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Poverty has remained high in these countries partly because economic growth rates have been comparatively low (Economic and Social Commission for Asia and the Pacific blood pressure chart webmd discount 20 mg telmisartan mastercard, 2007) arteria dawson 20 mg telmisartan with mastercard. Yet arteria spinalis buy telmisartan 80 mg on line, although progress has been uneven across the region blood pressure chart per age purchase telmisartan toronto, almost all countries are on track to meet the 2015 target. The prospects for halving poverty remain a major challenge, however, for Papua New Guinea, the Philippines and Timor-Leste. In the Philippines, for instance, even if the incidence of poverty declined from 30 per cent in 1990 to 23 per cent in 2005, at an annual rate of about 2 per cent, the country will need to reduce the number of people living in extreme poverty at an annual rate of 4 per cent in order to reach its 2015 target. Rates of population growth in these countries have remained high and have led to an enlargement of both the total population as well as the numbers living in extreme poverty. However, such growth has not been sufficiently inclusive and pro-poor to reduce the absolute number of persons living in poverty. Income inequalities have grown steadily in India since the early 1980s, in both urban and rural areas. South Asian countries have been unable to generate sufficient decent work opportunities to lift working poor people out of poverty. The headcount index declined in almost all countries with data on income poverty, with the exception of Bangladesh, where the estimated proportion of people living below the $1. In India alone, the poverty headcount fell by 18 percentage points, from 60 per cent in 1981 to 42 per cent in 2005. Pakistan also experienced a decline in the headcount index from 73 to 23 per cent during the same period. The ups and downs reflected in the poverty data collected during the 1990s are questionable. The variation could also be a result of sensitivity in respect of the poverty lines. Alternative sources of information report different poverty trends; for instance, the latest Human Development Report for Pakistan reports an increase in poverty during the 1990s, while a report by the Asian Development Bank cites several studies that showed a trend for the 1990s that was the reverse of the one reported by the World Bank (see hdr. Latin America and the Caribbean Over the last 25 years, Latin America and the Caribbean has had mixed results in eradicating poverty. These disparities are to a large extent a reflection of the huge inequalities in the distribution of income across the region and within countries. For example, 12 out of 23 countries in the world with Gini coefficients above 50 per cent in 2005 were in Latin America. It is estimated that, in Latin American and Caribbean countries, the per capita income of households in the tenth decile is about 17 times greater than that of the poorest 40 per cent of households (Economic Commission for Latin America and the Caribbean, 2008). Such growth, the highest the region has experienced since the 1970s, resulted in an increase in the average labour income of the poorest (Economic Commission for Latin America and the Caribbean, 2009). In absolute numbers, 184 million were considered poor, among whom 68 million were living in extreme poverty (Economic Commission for Latin America and the Caribbean, 2008). According to World Bank estimates, in 2005, most countries in the region were on track to halve poverty rates by 2015. This was accounted for largely by the fact that poverty levels had been very low in 1990, which is the base year for measuring progress made by countries towards the achievement of the Millennium Development Goals. For Haiti to halve its poverty rate by 2015, it will have to reduce poverty levels at an annual rate of 7. Middle East and Northern Africa the Middle East and Northern Africa region has managed to reduce both the incidence of poverty and the absolute number of people living in extreme poverty despite poor economic performance in the last two decades. Unlike other middle-income countries, the countries of the Middle East and Northern Africa have been very successful in reducing extreme poverty owing in part to improvements in the health and education levels of the general population, as well as to the availability of extensive food and energy subsidies in several countries. For example, between 1980 and 2000, the regional child mortality rate plunged from 138 per thousand live births to 47 per thousand, the average years of schooling per person over age 15 rose from 2. Gains of this magnitude within the social dimensions of development which 9 the findings of these surveys are reported on a regular basis in the issues of the Social Panorama of Latin America, published by the Economic Commission for Latin America and the Caribbean. While poverty rates are low at the regional level, poverty levels and trends differ across countries. Poverty levels are lower in oil-rich Gulf countries which are able to use the vast wealth derived from oil and gas to subsidize consumption goods and social services for their citizens (Iqbal, 2006). Net oil importers in the Middle East and Northern Africa region were impacted negatively by the recent increases in the prices of energy and food. This created fiscal burdens for Governments, increased production costs for small businesses, and reduced the food intake of poor families.
