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Similarly hypertension questionnaires cheap hydrochlorothiazide 12.5 mg with amex, regulating and supporting services provided by wild biodiversity may be particularly important to poorer households as they often come at little or no direct cost to the beneficiary pulse pressure endocarditis purchase hydrochlorothiazide 12.5mg without prescription. For example blood pressure bottom number low purchase genuine hydrochlorothiazide, wild biological control agents may be particularly important for farmers that are unable to afford purchased pesticides blood pressure 210120 purchase generic hydrochlorothiazide pills. However, while some studies have, indeed, indicated that poorer sections of the community tend to be particularly dependent on products obtained from the wild. In some cases, the relationship between the use of particular wild resources and wealth is positive. For example, access to other assets may be a prerequisite (Adhikari, Di Falco and Lovett, 2004; Coomes, Barham and Takasaki, 2004; Coulibaly-Lingani et al. Landowners may find it easier than landless people to access wild resources or may be better able to make use of them, for example using leaf litter gathered in the forest to make compost for use in their crop fields. Livestock owners may have more opportunity to make use of grasslands or other ecosystems that can be grazed or from which forage can be gathered. Access to some wild products may require investment in relatively expensive equipment. Lack of time or knowledge may be constraints and there may be various physical hazards that have to be overcome (rough terrain, dangerous animals, etc. Particularly where endangered and more valuable resources are concerned, political or social influence may affect access. Changing socio-economic conditions may alter the way in which wild biodiversity is used and valued, for example the high cultural value and therefore economic value that meat or other products from wild animals have acquired among some wealthy people in Africa and Asia (Nasi et al. There may also be legal, cultural or religious factors that inhibit or promote the use of particular resources, either by the population at large or by particular sections of society. Another concern that is sometimes raised is that while wild biodiversity is clearly a significant source of income (either regular or as a safety net) for many households, these people often remain poor. In other words, the use of wild biodiversity is not enabling them to break out of the "poverty trap" in which they find themselves and transition to other livelihood activities (Vira and Kontoleon, 2012). Moreover, overuse of wild products is a major problem in many places and has implications both for biodiversity and, in the medium term, for the sustainability of the livelihoods of people relying on these resources. The paradox is that rarity itself can give a species added value and thus promote further exploitation. Social capital "Social capital" in the context of the sustainable livelihoods framework refers to the social connections and bonds that people can draw upon for assistance. In pastoralist societies, for example, exchange of livestock via loans and gifts has traditionally been a means of building and maintaining social relationships that can later be drawn upon for help, typically again in the form of loans or gifts of animals (Morton and Meadows, 2000; Potkanski, 1999). Human capital the term "human capital" is used to refer to human capacity to contribute to livelihood activities, i. Moreover, for many households, sales of agricultural, forest or aquatic products are a means of financing expenditures on health and education. For example, among livestock-keeping households, medium-sized animals such as sheep and goats are often sold to finance educational expenses such as school fees. Another consideration is that activities that are time consuming or physically exhausting tend to "use up" human capital, i. For example, in poorer households in many parts of the world, donkeys often perform essential tasks, such as carrying water and fuelwood, which would otherwise have to be done by people, often by women (Valette, 2014). Raising locally adapted species, varieties and breeds of crops, livestock, trees or fish can be less demanding in terms of labour than raising their exotic counterparts. Many countries report on the economic contributions provided by major food and agricultural commodities. The forest sector is widely reported as a source of employment and of a wide range of wood and non-wood forest products. For example, Bhutan mentions that over 40 species of edible wild vegetables and 350 species of edible mushrooms have been identified in its forests. It notes that as well as making a direct contribution to diets some of these wild species are sold to generate cash income. Similarly, Burkina Faso draws attention to the importance of non-wood forest products in sustaining livelihoods, particularly those of women, who are often responsible for collecting, processing and commercializing such products. The Gambia notes that forests provide about 85 percent of its domestic energy requirements, in the form of fuelwood and charcoal, in addition to providing timber, wild foods, construction materials, medicine and forage for livestock.

