Transcript: Candace, Kira, Krystal A Child Who is Palliative What is Palliative Care? "Palliative care for children begins when an illness is identified and analyzed, and continues during the entire illness trajectory, aiming to alleviate physical, psychological, and social suffering" (Melin-Johansson, Axelsson, Jonson Grundberg & Hallqvist, 2014, p.61). What is Palliative Care? Similarities: Palliative care can be initiated at the beginning of an illness along with treatments aimed to cure Aims to improve quality of life Caregiving teams aid in decision making and establishing care goals Palliative care invloves many different disciplines Pediatric .VS. Adult Palliative Care Pediatric .VS. Adult Palliative Care Differences: Serious illness is not a "normal" condition for most children Medical decisions for young children are often made by their caregivers Pediatric palliative care can include play therapy, child life therapists and child behaviour specialists getpalliativecare.org Benefits of Palliative Care Benefits of Palliative Care Support Communication Comfort -Focuses on the whole child, while understanding how varying forms of treatment can affect the family as a whole -Support every step of the way, not only just a means of controling the childs symptoms, but also helping families understand treatment goals and options -Palliative care also ensures that children are provided with support through the maintinence of symptoms - Palliative care provides family with an overall extra layer of support, during such a difficult time , it is a resource in itself for families -Bereavement support is also an aspect of palliative care after the child has died getpalliativecare.org Childrens ideas regarding Death, What does it mean for them? Childrens ideas regarding Death, What does it mean for them? Varies depening on: Age Developmental Level Age and Developmental Differences in Response ... Children in this stage have limited understanding regarding accidental events, future and past time, not able to make discrepancies between living and nonliving - Outlook is that life is continuous with death, considered alternate states much like sleep and awake Age and Developmental Differences in Response to Death 1-3 Years 3-5 Years Concepts during this stage are crude and irreversible, unable to distinguish between reality and fantasy - Notion that death is reversible, because of child's egocentricity they are often convinced that they caused the death. Often death can be viewed as a personified entity (Bogeyman) 5-10 Years Thinking begins to become organized and logical, leading to some problem solving but child still lacks abstract reasoning - Child can percieve death as permanent and real. Sometimes may be unaccepting that death can happen to them or any of the people they care about, even though they are starting to know that people will die 10-13 Years Formal logic is starting to be incporated into thinking as well as abstract thoughts - Death viewed as real, final and universal. During this stage children may become more interested in the details such as the funeral, special care must be given to this age group as they will need to be provided with reassurance that they are cared for and loved Thinking is more refined and abstract, allowing this age group to vent emotions is very important - Mature and adult concept of death, may start to view death as an enemy at which they plan on fighting against or dealth can be percieved as failing and may present in this age group as giving up. 14-18 Years Hurwitz, C. A., Duncan, J. & Wolfe, J. (2004). Caring for the child with cancer at the close of life: "There are people who make it, and I'm hoping I'm one of them". Journal of the American Medical Association, 292(17), 2141-2149. Children's Subjective Experiences and Daily Struggles Children's Subjective Experiences and Daily Struggles Therapeutic Communication Emotional Support Physical Comfort Diversional Therapy Therapeutic Play Maintain Self Esteem (Adolescents) What Nurses can do for Children? What Nurses can do for Children? Familie's Subjective Experiences and Daily Struggles Familie's Subjective Experiences and Daily Struggles Financial Strain Emotional Strain (Frustration, Guilt) Breakdowns in Family Structure (Siblings, Spousal Roles) Lack of Self Care Loss of Caregiver Role Communication Empowering Normalization Support Encourage Self Care Encourage Respite Support (Resources) What Nurses can do for the Family? What Nurses can do for the Family? Resources Resources Courageous Parents Network Courageous Parents Network Normalize the Grief (Facilitate Positive Coping) Therapeutic Communication Create Memories Cultural and Spirtual Needs Bereavement Support Bereavement Support Gottlieb's 8 Core Values Gottlieb's 8 Core Values
