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银屑病关节炎患者就医行为及治疗现状的多中心调查

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牛皮癣是一种较常见的、顽固的、又极其令人痛苦的皮肤病，皮肤的症状只是表象，它的根源还是免疫系统的问题。

本篇文章系统地介绍了牛皮癣的原因、症状、常规疗法、自然疗法、饮食调理、精油疗法、牛皮癣的类型、并发症等，如果你真的关心并想有所了解，这无疑是一篇不错的科普文章。

牛皮癣（也叫银屑病）是一种慢性自身免疫性皮肤病，会导致皮肤发炎和结痂，大约会影响2%到2.6%的美国人口（约600万～800万人。而在中国，患者达约700万人）

正常、健康的皮肤大约每个月都会经历一次细胞更新，但如果你患了牛皮癣，皮肤细胞的更新速度很快，实际上会堆积在一起。

值得庆幸的是，可以通过遵循适当的、针对牛皮癣的饮食调理计划来帮助战胜这种情况。

我们知道牛皮癣始于免疫系统，涉及一种称为T细胞的白细胞。当患有牛皮癣时，T细胞会被错误地激活，变得过于活跃，导致不健康的肿胀和皮肤细胞的快速更新。

作为皮肤病领域的一个主要焦点，牛皮癣的症状可以因其形式而有所不同。你可能会认为牛皮癣只是一种令人讨厌的皮肤病，但它也可能导致牛皮癣关节炎，一种影响大约30%的牛皮癣患者的关节炎症。

传统的牛皮癣治疗方法可能有效，但通常作用不大，或者只是暂时的缓解，没有触及问题的核心。有许多治疗牛皮癣的自然疗法，但饮食是最重要的。

为什么牛皮癣相关的饮食如此重要？研究表明肠通透性或肠漏综合征在牛皮癣患者中非常常见。当谈到牛皮癣时，做出正确的食物选择会产生很大的不同。正如国家牛皮癣基金会所说，"快乐的饮食，快乐的生活。"我非常同意！

原 因

大多数医生不确定是什么导致牛皮癣，但许多自然疗法的医生已经找到了致病因素。

牛皮癣的原因包括：

免疫系统过度活跃（牛皮癣是一种自身免疫性疾病）

血液、真皮和表皮中的T细胞数量增加

如果想战胜牛皮癣，可以通过遵循健康和治愈牛皮癣的相关饮食看到很大的改善。

常 规 治 疗

牛皮癣被认为是一种自身免疫性疾病，在这种疾病中，身体错误地将自己的组织检测为外来物并攻击自己。当谈到常规治疗时，医生会考虑病情的严重程度、牛皮癣的类型和斑块的大小。如果一种疗法无效，并有不良反应，或者所有疗法都不起作用，医生通常会更换疗法。

常规治疗通常很困难，目前最常用的治疗方法是类维生素A或免疫抑制剂。后者通常是类固醇或环孢菌素，即使它们对治疗牛皮癣有效，也会带来令人担忧的副作用。

局部治疗是非常常见的，包括在有问题的部位涂上一层乳霜或软膏。另一个传统的选择是光疗法（light therapy），也被称为光照疗法（phototherapy），它结合使用来自太阳的天然紫外线和人造紫外线。

PUVA是一种光疗法，它结合了一种使皮肤对光更敏感的药物并暴露在长波紫外线光下。

当牛皮癣严重时，医生可能会采用全身治疗，这意味着要使用处方药或注射药物。牛皮癣的联合疗法采用局部涂抹、光疗法和全身疗法，所有这些都有副作用，而像牛皮癣相关饮食这样的自然疗法则不会。

牛皮癣的五种自然疗法

自然疗法或整体疗法的目的是从根本上解决问题。对许多人来说，抗炎食物与治愈牛皮癣的饮食相结合是自然治疗牛皮癣的最佳方法之一。

几十年来，人们一直在研究牛皮癣发生过程中肠道结构和功能之间的关系。一些专家认为牛皮癣实际上是由肠通透性引起的，特别是在十二指肠和空肠之间的区域。

因此，身体会通过皮肤来排除毒素。在这个模型中，牛皮癣代表着身体不顾一切地自我净化。以下是一些有助于对抗牛皮癣的自然方法：

1减轻压力

众所周知，压力在牛皮癣中也扮演着重要角色，这就是为什么身心疗法和压力管理确实可以帮助牛皮癣自然痊愈。祈祷、冥想和催眠都有帮助。事实上，研究表明，在接受光疗之前冥想的人比单独接受光疗的人有更好的结果。

2运动与喝水

这听起来可能太简单了，但是运动和多喝水是治疗牛皮癣的两种简单而有效的方法。

洗澡的时候，你绝对不要用太热的水，因为这样会使皮肤更加干燥和发炎。在含有死海盐、泻盐或燕麦的温水中浸泡15分钟可以帮助去除鳞屑和止痒。

一定要在刚洗完澡或淋浴后立即给皮肤涂上保湿霜，这样可以封住皮肤上的一些水分，帮助镇静和治愈牛皮癣斑块。

3局部疗法

有三种基于自然的局部疗法对牛皮癣有积极的效果：俄勒冈葡萄霜（10%），鳄梨和维生素B12霜，和芦荟霜（0.5%）。研究表明，使用Reliéva，一种含有俄勒冈葡萄提取物的顺势疗法药膏，对轻度至中度牛皮癣病患者有效且耐受性良好。

早期研究表明，一种含有鳄梨油和维生素B12的专利乳膏可能会减轻牛皮癣的症状。几项研究表明，含有0.5%芦荟提取物的乳膏优于安慰剂，且没有副作用。

4顺势疗法及其他

顺势疗法是另一种改善牛皮癣的天然疗法。研究表明，顺势疗法治疗牛皮癣患者可以改善症状和整体生活质量。

针灸和中药也可以帮助一些牛皮癣患者。在中医看来，牛皮癣被视为血瘀引起的健康问题。中医可能会开的一些草药，包括姜黄、莪术（类似于生姜）、当归、红牡丹和洋菝葜（拼音bá qiā，俗称金刚刺）。白蒺藜、苦参和蒺藜也可用于缓解牛皮癣相关的瘙痒。

如果你是阿育吠陀医学的粉丝，你可能会想尝试五业排毒（Panchakarma）疗法，这种疗法包括以植物为基础的疗法和旨在身体排毒的饮食改变。素食也经常被推荐。Panchakarma疗法包括食用酥油和药物灌肠。

5相关饮食

牛皮癣饮食是至关重要的。如果肠道有漏洞，那么部分消化的蛋白质和脂肪会渗透到肠道内膜，进入血液，导致过敏反应。如果没有修复，它会导致更严重的健康问题，如牛皮癣、抑郁、焦虑、偏头痛、肌肉疼痛和慢性疲劳。

研究表明，异常的小肠通透性和牛皮癣之间有联系。牛皮癣饮食有助于治愈肠道，从而结束牛皮癣及牛皮癣关节炎的痛苦。

牛皮癣相关饮食

想知道如何应用自然疗法摆脱牛皮癣吗？就像我一直说的，饮食是健康的基础，对于牛皮癣来说也一样。饮食不仅是治疗进行期牛皮癣的方法，也是预防牛皮癣的首要方法。

当谈到牛皮癣的自然疗法时，以下是定期食用的一些最佳食物。我也推荐这些食物给那些寻找牛皮癣关节炎饮食的人。你吃的治疗性的、抗炎的食物越多，皮肤就会越健康。

益生菌食品

食用富含益生菌的食物是帮助消化、清除体内毒素、减少炎症和提高免疫力的好方法。寻找有机的、未加工的、培养乳制品，如开菲尔、酸奶酪和有机蔬菜，它们能给你的身体提供健康所需的有益菌和酵母。

有大量关于益生菌治疗顽固性牛皮癣的个人报道，报道称对常规治疗没有反应。一位患者的脚后跟患了牛皮癣约10年之久，局部治疗无效。他开始服用益生菌，他的脚后跟变得干净，远离了牛皮癣。

高纤维食物

通过增加高纤维食物的摄入量，可以帮助保持消化系统健康，这有助于避免便秘并保持你的自然排毒过程处于正轨。水果、蔬菜、豆类和种子都富含纤维。

高抗氧化剂食物

与富含纤维的食物类似，富含抗氧化剂的食物包括：蔬菜、水果、香草、豆类和坚果。当提到抗氧化剂时，一些首选食物包括枸杞、野生蓝莓、山核桃、香菜和芸豆。抗氧化剂的摄入尤其重要，因为牛皮癣患者患癌症和心脏病的风险更大。

富含锌的食物

锌对保持皮肤健康至关重要。一些证据表明，锌有助于减轻牛皮癣患者的疼痛和关节肿胀。草饲的牛肉、羊肉，南瓜子、开菲尔和鹰嘴豆都是锌的重要来源。

富含维生素A的食物

想想橙色、黄色和深绿色的蔬菜。在你的日常饮食中加入这些"赢家"，将增加维生素A，这对皮肤愈合是至关重要的。哈蜜瓜、胡萝卜、芒果、西红柿、羽衣甘蓝、甘蓝菜和西瓜都富含维生素A。

野生鱼类

鲑鱼、鲭鱼、鲱鱼和沙丁鱼是维生素D和omega-3脂肪酸的极佳来源，它们都是改善牛皮癣的关键。临床证明维生素D有助于对抗牛皮癣。如果你患有牛皮癣，鱼应该是你生活中新的主要蛋白质来源，而不是肉类和传统乳制品。

研究表明，少吃富含蛋白质的食物，主要是肉类和奶制品，可能有助于缓解牛皮癣的发作。

生乳制品

生奶比传统牛奶更健康。含有丰富的维生素D和酶，可以治疗牛皮癣。

草药和香料

草药和香料是抗炎的，并含有抗氧化剂。姜黄素是一种被称为姜黄的香料中的活性成分，以其强大的健康特性而闻名。

2012年的一项科学综述特别指出，姜黄能够改变TNF细胞因子的表达，而TNF细胞因子在牛皮癣病变的开始和持续过程中发挥重要作用。这可能是为什么病人发现姜黄有助于减少牛皮癣和牛皮癣关节炎发作。

可以在食物中随意添加姜黄，要记住，美国食品和药物管理局认为每天摄入1.5到3.0克姜黄是安全的。

芦 荟

外用和内服，芦荟对身体非常舒缓，特别是对消化系统和皮肤。

在牛皮癣饮食调理过程中，一定要避免加工食品、单糖、酒精和传统乳制品、传统肉类、人造奶油（氢化油）和油炸食品。还应保持咖啡因的低摄入量。对于某些患者，无麸质饮食有助于改善症状。

如果你或你的医生认为你可能有麸质过敏或任何其他类型的食物过敏，那么食物过敏测试或一份排除饮食清单可以指导你在饮食中应避免什么。

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牛皮癣的五种自然疗法(上)

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牛皮癣是一种较常见的、顽固的、又极其令人痛苦的皮肤病，皮肤的症状只是表象，它的根源还是免疫系统的问题。 本篇文章系统地介绍了牛皮癣的原因、症状、常规疗法、自然疗法、饮食调理、精油疗法、牛皮癣的类型、并发症等，如果你真的关心并想有所了解，这无疑是一篇不错的科普文章。 ...

