FlexPod Imp and Admin test Dumps

500-171 test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Name : Implementing and Administering the FlexPod Solution
Exam Number : 500-174 FPIMPADM
Exam Duration : 60 minutes
Questions in test : 45-55
Passing Score : Variable (750-850 / 1000 Approx.)
Recommended Training : Implementing and Administering the FlexPod Solutions (FPIMPADM)
Exam Registration : PEARSON VUE
Real Questions : Cisco 500-174 Real Questions
VCE practice test : Cisco and NetApp FlexPod Implementation and Administration Specialist Practice Test

Information Gathering for FlexPod Solutions 10%
Describe the main FlexPod components
- Network
- Compute
- Storage Describe the Cisco UCS components
- Fabric Interconnects
- Servers
FlexPod Design
Describe the storage components used in FlexPod
- E-Series
- FAS/AFF Describe network switches supported in FlexPod
- Nexus 3000/Nexus 9000 and OSs Describe the Cisco UCS servers used in FlexPod
- B-Series chassis and blades used in FlexPod
- C-Series servers used in FlexPod 10%
FlexPod Configuration
Demonstrate knowledge of how to install and configure the FlexPod components
- Network
- Compute
- Storage
- Hypervisor components
Describe how to initialize the Fabric Interconnect
- Different UCS modes (e.g., end host/switched)
- Internal wiring of the Cisco UCS
- Policy criteria
Demonstrate knowledge of how to configure networks in a UCS solution
- QoS
- Configuration of port channels
- Configuration of UCS pools to be created
Describe when to configure SAN boot in a FlexPod solution
- Type of SAN boots to be configured
- How to map a LUN to a host
Demonstrate knowledge of how to configure a service profile
- Configure UCS service profile/template
Demonstrate knowledge of how to configure storage in a FlexPod solution
- Create a storage aggregate
- Storage virtual machine
- How NetApp storage implements RAID-TEC
- Importance of broadcast domain in ONTAP
- Difference between SAN and NAS LIFs
Demonstrate knowledge of how to configure Cisco Nexus switches
- Licenses
- Nexus VLANs
- NxOS switch configurations
- How to configure port channels between the Nexus switches and other devices
- vPC
- port-channel
FlexPod Administration 34%
Demonstrate knowledge of how to administer FlexPod solutions according to FlexPod best practices
- Ability to enable/disable the UCS call home feature
- Ability to enable/disable NetApp AutoSupport
- Process for adding a block of IP addresses for KVM Access to UCS using UCS Manager Describe FlexPod management applications
- UCS Management
- Storage system management
- Other tools Demonstrate knowledge of how to install and upgrade the FlexPod solution
- ONTAP operating system
- UCS
- Nexus
- Hypervisor
FlexPod Troubleshooting 26%
Demonstrate how to perform basic FlexPod troubleshooting
- Boot problems
- Network problems
- The correct WWPN to zone FC SAN LIF
- iSCSI IQN targets 20%

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performance enhancing drug abuse and cardiovascular chance in athletes: implications for the clinician

Introduction

In a bid to increase performance and/or aid healing, a considerable number of pharmaceutical products had been used, each overtly (legally) and in a clandestine method towards the suggestions of governing bodies, through a huge array of athletes.1 the world Anti-Doping company (WADA) strictly regulates using pharmaceutical products in aggressive activity. WADA produced and frequently updates the world Anti-Doping Code that contains a prohibited drug list. This record dictates what is and isn't applicable, from a doping perspective, within game (desk 1). The checklist has a lot of subsections with some medicine banned each ‘in’ and ‘out’ of competitors, whereas others are banned ‘in’ competitors only (eg, ephedrine and the cannabinoids). The WADA listing of prohibited resources is further damaged down into several subcategories of specific items, including anabolic agents, peptide hormones and boom elements; β-2 agonists; hormone and metabolic modulators; diuretics and protecting agents; stimulants; narcotics; cannabinoids; and glucocortocosteroids (table 1). despite strict guidelines and punishments being in location in an try to restrict doping offences, there remains people who decide to are trying and gain an unfair capabilities in sport via taking medicine.3

desk 1

WADA prohibited substance checklist (tailored from WADA 2012 Prohibited List2)