Transcript: 3 Inpatient Wards - Day/Night 1 PICU 6 Elective 2 Emergency Department 1 Acute/Pediatric After Hours Employee Benefits Health Insurance No monthly premiums! Expedited Appointments with GatorCare Access to on-site acute care Life Insurance Malpractice Insurance Disability, Accidental Death, Dismemberment Insurance 15 Days of Annual Vacation + 1 week during the December holidays 10 Days of Annual Sick Leave 5 Conference Days Roll over permitted* $850 Educational Stipend over 3 years Free Meals! Residency Program Outcomes Things to do in Gainesville Silver Tower Square (SW Gainesville) 2014 Graduates Where are they Now? From Learning to Achieving... Fellowships available at the University of Florida Additional Perks EMR system inpatient and outpatient iPads! Education resources (Health Science Library) FREE AAP membership AAP Legislative Conference/Advocacy Summit Present your Research for free! CATCH Grants Orange 4 weeks per rotation, 13 rotations per year Three Locations In 2014, 9 of the 15 graduates entered into subspecialties including Neonatal-Perinatal, Critical Care, Endocrinology, and Cardiology 4 weeks, 13 Rotations PICU Gold Nicole Paradise Black, M.D., M.Ed. Program Director $52,431 Research Track Pediatric Emergency Department & Pediatric After Hours Clinic Established 2011 Pediatric After Hours Clinic 2015-2016 Diabetes Camp Daphna Barbeau WWW.PEDS.UFL.EDU Scott Rivkees, M.D. Department Chair $50,696 2-3 PL1s & 1-2 PL2s Capped at 8 pts 6th Busiest in FL All Resident Retreat! 5 Inpatient Ward Day and/or Nights 2 NICU 1.5 Electives 1 Cardiology 1 Gastroenterology 1 Newborn Nursery 1 Adolescent or Development 0.5 Advocacy Emergency Department NICU International medical care training with a focus on sustainable care Electives in Epidemiology, research, tropical medicine, health problems of international travelers and beyond Targeted educational and research opportunities abroad in Central and South America with potential for travel to other continents Gastroenterology Primary Care Track Average of 69 per day (and climbing) Conferences 7 full-time attendings and several nurses dedicated solely to the Pediatric Emergency Department Inpatient Team Structure Continuity clinic is the same 1/2 day each week Residents have their own panel of patients One preceptor throughout their residency Open to residents interested in biomedical research as part of their career ABP Integrated Research Pathways (IRP) program option Opportunity to earn a Ph.D. during residency (if desired) or further research pursuits if a Ph.D. is already attained 3-6 months of dedicated research time with potential up to 11 months if part of the IRP program Future Chief Residents All Residents Retreat Senior Dinner Diabetes Camp Inturmural Sports So much more... Medical Education Track Rheumatology Hematology PGY2: 1/2 Way There 4 selective rotations built into first two years 6 months of individualization 5 residency tracks Hank Rohrs, M.D. Associate Program Director Rotation Schedule Green “The Full Nelson” Curriculum designed to encompass all of Nelson’s Textbook of Pediatrics in 18 months All residents complete the curriculum twice over their 3 years Periodic self-assessments with review of questions and answers Residents can identify their own strengths and weaknesses 3 Green Team 2 Acute / Pediatric After Hours 2.5 Electives 0.5 Advocacy 1 Adolescent or Development 1 Emergency Medicine 1 Newborn Nursery 1 PICU 1 NICU Outpatient Clinics Maureen Novak, M.D. Vice Chair of Medical Education Arwa Saidi, M.D., M.Ed. Associate Program Director Thank You! Hospital-within-a-Hospital PGY 3: Senior Residents 175 bed hospital to be built in phases from 2010 - 2015 It all starts here. 64 pediatric medical/surgical beds with flex capacity of 88 52 bed Level IV / III / II Neonatal ICU 46 bed PICU and CICU 5 private exam rooms Allison Ast, M.D.-Heme/Onc-Univ of Utah Nancy George, M.D.–Child Neurology–UT SW Sarah Irani, M.D. – Sports Medicine–Bayfront Health Ricardo Medina-Centeno, M.D.–GI–UT SW Sina Ogholikhan, M.D.–GI–Johns Hopkins Nasim (Moshtagh) Reedy, D.O. – Allergy/Immunology-Washington University Markus Renno, M.D.