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IMPORTANT UPDATE: ​ All Santa Clara County residents age 65 and older are now eligible to be vaccinated at any vaccination site in the County, regardless of their healthcare provider. See below to book an appointment.

Current Vaccination in Santa Clara County:
Vaccine availability and eligibility is changing rapidly, and all vaccinations are by appointment only at this time. The County will update this website regularly as new information becomes available.
Healthcare personnel and Long-Term Care Facility residents
Phase 1B (Tier 1 - partial)
County residents 65 and older

Who is Currently Eligible to be Vaccinated?

All healthcare personnel and long-term care facility residents in Phase 1A are currently eligible to be vaccinated, as are County residents age 65 and older. The County does not determine vaccine eligibility. Following the State's priority phases and tiers, each provider decides which categories of patients they have the capacity to vaccinate at any given time. Some local healthcare systems are vaccinating residents 65 and older, while others are vaccinating a more limited population. See below for current details.

Individuals who are eligible to be vaccinated are encouraged to contact their healthcare system to make an appointment. Most healthcare providers below are now offering vaccinations to all county residents age 65 and older, regardless of their healthcare care provider or insurance. See below for scheduling options by provider.

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Who Will be Eligible to Receive the Vaccine Next?

The State of California has established phases and tiers for when different populations are eligible to receive vaccine. Information on who will be eligible next is available on the State of California's vaccination website. Check this website regularly for updates on the expansion of vaccine eligibility.
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Frequently asked questions

No. None of the normal steps in the vaccine vetting process were skipped in order to quickly develop these vaccines. Rapid development was possible because:

1. manufacturing started while the clinical trials were still underway (normally manufacturing doesn't begin until after completion of the trials);

2. mRNA vaccines are faster to produce than other kinds of vaccines,

3. FDA and CDC was and is prioritizing the review process for COVID-19 vaccines: and d) researchers used existing clinical trial networks to quickly begin conducting the COVID vaccine trials.

​​​

Individuals who have had a severe or immediate allergic reaction (e.g., anaphylaxis) to a previous dose of an mRNA COVID-19 vaccine or any of its components should not receive mRNA COVID-19 vaccination at this time, unless they have been evaluated by an allergist-immunologist and it is determined that the person can safely receive the vaccine. Persons with immediate allergic reactions to polysorbate or polyethylene glycol [PEG] should also not receive the vaccine.

Individuals with a history of severe allergic reaction (e.g., anaphylaxis) to any other vaccine or injectable therapy (e.g., intramuscular, intravenous, or subcutaneous) should consult with a healthcare provider before receiving the vaccine.

In addition, individuals with active COVID-19 disease should not receive the vaccine until completion of their isolation period and resolution of their symptoms.

Note: Individuals with a history of allergic reactions that are not related to vaccines or injectable therapies (e.g., food, pet, venom, environmental, latex allergies, or oral medications) can receive the COVID-19 vaccines. ​​​

Even if you received the vaccine, it is still possible to be infected with COVID-19 since no vaccine is 100% effective. In addition, it typically takes a few weeks for the body to build immunity after vaccination. That means it is possible a person could contract COVID-19 shortly after vaccination and get sick. This is because the vaccine has not had enough time to provide protection.

Also, while we know the vaccine is effective at preventing serious illness from COVID-19, we don't yet know whether it prevents you from becoming infected but asymptomatic. For all of these reasons, it is critical that everyone (including those who have been vaccinated) continue wearing face coverings and maintain social distance. It will take many months before we reach the level of vaccination needed in the community to provide community protection.​​​

Yes. We all need to do our part to stay safe while we wait for vaccines to be widely available, and for a sufficient portion of the population to be vaccinated. Our county, like everyone else, has received a limited supply to start. More will come over time. It may take many months before everyone in the Bay Area who wants a vaccine has gotten one. This means we all need to work together to keep our risk of COVID-19 low. We can do that by protecting ourselves and others by wearing face masks, keeping our distance, and not gathering in groups.​​​

The federal government has created a program under which CVS and Walgreens are responsible for vaccinating residents and staff in nursing homes and other long-term care facilities across the United States. Most of these facilities in Santa Clara County are participating in this federal program, which began vaccinations in our county on December 28, 2020. The few facilities in Santa Clara County that chose not to enroll in this program will have residents and staff vaccinated through the County and its partners. ​​​​​

COVID-19 vaccines are available at no cost, but they are only available to eligible individuals.​​​

No, but talk to your healthcare provider to find out how they plan to notify you when you do become eligible.​​​

The State of California sets the number of doses of vaccine that go to each county. The County Public Health Department is then directed to apportion a subset of these doses to healthcare providers in the County, according to directions from the state and federal government. Some other organizations with facilities in Santa Clara County get additional supplies of vaccine from the state or federal government. These organizations include federal government agencies and large health care systems that operate in more than one county (including Kaiser and Sutter/Palo Alto Medical Foundation). Large retail pharmacies receive additional supplies to vaccinate people who live in certain types of nursing homes, through a program organized by the federal government.​​​​

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How are COVID-19 vaccines allocated to providers in Santa Clara County?

This chart shows how vaccines are allocated to local vaccine providers in Santa Clara County.
​COVID-19 Vaccine Allocation in Santa Clara County Back to Top ▲

Federal government allocates vaccines to:

1. State of California

2. Private pharmacies (CVS, Walgreens) for long-term care facilities

3. Directly to the VA Palo Alto and Indian Health Center

The State of California then allocates vaccines to:

1. Multi-County Entities (like Kaiser and Palo Alto Medical Foundation/Sutter)

2. The County Public Health Department

Multi-County Entities allocate vaccine to their local clinics in Santa Clara County

The County Public Health Department allocates vaccine to the County Health System and other local health providers, like Stanford

A box shows all of the local vaccine providers:

1. Local PAMF and Kaiser Clinics

2. County Health System

3. Other providers (e.g. Stanford)

4. CVS/Walgreens local delivery for Santa Clara County Skilled Nursing Facilities/Long-Term Care Facilities

5. Indian Health Center and VA Palo Alto

Learn more about the vaccines

Fact Sheets issued by the U.S. federal government are available.
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More information about Fact Sheets.

Recent County of Santa Clara COVID-19 vaccine planning updates
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February 11, 2021 - Read press release regarding County of Santa Clara Launches Community-Based Drop-In Vaccination Clinics to Further Expand Efforts in Areas Hardest Hit by COVID-19

​​February 5, 2021 - Read press release regarding San Francisco 49ers and County of Santa Clara Health System Partner to Create Largest Vaccination Site in California.

February 4, 2021​ - Read press release regarding County of Santa Clara Launches New Vaccine Dashboard.

February 4, 2021​ - Read press release and watch press conference regarding County of Santa Clara Health System and Several Other Providers to Begin Providing Vaccines to County Residents Age 65 and Older, Regardless of Where they Usually Receive Care​​.

​February 3, 2021​ - Read press release regarding Vaccine supply shortages prompt public health leaders throughout the Bay Area to urge prioritization of older adults for vaccination.

January 26, 2021 - Read press release regarding County Health System's expansion to 65 and older population.

See vaccine news archive and older vaccine planning updates from County of Santa Clara

Partnerships are a key to the effort

The County is working with partners from healthcare and community organizations, as well as public officials and other groups. Planning for vaccine doses and how to provide them to communities will take a united effort . Part of our commitment is to share information with our partners and provide people with the information they need to make decisions about the vaccine.
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See COVID-19 vaccine planning for health care providers.

The County of Santa Clara's role in COVID-19 vaccination

The County Public Health Department is responsible for logistics, planning, procedures, and allocations so that COVID-19 vaccines can be effectively distributed to healthcare providers, who will in turn vaccinate their patients.
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The County is not responsible for developing or testing any of the vaccines. That falls to federal and state authorities. However, once vaccines have been fully evaluated and approved by the federal government, the County will make sure they are distributed according to the guidelines provided.

County vaccine news archive and past planning updates

See more recent County of Santa Clara COVID-19 vaccine planning updates.

January 22, 2021 - Read press release and watch press conference​ about launch of County vaccination site at Mountain View Community Center.

January 15, 2021 - Read press release and watch press conference with updates on the expansion of vaccine distribution in Santa Clara County.

January 13, 2021 - Read press release announcing expansion of COVID-19 eligibility to residents 75 and older.

January 12, 2021 - County officials provided an update on vaccine planning to the County Board of Supervisors.

January 12, 2021 - Read press statement where County warns about misinformation being shared about availability of COVID-19 Vaccine.

January 8, 2020 - Read press release a​nd watch press conference where County officials announce expanded vaccination capacity and urge all healthcare personnel to get their vaccine.

December 31, 2020 - Read press release and watch press conference on COVID-19 vaccine updates.

December 17, 2020 - Press release - Santa Clara Valley Medical Center Hospitals and Clinics Administer First COVID-19 Vaccines to Frontline Hospital Workers

December 17, 2020 - Read press release and watch press conference about skilled nursing facility staff being first to receive COVID-19 vaccine.

