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  • Distinguished Professor and Chair, Department of Pathology, University of California San Francisco, San Francisco, California


He is also a member of the Expert Advisory Panel on Drug Dependence for the World Health Organization diabetic ulcer 25 mg acarbose overnight delivery. About 12 years ago blood glucose high in the morning purchase acarbose online from canada, he initiated a research program with the classic hallucinogen psilocybin diabetic diet meal purchase acarbose 50mg with mastercard, including studies of the effects of psilocybin in healthy volunteers and cancer patients blood glucose 77 after 2 hour purchase acarbose 25 mg with visa, and a pilot study of psilocybin-facilitated smoking cessation. Although the phenomenon of quantum change has been well described for more than 100 years, it has rarely been addressed within modern psychology and there are few meaningful prospective experimental studies because such experiences usually occur at low rates and often unpredictably. Recent rigorous double-blind studies at Johns Hopkins have shown that under carefully controlled conditions psilocybin, the active component of hallucinogenic mushrooms, can occasion profound personally and spiritually meaningful experiences. The experiences mediate sustained positive changes in behavior, attitudes, and personality. As assessed with questionnaires, most volunteers had a "complete" mystical-type experience after a high dose of psilocybin, although more than a third of volunteers also had experiences characterized by some fear, anxiety, or unpleasant psychological struggle. The finding that psilocybin can occasion, in most people studied, quantum change experiences indicates that such experiences and the behavioral changes they produce are now amenable to rigorous prospective scientific study. An exciting direction for future research is the exploration of possible therapeutic benefits of such experiences in treatment of various psychological and behavioral conditions. He and his students have conducted important research on a number of topics, but he is most well known for his pioneering work in behavior disorders. His brief functional analysis, an experimental approach to assessment in outpatient clinics, has revolutionized outpatient research by replacing the clinical interview as the basis of treatment with an empirical model whose utility has been established in dozens of studies. He is a principal investigator on several National Institutes of Child Health and Human Development-funded research projects as well as previously serving as a standing panel reviewer for the National Institute of Health, and as the president of the Society for the Experimental Analysis of Behavior. Abstract: In this presentation, the author will describe two projects that have successfully transferred functional analysis procedures to community settings. The second example summarizes National Institutes of Health and Maternal and Child Healthfunded projects that have shown how functional analyses can be conducted by parents in local outpatient clinics and in their homes. Following the summary of the projects, the author will discuss the results in terms of why it is critical for applied behavior analysts to continue to share their procedures with local staff and parents and how this practice of sharing sets us apart from most other professional groups. She is also an assistant professor of research in the Department of Psychology at Louisiana State University. Her research focuses on teacher effectiveness, intervention integrity, and the development of feedback systems that promote positive school climate and student achievement. Recently, her company received two Institute of Education Sciences Small Business Innovative Research awards to further enhance technology-enabled methods to facilitate educator use of a multicomponent classroom management program. The program is presently being used by general educators and data from the most recent research project shows that when teachers use the program with integrity noncompliance decreases and instructional time increases. Preliminary data also showed an increase in student achievement on the end of the year state tests. Singletary is a published researcher in the fields of education, school psychology, and applied behavior analysis and has presented at state, national, and international conferences. Daar (University of South Florida), and Abigail Kennedy (Southern Illinois University) 7. Law, Chris Ninness, Sarah Halle, Marilyn Rumph, Robin Rumph, Kellie McKee, and David Lawson (Stephen F. Douglas Greer (Teachers College, Columbia University) and Jennifer Longano (Fred S. Doing the Impossible: Putting a Short Answer Quiz Through the Scoring Machine (Well, Almost! Chelonis (National Center for Toxicological Research), Haley Aaron (Hendrix College), Shelly Baldwin (University of Arkansas for Medical Sciences), and Andrea Sutton and Merle G. Cox and Shelly Baldwin (University of Arkansas for Medical Sciences), and Andrea Sutton and Merle G. Asmus (University of Wisconsin-Madison), and Erik Carter (Vanderbilt University) 81. Yoder (Vanderbilt University), Jon Tapp (Vanderbilt Kennedy Center), Erik Carter (Vanderbilt University), and Jennifer M. Schwartz (University of Washington), Suzanne Cox (University of Kansas), Nancy Rosenberg (University of Washington), and Rose A. Mattaini has focused his research and practice on behavioral systems analysis for violence prevention with youth, constructing cultures of 146 respect in organizations and communities, and effective nonviolent social action. He has provided consultation to the National Police and community organizations working to develop more effective ways to work with criminal youth gangs in Medellin, Colombia. Mattaini completed a new book, Strategic Nonviolent Power: the Science of Satyagraha, published by Athabasca University Press and available in open access online, analyzing potential contributions of behavioral systems science to