–Cardiology-Vanderbilt University Ryan Stokes, M.D.–Neonatology–University of Texas Rochelle Wilson, M.D.-Endocrinology Fellowship–UT SW All Resident Retreat WARDS Separate check-in and waiting areas Entering General Pediatrics Family-Patient Centered Care Opportunity to do extended outpatient experiences Conferences Welcome to the University of Florida!!! Global Health Track Children's Medical Services (Central Gainesville) Every 4th night call (PL2/PL3s) Approx. 5-8 pts Phase 1 - Completed 2010: Oncology/ Immunocompromised Units on 4th Floor Phase 2 - Completed 2011: Pediatric Emergency Department & PAH Clinic Phase 3 - Completed 2014: 10th Floor Dedicated to Specialized PICU Units and refreshed pre- and post-operative areas (January); Dedicated, Distinct Entrance, Lobby, & Elevators (July). Phase 4 - Renovation of 3rd Floor
Transcript: Source of E v i l Riley Pries, Lauren Maloff, Cassie McRoberts, Alyssa Cooley, and Marlie Bloomster Where Does Evil Come From? Where Does Evil Come From? Nature Nurture Supernatural Nature Nurture Supernatural Nature A popular and contriversial answer is that evil is a subject of genetic influences or occurences in the body. Whether through DNA, or mistakes in the brain, the source of evil is being investigated in today's world. Nature Genetics A 2002 Study found that... - A particular variation of a gene predicted antisocial behavior in men who were mistreated as children. - The gene controls whether we produce an enzyme called MAOA (abbreviation) which at low levels has been linked to aggression in mice. - Boys who were neglected and who possessed a variation of the gene that produced low levels of MAOA were more likely to develop antisocial personality disorder, commit crimes and grow up to have a violent disposition. - Those living in a similar environment who produced more of the enzyme rarely developed these problems Genetics Split : Kevin Wendle Crumb - Mental illnesses are the reason for Kevin’s violent and inexplainable decisions - It is not Kevin, the biological being of that body, but rather the alter egos that live in his mind who chose to be evil. - Your brain no longer follows the commands you give it, that your senses can’t be trusted, that you’re at the mercy of internal forces you can’t comprehend or control Psychology Psychology - Aversion therapy that makes him violently ill at the thought of sex or violence, it is only the Prison Chaplain who stands up for him, claiming that the practice that has taken away Alex's ability to choose is itself criminal. - This leaves the viewer with the takeaway that Alex should be free to choose his path - even if it is one of pure evil. - “Everyone has the right to live and be happy” – Alex’s reply to convince someone else that what he was doing wasn’t wrong - Control vs. Human Nature A Clockwork Orange A Clockwork Orange Nurture Evil comes from our childhood surroundings. From parental influences, events or tramas, or even geography. Ultimately, people are shaped by their experiences. Nurture Evil in Disney Films Beauty and the Beast : The Prince - Mother's death - Father's negitive influence Tangled : Fylnn Rider - Orphanage - No parental guidance Evil in Disney Films Harry Potter : Voldemort - No parents - Orphanage - Thirst for power - Desire to be evil Superman : Lex Luther - Started with good intentions - Harsh childhood - Jealousy - Desire to be evil Evil in Film Evil in Film Supernatural Religion and Supernatural Forces play a huge role in providing us with the answers to where Evil comes from. The Religious and Supernatual anwsers to the origin of evil are demonstrated all throughout pop culture. Supernatural Religon Origin of Evil from the perspective of: Christianity Hinduism Christianity's Explanation shown in pop culture: Movies: Angel Heart, Hercules, Little Nicky, and Legend Music: Sympathy For The Devil, Runnin' With The Devil, and The Devil In Her Heart. Hinduism's Explanation shown in pop culture: Movies: The exorcist, Demon, The conjuring, and Sinister Music: Demons by Imagine Dragons Religon Origin of Evil from the Supernatural: Paranormal- Stranger Things Spirits and Demons- The Conjuring Dark Magic- Snow White and the Seven Dwarves Voodoo- The Princess and the Frog Paranormal Paranormal In Review... Genetic Makeup Childhood Environment Supernatural In Review... To sum it up.. To sum it up.. THE END THE END
Transcript: AFFÄRSIDÉ FRAMTID PRODUKTION 070-209 27 45 firstname.lastname@example.org beenaturaluf Bee Natural UF
