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In this model symptoms nausea headache gabapentin 400mg free shipping, lead turnaround partners take on the responsibility of integrating other providers into a coherent whole medicine ketoconazole cream 300mg gabapentin with amex. The current model assumes that someone in the school or district will accomplish this integration, but that appears to be more the exception than the rule. Many posters looked like pincushions, and many providers ­ including Mass Insight ­ were taken aback at the number of other providers who were hard at work in their best partner districts. None of us had any real idea how In the "Old-World" model of school/provider partnerships still prevalent today, multiple partners work independently in a fragmented, confusing web of disconnected support. In the "New-World" model most appropriate for turnaround, a lead turnaround partner acts as systems integrator and coordinates the providers. The "New-World" model illustrated here also reflects the greater capacity required for turnaround throughout the system: particularly at the school, but also at the district (through a turnaround zone organized to serve a cluster of schools), partner, and state levels. The key is lowering the bar so that these connections happen without requiring exceptional leadership. The final point to make regarding turnaround partners is connected to the need for turnaround capacitybuilding throughout the system. There is exceedingly little capacity, currently, in the supply of outside turnaround partners. Most states seeking to apply outside expertise to under-performing schools end up hiring recently retired educators as individual consultants, who then most often perform their responsibilities with very little training or coordination with their fellow consultants, or, for that matter, results. There is an important time consideration for 50 states in considering how they might expand provider capacity for turnaround ­ in effect, playing a role on the demand-side to stimulate the development of higher-capacity turnaround organizations. But states can maximize provider effectiveness through intentional, highly developed collaborations with outside partners and districts and an explicit strategy to expand provider capacity. Some districts ­ notably New York and Chicago ­ are already showing the way in working with foundations and local organizations to expand outside partner capacity. Consulting Partner Building Turnaround Management Capacity Decades of research on schools has firmly established the central importance of school leadership quality, Note: With its "Performance," "Contract," and "Charter" schools, Chicago provides good examples of these different forms of providers and district/provider relationships. Some providers there, like the Center for Urban School Improvement at the University of Chicago, have begun filling both kinds of roles in different schools. For more on governance issues in turnaround schools, see page 81 and related material in Part 5. Such leaders, they suggest, tend to pursue common actions including the following: Major Actions · Concentrate on a few changes with big, fast payoffs · Implement practices proven to work with previously low-performing students without seeking permission for deviations from district policies Support Steps · Communicate a positive vision of future school results · Collect and personally analyze school and student performance data · Make an action plan based on data · Help staff personally see and feel the problems students face · Get key influencers within district and school to support major changes · Measure and report progress frequently and publicly · Gather staff team often and require all involved in decision-making to disclose and discuss their own results in open-air meetings · Funnel more time and money into tactics that get results; halt unsuccessful tactics · Require all staff to change ­ not optional · Silence change naysayers indirectly by showing speedy successes · Act in relentless pursuit of goals rather than touting progress as ultimate success 3. A wide range of research suggests that leaders who will be effective in efforts to achieve dramatic improvement are likely to have characteristics that are very different from those of typical school leaders and take actions that diverge significantly from those required in more stable leadership situations. Some states, major school districts, foundations, universities, and non-profit organizations have put new energy into recruiting and training new principals for urban schools. But very few programs are specifically preparing leaders for the challenge of school turnaround. The Virginia School Turnaround Specialist Program, created by the education and business schools at the University of Virginia at the behest of then-governor Mark Warner, is one exception. States making a commitment to turnaround will need to address this capacity gap at the state level, because few districts have the resources necessary to do it themselves. Finding the Money for Turnaround Reforms significant enough to generate dramatic improvement in chronically low-performing schools will in most cases require substantial investment of financial resources. To the degree possible, system leaders will want to find this investment by reallocating existing resources first. As Harvard researcher Richard Elmore (2002) argued: "The evidence is now substantial that there is considerable money available in most district budgets to finance large-scale improvement efforts that use professional development effectively. A reallocation-first strategy also exerts discipline on system and school leaders to focus initially on the highestvalue-added changes. This kind of focus is one of the hallmarks of successful turnarounds across industries. That said: the costs of school turnaround (including money for new staff, incentive and responsibilitybased compensation, new program materials, outside partner services and support, and especially additional time in the school day or year) range from $250,000 to a million dollars per school, per year over three years, with declining investment in subsequent years. Clustering for Support: Organizing turnaround for effectiveness and efficiency in school clusters by need, type, or region. Educators engaged in turnaround need particularly strong support networks, located either within their district or (in low-capacity districts) across district lines.

