to ask more experienced physicians questions. Because there is no pressure to perform well and obtain a good evaluation, specialty interest groups are excellent ways to learn informally about a specialty before hitting the wards as an upperclass medical student. Some specialty interest groups have even established an national presence on the Internet. Future family practitioners, for example, can take advantage of one of the best ones-the Virtual Family Medicine Interest Group. Modeled after successful campus specialty groups, this web site provides information and resources to help students explore the specialty of family practice and all of its related topics (like residency training and the match process). They are not sure whether to work to make money, pursue research, read up before second year (! After all, students are generally worried about what those residency program selection committees might think about how exactly they spent their summer vacation. Your goal during this summer should be to attach yourself to clinicians (while at the same time taking a rejuvenating break from all the lecture and laboratory work from the first year). In these formative years of training in medical school, future doctors should seek out any and all experiences and chances to build a solid foundation on which to be the best physician that they can be. So take this summer break seriously and do something productive at least the majority of the time. Early clinical exposure during this summer will give you a jump-start to specialty decision-making before the crucial third year. There are a number of summer opportunities for career exploration, such as clinical externships, research programs, and community preceptorships. All of these paths can help you check out different medical specialties and start figuring out your preferences, likes, dislikes, and values when it comes to career options. Some medical students make informal arrangements to volunteer in community health clinics or shadow physicians (while also earning money through part-time jobs like waiting tables). For motivated students who do not mind another round of applications, there are formal programs that provide more structured clinical experience. Some examples include: the National Health Service Corps, a federal agency, offers a month-long rotation (funded with a stipend) to expose students to the practice of rural medicine and primary care in underserved areas. You might be placed in Alaska, Nevada, North Dakota, West Virginia, or other exotic locales. For instance, the Illinois Academy of Family Practitioners has a program for rising second-year students in which they are paired with a family practitioner for a month-long one-on-one preceptorship. For instance, Thomas Jefferson University Hospital in Philadelphia sponsors a 6-week experience in radiation oncology (The Simon Kramer Society Externship) for interested medical students. Above all, make every effort to use this summer to gain early exposure to different specialties without having to commit yourself to any of them. It will help you to begin prioritizing some of the many factors that go into deciding on a specialty (and on what you want out of your medical career in general). Even if your heart has always been set on orthopedic surgery, use this last summer to check out primary care or family practice. You never know what kind of meaningful clinical experience may end up changing your mind. The public no longer thought of physicians as wise, gentle men who made house calls. Instead, they began to have female doctors of their own- women who treated hypertension, performed cardiac bypass surgery, interpreted chest radiographs, and delivered babies. For many of these women physicians, their gender had an important role in their final choice of medical specialty. In 2001, for example, women made up only 9% of orthopedic surgery residents, compared to 71. After all, many medical students think of these specialties as having lower status, 59 Copyright © 2004 by the McGraw-Hill Companies, Inc. Typically more women seem to be drawn to the primary care specialties because they are compatible with their practice styles. In general, women physicians perform more preventive medicine services, show more compassion and empathy, and spend more time with their patients, especially when it comes to just simply listening. One prominent female physician believes that "pediatrics and obstetricsgynecology are related to mothering and child-bearing, which are very important for women in our society, and may be why these specialties seem consistent with the personality of women. By demanding equality, these pioneers make it easier for female medical students to follow in their paths. Although women and men now work side by side within every specialty, this does not necessarily mean that their lives and career paths are alike. This may be in part because of a sociologic difference of perspective in what makes for a satisfying career between men and women. There are also practical concerns to consider, such as comfortably integrating the issue of pregnancy (and all of the decisions that come with it) and how its timing will affect their medical careers. Many women in medicine want a specialty that is family friendly-one that lends itself to having greater control over work hours and the possibility of working parttime when they have children. When deciding on her specialty of choice, every female medical student should spend some time honestly weighing these concerns and competing responsibilities. In doing so, you will likely choose the best specialty and have a rewarding professional career in medicine. But surprisingly, a solid number (38%) would choose a new specialty if they could do it all over again. Many variables- work stress, degree of autonomy, work hours, income, and so on-affect how content a doctor is with his or her career. Choosing a medical specialty with the right balance, then, makes a big difference between a happy physician and a dissatisfied one. In fact, the same survey of female physicians revealed that work environment and stress (two factors directly related to their specialty) are the strongest predictors of career satisfaction.
