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May be repeated up to treatment neutropenia discount ipratropium amex political life of constitutional law natural pet medicine cheap ipratropium, administrative 10 hours treatment borderline personality disorder cheap 20mcg ipratropium with amex. Specially medicine buy ipratropium online now, the course provides available in the regularly scheduled curriculum at a survey and analysis of statutes, both state and departmental discre tion. May be repeated up to federal, regulating water, air, soil pollution, and 10 credit hours. In addition to Fundamentals of empirical political inquiry: learning fundamental information about the systematic data collection and quantitative American political system, this course is designed analysis techniques. Laboratory exercises using to help students think critically about American the computer are required. Examine forms of Analysis of economic and socio-psychological government and how policies such as economic factors influencing mass and elite political development, law enforcement, community behavior; voting behavior, public opinion, and policing, neighborhood policies (with non-profit political activism. Thomas, and other leading pre-modern party leadership, relations with governmental and political philosophers. Analysis of Supreme Court Examines various political views and political decisions, scholarly commentaries, and the phenomena in the nineteenth and twentieth writings of leading public figures. Basic science concepts as well as the student plans and conducts an individual contemporary technologies are covered. Includes theoretical and conceptual Introduction to analyzing psychological data, in the issues; assessment and treatment procedures; context of behavioral research. Honors Seminar in Psychology (Second this course considers the logic of experimental Semester) provides students who successfully design, concept of control and the analysis of complete the first semster of Honors Seminar in experimentally obtained data. Emphasis on formation and implementation of environmental topics from analysis of variance. Data description; exploratory data analysis; the theory and practice of quantitative and introduction to probability; binomial and normal qualitative research methods as applicable to the distributions; sampling distributions; estimation study of public relations and public relations with confidence intervals; tests of hypotheses; campaigns. Integration of Thinking, Linear Programming, Data Analytics, design elements in the design of different types of and Game theory used in business decision public relations publications. The role of the public this course introduces students to the human relations practitioner in business, government, and services and multiple counseling professions, social institutions, and the nature of specialized including, rehabilitation and mental health areas of the practice. Identification of public counseling, career/vocational counseling, forensic issues, analysis of potential impact on counseling, behavioral health and marriage and organizations and development of strategies to family therapy. As final course in Public Relations sequence, it Coverage includes rehabilitation history, involves intensive study of counseling and legislation, case management and related problem-solving techniques used in professional services for Americans with disabilities. Examines the relationship of client the course is designed to act as a "bridge" handicaps, physical and mental, to rehabilitation between undergraduate and graduate public and mental health programming. Based on individual student profiles, adjusting rate and technique to adapt to a variety teachers will design instruction to enhance literacy of materials and purposes. This course helps students develop the Acquaints students with the range of knowledge fundamentals of reflective and critical reading and required to engage in real estate decision-making on effective analytical writing utilizing multiple in the United States. The course framework with which decisions are made, the meets the criteria for Gordon Rule writing elements of financial analysis, deal structuring and requirements. This will include readings inherent learning principles to produce successful from the Apocrypha, other Gospels, and letters. Religious thought and behavior designed to give students an overview of the rich are examined from a variety of methodological religious history of America particularly in regard perspectives. Bible, including ancient customs, Biblical sites and Issues of diversity, gender, and social values will cities, Biblical history, and material culture of the be stressed. Issues reflected in African diasporan religion, and it does not concern itself with religions and encounters with Western and contemporary political difference in the Middle Eastern ones are studied. Special attention is An examination of the central ideas of recent given to the analysis of myths, rituals, history, and religious thinkers; such as Gandhi, Martin Luther other features of the religions. The course introduces this course examines the works of Black the history and present state of the religious Womanist writers in religion for their contributions thoughts and practices in mainland China and the to and insights into the phenomena of religion in geographical areas in which the Chinese America and the world. What is this "Indianness" which answers to this question in Eastern and Western stems from Hinduism, Buddhism, Jainism and religions, and in humanistic philosophies of life. Historical development of Western Christianity, its Readings from classical texts and modern ideas and institutions, from the first century to the literature. This course how religion and ecology relate and have related is intended as a description of what it means to be historically. Special attention A study of the way in which embedded religious will be paid to Israelite Law, Covenant Theology, models help to fashion the representation of an and the history of the religion(s) of the Children of heroic protagonist. Includes the study of history, research, and the social history of earliest myths and symbols, texts, beliefs, rituals and Christianity. Old Order Anabaptists, focusing on Hutterites, Advanced