Nephritic syndrome Nephrotic syndrome Acute renal failure Renal tubular defect Urinary tract infection 333 medicine 2015 song buy gabapentin overnight. A 35-year-old female recovering from hepatitis B develops hematuria symptoms 5 days after conception order generic gabapentin canada, proteinuria, and red cell casts in the urine. Which of the following would best describe the changes within the kidney in this patient? Plasma cell interstitial nephritis IgG linear fluorescence along the glomerular basement membrane Granular deposits of antibodies in the glomerular basement membrane Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits. Treatment with steroids would most likely produce a beneficial response in a young child with a. Acute cystitis Acute pyelonephritis Focal segmental glomerulosclerosis Minimal change disease X-linked agammaglobulinemia Urinary System 359 335. Histologic sections of the kidney reveal the combination of normal-appearing glomeruli and occasional glomeruli that have deposits of hyaline material. Additionally, there is cystic dilation of the renal tubules, some of which are filled with proteinaceous material. Electron microscopy reveals focal fusion of podocytes, and immunofluorescence examination finds granular IgM/C3 deposits. Physical examination reveals bilateral periorbital edema, but peripheral edema is not found. A microscopic section from the kidney reveals increased numbers of cells within the glomeruli. An electron microscopic section of the kidney reveals large electron-dense deposits in the glomeruli that are located between the basement membrane and the podocytes. Which one of the following renal diseases most likely produced the abnormalities in this young boy? Acute post-streptococcal glomerulonephritis Focal segmental glomerulonephritis Focal segmental glomerulosclerosis Membranous glomerulonephritis Minimal change disease 360 Pathology 337. Immune complexes located within the glomerular basement membrane would most likely be found in a patient with a. She states that about 2 months ago her urine turned brown 2 days after a cold and stayed brown for about 3 days. At the current time a urinalysis reveals 2+ blood with red cells and red cell casts. Immunofluorescence examination of a renal biopsy from this patient reveals the presence of large, irregular deposits of IgA/C3 in the mesangium. Crescents in the glomeruli Fibrinoid necrosis of the afferent arterioles Fibromuscular hyperplasia of the renal artery Neutrophils in the interstitium Splitting of the basement membrane by mesangial cells Urinary System 361 340. A linear pattern of immunoglobulin deposition along the glomerular basement membrane that can be demonstrated by immunofluorescence is typical of a. Marked thickening of the glomerular basement membrane, as shown in the photomicrograph below, may be seen in a. Histologic sections of a kidney reveal patchy necrosis of epithelial cells of both the proximal and distal tubules with flattening of the epithelial cells, rupture of the basement membrane (tubulorrhexis), and marked interstitial edema. Acute pyelonephritis Acute tubular necrosis Chronic glomerulonephritis Chronic pyelonephritis Diffuse cortical necrosis Urinary System 363 344. The gross appearance of the kidney shown below is most compatible with which of the following conditions? Cystic renal dysplasia Acute pyelonephritis Chronic pyelonephritis Acute glomerulonephritis Chronic glomerulonephritis 345. During a routine physical examination, a 42-year-old female is found to have an elevated blood pressure of 150/100 mmHg. Further workup reveals that renal vein renin levels are increased on the left but decreased on the right. Atherosclerotic narrowing of the left renal artery Atherosclerotic narrowing of the right renal artery Fibromuscular hyperplasia of the left renal artery Fibromuscular hyperplasia of the right renal artery Hyaline arteriolosclerosis 364 Pathology 346. Which one of the following gross appearances of a kidney is most characteristic of malignant nephrosclerosis? Broad U-shaped cortical scars overlying dilated calyces in renal poles Depressed cortical areas overlying necrotic papillae of varying stages Multiple small petechial hemorrhages on the surface Multiple small white areas on the surface Wedge-shaped. The combination of severe acute flank pain and microscopic hematuria is suggestive of a. Cholelithiasis Choledocholithiasis Kidney tumor Urinary bladder tumor Urolithiasis Urinary System 365 348.