nonviolent social action and civil resistance supporting justice and human rights domestically and internationally. He is currently working with the American Friends Service Committee on related projects. Abstract: Informed activism and advocacy supporting human rights, sustainability, and democracy is a crucial contemporary need with high visibility, whether in the Middle East, where the question of armed or nonviolent civil resistance is paramount; in phenomena like the Occupy movement challenging failed economic systems, where questions regarding "diversity of tactics" has been an obstacle to collective action; or in stalled efforts to achieve sustainable cultures. Yet the armed option continues to be chosen, in part because the resources dedicated to the development and dissemination of rigorous science supporting nonviolent alternatives have been vanishingly small. Even less attention has been given to the strategic exercise of power addressing issues of sustainability or structural injustice. The moment now appears to be right, however, for behavioral systems science to contribute to the development of effective activism and science-based advocacy in all of these areas. This tutorial will briefly review the current state of knowledge regarding nonviolent activism, advocacy, and civil resistance, drawing on examples of more and less successful campaigns from every inhabited continent. Drawing particularly on current work in cultural analysis and organizational behavior management, the presenter will then provide detailed explorations of behavioral systems science principles that have promise for supporting strategic civil resistance and leveraging "people power. Examples for analysis will be drawn from current work being done by the presenter and others involved in activism and advocacy. While acknowledging the limits of current knowledge and the ethical challenges involved in working as a scientist-activist, the presentation will offer resources for immediate application, suggesting directions for the next generation of behavioral systems science advancing sustainability, human rights, and structural justice. Subsequently, he completed an augmentation program in clinical psychology at West Virginia University. Stokes has held academic positions at the University of Manitoba, West Virginia University, University of South Florida, and James Madison University in clinical psychology, school psychology, child and family studies, behavioral medicine and psychiatry, special education, and applied behavior analysis. Stokes also has maintained an active practice in psychology in homes, schools, hospitals, community mental health centers, and university student-training clinics. Stokes is a licensed clinical psychologist in Virginia, West Virginia, and Florida and is a board certified behavior analyst­doctoral. Abstract: Effective practice of applied behavior analysis requires carefully targeted and efficient intervention procedures which lead to meaningful and generalized behavior change outcomes across circumstances and time. The strong practice movement toward interprofessional collaboration and communication among professionals across multiple disciplines also may be a perplexing challenge. These issues will be presented within the context of case examples focusing on outcome assessment and data-based planning and adjustment in procedures as treatment continues from initial focused changes to generalized outcomes. Case examples will include oppositional defiance related to sensory defensiveness, leukemia with excessive hospital visits resulting from pain, interpersonal-focused interventions based on teacher and parent-child interaction therapy protocols, sibling interaction for children with autism, and interprofessional treatment merge in coordination of services for children with autism. Lawson green and gold professor of Psychology at the University of Vermont, where he has been teaching since 1980. Since that time, his research has investigated the relationships among context, behavior, and memory with a special emphasis on inhibitory processes like extinction. His research has been funded by the National Science Foundation and 148 the National Institutes of Health since 1981. Since at least 1988, he has been publishing translational papers that attempt to connect basic behavioral science (learning theory) with clinical issues such as relapse after therapy, panic disorder, fear and anxiety, and overeating and addiction. He has been a Fulbright scholar, a James McKeen Cattell scholar, a University scholar at the University of Vermont, a fellow at the Center for Advanced Study in the Behavioral Sciences (Stanford), and editor of the Journal of Experimental Psychology: Animal Behavior Processes (1998­2003). He is a fellow of the American Psychological Association, the American Psychological Society, and the Society of Experimental Psychologists, and in 2010 was awarded the Gantt Medal by the Pavlovian Society. He is currently writing the second edition of his 2007 textbook, Learning and Behavior: A Contemporary Synthesis (Sinauer Associates). Abstract: Although extinction in Pavlovian learning is highly context-dependent, less research has investigated the role of context in the extinction of operant learning. This talk will fill this gap and explore a number of parallels between Pavlovian and operant extinction. Recent research has studied the "renewal" effect after operant extinction, in which extinguished responding returns when the context is changed. We also have demonstrated renewal in nondeprived rats working for sucrose or sweet/fatty food pellets-the rodent equivalent of junk food. Other experiments have studied "resurgence," in which a behavior that is extinguished while a second is reinforced recovers when the second behavior is extinguished. However, the extinction of operant behavior, like the extinction of respondent behavior, is especially sensitive to the context with a number of interesting implications for understanding behavioral inhibition, lapse, and relapse.

