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A. Jaffar, M.B.A., M.D.
Medical Instructor, UCSF School of Medicine
Class 8: March 6: Discussion of paper status antibiotics joke cheap clindamycin 150 mg mastercard, research virus 43 states clindamycin 300 mg generic, obstacles virus dmmd purchase clindamycin 300mg otc, and achievements virus blocker cheap clindamycin 150 mg overnight delivery. The meetings will start during the week of April 3 and students will sign up in order of when they are presenting their papers. Class 13: April 17: Class Presentations of Papers Class 14: April 24: Class Presentations of Papers April 26: v Final Draft of Paper Due 10 Seminar Paper Grading Sheet Advanced Issues in Criminal Justice Style: Title Lead Used shorter words Used shorter sentences Used active voice Used vivid language & images Avoided unnecessary words and qualifiers Proofreading Correct citation format Used helpful headings Double spaced, Times New Roman, 12 pt. Total Possible Points: 25 Content: Gave good description of background information Applied information well Used good analysis Demonstrated understanding of the subject Used clear argument/explanation Clear conclusion Total Possible Points: 60 Research: Demonstrated high quality of research Used appropriate variety of sources Provided sufficient support for statements Total Possible Points: 35 Points deducted for late Topic Statement Points deducted for late First Draft Points deducted for late Final Draft Points deducted for failure to meet with Professor outside class Minimum of 6500 words exclusive of footnotes/endnotes (if no, will fail course). If you have any questions on what is appropriate please ask before you are scheduled to present. Basics of the Court: In this section you should describe who is eligible for this court and what the goals of the court are; whether it is pre or post-conviction; what the requirements are for completion; how long this court has been operating; and how many participants have successfully completed it. Description of Court Proceedings during your observation: Describe what happened in the court while you were observing. Interviews with Judge, Prosecutor & Defense Lawyer: If possible you should try to talk with the Judge, the Prosecutor and a Defense lawyer while you are at the court. In addition to asking them information about how the court operates, you might also want to ask them about their views of the court, how it compares to what would have happened with these cases and defendants in a standard court or before this court was in operation, and if they see their roles to be any different in the context of the specialty court. Conclusion: You should give you analysis of whether this court seems well run, your views of how the various professionals are doing their jobs, whether this court seems to be achieving its goals, whether you would want to practice in one of these courts as a lawyer (and why or why not), and any other conclusions from the experience. Note: this summary should be a minimum of 5 pages, and a maximum of 10 pages, double spaced, Times New Roman 12 pt. Sandra Williams (sandra-williams) (11/15/18 10:06 am): Rollback: Syllabus has incorrect course number. Course Objectives: By the end of this course, you should: · · · · · Required Text and Other Readings: · Have knowledge of the legal authorities typically used to research legal issues; Be familiar with the commercial electronic legal research databases including Westlaw, Lexis Advance, and Bloomberg Law Be familiar with free electronic legal research sites Understand the search syntax and strategies for the various electronic legal research sites Have experience conducting yourself in an ethical and professional manner in the use of legal analytical skills, both in the classroom and in outside preparation for class. The final grades for this course will be weighted as follows: Class Participation (100 points). This course is scheduled to have (1) six "online classes" and (2) six live classroom meetings during the fall semester. Aggie Code of Honor: An Aggie does not lie, cheat or steal, or tolerate those who do. Due to the fact that the law school frequently requires or utilizes testing anonymity, students should not discuss their disabilities with professors. Faculty teaching this course may, however, change or expand upon any part of this syllabus during the semester as circumstances warrant. For that reason, pay attention to announcements in class, as well as to email or postings on the course eCampus site. Professionalism is conduct consistent with civility, honesty, integrity, character, fairness, competence, ethical conduct, public service, and respect for the rule of law. My intent is that we will model professionalism in all of our interactions in and around this course. Prerequisites and Restric ons Should catalog prerequisites / concurrent enrollment be enforced? The goal of this overview is to facilitate effective management of legal services by empowering client-side perspective on the work that lawyers do. You must also participate in on line classes before each live class, as described in more detail below. Contact Information and Office Hours: Professor Mark Burge, Director of San Antonio Programs Email: markburge@law. Faculty are also available through their respective email addresses and by telephone. Instructional Methods: this course will use a variety of instructional methods in both the live classes and online classes. These methods will include assigned readings, problem solving, analysis, and interactive exercises. You will be enrolled in eCampus pages for your courses (including for this course) by the law school administration. Course Objectives: By the end of this course, you should: Course Web Site: this course has a Texas A&M eCampus (or "Blackboard") web site · · · Be able to apply, at an introductory level, the most common analytical methods used by lawyers in legal problem solving, including inductive and analogical reasoning; Recognize the form and function of common legal documents, such as analytical memoranda, pleadings, motions, and contracts; Be able to comment on drafts of common legal documents in a manner that translates business concerns into legal frameworks generally recognized by common-law trained lawyers; · Perceive the practical participatory roles of both lawyers and non-lawyers in the functioning of the United States legal system in aid of working both roles more efficiently and effectively. Have experience conducting yourself in an ethical and professional manner in the use of legal analytical skills, both in classroom discussion and in outside preparation for class.