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In adults (including older persons) and adolescents with pain related to active cancer and who are taking a single opioid blood pressure 3rd trimester buy hydrochlorothiazide with american express, what is the evidence for the practice of opioid rotation or opioid switching as compared with continuing use of one opioid in order to maintain effective and safe pain control and minimize adverse effects In adults (including older persons) and adolescents with pain related to active cancer hypertension diet plan 25 mg hydrochlorothiazide free shipping, what is the evidence for the benefit of administering modified-release morphine regularly as compared with immediate-release morphine on a 4-hourly or as-required basis heart attack signs discount hydrochlorothiazide 25mg with visa, in order to maintain effective and safe pain control In adults (including older persons) and adolescents with pain related to active cancer heart attack jaw pain discount 25mg hydrochlorothiazide with amex, what is the evidence for the benefit of using the subcutaneous, transdermal or transmucosal route as compared with the intramuscular and intravenous routes when the oral route for opioids is inappropriate. In adults (including older persons) and adolescents with cancer-related pain, what is the evidence for certain dosing regimens or interventions in order to cease opioids effectively and safely In adults (including older persons) and adolescents with cancer-related pain, are adjuvant steroids more effective than placebo, no steroids or other steroids to achieve pain control In adults (including older persons) and adolescents with bone metastases, what is the evidence for the use of bisphosphonates or monoclonals compared with each other or no treatment or other bisphosphonates in order to prevent and treat pain 5. In adults (including older persons) and adolescents with cancer-related neuropathic pain, what is the evidence for the use of antidepressants compared with placebo, no antidepressant or other antidepressants in order to relieve pain In adults (including older persons) and adolescents with cancer-related neuropathic pain, what is the evidence for the use of second-generation anti-epileptics such as gabapentin or first-generation anti-epileptics such as carbamezapine or sodium valproate compared with placebo, no anti-epileptic or other anti-epileptics in order to achieve rapid, effective and safe pain control In adults (including older persons) and adolescents with pain related to bone metastases, what is the evidence for the use of low-fractionated radiotherapy as compared with high-fractionated radiotherapy or radioisotopes in order to achieve rapid, effective and safe pain control In adults (including older persons) and adolescents with pain related to bone metastases, what is the evidence for radiotherapy or radioisotopes as compared with no radiotherapy or radioisotopes in order to achieve rapid, effective and safe pain control Conference invitations to discuss and present the guidelines will be accepted when possible. A publication in a peer-reviewed journal articulating novel developments that emerge from the systematic reviews will be considered. Translation into non-United Nations languages and publication in these languages by third parties will be encouraged. The guidelines will also add to the growing compendium on pain management guidance. Ongoing cancer control programmes and palliative care programmes will be supported with the new guidelines. The new guidelines will be provided to various palliative care training programmes which will be encouraged to include them in their curricula. The guidelines will be assessed for their implementation following their dissemination. It is believed, however, that the degree to which they are implemented depends more heavily on the regulatory frameworks of each country than it does on the willingness to use the guidelines. One of the primary goals of the guidelines is to create a policy environment that is favourable to the development of balanced national policies for uses of controlled essential medications. Therefore, useful proxies for the impact of the guidelines will be the extent of their dissemination and the degree of interest in them. The number of translations by third parties is also an indication of the impact that others expect that the guidelines will have. The guide will be evaluated through a user-feedback questionnaire disseminated by the steering group one year after the initial publication of the guidelines. The network metaanalysis team worked with the systematic review team on review questions 1. No conflict management required Considered to have no significant conflicts of interest. No conflict management required No conflicts declared Considered to have no significant conflicts of interest. All conflicts of interest reported were reviewed by the guidelines coordinator and the responsible technical officer.

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Leadership the effective and efficient operation of a pathology laboratory is a multidisciplinary effort arteria adamkiewicz buy cheap hydrochlorothiazide on line. Pathology services are primarily delivered by three groups of professionally qualified staff-pathologists blood pressure essentials reviews cheap 12.5mg hydrochlorothiazide fast delivery, clinical scientists fetal arrhythmia 34 weeks hydrochlorothiazide 12.5 mg without a prescription, and technicians (also referred to as technologists)-supported by assistants blood pressure regulation cheap hydrochlorothiazide 25mg line, managers and administrators, and technology specialists. In most places, clinical scientists or technicians undertake the role of administrator or manager. Pathologists provide leadership and serve as the interface between laboratory and clinical services; in some countries and specialties, pathologists share these roles with clinical scientists. Pathologists and clinical scientists also oversee quality improvement and service development as well as pathology-led research and development. Laboratory technologists are responsible for delivering the technical aspects of the service. The goal of this joint effort is to provide a service that is patient oriented and meets clinical needs. These clinical needs are defined by standards of care, expectations of individual physicians, and patients. Accordingly, laboratory leadership needs to monitor the activities of staff to ensure that clinically relevant services are being provided. Laboratories produce information that result from their processes, personnel, and equipment. This information is also influenced by the clinical settings in which the laboratories operate and from which they receive specimens. Patient-specific, disease-specific, and therapyspecific factors may influence the information that the laboratories produce. Those in leadership positions need to understand the interactions between these factors, especially as those interactions affect how the information will be used for patient care. Pathologists, as clinicians, have insights into the thought processes behind requests for laboratory tests and the decisions that may be made with the information received. These insights are not only invaluable in determining how to most effectively organize and direct laboratory services, but they are also crucial to provision of clinical advice on the further investigation and management of individual patients. Clinical scientists, who have had training significantly similar to that received by clinical pathologists, may also provide this level of leadership. Reflecting the integral role that pathology plays in the wider heath care system, laboratory leadership also needs to be involved in the development of national strategic plans for laboratories. To be effective, development of this national blueprint needs to recognize the local disease burden, available clinical skills and services, clinical requirements for diagnosis and monitoring, and technical realities. Doing so entails the ability to read about and understand scientific and technological advances in the field of medicine as well as improvements in laboratory technology. Similarly, advances in the technical capacity of laboratories, including the introduction of new tests and the withdrawal of obsolete ones, 222 Disease Control Priorities: Improving Health and Reducing Poverty need to be assessed in relation to their ability to improve the clinical effectiveness of the laboratory, as well as the clinical effectiveness and cost-effectiveness of the whole care pathway. To effectively lead the response to such changes, pathologists need the authority to alter aspects of the operations to ensure that laboratories remain true to their goal of enhancing the quality of patient care. Education, Training, and Continuing Professional Development Educating and training larger numbers of qualified personnel is clearly of paramount importance in developing a sustainable pathology network. There are three major categories of staff: pathologists, clinical scientists and technologists, and technicians. Their education consists largely of a combination of formal courses for degrees and diplomas and hands-on training and experience under the supervision of qualified individuals. In contrast, clinical scientists and technicians predominantly received their education locally. Pathologists are medically qualified practitioners who have undergone postgraduate education and training in pathology. This model reflects countries with more-developed health care systems, such as South Africa. In much of South America, pathologists are only trained as mono-specialty anatomic pathologists; the other disciplines of pathology are staffed by clinical scientists, such as clinical biochemists. These training courses are largely experiential in nature, with considerable hands-on involvement in pathology service delivery supplemented by small group teaching and formal lectures.

