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Intelligence is usually within the normal range, but a few girls have educational or behavioural problems. Associations with autoimmune thyroiditis, hypertension, obesity and non-insulin dependent diabetes have been reported. Growth can be stimulated with androgens or growth hormone, and oestrogen replacement treatment is necessary for pubertal development. Other X chromosomal abnormalities including deletions or rearrangements can also result in Turner syndrome. The additional chromosome usually arises by a nondisjunction error in maternal meiosis I. Educational problems are encountered more often in this group than in the other types of sex chromosome abnormalities. Mild delay with early motor and language development is fairly common and deficits in both receptive and expressive language persist into adolescence and adulthood. Mean intelligence quotient is often about 20 points lower than that in siblings and many girls require remedial teaching although the majority attend mainstream Figure 5. Occasional menstrual problems are reported, but most triple X females are fertile and have normal offspring. It arises by nondisjunction and the additional X chromosome is equally likely to be maternally or paternally derived. Pubertal development usually starts spontaneously, but testicular size decreases from mid-puberty and hypogonadism develops. Educational difficultes are fairly common and behavioural disturbances are likely to be associated with exposure to stressful environments. Shyness, immaturity and frustration tend to improve with testosterone replacement therapy. The majority of males with this karyotype have no evidence of clinical abnormality and remain undiagnosed. Accelerated growth in early childhood is common, leading to tall stature, but there are no other physical manifestations of the condition apart from the occasional reports of severe acne. Intelligence is usually within the normal range but may be about 10 points lower than in siblings and learning difficulties may require additional input at school. Behavioural problems can include hyperactivity, distractability and impulsiveness. Although initially found to be more prevalent among inmates of high security institutions, the syndrome is much less strongly associated with aggressive behaviour than previously thought although there is an increase in the risk of social maladjustment. Individual disorders of this type are often rare, but are important because they are numerous. Risks within an affected family are often high and are calculated by knowing the mode of inheritance and the structure of the family pedigree. Mild or late onset conditions can often be traced through many generations of a family. Affected people are heterozygous for the abnormal allele and transmit this to half their offspring, whether male or female. Estimation of risk is therefore apparently simple, but in practice several factors may cause difficulties in counselling families. Late onset disorders Dominant disorders may have a late or variable age of onset of signs and symptoms. People who inherit the defective gene will be destined to become affected, but may remain asymptomatic well into adult life. Young adults at risk may not know whether they have inherited the disorder and be at risk of transmitting it to their children at the time they are planning their own families. The possibility of detecting the mutant gene before symptoms become apparent has important consequences for conditions such as Huntington disease and myotonic dystrophy. Variable expressivity the severity of many autosomal dominant conditions varies considerably between different affected individuals within the same family, a phenomenon referred to as variable expressivity. In some disorders this variability is due to instability of the underlying mutation, as in the disorders caused by trinucleotide repeat mutations (discussed in chapter 7). A mildly affected parent may have a severely affected child, as illustrated by tuberous sclerosis, in which a parent with only skin manifestations of the disorder may have an affected child with infantile spasms and severe mental retardation.