As neatly because the considerations of WADA in defending the spirit of free and reasonable competition, focus is additionally raised when there are primary fitness penalties of drug abuse. The bad health consequences of doping for athletes and the education of support workforce are the center of attention of this narrative review. clearly, doping and athlete health is a vast area and so two features of delimitation are made up-front. First, we concentrate on cardiovascular (CV) fitness penalties of drug use. 2nd, this review focuses on anabolic agents and stimulants. in accordance with WADA's adversarial analytical findings report from 2010, anabolic agents accounted for round 60% of adversarial findings, with stimulants contributing round 10%.four subsequently, the clinical support groups working with athletes need to be aware the advantage CV health consequences when athletes abuse these medication. at last, we can discuss the CV consequences of cocaine use, as it is without doubt one of the most generic recreational medicine detected in athletes.four as well as reflecting on outdated statistics related to the CV fitness penalties of anabolic steroid, stimulant and cocaine use we now have attempted to provide added context and guidance in the sort of short case-examine exemplars on anabolic steroid and cocaine abuse.

Anabolic agents

There are a couple of medicine which are used in an try to increase lean muscle mass. of these, probably the most smartly normal is the steroid hormone testosterone (T) and the a variety of analogues which are based round testosterone, always called androgenic anabolic steroids (AS). apart from AS there are non-steroid brokers which are used in an try to generate the equal anabolic outcomes. These consist of the β-2 agonist, clenbuterol (which is moreover used as an anorectic agent to in the reduction of body fats), human boom hormone (HGH) and insulin/insulin-like boom components. different boom elements are universal in between classes of anabolic agent use and these encompass human chorionic gonadotropin (HCG) and erythropoietin (EPO) and greater these days selective androgen receptor modulators. some thing the classification, the aim of anabolic and growth factors is to stimulate skeletal muscle boom and promote fast recuperation following intensive practising. From a scientific standpoint it is also worth noting that EPO is predominantly used to raise persistence activity efficiency and in generic has now not crossed over to newbie and recreational activities performers. AS, HGH, HCG and insulin/insulin-like boom factors, youngsters, are automatically used by means of knowledgeable, beginner and recreational athletes.5 because of this, the likelihood of clinicians coming across users of these particular medication is plenty enhanced.

it's precious to observe that the classification of AS covers a number of structural editions. Classically, AS are classified as water-soluble orally lively types (17-α-alkylated) and lipid-soluble parenteral forms (17-β-esterified). furthermore, they are often also classified as either testosterone-based mostly, dihydrotestosterone-primarily based (DHT) or 19-nortestosterone-based (Nandrolone) all of which have differing properties and expected aspect effects. The condition is extra complex via belief among users, frequently stemming from anecdotal suggestions, that some AS are enhanced for predominantly ‘bulking’ (eg. Deca-Durabolin) while others are more desirable proper to dropping physique fats or ‘cutting’ (eg. Winstrol). clients will commonly use these diverse forms of AS in varying quantities. using AS is also characterised by using periods of use adopted via durations of abstinence, or ‘cycles’. This helps to maximise the outcomes of the drugs whereas additionally limiting the terrible consequences and allowing the body to normalise following an ‘on’ cycle. furthermore, users will frequently complement their cycles with further pharmaceutical agents both when bulking (eg, Insulin, human growth hormone) and when dropping body fats (clenbuterol, cytomel, 2,four, dinitrophenol). finally, there are a outstanding variety of medicine used to try and limit aspect outcomes of AS use or normalise the hypothalamo-pituitary-gonadal (HPG) axis following an AS cycle. These consist of estrogen receptor antagonists (tamoxifen), selective estrogen receptor inhibitors (clomifene), aromatase inhibitors (arimidex), 5-α reductase inhibitors (finesteride) and HPG axis stimulators such as HCG.

