Farmers had little need for cash and adjusted their level of effort to what was required to meet that need (Dove treatment walking pneumonia order lopinavir 250 mg with mastercard, 1993) treatment models cheap lopinavir 250mg line. Attribute Ethnic group Year rubber introduced General characteristics of the five cases presented in this chapter symptoms quad strain trusted lopinavir 250mg. Second Division medications you can take while pregnant order lopinavir 250 mg, Sarawak Iban 1910s West Kalimantan Kantu 1940s Not available Poor Rubber incorporated into swidden fallow cycle. Still little impact of rubber on general land use Ngira Tae Bagak the Impact of Rubber on the Forest Landscape in Borneo Bidayuh 1930s 110 person km-2 Good All stages of forests and tree vegetation, including rubber, have stabilized. Rubber boosts expansions of forest gardens Increased cash production; existing forest management technology 1930s 80 person km-2 Regular Rubber stable part of land use. No further encroachment into forest area Local customs related to forest ownership; communal management of forest reserves Population density Not available Accessibility Stage of development 391 Good Rice cultivation being abandoned because of land pressure. Much rubber also abandoned Population pressure; government control; abandoning of rubber gardens Key factors that influence impact of rubber technology on forest landscape Incorporation of technology in extensive land cultivation 377 378 Wil de Jong feasible and there was sufficient land for new swiddens. The fact that they continued to grow rice also reflected their cultural preference to produce their principal staple in their own private fields. In three of the five cases discussed, local and/or national authorities increasingly circumscribed encroachment on additional forest areas. Pressure from within the communities to preserve the remaining forests increased and governments persuaded farmers to stop further encroachment. In West Kalimantan, as in many other places in the world, the laws largely prohibit farmers from encroaching on forests. However, such rules only became relevant once the government had sufficient presence to enforce them. The introduction of a new cash-based production system coincided with and was a catalyst for a number of cultural and socio-political changes, including the increased presence of the state. The rising importance of cash-based economic transactions and improved infrastructure allowed for better communication between state officials and communities. Officials at the regional level adopted national concerns about forest encroachment, and that facilitated enforcement of forest regulations. Lastly, the cases discussed above demonstrate that new technologies involving some kind of tree or forest production may contribute to reforestation. The presence of tree crops also influences what happens to the forest landscape when other changes occur in local agricultural systems and demographic patterns. For example, land already under tree vegetation is much more likely to revert to forest when farmers shift from upland rice to wet rice cultivation or migrate to the cities. This is taking place in West Kalimantan in areas with out-migration from rural areas. One observes many old tembawang and rubber gardens that have developed into closed dense forests. Tree-planting technologies, like rubber production, have a low impact on the forest landscape when they are incorporated into long-existing extensive agricultural systems. However, when population pressure and market integration increase alongside each other, these effects change. When these technologies are introduced at an early stage in a resource-use continuum from extensive to more intensive land use, socio-economic progress allows for a consensus on land use that preserves forests. This may offset negative effects that might otherwise have been caused by the impact of the technology under changing conditions, such as increased land pressure caused by higher population densities. Tree-planting technologies may be incorporated in local forest management practices and subsequently have a positive effect on the forest landscape. In general, tree technologies have significant advantages when trying to improve local agriculture. Before promoting new technologies, policy-makers should the Impact of Rubber on the Forest Landscape in Borneo 379 take into account the degree of government presence and negotiations with communities over preservation of certain areas. The promotion of new technologies should always be considered in the light of local resource (forest) management practices, to obtain positive synergies and achieve an outcome acceptable to local farmers and national authorities, as well as limiting negative environmental impacts. Conclusions the introduction of rubber in West Kalimantan contributed little to encroachment into primary forest. On the other hand, it apparently favoured the restoration of forests in areas where land use became less intensive. It needs to be emphasized, however, that specific conditions in the local context allowed this to take place. If, for example, adoption of rubber had been accompanied by substantial migration into rural areas, that would probably have resulted in encroachment into forest areas. This has happened in places in Sumatra (see also Chapter 16 in this volume by Ruf). The impact of a new agricultural technology on forest conversion depends on the technology itself, but also on the economic and socio-political circumstances in which it happens. In addition, the impact changes over time, in part as a result