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Myeloperoxidase is an enzyme within the primary (azurophilic) General Pathology Answers 105 granules of neutrophils 4 medications walgreens purchase gabapentin 300mg, while alkaline phosphatase is an enzyme in their secondary (specific) granules medications valium gabapentin 400mg fast delivery. In contrast, chronic inflammatory processes are associated with increased numbers of monocytes and lymphocytes. Monocytes are mononuclear leukocytes with a "bean-shaped" or "horseshoe-shaped" nucleus. The activated form of macrophages have abundant eosinophilic cytoplasm and are called epithelioid cells. Lymphocytes are smaller mononuclear leukocytes that have a round to oval nucleus and little cytoplasm. B lymphocytes (B cells) mature into plasma cells, which have an eccentric nucleus with a "clock-face" appearance of their chromatin. Plasma cells secrete immunoglobulin, while certain T lymphocytes (T cells) secrete lymphokines. Numbers of lymphocytes are increased in acute viral infections or chronic disease. Eosinophils are bilobed leukocytes that contain abundant eosinophilic granules within their cytoplasm. These granules contain many different types of substances, such as major basic protein (which is toxic to helminthic parasites), arylsulfatase (which neutralizes leukotrienes), and histaminase (which neutralizes histamine). They participate in specific types of inflammatory processes, such as allergic disorders, parasitic infections, and some diseases of the skin. Basophils are a type of leukocyte that have numerous deeply basophilic granules within their cytoplasm that completely hide the nucleus. Basophils participate in certain specific types of immune reactions because they have surface receptors for IgE. Mast cells, although not exactly the same as basophils, are found in tissue and are very similar to basophils. When called upon, the circulating monocyte can enter into an organ or tissue bed as a tissue macrophage (sometimes called a histiocyte). Examples of tissue macrophages are Kupffer cells (liver), alveolar macrophages (lung), osteo- 106 Pathology clasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen, and lymph nodes. The entire system, including the peripheral blood monocytes, constitutes the mononuclear phagocyte system. In the lung, alveolar macrophages can phagocytize the red blood cells that accumulate in alveoli in individuals with congestive heart failure. These cells may be surrounded by mononuclear cells, mainly lymphocytes, and multinucleated giant cells, which result from the fusion of several epithelioid cells together, may be present. Granulomatous inflammation is a type of chronic inflammation initiated by a variety of infectious and noninfectious agents. Indigestible organisms or particles, or T cell­mediated immunity to the inciting agent, or both, appear essential for formation of granulomas. Although tuberculosis is the classic infectious granulomatous disease, several other infectious disorders are characterized by formation of granulomas, including deep fungal infections (coccidioidomycosis and histoplasmosis), schistosomiasis, syphilis, brucellosis, lymphogranuloma venereum, and cat-scratch disease. In sarcoidosis, a disease of unknown cause, the granulomas are noncaseating, which may assist in histologic differentiation from tuberculosis. Tissue repair involves the formation of granulation tissue, which histologically is characterized by a combination of proliferating fibroblasts and proliferating blood vessels. Proliferating cells are cells that are rapidly dividing and usually have prominent nucleoli. It is important not to confuse the term granulation tissue with the similarsounding term granuloma. The latter refers to a special type of inflammation that is characterized by the presence of activated macrophages (epithelioid cells). Collagen is a triple helix of three polypeptide chains that is secreted by fibroblasts and has a high content of glycine and hydroxyproline. Fibronectin, secreted by fibroblasts, monocytes, and endothelial cells, is also capable of binding many substances, such as collagen, fibrin, proteoglycans, and integrins. Basically, fibronectin links extracellular matrix component and macromolecules to integrins and is chemotactic for fibroblasts and endothelial cells. Instead of being crossshaped like laminin, fibronectin is a large glycoprotein composed of two chains held together by disulfide bonds. Albumin is secreted by hepatocytes and is mainly responsible for intravascular oncotic pressure, while immunoglobulins are secreted by plasma cells and are important in mediating humoral immunity.