December 16, 2020 - Dr. Marty Fenstersheib shares information about the arrival of the first doses of vaccine on Facebook Live.

December 15, 2020 - Press release - First Doses of Pfizer COVID-19 Vaccine Arrive in Santa Clara County: Healthcare workers and skilled nursing facility residents will be first to receive the vaccine

December 15, 2020 - Press release - Joint Statement of the Bay Area Health Officers: COVID-19 vaccine will be distributed following federal, state framework​

December 15, 2020 - The County of Santa Clara Health Officer gave an update on vaccine planning to the County Board of Supervisorsand presented a report.

December 14, 2020 - Press conference - Updates on COVID-19 Vaccine and Quarantine Guidance

December 9, 2020 - The County of Santa Clara Health Officer gave an update on vaccine planning to the County Board of Supervisors Health and Hospital Committee and presented a report. The County updated its plan for vaccine management and community engagement required by the State of California and presented it to the Committee.

December 9, 2020 - Press release - County of Santa Clara To Receive 39,300 Doses of Moderna Vaccine in First Allocation

December 8, 2020 - Update on vaccine planning to the County of Santa Clara Board of Supervisors

December 7, 2020 - Press conference - Updates on COVID-19 Vaccine Plan and ICU Capacity

December 1-2, 2020 - The County of Santa Clara sent a required document to the State of California on plans for vaccine management and community engagement. You can review the County of Santa Clara COVID-19 Vaccination Plan​, read the press release, or watch the press conference.

November 3, 2020 - Update on vaccine planning to the County of Santa Clara Board of Supervisors
See the County of Santa Clara's vaccine plan submitted to the State in early December​.

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County of Santa Clara COVID-19 Vaccine Information for the Public

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IMPORTANT UPDATE: ​ All Santa Clara County residents age 65 and older are now eligible to be vaccinated at any vaccination site in the County, regardless of their healthcare provider. See below to book an appointment. Current Vaccination in Santa Clara County: Vaccine availability and eligibility is changing rapidly, and all vaccinations are by appointment only at this time.

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银屑病有寻常型、脓疱型、红皮病型和关节病型4种类型，银屑病关节炎即银屑病中关节病型。银屑病关节炎(psodatic aIthritis,PsA)是一种既有银屑病（牛皮癣）样皮肤损害，又有关节症状的少见病，可继发于银屑病反复发作之后，也可先出现关节症状或与脓疱性或红皮病性银屑病并发。约2/3患者先有银屑病，5～10年后出现关节炎，15%～20%患者可先有关节炎，10%左右两者同时发病。其主要特征是累及远端指间关节，关节症状往往与皮肤损害同时减轻或加重，指（趾）甲受累，类风湿因子试验和LE细胞试验均为阴性。本病发病高峰年龄多在30～50岁，无性别差异，但脊柱受累以男性较多。
1818年Alibert最早注意到银屑病与关节炎的关系，而银屑病关节炎的命名是1860年由法国皮肤科医师Bazin提出的。早年很多学者认为本病是银屑病伴有类风湿关节炎，直至1948年类风湿因子的检测方法建立以后，将炎症性关节炎分为血清阳性及血清阴性两组，而银屑病关节炎属于类风湿因子阴性关节炎。根据临床、血清学及关节X线的表现，近年来已比较明确，本病是一个独立的疾病。
关于银屑病关节炎的发病情况，各家报告不太一致，根据我国1984年24省市600万人口银屑病流行病学调查结果，我国银屑病总的患病率是1.23%，其中主要是寻常型银屑病（占97.98%），银屑病关节炎仅占银屑病的0.69%。欧美国家银屑病的患病率明显高于我国，为1%～3%，其中5%～7%伴银屑病关节炎。

1．遗传因素：一般认为，约1/3银屑病患者有阳性家族史。Kammer经家系调查，发现银屑病患者第一代亲属中银屑病的发病率为16.9%，而银屑病关节炎的发病率为3.3%，明显高于正常人群。多数学者认为寻常型银屑病与HLA-B13、-B17、-A1、-Cw6相关，银屑病关节炎则与HLA-B27相关，其HLA-B27阳性率可达46%～78%。也有学者认为周围型银屑病关节炎与HLA-B38，-B39相关。关于本病的遗传方式迄今尚无定论，多数认为是多因素遗传，并受环境的影响。
2．免疫异常：本病患者细胞免疫功能偏低，淋巴细胞转化率和自然玫瑰花形成率均显著低下。体液免疫的变化则各家意见不一，大多数作者报道血清IgA、IgE升高，IgM降低，唾液中分泌性IgA亦增高，在角层尚可见有抗角层自身抗体，约60%银屑病关节炎患者外周血中含IgG的免疫复合物升高，而且IgA型免疫复合物升高更明显，但免疫复合物的升高与疾病活动性无明显相关性。血清补体CH50及C3可升高。近年来随着细胞生物学和分子生物学的进展，发现银屑病患者存在多种细胞因子的异常，可直接或间接地影响表皮细胞的增殖和分化及炎症细胞的浸润，如银屑病皮损处角朊细胞过度表达白介素-6(IL-6)，白介素-8(IL-8)及转化生长因子-α(TGF-α)，角朊细胞和血管内皮细胞表达细胞间粘附分子-1(ICAM-1)增强。因此，细胞因子的异常在银屑病发病机制中是有重要意义的。本病与免疫的关系值得进一步探研。
3．代谢障碍：有人认为，脂肪、蛋白质、糖三大物质代谢障碍对本病有致病作用；也有人认为本病与三大物质代谢障碍无关。目前对银屑病的发病是由于脂类代谢障碍的看法基本予以否定。研究表明银屑病表皮中环腺苷酸(cAMP)水平降低，环鸟苷酸(cGMP)水平增高，cAMP/cGMP比率失调。多胺含量增高，钙调蛋白含量增高。前列腺素F2及前列腺素E2比率失调，导致表皮更换周期缩短，自正常的28天缩短至3～4天，使表皮过度增生。有报告10%～50%银屑病及银屑病关节炎患者血尿酸升高，系由于表皮细胞增生快，嘌呤代谢加速所致。
4．感染：早在1916年Winfield即发现扁桃体切除后银屑病能随之好转。临床上常见到某些银屑病尤其是急性点滴型银屑病患者发病之前有扁桃体炎史，患者咽培养有甲型溶血型链球菌生长，抗链球菌"O"值也增高。约6%的患者发病前有咽部感染史和上呼吸道感染症状，尤以妇女、儿童为多，用抗生素治疗有效，扁桃体摘除后皮损可明显好转或消失。Vasay指出，银屑病关节炎患者抗DNA酶B抗体（甲型链球菌产生的外毒素）升高。也有报告葡萄球菌α-抗毒素滴定度升高，因此认为细菌抗原可能与银屑病关节炎的发病相关。目前虽然对病毒感染的致病作用似有一定依据，但至今从未培养出病毒。
5．其他因素：精神因素、外伤、季节变化、内分泌改变、血液流变学的改变及某些药物如心得宁均可诱发或使本病加重。根据皮肤和滑膜毛细血管光镜及电镜的改变，多数学者认为微循环的改变在银屑病关节炎发病中起着重要的作用。