of parallel economic and socio-political changes. Policy-makers should consider the degree of government presence and negotiated agreements concerning forest conservation before promoting new technologies in forested regions. Incorporation of local resource management technologies, especially tree-planting or forest-management technologies, may enhance positive outcomes in terms of increased income and forest preservation. Notes 1 the results presented here stem partly from research conducted between 1992 and 1996 on Dayak forest management in the subdistrict of Noyan, West Kalimantan, Indonesia. The New York Botanical Garden, the Tropenbos Foundation and the Rainforest Alliance through their Kleinhans Fellowship funded the research and the Indonesian Academy of Sciences and Tanjungpura University sponsored it. I thank Noboru Ishikawa, Patrice Levang, the editors and an external reviewer for their comments. The future income security and flexibility rubber provides are probably among the main reasons why farmers planted rubber in the midst of the crisis (Sunderlin et al. Skripsi Fakultas Pertanian, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia. Viewing the Link in the Larger Context the opportunity for farmers or companies to capture a forest rent by converting forest to pasture or cropland largely drives deforestation. A number of factors help create such opportunities beside agricultural technologies. These include high output prices, road construction and maintenance in forested areas and cheap and abundant labour and capital, among others. To understand the link between agricultural technology and tropical deforestation, one must view it within this larger context. The contributors to this book have sought to keep a clear focus on the link between technology and deforestation, without losing sight of the context in which that link occurs. Section 2 looks at the main conditioning factors that determine how technological change affects forests at a more general level. Shiftingcultivation systems Holden (14) de Jong (20) Ruf (16) Yanggen and Reardon (12) New technologies can, in principle, reduce the need for land, but farmers often choose to expand land area. If migration is also attractive, the innovations easily become deforestation agents Outcome depends on factor intensities and market conditions. Developed countries the concept of a forest transition plays a central role in the historical reviews by Rudel and Mather. This implies that forest cover declines before it levels out and slowly increases again. Since the first half of the 19th century, forest cover has risen in several European countries, including the three studied by Mather: Denmark, France and Switzerland. This might suggest that growth in yields helped reverse the decline in forest cover.
On examination medicine 627 buy cheap lopinavir 250 mg online, he has microcephaly medicine for depression discount lopinavir 250 mg on line, craniofacial dysmorphisms including hypertelorism with epicanthal folds treatment yeast infection nipples breastfeeding generic lopinavir 250mg line, short nose with upturned nares treatment 911 buy 250mg lopinavir overnight delivery, and micrognathia, tachycardia, a sacral dimple, and generalized hypotonia. Considerations the 13-month-old child in the case is a typical case of Miller-Dieker syndrome. Refractory epilepsy presents during the first 6 months of life in 75% of affected children, with infantile spasms beginning shortly after birth in 80%. Mental retardation and developmental delay are severe, with most cases not capable of progressing beyond the 3- to 6-month level of milestones. Distinct craniofacial dysmorphic features as described for our patient, generalized hypotonia that progresses to opisthotonos and spasticity with age, contractures, clinodactyly, cryptorchidism, omphaloceles (an abdominal wall defect), cardiac and renal abnormalities are all phenotypic. Feeding and swallowing problems often result in poor weight gain and aspiration pneumonia. Past history will often reveal a gestation complicated by polyhydramnios, intrauterine growth retardation, and decreased fetal movements. Miller-Dieker syndrome: A severe lissencephaly phenotype secondary to deletion on chromosome 17p13. Infantile spasms: Dramatic repetitive bouts of rapid neck flexion, arm extension, hip and knee flexion, and abdominal flexion, often with arousal from sleep. The mother might describe them as unprovoked startle responses or colicky spells as a result of abdominal pain, although there is no crying typical of colic. Epicanthal fold: Skin fold of the upper eyelid (from the nose to the medial side of the eyebrow) covering the medial corner (medial canthus) of the eye. Clinodactyly: Congenital condition where the little finger is curved toward the ring finger. Opisthotonus: Severe hyperextension of the back caused by spasm of the muscles along the spinal column. Clinical Approach Epidemiology and Differential Diagnosis Lissencephaly is a set of rare brain disorders where the whole or parts of the surface of the brain appear smooth. The word lissencephaly is derived from the Greek lissos meaning smooth and encephalos meaning brain. In lissencephaly these convolutions are completely or partially absent from the brain, or areas of it, have a smooth appearance. The convolutions are also called gyri and their absence is known as agyria (without gyri). In some cases convolutions are present, but thicker and reduced in number, and the term pachygyria (broad gyri) is used. This severe form is estimated to be the cause of almost one-third of patients with identified lissencephaly. Both