Deep leg veins Lumen of left ventricle Lumen of right ventricle Mesenteric veins Superficial leg veins General Pathology 51 51 symptoms after hysterectomy purchase gabapentin with amex. He is taken to the emergency room treatment 3 antifungal order gabapentin 100mg on line, where he is evaluated and immediately taken to surgery. There his left testis is found to be markedly hemorrhagic due to testicular torsion. Arterial occlusion Septic infarction the collateral blood supply of the testis the dual blood supply of the testis Venous occlusion 52. A young child who presents with megaloblastic anemia is found to have increased orotate in the urine due to a deficiency of orotate phosphoribosyl transferase. The combination of a primary defect, such as bilateral renal agenesis, along with its secondary structural change is best referred to by which one of the listed terms? As a general rule, familial disorders that involve abnormalities of structural proteins (rather than deficiencies of enzymes) and present during adulthood (rather than childhood) have what type of inheritance pattern? Autosomal dominant Autosomal recessive Mitochondrial X-linked dominant X-linked recessive 52 Pathology 55. Myotonic dystrophy Limb-girdle dystrophy Facioscapulohumeral dystrophy Duchenne muscular dystrophy Polymyositis 56. Assume that both parents are carriers for the abnormal gene that causes cystic fibrosis. The Hardy-Weinberg principle states that, given a frequency of a certain allele A of p and a frequency q of another allele a at the same locus on the same autosomal chromosome in a population with random mating (panmixia), then the number of heterozygous carriers is equal to a. A 6-year-old female is being evaluated for recurrent episodes of lightheadedness and sweating due to hypoglycemia. Physical examination reveals an enlarged liver and a single subcutaneous xanthoma. Laboratory examination reveals increased serum uric acid and cholesterol with decreased serum glucose levels. Following oral administration of fructose, there is no increase in blood glucose levels. A liver biopsy specimen reveals increased amounts of glycogen in hepatocytes, which also have decreased levels of glucose-6-phosphatase. In tissues affected by the predominant form of Niemann-Pick disease, which one of the following is found at abnormally high levels? Physical examination reveals a child with short stature, coarse facial features (low, flat nose, thick lips, widely spaced teeth, facial fullness), a large tongue, and clear corneas. Laboratory examination reveals increased urinary levels of heparan sulfate and dermatan sulfate. Metachromatic granules (Reilly bodies) are found in leukocytes from a bone marrow biopsy. Hyperphenylalaninemia Tyrosinemia Tyrosinase-positive oculocutaneous albinism Alkaptonuria Maple syrup urine disease 62. Which one of the listed processes is the most likely cause of an aneuploid karyotype? A reciprocal translocation between two acrocentric chromosomes Deletion of both ends of a chromosome with fusion of the damaged ends Division of the centromere along a transverse plane Failure of homologous chromosomes or paired chromatids to separate Two breaks within a single chromosome with reincorporating of the inverted segment 63. Gross examination at the time of autopsy reveals polydactyly, a cleft lip and palate, and a single, central eye ("cyclops"). Further examination reveals holoprosencephaly, consisting of fused frontal lobes with a single ventricle. Which of the listed chromosomal abnormalities is most consistent with these findings? A 2-month-old girl presents with a soft, high-pitched, mewing cry and is found to have microcephaly, low-set ears and hypertelorism, and several congenital heart defects. A 6-year-old female with a fair complexion is being evaluated for severe mental retardation and seizures. A 19-year-old female of average intelligence and short stature is being evaluated for amenorrhea. Physical examination reveals that she has a shield-shaped chest and her elbows turn outward when her arms are at her sides.