Transcript: A Day in The Life: By: Andrew Leslie, Fabio Soares, Hannah Bernard, Sancia Ackie & Shian Henry PEDIATRICS They require care from a Pediatric Nurse with specializ... Children are “our most defenseless and vulnerable population….,” Feeg, V. (1999) according to Jacqueline Gonzalez, in an issue of Nursing Spectrum They require care from a Pediatric Nurse with specialized knowledge, skills and abilities, to ensure efficiency and advocacy for the child True Or False?: 'I love working with children so I'm most definitely capable of pursuing said career specialty!' False! Skills & Abilities Skills & Abilities Lifestyle & Impact " [Health care providers] have the enormous privilege of touching and changing lives” (Rubin, 2013) so it's important to know how your own life is about to change. They work 45-60 hrs/wk Work in a variety of settings (hospitals, clinics, academic) 36% of pediatricians asked in a survey conducted by MedScape Lifestyle said they were very happy with their job Finding balance is very very hard, but not impossible! Lifestyle & Impact TRENDS & OUTLOOKS *No governing body specific to pediatrics in Ontario TRENDS & OUTLOOKS •24 current job openings currently in Toronto which is higher than anywhere else in Ontario. (Job Bank, 2017) • The current outlook looks to be fairly average, as it is expected that the field will neither increase or decrease in demand. (Ontario Labour Market, 2017) • Although the projected job openings seem to be coming mostly from retirements instead of new jobs being created. (Ontario Labour Market, 2017) This is likely because people tend to be more comfortab... As expected, the gender ratio in this field is about 59% female to 41% male and the number of females has only been increasing in the last 10 years. This is likely because people tend to be more comfortable bringing their child to a female practitioner (CMA Masterfile, 2016) An interesting trend in the recent world of pediatricians ... An interesting trend in the recent world of pediatricians is dealing with kids and “screen time”. This is how much time a child spends in front of screens. Apart from psychological health impacts, there is strong association between screen time and body mass index. As well as sleep problems for children. Education, Certificates/License Education, Certificates/License 1 YR 4 YRS 4 YRS 4 YRS Pre Health Science Medical School Undergraduate Residency *Potential fellowship opportunity EMPLOYMENT & SALARY INFO EMPLOYMENT & SALARY INFO Employment Organizations: Canadian Pediatric Society Medical Council of Canada Ontario Medical Association 46% of Employment opportunities for specialist physicians are in Toronto 44% of specialist physicians are self employed Unemployment rate is 1.6% Salary: Entry: $132,000 Average: $188,071 Experienced: $263,000 Works Cited Interactive, E. (n.d.). Pediatricians - SchoolFinder.com! Retrieved July 29, 2017, from http://www.schoolfinder.com/Careers/Requirements/3111ped/Pediatricians Network, W. N. (n.d.). Job details. Retrieved July 29, 2017, from http://niche.workopolis.com/frontoffice/seekerViewJobDetailAction.do?sitecode=pl517&jobId=1513742&page=search&cid=N%7CC%7CDRCAREERS%7CWIDGET&country=CA&language=en Pediatrician - Toronto, ON - Job posting. (2017, June 28). Retrieved July 29, 2017, from https://www.jobbank.gc.ca/jobsearch/jobposting/23945959 Specialist physicians. (n.d.). Retrieved July 29, 2017, from https://www.app.tcu.gov.on.ca/eng/labourmarket/ojf/profile.asp?NOC_CD=3111#Wages Pre-Health Sciences Pathway to Advanced D iplomas and Degrees - Durham College - Oshawa, Ontario, Canada. (n.d.). Retrieved July 29, 2017, from http://www.durhamcollege.ca/programs/pre-health-sciences-pathway-to-advanced-diplomas-and-degrees (n.d.). Retrieved July 29, 2017, from https://www2-careercruising-com.gbcprx01.georgebrown.ca/careers/education/321 Government of Canada. (n.d.). Retrieved July 26, 2017, from https://www.jobbank.gc.ca/jobsearch/jobsearch?sort=M&searchstring=pediatrician&button.submit=Search Specialist physicians. (n.d.). Retrieved July 26, 2017, from https://www.app.tcu.gov.on.ca/eng/labourmarket/ojf/profile.asp?NOC_CD=3111#Wages 3111 Specialty Physicians . (n.d.). Retrieved July 26, 2017, from http://noc.esdc.gc.ca/English/noc/ProfileQuickSearch.aspx?val=3&val1=3111&ver=16&val65=specialist%20physician Society, C. P. (n.d.). Canadian Paediatric Society / Société canadienne de pédiatrie. Retrieved July 26, 2017, from http://www.cps.ca/en/ Works Cited Society, C. P. (n.d.). Canadian Paediatric Society / Société canadienne de pédiatrie. Retrieved July 26, 2017, from http://www.cps.ca/en/ Medical Council of Canada. (n.d.). Retrieved July 26, 2017, from http://mcc.ca/home/ Welcome to MD Financial Management. (n.d.). Retrieved July 29, 2017, from https://mdm.ca/md-wealth-management?gclid=CjwKEAjw5PDLBRD0rICj35CtqS4SJACH7bsyg9G8JAgt_nHS_GfbBXtlQZBRb-oig703XUlIUYeGSBoC-q3w_wcB Pediatrician salary in Canada. (n.d.). Retrieved July 29, 2017, from