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Certain thoracic characteristics are also important in pediatric patients who blood glucose range chart buy acarbose 25mg visa, in fact diabetes update 2015 purchase acarbose with american express, have low residual functional pulmonary ability blood glucose level chart 25 mg acarbose free shipping, so that small apneas can also induce desaturation diabetes symptoms with feet order acarbose 25 mg without prescription. Snoring, particularly when noisy, is present during the night for a long time and is accompanied by an increase in thoracic-abdominal movements, followed by movements in the sleep. Frequently, the child awakens in a state of nervousness, with enuresis, profuse perspiration, and/or unusual sleep positions, such as on the elbows and knees, in an attempt to alleviate the respiratory difficulty. Infections of the upper respiratory tract cause an increase in the gravity of the symptomatology mentioned above. The presence or absence of diurnal hypersomnia depends on the frequency and severity of the night-time symptoms, and therefore waking up in the morning is often difficult. Nevertheless, children can present with behavioral problems, such as difficulty in learning and low educational output, while hyperactivity sometimes alternates with excessive drowsiness and, finally, aggressiveness. This is partly attributed to anorexia or dysphagia, as a consequence of the adenotonsillar hypertrophy, or to increased respiratory stress during sleep, and partly to an anomalous secretion of the growth hormone released during the night, in relationship to the circadian rhythm. Children in whom the nasal obstruction is persistent are apt to breathe orally, and consequently have an adenoid facial expression. Clinical observation consists of careful evaluation of the physical characteristics, observing the child when he is breathing quietly. A subsequent otorhinolaryngological evaluation can verify the presence of Obstructive sleep apnea syndrome 205 nasal polyps, adenotonsillar hypertrophy, or hypertrophic rhinitis. The presence of retrognathia or micrognathia, characteristic syndromes related to skull facial anomalies, or septal deviation, can lead to respiratory problems during sleep. Instrumental examinations can identify the macroscopic anatomical anomalies that can cause obstruction of the upper respiratory tract during sleep. These include radiography of the skull with visualization of the epipharynx, cephalometry, computed tomography, and pharyngolaryngoscopy. Such investigations only provide morphological information, without dynamically assessing the exact condition of the patient during sleep. Hultcranz E, Svanholm H, Ahlqvist-Rastad J: Sleep apnea in children without hypertrophy of the tonsils. Lugaresi E, Cirignotta F, Montagna P, Sforza E: Snoring: pathogenic, clinical and therapeutic aspects. Lyberg T, Krogstad O, Djupesland G: Cephalometric analysis in patients with obstructive sleep apnoea syndrome: skeletal morphology. Petri N, Suadicani P, Wildschiodtz G et al: Predictive value of Mьller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Some of these factors are similar to those identified in adults, but several factors are different. The reason why enlargement (hyperplasia) severe enough to cause obstruction develops in some children and not in others is unclear. Neither the thickness of the adenoids nor the actual size of the airway, determined on X-ray, is a strong predictor of obstruction. Although the most common time for enlargement to occur is at about the age of five years, symptoms of enlargement have been reported as early as at two months of age. Some variation exists in the exact mechanism of obstruction from syndrome Address for correspondence: M. The tonsils and adenoids are often the main cause of obstruction, or at least play some role in airway obstruction in these persons. In these patients, a combination of abnormal pharyngeal muscle tone and hyperplasia of their tonsils and adenoids produces airway obstruction. These figures compare with a level of allergy in the general pediatric population of approximately 12%. Sinus problems contribute to airway obstruction by virtue of the narrowing that occurs as a response to exudate and inflammation. In addition, children with large, soft palates are more predisposed to obstruction because of the narrowing of the airway to accommodate the additional tissue. In addition, Mathur and Douglas6 found that the sleep apnea-hypopnea syndrome has a strong familial component that may be caused by differences in facial structure. Children with craniofacial anomalies may have a smaller nasopharynx and oropharynx, and are likely to have obstruction. In these children, normal or even minimal amounts of adenotonsillar tissue may cause severe obstruction. Patients with Down syndrome have some of the pharyngeal