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Topics within the realm of reproductive psychiatry were well-represented in these curricula with all reporting programs offering didactic sessions on perinatal depression antibiotic kills 99.9 bacterial population purchase 250mg zithromax, anxiety antibiotic premedication for dental procedures purchase discount zithromax on-line, bipolar disorder and psychosis antibiotic development zithromax 500mg free shipping. Nearly all programs offered didactic sessions on psychiatric aspects of perimenopause (n = 5 antibiotic resistance crisis order zithromax american express, 83%), infertility (n = 5, 83%), perinatal chemical dependency (n = 5, 83%), influence of sex hormones on mood (n = 5, 83%), eating disorders (n = 4, 67%), perinatal loss (n = 4, 67%), premenstrual dysphoric disorder (n = 4, 67%), and perinatal post-traumatic stress disorder (n = 4, 67%). Fewer programs offered didactic sessions on psychotherapy modalities focused on perinatal women (n = 3, 50%), women and trauma (n = 3, 50%), complementary and alternative medicine interventions in perinatal mental health (n = 3, 50%), understanding peripartum research (n = 3, 50%), family planning (n = 2, 33%), and dyadic mother-child treatment (n = 2, 33%). The majority (n = 10, 83%) of these programs indicated reproductive psychiatry as the primary focus of the fellowship, and all programs provided rich and diverse exposures to the field. It is notable that nearly half (n = 5, 41%) of all identified programs were established in the year 2016, with 75% (n = 9) of programs established during or after the year 2012. The establishment of a fellowship program is a difficult task that requires at least one or more faculty member "content experts," clinical services with adequate volume and diversity of experience, and a significant amount of departmental and institutional support. While this study was not designed to capture the training programs that may have been started but not continued, we hypothesize that this growing field has reached a "tipping point" where these necessary components are available within an increasing number of medical centers. The study elucidated commonalities among fellowships that provide a framework for developing programs and future efforts toward standardization. Figure 1 provides recommendations for core components of any reproductive psychiatry fellowship training program, which were developed in accordance with these commonalities. Interestingly, all 12 identified programs reported a specialized inpatient obstetrics and gynecology consultation service. While this commonality may likely reflect the practical need for such services in academic medical centers, it is also possible that an inpatient consultation service may contribute to the relationship-building necessary for the diverse reproductive psychiatry services illustrated in this study. Nearly all programs (n = 10) reported an integrated outpatient clinic in either obstetrics and gynecology or primary care. Similarly, half of programs that submitted educational objectives expressed inter-professional and team-based care as a stated goal of their program. As integrated care gains increasing attention in the healthcare policy arena, this study indicates that such models may be especially relevant for reproductive psychiatry. For this reason, while no fellowship programs reported existing didactic teaching on integrated care models, we did include this topic as a core didactic recommendation. While this study found much overlap among fellowship programs, it also revealed some unique components that illustrate the boundary-spanning role that Reproductive Psychiatrists often serve. The departmental affiliations of the training programs included not only Departments of Psychiatry but also Departments of Obstetrics and Gynecology and Internal Medicine. Furthermore, at least 2 programs reported eligibility criteria that were not limited to psychiatrists. A notable limitation of the study is that it does not include training programs that provide education in reproductive psychiatry under the umbrella of a broader focus. Only one of these programs responded to this outreach effort, suggesting that different outreach methods will be necessary to characterize the reproductive psychiatry education provided in these fellowship programs. Compliance with Ethical Standards this study was granted exemption by the Institutional Review Board of Case Western Reserve University. Disclosures On behalf of all authors, the corresponding author states that there is no conflict of interest. Effects of onsite assessment on treatment entry after perinatal depression screening. Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit. Reproductive psychiatry residency training: a survey of psychiatric residency training directors. For additional information, please call our Nutrition Services team or visit our web site at Our staff is comprised of individuals with the highest level of expertise ready to offer support and reliability to our customers. Consumers and Patients: Nutricia products are available for convenient home delivery directly from Nutricia North America. Pharmacies can special order Nutricia products from their wholesaler or directly from Nutricia North America. Nutrition Information: Nutrients Calories Protein Equivalent, g Fat, g Linoleic Acid, mg a-Linolenic Acid, mg Per 100 g 475 13. 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Average coefficients of variation for these properties from a limited sampling of specimens are reported in Table 5­6 antibiotic resistance laboratory order generic zithromax canada. Modulus of rupture-Reflects the maximum load-carrying capacity of a member in bending and is proportional to maximum moment borne by the specimen infection blood order discount zithromax. Modulus of rupture is an accepted criterion of strength antibiotics beginning with c buy zithromax 250mg line, although it is not a true stress because the formula by which it is computed is valid only to the elastic limit bacteria urine cheap zithromax 100mg visa. Work to maximum load in bending-Ability to absorb shock with some permanent deformation and more or less injury to a specimen. Work to maximum load is a measure of the combined strength and toughness of wood under bending stresses. Compressive strength parallel to grain-Maximum stress sustained by a compression parallel-to-grain specimen having a ratio of length to least dimension of less than 11. Compressive stress perpendicular to grain-Reported as stress at proportional limit. Shear strength parallel to grain-Ability to resist internal slipping of one part upon another along the grain. Impact bending-In the impact bending test, a hammer of given weight is dropped upon a beam from successively increased heights until rupture occurs or the beam deflects 152 mm (6 in. The height of the maximum drop, or the drop that causes failure, is a comparative value that represents the ability of wood to absorb shocks that cause stresses beyond the proportional limit. Tensile strength perpendicular to grain-Resistance of wood to forces acting across the grain that tend to split a member. Hardness-Generally defined as resistance to indentation using a modified Janka hardness test, measured by the load required to embed a 11. Tensile strength parallel to grain-Maximum tensile stress sustained in direction parallel to grain. Relatively few data are available on the tensile strength of various species 5­3 0. As with moduli of elasticity, the moduli of rigidity vary within and between species and with moisture content and specific gravity. Willow Oak, white Bur Chestnut Live Overcup Post Swamp chestnut Swamp white White Sassafras Sweetgum Sycamore, American Tanoak Tupelo Black Water Walnut, black Willow, black Yellow-poplar Moisture Specific content gravityb Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% 0. Strength properties of some commercially important woods grown in the United States (metric)a-con. Pond Ponderosa Red Sand Shortleaf Slash Spruce Sugar Virginia Western white Redwood Old-growth Young-growth Spruce Black Engelmann Red Sitka White Tamarack Moisture Specific content gravityb Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% 0. Interior West includes California and all counties in Oregon and Washington east of, but adjacent to , the Cascade summit; Interior North, the remainder of Oregon and Washington plus Idaho, Montana, and Wyoming; and Interior South, Utah, Colorado, Arizona, and New Mexico. Strength properties of some commercially important woods grown in the United States (inch­pound)a Static bending Work Comto Modulus pression Modulus maxiof Impact parallel of mum elasticityc bending to grain rupture load (lbf in­2) (106 lbf in­2) (in-lbf in­3) (in. Static bending ComWork Compression Shear Tension to Modulus pression perpen- parallel perpenModulus maxiof Impact parallel dicular to dicular of mum elasticityc bending to grain to grain grain to grain rupture load (lbf in­2) (lbf in­2) (lbf in­2) (lbf in­2) (lbf in­2) (106 lbf in­2) (in-lbf in­3) (in. Strength properties of some commercially important woods grown in the United States (inch­pound)a-con. Static bending Work Comto Modulus pression maxiof Impact parallel mum elasticityc bending to grain load (in. Water Willow Oak, white Bur Chestnut Live Overcup Post Swamp chestnut Swamp white White Sassafras Sweetgum Sycamore, American Tanoak Tupelo Black Water Walnut, Black Willow, Black Yellow-poplar Moisture Specific content gravityb Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% 0. Static bending Work Comto Modulus pression Modulus maxiof Impact parallel of mum elasticityc bending to grain rupture load (lbf in­2) (in. Port-Orford Western redcedar Yellow Douglas-fire Coast Interior West Interior North Interior South Fir Balsam California red Grand Noble Pacific silver Subalpine White Hemlock Eastern Mountain Western Larch, western