Transcript: General: Denies unusual weight gain or loss, fever, fatigue, temperature sensitivity, chills, fatigue, and sweats. Skin: Denies rashes, hives, itching, pigmentation/texture changes, lumps, moles, nail changes, and masses. Head: Denies trauma, dizziness, injury, syncope, and LOC. Eyes: Denies familial eye disorders, photophobia, dryness, and redness. Ears: Denies infections, discharge, and pain. Nose: Denies congestion, snoring, mouth breathing, discharge, and epistaxis. Throat/Mouth: Denies difficulty swallowing, hoarseness, bleeding gums, or an abscess. Teeth: R.E. has no teeth as of today. Neck: Denies any swollen glands/masses, stiffness, pain, thyroid problems, or any movement limitations. Respiratory: R.E. has CHF that is currently being managed by Lasix. She follows up every 3 months with cardiology. She has been hospitalized twice with RSV/bronchiolitis and pneumonia and was on O2 in the hospital. Currently denies sputum, wheezing, coughs, asthma, expectoration, cyanosis, edema, dyspnea, chest pain, and lung infections. Cardiovascular: R.E. has a common AV valve with mild AV valve regurgitation beginning in the middle of the heart and jetting towards the lateral wall of the right atrium. The common AV valve has thick chordal attachments to the crest of the septum from the right sided valve. The chordal attachments split the flow across the VSD into two separate jets across the VSD. Small primum atrial septal defect with left to right shunt. There is also a small secundum atrial septal defect with left to right shunt. There is no atrial or ventricular enlargement. She is currently managed on Lasix. Her cardiologist is following up every 3 months and she will have surgery around her first birthday. According to her cardiologist, R.E. does not have any physical restrictions; she does not require endocarditis prophylaxis. Gastrointestinal: Denies Vomiting, diarrhea, constipation, abdominal pain or discomfort, jaundice. R.E produces formed, soft bowel movements. Genitourinary: Denies dysuria, frequency, polyuria, pyuria, hematuria, and vaginal discharge. Extremities: Denies reduced ROM, warmth, swelling, redness, and deformities. Neurologic: Denies syncope, seizures, tremors, postural deformities, spasms, paralysis, and weakness. Hematologic: Denies clotting problems, easy bruising, anemia, swollen lymph nodes, easy bleeding, transfusions, and other blood abnormalities. Endocrine: Denies polyuria, polydipsia, polyphagia, goiter, growth disturbances, excessive sweating and skin/hair changes. Ears- R.E. has small pinnae, no tenderness in tragus, pinna or mastoid process. Otoscopic exam clear cone of light, no discharge or redness. Nose- R.E. has a flattened nasal root, the patency of nares is good, no discharge or polyps Mouth/pharynx- Large tongue, no redness, ulcerations, bleeding lesions or exudates. Thorax/lungs- normal respiratory rate and pattern, chest symmetrical, no labored breathing, non-tender to palpation, lungs clear to auscultatation. Cardiovascular system- Systolic regurgitant murmur auscultated. RRR, temporal, carotid, brachial, radial, ulnar, femoral, posterior tibial, and dorsalis pedis pulses are all normal. Abdomen- No guarding or tenderness on palpation, bowel sounds are WNL. Soft abdomen to palpation. No masses or organomegaly. Musculoskeletal- Mild hypotonia in lower extremities. Full range of motion demonstrated in upper and lower extremities. Nervous system- facial expressions intact and normal. Her biceps and brachioradialis reflexes are intact. Antenatal: R.E was born to a 45 year old G3P2 healthy mother via C-section at 39 weeks gestation. Prenatal history was remarkable for Down syndrome suspected due to increased nuchal translucency. An amniocentesis was not performed. Mother had a healthy pregnancy with no complications. Mother is O+ blood type. Natal: Pregnancy was 39 weeks in length. R.E weighed 6 lbs 1 oz at birth. A