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The right to treatments yeast infections pregnant buy cheap cytotec 100 mcg make informed decisions includes being informed about your health status symptoms gluten intolerance buy cytotec overnight, being involved in care planning and treatment and being able to medicine world best purchase cytotec request or refuse treatment. That is why you and your family are asked to share in certain responsibilities with the hospital. These include the responsibility for: Letting us know your expectations about hospitalization and treatment. We recognize that patients may face unique health care challenges, and we commit to caring for you with respect, dignity and cultural humility. Let us know how you identify yourself and how our services can best meet your needs. This mistaken belief is based on generalizing from the contemporary situation in Europe and North America, where the ratio of women to men is typically around 1. In South Asia, West Asia, and China, the ratio of women to men can be as low as 0. At birth, boys outnumber girls everywhere in the world, by much the same proportion-there are around 105 or 106 male children for every 100 female children. Just why the biology of reproduction leads to this result remains a subject of debate. Considerable research has shown that if men and women receive similar nutritional and medical attention and general health care, women tend to live noticeably longer than men. Women seem to be, on the whole, more resistant to disease and in general hardier than men, an advantage they enjoy not only after they are forty years old but also at the beginning of life, especially during the months immediately following birth, and even in the womb. When given the same care as males, females tend to have better survival rates than males. But even after these are taken into account, the longer lifetimes enjoyed by women given similar care appear to relate to the biological advantages that women have over men in resisting disease. Whether the higher frequency of male births over female births has evolutionary links to this potentially greater survival rate among women is a question of some interest in itself. Women seem to have lower death rates than men at most ages whenever they get roughly similar treatment in matters of life and death. In these places the failure to give women medical care similar to what men get and to provide them with comparable food and social services results in fewer women surviving than would be the case if they had equal care. In India, for example, except in the period immediately following birth, the death rate is higher for women than for men fairly consistently in all age groups until the late thirties. This relates to higher rates of disease from which women suffer, and ultimately to the relative neglect of females, especially in health care and medical attention. The result is a lower proportion of women than would be the case if they had equal care-in most of Asia and North Africa, and to a lesser extent Latin America. SubSaharan Africa, for example, ravaged as it is by extreme poverty, hunger, and famine, has a substantial excess rather than deficit of women, the ratio of women to men being around 1. The "third world" in this matter is not a useful category, because it is so diverse. Even within Asia, which has the lowest proportion of women in the world, Southeast Asia and East Asia (apart from China) have a ratio of women to men that is slightly higher than one to one (around 1. Indeed, sharp diversities also exist within particular regions-sometimes even within a particular country. To get an idea of the numbers of people involved in the different ratios of women to men, we can estimate the number of "missing women" in a country, say, China or India, by calculating the number of extra women who would have been in China or India if these countries had the same ratio of women to men as obtain in. When that number is added to those in South Asia, West Asia, and North Africa, a great many more than 100 million women are "missing. To account for the neglect of women, two simplistic explanations have often been presented or, more often, implicitly assumed. One view emphasizes the cultural contrasts between East and West (or between the Occident and the Orient), claiming that Western civilization is less sexist than Eastern. That women outnumber men in Western countries may appear to lend support to this Kipling like generalization. There may be elements of truth in each of these explanations, but neither is very convincing as a general thesis. To some extent, the two simple explanations, in terms of "economic development" and "EastWest" divisions, also tend to undermine each other. A combined cultural and economic analysis would seem to be necessary, and, I will argue, it would have to take note of many other social conditions in addition to the features identified in the simple aggregative theses. T o take the cultural view first, the EastWest explanation is obviously flawed because experiences within the East and West diverge so sharply. Japan, for example, unlike most of Asia, has a ratio of women to men that is not very different from that in Europe or North America. This might suggest, at least superficially, that real income and economic development do more to explain the bias against providing women with the conditions for survival than whether the. In the censuses of 1899 and 1908 Japan had a clear and substantial deficit of women, but by 1940 the numbers of men and women were nearly equal, and in the postwar decades, as Japan became a rich and highly industrialized country, it moved firmly in the direction of a large surplus, rather than a deficit, of women. Some countries in East Asia and Southeast Asia also provide exceptions to the deficit of women in Thailand and Indonesia, for example, women substantially outnumber men. In its rudimentary, undiscriminating form, the EastWest explanation also fails to take into account other characteristics of these societies. For example, the ratios of women to men in South Asia are among the lowest in the world (around 0. Indeed, each of the four large South Asian countries-India, Pakistan, Bangladesh, and Sri Lanka-either has had a woman as the elected head of government (Sri Lanka, India, and Pakistan), or has had women leading the main opposition parties (as in Bangladesh). It is, of course, true that these successes in South Asia have been achieved only by upperclass women, and that having a woman head of government has not, by itself, done much for women in general in these countries. However, the point here is only to question the tendency to see the contrast between East and West as simply based on more sexism or less. The large electoral successes of women in achieving high positions in government in South Asia indicate that the analysis has to be more complex. It is, of course, also true that these women leaders reached their powerful positions with the help of dynastic connections-Indira Gandhi was the daughter of Jawaharlal Nehru, Benazir Bhutto the daughter of Zulfikar Bhutto, and so on. But it would be absurd to overlook-just on that ground-the significance of their rise to power through popular mandate. Dynastic connections are not new in politics and are pervasive features of political succession in many countries. The dynastic aspects of South Asian politics have certainly helped women to come to power through electoral support, but it is still true that so far as winning elections is concerned, South Asia would seem to be some distance ahead of the. In this context it is useful also to compare the ratios of women in American and Indian legislatures. Certainly all the countries with large deficits of women are more or less poor, if we measure poverty by real incomes, and no sizable country with a high gross national product per head has such a deficit. There are reasons to expect a reduction of differential female mortality with economic progress. For example, the rate of maternal mortality at childbirth can be expected to decrease both with better hospital facilities and the reduction in birth rate that usually accompanies economic development. However, in this simple form, an economic analysis does not explain very much, since many poor countries do not, in fact, have deficits of women.