characteristics observed in craniofacial anomalies, and may have altered pharyngeal support. Children with achondrophasia have similar anatomical characteristics that make obstruction common in this group. Mandibular hypoplasia may also contribute to obstruction of the oropharynx by altering the shape and support of the oral cavity. Children with the Pierre Robin sequence have obstruction from collapse of the tongue into the pharynx and nasal obstruction when the tongue enters the cleft palate. Adenotonsillar tissue in these children does not usually play a major role in the mechanism of the obstruction. Patients with cleft palates, who have undergone a pharyngeal flap in order to correct velopharyngeal incompetence, may develop signs and symptoms of obstruction. The flap is designed to obstruct the lower portion of the nasopharynx sufficiently to reduce the incompetence. If the nasopharynx is occluded with adenoid tissue, or if large tonsils rotate into the pharynx, the combination of this tissue and the surgically created obstruction may be very significant. They may have a small pharynx, redundant tissue, altered airway support, and adenotonsillar hypertrophy, predisposing them to airway obstruction. These children may also have lower airway problems, making their management even more difficult. Children with chronic inflammation of the nasal tissues, or deformities of the nasal cavity that are congenital or traumatic, may have an additional contributing factor. Severe nasal deviation is uncommon in children, but when it occurs, it may contribute to obstruction. Nasal congestion from allergic rhinitis or upper respiratory infections may cause intermittent acute signs of obstruction, whereas chronic inflammation may lead to polyp formation and cause signs and symptoms of chronic upper airway obstruction. This obstruction may vary in its severity, depending on the degree of inflammation and size of the polyps. Nasal polyps, chronic nasal congestion, chronic infections, and chronic nasal obstruction are also common in children with cystic fibrosis. Children with altered neuromuscular tone may have poor support of the tongue and pharyngeal tissues. This, in conjunction with relatively small amounts of adenotonsillar tissue, may allow collapse of the tongue and the pharynx, leading to obstruction. Older children who have chronic neuromuscular developmental delay or progressive degenerative neuromuscular disorders often suffer from snoring and interrupted periods of breathing during sleep, which worsens as their muscular support deteriorates or as the adenotonsillar tissue enlarges. Although the otolaryngologist evaluating a child must be aware of the predisposing conditions that contribute to obstruction and the unusual occurrence of space-occupying lesions in the pharynx, such as lymphoma and rhabdomyosarcoma, the vast majority of children with pharyngeal obstruction have adenotonsillar hypertrophy as the only cause, and otherwise appear to be healthy. Diagnosis Polysomnography is still the most complete study for evaluating and characterizing chronic obstruction and sleep apnea in children. Simultaneous recording of chest wall movement, nasal and oral airflow (thermistors), electrocardiography, electroencephalography, electrooculography, electromyography, and pulse oximetry may be performed in a sleep laboratory or hospital bed. Polysomnography is particularly helpful for differentiating central from obstructive and mixed apnea. Apnea related to gastroesophageal reflux can also be evaluated by adding an esophageal pH probe to the recorder. Moreover, there is less agreement on the criteria for diagnosis of obstructive apnea in children than in adults. In children, there may be more frequent episodes of partial obstruction and fewer episodes of complete obstruction than in adults. These limitations have led physicians to obtain polysomnographies in only the most severely affected children with adenotonsillar hypertrophy, in order to confirm what they have already established in other ways. These monitors do not provide all the information available with polysomnography, but they are sufficient to assess patients with adenotonsillar hypertrophy and obstructive sleep problems. Cutaneous oxygen and carbon dioxide monitoring in obstructive apnea patients is not as practical as the home-monitoring technique, but pulse oximetry has made the continuous monitoring of arterial oxygenation possible and convenient. This can easily be performed at home and provides a printed record of arterial oxygen saturation changes. Despite all the assessment techniques available, judgment as to whether adenotonsillar hypertrophy is present and whether the signs and symptoms caused by obstruction are significant, still rests on clinical judgment. The physician cannot rely on any standardized measurement provided in a laboratory to make the decision for him.