Researchers are building on the gene discoveries to understand how gene defects cause disease and to move toward therapies hypertension synonym telmisartan 20mg without prescription, for example by creating mice with the same gene defects and by developing laboratory tests for rapid screening of candidate drugs arteria tapada buy 80mg telmisartan with mastercard. Studies of brain plasticity are among several other rapidly advancing areas of neuroscience research that contribute to our understanding of dystonia heart attack kit telmisartan 40mg with mastercard, including attention to non-genetic determinants of the disease blood pressure percentile by age telmisartan 20 mg low price. This Coalition of researchers and patient advocacy groups is advancing the pace of translational and clinical research to find better treatments. Since it began in 2009, the Coalition has expanded to include more than 40 clinical sites and 13 patient advocacy groups. The 2013 conference will reunite the community to assess the current state of epilepsy research, and to identify emerging or unmet scientific opportunities and challenges for Benchmarks priorities over the next five to ten years. The meeting included sessions on comorbid conditions that affect people with epilepsy and post-traumatic epilepsy research within the Department of Veterans Affairs. In particular, meeting participants discussed the recommendation to develop formal accreditation for epilepsy centers, which would meet specific criteria for epilepsy care and could also conduct clinical and health services research. Existing accredited centers for other diseases, such as stroke, were cited as potential models. For example, recommendations for improved surveillance and the prevention of epilepsy and its consequences include an emphasis on epilepsy-related mortality. One of these projects, a whole genome association study to identify genes involved in migraine and their interaction with environmental factors, recently identified 3 genetic factors associated with migraine. The network is explicitly designed to increase the speed, efficiency, and quality of early phase clinical trials for neurological disorders. Biomarkers, which include surrogate endpoints, are objective measures of the disease process or the biological actions of candidate therapeutics that can expedite therapy development. Biomarkers of disease progression or therapeutic action are key measures that will speed testing of therapeutic candidates. The most recent report, published in January of 2012, recognized 48 priority areas. Those pre-meeting scores were used to identify which proposals were discussed and further optimized for consideration as a top priority. Recommendations from Phase 2 of the planning process were presented and discussed at the September 2012 meeting of the National Advisory Neurological Disorders and Stroke Council. The Task Force developed and recently updated A Public Health Action Plan to Combat Antimicrobial Resistance with input from state and local health agencies, professional societies, pharmaceutical companies, consumer groups, and the public. The Task Force encourages feedback from external stakeholders, including via annual public meetings where progress on implementation of the Action Plan is discussed. The antibacterial resistance 51 leadership group will develop and implement a comprehensive clinical research agenda to address the problem of antibacterial resistance. This new program will also have an advisory component to help guide the research agenda. One member of this drug class has been shown to rid mice of malaria parasites after a single oral dose. Further tests are planned to inform whether the pharmaceutical company will continue development of this spiroindolone. The partnership has characterized dihydroorotate dehydrogenase, a promising target for anti-malarial therapies, and identified a candidate drug for further study and product development. This project could be a model to inform efforts to counter artemisinin resistance and improve malaria treatment worldwide. These compounds will be further investigated as candidate anti-malarial medicines. These same children could consume dietary egg without allergic reactions for at least one year. Such studies will be critical in the further development of successful approaches to prevent and treat food allergy. However, drugs are effective in only half of the population, and for those patients that can take these medications there is still only a 50 percent reduction in mortality over a 10-year period.
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Avian botulism is currently the most important disease of waterfowl and shorebirds blood pressure medication beginning with r purchase telmisartan 20mg with amex, nationally and internationally blood pressure 68 over 48 order 40 mg telmisartan free shipping, and outbreaks of this disease commonly kill tens of thousands of birds during a single event arteria circumflexa femoris lateralis buy genuine telmisartan on line. Up to a million birds have recently been lost within a single location during the course of a protracted outbreak juvenile blood pressure chart purchase telmisartan 20mg line. Because many avian botulism die-offs occur on the same wetlands year after year, one of the primary areas of research on this disease has focused on identifying and understanding the microenvironmental characteristics that contribute to a mortality event. The development of wetland-specific risk assessment tools will enable wildlife disease specialists and natural resource managers to more effectively manage avian botulism. Fungi are an additional source of microbial biotoxins that cause the death of free-ranging wild birds. Mycotoxins, which are toxins produced by fungi, have received considerable study because of their effects on food animals and humans. In poultry, for example, many types of mycotoxins are known to cause problems that include mortality, decreased growth, impaired reproduction, immunosuppression, and pathologic effects on a variety of other organ systems. Although these toxins have received little study in wildlife, a growing body of literature documents similar effects of mycotoxins in a variety of free-ranging species. The chapter about mycotoxins illustrates the capabilities of aflatoxins and trichothecenes to cause large-scale bird losses as the result of bird ingestion of food contaminated by molds that produce these toxins. As more becomes known about the occurrence of mycotoxins 260 Field Manual of Wildlife Diseases: Birds in the natural environment, and as analytical techniques for the specific toxins become more commonly available, it is likely that more and more cases of mycotoxicosis will be reported in wildlife. The range of living organisms that cause poisoning in wild birds is further illustrated by plant toxins in the chapter about algal toxins. Less is known about poisoning of birds from toxic plants than is known about poisoning from bacterial