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Burlingame medications 5 rights discount cytotec 100 mcg on-line, a suffragist medicine 91360 cytotec 100 mcg visa, goes into private practice and "so successful was she that she won every case entrusted to symptoms kidney generic cytotec 100mcg otc her" prior to her death from "la grippe" in 1890. Such women were often treated for "mental exhaustion" by being deprived of any "unwomanly" intellectual stimulation whatsoever, including basic writing materials or the right to hear news or speak to friends. Supreme Court, relying on the 1873 Bradwell decision, reaffirms that state bars may discriminate on the basis of sex. As part of the Fair, its legal committee organizes the first nationwide meeting of women lawyers. Lytle, an African-American attorney, becomes the first woman law professor in the nation when she joins the faculty of the Central Tennessee College of Law. Ellen Spencer Mussy and Emma Gillett found the Washington College of Law in the District of Columbia, now the law school of the American University. The Twentieth Century 1908 the Portia Law School in Boston is created for women to attend classes in the evening. The program continues to flourish even after other area law schools begin admitting women, and becomes the New England School of Law in 1969. It reads, "The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any State on account of sex. For the first time, all women in the United States except for the residents of the District of Columbia are guaranteed the right to vote in federal elections. Supreme Court holds that "[t]he systematic and intentional exclusion of women, like the exclusion of a racial group, or an economic or social class, deprives the jury system of the broad base it was designed by Congress to have in our democratic society. The injury is not limited to the defendant - there is injury to the jury system, to the law as an institution, to the community at large, and to the democratic ideal reflected in the processes of our courts. Echoing the origin of the first wave of feminism in the abolition movement of the Nineteenth Century, the modern civil rights movement for racial equality spurs the second wave of feminism to seek broader gender equality. Supreme Court holds that state laws which effectively exclude women from jury pools are not invidious discrimination, but rather, are an "inoffensive" attempt to accommodate the "special responsibilities" of women, and that women tried before the resulting all-male juries have no valid claims under the equal protection clause. The Civil Rights Act creates the Equal Employment Opportunity Commission to enforce workplace equality. Supreme Court strikes down state antimiscegenation statutes, guaranteeing the liberty to form traditional marriages without regard to race. In 1972, Judy Lyons Wolf and Nancy Stanley teach it at George Washington University, and in 1973, Marna Tucker and Brooksley Born do so at Georgetown. Baird assures nationwide access to contraception regardless of marital status, fifty-six years after the first birth control clinic is opened. Wade establishes a nationwide right to abortion, with restrictions permissible at late stages of pregnancy. Davidson, Ruth Bader Ginsburg, and Herma Hill Kaye, is published as the first law school casebook addressing the topic. Facilities located in large cities report that they may have to turn away as many as 70% of the women who seek temporary respite from violence in their own homes. Grasso of Connecticut becomes the first woman to win a governorship without being the spouse of an earlier governor. Louisiana, the Supreme Court reverses its 1961 position about the Sixth Amendment rights of criminal defendants, and now holds that exclusion of women from juries is impermissible. Freedman, Eleanor Holmes Norton, and Susan Deller Ross, is published, providing a second casebook on the subject. The book evolved from materials the authors used for the first Women and the Law classes at Georgetown, George Washington University, and Yale. The Act also mandates that employers provide the same benefits to women at any stage of pregnancy, delivery, or recovery from delivery when they are medically unable to work as to all other employees with temporarily disabling conditions. It also forbids workplace discrimination against women based on the mere possibility of pregnancy. In 1982, it is renamed the Sex Discrimination Clinic, and is taught by Laura Rayburn. Supreme Court holds that single-sex registration for the military draft is constitutional. In the dissent, Justice Thurgood Marshall notes that the decision relies upon "ancient canards about the proper role of women" and "categorically excludes women from a fundamental civil obligation. Hogan establishes that, under the equal protection clause of the Fourteenth Amendment, public schools may not discriminate on the basis of sex without "exceedingly persuasive justification. Both private civil enforcement of such orders and public criminal prosecution of the underlying behavior are upheld. African women attorneys and judges study and work in Washington for sixteen months. The graduates return to advocate for women in their native countries and network with one another throughout the continent. Supreme Court holds that even peremptory challenges are impermissible if their effect is to discriminate on the basis of gender when seating a jury panel. The Court at last affirms that the equal protection rights of the potential jurors to serve, rather than the Sixth Amendment rights of the defendant to a fair trial, are a sufficient justification for ending invidious discrimination against jurors due to gender: "When persons are excluded from participation in our democratic processes solely because of race or gender, this promise of equality [under the law] dims, and the integrity of our judicial system is jeopardized. Supreme Court rules that the Virginia Military Institute, a state-supported military academy previously limited to men, must admit women in order to cure its violation of the equal protection clause of the Fourteenth Amendment, or cease to operate from tax funds. Tightening the "exceedingly persuasive" standard of review, the Court holds that separate is not equal as regards the creation of a military program for women at another school, and that categorization by sex "may not be used. Lichtman, who joined the Fund in 1974 as executive director and was named president in 1981, continues as president of the National Partnership. To cite this work (as students must, to avoid academic disciplinary action - remember, your teachers can use the web just as easily as you can! An alternative, if acceptable to your instructor, is to use the format "Cunnea, Professor. Domperidone increases the level of the hormone prolactin which is involved in breast milk production. Expressing or breastfeeding frequently, while taking domperidone, will help increase your breast milk supply. To increase breast milk production, you will use 10mg of domperidone (one tablet) three times a day until breast milk supply is well established. Occasionally, your lactation consultant or doctor may increase the dose to 20mg (two tablets) three times a day. The dose may vary depending on your milk supply, but you should not have more than 60mg (six tablets) in one day. Taking domperidone to increase breast milk supply should only be done under medical supervision. Domperidone may be used when breast milk supply is low and when extra breastfeeding or expressing are not enough to increase milk supply. It may be useful for mothers of premature babies, very sick newborns or adopting mothers as keeping up a milk supply can be difficult for some of these mothers. It may take a week before you notice an increase in breast milk supply and two to four weeks to achieve the maximum effect.