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At 9 weeks diabetes symptoms foot pain cheap acarbose 25 mg with mastercard, the face is broad diabetes online discount acarbose 25mg line, the eyes are widely separated diabetes 44 reviews order acarbose 50mg on line, the ears are low set diabetes type 1 metformin safe 50mg acarbose, and the eyelids are fused. By the end of 12 weeks, primary ossification centers appear in the skeleton, especially in the cranium (skull) and long bones. By the end of 12 weeks, the upper limbs have almost reached their final relative lengths, but the lower limbs are still not so well developed and are slightly shorter than their final relative lengths. The external genitalia of males and females appear similar until the end of the ninth week. By 36 weeks, the circumferences of the head and the abdomen are approximately equal. Figure 6-4 A 9-week fetus in the amniotic sac exposed by removal from the chorionic sac. Note the following features: large head, fused eyelids, cartilaginous ribs, and intestines in umbilical cord (arrow). Note its relatively large head and that the intestines are no longer in the umbilical cord. By the end of 12 weeks, this activity has decreased in the liver and has begun in the spleen. Urine formation begins between the 9th and 12th weeks, and urine is discharged through the urethra into the amniotic fluid. Fetal waste products are transferred to the maternal circulation by passing across the placental membrane (see Chapter 7). By 16 weeks, the head is relatively small compared with that of the 12-week fetus and the lower limbs have lengthened. Limb movements, which first occur at the end of the embryonic period, become coordinated by the 14th week but are too slight to be felt by the mother. Ossification of the fetal skeleton is active during this period, and the bones are clearly visible on ultrasound images by the beginning of the 16th week. In addition, the external ears are close to their definitive position on the sides of the head. Seventeen to Twenty Weeks Figure 6-6 Diagram, drawn to scale, illustrating the changes in the size of the human fetus. Because there is little subcutaneous tissue and the skin is thin, the blood vessels of the scalp are visible. Fetuses at this age are unable to survive if born prematurely, mainly because their respiratory systems are immature. It consists of a mixture of dead epidermal cells and a fatty substance (secretion) from the fetal sebaceous glands. The vernix caseosa protects the delicate fetal skin from abrasions, chapping, and hardening that result from exposure to the amniotic fluid. The fetuses are usually completely covered with fine downy hair-lanugo-that helps to hold the vernix caseosa on the skin. Brown fat forms during this period and is the site of heat production, particularly in the newborn infant. Brown fat is chiefly found at the root of the neck, posterior to the sternum, and in the perirenal area. By 20 weeks, the testes have begun to descend, but they are still located on the posterior abdominal wall, as are the ovaries in female fetuses. Integration link: Brown fat Twenty-one to Twenty-five Weeks There is a substantial weight gain during this period, and the fetus is better proportioned. The skin is usually wrinkled and more translucent, particularly during the early part of this period. The skin is pink to red in fresh specimens because blood is visible in the capillaries. At 21 weeks, rapid eye movements begin and blink-startle responses have been reported at 22 to 23 weeks. Although a 22- to 25-week fetus born prematurely may survive if given intensive care. Integration link: Preterm birth page 101 page 102 Figure 6-9 A 25-week-old normal female newborn weighing 725 g. The lungs and pulmonary vasculature have developed sufficiently to provide adequate gas exchange. In addition, the central nervous system has matured to the stage where it can direct rhythmic breathing movements and control body temperature. The highest neonatal mortality occurs in infants of low (в¤2500 g) and very low (в¤1500 g) birth weight. Toenails become visible, and considerable subcutaneous fat is now present under the skin, smoothing out many of the wrinkles. This ends by 28 weeks, by which time bone marrow has become the major site of this process. Usually by the end of this period, the skin is pink and smooth and the upper and lower limbs have a chubby appearance. If a normal-weight fetus is born during this period, it is premature by date as opposed to being premature by weight. Integration link: Pupillary light reflex Thirty-five to Thirty-eight Weeks Fetuses born at 35 weeks have a firm grasp and exhibit a spontaneous orientation to light. As term approaches, the nervous system is sufficiently mature to carry out some integrative functions. After this, the circumference of the abdomen may be greater than that of the head. The fetal foot measurement is usually slightly larger than femoral length at 37 weeks and is an alternative parameter for confirmation of fetal age. A fetus adds approximately 14 g of fat per day during these last weeks of gestation. The thorax (chest) is prominent, and the breasts often protrude slightly in both sexes. The testes are usually in the scrotum