Pine Eastern white Jack Loblolly Lodgepole Longleaf Pitch Moisture Specific content gravityb Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% 0. Static bending Work to Modulus Modulus maxiof of mum elasticityc rupture load (lbf in­2) (106 lbf in­2) (in-lbf in­3) 7,400 11,600 5,100 9,400 5,800 11,000 7,500 11,600 7,400 13,100 8,700 16,300 6,000 10,400 4,900 8,200 7,300 13,000 4,700 9,700 7,500 10,000 5,900 7,900 6,100 10,800 4,700 9,300 6,000 10,800 5,700 10,200 5,000 9,400 7,200 11,600 1. Pond Ponderosa Red Sand Shortleaf Slash Spruce Sugar Virginia Western white Redwood Old-growth Young-growth Spruce Black Engelmann Red Sitka White Tamarack a Moisture Specific content gravityb Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% Green 12% 0. Definition of properties: impact bending is height of drop that causes complete failure, using 0. Mechanical properties of some commercially important woods grown in Canada and imported a into the United States (metric) -con. Static bending Common species names Engelmann Red Sitka White Tamarack a Moisture content Green 12% Green 12% Green 12% Green 12% Green 12% Specific gravity 0. Table 5­7 lists average tensile strength values for a limited number of specimens of a few species.

These include references to issues such as dowry infection 3 months after abortion zithromax 500mg free shipping, bride price antibiotic eye drops for cats 500 mg zithromax otc, and other marriage-related social norms and institutions bacteria 100x purchase zithromax 100 mg on line. Reported speech coded both the voice of the researcher (3 12) and the voice of the identified speaker antibiotics for sinus infection not working zithromax 250 mg for sale. For example, (3 5) and (3 1) would be used to code the reported speech of a poor woman. A code was only assigned if a speaker was explicitly identified by that category in the text. No inferences as to whether a speaker was rich or poor, minority or majority, and so on, were made. Unspecified Gender: If a direct quote is provided but the gender of the speaker is unspecified, this code was assigned. Children: Used to code the reported speech of children (with a gender coding as appropriate). Minority: Used to mark text units in which the speaker is identified as a member of a minority social group. Unspecified Gender: Used to code discussions pertaining to people whose gender is unspecified. Minority: Used to code discussions pertaining to people identified as belonging to a minority group. Majority: Used to code discussions pertaining to people identified as belonging to a majority group. In most cases, a more specific need was identified; in these cases, the nodes below were used: (5 1 1) (5 1 2) (5 1 3) (5 1 4) (5 2) Food Shelter Clothing Water Health Care: References to health and health care were assigned this code. In combination with a code from group 2 (Institutions), the node can represent a formal educational system. It was also used to mark discussions of training and other types of information dissemination discussed in the documents. References to employment, income generation, and general participation in the formal cash economy were assigned this code. Culture, Identity, Dignity, Self-Respect: References to communitvspecific norms, values, and self-identification were assigned this code. Livable Environment: References to environmental quality and access to natural resources were assigned this code. Choices and Options: References to the degree of control people describe over the social processes in which they are involved. For example, choices regarding children, marriage, political participation, expression, association, mobility, speech, thought, and others were assigned this code. Conflict and Crime: References to war, violence, and crime were assigned this code. Property and Land: this node contains references to land and land rights or access, as well as any form of material property. Discussions of soil quality and soil fertility were coded (5 9) in combination with free nodes for agricultural productivitv (F 16) and quality (F 4). Risk and Vulnerability: Mentions of a particular sensitivity to an event or occurrence that poses an immediate threat to health and social and/or economic well-being were assigned this code. Social Fragmentation: Used to code passages in which there is reference to the disintegration of social groups, particularly at the household or community level. Effectiveness: Used to refer to the overall level of capacity of a given institution, usually a formal institution, with a specific mandate to provide some type of service. Trust and Confidence: Used to code text in which trust and confidence (or lack thereof) is specifically referred to . Security: Often used in conjunction with the Basic Needs codes to indicate issues of food security, and so on. Also used in reference to issues of general safety and predictability of physical well-being.

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