本病的高峰发病年龄约40岁，多数缓慢发病，约1/3患者可以起病较急，伴 发热等全身症状。起病前通常无明显的诱因，然而少数可先有关节外伤史，然后局部出现银屑病关节炎。本病的临床特征是伴有银屑病，远端指间关节最易受累，而且关节受累不对称，关节症状和银屑病皮损的活动性常一致，指（趾）甲常受累，无类风湿结节，类风湿因子阴性等。现将关节、皮肤及指甲等表现分述如下：
1．关节表现
关节炎多出现在皮肤银屑病之后，少数在银屑病以前或与之同时出现，症状与银屑病皮损的活动程度一致。以累及指（趾）关节、掌指关节、跖趾关节等手足小关节为主，也可累及腕关节、肘关节及膝关节等四肢大关节，少数可累及骶髂关节及脊柱，关节受累常不对称，远端指间关节最易受累，早期累及手关节较足关节多见。临床上除有关节 疼痛外，可伴有关节红肿、晨僵，日久可出现关节强直、关节畸形及不同程度的功能障碍，少数引起残毁。本病主要分为5型，60%类型间可相互转化，合并存在。
(1)单关节炎或寡关节炎型：这种情况最为常见，约占70%。以累及髋、膝、踝等大关节为主，也常同时累及1、2个指（趾）间关节。表现为 关节痛和晨僵，由于其主要病变为滑膜炎，因此常伴有关节肿胀。由于伴发腱鞘炎症，受累的指或趾可呈典型的腊肠指（趾），多数伴有指甲病变。1/3～1/2此型患者可演变为多关节炎类型。
(2)对称性多关节炎型：约占15%，表现与类风湿性关节炎相似，受侵犯的关节数目不及类风湿关节炎广泛，畸形程度亦比类风湿关节炎轻。关节受累以近端指（趾）间关节及掌指关节为主，也可累及远端指（趾）间关节及肘、腕、膝等四肢大关节。除关节肿痛外，晨僵较明显，也可伴有骨间 肌萎缩。病程长者指（趾）间关节骨性强直较明显，并可伴有关节畸形，少数甚至可有关节残毁。偶有类风湿结节或RF阳性。
(3)远端指间关节型：占5%～10%，病变累及远端指间关节，为典型的PsA，通常与银屑病指甲病变相关。
(4)残毁性关节炎型：此型是银屑病关节炎的最严重型，占5%。好发年龄为20～30岁，多侵犯手、足等多个关节和骶髂关节，受侵犯的跖骨、掌骨或指骨可发生严重的骨溶解。指节常有望远镜式的"套叠"现象。病变关节可发生强直、畸形。常伴 发热、体重下降及严重而广泛的皮肤病变，以及经常伴发骶髂关节炎。此型的皮肤银屑病常广泛而严重，为脓疱型或红皮病型。
(5)银屑病脊柱炎：约占5%，以累及脊柱及骶髂关节为主，也常伴有周围关节炎，尤其HLA-B27阳性者常属此型。男性发病较多，男女之比约为6:1。与强直性脊柱炎相比，银屑病脊柱炎临床上腰 背痛及强直的症状较轻，并常于出现周围关节炎数年后才表现脊柱炎的症状，少数仅有脊柱炎而无周围关节炎。银屑病骶髂关节炎常为单侧受累，而脊柱炎的X线特征表现为不对称性的脊椎旁骨化。韧带骨赘可发生在无骶髂关节炎者，并可累及脊柱的任何部分，通常不发生在边缘而是在椎体的前面和侧面。
近代有学者将PsA分为3种类型：①类似反应性关节炎伴附着点炎的单关节炎或寡关节炎型；②类似类风湿性关节炎的对称性多关节炎型；③类似强直性脊柱炎的以中轴关节病变为主（脊柱炎、骶髂关节炎和髋关节炎），伴有或不伴有周围关节病变的脊柱病型。
2．皮肤表现
75%患者皮疹出现在关节炎之前，约10%出现在关节炎之后，同时出现者约15%。临床上银屑病主要有以下4种类型。
(1)寻常型银屑病：最常见，皮损好发于头皮及四肢伸侧，尤其是肘关节伸侧，皮疹不断扩大和增多后可呈现各种形态，如点滴状、钱币状、花瓣状、地图状、带状，重者可泛发全身。基本损害是红色丘疹，以后可扩大融合成大小不等的斑块，表面覆以多层银白色鳞屑，鳞屑刮去后可露出半透明的薄膜，称为"薄膜现象"。刮去此膜可有点状 出血称Auspitz征。白色鳞屑、发亮薄膜和点状 出血是本病的特征。头皮皮损表面的毛发可呈簇状。病情活动时可于针刺、手术切口及搔抓的局部出现同样皮损称同形现象。本病可有一定的季节性，多数患者冬季重、夏季轻，有时夏季皮损还能自然消退。消退后可留有色素沉着或色素减退斑。
(2)红皮病型银屑病：此型临床上少见，是皮损中最严重的一种类型，主要见于成年人。本型可由寻常型和脓疱型皮损发展而来，也可因为使用刺激性强的外用药物，或因内服糖皮质激素治疗停药后病情反复，使皮损迅速扩展。临床表现为剥脱性皮炎。初起时，原有的皮损部位潮红，范围迅速扩大，以后则全身皮肤呈弥漫性红色和暗红色，炎症浸润明显，表面有大量麸皮样鳞屑，并不断脱落。指（趾）甲浑浊、肥厚、变形或指（趾）甲脱落。口腔、咽部、鼻腔粘膜均充血发红，并伴有畏寒 发热、 头痛等全身症状。浅表淋巴结多肿大。病情顽固，易复发。
(3)脓疱型银屑病：临床上少见，可分为泛发性和掌跖脓疱型两个类型。
①泛发性脓疱型：起病急，皮损可遍及全身，但以四肢屈侧多见。多伴有 发热、关节肌肉 疼痛、全身不适等症状。皮损在一般牛皮癣皮损的基础上，可出现密集、粟粒样大小的无菌浅表脓肿，表面覆盖鳞屑，如因摩擦破溃后可出现糜烂、渗出、结痂和脓痂。大多数患者可有指（趾）甲萎缩、碎裂或松解。有的甲板肥厚，甲床也可出现小脓疱，病情缓解后可出现寻常性皮损。容易复发。
②掌跖脓疱型：皮损只限于手足部，多出现于掌部，损害为对称性红斑，红斑上有许多粟粒大小的脓疱，经一周左右可自行干燥结痂，痂脱落后出现小片鳞屑，剥除鳞屑可见有小 出血点。以后又可在鳞屑下出现新的脓疱，因此，在同一红斑上可出现脓疱和结痂并存。皮损处可有 疼痛和瘙痒，部
分患者可伴有低热、全身不适等症状。
(4)关节病型银屑病：又称银屑病关节炎，即银屑病伴有关节炎的症状。常见于寻常型银屑病反复发作后，也可发生于脓疱型及红皮病型银屑病，但多数认为本病与银屑病的类型无明显关系。有时银屑病皮损可很局限，很轻微，甚至不易被发现，也可较广泛，甚至呈红皮病。一般认为，关节症状和银屑病皮损的活动性常一致。
3．甲病变
约80%银屑病关节炎患者有指（趾）甲病变，而在无关节炎的银屑病患者中有此现象者仅20%，因此指（趾）甲病变是PsA的特征，尤其是远端指间关节型。最常见的指甲病变是顶针样或斑点状凹陷，一般认为如患者指、趾甲斑点状凹陷超过20个，提示可能有银屑病关节炎，如超过80个大多可确诊。还可见到甲板增厚，浑浊，失去光泽，色泽发乌或有白甲，表面常高低不平，有横沟及纵嵴，常有甲下角质增生，重时可有甲剥离。有时可形成匙形甲。
4．其他表现
(1)全身症状：少数有 发热、 消瘦、贫血等。
(2)系统性损害：7%～33%患者有眼部病变，如结膜炎、巩膜炎、葡萄膜炎、虹膜炎、虹膜睫状体炎及干燥性角膜炎等；<4%的患者出现主动脉瓣关闭不全，常见于疾病晚期，另有心脏肥大、传导阻滞等；肺部可见上肺纤维化；胃肠道可有炎性肠病；罕见淀粉样变。
(3)附着点炎：特别在跟腱和跖腱膜附着部位。足跟痛是附着点炎的表现。

具有典型银屑病皮损，关节受累以远端指间关节为主，类风湿因子阴性，并伴有甲病变，X线有特征性改变时，银屑病关节炎的诊断不难，但有些患者先有关节炎而无银屑病史，应仔细检查头皮及肘关节伸侧等银屑病好发部位，是否有未被察觉的、轻微的银屑病皮损，并注意是否伴有甲病变。国外有些学者认为指甲有大于20个顶针状凹陷时，对银屑病的诊断有意义。

PsA的药物治疗目的是控制炎症过程，减轻或消除皮肤损害，保持关节功能，预防和阻止关节骨质破坏。早期、及时和有效的药物治疗可以阻止关节损害的加重，这对改善预后，提高患者生存质量有重要意义。治疗PsA的一线药物主要为非甾类抗炎药(NSAIDs)，二线药物为缓解病情的抗风湿药(DMARDs)，包括 甲氨蝶呤(MTX)、柳氮磺胺吡啶(SSZ)、 环孢素(CsA)等。该患者病程长，一直没有正规治疗，现已出现关节变形，有关节破坏性改变，应该采用积极的治疗方案。一线药物可选择一种副作用小的药物，二线药物可以选用 甲氨蝶呤，根据患者体重，剂量可以用到每周15～20mg，治疗3个月后如果效果不好，可以联合应用柳氮磺胺吡啶、 来氟米特 等。用药的过程中要注意监测血象、肝肾功能，防止不良反应。有报道皮疹明显的患者可用反应停，有一定的效果，有关确切疗效还需积累经验和研究。

（更新时间： 2016-01-08 本信息由中国医学科学院医学信息研究所专家团队审核）

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牛皮癣关节炎_常见疾病_中国公众健康网

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银屑病有寻常型、脓疱型、红皮病型和关节病型4种类型，银屑病关节炎即银屑病中关节病型。银屑病关节炎(psodatic ...

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What other health risks do I have if I have psoriatic arthritis? What can I do about them?

Psoriatic arthritis affects more than just your joints and skin. It increases your risk of a number of other chronic health conditions. The body-wide inflammation that triggers the joint pain and skin symptoms in psoriatic arthritis also can affect your heart, eyes, intestines and other areas of the body.

Conditions commonly seen in those with psoriatic arthritis include:

Heart disease

High blood pressure

High cholesterol

Diabetes

Obesity

Osteoporosis

Inflammatory bowel disease

Eye inflammation (uveitis)

Living with psoriatic arthritis can also make you feel depressed or anxious.

Reduce your risk

Fortunately, you can take steps to reduce your risk of conditions related to psoriatic arthritis:

Be honest with your doctor. Open communication allows your doctor to better monitor your health and schedule health screenings so that any other conditions can be diagnosed and treated early. Don't hesitate to tell your doctor about any new symptoms, even if you think they might not be related to your psoriatic arthritis.

Stick to your treatment plan. Properly managing your psoriatic arthritis may help you fight off other chronic diseases. For example, research shows that aggressive treatment of psoriatic arthritis may lower your risk of heart disease.

And some medicines that may be prescribed for psoriatic arthritis - called tumor necrosis factor (TNF)-alpha blockers - have been linked to lower rates of depression.

Get moving. Exercise reduces inflammation and boosts heart health, greatly lowering your risk of diabetes and other chronic health conditions. Walking, swimming and yoga are some good ways to keep your joints strong and flexible.

Live a healthy lifestyle. Eat a balanced diet and limit alcohol. Alcohol can make psoriasis medications less effective.

If you smoke, quit. Research shows that kicking the habit leads to fewer psoriasis flares and a lower risk of other chronic diseases, including heart disease. If you need help quitting, ask your doctor for ways to get started.

Show references

See more Expert Answers

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Managing psoriatic arthritis health risks

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What other health risks do I have if I have psoriatic arthritis? What can I do about them? Psoriatic arthritis affects more than just your joints and skin. It increases your risk of a number of other chronic health conditions.

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Happy February Break! I realize that there has been a lot of information disseminated this week...and today, in particular. We want you to have the latest information, especially if there is a chance it can help you stay safe during the pandemic.

Please keep this email and attachment nearby!

Vaccination Information

Many of you have been closely following the news about educator vaccination and asking good questions. The vaccines cannot come soon enough for all of us!  You have likely heard some of the recent news about large vaccination sites (Oakland Coliseum, Santa Clara County Fairgrounds, Levi’s Stadium, etc). Perhaps you’ve also heard about Santa Clara’s “No Wrong Door” policy which encourages vaccination wherever there is supply, regardless of medical insurance provider. These are all helpful measures in getting you closer to the vaccine.

The bottom line: Santa Clara County has plans to vaccinate teachers “next,” but has not identified a date when vaccines will become available to all educators*. The best way to stay up to date on eligibility is by registering on California’s online MyTurn system. When you register as someone who works in education, you are likely to see a message that appointments are not currently available (for those under 65). Nevertheless, this website will help alert you when they do become available.