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Something similar might be said of the justification the Court offered for abortion restrictions medicine for anxiety order cytotec australia. The Court gave constitutional approval to symptoms joint pain fatigue purchase 200 mcg cytotec fast delivery a government interest in regulating abortion to treatment syphilis safe 100mcg cytotec protect potential life, but only barely explained or justified this interest, leaving unstated how this regulatory interest related to the old statutes criminalizing abortion or the claims of the contemporary antiabortion movement. If Roe conformed to then-dominant modes of reasoning about abortion, at a time when the Gallup poll reported the belief of two-thirds of Americans that the abortion decision should be left to a woman and her doctor, how are we to understand the outcry against the decision that steadily mounted over the 1970s? Our review of the debate before Roe reveals several factors contributing to the conflict over abortion that were in play well before the Court issued its decision in January 1973, and identifies still other developments that intensified the conflict much later in the decade. As we have seen, in the period between 1970 and 1972, even as public support for decriminalization was continuing to grow, bitter conflict over abortion had already begun. And so, by 1972, abortion was beginning to find a life in national party politics. Republican Party strategists seeking to persuade Catholic voters and other so-called social conservatives to abandon their traditional alignment with the Democrats and join the Republican cause began to incorporate arguments against abortion rights into their case against the 1972 Democratic presidential nominee, George McGovern. Abortion rights, in this view, symbolized the new morality-a problematic "permissiveness" that afflicted the nation. Triple-A claims about abortion had little to do with the concerns motivating public health reformers (who spoke of back alleys and coat hangers) or the claim advanced by religious opponents of abortion that abortion was murder. But the triple-A claim had much to do with feminist arguments for abortion repeal. TripleA attacks on McGovern condemned abortion rights as part of a permissive youth culture that was corrosive of traditional forms of authority. The objection to abortion rights was not that abortion was murder, but that abortion rights (like the demand for amnesty) validated a breakdown of traditional roles that required men to be prepared to kill and die in war and women to save themselves for marriage and devote themselves to motherhood. The claims reframing abortion that we have examined were designed to mobilize Catholic and conservative voters. The reframing of abortion that would take hold over the course of the 1970s had only incrementally begun at the time the Court handed down Roe. His views on abortion were unknown, yet at his Senate confirmation hearing, he was not asked a single question about abortion. By 1975, the National Conference of Catholic Bishops had promulgated a Pastoral Plan for Pro-Life Activities that declared that "the decisions of the United States Supreme Court (January 22, 1973) violate the moral order, and have disrupted the legal process which previously attempted to safeguard the rights of children. Others believed that abortion should be decriminalized but criticized the Court for deciding a question that might have been left to the political process. Those who believed the question should have been left to the legislature did not support a human life amendment constitutionalizing prohibitions on abortion of the kind the right-to-life movement was then advocating. Advocates of a human life amendment could not find the support they needed, even among religious leaders. As we have seen, mainline Protestant groups approved of liberalizing access to abortion; some approved repeal, while others endorsed variants of the "reform" position, advocating regulation on the "therapeutic model. When Roe was handed down, the family-values movement that would mobilize against the decision and ultimately carry Ronald Reagan to national office in 1980 had already begun to take shape, but it had not yet crystallized. That coalition did not form in spontaneous response to Roe but was instead built with the help of strategists for the Republican Party, including many brilliant Catholic conservatives. In the process, opposition to abortion as murder was married to a variety of socially conservative causes, accelerating the process of party realignment that had begun before Roe during the Nixon administration. When conservatives of the New Right began to assemble a pan-Christian coalition against Roe in the late 1970s, the crusade against Roe would proceed under the banner of "pro-life" and "pro-family. During the mid-1970s, funding battles in Congress provided a lower-stakes arena in which to forge new alliances and erode support for the abortion right. By the late 1970s, Richard Viguerie and Paul Weyrich-architects of a more conservative Republican Party-were approaching such Protestant evangelicals as the Reverend Jerry Falwell and helping them to see in the abortion issue a question that could create a pan-Christian movement united against "secular humanism" and for "family values. Increasingly lost in this transformation was an earlier Catholic association of a pro-life position with liberal ideals of social justice; forged was an increasingly tight association of pro-life with pro-family politics. But over the course of the 1970s, prominent Republicans shifted positions on abortion, acting on alignments and framings that were already in evidence by the 1972 election. They attacked Roe as a threat to life and family and as a symbol of judicial overreaching. Republican Party platforms began regularly to support "the appointment of judges who respect traditional family values and the sanctity of innocent human life. Ensuing Supreme Court appointments by Presidents Reagan and Bush seemed to provide sufficient votes to overturn Roe. And yet, in 1992-during a presidential campaign in which the abortion right was a burning issue-the Supreme Court decided Planned Parenthood v. Casey justified both the abortion right and its regulation in terms that reflected the views of mobilized proponents and opponents of abortion rights more clearly than Roe itself had in 1973. Even as Casey narrowed the right recognized in Roe, it justified that right more expansively than Roe did. The destiny of the woman must be shaped to a large extent on her own conception of her spiritual imperatives and her place in society. Carhart in 2007, the Court voted 5 to 4 to uphold the federal Partial-Birth Abortion Ban Act of 2003. The law had been devised by the right-tolife movement to focus attention on abortions that doctors perform late in pregnancy for medical reasons; the law was designed to provoke public unease with abortion, and it succeeded. Doctors developed the regulated procedure as safer for the woman under some circumstances; abortion opponents succeeded in portraying the procedure as a step from infanticide. The five justices in the majority insisted that Congress could regulate the method doctors employed in later-term abortions in order to differentiate abortion and infanticide, and so express respect for human life. But while in Casey the Court had, at last, placed women at the center of the abortion decision, in Carhart the Court spoke less clearly. The future of abortion rights under the United States Constitution remains uncertain. The Supreme Court will again speak to the question, but the record suggests that it is not likely to have the last word. Today, many Americans blame polarizing conflict over abortion on the Supreme Court. Wade on narrower grounds, they argue, the nation would have reached a political settlement and avoided backlash. Where others have deplored the abortion conflict as resulting from courts "shutting down" politics, we approach the abortion conflict as an expression of politics-a conflict in which the Supreme Court was not the only or even the most important actor. In this essay, we ask what escalation of the abortion conflict in the decade before the Supreme Court decided Roe might teach about the logic of conflict in the decades after Roe. To do so, we draw on sources we collected for our recently published documentary history, Before Roe v. We show how Republicans campaigning for Richard Nixon in 1972 took new positions on abortion to draw Catholics and social conservatives away from the Democratic Party. Evidence from the post-Roe period suggests that it was party realignment that helped escalate and shape conflict over Roe in the ensuing decades. The backlash narrative suggests that turning to courts to vindicate rights is too often counter-productive, and that adjudication is to be avoided at all costs.