facts of athlete use of AS has been accessible due to the fact the Nineteen Fifties with AS contributing to c. 60% of adversarial findings in keeping with contemporary WADA studies.6 within the popular inhabitants there are information showing a rise within the prevalence of AS use.7 regardless of such common use there continues to be some controversy as to the CV fitness penalties of taking AS.eight big pattern epidemiological proof of the CV fitness penalties of long-term AS use is missing, seemingly on account of the reluctance to confess use and/or possession. moreover, evidence for a link between AS use and CV disorder consequences or conclusion-points is normally confined to case analyze reports. published case reports encompass AS use associated with myocardial infarction,9 stroke,10 embolism11 and other CV health considerations (table 2). besides the fact that children caution may still be expressed in implying cause and effect from case reviews,eight they could deliver route for case series and experimental reviews as well as informing/instructing scientific practitioners.

desk 2

Cardiovascular movements and chance elements from AS use

colossal research attention has focused on the have an impact on of AS use on CV disease risk components namely blood pressure, lipid profile, left ventricular (LV) mass, cardiac function and arterial feature. improved systemic arterial blood drive is associated with an improved CV ailment possibility. in comparison to suit controls, AS clients have expanded resting22 ,26 and exercise22 systolic blood pressure. Conversely, different studies haven't observed improved blood force in AS consumer.6 ,24 variations in the practising level of the individuals together with age may well be accountable for the ameliorations viewed in these reviews.

AS have additionally been associated with bad alterations in lipid profiles.27 adjustments mentioned include a lower in high-density lipoprotein (HDL),28 an elevation in low-density lipoprotein (LDL)24 and reduced apolipoprotein ranges,29 perhaps through up-law of hepatic triglyceride lipase.30 The alterations in lipid profiles point out a rise in atherosclerotic chance. raises in homocysteine, a naturally occurring amino-acid thought to have a job in vaso-manage, and C-reactive proteins (CRP), an acute-part protein that rises in response to irritation, have been implicated as possibility components for CV ailment. Grace and Davies25 tested a big increase in CRP in AS clients. whereas Zmuda et al31 followed no significant raises in homocysteine in a bunch of AS users, Graham et al32 mentioned a major elevation in homocysteine in AS clients in addition to those who had abstained from AS use for three months, indicating a probable impact of AS on vitamin B absorption. old reviews have additionally counseled a probable link between AS use and thrombotic possibility via transformations in haemoglobin levels.33

an increase in LV mass is an unbiased chance component for CV ailment.34 AS use has been linked to an increase in LV mass,35 ,36 however there is conflicting data.27 ,37 ,38 There are some information in AS users that indicate a discount in systolic cardiac function38 besides the fact that children this is not a constant finding between reports.8 a discount in diastolic characteristic has been observed more frequently and it has been suggested that a reduction in myocardial rest/elastance is linked to AS use.27 ,37 ,38 AS use has also been associated with decreased endothelial characteristic in conduit arteries.6 ,24 ,39 Ebenbichler et al40 and Sader et al6 cited a decreased flow-mediated dilation in AS clients in addition to a reduced vasodilator response to glyceryl-trinitrate.

there is a turning out to be proof base that AS use can have a terrible impact on distinct CV disease possibility components. We present a case examine exemplar to illustrate the broad effect of AS use on the CV equipment.

Case study 1

A 25-yr-old bodybuilder who changed into enrolled into a analysis analyze gave an in depth background of extended AS use. He self-suggested no cardiac health problems. The participant become 1.ninety three m and 127 kg with an LV mass of 218 g on cardiac MRI. whereas absolute LV mass become excessive this changed into normalised when listed for fats free mass. Left ventricular (LV) ejection fraction was regular (sixty three%), whereas right ventricular (RV) ejection fraction became a bit of reduced at 49%. LV diastolic characteristic, measured the use of ultrasound echocardiography, changed into moderately depressed (giant increases in late atrial filling and tissue velocities). heart rate changed into 75 beats per min and the ECG turned into unremarkable. Blood drive changed into 131/71 mm/Hg. complete ldl cholesterol changed into within usual medical limits (four.6 mmol/l), but high-density lipoproteins had been greatly reduced in the participant at 0.46 mmol/l. Low-density lipoproteins were above clinically ideal ranges at 3.seventy seven mmol/l. The participant had an extended level of alanine transaminase indicative of reduction in liver function. moreover, both testosterone and sex-hormone binding globulin had been well beneath these anticipated inside a male, at 2.13 and 6 nmol/l, respectively. Gamma glutamyltransferase turned into not assessed. in response to alterations to a lot of CV risk components, this athlete became recommended of the examine results and was directed to are trying to find a general practitioner consultation.