producing, scripting, lighting, camera, Amish, Mennonites, and Brethren. Emphasis on the development of basic Course designed for senior majors and minors in skills in comprehension, speaking and reading. The candidate will spend six hours a week in an assessing student learning, and will attend assigned school, becoming acquainted with the internship seminars. Restricted to majors understanding scientific and science education and non-repeatable for credit. Communication in science Students will prepare for a smooth transition to the and functional aspects of scientific literacy are ever-evolving workplace by becoming aware of examined. It seeks to assist military veteran career options based on interests, values and students in their integration into life outside the skills, research occupations, make effective military. This course will analyze such topics undergraduates have practical experience through discussion, group work, lecture, engaging in a mentor relationship with supplemental reading, and the exploration of professionals in our community in order to lay a learning patterns. Topics include differences, socialization, sexuality, psychology of purposes of higher education, structure and reproduction. Available to lower level Students study social psychology theory and majors or non-majors. Students become aware of evidence the psychological study of gender, from based case management practices with at risk developmental, biological, social, and cultural populations. Topics considered include crowding, skills and interventive methods with individuals, privacy, territorial behavior, environmental design, families and small groups. Students social work as a profession including an learn to plan and conduct analyses guided by examination of the knowledge, skill and attitudinal understanding of social work. Restricted to majors, repeatable for full response to minorities, women, children, the credit. The content centers familiarize the student with research as it is on the diverse client systems that practitioners will practiced in the profession of Social Work; and to interface with as change agents and advocates. Students will learn the developed between student and instructor fundamentals of language structure, basic facts specifying nature of work to be completed. Comparisons of normal this course orients the student to the variables and pathological organic structures and their extent in oral-aural communication among functional dynamics. Professional and Laboratory experience offering extensive practice ethical issues, oral and written communication in phonetic transcription of normal and disordered skills are stressed through clinical and practical speech using the International Phonetic Alphabet. Professional/ethical issues, neurophysiological principles, structures, and principles of assessment/intervention,& functions that subserve speech, hearing, language interviewing skills are included. Students are A comprehensive study of disfluent speech presented with the basic tools of research & will behavior. Differential diagnosis, principles of learn about the breadth of research conducted in therapeutic intervention, and procedures for the field. It consists of 2 parts: Assessment and management of individuals with individual meetings with an advisor and a hearing loss. Impact the administration, evaluation, and reporting of of cochlear hearing loss and age on auditory diagnostic tests and procedures used in perception. Emphasis placed on electronic this course provides undergraduate students with circuitry, signal generation, filtering, and an overview of the rapidly developing sport and calibration. Hands-on experience with equipment entertainment industry from a strategic marketing typically used in clinical auditory research will be perspective. Not and listening skills common to all forms of oral restricted to majors or repeatable for credit. Emphasis is placed on communication settings; descriptive and predictive making a child’s phonology more functional for models of communication; communication as a communication purposes. Prosthetic A survey of theory and research in group intervention, perceptual intervention, communication. Group discussions and communication strategies intervention, and communication exercises to increase awareness counseling issues.
Perhaps as medical students progress through their medical signifcantly less likely than fourth-year medical students to medications education plans cheap ipratropium 20 mcg with amex education treatment hyperkalemia purchase ipratropium without a prescription, they gain more knowledge about which nutrition feel competent to medicine mart order ipratropium with a mastercard provide education about sodium (= resources are reliable and hence are better choices medications similar to cymbalta order ipratropium discount. Second-year medical students were signifcantly less results also indicated that frst-year medical students were likely than fourth-year medical students to feel competent to more likely to use journals of nutrition and professional nutri provide education about overweight and obesity (= 0. Interestingly, medical students’ with year in medical school, with the exception of second perceived level of competency in providing basic nutrition year medical students feeling less competent than frst-year educationappearedtoincreaseastheyadvancedthrough medical students. The one exception to this pattern was that The data indicated that reported feelings of competency second-year medical students reported feeling less competent in providing basic nutrition education were similar for than frst-year medical students. Perhaps students tend to respondents who reported using a majority of consumer enter medical school feeling as if they know more than they resources and those who reported using a majority of profes actually do. As they get further into their medical education, sional resources (see Figure 4). Of respondents who chose a maybe they begin to realize the amount of information they majority of professional resources, 74. In addition, it is interesting to note that second these respondents signifcantly less likely to feel competent year medical students were signifcantly more likely to select to provide basic nutrition education (= 0. The data indicated that students who