Vaccination Letter:

In the coming weeks we expect a ramp-up of COVID-19 vaccine availability.

Please keep the following items in a convenient location so when your turn comes to be vaccinated you have the necessary proof with you when you arrive at your appointment.

The attached letter showing that you are part of Phase 1B Tier 1

Recent paystub, W-2, and/or school I.D.

Government issued ID such as your driver’s license

Medical insurance (card just in case)

*If you qualify for vaccination in another county or as part of a group who may be further ahead you should avail yourself of that opportunity.

Visit the sccfreevax.org for more information.

Brian SafineHuman Resources Director
Los Gatos-Saratoga Union High School District17421 Farley Road WestLos Gatos, California 95030(408) 402-6309bsafine@lgsuhsd.org www.lgsuhsd.org

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点滴型银屑病好转的征兆 点滴型银屑病好转的症状表现有哪些 有来医生

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Overview

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis - a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear.

Joint pain, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment, psoriatic arthritis may be disabling.

Products & Services

Symptoms

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse.

Psoriatic arthritis can affect joints on just one side or on both sides of your body. The signs and symptoms of psoriatic arthritis often resemble those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch.

However, psoriatic arthritis is more likely to also cause:

Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.

Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones - especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).

Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).

When to see a doctor

If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic arthritis can severely damage your joints if left untreated.

Causes

Psoriatic arthritis occurs when your body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.

It's not entirely clear why the immune system attacks healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical trauma or something in the environment - such as a viral or bacterial infection - may trigger psoriatic arthritis in people with an inherited tendency.

Risk factors

Several factors can increase your risk of psoriatic arthritis, including:

Psoriasis. Having psoriasis is the single greatest risk factor for developing psoriatic arthritis. People who have pitted, deformed nails are especially likely to develop psoriatic arthritis.

Your family history. Many people with psoriatic arthritis have a parent or a sibling with the disease.

Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.

Complications

A small percentage of people with psoriatic arthritis develop arthritis mutilans - a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.

People who have psoriatic arthritis sometimes also develop eye problems such as pinkeye (conjunctivitis) or uveitis, which can cause painful, reddened eyes and blurred vision. They are also at higher risk of cardiovascular disease.

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Psoriatic arthritis - Symptoms and causes

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Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis - a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear.

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Remake of Chinese Placement 2021

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Good morning!

Here is the 2021-2022 Teacher Master Schedule Planning Form.  By the end of this week, please take a moment to complete this short survey to help identify your preferences for next year.  As we did last year, we will consult your responses to help inform how we finish the master schedule.

The planning form was discussed at the Leadership Team meeting yesterday and a few questions came up.  Below is an FAQ regarding how we use the 2021-2022 Teacher Master Schedule Planning Form.

Thanks,

Greg

FAQQ: Is this document actually used?  If so, how?A: Yes, this document is used.  I share it with the Department Chairs when they help to build the master schedule and finalize the details of who is teaching what and when in their department.  It also helps me to see the big picture and the details when going through the process of building the master schedule.Q: Do I have to complete this form?A: No.  This is not a requirement, but doing so helps me to know what you prefer and I do try to honor that during the process.Q: What's the point of completing this form?  I did it last year and still got stuck teaching stuff I didn't want during times I didn't want.A: In an ideal situation, we can create a master schedule that:

1) meets the needs/requests of all of our students; and 2) meets the needs/requests of all of our teachers.

Unfortunately, as a relatively small high school with nearly 50 singletons and only 9 courses with 6 or more sections, the rubrics cube that is our Master Schedule does not always fit for everyone.Q: Is any of this going to change due to the pandemic, reopening of school, hybrid model, etc?A: It is definitely possible.  We need to maintain flexibility and understand that for this August, we may have to account for a hybrid model that incorporates some kind of plan for our students who do not return to school due to continued fear of the virus, lack of vaccination, etc.Q: How is the Master Schedule built?  When is it built?  Can I be involved?A: Yes.  Anyone who wants to be involved in building the Master Schedule can be involved.  It's not a secret.  Here is the timeline for building the 21-22 Master Schedule:

January 25: Electives Night for Incoming 9th grade families (6pm-8:30pm)

January 26: Incoming Senior Parent Night (7pm-8pm)

January 27: Student course selection meetings

Seniors: 9:45-10:45am

Juniors: 11-12pm

Sophomores: 1-2pm

January 27-February 1: Seniors-Course Selection window

January 27-February 1: Juniors-Course Selection window

January 27-February 1: Sophomores-Course Selection window

January 27: Incoming Junior Parent Night (7pm-8pm)

January 28: Incoming Sophomore Parent Night (7pm-8pm)

January 29: Course recommendations from Math/Science due to Robert Wise

February 2: Incoming Freshmen Parent Night (7pm-8pm)

February 2: Incoming Freshmen Student Course selection video

February 3-5: Office Hours for Redwood MS students

February 8: Teacher Preference Form review/approval @ Leadership

February 9: Teacher Preference Form Distribution to all teachers

February 22-26: Individual meetings with Redwood students (1:30pm-3pm)

*March 1: Leadership Meeting: Constraints discussion/definition; DC’s to go back to departments on March 10

March 1-5: Individual meetings with out-of-district families and students

March 12: 95% of Course requests locked in

March 19: Course request/FTE analysis

*March 29: Leadership Meeting: Constraints lists due

*April 19: Leadership Meeting: Constraints Identification discussion/ agreement

April 26: Singleton Building Party (afterschool)

April 28: Doubleton Building Party (afterschool)

April 29: Tripleton/Quads/Quinces Building Party (afterschool)

April 30: Draft of Master Schedule shared with DC’s

May 3: Leadership Meeting (Master Schedule discussion)

May 17: Leadership Meeting (DC’s return Master Schedule edits)

* make sure all DC’s are at these meetings

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If you have coronavirus symptoms or are at high risk for serious illness, it's especially important to stay home and avoid in-person contact with others.

On this page you will find:
Coronavirus symptoms include, but are not limited to:

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Symptoms may appear 2-14 days after exposure to the virus.
You can check your symptoms using the Symptom Screener or by contacting your doctor through telehealth.

What increases your risk of infection

You are more likely to be infected with coronavirus if:

You have close contact with an infected person (within 6 feet for at least 15 minutes over a 24-hour period)

You are frequently in a group setting (like an assisted living facility, college dormitory, homeless shelter)

You have been in an area with high infection rates

You can reduce the risk to yourself and others by:

See other preventative measures you can take.

Who is likely to get very sick

Some people are at higher risk to get very sick from COVID-19, including:

Seniors over 65

People with certain medical conditions:

Cancer

Chronic kidney disease

COPD

Down syndrome

Weakened immune system from organ transplant

Obesity

Serious heart conditions

Pregnancy

Sickle cell disease

Smoking

Type 2 diabetes

There are more conditions which might increase risk for severe illness from COVID-19. See what specific actions you should take for your medical condition.

Extra precautions for high-risk groups

If you are at higher risk for serious illness, you should take extra precautions to protect yourself:

Stay home. It's the most important thing you can do.

Avoid contact with people who are sick. Isolate anyone sick in your home in a separate room, if possible.

Get food brought to your house through family, social, or commercial networks. Wipe off containers with disinfectant wipes.

Listen to public health officials. They may recommend community actions to reduce exposure in times of local outbreak.

Stay safe by preparing

Find Family and Friends Caregiver Resources from the California Department of Aging, including guidelines to protect both you and your loved ones from COVID-19.

Read how to Prepare for a Public Health Emergency (PDF) from Listos California.

Questions and answers

Influenza (flu) and COVID-19 are both contagious respiratory illnesses, but they're caused by different viruses. COVID-19 is caused by a new coronavirus (called SARS-CoV-2) and flu is caused by influenza viruses.

The symptoms of flu and COVID-19 are similar. It is hard to tell the difference between them without testing.

Cases of COVID-19 and flu can have anything from no symptoms (asymptomatic) to severe symptoms. Common symptoms that COVID-19 and flu share include:

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue (tiredness)

Sore throat

Runny or stuffy nose

Muscle pain or body aches

Headache

Vomiting and diarrhea (more common in children than adults)

The major difference between them is COVID-19 may include change in or loss of taste or smell.

The CDC has more information about similarities and differences between the flu and COVID-19.

Anyone can get infected with coronavirus. Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact (within 6 feet for at least 15 minutes over a 24-hour period) with a patient with confirmed coronavirus infection, regardless of whether the patient has symptoms. Those frequently in group settings (like homeless shelters, assisted living facilities, or college dormitories) are at increased risk of acquiring infection because of the increased likelihood of close contact. Those who live in or have recently been to areas with sustained transmission may also be at higher risk of infection. Everyone can reduce the risk to themselves and others by:

Children can be infected with coronavirus and can get sick with COVID-19. Most children with COVID-19 have mild symptoms, or they may have no symptoms at all ("asymptomatic"). Fewer children have been sick with COVID-19 compared to adults. However, children with certain underlying medical conditions and infants (less than 1 year old) might be at increased risk for severe illness from COVID-19. Some children have developed a rare but serious disease that is linked to COVID-19 called multisystem inflammatory syndrome (MIS-C).

For more information for parents or caregivers of children, see the CDC's page on Children and Teens and their COVID-19 Parental Resources Kit.

For more information about how people get sick with the virus that causes COVID-19, see How COVID-19 Spreads.

If your child gets sick with symptoms of COVID-19, take these steps:

Keep your child home

Call your child's doctor to discuss whether they need to be tested for COVID-19.

If you are unsure if your child's symptoms are related to COVID-19, visit Coronavirus self-checker. This online tool will help you decide when to seek testing or medical care for your child.

If you don't have health insurance or a regular doctor,call Medi-Nurse. Medi-Nurse is a free, 24/7 nurse advice line available at 1-877-409-9052. You can speak directly with a healthcare professional about their symptoms, get advice on testing and treatment in your area, or ask how to apply for health insurance.

Protect yourself from COVID-19 while caring for your child.

Notify your child's school that your child is sick. Also inform the school once your child has had a COVID-19 test and what the result is.