Miller-Dieker syndrome and isolated lissencephaly sequence are considered classical lissencephalies or lissencephaly type 1. First, if the condition is genetic and has been inherited, it will allow parents to understand the risk for future pregnancies and also whether other children in the same family are also carriers for the faulty gene. A diagnosis of lissencephaly or pachygyria is not a full diagnoses, and the cause cannot be determined without a more detailed evaluation from a neurologist, pediatrician, or geneticist. In these instances it is important to be referred to specialists where the expertise exists. Improved symptomatic therapy has lengthened the life expectancy of these patients from a few years to the early teens. Poor feeding and swallowing predispose to malnutrition and aspiration pneumonia; a feeding tube and gastrostomy in the long-term can help reduce these comorbidities. Hypotonia in the early years progresses to spasticity and contractures that, if untreated, can result in severe pain and discomfort, as well as immobility and complications such as falls, atelectasis, and decubitus ulcers. Frequent stretching physical therapies, braces, and muscle relaxants can slow the development of spasticity and contractures, whereas special wheelchairs and mattresses can reduce problems arising from immobility. Lissencephaly patients can also have congenital cardiac and renal abnormalities that must be closely monitored and managed. The recurrence risk for Miller-Dieker syndrome is very low, because most cases are caused by a de novo chromosomal deletion. However, recurrence risk can be as high as 33% if a familial reciprocal translocation is determined. Imaging for cerebral gyral malformations is more sensitive beyond 28 weeks of gestation. Motor delay, seizures, microcephaly are the hallmarks of this Miller-Dieker syndrome. The management of the Miller-Dieker lissencephaly patient is supportive, centering around the three major complications: epilepsy, poor feeding, and spasticity. This infant is normal in every way except drawing up of his legs and tightening of the abdomen after feeding, which is most likely intestinal colic. Treatment of lissencephaly patients should focus on symptomatic therapy for complications including epilepsy, poor feeding, and spasticity. Genetic counseling is an important part of the care of lissencephaly patients and their families. At 16 months, the child had not yet articulated any words although he was noted to babble occasionally and showed no affection to his parents or siblings. He was easily upset, particularly by changes from his usual routine, and soothed himself by rocking back and forth or slowly spinning in a circle. At presentation, the child had not developed any spoken words, and his temperament remained irritable and isolative. His parents state that he hardly ever makes eye contact, and if forced by others, he becomes upset. On examination, he is an active and healthy appearing toddler who is wandering around the office, ignoring the doctor and his parents, paying attention only to the books, which he rhythmically pulls off the shelf without playfulness. When his mother tries to keep him from doing so the little boy screams, looks up to the ceiling, flaps his arms, and then retreats to the corner and rocks back and forth. He has a normal toddler gait but seems somewhat uncoordinated for his age when reaching for and grasping objects. The child has physically been healthy, has never been hospitalized, and has never had surgery. He is physically healthy, and there is nothing of note in his prenatal, medical, surgical, or family histories. His examination is significant only for demonstrating the deficits and behaviors reported by the parents. Most likely diagnosis: Autism Next diagnostic step: Audiological evaluation Next step in therapy: Educational intervention and behavioral modification Analysis Objectives 1. Understand the difference between developmental delay and developmental regression. Clinical Considerations this 28-month-old boy is brought to the office with concerns about his development and his behavior. Clinically, the most important first step is to carefully distinguish between developmental delay and developmental regression. Delay implies that the child is making progress, although at a rate slower than that considered to be normal. This is generally because of a static process and can lead to an eventual diagnosis of mental retardation. Developmental regression, conversely, implies that the child is now losing previously attained skills and raises the possibility of a progressive neurodegenerative process. Distinguishing between delay and regression can be clinically difficult, at times. For example, children can inconsistently demonstrate a new developmental skill leading to the impression that it has been lost. True developmental regression is a red flag, which necessitates an expedited search for a progressive disorder of the nervous system. In this patient, however, there is no hint of developmental regression but instead a picture of developmental delay. An isolated language deficit, for example, can be caused by hearing impairment alone, while global developmental delay (involving all four domains) is more likely to be caused by a significant in utero, perinatal, or genetic disturbance. A delay in gross motor skills arising prior to 1 year of age strongly suggests the diagnosis of cerebral palsy.