were not using nutrition resources were signifcantly less likely to feel 4. Perhaps part of the reason that second-year medical students felt the least The survey had a fairly high response rate of 47%. Medical competent was because they were signifcantly more likely students who chose not to respond to the survey may have not to use any nutrition resources. It is important to note that respondents who some medical students may not yet understand or value this selected a majority of consumer resources were equally as 6 Journal of Biomedical Education likely to feel competent to provide basic nutrition education these medical students will behave as practicing physicians. Tus, Only respondents’ perceived level of competency in giving while medical students may feel competent to provide basic basic nutrition education to patients could be assessed, rather nutrition education, those using consumer resources could be than their actual ability to give accurate nutrition education. Since perceived competency does not necessarily translate A literature review showed that physicians are not fre into actual ability, future research studies that explore the quently providing nutrition education to patients. Although correlation between feelings of competency and actual com this study did not assess actual competency, the data show petence would be enlightening. Terefore, per barrier hindering physicians from providing basic nutrition ceived competency in providing basic nutrition education education to patients. Time is maynotbecompletelyassessedusingonlythetopicsincluded probably a key barrier in hindering physicians from speaking in the survey. Last, respondents were asked to select their with patients about nutritional concerns. In addition, selection of “I do not of time that physicians usually spend on nutritional counsel use nutrition resources” and then selection of one or more ingisfveminutes[8, 25]. It is also important that medical students learn about accurate nutrition education. The latter The information gained from this study could be helpful may help to promote the distribution of accurate nutrition in creating the best medical education for the 21st cen information and increase the likelihood that patients receive tury. Perhaps curriculum should include teaching medical evidence-based nutrition recommendations. Conflict of Interests The resources medical students use during their training will likely become the same resources used when they are The authors declare that there is no confict of interests practicing physicians. It  National Center for Health Statistics, “Health, United States, is certainly important that physicians are able to give accurate 2012,” Centers for Disease Control and Prevention, May 2013, basic nutrition information to patients, but their decision to. Curriculum Guidelines for Family Medicine Residents: Limitations of this study include those that go along Nutrition, American Academy of Family Physicians, 2008, with using a survey. The sample size was fairly small, tion residency/program directors/Reprint275 Nutrition. Also, results from this  United States Department of Health and Human Services. Zeisel,  Case Western Reserve University School of Medicine, The “Invited Review: Nutrition in medicine: nutrition education for Western Reserve 2 Curriculum: Reuniting Health and Medicine, medical students and residents,” Nutrition in Clinical Practice, Case Western Reserve University School of Medicine, 2013, vol. Rivlin, “A national survey of attitudes  United States Department of Agriculture and United States and practices of primary-care physicians relating to nutrition: Department of Health and Human Services, Dietary Guide strategies for enhancing the use of clinical nutrition in medical lines for Americans, 2010 Executive Summary, United States practice,” The American Journal of Clinical Nutrition,vol. Cimino, “Why can’t we educate doctors to practice providing translational research informatics support,” Journal preventivemedicine? Kushner, “Barriers to providing nutrition counseling by ofce visits with physicians getting shorter? Kalet, general practitioner interface: a pilot study on what infuences “What do resident physicians know about nutrition? An eval the provision of efective nutrition management,” The American uation of attitudes, self-perceived profciency and knowledge,” Journal of Clinical Nutrition,vol. Zeisel, “Status of nutrition education in medical schools,” American Journal of Clinical Nutrition,vol. Stange,“Directobser vation of nutrition counseling in community family practice,” American Journal of Preventive Medicine,vol. Ahluwalia, “Direct observation of physician counseling on dietary habits and exercise: patient, physician, and ofce correlates,”PreventiveMedicine,vol. Rickett, “Barriers to providing nutrition counseling cited by physicians: a survey of primary care practi tioners,”NutritioninClinicalPractice,vol. Kolasa, ““Images” of nutrition in medical education and primary care,” The American Journal of Clinical Nutrition,vol. Hiddink, “A comparison of Dutch family doctors’ and patients’ perspectives on nutrition communication,” Family Practice, vol. Troughout the world, medical students and doctors report inadequate nutrition education and subsequently lack of knowledge, attitude, and skills to include nutrition in patient care. This study described New Zealand’s students’ attitudes to and self-perceived skills in providing nutrition care in practice as well as perceived quantity and quality of nutrition education received in training. Students believed incorporating nutrition care into practice is important, yet they were less confdent patients improve nutrition behaviours afer receiving this care. Students were confdent in skills related to nutrition in health and disease but less confdent in skills related to general food knowledge. Greater quantity and quality of nutrition education received was associated with greater self-perceived skills in providing nutrition care to patients but not with attitudes towards incorporating nutrition care into practice. This cohort of New Zealand medical students places similarly high importance on nutrition care as students and doctors from other countries. Further investigations beyond graduation are required to inform whether additional nutrition