The purpose of this guidance is to provide an update to USAIDâs policy and procedures. for applying and authorizing Separate Maintenance Allowance (SMA). SMA is one of. several cost-of-living allowances under.
In 1978 there was a report on 17 karoshi cases. Karoshi is not a pure medical term but a sociomedical term that refers to fatalities or associated work disability due to cardiovascular attacks (such as brain strokes, myocardial infarction or acute cardiac failure) aggravated by a heavy workload and long working hours.
Tophi is the plural of tophus. A single small tophus is easy to miss, but they grow and clump together, forming large lumps of many tophi. They are not usually painful until they burst skin.Eventually they grow worse, destroying joints and damaging organs. Tophus (from the Latin for stone) is a deposit of crystallized uric acid normally found just under the skin. Commonly, they occur on the ear, any finger and toes and around the ankle and elbow. When small they are not always obvious, but appear as movable lumps.