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Fetishistic fantasies are common treatment kitty colds generic lopinavir 250 mg with mastercard, but they do not amount to a disorder unless they lead to rituals that are so compelling and unacceptable as to interfere with sexual intercourse and cause the individual distress medications covered by blue cross blue shield cheap lopinavir 250mg overnight delivery. Usually more than one article is worn and often a complete outfit medicine 44 159 discount 250mg lopinavir with mastercard, plus wig and makeup symptoms 10dpo buy generic lopinavir 250 mg. Fetishistic transvestism is distinguished from transsexual transvestism by its clear association with sexual arousal and the strong desire to remove the clothing once orgasm occurs and sexual arousal declines. A history of fetishistic transvestism is commonly reported as an earlier phase by transsexuals and probably represents a stage in the development of transsexualism in such cases. Exhibitionism A recurrent or persistent tendency to expose the genitalia to strangers (usually of the opposite sex) or to people in public places, without inviting or intending closer contact. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation. This tendency may be manifest only at times of emotional stress or crises, interspersed with long periods without such overt behaviour. Diagnostic guidelines Exhibitionism is almost entirely limited to heterosexual males who expose to females, adult or adolescent, usually confronting them from a safe distance in some public place. For some, exhibitionism is their only sexual outlet, but others continue the habit simultaneously with an active sex life within long-standing relationships, although their urges may become more pressing at times of conflict in those relationships. This usually leads to sexual excitement and masturbation and is carried out without the observed people being aware. Paedophilia A sexual preference for children, usually of prepubertal or early pubertal age. Some paedophiles are attracted only to girls, others only to boys, and others again are interested in both sexes. Contacts between adults and sexually mature adolescents are socially disapproved, especially if the participants are of the same sex, but are not necessarily associated with paedophilia. An isolated incident, especially if the perpetrator is himself an adolescent, does not establish the presence of the persistent or predominant tendency required for the diagnosis. Included among paedophiles, however, are men who retain a preference for adult sex partners but, because they are chronically frustrated in achieving appropriate contacts, habitually turn to children as substitutes. Men who sexually molest their own prepubertal children occasionally approach other children as well, but in either case their behaviour is indicative of paedophilia. If the individual prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities. Mild degrees of sadomasochistic stimulation are commonly used to enhance otherwise normal sexual activity. This category should be used only if sadomasochistic activity is the most important source of stimulation or necessary for sexual gratification. Sexual sadism is sometimes difficult to distinguish from cruelty in sexual situations or anger unrelated to eroticism. Where violence is necessary for erotic arousal, the diagnosis can be clearly established. Other disorders of sexual preference A variety of other patterns of sexual preference and activity may occur, each being relatively uncommon. These include such activities as making obscene telephone calls, rubbing up against people for sexual stimulation in crowded public places (frotteurism), sexual activity with animals, use of strangulation or anoxia for intensifying sexual excitement, and a preference for partners with some particular anatomical abnormality such as an amputated limb. Erotic practices are too diverse and many too rare or idiosyncratic to justify a separate term for each. Swallowing urine, smearing faeces, or piercing foreskin or nipples may be part of the behavioural repertoire in sadomasochism. Masturbatory rituals of various kinds are common, but the more extreme practices, such as the insertion of objects into the rectum or penile urethra, or partial self-strangulation, when they take the place of ordinary sexual contacts, amount to abnormalities. Most commonly this occurs in adolescents who are not certain whether they are homosexual, heterosexual, or bisexual in orientation, or in individuals who after a period of apparently stable sexual orientation, often within a long-standing relationship, find that their sexual orientation is changing. The gender identity or sexual preference is not in doubt but the individual wishes it were different because of associated psychological and behavioural disorders and may seek treatment in order to change it. The gender identity or sexual preference abnormality is responsible for difficulties in forming or maintaining a relationship with a sexual partner. An attention-seeking (histrionic) behavioural syndrome develops, which may also contain additional (and usually nonspecific) complaints that are not of physical origin. The patient is commonly distressed by this pain or disability and is often preoccupied with worries, which may be justified, of the possibility of prolonged or progressive disability or pain. Dissatisfaction with the result of treatment or investigations, or disappointment with the amount of personal attention received in wards and clinics may also be a motivating factor. Some cases appear to be clearly motivated by the possibility of financial compensation following accidents or injuries, but the syndrome does not necessarily resolve rapidly even after successful litigation. For