in full-term male infants; premature male infants commonly have undescended testes. Although the head is smaller at full term in relation to the rest of the body than it was earlier in fetal life, it still is one of the largest regions of the fetus. Approximately one third of those with a birth weight of 2500 g or less are actually small for gestational age. These "small for dates" infants may be underweight because of placental insufficiency (see Chapter 7). The placentas are often small or poorly attached and/or have undergone degenerative changes that progressively reduce the oxygen supply and nourishment to the fetus. The decline, particularly after full term (38 weeks), probably reflects inadequate fetal nutrition caused by placental changes. Approximately 12% of babies are born 1 to 2 weeks after the expected time of birth. Postmaturity Syndrome page 103 page 104 Prolongation of pregnancy for 3 or more weeks beyond the expected date of delivery occurs in 5% to 6% of women. Some infants in such pregnancies develop the postmaturity syndrome and have an increased risk of mortality. These fetuses have dry, parchment-like skin, are often overweight, and have no lanugo, decreased or absent vernix caseosa, long nails, and increased alertness. Gases and nutrients pass freely to the fetus from the mother through the placental membrane (see Chapter 7). Glucose is a primary source of energy for fetal metabolism and growth; amino acids are also required. Insulin required for the metabolism of glucose is secreted by the fetal pancreas; no significant quantities of maternal insulin reach the fetus because the placental membrane is relatively impermeable to this hormone. Insulin, insulin-like growth factors, human growth hormone, and some small polypeptides (such as somatomedin C) are believed to stimulate fetal growth. Severe maternal malnutrition resulting from a poor-quality diet is known to cause reduced fetal growth (see. The growth rate for fetuses of mothers who smoke cigarettes is less than normal during the last 6 to 8 weeks of pregnancy (see. On average, the birth weight of infants whose mothers smoke heavily during pregnancy is 200 g less than normal, and perinatal morbidity is increased when adequate medical care is unavailable. The effect of maternal smoking is greater on fetuses whose mothers also receive inadequate nutrition. Multiple Pregnancy Individuals of multiple births usually weigh considerably less than infants resulting from a single pregnancy (see.

The taxonomy of this group has been confused for decades and synonyms include Giardia duodenalis and Giardia lamblia metabolic joint disease 25 mg acarbose with mastercard. Trophozoites of Chilomastix mesnili may be confused with Giardia cysts; however blood glucose quantitative test cheap 50 mg acarbose fast delivery, only one nucleus will be present in Chilomastix trophozoites diabetes insulin dependent definition discount 50mg acarbose fast delivery, and you may see a pale diabetes medications nclex discount acarbose 25mg on line, transverse band (the spiral groove) along the middle of the organism. It has four terminal flagella and an undulating membrane that extends less than one-half of the length of the body. Trichomonas tenax is found only in the mouth, has four anterior flagella, and the undulating membrane extends greater than one-half the body length. It is considered non-pathogenic and you will not need to look at any slides of these. Pentatrichomonas hominis may be found in the colon and is also a tiny, harmless commensal. It has five anterior flagella and the recurrent flagellum within the undulating membrane often trails beyond the body of the trophozoite. You will have no slides of this species, although it is the most common trichomonad of humans. Four principle morphological types of kinetoplastids can be recognized, based on the location of the flagella, kinetoplast, and nucleus. The trypomastigote form is elongate and the kinetoplast is posterior to the nucleus. The flagellum runs along the surface of the organism anteriorly in a fold of the undulating membrane. The epimastigote form is found in some life cycles and the kinetoplast is located between the nucleus and anterior end. The promastigote form is elongate and has the flagellum extending forward as well. However, the kinetoplast is located anterior to the nucleus and no undulating membrane is present. The organism is small and ovoid, with a short flagellum projecting only slightly beyond the organism, if at all. The principle types of human African trypanosomes cause African sleeping sickness. In the blood they are generally long, slender trypomastigotes, with a small kinetoplast, prominent nucleus, and undulating membrane. They are transmitted by the bite of any one of a number of Glossina spp (tsetse flies). The former species is found in central and east Africa and causes an acute infection. The latter species is found in west central and central Africa and causes the chronic form of the disease characteristic in textbooks. Both species are thought to be derived from Trypanosoma brucei, a morphologically identical 25 26 trypanosome found in the bloodstream of native African ruminants. Humans are not susceptible to this parent