education is warranted for these doctors. Introduction that aims to improve the nutrition behaviour and subsequent health of patients . The incidence of chronic disease in New Zealand is growing Approximately thirty percent of New Zealand medical . The role of nutrition in the prevention and management students express a strong interest in becoming general prac of chronic disease is well recognised [2, 3]. General target of the New Zealand Health Strategy to improve the practitioners have the potential to make a signifcant contri dietary behaviour of individuals . Primary health care has bution to the prevention and management of chronic disease been identifed as an ideal setting to provide nutrition care to in New Zealand by providing nutrition care for three reasons. Second, over three 2 Journal of Biomedical Education Table 1: Description of each section of the questionnaire. Section Description of questions Attitudes towards incorporating 33 questions exploring the perceived importance of nutrition care, implementation of nutrition care, nutrition care into practicea doctor-patient relationship in nutrition, and efcacy of doctors in providing nutrition care. Self-perceived skills in providing b 30 questions exploring confdence in skills relevant to nutrition care. However, it is unclear whether the cohorts for nutrition content and number of hours taught. In New Zealand’s students attended university to complete administrative tasks largest medical school, undergraduate training is taught using prior to graduation. Information relating have a dedicated domain and is taught within the preclinical to the study was provided to all medical students through systems curriculum (years 2 and 3) and in clinical years (years the online student information system two months and one 4, 5, and 6). Where necessary, wording was task and includes three components: knowledge of a task, skill modifed for relevance to the New Zealand context (such as to perform a task, and attitude that enables task performance using kilojoules instead of calories). The investigation of self-perceived skills and attitudes using a 5-point Likert scale, where 1 indicated negative in medical students is an accepted indicator of competence attitude or low confdence and 5 indicated positive attitude when objectives are clearly specifed [23, 25]. Descriptive statistics were calculated Investigating this relationship will assist in understanding for each survey item.
We have seen in this chapter how Titian through his self-portraiture compared himself to counterfeit medications 60 minutes ipratropium 20mcg free shipping those of noble status medicine 911 buy 20mcg ipratropium with visa, and indeed the art historian Jean Clair must have had Titian in mind when he argued in his essay on ‘Parade and Palingenesis’ that biographies of painters from the Renaissance to symptoms food poisoning discount ipratropium generic the end of the eighteenth century are replete with anecdotes describing 76 how the artist acquired social status through his creative talent symptoms lyme disease purchase ipratropium 20mcg without prescription. Clair proceeded to describe the toppling of the artist’s status which, in his opinion fell into two phases: the first beginning, in Domenico’s time, with the French Revolution in 1789, the 74 Clair in Paris 2004, p. The desire for Liberty, Egality and Fraternity in certain quarters may explain why Domenico did not follow Titian’s example and portray himself as the grand old painter, and why the spiritual meditation on the body of Christ favoured by Giambattista, and a whole lineage of artists before him, gave way to self-parody in the Divertimento. Finally, in this, his last work, Domenico sloughed off the customary role of ‘diligent imitator’ and pursued the uncharted territory of pioneer. Death in Venice It has been observed in the Introduction to this thesis that although death is a subject which has been interrogated in a number of ways, specific analysis of death in eighteenth-century Venice remains an under-researched area. However, it has been possible to make use of studies devoted to death in other Catholic cultures in Europe, 77 for example, Carlos Eire’s research on dying in sixteenth-century Spain. For despite any temporal and possibly cultural differences, the liturgy of the Catholic Church remained virtually unchanged following the Council of Trent (1545-1563) until the 78 second Vatican Council (1962-1965). Certain ideologies were accepted trans culturally, for example, notions of dying a ‘good’ and ‘bad’ death endured over time in both Catholic and Protestant traditions. Nigel Llewellyn, in his study on the visual culture of death ritual, focused on 79 the notion of ‘good’ and bad’ deaths and noted that both were used as subjects in art. Eire, From Madrid to Purgatory: the Art & Craft of Dying in Sixteenth-Century Spain, (Cambridge: Cambridge University Press, 1995). Indeed, in the Divertimento, Domenico shows Pulcinella dying in a variety of ways, experiencing both good and bad deaths. Whilst it is not certain that Domenico would have been familiar with the Rowlandson imagery, it is apparent that Domenico was engaged with the idea of dying a ‘good’ death. Exactly what a ‘good’ death involved may be explored by reference to an emblem book, with etchings by Romeyn de Hooghe (1645-1708), and annotated by De Chertablon: La Manière de se bien préparer à la Mort Par des Considérations sur la Cène, la Passion & la Mort de Jésus-Christ, published in 80 Antwerp in 1700. Domenico was certainly familiar with this volume as he owned a copy of it, as revealed by the Vente Tiépolo (Lot no. The painter’s ownership of this book reveals that he would not only have been acquainted with the idea of preparing himself for death, but that he had at his disposal a series of visual references for illustrating it. This particular series of prints presents a visual example of a ‘good’ 81 death consisting of three general plates and 39 prints of a man on his deathbed. The main body of De Chertablon’s book is divided into three sections, and there are thirteen etchings illustrating each section. The etchings are all accompanied by a verse from the synoptic gospels cited first in Latin, and underneath in French. Each engraving includes a small picture within the main picture: the