physical symptoms this may even extend to self-infliction of cuts or abrasions to produce bleeding, or to self-injection of toxic substances. The imitation of pain and the insistence upon the presence of bleeding may be so convincing and persistent that repeated investigations and operations are performed at several different hospitals or clinics, in spite of repeatedly negative findings. The motivation for this behaviour is almost always obscure and presumably internal, and the condition is best interpreted as a disorder of illness behaviour and the sick role. Individuals with this pattern of behaviour usually show signs of a number of other marked abnormalities of personality and relationships. Malingering, defined as the intentional production or feigning of either physical or psychological symptoms or disabilities, motivated by external stresses or incentives, should be coded as Z76. The commonest external motives for malingering include evading criminal prosecution. Malingering is comparatively common in legal and military circles, and comparatively uncommon in ordinary civilian life. F70-F79 Mental retardation Overview of this block - 174 - F70 F71 F72 F73 F78 F79 Mild mental retardation Moderate mental retardation Severe mental retardation Profound mental retardation Other mental retardation Unspecified mental retardation A fourth character may be used to specify the extent of associated behavioural impairment: F7x. However, mentally retarded individuals can experience the full range of mental disorders, and the prevalence of other mental disorders is at least three to four times greater in this population than in the general population. In addition, mentally retarded individuals are at greater risk of exploitation and physical/sexual abuse. Adaptive behaviour is always impaired, but in protected social environments where support is available this impairment may not be at all obvious in subjects with mild mental retardation. A fourth character may be used to specify the extent of the behavioural impairment, if this is not due to an associated disorder: F7x. The presence of mental retardation does not rule out additional diagnoses coded elsewhere in this book. However, communication difficulties are likely to make it necessary to rely more than usual for the diagnosis upon objectively observable symptoms such as, in the case of a depressive episode, psychomotor retardation, loss of appetite and weight, and sleep disturbance. Diagnostic guidelines Intelligence is not a unitary characteristic but is assessed on the basis of a large number of different, more-or-less specific skills. Although the general tendency is for all these skills to develop to a similar level in each individual, there can be large discrepancies, especially in persons who are mentally retarded. This presents problems when determining the diagnostic category in which a retarded person should be classified. Associated mental or physical disorders have a major influence on the clinical picture and the use made of any skills. The diagnostic category chosen should therefore be based on global assessments of ability and not on any single area of specific impairment or skill. The categories given below are arbitrary divisions of a complex continuum, and cannot be defined with absolute precision. Without the use of standardized procedures, the diagnosis must be regarded as a provisional estimate only. F70 Mild mental retardation Mildly retarded people acquire language with some delay but most achieve the ability to use speech for everyday purposes, to hold conversations, and to engage in the clinical interview. Most of them also achieve full independence in self-care (eating, washing, dressing, bowel and bladder control) and in practical and domestic skills, even if the rate of development is considerably slower than normal. The main difficulties are usually seen in academic school work, and many have particular problems in reading and writing. However, mildly retarded people can be greatly helped by education designed to develop their skills and compensate for their handicaps. Most of those in the higher ranges of mild mental retardation are potentially capable of work demanding practical rather than academic abilities, including unskilled or semiskilled manual labour.
The Aggressive F2 scenario had the largest impact in reducing end stage liver disease and liver-related mortality medicine x topol 2015 order lopinavir 250mg without a prescription. Sensitivity Analysis For total viremic infections in 2030 atlas genius - symptoms quality 250mg lopinavir, inputs for annual new infections medications jamaica trusted lopinavir 250 mg, base prevalence and annual treated were the greatest drivers of uncertainty treatment hepatitis b discount lopinavir 250mg online, together accounting for >95 percent of uncertainty (see Figure B-12). Key insights are derived by comparing scenarios and identifying the factors that are important. Although cirrhotic cases have been used as a measure of disease burden in the past, this disease stage can contain individuals with compensated and decompensated cirrhosis. The latter was selected since it is associated with a high mortality rate and potentially more accurate reporting. The number of people diagnosed, treated, or progressing to advanced liver disease had a much smaller impact on total viremic infections in the United States. In the absence of vaccines, treatment of this population can also reduce the viral pool of this population resulting in a reduction in total and new infections over time (Martin et al. The sensitivity analysis showed that the number of