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After 4 rigorous years and a formidable financial investment treatment ulcerative colitis cytotec 100 mcg cheap, these students generally refuse to medicine to calm nerves cheap 200 mcg cytotec fast delivery commit to treatment for hemorrhoids purchase 200 mcg cytotec free shipping a particular specialty unless they are absolutely 100% certain. The undecided student believes that it is better to hold off on making a final decision than to select the wrong one and become an unhappy, dissatisfied doctor. They would rather do it right the first time or not do it at all (by delaying the decision). Putting off a final commitment is one of several options for an undecided medical student. You should keep in mind, however, that simple procrastination is not necessarily going to make the big decision any easier when the time comes around again to make a commitment. If you are a fourth-year medical student and still undecided about what specialty to choose, you have several options. You can delay making your choice and seek refuge in a year of research or internship only. Or, you can tackle your indecision head on and apply to more than one specialty or apply to a combined residency program. Either way, the undecided student should not be over81 Copyright © 2004 by the McGraw-Hill Companies, Inc. And after all, no matter what field of medicine you end up in, you will still be a practicing physician. This chapter addresses the needs of undecided students who, because of these fears, want additional time to reflect on the specialties before making the important choice. If you find it impossible to make up your mind, then consider only applying for general internship positions (with no further postgraduate commitment), rather than a complete residency. After all, this is what nearly every physician did back in the old days (before 1972) to decide upon their eventual specialty. By entering a 1-year internship, the undecided graduating medical student still earns credit for postgraduate training while at the same time continuing to explore other specialties. There are three types of internships, all of which are described in further detail in Chapter 9. In a transitional year internship, you receive broad exposure to many fields of medicine, like internal medicine, surgery, pediatrics, and obstetrics-gynecology, plus electives. It is similar to the third year of medical school, but you are now a full-fledged first-year resident, with all the responsibilities that go along with that status. If undecided students can at least make up their minds about where they stand on the medicinesurgery dichotomy, then the other internships will suit them well. A preliminary medicine internship is equivalent to the first year of a complete internal medicine residency, whereas a preliminary surgery internship is identical to the first year of a categorical general surgery residency. During the internship year, you will have many new clinical experiences and the right specialty may present itself. In reality, you are really only delaying your decision for 1 more year (from the beginning of senior year to the early months of internship) compared to the rest of your classmates. In the end, you will only have about 3 months of internship experiences on which to make that important career decision (this excludes, of course, any clinical rotations from the fourth year of medical school). Not to mention the fact that internship is much more difficult and time-consuming than the senior year of medical school. How will you have the time and energy to spend on making the decision and the application process? Will a program director really give you time off from internship to fly around the country for interviews? One of the main caveats about applying only for internship positions is the possibility of having to repeat this first postgraduate year. This really depends on the type of internship taken and the specific field of medicine sought. Categorical programs like psychiatry and obstetrics-gynecology may require you to repeat their own internship years, particularly if they were taken in internal medicine and surgery. Pursue a Combined Training Program Many confused and undecided senior medical students often waver between two different specialties, like internal medicine and pediatrics, or neurology and psychiatry. A good choice for them might be the combined residency programs, in which you receive extended training (leading to dual board certification) in both specialties. Instead of having to decide on just one area of medicine, an undecided student can end up with the best of both worlds and be able to pursue a medical career in both specialties. Chapter 7 gives a detailed explanation of the advantages and disadvantages of entering a combined training program, as well as a thorough description of the possible choices. Although a combined residency program is an excellent option for an undecided medical student, positions are limited. Moreover, most programs combine similar fields, like internal medicine and emergency medicine. If you are trying to decide between neurology and orthopedic surgery, no such combined program exists. This, in effect, delays the ultimate decision until late winter of senior year, when rank lists are due and the match process actually takes place. Aspiring physicians who are interested in both orthopedic surgery and radiology, for example, or doctors-to-be who could see themselves as either neurologists or neurosurgeons can use this option to delay making the final selection for another 6 months or so. Both specialties will require their own set of recommendation letters, personal statements, and interviews. Many undecided students apply and rank multiple specialties every year and let the computer break the tie for them. If you simply cannot decide on a specialty, and do not mind surprises on Match Day, then consider this alternative. Enter a Specialty Training Program with the Intertion of Switching Fields Later Some undecided medical students end up applying to a desired (although not perfect) specialty, with the intention of switching fields later. Although these students may not feel committed to that specialty, they are willing to give it a try while at the same time keeping open the option of changing. Several studies have found that specialty switching is not such an uncommon phenomenon. In fact, 20% of medical school graduates switch fields before completing their first residency, 15% change after completing residency, and nearly 20% of practicing physicians report a high level of unhappiness and career dissatisfaction with their chosen specialty. Every day, month, and year of clinical experiences can bring about a whole new phase of self-discovery (and its accompanying self-doubt) a period of contemplation that may even lead to the conclusion that your chosen specialty just is not the right one or the best fit. To change fields of medicine, the simpler application process occurs out of the match. Every physician should practice in a specialty for which they have passion and enthusiasm. However, there are several disadvantages to starting a residency program in one specialty with the intention of soon changing to another. Besides the recurring feelings of having wasted time, you (and possibly your family) will have to adjust again to a new hospital and a new life. The faculty at the first program may not appreciate your anticipated departure and may make the remainder of the year much more difficult.