Review policies for your child's school or childcare facility related to when a child can return after being sick.

Bring your child back to school or other in-person activities only after they can safely be around others. Discuss this with your child's doctor.

If your child is sick but doesn't have COVID-19, they may still need to stay home for some time.
In a medical emergency, call 911 or bring your child to the emergency room.
Do not delay seeking emergency care for your child because you are worried about the spread of COVID-19. Emergency rooms have infection prevention plans to protect you and your child from getting sick with COVID-19 if your child needs emergency care.

If your child is showing any of these emergency warning signs, seek emergency medical care immediately.

Trouble breathing

Pain or pressure in the chest that doesn't go away

New confusion

Can't wake up or stay awake when not tired

Bluish lips or face

Call your child's healthcare provider for any other symptoms that are severe or concerning to you.

See the CDPH's Guidance on Returning to Work or School Following COVID-19 Diagnosis and CDC's COVID-19 in Children and Teens for more details.

The disease has not existed long enough for us to really know. But as the pandemic unfolds, we are learning that many organs besides the lungs are affected by COVID-19, and there are many ways it can affect someone's health.

While most people with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness. Even people who are not hospitalized and who have mild illness can experience persistent or late symptoms.

The most commonly reported long-term symptoms include:

Other reported long-term symptoms include:

Difficulty with thinking and concentration (sometimes referred to as "brain fog")

Depression

Muscle pain

Headache

Intermittent fever

Fast-beating or pounding heart (also known as heart palpitations)

More serious long-term complications appear to be less common but have been reported. These have been noted to affect different organ systems in the body. These include:

Cardiovascular: inflammation of the heart muscle

Respiratory: lung function abnormalities

Renal: acute kidney injury

Dermatologic: rash, hair loss

Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems

Psychiatric: depression, anxiety, changes in mood

The long-term significance of these effects is not yet known.

See the CDC's Long-Term Effects of COVID-19 for more details.

We don't yet know. The duration of immunity to coronavirus infection is not yet understood. Patients infected with similar viruses are unlikely to be re-infected in the months after they recover. But we don't yet know if similar immune protection happens in patients with COVID-19.

You should self-quarantine if you have had close contact with someone who has COVID-19. If you tested positive for COVID-19 in the 3 months prior to the close contact but do not currently have symptoms, you do not need to quarantine or be tested again. If you develop symptoms, you may need to quarantine and be tested again.

You have had close contact if:

You were within 6 feet of someone who has COVID-19 for 15 minutes or more over a 24-hour period

You provided care at home to someone who is sick with COVID-19

You had direct physical contact with the person (like hugging or kissing them)

You shared eating or drinking utensils

They sneezed, coughed, or somehow got respiratory droplets on you

Travelers are strongly discouraged from entering into California for tourism and recreation. If you do travel into California, you will need to self-quarantine for 10 days after you arrive, and should limit your interactions to people in your household. If you are traveling into California for essential purposes, you should still self-quarantine for 10 days and ensure you do not mix with others outside of those necessary to conduct your essential work. See the Travel page for more information.

It's possible. Under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising.

Under these circumstances, scientists believe that the amount of infectious smaller droplets and particles produced by the people with COVID-19 became concentrated enough to spread the virus to other people. The people who were infected were in the same space during the same time or shortly after the person with COVID-19 had left.

It is much more common for the virus to spread through close contact with a person who has COVID-19 than through airborne transmission.

There is no evidence that COVID-19 spreads indoors through air conditioning. There are a wide variety of heating, ventilation and air conditioning (HVAC) systems. Well-designed HVAC systems can actually help reduce risk. Since the system filters air as it circulates, it adds cleaner air to the space. Introduction of fresh outdoor air dilutes the concentration of infectious particles. Air conditioning is also necessary in some areas to protect from excessive heat. For more information, see ASHRAE guidelines for homeowners and HVAC professionals.

Air pollutants from wildfire smoke can irritate the lungs, cause inflammation, weaken your immune system, and increase your risk of respiratory infections like COVID-19. Also, wildfire smoke exposure can worsen COVID-19 symptoms and outcomes.

Keep in mind that some respiratory symptoms from wildfire smoke exposure and COVID-19 may be similar. These include cough, sore throat, and difficulty breathing.

COVID-19 symptoms that are unrelated to smoke exposure include fever or chills, muscle or body aches, and diarrhea. If you think you may have COVID-19, contact your doctor.

The CDC has more detailed information about Wildfire Smoke and COVID-19.

Stay informed

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If you have coronavirus symptoms or are at high risk for serious illness, it's especially important to stay home and avoid in-person contact with others. On this page you will find: Coronavirus symptoms What increases your risk of infection Who is likely to get very sick Extra precautions for high-risk groups Stay safe by preparing [...]

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醫療：生物製劑治牛皮癬效果較顯著 副作用較少-20200321-TVB News

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For informational purposes only. Consult your local medical authority for advice.

Symptoms of psoriatic arthritis

Loudoun County, Virginia - From your Internet address - Learn more

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psoriatic arthritis diagnosis - Google Search

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Please click here if you are not redirected within a few seconds. For informational purposes only. Consult your local medical authority for advice. Symptoms of psoriatic arthritis Loudoun County, Virginia - From your Internet address - Learn more

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2021中国新年教案大放送|各种好玩有趣的庆祝新年活动|THE BEST LESSON PLAN FOR THE CHINESE NEW YEAR

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Agent Overview of the Tax Diversify Your Retirement Income: Educational Event with New York Life Insurance Co. CC & 1P
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Find International Universities that Recognize AP

Access resources useful to international educators and students, including a list of more than 650 universities outside the United States that recognize College Board programs.

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Find Universities Outside the US That Recognize AP Scores

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Find International Universities that Recognize AP Access resources useful to international educators and students, including a list of more than 650 universities outside the United States that recognize College Board programs.

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SHS Chinese Placement Survey Sheet
https://globallearningc.padlet.org/GLC/ChinesePlacementPadlet2021
Chinese Placement 2021
Chinese Placement 2020
Filial piety/东西方孝道文化的异同/東西方孝道文化的異同

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Coverage amounts range from $25,000 to $1,000,000+.

Level premium periods or "term" options include 10, 15, 20, 25 and 30 years.

Ages 18 to 80 are eligible to apply, though your age and health will determine if you are eligible for some of the longer term periods and best rates.

Your rate is guaranteed to remain the same during the length of your term.

Your spouse, age 18-80, is also eligible to apply for coverage.

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My Turn - California Vaccine Scheduling & Notifications

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Search Criteria[Click to Expand/Collapse]

Your search returned job postings for a total of job vacancies. Please click a job title below for detailed information about a specific posting. You can sort your results in both directions (ascending/descending) by clicking on a column header.

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Education jobs, education jobs in America, education jobs in United States, Teaching jobs, Teaching jobs in America, Teaching jobs in United States, Education, Jobs, America, United States, Teaching, Job Listings, Job Seekers, Professional, Employment, Career Opportunities, Jobs Availability, Schools, Higher Education, Grade School, Elementary, High School, Junior High, Children, Special Education, Teachers, K12, K-6, K-5, 6-8, 9-12

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arthritis mutilans 肢体关节炎
rheumatoid arthritis 类风湿关节炎
psoriatic arthritis 银屑病关节炎
A small percentage of people with psoriatic arthritis develop arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.

People who have psoriatic arthritis sometimes also develop eye problems such as pinkeye (conjunctivitis) or uveitis, which can cause painful, reddened eyes and blurred vision. They are also at higher risk of cardiovascular disease.
Stick to your treatment plan. Properly managing your psoriatic arthritis may help you fight off other chronic diseases. For example, research shows that aggressive treatment of psoriatic arthritis may lower your risk of heart disease.

And some medicines that may be prescribed for psoriatic arthritis — called tumor necrosis factor (TNF)-alpha blockers — have been linked to lower rates of depression.

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中文密室逃脱教案分享 | HOW TO CREATE ESCAPE ROOM CLASS!

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Ventura County Community College District Academic Careers

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Welcome to Ventura County Community College District's online application process! We are pleased that you are interested in joining our team of talented and committed employees. We are dedicated to attracting, developing, and supporting a qualified workforce with a focus on serving the educational needs of our students.

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Special New Org. Meeting on February 16th from 3 - 4 PM

https://nylife.zoom.us/j/94974147482?pwd=VlV4V2w3UlYyaGJmbkN6cGw2UWRBUT09#success

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1. Ensure you've joined your class section online.

2. Register-or confirm your existing registration-in My AP.

If your school requires you to indicate your exam registration, you'll see a Register button in your class section view in My AP after you join your class sections. Clicking this button will let your coordinator know that you plan to take the exam, and they will order it for you. If you don't see that button, it means you've already been automatically registered for the exam.

If you'd like to register for an exam after November, your order may be subject to a late fee. You'll need to ask your AP coordinator to update your registration. If your class doesn't start until the spring or you've transferred to a new school after the exam ordering deadline, don't worry-your coordinator will be able to order your exam, and you won't be charged a late order fee.

3. Talk to your school's AP coordinator about paying exam fees.

You can't pay for your exam on this website. Your AP coordinator will collect any fees that you owe.

4. Review your registration details.

Once you have selected to register, the date and time of your exam will appear in your course card in My AP. You can review the exam schedule and talk with your AP coordinator if you have any questions about the start time for the exam(s) you're scheduled to take.

Your AP coordinator will notify you when and where to report for the exams.

If you're homeschooled or you go to a school that doesn't administer AP Exams, you'll need to arrange to take exams at a local school that is authorized to administer them.

Your first step is to search the AP Course Ledger. The AP Course Ledger is the official, up-to-date, comprehensive list of schools that have passed the AP Course Audit. You can search by country, state/province, or city to find a school where you might be able to test. After finding schools near you that offer the courses you want to take exams for, do an internet search for the school's phone number. Then call and ask to speak with the school's AP coordinator to learn if the school is allowing homeschooled students to test there this year.

Look for and contact schools as early in the school year as possible. Note that schools may have their own local deadlines and policies for receiving requests from outside students to test at their school, so you'll want to give yourself as much time as possible to contact schools. Updates will be made to the AP Course Ledger every November, so if you still need to find possible schools, you can check the Ledger again in November to see if any schools in your area were added. The exam ordering deadline for schools is November 15.