species, but livestock, horses, swine, and canines are. These organisms are engulfed by phagocytic cells and then transform into amastigotes, which undergo binary fission and destroy the host cells. Infection may lead to either an acute or chronic form of the disease, either of which may be fatal. The parasite enters the wound when the host rubs the contaminated feces into the lesion. The parasite may also infect people via blood transfusions, and dogs have been shown to become infected when they ingest infected reduviids. They are transmitted by the bite of sandflies (where they multiply in the gut as promastigotes) and, like T. Various species and strains have a predilection for different sites in the body and pathology varies as well. Leishmania donovani is a serious pathogen that can be seen living as clusters of amastigotes within the reticuloendothelial system of the viscera, including spleen, liver, intestine, lymph nodes, and bone marrow. Leishmaniasis tends to be a chronic, disfiguring illness and most species respond poorly to pharmaceutical intervention. During the second week, review the flagellates but concentrate most heavily on the amoebae. As stated above, they will prove to be difficult to distinguish, so considerable time must be spent at the microscope. Amoebae reproduce by binary fission and most species are capable of forming cysts (usually the infective stage). The most pathogenic intestinal species is Entamoeba histolytica, whose trophozoites may penetrate the intestine, enter the liver or lungs, and cause serious illness and often death. Several non-pathogenic intestinal species are morphologically indistinguishable from E. Entamoeba gingivalis is found in the mouth of many individuals, forms no cysts, but is also similar to trophozoites of E. However, other intestinal amoebae that will be covered include Entamoeba coli, Endolimax nana, and Iodamoeba buetschlii. Dientamoeba fragilis is also intestinal and included here with the amoeba, although electron microscopy has shown that it is actually a flagellate (but forms no flagella). It may cause acute or chronic clinical signs of intestinal distress and forms no cysts. It may enter the brain through the nasal passages, erode the olfactory bulbs and rest of the brain, and cause death within six days. First, the structure of the nucleus and endosome (nucleolus); second, the number of nuclei within the trophozoite (Dientamoeba fragilis is the only amoeba with two); third, the presence or absence of glycogen or red blood cells within the trophozoites; and fourth, whether an amoeba forms cysts or not and, if so, the number of nuclei in the cyst, the morphology of the nucleus, and the presence or absence of various inclusions. Cysts are not formed within the brain, which helps differentiate this species from Acanthamoeba spp. The only important ciliate pathogen in humans is Balantidium coli, which is also commonly found in swine and other primates. It is the largest protozoan parasite of humans and trophozoites are oblong or spherical, possess cilia, and multiply by binary fission. It can easily be seen at 10x magnification, so there is no reason to use oil immersion. In some individuals, these trophozoites become invasive and are capable of causing colonic ulceration. Large, spherical cysts are formed (ca 50 um in diameter) that pass out with the feces and are capable of infecting new hosts. A large, sausage-shaped macronucleus can be seen easily within both trophozoites and cysts, which is a diagnostic feature of most ciliates. Isospora belli forms resistant cyst stages (oocysts) that are transmitted from host-to-host. Oocysts are elongate-ellipsoidal, passed unsporulated, and the cytoplasm within these oocysts stains reddish in your slides. This is an intestinal species, preceded by two generations of merogony (multiple fission) and finally gamogony (sexual reproduction). Similarly, oocysts of Cyclospora cayetanensis are passed unsporulated but instead of being elongate they are spherical and much smaller. These oocysts show up as small, reddish blotches in your slides and are best seen using either a 40x or 100x objective lens. If an oocyst is ingested, sporozoites penetrate intestinal epithelial cells, undergo two generations of merogony, eventually gamogony, and form new oocysts that are passed in the feces (analogous to I. Although normally self-limiting by your immune system, individuals with immune deficiencies are at severe risk with both species of Cryptosporidium since the organisms are capable of recycling within the host. Toxoplasma gondii is also a serious coccidial pathogen of a variety of mammals, which can lead to swollen lymph glands, fever, headache, muscle pain, anemia, blindness, encephalitis, myocarditis, and death. Oocysts are only found within the feces of felines and, upon ingestion by virtually any mammal, the sporozoites penetrate the gut wall and enter various tissues where they multiply rapidly by endodyogeny (formation of daughter cells while still retained within the mother cell) as tachyzoites (rapidly dividing zoites). These slowly dividing zoites, now called bradyzoites, are contained within spherical cysts 20-80 um in diameter.

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