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In Pakistan symptoms nicotine withdrawal cytotec 200 mcg free shipping, the permissibility of abortion can depend on the stage of fetal development; specifically medicine 5513 purchase cytotec 100 mcg on line, whether the fetal organs are developed medicine vicodin cheap cytotec american express. Unsafe abortion is common and often results in health complications and even death. A scholar from the Hanafi school of thought demonstrated how legal thinkers permit abortion for unwed mothers. Tunisia stands out as a special case, where legal abortion became permissible in 1965 and more widely available in 1973, following the passage of a law permitting abortion in the first trimester. Health professionals and activists cite the general social acceptance of abortion and the lack of opposition to it as an important influence in national population policies. Within the United Nations system (where several different specialized agencies are involved), child marriage is defined as "a formal marriage or informal union before age 18. It is a reality for both boys and girls, although girls are disproportionately the most affected. The medical abortion experiences of married and unmarried women in Tunis, Tunisia. Hindu Contexts the principle of gender equality is enshrined in the Preamble, Fundamental Rights, Fundamental Duties and Directive Principles of the Indian Constitution. The State has formulated several policies to delay age of marriage and first birth such as the National Population Policy, the National Youth Policy, and the National Adolescent Reproductive and Sexual Health Strategy. Despite this fact, India accounts for 40 per cent of child marriages globally; 47 per cent of Indian girls are contracted into marriage before age 18 and 22 per cent of Indian girls have already given birth before turning 18. Child marriage is more common in rural (48 per cent) than urban areas (29 per cent). Efforts to combat child marriage are viewed as interfering in religious matters of the community. The caste system plays a role; one example cited is the practice whereby the dominant caste organizes child marriage ceremonies for the poor in their communities as a method to ensure that the poor remain obliged to the rich. Chintamani Yogi, a Hindu religious leader in Nepal, denounces child marriage and states, "[t]he Holy books revere marriage as a holy union and a part of culture. Someone who does not send their children to school and prevents them from gaining an education is not a parent but an enemy. Child marriage is mentioned in the Bhikkhuni Vibhanga, which is a part of the Vinaya Pitaka, and it is also found in Milinda-panda. Some argue that it is "quite reasonable to assume that the custom of child marriage, though rare, emerged after the death of the Buddha. Buddhist texts do not have religious laws advocating marriage or refraining from it; each individual has the freedom to decide his or her life course and spiritual attainment. Though Buddhist teachings do not explicitly sanction child marriage, it is widely practised in countries with Buddhist majorities, including Bhutan, Cambodia, Thailand and Myanmar. Although child marriage is uncommon in urban areas, there are reports of secret marriage ceremonies involving girls younger than 15 in remote villages. Dharmamurti Maha Thero, a Buddhist Monk, also denounces child, early and forced marriages thus: "[M]arriage is a social union. Something that should only take place when both individuals have developed physically and mentally. A noted scholar of Buddhism states, "[a] basic principle of Buddhist ethics is that all beings are alike in disliking pain and in wanting to be happy, so that we should not inflict on another being what we would not like done to ourselves. We have a duty to others to respect their interests, and a duty to ourselves not to coarsen ourselves by abusing others. Some Orthodox groups refer to the story of Rebecca and Isaac, the children of Abraham and Sarah. According to a strict interpretation of this text, Rebecca was only three years old when she got married. Although Israel has passed legislation concerning child marriage, it is not fully complied with by everyone and in some conservative communities couples marry at age 15: "The law in Israel prohibits marriage under the age of 17, except by special court permission. According to Jewish Law, marriages usually do not take place before the age of 18, except in the most radical sectors of the Bratslav Hasidim, where couples can marry at age 15. In the strict ultra-Orthodox Eda Haredit in Jerusalem, the custom is to get engaged at age 16 and wait two years until marriage"164. Hence, strict readings of the Holy Scriptures can lead to the justification of child marriage. Even though many Jewish scholars - for instance Maimonides and Sifrei - have explained that age in the Bible is a fabrication, the truth is that incidents of child marriage are still present in the Jewish context. Child marriage has become less common in Christian communities worldwide, but it is still practised in many Christian Sub-Saharan African communities, explained by a combination of factors that include religious beliefs. In Ethiopia, for example, although the Orthodox Church has officially opposed child marriage, child marriage is embedded in tradition and in Orthodox Christian communities such as those in the Amhara region, early marriage is common. However, many Christian-majority countries have national laws that prohibit early marriage. Moreover, once a girl begins menstruating, she is considered sexually mature and ready for marriage and childbearing; and (3) early marriage curbs promiscuity and keeps sexual activities within the confines of matrimony for the greater good of society. The Council of Islamic Ideology in Pakistan, an official panel that advises the Government on Islamic law, ruled that proposed amendments to impose harsher punishment for child marriage were "un-Islamic. Women and girls around the globe disproportionately face many forms of degradation and violence. Trafficking of women is an example: it affects many world regions and is facilitated and encouraged by attitudes towards women in patriarchal and religious contexts. No religious tradition sanctions violence (although specific approaches to various forms of domestic violence vary), and yet violent practices are often carried out or justified in the name of religion. Such practices and the violent attitudes that support them are influenced by cultural and religious traditions. The terms "gender-based violence" and "violence against women and girls" are used interchangeably but they have different meanings. Deeply patriarchal traditions marginalize women and institutions and legal systems reinforce gender inequalities and support conceptions of chastity, honour, and shame that underlie many violent practices. Hindu women did not participate in religious rituals due to the belief that the "female becomes polluted during two of the distinctive expressions of female sexuality, menstruation and childbirth. Recent cases of brutal rape and patterns of impunity have galvanized Indian communities. So-called "honour" killing is the practice of murdering girls/women and/or boys/men who are perceived to have violated established norms. Such killings are concentrated in areas of Punjab, Haryana, Uttar Pradesh, and Rajasthan, where marriage is usually within the same caste and other unions. The National Crime Records Bureau of India reported 8,233 dowry deaths in 2012: one wife killed every 60 minutes.