and fungal toxins. Plant toxins other than algal toxins that have caused bird mortality have rarely been reported. Choke cherry seeds contain chemical compounds that release cyanide upon digestion if the seed capsule is broken during digestion. Waterfowl mortality has been attributed to ingestion of castor beans, which results in intoxication from ricin, the active ingredient within the seed that causes poisoning. A small number of other reports of plant toxins causing wild bird mortality also exist. The so-called algal toxins are produced by a variety of organisms, including true algae, dinoflagellates (aquatic protozoa), and blue-green algae, and are the least understood of the biotoxins covered in this Section. Algal blooms, especially red tides and blue-green blooms, wreak aesthetic and economic havoc in many freshwater and marine environments because of the potential for toxins to be present. Perhaps one of the most widely recognized toxins in this group is saxitoxin, the agent of paralytic shellfish poisoning, which causes occasional human deaths and renders many tons of shellfish inedible throughout the world. Algal toxins are likely to become increasingly recognized as a cause of waterbird mortality. Eutrophication of inland waterbodies due to nutrient loads is causing more algal blooms within those waters, many of which are used by large numbers of water birds. Enhanced technology and increased study are needed to better understand the ecology of algal blooms and the production of toxic components that are hazardous to bird life. With the exception of avian botulism, biotoxins as a cause of disease in wild birds have received little study. However, there should be no debate regarding the need for study since disease caused by biotoxins extends beyond direct mortality. Impaired immune system function or immunosuppression and cancers caused by biotoxins have both been documented in animals and humans. Other effects on wildlife are also likely because of the diversity of disease impacts seen in humans and domestic animals. Introduction to Biotoxins 261 262 Field Manual of Wildlife Diseases: Birds Chapter 36 Algal Toxins Synonyms Red tide toxins, phycotoxins Periodic blooms of algae, including true algae, dinoflagellates, and cyanobacteria or blue-green algae have been reported in marine and freshwater bodies throughout the world. Although many blooms are merely an aesthetic nuisance, some species of algae produce toxins that kill fish, shellfish, humans, livestock and wildlife. Pigmented blooms of toxinproducing marine algae are often referred to as "red tides". Proliferations of freshwater toxin-producing cyanobacteria are simply called "cyanobacterial blooms" or "toxic algal blooms. Although algal blooms historically have been considered a natural phenomenon, the frequency of occurrence of harmful algae appears to have increased in recent years.
Gross Lesions Avian influenza virus infection in wild birds is not indicated by gross lesions arrhythmia medication discount telmisartan 20mg overnight delivery. Common terns that died in South Africa did not have gross lesions blood pressure normal readings discount telmisartan 20 mg, but a few birds had microscopic evidence of meningoencephalitis or inflammation of the membrane that covers the brain heart attack lyrics cheap telmisartan online american express. Mallards experimentally infected with a virulent influenza virus developed discrete purple areas of lung firmness and cloudy lung coverings digital blood pressure monitor order genuine telmisartan line. However, virulent viruses are rarely found in wild birds, and these lesions may not appear in natural infections. Seasonality Influenza virus has been found in wild birds throughout the year, but waterfowl are the only group in which these viruses are found year round. The highest occurrence of infection is in the late summer months in juvenile waterfowl when they assemble for their first southward migration. The number of infected waterfowl decreases in the fall as birds migrate toward their southern wintering grounds and is lowest in the spring, when only one bird in 400 is infected during the return migration to the north. In contrast, the number of birds infected is highest in shorebirds (primarily ruddy turnstone) and gulls (herring) during spring (May and June). Influenza viruses have not been found in shorebird and gull populations during other months of the year. Influenza viruses have been found in marine birds such as murres, kittiwakes, and puffins while they have been nesting, but the pelagic habits of these species preclude sampling during other periods of the year. Signs of disease may appear as respiratory, enteric, or reproductive abnormalities. Included are such nonspecific manifestations as decreased activity, food consumption, and egg production; ruffled feathers; coughing and sneezing; diarrhea; and even nervous disorders, such as tremors. In domestic chickens and turkeys, certain virus subtypes like H5N2 and H7N7, respectively, Figure 22. Avian Influenza 183 Domestic birds Natural avian influenza cycle Shorebirds Waterfowl Pandemic disease cycle Mammals (Primarily swine) Humans Figure 22. Diagnosis Infected birds are detected by virus isolation from cloacal swabs in embryonated chicken eggs, and by serological testing of blood for antibody. The last test indicates that a bird was exposed to these viruses rather than if it is infected or carries the disease. Reference antisera to all of the subtype antigen combinations are used to determine the identity of the virus; however, the virulence of a virus cannot be determined by the antigenic subtype. Laboratory and animal inoculation tests are required to establish the virulence of strains based on an index established for domestic birds. This issue should be considered when land use near wetlands is planned and when wildlife managers plan for development for wildlife areas. Human Health Considerations Although this group of viruses includes human influenza viruses, the strains that infect wild birds do not infect humans. It is believed that waterfowl and shorebirds maintain separate reservoirs of viral gene pools from which new virus subtypes emerge. These gene pools spill over into other animals (mammals) and may eventually cause a new pandemic. Wallace Hansen Control Avian influenza viruses in wild birds cannot be effectively controlled because of the large number of virus subtypes and the high frequency of virus genetic mixing resulting in new virus subtypes. Also, virus has been recovered from water and fecal material in areas of high waterfowl use. The virus has been recovered from poultry houses more than 100 days after flock depopulation for markets. In the domestic bird industry, preventing the entry of the virus into poultry flocks is the first line of defense. Killed vaccines are selectively used to combat less virulent forms of this disease. Antibody present in the blood of recovered and vaccinated birds prevents virus transmission.