subsidiary image illustrates the passage quoted from the gospel, whilst the main image shows a man in late seventeenth-century costume in the various stages of his preparation for death. It is a didactic treatise and includes a preliminary essay discussing the origins of and fear of death, a prayer in preparation for death and proverbs in Latin and French. The plates must have gone astray as the series was published again with Dutch text by David de la Vigne in 1694, with the plates newly engraved in slightly smaller size and in reverse. In De Chertablon’s volume, the frontispiece consists of Death, in the form of a skeleton, standing on top of man’s worldly goods, on a tomb, knocking on its 82 door with his scythe (Fig. Over the tomb is the inscription ‘Statutem est omnibus hominibus semel mori’ (‘it is determined that all men should die once’). On the base of the sarcophagus is a skeleton being placed in a shroud and tomb, surrounded by living figures and two skeletons, one blowing a trumpet, indicating the last judgement, another with a scythe. These compliment a cartouche on the lower right-hand-side of the engraving showing the hand of Atropos, one of the Three Fates, about to cut a thread with her shears. In the middle-ground is a formal garden with carousing couples enjoying its precincts. The background shows a winding mountain path on which a small figure of Christ carrying his cross can be discerned. On top of the gate is a single eye, presumably the omniscient eye of God, encircled with schematic rays. This genre of imagery and writing falls into a long memento mori tradition which translates as ‘remember you are mortal’. In the formulaic convention of ars moriendi the main protagonist, according to Ariès, always died in bed: ‘In the iconography of death [the bedroom] became the arena of a drama in which the fate of the dying man was decided for the last time, in which his whole life and all his passions and attachments 82 For further reference to this frontispiece see William F. Scherer, ‘A “Living” Baroque “Exemplum” of Dying’, the Bulletin of the Rocky Mountain Modern Language Association, 27, no. According to George McClure, Ars Moriendi as a genre emerged in the 15th century, growing out of the De Scientia Mortis of Jean Gerson, an illustrated Ars Moriendi of c. His guardian angel (who remains at his side throughout his spiritual journey) indicates that he must reflect upon imagery, in the form of small framed pictures, which show the Last Supper, the Passion and Crucifixion of Christ. His wife appears at his bed, and takes issue with the monk because she doesn’t believe her husband is in danger (Fig. Following confession, candles are brought to his bedside and the monk carries the Viaticum to his bed. Following this, the monk ushers a lawyer to a desk so that the invalid might make his last will and testament, and the notary transcribes his client’s final wishes. The ailing man is shown surrounded by the poor, to whom he offers money and a small box, so as to demonstrate his detachment from worldly goods. Historically, the public nature of death is stressed by Ariès, both in the realms of the ars moriendi and in reality, dying 84 privately or alone is a relatively recent phenomenon. Here, after the lawyers and witnesses take their leave, a second monk kneels at the sick man’s bedside and offers further prayers for his soul. Following the administration of Extreme Unction, the Guardian Angel prepares his charge for the possibility of demonic attacks (Fig. Drained by this succession of infernal assaults, the dying man lies prone on his bed. Another man arrives and offers the dying man a goblet containing a disagreeable tonic (Fig. He is then offered another crucifix which, he is reminded, he should contemplate often and kiss at intervals (Fig. The sick man prays to God, and during his prayers he accepts the Almighty’s will and is ready 86 to die at the appointed time (Fig. The guardian angel then offers the dying man an olive branch signifying his reconciliation with God (Fig. The sick man draws his final breath whilst his confessors and family pray and mourn at his bedside; the ravages of pain and illness have disappeared from his formerly tortured physiognomy. This is apparent in the commentary throughout the text, where attention is frequently drawn to the facial traits and bodily disposition. Therefore, in some respects, it can be compared with, and may have been influenced by, Charles Lebrun’s (1619-1690) posthumously-published lecture, Méthode pour apprendre à dessiner les passions (1698). Lebrun had developed a highly sophisticated theory of ‘pathognomics’, which related to how the expressive movements of the features may reveal the passions. These ideas had, in turn, been influenced by René Descartes (1596-1650) treatise, Les Passions de l’Âme (1649), which identified the seat of the soul in the pineal gland, located at the centre of the brain. Lebrun applied Cartesian theory to the area of pictorial expression, and techniques by which the artist could convey certain sentiments to his viewer. He presented these thoughts, in two parts, to the Académie 87 Royale in April and May 1668. The lecture consisted of descriptions of the physiognomies associated with each passion (translated into English as Admiration, Esteem, Veneration, Ravishment, Scorn, Horror, Terror, Simple Love, Desire, Hope, Fear, Jealousy, Hatred, Sorrow, Bodily Pain, Joy, Weeping, Anger, Extreme Despair 88 and Rage) and accompanied by LeBrun’s own line drawings. The appearance of Chertablon’s commentary just two years after the publication of LeBrun’s lecture may be circumstantial. However, the way in which De Chertablon frequently draws his reader’s attention to the way in which the illustrator, through expression and bodily disposition, conveys the corporeal pain and mental anguish of the dying man and its 87 See Jennifer Montagu, the Expression of the Passions: the Origin and Influence of Charles Le Brun’s Conférence sur l’Expression Générale et Particulière (New Haven and London: Yale University Press, 1994). It is highly likely that Domenico was inspired by the ars moriendi tradition and even this particular book in the making of the Divertimento, as no less than nine sheets from the series meditate on the illness and death of Pulcinella. Amongst the unnumbered sheets one also finds Pulcinella collapsing on a road, the doctor’s visit, Pulcinella receiving extreme unction, Pulcinella viewed by mourners and Pulcinella’s funeral. In drawings depicting the Last Illness of Pulcinella and Pulcinella Receives Extreme Unction (Fig. In the one drawing he is lying prone, whilst a doctor takes his pulse, flanked by grieving relatives.