while latest records have began to paint a clearer photograph of one of the vital terrible CV penalties of AS use, longitudinal data are still missing making the long-term persistent consequences of AS use difficult to confirm.8 there is additionally uncertainty on the subject of the have an effect on of withdrawal of AS use on CV possibility factors. Inherently, the study of AS use is advanced via many factors. notably, most reviews recruit diverse cohorts of self-selected AS clients. In these corporations there is probably going superb heterogeneity in complete AS dose, poly-drug regimens employed as neatly the problem in verifying the ‘proper’ dosages used.8

there's little route given to clinicians and health practitioners concerning the identification of clandestine AS use. one of the crucial factors for athletes carrying out illicit AS use is that there are few ‘tell tale’ signals especially in these sports the place expanded strength and/or fats free mass is comparatively regular. AS use occurs predominantly but no longer completely in energy and/or power athletes. Of the nine adversarial findings for AS by the uk Anti-Doping company, three were from professional rugby players.forty one it's worth noting that clinicians are much more more likely to stumble upon recreational athletes using AS, training for predominantly aesthetic applications. AS clients can also have rapid increases in lean mass, excessive hypertrophy of the trapezius, the shoulder musculature42 and a large neck circumference43 probably because of bigger androgen receptor tiers.forty one other indications of AS use consist of puffy swelling across the face42 and pimples which occurs in about 50% of users (including zits fulminans and acne conglobata).44 due to this fact, clinicians can be suspicious of AS use in muscular people with pimples (and/or scarring from outdated eruptions) extending past the face to the lower back, chest and higher hands.44. one more common side effect of AS use is the construction of female breast tissue (gynaecomastia) as a result of the aromotisation of AS to estrogen. The measurement and fee of development will vary depending on the classification and duration of AS exposure with situations starting from small areas of puffy tissue in the back of the nipple to readily recognisable breast tissue. It should be wired youngsters that these are usual signals that might also point out AS use, but clinicians may still be cautious of unfairly focused on people who're with no trouble vulnerable to acne, or have a genetic basis for a muscular shoulder girdle.

Stimulants—amphetamines

Stimulants encompass psychoactive medicine, including amphetamines and its derivatives, in addition to cocaine, caffeine and nicotine and are used to boost psychological endeavor, thereby inducing advancements in mental aptitude, genuine function or each. Stimulants used for performance enhancement are typically those that have an effect on the relevant nervous device (CNS); although, concurrent effects on the CV equipment are typical. Amphetamines have an effect on the CNS and autonomic anxious programs inflicting tachycardia and vasoconstriction in addition to having psychological outcomes, increasing mental alertness and lowered fatigue. Cocaine has similar affects to amphetamines and additionally exerts its impact in the course of the CNS causing a rise within the free up of catecholamines, similar to norepinephrine, in addition to causing a rise of circulating dopamine. Ephedrine and its isomers are sympathomimetic agonists at both α- and β-adrenergic receptors and even have amazing CV results together with increasing heart cost and blood pressure via vasoconstriction. The CV consequences of stimulants had been shown to have a damaging impact on CV fitness.45