Some analysts have seen little value in the notion of social exclusion arrhythmia online cheap telmisartan 40mg on-line, decrying its limited theoretical or researchable content (Oyen pulse pressure points body buy telmisartan 20 mg line, 1997) hypertension 101 order discount telmisartan. Others have pointed out that it perhaps reflects the attempt to address the old agenda of poverty hypertension reading chart buy telmisartan visa, albeit with reduced power and precision (Townsend, 2002; Levitas, 2000). However, through its focus on the non-material dimensions of deprivation, and through incorporating subjective and experiential perspectives, the social exclusion approach expands the final outcomes that signal development objectives. Dimensions of self-esteem, dignity and recognition of mutual social acceptability enter the expanded societal frame. Deprivation, vulnerability and exclusion 67 the social exclusion concept encompasses processes, social relations, causality and dynamics in analysing outcomes, while taking into account initial conditions such as asset ownership. Thus, the social inclusion approach can effectively complement other poverty reduction strategies. Social exclusion: ubiquitous presence, multiple forms Forms of social exclusion can be defined in terms of the final outcomes of the development process. Here, the focus is generally on the elements of basic needs, or a wider set of elements that include non-material dimensions of wellbeing. They could also be defined in terms of the features of the structures, processes and policies that generated these final outcomes; this would link up with the various instrumental elements of causal processes: exclusion from employment, from credit, from access to land, etc. The concept of social exclusion could also be applied to social constituencies that have been excluded on account of relatively immutable attributes of their identity, implying the existence of discrimination. The following sections present selected illustrations of poverty and social exclusion, with a wide range of examples drawn from various regions, countries and social groups. The diversity of these examples highlights the pervasiveness of poverty and social exclusion-in developed as well as developing countries and among people of all ages and ethnic groups. Regional diversity in its manifestations In Africa, social exclusion is mostly seen as a direct consequence of poverty, and they both stem from discrimination on the basis of race, ethnicity and gender, inequality, unbalanced rural/urban development, unequal distribution of assets or unequal access to services. Persistent conflicts and instability, often resulting from long-term exclusion, impede poverty reduction efforts. In Latin America and the Caribbean, social exclusion often denotes a specific problem, such as the existence of an underclass or the long-term unemployed. It is often seen as a major concern in the context of high inequality, as well as ethnic and racial discrimination. The gap between indigenous and non-indigenous populations is especially persistent. For instance, in Brazil, in the early 1990s, illiteracy rates for the black population were more than double those of the white population (Hopenhayn, 2008). The causes of discrimination in Latin America relate mostly to being poor, old or uneducated or belonging to an ethnic minority. Recent data indicate that only 34 per cent of indigenous children attend secondary school as compared with 48 per cent in the general population (Economic Commission for Latin America and the Caribbean, 2008). In Asia and the Pacific, the region with the highest number of older persons in the world, income security, employment, health, nutrition and social services for older persons are of major concern. Migrant workers, facing exploitation, abuse and discrimination, experience significant exclusion. Prolonged migration has been found to cause the break-up of families and violent behaviour and delinquency in the children left behind (Economic and Social Commission for Asia and the Pacific, 2008a). In Western Asia, conflict and displacement intensify exclusion, with minorities being at a greater risk of displacement. Many migrant workers in the region lack the status of citizens and are thus excluded from the poverty eradication programmes. In respect of exclusion, the focus of developed countries is on marginalized groups. This is especially warranted considering that some of these groups are affected by exclusion and poverty more than others. Consequently, focusing on reducing child poverty is considered a very important component of overall efforts to combat poverty in Europe and prevent intergenerational transmission of poverty. Everywhere, a key feature of social exclusion is the relative powerlessness of those excluded. The ability of a person living in poverty to improve his or her material and non-material well-being depends on the socio-political structure of the society he or she lives in. It further depends on the institutions fostering economic opportunity and local democracy.
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