When you find an AP coordinator able to administer your AP Exam(s), they are responsible for ordering your exam materials, telling you when and where to report for the exams, and collecting the exam fees.

Note: If you're unable to find a school by November 15, you can keep looking. At their discretion, a school could add you to their order after November 15, and they could request that the late order fee be waived in that circumstance. But because schools can set their own deadlines and policies related to ordering and fees, start looking for a school as early as possible.

Note for students outside the U.S.: There are a few authorized AP test centers if there are no AP schools in your area or none that will administer AP Exams to external students.

Yes. You can't order AP Exams directly, but you should be able to arrange to take exams at a nearby high school that administers AP Exams. Here's how.

Your first step is to search the AP Course Ledger. The AP Course Ledger is the official, up-to-date, comprehensive list of schools that have passed the AP Course Audit. You can search by country, state/province, or city to find a school where you might be able to test. After finding schools near you that offer the courses you want to take exams for, do an internet search for the school's phone number. Then call and ask to speak with the school's AP coordinator to learn if the school is allowing students from other schools to test there this year.

Look for and contact schools as early in the school year as possible. Note that schools may have their own local deadlines and policies for receiving requests from outside students to test at their school, so you'll want to give yourself as much time as possible to contact schools. Updates will be made to the AP Course Ledger every November, so if you still need to find possible schools, you can check the Ledger again in November to see if any schools in your area were added. The exam ordering deadline for schools is November 15.

When you find an AP coordinator able to administer your AP Exam(s), they are responsible for ordering your exam materials, telling you when and where to report for the exams, and collecting the exam fees.

Note:  If you're unable to find a school by November 15, you can keep looking. At their discretion, a school could add you to their order after November 15, and they could request that the late order fee be waived in that circumstance. But because schools can set their own deadlines and policies related to ordering and fees, start looking for a school as early as possible.

If your school doesn't offer the exam you want to take, you'll need to arrange to take the exam at a local school that does administer it.

Your first step is to search the  AP Course Ledger. The AP Course Ledger is the official, up-to-date, comprehensive list of schools that have passed the AP Course Audit. You can search by country, state/province, or city to find a school where you might be able to test. After finding schools near you that offer the courses you want to take exams for, do an internet search for the school's phone number. Then call and ask to speak with the school's AP coordinator to learn if the school is allowing students from other schools to test there this year.

Look for and contact schools as early in the school year as possible. Schools may have their own local deadlines and policies for receiving requests from outside students to test at their school, so you'll want to give yourself as much time as possible to contact schools. Updates will be made to the AP Course Ledger every November, so if you still need to find possible schools, you can check the Ledger again in November to see if any schools in your area were added. The exam ordering deadline for schools is November 15.

When you find an AP coordinator able to administer your AP Exam(s), they are responsible for ordering your exam materials, telling you when and where to report for the exams, and collecting the exam fees.

Note:  If you're unable to find a school by November 15, you can keep looking. At their discretion, a school could add you to their order after November 15, and they could request that the late order fee be waived in that circumstance. But because schools can set their own deadlines and policies related to ordering and fees, start looking for a school as early as possible.

Many schools across the world offer AP Exams. If your school doesn't administer AP Exams, please review the steps to find an alternate school for testing.

If you're unable to locate an alternate school for testing, you might consider expanding your search area.

Alternatively, you can consider testing at an authorized AP test center, available in the countries below:

You can take an AP Exam each time it's offered. Exams are administered once a year in May. Your score report will include your scores for all the AP Exams you have taken unless you request that one or more scores be withheld or canceled.

Yes. We recommend taking the AP course before taking an AP Exam-but it's not required. We want to be sure homeschooled students and students in schools that don't offer AP can take AP Exams.

You will have to arrange to take the exam at your school or, if your school doesn't administer the exam, at a local school or testing center that administers it. See The AP Exam I want to take isn't offered at my school. What should I do? and I'm homeschooled. How can I take an AP Exam? for details.

To prepare for the exam without taking the course, you should study the skills and content outlined in the course and exam description for your subject, which you can find on the specific course page. For most courses, this document also explains how your knowledge of the course content and skills is assessed on the exams.

Get to know the exams by reviewing free practice questions. The AP Program releases free-response questions every year for exams that have them. We also offer free-response questions from past exams along with sample student responses and scoring guidelines so you can see why a real exam taker got the score they did.

Note: AP Seminar and AP Research students who are homeschooled or taking the class through an online provider must be enrolled in both an exam only section and a teacher-led class section so:

If two of the exams you want to take are scheduled for the same time, ask your AP coordinator for information about taking one of the exams during the late-testing period. You may still register for both.

Yes. Although AP Art and Design students will submit portfolios instead of taking a traditional exam, they still need to register. You'll need to join your class section in AP Classroom in order to register for the portfolio exam.

AP Exams are only given once a year, but you may repeat an exam in a subsequent year. If you do, both scores will be reported unless you request that one be withheld or canceled.

If an unexpected issue occurs during the exam you were scheduled for or that prevents you from testing on your scheduled exam dates, your AP coordinator will advise whether a late testing date is available.

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Register for AP Exams – AP Students | College Board

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Find out how to register for your AP exams.

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If a student is planning to take a Chinese class at SHS in the upcoming school year, please read SHS Chinese placement information and complete the Placement Survey. (tinyurl.com/srvmy9o) Students new to Chinese can just sign up for Chinese 1 and do not need to take the placement test. Students can create a composition in writing or typing and submit it with the Placement Survey if they are planning to take Chinese 2 or above. The purpose of the Placement Survey and test is to help SHS determine the students’ level in Chinese to help the student succeed in furthering his/her knowledge of the Chinese language and culture. Please visit Chinese portfolio (tinyurl.com/ubrbu4t) for reference.

During the placement test, students will be tested in the following categories: listening, speaking, reading, writing, and typing. They will listen to passages and summarize those passages or write reflections on the passages in Chinese. They will write and type compositions on the topics related to Chinese culture, current events, or news. The test will include materials from the textbooks, supplementary materials, current events, and news. Please see the SHS Chinese Materials Samples (https://tinyurl.com/y7nurcge) as a reference for different levels. Students are expected to be able to understand the texts by listening and reading as well as present their summary or reflection of the text in speech, writing, and typing.

If the students will take the placement test on 1/31. Please click and print 8 pages of the writing sheet with 6 pages of 200 words per sheet and prepare pens for the writing session of the placement test.

Please contact me if you have any questions or if the students need to reschedule another date for the placement test.

Best regards,

Mariam Fan

Chinese Instructor

Saratoga High School

mfan@lgsuhsd.org

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Chinese New Year Padlet

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yesuaini

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Your browser version is not fully supported, or your browser has Compatibility View turned on.

For the best experience please use a modern browser with compatibility view turned off.

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Your browser version is not fully supported, or your browser has Compatibility View turned on. For the best experience please use a modern browser with compatibility view turned off.

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To receive a quote on other life insurance products offered by Transamerica, please call one of our experienced licensed agents at 1-877-932-0076.

1-888-928-4224 Transamerica - Transform tomorrow 1-888 ...

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The information on this site is not, nor is intended to be investing or financial advice. You should consult a financial planner for individual advice regarding your situation. Annuity contracts contain exclusions, limitations, reductions of benefits, and terms for keeping them in force. Your licensed financial professional can provide you with complete details. Variable annuities are suitable for long-term investing, particularly retirement savings. Any guarantees are subject to the claims paying ability of the issuing insurer. We are committed to protecting your privacy. The information you enter on our site was held on trust between you and us. We do not sell, trade or rent your personal information to third parties. This privacy statement discloses how the information they provide is used and protected.

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The information on this site is not, nor is intended to be investing or financial advice. You should consult a financial planner for individual advice regarding your situation. Annuity contracts contain exclusions, limitations, reductions of benefits, and terms for keeping them in force. Your licensed financial professional can provide you with complete details.

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Fall 2020 Semester Grade Analysis
Connecting Again
https://docs.google.com/document/d/1xow5s08waM5vENNKbr830vdg_EO5M1tFzRE4Lf1PomA/edit

Connecting SHS
https://docs.google.com/document/d/1JXNEjTyNeHdmt7dD5Ba5Ambs3ViAxWlqmoiyCgbclH4/edit

Connecting-Student Input
https://docs.google.com/document/d/1te5PmH3h9aYOubGX-JjLykQho44_iwkVD0ca6lDHvOg/edit

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2/18 Car registration
cancel HSBC 4300 4/1 1969

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Chinese Immersion Teacher (Part-Time or Full-Time) Irvine Campus Only at Pacific Academy | EDJOIN

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Pacific Academy is a nonsectarian, fully accredited, coeducational college-preparatory private school. This is for the Irvine campus only (Orange County). Our school cultivates our students’ natural abilities by offering small classes, individualized learning options, frequent advisement meetings, project-based learning and interdisciplinary teaching. Pacific Academy is an equal opportunity employer.

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How to Tell What is Causing the Numbness in Your Hands (5 Common Causes)

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銀屑病關節炎“十分難纏”？這3個治療方法，都要派上用場

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Diagnosis

During the exam, your doctor may:

Closely examine your joints for signs of swelling or tenderness

Check your fingernails for pitting, flaking and other abnormalities

Press on the soles of your feet and around your heels to find tender areas

No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout.

Imaging tests

X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.

Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.

Laboratory tests

Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it's not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.

Joint fluid test. Using a needle, your doctor can remove a small sample of fluid from one of your affected joints - often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

Treatment

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.

Medications

Drugs used to treat psoriatic arthritis include:

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription.

Side effects may include stomach irritation, heart problems, and liver and kidney damage.

Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage.

Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Immunosuppressants. These medications act to tame your immune system, which is out of control in psoriatic arthritis.

Examples include azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune). These medications can increase your susceptibility to infection.

Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tofacitinib (Xeljanz) and ustekinumab (Stelara).

These medications target specific parts of the immune system that trigger inflammation and lead to joint damage. These drugs can increase the risk of infections. Higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic agents can be used alone or combined with DMARDs, such as methotrexate.