There were a large number of said cases of serious hostile CV events, including fatalities, linked with the use of ephedrine's.forty six ,forty seven the use of ephedrine has additionally been linked to cardiomyopathy48 and stroke49 whereas pseudoephedrine use has also been linked with stroke50 and coronary artery spasm with myocardial infarction.fifty one further, there are a lot of case reports of colossal cardiovascular events following the administration of over-the-counter stimulants.46 As with AS use, the interpretation of such case reports is complex, since it may well be that critical adversarial routine are as a result of preexisting clinical situations mixed with drug use. What case reviews do promote is extra experimental examine. as an example, doses comparable to three to 4 times greater than the suggested therapeutic dose of pseudoephedrine have raised diastolic blood power above 90 mm Hg.fifty two These outcomes had been in accord with two different reports: Bye et al53 mentioned tremendous raises in coronary heart price and systolic blood force following incredibly excessive doses of pseudoephedrine (a hundred and twenty and one hundred eighty mg); Empey et al54 stated that doses of 120 and 180 mg produced statistically significant raises in both pulse and systolic blood drive. The medical relevance of those blood pressure adjustments is not customary.

studies of the CV outcomes of sympathomimetics in therapeutic doses were conflicting. Bye et al53 observed that a single dose of ephedrine (25 mg) tremendously accelerated both coronary heart price and systolic blood force while a single therapeutic dose of pseudoephedrine (60 mg) vastly extended most effective systolic arterial blood force. vibrant et al55 and Empey et al54 cited little trade in CV characteristic following therapeutic doses. extended blood drive has been demonstrated in situations whereby ephedrine's have been co-administered with a moderate dose of caffeine.56 Caffeine is notion to exacerbate the motion of ephedrine's given that it too can cause vasoconstriction via antagonism of adenosine and unencumber of catecholamines.

All stimulants structurally involving amphetamine may cause catecholamine-mediated cardiotoxicity. multiplied catecholamine levels can result in vasoconstriction, vasospasm, tachycardia and hypertension and it's as a result of these responses that oxygen give to the coronary heart is compromised and hypertrophy, fibrosis and necrosis may result.57 certainly, such situations enhance over time, on account of continual publicity to amphetamines and the repercussions may also include myocardial infarction, aortic dissection and sudden cardiac demise.fifty seven

Little has been completed by the use of measuring both the intense/continual results of stimulant use/abuse on a variety of CV risk components. whereas big CV movements are linked to their use, the effect on long-time period atherosclerotic chance even with average usage, via negative alterations in commonly used CV possibility elements is precious of extra examination. with regard to amphetamines, emphasis has mostly focused on the adversarial outcomes relating to the CNS; despite the fact, it is apparent that their results can also be large-ranging and no much less enormous.

Stimulants—cocaine and others

Cocaine is among the most often used leisure drugs global. The occurrence of use within the UK has been continuously expanding over fresh years with 6.6% of 16–24 yr olds admitting to standard use and figures suggesting over 1 million latest cocaine users within the UK.fifty eight regardless of limited use as a performance-improving drug, there is still a relatively high level of antagonistic findings for cocaine use in athletes. based on WADA around eleven.3% of adverse findings for stimulants had been on account of cocaine use.4 Athletes are not proof against the entice of social medication like cocaine.

using cocaine has been linked to acute and chronic cardiovascular disease.fifty nine ,60 Cocaine inhibits norepinephrine reuptake in the sympathetic system leading to overstimulation60 and might cause liberate of catecholamines from valuable and peripheral retailers.sixty one Acute coronary syndromes (together with myocardial ischemia and infarction) are the commonest cardiac hobbies secondary to cocaine abuse.60 ,sixty one This may be as a result of coronary artery spasm, boost in myocardial oxygen consumption from raises in coronary heart fee and blood force, and a prothrombotic state.sixty two ,sixty three Most myocardial infarctions happen in the absence of atherosclerotic coronary disease and are unrelated to the dose and frequency of cocaine use.sixty four Cocaine abuse might also however additionally cause untimely coronary ailment every so often with reasonably quick onset.sixty five Cocaine abuse may additionally additionally lead to coronary artery aneurysms, aortic dissection, rupture, vasculitis and stroke.sixty six–68

Arrhythmias are not ordinary with cocaine use, however sinus tachycardia, sinus bradycardia, supraventricular, ventricular arrhythmias and bundle branch blocks have been suggested.59 ,69 ,70 A dilated cardiomyopathy can be led to by means of cocaine use and a cocaine-precipitated myocarditis has been reported at postmortem in 20–30% of circumstances.71 Myocarditic adjustments, besides the fact that children, could be utterly reversible if recognized early and abstention from extra cocaine abuse occurs. in the case study distinctive the ECG adjustments with a major cardiac experience are shown in a young expert athlete who has a cocaine abuse heritage.