C-section was scheduled at 39 weeks due to previous C-section in 2008. Mother had an epidural during the C-section. Neonatal: APGAR scores were 7 and 8 at 1 and 5 minutes respectively. There were no signs of jaundice at birth. No excessive mucus, paralysis, convulsions, fever, hemorrhage, or birth injury. At birth some dysmorphism was present which were suggestive of Down's. These included close set eyes and epicanthal folds. Chromosome analysis was completed which confirmed trisomy 21: 47, XX, +21. R.E had some difficulty feeding in the hospital, but after day one, she learned to latch on and suck. A systolic regurgitant murmur was discovered in the hospital, so family was referred to cardiology. A state newborn screen was completed and found to be within normal limits. R.E was d/c from the hospital with the mother three days after delivery. She weighed 5 lbs 14 oz. Commercial Break R.E. is a 7 month old Caucasian female with Down syndrome, VSD, ASD, and CHF. She is currently managed on Lasix. She has had two recent hospitalizations due to RSV/bronchiolitis
Transcript: Shared values and experiences make us community Need to embrace idea that we all stand for the same things Areas of community: diversity/inclusivity, values alignment, collaboration Student Involvement Survey outgoing leaders on issues facing community - survey focuses on four values Survey incoming leaders on areas of leadership development Pre-participation assessment What would success look like? Greek Advance: Why? Educate and instill core values of UF Greek community: Scholarship Service Leadership Community Learning Outcomes: Build relationships with officers from other councils Feel better prepared for leadership position Stronger understanding of relationships between councils and chapters Embrace core values of UF Greek Life and be comfortable influencing members to display actions in line with those values Betsy Adams June 17, 2013 Schedule Strengths and challenges Personal values vs. organizational values Accountability Increasing campus involvement Curriculum Development University of Florida Greek Advance Budget Post-Retreat Creating academic plans for chapters/councils Developing programs to focus on scholarship Recruit Additional Facilitators 4-6 facilitators Student Affairs staff, local volunteers, headquarters staff Pre-retreat training evening before Day 1: 8:00 am - Meet up 8:30 am - Depart 9:30 am - Arrival 10:00 am - Welcome 10:45 am - Small Group Session 1 12:30 - Lunch 1:30 - Keynote and workshop 4:30 - Break 5:00 - Updates 6:00 - Dinner 7:30 - Small Group Session 2 9:30 - Social Time Positive assessment results Council goals reflect experiences from program New partnerships occur because of the relationships created Elevated conversations - are leaders continuing the conversation after the retreat? Are behaviors shifting? Leadership Pre-Retreat Service Debrief sessions with councils Utilize sessions to create goals and action plans Follow-up with chapter presidents about plans Session highlights to advisors and national organizations Scholarship $4,000 Facility and catering $4,000 Speaker fees $1,000 Transportation $500 Materials $500 Miscellaneous Community Introduction to community engagement and service-learning Action plans for increasing service hours Incorporate service component into retreat schedule Day 2: 8:00 Breakouts 10:00 Small Group 11:30 Load Out 12:00 Depart $10,000 to spend:
Transcript: Helping Others Salary Flexible Schedule Notariety Effecting Positive Change Long Patient History Must diagnose a patient correctly It is important to note that during internship and residency years, while still learning, it is really not school and are getting paid for the work. -Providing medical care to minors from the point of birth to adulthood. -Responsible for the healthy growth and development of a child. -Ability to thoroughly examine every patient in order to determine whether or not there is a health condition that the child is suffering from. -Able to provide the appropriate treatment measures for a disease Pros Pediatrics The word pediatrics and its cognates mean healer of children; they derive from two Greek words: αῖς (pais = child) and ἰ(iatros = doctor or healer). -Four years of college -Four years of medical school -One year of a Pediatrics internship -Two years of a Pediatrics residency Description of Job Expose to deadly or contagious disease Cons
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