Application of the Daubert standard requires the expert to medications overactive bladder discount ipratropium online american express jump through a series of "hoops" to medicine allergic reaction discount ipratropium 20mcg without a prescription qualify their testimony on an issue they usually have intimate familiarity with medicine prescription drugs purchase generic ipratropium canada. Because Daubert is more technical in its application acne natural treatment buy ipratropium master card, the courts have extended the periods that cases are on the docket to provide for scheduling to deal with expert witnesses. Having said that, I have found that Daubert has had virtually no impact on the admissibility of testimony. Yes, there is case law already showing examples of "gotcha litigation" where opinions have been excluded because the expert was poorly prepared during discovery, but these cases highlight that the change is technical and not substantive in nature. The Daubert standard does not provide for more credible testimony, as its technical nature encourages the hiring of "professional" witnesses, rather than professionals who are qualified to be witnesses. Why adopt a standard that costs more, does not really limit the opinions that come into evidence and encourages the use of less credible witnesses? It would also bring Florida in line with the majority of state courts (at least 30 states follow Daubert). By incorporating the Daubert standard over the last two years, the legislature has managed to clog up the court system even more which has prevented many people from getting their day in court. I practiced for several years under the Frye standard and thought it was the most fair and straightforward way to judge experts. While I understand that some states as well as the federal courts utilize Daubert, those other states and the federal courts do not have the backload of cases that Florida always does. Quite simply, the use of the Daubert standard has made practicing law in Florida even more difficult both for lawyers and the Plaintiffs/Defendants. On behalf of the vast majority of Florida attorneys, please bring back the Frye standard. Have litigated extensively in state and federal court in cases involving expert testimony. Have seen many an expert who has been permitted to testify whose opinions would not have met the Daubert standard, if reasonably enforced. Nobody who brings a meritorious case in which expert testimony would be helpful should fear the Daubert standard. In many instances if there is no expert testimony there is no case which reaches a jury, or the case will be limited in scope. Accordingly, judicial and other resources are preserved for those claims which warrant the expenditure of such resources. I am almost exclusively a commercial litigator, and bring and defend claims which require expert testimony. The Daubert standard protects parties on either side from being subjected to expert opinions which are not well founded. Switching to a new standard will usher in a new era of litigation over how it will be interpreted in Florida, causing problems for judges and counsel on both sides. This is a good way to survey membership about issues like reciprocity for example. There is just too much "junk science" being allowed, particularly in medical malpractice cases. The Daubert standard will also reduce the admissibility of junk science and untested theories in the courtroom which will lead to greater public acceptance of the results of our judicial system. Significant questions have been raised regarding disinformation campaigns that have been mounted against widely accepted phenomena such as climate change. The disinformation campaigns have been well-funded and have created a body of "research" sufficient to raise questions of reliability under Daubert. Florida should retain Frye, which is founded on appropriate checks and balances between the roles of judge and jury to ensure fairness in our deliberative processes. The Frye rule requires that before expert scientific evidence can be admitted, the methodology must be shown to be generally accepted in the applicable scientific community. With science progressing at a rate much faster than it was at the time when the Frye Rule was adopted, that rule was excluding what would otherwise be helpful to prove cases based on new but reliable tests and application. The Daubert Rule includes the Frye Rule of generally accepted as one of its considerations, but considers many others such as publication, pier review, error rate, etc this seems much more practical and adds the gatekeeper function for the trial judge to keep out what is not reasonably based on reliable scientific methodology and much the better rule. I believe the Frye Rule had long outlived its usefulness and I find it hard to believe that Florida would want to keep it for its courts. Even worse, the appellate courts then defer to the non-expert conclusions of the trial court as "gatekeeper" too much. The state rule can be criticized for allowing junk science which the federal rules would not allow. The existing state rules, however, could be properly used to preclude expert testimony on the grounds it is not helpful to the finder of fact. I think the pure opinion allowed by the state rule for things such as medical or dental diagnosis is conceptually correct in many circumstances as it allows testimony based on experience even if the. The state practice which allows for damage experts is also superior to the federal practice. In short while there is room for improvement on the state interpretation of the expert rules, I think that the wholesale adoption of Daubert should be resisted. The actions of the legislature, in attempting to pass Daubert by legislative fiat, is nothing more than an unabashed attempt to insert politics into our justice system - and to give a political handout to the insurance industry which has been pushing for this for years. Beside