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With wild cries and desperate energy she leaped to medicine used for adhd cytotec 100mcg generic another and still another cake;-stumbling medicine website cheap 100 mcg cytotec visa,-leaping medicine grand rounds cheap cytotec 100mcg amex,-slipping,-springing upwardsagain! Thesource of their strength was not some mystical power attached to motherhood, but rather their concrete experiences as slaves. Some, like Margaret Garner, went so far as to kill their children rather than witness their growth to adulthood under the brutal circumstances of slavery. Had she not been threatened with the sale of her son, she would have probablylivedhappilyeverafterunderthebeneficenttutelageofhermasterandmistress. The Elizas, if they indeed existed, were certainly oddities among the great majority of Black women. They did not, in any event, represent the accumulated experiences of all those women who toiled under the lash for their masters, worked for and protected their families,foughtagainstslavery,andwhowerebeatenandraped,butneversubdued. Itwas those women who passed on to their nominally free female descendants a legacy of hard work, perseverance and self-reliance, a legacy of tenacity, resistance and insistence on sexualequality-inshort,alegacyspellingoutstandardsforanewwomanhood. Andhe knew that women were indispensable within the abolitionist movement-because of their numbersaswellas"theirefficiencyinpleadingthecauseoftheslave. Was there something special about abolitionism that attracted nineteenth-century white women as no other reform movement had been able to do? Asportrayedinthepress,inthenewpopularliteratureandeveninthecourts of law, the perfect woman was the perfect mother. Asironicasitmayseem, the most popular piece of anti-slavery literature of that time perpetuated the racist ideas whichjustifiedslaveryandthesexistnotionswhichjustifiedtheexclusionofwomenfrom thepoliticalarenawherethebattleagainstslaverywouldbefought. Whilemen had tilled the land (often aided by their wives), the women had been manufacturers, producing fabric, clothing, candles, soap and practically all the other family necessities. When manufacturing moved out of the home and into the factory, the ideology of womanhood began to raise the wife and mother as ideals. As workers, women had at least enjoyed economic equality, but as wives, they were destined to become appendages to their men, servants to their husbands. As mothers, they would be defined as passive vehicles for the replenishment of human life. The early thirties also brought "turn-outs" and strikes to the Northeastern textile factories, operated largely by young women and children. Around the same time, more prosperouswhitewomenbegantofightfortherighttoeducationandforaccesstocareers outsidetheirhomes. Well-situated women began to denounce their unfulfilling domesticlivesbydefiningmarriageasaformofslavery. Forworkingwomen,theeconomic oppression they suffered on the job bore a strong ressemblance to slavery. When the mill women in Lowell, Massachusetts, went out on strike in 1836, they marched through the town,singing: Oh,Icannotbeaslave, Iwillnotbeaslave. Yetitwasthewomenof means who invoked the analogy of slavery most literally in their effort to express the oppressivenatureofmarriage. The early feminists may well have described marriage as "slavery" of the same sort Black people suffered primarily for the shock value of the comparison-fearing that the seriousness of their protest might otherwise be missed. They seem to have ignored, however, the fact that their identification of the two institutions also implied that slavery was really no worse than marriage. But even so, the most important implication of this comparison was that white middle-class women felt a certain affinity with Black women andmen,forwhomslaverymeantwhipsandchains. During the 1830s white women-both housewives and workers-were actively drawn into the abolitionist movement. While mill women contributed money from their meager wages and organized bazaars to raise further funds, the middle-class women became agitators and organizers in the anti-slavery campaign. Prudence Crandall was a teacher who defied her white townspeople in Canterbury, Connecticut, by acceptingaBlackgirlintoherschool. Charles Harris-a Black woman she employed-Crandall decided to recruit more Black girls, and if necessary, to operate an all-Black school. Harris introduced Crandall to William Lloyd Garrison, who published announcements about the school in the Liberator, his anti-slavery journal. The Canterbury townspeoplecounteredbypassingaresolutioninoppositiontoherplanswhichproclaimed that"thegovernmentoftheUnitedStates,thenationwithallitsinstitutionsofrightbelong to the white men who now possess them. On top of such fierce inhumanity, rowdies smashedtheschoolwindows,threwmanureinthewellandstartedseveralfiresinthebuilding. Probably through her bonds with the Black people whose cause she so ardently defended. Her school continued to function until Connecticut authorities ordered her arrest. Lucidly and eloquently, her actions spoke of vast possibilities for liberation if white women en masse wouldjoinhandswiththeirBlacksisters. Iamin earnest-I will not equivocate-I will not excuse-I will not retreat a single inch-and I will be heard. By 1833, two years later, this pioneering abolitionistjournalhaddevelopedasignificantreadership,whichconsistedofalargegroup of Black subscribers and increasing numbers of whites. Indeed, once the antislavery movement was organized, factory women lent decisive support to the abolitionist cause. Yetthemostvisiblewhitefemalefiguresintheanti-slaverycampaignwerewomen who were not compelled to work for wages. They were the wives of doctors, lawyers, judges, merchants, factory owners-in other words, women of the middle classes and the risingbourgeoisie. In1833manyofthesemiddle-classwomenhadprobablybeguntorealizethatsomething had gone terribly awry in their lives. As "housewives" in the new era of industrial capitalism,theyhadlosttheireconomicimportanceinthehome,andtheirsocialstatus as women had suffered a corresponding deterioration. In the process, however, they had acquiredleisuretime,whichenabledthemtobecomesocialreformers-activeorganizersof the abolitionist campaign. Abolitionism, in turn, conferred upon these women the opportunitytolaunchanimplicitprotestagainsttheiroppressiverolesathome. At the opening session, she confidently arose from her "listener and spectator" seat in the balcony and argued against a motion to postponethegatheringbecauseoftheabsenceofaprominentPhiladelphiaman: Rightprinciplesarestrongerthannames. In1838,thisfrail-lookingwoman,dressedinthesober,starchedgarboftheQuakers,calmlyfaced the pro-slavery mob that burned down Pennsylvania Hall with the connivance of the mayor of Philadelphia. On one occasion, Lucretia Mott herself assistedaslavewomantoescapeinacarriageunderarmedguard. Astheyworkedwithintheabolitionistmovement,whitewomenlearnedaboutthenature of human oppression-and in the process, also learned important lessons about their own subjugation. In asserting their right to oppose slavery, they protested-sometimes overtly, sometimesimplicitly-theirownexclusionfromthepoliticalarena.