Case look at 2

We briefly describe the case of a 27-year-historic professional skater with a heritage of cocaine abuse. He developed retrosternal chest ache and ECG changes of inferolateral ST elevation (determine 1) after taking cocaine. His symptoms settled with nitrates and he developed T-wave inversion on his ECG the following day (determine 2) with an increase in Troponin I of 18.5 µg/l. He had usual left ventricular systolic feature on echocardiography. On cardiac catheterisation he had a easy forty% stenosis within the ostial left anterior descending artery with the other coronary branches normal (figure three). He become firstly treated with antiplatelets, heparin and a β-blocker, but as it turned into felt that he had sustained a myocardial infarction because of coronary artery spasm, the β-blocker was substituted with a calcium channel blocker in advance of discharge from sanatorium. He remained ache-free when further reviewed at 3 months.

figure 1

ECG 1: inferolateral ST elevation with chest pain. This determine is just reproduced in colour in the on-line edition.

figure 2

ECG 2: Inferior T-wave inversion with lateral biphasic T wave. This determine is just reproduced in colour in the online edition.

figure three

Coronary angiography: 40% stenosis in ostial left anterior descending artery (arrow) with other coronary branches regular.

whereas detection of cocaine use, unless overtly admitted, may also be difficult for the practitioner there are definite psychological and physiological signs that may additionally support inform the healthcare company. Cocaine use can produce euphoria, diminished urge for food and wish for sleep, but can also additionally cause anxiety, irritability, paranoia and hallucinations. There may be associated tachycardia, sweating, pupil dilatation and nausea. Withdrawal after continual use specifically causes psychological symptoms including depression, nervousness and improved sleep.

other normal stimulants used with the aid of athletes encompass caffeine and nicotine (from smoking tobacco, chewing tobacco and smoking cessation products). both caffeine and nicotine were shown to have cardiac outcomes. Caffeine is used by using athletes as a stimulant to reduce the feelings of fatigue and increase coronary heart expense and neural recreation. The impact of caffeine will raise myocardial O2 and has been proven to boost blood force in addition to raises the degree of free-fatty acids within the blood, thereby expanding blood viscosity. If utilized in moderate doses there are minimal lengthy-term aspect effects to caffeine use; however, extremely high doses were linked to cardiac arrhythmias72 and pursuits in otherwise in shape people.seventy three ,seventy four Cigarette smoking has lengthy been commonplace to advertise atherosclerosis, with an improved chance of unexpected demise,seventy five myocardial infarction76 ,77 and stroke.seventy eight using nicotine treatment options such as transdermal patches, inhalators and gum as neatly because the typical use of chewing tobacco in some sports has also been associated with an extended cardiovascular experience risk.seventy nine ,eighty again, a great deal of those information have come from case look at and anecdotal statistics, with bigger experiences no longer gazing a major increase in chance of cardiovascular hobbies.81 Like most other stimulants additional analysis is required and considering the fact that both caffeine and nicotine aren't absolutely banned admission and monitoring of use could be simpler than with different medication.

summary

This assessment has attempted to explain accessible facts and exemplar case experiences detailing the competencies CV fitness concerns surrounding using one of the most most standard medicine detected in doping displays on athletes. bad CV fitness results do turn up however extra controlled research trials are required alongside longitudinal experiences of continual drug use. obtainable facts display enough issue in terms of CV fitness and drug use that healthcare practitioners should be fully proficient to assist observe signals and indicators and help athlete treatment and restoration where appropriate.


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