By about 4000 B.C.E., some people had settled to farm south of the Sahara. The earliest farming communities were comprised of extended families, which included close relatives, such as grandparents, as well as aunts, uncles, and cousins.
An extended-family community might have had about 15 to 20 members. Each community produced most of the things it required. Family members worked together to clear the fields, plant seeds, and harvest crops. These small communities traded with one another for additional goods. Very likely, one of the male elders made decisions for the family community.
The geography of West Africa influenced the patterns of trade that developed there. Different resources are found in each of the vegetation zones. As a result, people living in different zones had to trade to acquire items they could not provide for themselves. For example, people on the savanna may have traded grains for yams or mahogany from forest dwellers.
While several major rivers served as trading routes in West Africa, the region's longest river, the Niger, became a kind of trading highway. People in ancient times traveled the Niger and other rivers by canoe to trade goods. Some traders also crossed the Sahara from North Africa, but most early trade was among West African settlements.
In the north, West Africa begins in the Sahara. To the west and south, the region is bordered by the Atlantic Ocean. To the east, it is bordered by the mountains of the present-day country of Cameroon. West Africa includes varied vegetation zones of desert, semidesert, savanna, and forest.
The Sahara spreads across approximately 3.5 million square miles in North Africa and the northern part of West Africa. Although sand dunes cover one-quarter of the Sahara, this desert also has bare, rocky plains, and even mountains. The Sahara is very dry except for some scattered oases, or water sources with some vegetation, so it was not a suitable location for large settlements.
People have lived in West Africa for tens of thousands of years. For most of this time, historians do not have written records to study. Muslim scholars first began writing about the kingdom of Ghana in the 800s. By then, Ghana was perhaps 300 years old, and possibly much older. How did the first kingdoms arise? Why did they develop where they did?
To answer questions like these, historians and archaeologists study many kinds of clues. For example, they look closely at geography. Natural features, such as rivers and vegetation, help explain why people chose to settle where they did and what kind of life they created for themselves.
Subjective
Pt:
DOB:
CC: Patient presents for well adult exam.
HxCC: Patient’s last well adult visit was 1 year ago. Did the patient have blood work, colonoscopy, mammogram, PAP smear? What were the results of this test? Have there been any changes to your health in the last year? Do you present with any new concerns today?
PMHx: Do you had any significant medical issues in the past? Hospitalizations/Injuries?
Chronic Disease?
PSHx: Any hx of surgeries in the past?
Ob/GYN: When was your first period? When was the first day of your last period? Is your cycle regular? Have you previously been pregnant and if so, what were the outcomes?
Immunizations: Have you received your childhood vaccinations? Have you received a recent flu shot and a Tetanus shot in the last 10 years?
Medications: Do you take prescription medications, OTC medications, or supplements?
Allergies: Do you have allergies to drugs, food, or the environment? Family Hx: How is the health of siblings, parents, children or grandparents
Social Hx: Living situation, Occupation, Nutrition, Exercise, Caffeine, Tobacco, Alcohol, and Recreational Drug use?
ROS -> I am now going to ask series of yes or no questions in relation to your body systems
General: Denies recent fever, fatigue, and weight gain/loss Integumentary: Denies rashes, hair loss, nail pitting
Head: Denies headache, hx of traumatic head injury, dizziness
Eyes: Denies changes in vision, eye pain, excessive tearing
Ears: Denies loss of hearing, tinnitus, and earaches
Nose: Denies congestion, bloody nose, and loss of olfaction Mouth/Throat: Denies difficulty swallowing, sore throat, tooth pain Neck: Denies restriction in ROM, neck pain, and palpable goiter Chest/Breast: Denies breast pain, nipple discharge, and breast lesions Cardiovascular: Denies chest pain, palpitations, and peripheral edema Respiratory: Denies dyspnea, cough, and wheezing
GI: Denies nausea, vomiting, diarrhea
GU: Denies OAB, gross hematuria, and incontinence
Sexual: Denies hx of STDs, genital lesions, dyspareunia
MSK: Denies joint pain, muscle stiffness, and back pain
Neurological: Denies paresthesia, numbness, and muscle weakness
Endocrine: denies intolerance to cold, excessive thirst, excessive sweating
Heme: Denies hx of blood transfusion, excessive bleeding, and excessive bruising. Psych: Denies feelings of depression, anxiety, and changes in mood.
Objective:
Vital Signs:
Blood pressure:
Vascular: Radial and Dorsalis Pedis pulses +2/4 bilaterally
General: Patient is pleasant and cooperative, in no distress, and appears alert
Heart: HRRR with no murmurs/rubs/gallops
Lungs: Clear to auscultation bilaterally. No wheezing or crackles.
Osteopathic: Red reflex in-tact. No tissue texture changes. Excessive kyphosis.
Integumentary: Skin warm and dry. Hair of normal texture. Nails without clubbing or cyanosis.