new infections has a very small impact on the forecasted number of liver-related deaths in 2030 (see Figure B-12). However, a number of studies have examined these populations and report a higher number of infections (Chak et al. The last variable that had a large impact on forecasted liver related deaths was the rate of progression from mild to moderate fibrosis. This progression rate is influenced by alcohol consumption and body mass (Hourigan et al. The above discussion focused on quantifying the main drivers of uncertainties for total infections and liver-related deaths. Relative to the treatment paradigm represented by the 2013 Base scenario, great advances have already been made. Here, we assume the total number of treated patients will decline to 130,000 per year (50 percent of 2015 value) and the number of newly diagnosed will also decline by 50 percent as it will become more difficult to find undiagnosed individuals. With a continued focus on treating F2 patients, 98,500 deaths may be averted by 2030 relative to the 2015 base scenario (see Table B-3). Yet most new infections are occurring among younger individuals infected by those with no or early stages of fibrosis (F0-F2). Therefore, focusing treatment on F2 will have minimal impact on new infections (see Table B-3). Under this scenario (Aggressive F0), we project 28,000 deaths averted and >90 percent reduction in the number of new infections in the United States corresponding to 279,400 total new infections averted (see Table B-3). This strategy will reduce infections by 90 percent and avert nearly a quarter million deaths in the next 14 years. Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey, 2003 to 2010. Mortality in patients with substance abuse: A follow-up in Stockholm County, 1973-1984. Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: Modelling the predicted impact of treatment under different scenarios. Drug-related mortality and fatal overdose risk: Pilot cohort study of heroin users recruited from specialist drug treatment sites in London. Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis. Editorial commentary: Interferon-free hepatitis C treatment efficacy from clinical trials will translate to "real world" outcomes. The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Death and survival in a cohort of heroin addicts from London clinics: A 22-year follow-up study. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest). Long-term treatment outcomes of patients infected with hepatitis C virus: A systematic review and meta-analysis of the survival benefit of achieving a sustained virological response. Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: Pooling of U. New York: United Nations, Department of Economic and Social Affairs, Population Division. A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report Appendix D Committee Biographies Brian L. Strom was formerly the executive vice dean of institutional affairs, founding chair of the Department of Biostatistics and Epidemiology, founding director of the Center for Clinical Epidemiology and Biostatistics, and founding director of the Graduate Program in Epidemiology and Biostatistics, all at the Perelman School of Medicine of the University of Pennsylvania (Penn). He has been on the faculty of the University of Pennsylvania School of Medicine since 1980. As one of many specific contributions, his research was pivotal in prompting the American Heart Association and American Dental Association to reverse 50 years of guidelines, and recommend against use of antibiotics to prevent infective endocarditis, instead of recommending for this widespread practice. At the Perelman School of Medicine, he developed graduate training programs in epidemiology and biostatistics. More than 625 clinicians have been trained or are in training through the largest of these training programs, which leads to a Master of Science in Clinical Epidemiology degree. He has been the primary mentor for more than 65 former and current clinical research trainees and numerous junior faculty members. Strom was a member of the Board of Regents of the American College of Physicians, the Board of Directors of the American Society for Clinical Pharmacology and Therapeutics, and the Board of Directors for the American College of Epidemiology. He is currently a member of the Board of Directors for the Association for Patient-Oriented Research. He was previously president of the International Society for Pharmacoepidemiology and the Association for Clinical Research Training. Strom was on the Drug Utilization Review Committee and the Gerontology Committee of the U. Strom is also a member of the American Epidemiology Society, and is one of a handful of clinical epidemiologists ever elected to the American Society for Clinical Investigation and American Association of Physicians. He is an elected member of the National Academy of Medicine and National Academy of Science. Strom received the 2003 RawlsPalmer Progress in Medicine Award from the American Society for Clinical Pharmacology & Therapeutics, the Naomi M. Kanof Clinical Investigator Award of the Society for Investigative Dermatology, the George S. Pepper Professorship of Public Health and Preventive Medicine, and the Sustained Scientific Excellence Award from the International Society for Pharmacoepidemiology. Strom was the 2008 recipient of the John Phillips Memorial Award for Outstanding Work in Clinical Medicine. This award is from the American College of Physicians and is considered to be one of the highest awards in Internal Medicine.
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