the independence of the Courts issue, we are already seeing Daubert raised to an ad-absurdum level by insurance companies wasting precious time and judicial resources. Federal district judges typically handle 1/10th the case-load of a circuit judge, and have 2-3 law clerks to help them. So they are better able than circuit judges to conduct pre-trial evidentiary Daubert hearings that may take days. Federal judges generate written Daubert opinions that sometimes take hundreds of pages. Our state circuit judges simply do not have the time or help to do this and still move cases to trial expeditiously. If circuit judges conduct Daubert hearings in the same proportion of cases as federal judges, it will triple the time it nowtakes the average litigant to get a typical case to trial. What the legislature is proposing is tripling the workload of circuit judges without tripling the number of circuit judges and/or giving them the administrative clerical help that a federal district judge has. It will collapse the state trial system, which is far less suited than federal court to the time demands of Daubert; and will also introduce novel appellate issues into virtually every case. I have also handled (one through trial and appeal) significant products liability cases involving the DuPont Benlate fungicide. I have substantial experience in both state and federal court and I am familiar with and have briefed and argued expert witness exclusion issues. From my experience, it appears to me that the Daubert rule, as applied in the federal courts, is far too restrictive and results in the exclusion of evidence that a jury should be permitted to consider. The Daubert rule places the wealthy and the corporate interests at a huge advantage. The rule does not permit admission of scientific opinion that is not "mainstream" in the sense that it is widely accepted. Under Daubert, their opinions may well have been rejected as not having been peer reviewed or as not having been determined by an accepted methodology in the scientific community. The Frye standard allows the jury to determine the validity of the scientific evidence, as it should. I am opposed to adoption of the Daubert standard as a rule of evidence in Florida. All experts involved in litigation will be presumed to be practitioners of "junk science," pending an expensive, high-stakes, scientific audit by the judge. Practitioners can find a federal case to support the position of either side of virtually any Daubert motion, and the judge is left to determine which authorities it likes best. It would put the state in compliance with the federal courts, and better addresses the reliability of potential expert testimony. We are already seeing that in many automobile negligence cases, where a Daubert motion or motions is now a common feature. There is also no empirical evidence whatsoever that Frye failed to keep junk science out of Florida;s courts. It does not matter that the courts get it right, eventually, for some other party. Daubert is the rational approach for those who are not afraid that the truth will prove them to have been wrong in the past.
Alternatively it is suggested that steroids would suppress the local infammation caused by tissue trauma that occurs during the treatment process medicine nausea cheap 20mcg ipratropium otc. Topical hydrocortisone 1% may reduce non-specifc infammation with minimum damage to medicine song order 20 mcg ipratropium otc the infltrated area and surrounding tissue symptoms uterine fibroids buy ipratropium 20mcg low cost. Antidotes the reported benefts of the use of antidotes are conficting and no antidote has clear validation in clinical trials medicine nausea ipratropium 20mcg with amex. It is routinely used with vinca-alkaloids and its use has been advocated with other agents such as paclitaxel. It has few side effects but requires to be administered by subcutaneous injection in a ‘pin cushion’ fashion. It has not been included in this guideline as it has not been approved for use in Scotland by the Scottish Medicines Consortium. There is currently insuffcient evidence to compare its effcacy against the fush out technique. General treatment 1 Stop infusion and disconnect the drip instructions 2 Try to aspirate the extravasated drug by connecting a clean syringe to the venfon/cannula and drawing back. Bevacizumab Bleomycin In large volume extravasations where the patient is Cetuximab experiencing discomfort due to swelling, the following Cladribine may be considered: Clofarabine 1 Dispersal of the drug can be facilitated by the use of Crisantaspase subcutaneous hyaluronidase (1500 units in 1ml water for Cyclophosphamide injection), injected around the area of the injury. Apply Gemcitabine heat and compression to assist natural dispersal of the Ifosfamide drug. Melphalan Nelarabine Pemetrexed Pentostatin Rituximab Thiotepa Trastuzumab page 14 Chemotherapy extravasation in practice. Bortezomib Fluorouracil 3 When the initial infammatory reaction has subsided, a Methotrexate warm compression may be used to aid the dispersal of any Raltitrexed residual fuid. Carboplatin Etoposide 3 Apply topical hydrocortisone cream 1% every 6 hours for Irinotecan up to 7 days or as long as erythema continues Teniposide For Carboplatin extravasations, when the initial infammatory reaction has subsided, a warm compression may be used to aid the dispersal of any residual fuid. Exfoliants 1 Follow general treatment instructions 2 Firmly apply a heat pack to the extravasated area for Cisplatin 20 minutes every 6 hours for the frst 24 hours Docetaxel Oxaliplatin 3 Apply topical hydrocortisone cream 1% every 6 hours for 7 days or as long as erythema continues. In large volume extravasations where the patient is experiencing discomfort due to swelling, dispersal of the drug can be facilitated by the use of subcutaneous hyaluronidase (1500 units in 1ml water for injection) injected around the area of injury. Streptozocin For extravasations of >5ml use the fush-out technique according to local procedure page 16 Chemotherapy extravasation in practice. Vinblastine Vincristine For extravasations of <5ml, infltrate the site with 1500 Vindesine units of hyaluronidase in 1ml water for injection. For Paclitaxel extravasations, follow this with application of 1% hydrocortisone cream every 6 hours for 7 