Head: Normocephalic, Scalp without lesions
Eyes: PERRLA, EOMI, and sclera white. Optic vasculature visualized and normal
Ears: Tragus non-tender. TM’s fully visualized and without erythema.
Nose: Septum midline, mucosa moist and pink.
Neck: Trachea midline, no goiter present, and no lymphadenopathy present. Throat: Oral mucosa pink, dentition in good repair, and pharynx without erythema.
Assessment
1. 22-year old annual well adult
2. Tobacco use disorder
3. Thoracic kyphosis
Plan
1. Discussed nutrition
2. Discussed smoking cessation
3. Discussed follow-up in 1 year or sooner if symptoms arise.
Shaurya Patel, OMS-I 10/01/2024 10:45
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General - Fever, Fatigue, Changes in weight
Integumentary - Nail clubbing or pitting, hair loss, rashes
Psych - down or depressed, hopelessness, thoughts of harming self or others
Head - headaches, palpable masses, head trauma
Eyes - drainage, blurry vision, changes in vision
Ears - changes in hearing, ringing ears, ear pain
Nose - runny nose, congested nose, bloody nose
Neck - Decreased ROM, palpable masses laterally, neck pain
Throat - difficulty chewing or swallowing, pain with chewing or swallowing, last dental appointment?
MSK - pain in joints, swelling in joints, changes in mobility
CV - palpitations, tachycardia, chest pain
Chest - Nipple discharge, chest tenderness, palpable masses
Heme - Abnormal bruising, hx of transfusions, anemia diagnosis
Pulm -difficulty breathing, pain with breathing, coughing
Endo - increased hunger, increased thirst, temperature intolerance
GI - Diarrhea, constipation, nausea
UI - increased urination, blood in urine, pain with urination
Sexual - new genital discharge, genital rashes, or hx of STIs
Neuro - numbness or tingling, dizziness, muscle weakness
nerothecat
Regarding holding multiple defendants liable for negligence when their actions confuse the causation.
If D is a substantial enough factor in causing the harm, D can be found liable, though the proportion of fault may differ.
Precludes certain public employees from recovering against a defendant whose negligence caused the employee’s on the job injury.
In determining whether an activity is dangerous the D’s activity creates a reasonably foreseeable and highly significant risk of physical harm even where reasonable care is exercised by all actors; and the activity is not one of common usage.
an employer is strictly liable for the tort of their employee that occurs within the scope of the employee’s employment.
In conclusion, it is undeniable that there are a variety of opinions about this topic. However, after considering this matter in a careful manner, it can be concluded that each side of the debate has its strengths, as discussed above.
In contrast, it is commonly known as the fact that the main idea can harm/benefit our communities. Nevertheless, the statement does hold water to some extent. Moreover, it should be pointed out that there are various concerns/advantages, such as ex3 and ex4. Furthermore, these examples can be significant factors that ought to be considered.
First of all, it is quite reasonable for me to believe that the idea of promoting keyword provides several merits. The first point with regards to the issue is that the benefits of main idea have contributed to the advancement of the subject; ex1 and ex2 would be convincing examples to name but a few. As a result, topic can be beneficial for both old and new generations across the world.
Recently, keyword has become the subject of heated debate. Some people assert that the main idea, while others argue otherwise. Personally, I believe that both arguments should be given equal weight. In the following essay, the evidence supporting this contention will be discussed alongside relevant examples.
"News that a colleague's baby has taken some first tentative steps usually merits little more than
polite congratulations or an obligatory glance at some e-mailed images. When Nadrian ("Ned")
C. Seeman and William B. Sherman of New York University recently made such an
announcement, however, it earned coverage in several scientific journals. The attention had to
do with the new walker's size, which is very small for its age-or any age. A pair of legs and feet
constructed from DNA strands, the walker stands just 10 nanometers tall-or roughly 1/25,000
the diameter of the period that concludes this sentence. Seeman says the walker's stroll along a
DNA sidewalk is "a natural outgrowth of work that's been done before. Seeman and Sherman,
who christened their pride and joy A Precisely Controlled DNA Biped Walking Device, make
clear that the walker has no practical application. And even, though he calls it "the robot,
Seeman seems wary of characterizing it as a harbinger of submicroscopic automation. He does,
however, see the possibility of some practical uses. "We're going to look at longer sidewalks," he
says. "Eventually we might have it try to carry a load. We'll probably also look into using it for
polymer deformation-maybe using circular sidewalks and have them holding strands and
twisting or braiding them." Bragging rights and applications aside, Seeman sees the walker as
one more event in an accelerating series that is transforming nanotechnology from science
f
iction to science fact-developments that are making nanotechnology a very exciting field to be
in right now. "I figured out this was going to be fun in 1980," Seeman says. "Now that I've been
working in this area for nearly a quarter of a century, it's really starting to snowball." " how many words in this peragraph
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