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Bulimia nervosa is characterized by frequent episodes of binge eating followed by behaviors such as selfinduced vomiting medications 122 200mcg cytotec for sale, abuse of laxatives medications in mexico buy cytotec 100mcg with mastercard, diuretics or other medications medications zyprexa cytotec 200mcg otc, fasting, or excessive exercise to avoid weight gain. Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control. The person may have feelings of guilt, embarrassment, or disgust, and may binge eat alone to hide the behavior. This disorder is associated with marked distress and occurs, on average, at least once a week over three months. While overeating is a challenge for many, recurrent binge eating is much less common, far more severe and is associated with significant physical and psychological problems. In contrast, the prevalence in team sports is about 15% in elite female athletes, while corresponding values in technical sports are about 17%. In addition, there are factors specific to the athletic community, such as dieting to enhance performance, personality factors (such as perfectionism, obsessiveness), pressure to lose weight, frequent weight cycling, early start of sportspecific training, overtraining, recurrent and nonhealing injuries, unfortunate coaching behavior, and regulations in some sports. Injured athletes often experience undesired weight gain, combined with the negative effects that injuries may cause. However, it is reasonable to expect that the health consequences reported among nonathletes will also apply to athletes. Most complications of anorexia nervosa, such as depletion of muscle glycogen stores, loss of muscle mass and bone mass, and anemia, occur as a direct or indirect result of starvation. These conditions are associated with fragility fractures and stress fractures, even in the young population. Severe complications such as collapse of the femoral head and hip fracture have been reported even among athletes. The consequences of bulimia nervosa have not been studied as extensively as anorexia nervosa, possibly due to more normal ranging body weight values and because it is a more difficult problem to diagnose. While multiple neuroendocrine abnormalities may be present, they tend to be less pronounced than with anorexia nervosa. The loss of fluids and electrolytes during purging can result in serious medical problems such as acidbase abnormalities, cardiac rhythm disturbances, and dehydration. The variety of medical problems related to bulimia nervosa includes tooth decay, parotid enlargement, carpopedal spasm, stomach rupture, metabolic alkalosis, hypercarotenemia, hypokalemia, and pancreatitis. Menstrual dysfunction and impaired bone health are also present in this group, but the incidence is highly variable and seems to increase with the presence of previous anorexia nervosa. The weight gain related to binge eating will likely lead to the same medical problems in athletes as in nonathletes, especially in those athletes participating in the more technical, less endurance type sports. Furthermore, the risk of overuse injuries and other muscle skeletal problems is likely higher than in nonbinging athletes. In the sports medicine field, the relationship between energy availability, menstrual function, and bone health is referred to as the female athlete triad (the Triad). Each clinical condition of the Triad comprises the pathologic end of a spectrum of interrelated subclinical conditions between health and disease. Typically function by suppressing appetite and may cause a slight increase in metabolic rate. May induce rapid heart rate, anxiety, nervousness, inability to sleep, and dehydration. Weight loss is primarily water and any weight lost is regained once use is discontinued. Dehydration and electrolyte imbalances, constipation, cathartic colon, and steatorrhea are common. Weight loss is primarily water and any weight lost is quickly regained once use is discontinued. Gastrointestinal problems, including esophagitis, esophageal perforation, and esophageal ulcers may occur. Effect on performance Poor exercise performance due to general weakness, reduced ability to cope with pressure, decreased muscle force, and increased susceptibility for diseases and injuries. May be addictive and the athlete can develop resistance, thus requiring larger and larger doses to produce the same effect. Saunas Excessive exercise Weight loss is primarily water and any weight lost is quickly regained once fluids are replaced. In recent years, studies have found the Triad in elite athletes representing both leanness and nonleanness sports, in female college athletes and highschool athletes, as well as in women who are not competing in sports. A study of the entire population of female elite athletes in Norway demonstrated that 4. Therefore, we recommend that health personnel working with female athletes look closely for evidence of Triad disorders. It should also be noted that an additional component of Triad disorders, endothelial dysfunction, has recently been introduced in the literature. Endothelial dysfunction is an important factor in the pathogenesis of cardiovascular disease, which needs further examination in future studies on athletes. This is especially true in females and particularly in sports where leanness or a low body weight is considered important for optimal performance. Delayed menarche, bone growth retardation, reduced height, weight, and body fat have been reported in gymnasts. Performance consequences It goes without saying that health should be more important than performance for the athlete and their respective team. For them, a focus on performancerelated consequences may provide more incentive to improve than a focus on the health consequences in terms of being willing to cooperate in a treatment program. It has been shown that cortisol maintains plasma glucose concentration by breaking down skeletal muscle into amino acids for gluconeogenesis in the liver. Stimuli such as starvation or intense training leading to reduced plasma glucose concentration may therefore result in atrophy, leading to decreased muscle strength and power and an increased injury risk. Endurance performance is likely to be impaired if the liver and muscle glycogen levels are lower or if the athlete is dehydrated or anemic. Further, acute dehydration can lead to loss of motor skills and coordination, while a reduced blood volume may impair thermoregulatory capacity during exercise, which can lead to impaired performance. In addition to causing energy and nutrient deficiencies, purging poses some unique problems regarding athletic performance, including most notably dehydration and severe electrolyte imbalances. Electrolyte imbalances may slow nerve conduction velocity and muscle contraction leading to increased reaction times and reduced recovery rates. Electrolyte abnormalities over time may also lead to a loss of muscle mass followed by decreased strength and power. Other consequences related to fluid and electrolyte imbalances not coincident with peak performance are fatigue, lightheadedness, insomnia, and reduced ability to concentrate (Table 5. For athletes, the stress of constantly obsessing about food, denying hunger, agonizing over body weight, and fearing increased body weight can be mentally exhausting. Special considerations One challenge for health personnel, coaches, and athletes is that some who severely restrict their energy intake for short periods and lose weight do experience an initial, albeit transient, improvement in performance.