days. For extravasations of >5ml refer for fush-out technique according to local procedure 1 Follow general treatment instructions. Busulfan Carmustine 2 Firmly apply a cold pack to the extravasated area for 30 Treosulfan minutes every 4 hours for the frst 24 hours. For extravasations of <5ml, apply topical 1% hydrocortisone cream every 6 hours for up to 7 days or as long as erythema continues. Chlormethine (Mustine) 2 Firmly apply a cold pack to the extravasated area every 4 hours for the frst 24 hours. For extravasations of <5ml, infltrate the area subcutaneously with 1-3ml sodium thiosulphate 3%. Apply topical hydrocortisone cream 1% every 6 hours for up to 7 days or as long as erythema continues. It aids the dispersal of vinca-alkaloids and other non-vesicant induced injuries where “spread and dilute” treatment is required. Where heat is advocated, it is recommended to use a heat pack on the extravasated area for 20 minutes every 6 hours. Topical cooling Topical cooling diminishes pain and discomfort at the extravasation site and causes vasoconstriction, localising the extravasated vesicant and allowing time for the agent to be dispersed by local vascular and lymphatic systems. Decreasing the blood supply decreases the metabolic demand of the affected and at risk tissue slowing drug uptake. It also changes the fuidity of the cellular membrane making the cells less sensitive to the damaging effects of the drug. This approach should not be used for vinca-alkaloid induced injuries as it is shown to increase ulcer formation. Where cooling is advocated, it is recommended to use a cold pack on the extravasated area for 30 minutes every 4 hours. A piece of dry gauze should be placed as a protective barrier between the skin and heat / cold source. Surgery Referral to a plastic surgeon is indicated when, despite conservative treatment, the extravasation injury progresses to ulceration. Earlier surgical intervention (fush out technique) is recommended for large volume vesicant extravasations. Location Extravasation kits are available in areas designated for the administration of cytotoxic chemotherapy. Should chemotherapy be administered out with these areas (in exceptional cases only and after full assessment of clinical risk involved), an extravasation kit should be made available. Contents 1x10 Hyaluronidase 1500iu injection 1x15g Hydrocortisone 1% Cream 5x10ml Sodium Chloride 0. Documentation It is important that a complete and accurate history of the extravasation and the follow up visits is documented. This aids both the management of the injury and the regular audit of administration practice. The Green Card Scheme is a national, anonymised and confdential scheme designed to collate data and statistics on the number of incidents according to drug category, treatment methods, antidotes used and outcome of events. Photographs of the affected area should be included if appropriate, this aids management and follow up. Patients should be assessed for pain, erythema, mobility, skin changes and necrosis. Areas of extensive blistering or ulceration, progressive induration and erythema or persistent, severe pain are indications for surgical assessment and possible excision of injured tissue. Incomplete cellular repair after the frst injury combined with additional damage during the subsequent injections may see a reactivation of skin toxicity and an exacerbation of the initial tissue damage. This phenomenon is said to be more common with anthracyclines but has been observed with paclitaxel and mitomycin. Journal of Oncology Pharmacy Practice 2004;10(4):197-200 National Extravasation Information Service. The Annals of Pharmacotherapy 2007; 41 (7): 1238 1242 Sauerland C, Engelking C, Wickham R & Corbi D. Vesicant Extravasation Part I : Mechanisms, Pathogenesis, and Nursing Care to Reduce Risk. Oncology Nursing Forum 2006; 33 (6): 1134 – 1141 page 22 Chemotherapy extravasation in practice. Commercial use or systematic downloading (by robots or other automatic processes) is prohibited without explicit Publisher approval, unless otherwise noted. The Publisher does not warrant or guarantee the article’s accuracy, completeness, merchantability, fitness for a particular purpose, or non-infringement. Descriptions of, or references to, products or publications, or inclusion of an advertisement in this article, neither constitutes nor implies a guarantee, endorsement, or support of claims made of that product, publication, or service. We built a database of 414 clinical trials for advanced gastric cancer and use it to build statistical models that attain an out-of-sample R2 of 0. Though it is inherently challenging to evaluate the performance of such models without actually running clinical trials, we use two techniques to obtain estimates for the quality of regimens selected by our models compared with those actually tested in current clinical practice. This evaluation of the proposed models suggests that they merit further testing in a clinical trial setting. Keywords: healthcare: treatment; programming: integer; simulation; statistics History: Received October 1, 2014; accepted September 23, 2015, by Noah Gans, stochastic models and systems. Introduction regimens, with a focus on exploring treatments that Cancer is a leading cause of death worldwide, account have never been previously tested for a disease: in ing for 8. Although some trials evaluate a new drug for a prognosis for many solid-tumor cancers is grim unless particular cancer, the majority (84. At drugs in different dosages and schedules; in this work the time of diagnosis, the tumor is often sufﬁciently we focus primarily on this type of chemotherapy regi advanced that it has metastasized to other organs and men. To our patients is a key goal of oncology research for advanced knowledge, this is the ﬁrst paper to employ statistical cancer (Overmoyer 2003, Roth 2003). Our methodology balances in this work we found that 80% of all chemotherapy the dual objectives of exploring novel chemotherapy clinical trials for advanced gastric cancer have tested regimens and testing treatments predicted to be highly multidrug treatments. In are often incurred either by pharmaceutical compa §5 we discuss the next step in evaluating our mod nies or by the government.
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