Providing people with the information they need to protect themselves and prevent harm to others allows them to reduce risks and contributes to an effective response. Risk communication is the exchange of information, advice and opinions among experts, community leaders or officials, and the people who are at risk or whose practices or behavior affect risk. Risk communication ensures that people and communities are aware of current threats, and can be used to change behavior to reduce ongoing risks. Community engagement means that affected communities are consulted about and included in the response to risk reduction efforts for a zoonotic disease by taking into account local social, cultural, political, economic and other realities in the communication. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries 79 5. Where they do not exist, a mechanism by which communications staff from across the sectors could work together and share information in the event of an outbreak should be considered. Such networks should be established during planning and preparedness so that all relevant sectors can contribute before an emergency occurs, and so that communication can be tested to be sure that the intended audience understands it. Option If communications networks are set up during an emergency, continual evaluation of activities allows for adaptation and improvement both during the emergency and when performance is evaluated afterwards. Many countries and regions have established multisectoral networks of communications staff as part of planning and preparedness. These groups work together with stakeholders, including the media, to plan response to events and emergencies. As well as developing advice and messaging, such networks can also provide mutual support for staff and access to a range of different stakeholders. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries 80 5. The best way to engage with affected and hard to reach populations must be considered, as they need to know how to protect themselves. Identifying and analysing risk factors Risk factors are things that contribute to the likelihood or impact of both priority zoonotic diseases and zoonotic disease events and emergencies. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries 81 5. Pathogens can spread through water and soil to people and animals, and events that disrupt the environment, including natural disasters, increase the risk of zoonotic outbreaks (e. Identifying potential risk reduction practices and establishing strategies and plans for coordinated risk reduction Ways to reduce the effect of each risk factor in each situation are identified jointly by all relevant stakeholders. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries 82 5. An example of coordinating risk reduction and communication risk reduction practices is described in the box. Example: Coordinating risk reduction and communication Transmission pathways and risk factors are unknown for some zoonotic diseases. In these cases, authorities may be under pressure to intervene before there is enough information to know what is best to do, and actions taken under these circumstances may have unintended consequences. Risk reduction and risk communication activities should be planned and implemented taking a multisectoral, One Health approach, as well as be consistent, based on scientific evidence, and culturally appropriate. Risk communication strategies should be regularly evaluated to increase the likelihood that risk communication will be accepted and lead to behavior change. Developing a joint risk communication and community engagement strategy and plan the best way to develop and implement risk reduction strategies, risk communication and community engagement is for communications staff to work alongside technical experts to share knowledge, advice and opinions. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries 83 5. Jointly developing key messages to ensure consistency All stakeholders should work together to develop the messages for communication about zoonotic diseases.

In the followang pages we include under the urinary findings of cystitis those which the kidneys contribute. Organisms introduced very resistant, and therefore hard are quickly gotten rid of, and seldom this resistance to infection seems explained set up an inflammation. Most organisms can by the gain foothold there only after some predisposing factor has lowered the resistance of the bladder wall. Among these conditions favoring infection may be mentioned, the irritation from a calculus a posterior is; gonorrhoeal ureteritis; and especially the retention of urine from any cause, such as childbirth, enlarged prostate, urethral stricture, spinal cord disease, and prolonged narcosis. If to these conditions be added frequent catheterizations the chances of a cystitis are excellent. There is another origin of infection which just now is attracting considerable attention; we refer to a direct extension from the rectom. The urine is acid; there is a variable amount of, and often considerable, pus present, and cultures made from the urine are negative. All persistent, acid pyurias in the young are presumably tuberculous sterile until the contrary is proven (Kelly); and all pyurias are of either tuberculous or gonorrhoeal origin. It is easier to demonstrate the tubercle bacillus in tuberculous cases than the gonococcus in the gonorrhceal. There is another interesting group of very early cases of tuberculous cystitis in which practically no pus is present in the urine. It may persist for a few days and then not reappear until after an interval of weeks. The tubercle bacilli should be looked for urine is clear, rather highly colored, but with the last of the voiding are usually seen a few drops of blood. It is ureteritis important to remember that cases of tuberculous prostatitis and may so resemble tuberculous cystitis that only a cystoscopic will decide the question. A definite cystitis may develop as part of an acute urethritis and clears up rapidly, unless we include most of the cases of acute trigonitis. The gonorrhoeal and tuberculous types are the two which seem exceptions to the rule that pyuria is an almost invariable symptom of cystitis. It is very difficult indeed to demonstrate the gonococcus sequel of this condition. Secondary pyogenic infections superimposed on a gonorrhceal cystitis are a not uncommon Proteus cystitis is a common and very distressing form. This seems almost the only organism which when introduced into a normal bladder will set up a cystitis (Melchior). The urine in these cases is very alkaline, and the abundant pus is transformed into a ropy, sticky, mucoid material. Certain cases of tuberculosis and of gonorrhoea are possible exceptions As already mentioned, the source of much of this pus to this rule. When this is acid, the pus cells are well preserved, somein the first glass, and least in the glass. In chronic cystitis due to the colon bacillus and Staphylococcus albus and other organisms with slight virulence the urine may be acid or alkaline. W^hen the urine is alkaline the phosphates are precipitated, the pus cells transformed and the odor becomes alkaline and foul. Red blood cells are numerous in the urine of cases of acute cystitis and vary in number with the acuteness of the attack. The larger haemorrhages come from the kidney, from vesical tumors, or especially from the prostatic urethra. In gangrenous cystitis fragments of the epithelial and muscular coats of the bladder are expelled in the urine. In hemorrhagic cystitis there may be much bloody infiltration of the bladder wall. They occur especially after traumatic or operative opening of the bladder and are usually terminal events. An interesting problem for the clinical laboratory workers to decide is how well justified is the statement, frequently heard, that changes in the reaction, the specific gravity, and the amounts of normal constituents of the urine are important in lowering the resistance of the wall of the bladder to infection.