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Only about a quarter of stories in La Repubblica and about forty percent of the articles in La Stampa and Il Corriere della Sera cited any explanation for population movements blood pressure medication beginning with d order line hydrochlorothiazide. They are asylum seekers blood pressure 210 over 110 cheap hydrochlorothiazide 12.5 mg line, refugees (La Stampa blood pressure medication ptsd buy 12.5 mg hydrochlorothiazide visa, 21 October 2014) There is a direct link between the conflicts currently taking place in Syria and other countries and the rise of deaths in the Mediterranean sea (Il Corriere della Sera blood pressure 5 year old order genuine hydrochlorothiazide line, 16 September 2014) the second most prominent reason in La Stampa (12. Often, news accounts suggested migration flows were driven by a number of push and pull factors, as in the following examples: War/conflict/Atrocities 33. When we turn to the question of what to do about the crisis, it is clear that the Italian press featured a greater volume of solutions and responses than other countries in our study, with each newspaper on average featuring approximately one solution per article (La Repubblica 1. The solutions that were present in coverage were filtered through the same national lens that defined the rest of the Italian coverage. Thus, the solutions predominantly aimed at solving the problem(s) the crisis had created for Italy. This does not mean, however, that the Italian coverage was not humane, or did not stress the need to protect the welfare of refugees. However, it is clear that that much of the focus is on the need to reduce the pressure this crisis was placing upon its search and rescue operations, its reception structures and its welfare system. It is difficult not to interpret the prominence of these two solutions in the light of the debates on the joint rescue operations, and on Mare Nostrum and Triton, two debates that dominated the coverage and have been largely documented above. Solutions that would contribute to tackle the push factors forcing refugees to leave their countries of origin, such as conflict resolution, were higher in the Spanish Press 104 than in other countries in our sample. This was particularly the case for La Stampa where this solution appeared in one in eight articles: [Mare Nostrum] alone is not enough, because it treats the symptoms, not the disease. The main effort should be directed to the solution of conflicts (La Repubblica, 7 March 2015) As can be seen above, whilst some articles stressed the need to encourage conflict resolution so as to prevent people fleeing their countries for humanitarian reasons, the strong focus here on stabilizing Libya, in particular, is likely to be guided more by a sense of self-interest. Re-establsihing a strong central authority in Libya would mean that the state would then be able to control its borders effectively and prevent refugees and migrants making the sea crossing to Italy. Although this would potentially reduce the numbers making the central Mediterranean crossing it would nothing to reduce the push factors forcing people to flee their homelands. Although the solutions offered in Italian newspapers largely outnumbered those offered in their European counterparts in our sample, these solutions still tend to locate solutions to the refugee crisis within Europe, rather than in the countries of origin of most refugees and migrants. These newspapers were selected on the basis that they represented both the popular and quality press as well as a spectrum of left and right opinion. Its stories tend to be brief and editorially it adopts a populist right of centre position. It currently has a daily circulation of approximately 200,000 copies and is widely considered to have a conservative orientation. Prevalence and Positioning of Refugee Stories In our German sample refugee stories were significantly more prevalent in Suddeutsche Zeitung than either Bild or Die Welt. This may be a function of the fact that as a left-liberal newspaper refugee stories may be seen as more newsworthy to their target audience. Bild stories were by far the shortest, were more likely to be sensationalist and often contained relatively little information. Sddeutsche Zeitung, as a serious broadsheet featured longer, more in depth stories that drew in a greater range of sources. However, the longest and most analytical stories appeared in Die Welt which was also the title most likely to feature extended discussion of policy. In our German sample, quantity of sources appearing in articles is strongly correlated with average length of articles in each of our three newspapers. Bild, whose articles are much shorter than the other two newspapers, features an average of 1. Die Welt features far more political sources than other newspapers because of the length of its articles and because its stories are more likely to feature in-depth discussion of policy. In many respects the prominence of elite political sources in German newspapers is similar to that found across other countries in our sample.

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