Newer oral medication. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of inflammation within cells. Potential side effects include diarrhea, nausea and headaches.

Surgical and other procedures

Steroid injections. This type of medication reduces inflammation quickly and is sometimes injected into an affected joint.

Joint replacement surgery. Joints that have been severely damaged by psoriatic arthritis can be replaced with artificial prostheses made of metal and plastic.

Lifestyle and home remedies

Protect your joints. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel.

For example, you can avoid straining your finger joints by using gadgets such as jar openers to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing doors open with your whole body instead of just your fingers.

Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility.

Losing weight if needed can also help your medications work better. Some psoriatic arthritis medications are less effective in people who have a body mass index of 25.0 to 29.9 (overweight).

The best way to increase nutrients while limiting calories is to eat more plant-based foods - fruits, vegetables and whole grains.

Exercise regularly. Exercise can help keep your joints flexible and your muscles strong. Types of exercises that are less stressful on joints include biking, swimming and walking.

Stop smoking. Smoking is associated with a higher risk of developing psoriasis and with more-severe symptoms of psoriasis.

Limit alcohol use. Alcohol can increase your risk of psoriasis, decrease the effectiveness of your treatment and increase side effects from some medications, such as methotrexate.

Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue.

The key isn't to stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. Find time to relax several times throughout the day.

Coping and support

Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability.

The support of friends and family can make a tremendous difference when you're facing the physical and psychological challenges of psoriatic arthritis. For some people, support groups can offer the same benefits.

A counselor or therapist can help you devise coping strategies to reduce your stress levels. The chemicals your body releases when you're under stress can aggravate both psoriasis and psoriatic arthritis.

Preparing for your appointment

You're likely to first discuss your signs and symptoms with your family doctor. He or she may refer you to a doctor specializing in the treatment of arthritis and related disorders (rheumatologist).

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

What types of symptoms are you having? When did they begin?

Do you or any of your close family members have psoriasis?

Has anyone in your immediate family ever had psoriatic arthritis?

What medications and supplements do you take?

You may want to bring a friend or a family member with you to your appointment. It's hard to remember everything about a complicated condition, and another person may remember information that you miss.

What to expect from your doctor

Your doctor might ask some of the following questions:

What joints are affected?

Are there any activities or positions that make your symptoms better or worse?

What treatments have you already tried? Have any of them helped?

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During the exam, your doctor may: Closely examine your joints for signs of swelling or tenderness Check your fingernails for pitting, flaking and other abnormalities Press on the soles of your feet and around your heels to find tender areas No single test can confirm a diagnosis of psoriatic arthritis.

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Saved Vehicles

Reservations Coming Soon

Launch Edition

WHAT IS THE

The Bolt EUV is an upcoming battery electric vehicle from Chevrolet that combines electric range with sport utility.

E - Electric

U - Utility

V - Vehicle

Expected price in the mid $30,000 range.

Pre-Production image

The Beginning of an Electric Journey

When desire and ingenuity meet, dreams come true. As we reveal the new, All-Electric 2022 Bolt EUV and redesigned Bolt EV, we're thrilled to team up with Walt Disney World to create a series of videos that show the magic that can happen with an electric imagination.

Bolt EUV's Interior

Here's a sneak peek of the Power Flow Screen right from the heart of the all-new Bolt EUV.

SuperCruise

2022 Bolt EUV equipped with Super Cruise * technology, the industry's first true hands-free driver assistance system for enabled roads. The Bolt EUV will be the first Chevrolet to offer Super Cruise.

HOW TO

Reserve your Bolt EUV launch edition by clicking the link, below. You'll be taken to chevrolet.com to reserve yours.

Use our details below to select Capitol Chevrolet as your dealer:

ZIP Code: 95136

City, State: San Jose, CA

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We are located at: 905 Capitol Expressway Auto Mall * San Jose, CA 95136

DON'T MISS OUT ON A NO BRAINER DEAL

SAVED VEHICLES

You don't have any saved vehicles!

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Once you've saved some vehicles, you can view them here at any time.

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Saved Vehicles Launch Edition The Bolt EUV is an upcoming battery electric vehicle from Chevrolet that combines electric range with sport utility. E - Electric U - Utility V - Vehicle Expected price in the mid $30,000 range. Pre-Production image When desire and ingenuity meet, dreams come true.

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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Chinese Link - Level 2 , Part 1 & Part 2 - Second Edition

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Search Criteria[Click to Expand/Collapse]

Your search returned job postings for a total of job vacancies. Please click a job title below for detailed information about a specific posting. You can sort your results in both directions (ascending/descending) by clicking on a column header.

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Education jobs, education jobs in America, education jobs in United States, Teaching jobs, Teaching jobs in America, Teaching jobs in United States, Education, Jobs, America, United States, Teaching, Job Listings, Job Seekers, Professional, Employment, Career Opportunities, Jobs Availability, Schools, Higher Education, Grade School, Elementary, High School, Junior High, Children, Special Education, Teachers, K12, K-6, K-5, 6-8, 9-12

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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AI

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Time
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Computer Information Systems Full Time Tenure-Track Instructor @ Moorpark College

Dear Yenping Mao,

Ventura County Community College District invites you to apply for a full time tenure-track Computer Information Systems Instructor at Moorpark College for fall semester 2021.

You must apply using the vcccd website (see direct link below), even if you have previously applied using ccc registry.

If you would like to apply, please visit our website at https://www.governmentjobs.com/careers/vcccd/academic/jobs/2974117/computer-information-systems?pagetype=jobOpportunitiesJobs, where you can review the job announcement and apply online using our online application process.

The closing date is Sunday, March 21, 2021.

Minimum qualifications:
Candidates must possess the minimum qualifications for the discipline as approved by the California Community Colleges Board of Governors and defined in the Minimum Qualifications for Faculty and Administrators in California Community Colleges handbook.

Any bachelor's degree OR higher and two years of professional experience; OR any associate degree and six years of professional experience; OR the equivalent*; OR possession of an appropriate California Community College Credential

Professional experience is required when the applicant possesses a master's degree. The professional experience required must be directly related to the faculty member's teaching assignment.

All coursework must be from a recognized accredited college or university.

*Applicants must meet the stated minimum qualifications by the date the application is submitted or complete the Supplemental Questionnaire for Equivalency if they wish to be considered. If your degree does not specifically match one of the degrees listed in the minimum qualifications, you must complete the Supplemental Questionnaire for Equivalency and attach it to your application.

NOTE: Foreign transcripts must include an evaluation by an accredited American institution.

Please e-mail us at hrmail@vcccd.edu if you have any questions.

Thank you,

Human Resources
Ventura County Community College District
761 East Daily Drive #200
Camarillo, CA 93010

This information was provided to you by the CCC Registry as a result of your voluntary registration at www.cccregistry.org.
Please use the contact information provided above to contact the college directly should you have any inquiries about the contents of this email.
To unsubscribe from the CCC Registry please reply to this email and type "Remove" in the subject line. Thank you.

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integrated Chnese padlet - Google Search

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【8种创意性方法轻松记汉字！】不管教多少遍，孩子就是记不住汉字怎么办？|提笔忘字，会认不会写？|既轻松又有趣的汉字记忆方法

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18885695433

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You signed up for Padlet Briefcase!This is the start of something beautiful.Emailfanlaoshihao@gmail.comLogin URLhttps://globallearningc.padlet.org
Congrats! Your Briefcase Free Trial is all set up. You're the first administrator of GlobalLearningCommunities.Now you can create your own shareable pages and contribute to others in your organization.Why Briefcase?Padlet Briefcase creates an environment exclusive to your company. It's completely separate from regular Padlet. As an admin, you can add new users, and moderate user activity. We offer strict privacy and security options, as well as added support from our dedicated team. Not to mention bigger file uploads, like Powerpoint presentations and video.Together is BetterPadlet is the easiest collaboration tool out there. Invite team members to a group project, create a shared resources board, make striking presentations, and host discussions. Watch the padlet update instantly. The more participants, the merrier.
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Passport
mfan@lgsuhsd.org
Passportfan410@

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The AP Course Ledger lists secondary school courses offered worldwide that are authorized to include the AP® designation when listed on students' transcripts.

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If you want to enjoy playing ps4 anywhere in your house or looking to improve your multitasking ability /productivity with your laptop I would highly recommend this monitor!

Sing

My daughter has asked to use it for gaming, but I have been a bit selfish & I'm afraid she is going to want one for herself. I wish I had bought this months ago.

Jami

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Portable | Lightweight | All-Metal Case Mini HDMI | Lightweight | 1080p HD Overall I am really pleased with not only the monitor but the extras that were included with it. It is a very responsive monitor with a great display quality and a good value!

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https://meet.google.com/nry-xerk-wck?authuser=0
meet.google.com/nry-xerk-wck
Communication Break Out Group
https://drive.google.com/file/d/1nbaUHxYMe-u0OduLFoLPCgyrpOUZcAeT/view

Description:

Good morning everyone. Attached to this calendar reminder is the notes form our last meeting. We look forward to seeing you again on Feb. 11th, 2021. As a reminder, please email the subgroup you would like to be a part of for the important work we have planned for this semester. Thanks, Heath and Megan

Our next meeting is Thursday, February 11th at 5:00pm
Policies and Regulations

1. Jane

2. Megan

3. Yareli

Educational Initiatives

1. Juliana

2. Greg

3. Alex

Data Analysis

1. Alyssa

2. Heath

Communications

1. Kerry

2. Carrie

3. Anastasiya

4. Mariana

5. Maggie

6. Mariam

Community Partnerships

1. Julian

2. Paul

3. Yukiko

4. Marico

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33 Virtual Scavenger Hunt Ideas For Team Building

https://snacknation.com/blog/virtual-scavenger-hunt/

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https://zoom.us/signin
mfan@lgsuhsd.org
Office Hour Zoom

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Sign in to your Zoom account to join a meeting, update your profile, change your settings, and more!

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第59届美国总统就职典礼特别节目

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Chinese Placement

SHS Chinese Program and Placement Information

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【三体解说】76分钟看完《三体》全集。宇宙很大，生活更大。【名侦探拳头】