In the video "This Is Our Creed," Shekau presented a rudimentary Salafism: Our creed is the creed of our Messenger, may God bless him and grant him peace. Lanre Odo and Kwasi Kpodo, "Suspected Boko Haram Gunmen Kill Emir, Policemen in Nigeria," Reuters, May 30, 2014. Abubakar Shekau, "Risala ila al-Za`im al-Musamma bi-Malik Kano," December 2014. Andrea Brigaglia, "Note on Shaykh Dahiru Usman Bauchi and the July 2014 Kaduna Bombing," Annual Review of Islam in Africa, no. Then Shekau turned to the issue of takfir, or declaring other Muslims unbelievers. Oh people of the world, repent to Allah Most High and if not, you will see what you see. And He has said, "Whoever does not rule by what God has revealed, they are the unbelievers" (5:44). Yet the concept "Boko Haram" encompasses a broader critique of Nigerian society, targeting the perceived fruits of such schools. Boko Haram is not alone in resenting the highly educated Nigerian elites who have failed to deliver prosperity to the majority of Nigerians. Some Muslims in the North, where classical Quranic and Islamic education is a powerful social force, feel ambivalence toward Western-style institutions of learning. On the other hand, some Northern Muslims believe Western-style schools fail to inculcate Islamic values. It rejects compromises such as "Islamiyya" schools that blend government curricula with religious instruction. Children of different genders interacted at school, promoting "fornication, lesbianism, homosexuality, and other [corruptions]. In diverse ways, most Northern Muslims believe that Islam provides policymaking frameworks that should shape public life. Sharia implementation was led by politicians who belonged to major, non-Islamist political parties, and the effort drew support from diverse constituencies, including Sufis, Salafis, and unaffiliated Muslims. Many proponents of Sharia considered it compatible with a federal, democratic system71-they called for elected politicians to enforce Islamic law, rather than for a theocracy in which unelected clerics would rule. Muslim activists in 21st century Nigeria have often contended that "Islamic" courts, banks, state-subsidized pilgrimages, and other institutions can co-exist alongside secular institutions at both the state and the federal level. For their part, non-jihadi Salafis sometimes hold government appointments or offer public "advice" to politicians, indicating their basic acceptance of electoral politics and a secular framework for government. For Boko Haram, politics entails total commitment to the idea of Islam as a societal blueprint. Brandon Kendhammer, "The Sharia Controversy in Northern Nigeria and the Politics of Islamic Law in New and Uncertain Democracies," Comparative Politics, vol. He warned that majority rule allows for agreement on an error, whereas Islam demands obedience to the Quran and the Sunna. From democracy, he continued, multiple evils flowed, all of them cloaked as freedom: for example, "freedom of belief " allowed for apostasy from Islam. Democracy "is the school of the infidels: following it, having dealings with it, or using its system is unbelief. In one message, Shekau contrasted his faith in God with the National Pledge recited in government schools: "You are worshipping the nation," he told listeners. The only suitable response is to violently oppose that system: "Know, people of Nigeria and other places, a person is not a Muslim unless he disavows democracy and other forms of polytheistic unbelief (shirk). Boko Haram, "Min dunihi fa-Kiduni thumma La Tanzurun," May 5, 2014: Saharatv, "Boko Haram Leader Shekau Releases Video On Abduction of Chibok Girls," YouTube video, May 5, 2014. He mentioned famous MuslimChristian clashes: the 1987 riots in Kafanchan, Kaduna State; the 1992 killings in Zangon-Kataf, Kaduna; and cyclical violence in Plateau State, dating to 1994. Likewise, the infidel and the hypocrite will not give up his polytheism and his craftiness.