The decision to discontinue the apnea monitor should be made jointly between the family and the healthcare professionals antibiotic questionnaire order clindamycin 300mg fast delivery. If the decision is made to end monitoring antimicrobial mouth rinse brands purchase clindamycin 150mg fast delivery, give the parents a clear statement of the status of the problem and explain that it appears to have resolved infection tooth extraction cheap clindamycin 150 mg, and that the infant can be expected to grow and progress normally infection prevention week 2014 cheap 300mg clindamycin with visa. Because of the diligence required for successful home monitoring, many parents find it difficult to stop home monitoring when it is no longer required for their infant. The caregiver has learned to rely on the monitor to provide a comforting reassurance that the child is well. Young children (particularly those 6 months2 years of age) explore the environment by putting objects in their mouth and are at highest risk for aspiration. In addition, they may seek relief from the teething process by chewing on hard objects. If an object is too large or of a shape that does not allow it to be expelled by coughing, respiratory symptoms result. Foreign bodies in the upper airway often cause a mechanical or partial obstruction that results in nonspecific respiratory signs and symptoms such as cough, wheeze, stridor, dyspnea (labored or difficult breathing resulting from air hunger), voice changes, cyanosis, retractions, and hemoptysis (coughing blood). Assessment the location of the foreign body is a key factor in determining the signs, symptoms, and physical assessment findings (Table 163). Although nearly all children who have aspirated a foreign body exhibit a chronic cough, a history of an acute coughing episode, or both, other symptoms vary according to where in the respiratory tract the object is lodged. The child with a foreign body that lodges in the upper airway, such as the larynx or trachea, usually presents with an acute and rather fierce onset of stridor and respiratory distress necessitating immediate intervention to dislodge the foreign body. A foreign body lodged in the bronchus may act as a ball valve, obstructing the airway perhaps partially on inspiration and completely on expiration. Wheezing localized to one side of the chest on inspiration and diminished breath sounds on expiration result. In children with an esophageal foreign body, the distended esophagus compresses the nearby trachea, thus causing respiratory distress. Physical assessment findings may reveal asymmetry of chest wall movement, and wheezing or diminished breath sounds in a localized area of the lungs. Radiographs may be normal, may allow clear visualization of the presence of a foreign body, or may show changes related to the foreign body directly or caused by secondary inflammatory changes. Foreign bodies retained in the airway can be potentially life threatening and can produce severe lung damage. Commonly aspirated objects include foods such as hot dogs, peanuts, other nuts and seeds, grapes, popcorn, and carrots as well 690 Unit 3 n n Managing Health Challenges T A B L E 1 6-3 Locations of Foreign Body Aspirates and Associated Findings Location of Foreign Body Supraglottic Larynx Trachea, intrathoracic Trachea, extrathoracic Bronchi Esophageal Clinical Findings Cough, dyspnea, drooling, gagging, changes in phonation Cough, stridor, changes in phonation; at times, severe respiratory distress Expiratory wheeze, inspiratory noise Inspiratory stridor, expiratory noise Cough, asymmetric breath sounds or wheeze, hyperresonance Drooling, dysphagia, stridor, respiratory distress located above the bifurcation of the mainstem bronchus. The right mainstem bronchus is a common site for foreign body lodgment because of its angle. Materials such as nuts, which contain fats, cause an especially intense inflammatory response. Chronic obstruction of air exchange to the alveoli could mimic obstructive emphysema on chest radiographs. Foreign bodies that have been dislodged by coughing can lead to involvement as described here in different lung segments. Atelectasis, bronchospasm, and pneumothorax all are possible postbronchoscopy complications. The most dramatic scenario involves the infant or child with a complete airway obstruction who is experiencing respiratory arrest and requires immediate resuscitation. The grief and guilt that parents and caregivers experience in this situation are tremendous and often incapacitating. Education for parents and other caregivers of infants and young children regarding aspiration risk factors is an essential role for all pediatric healthcare providers. Information on common items aspirated, age groups especially at risk, and developmental and environmental considerations can help parents be more aware of potential dangers and take proper precautions. Remind parents that watching television during meals can be a dangerous distraction to young children and should be avoided. Caregivers of children at play must be cautioned about being vigilant with small children, to keep them from putting objects in their mouths. Visitors to the home should place purses and other personal items out of reach of the small child. Last, products containing any small, cylindrical components should bear labels discouraging use around young children and should detail the age groups particularly affected. Interdisciplinary Interventions Emergency treatment for the choking child includes the use of abdominal thrusts (the Heimlich maneuver) in the child older than 1 year of age and use of back blows and chest thrusts in the infant younger than 1 year.
It may be repeated every four hours till the bleeding is controlled antibiotics for sinus infection with penicillin allergy 300 mg clindamycin with amex, when oral therapy is started antibiotic resistant bacterial infection discount clindamycin 150 mg fast delivery. Proliferation of endometrium antibiotic resistance methods order clindamycin 150 mg on line, increase in the level of fibrinogen antibiotics homemade buy 300mg clindamycin overnight delivery, factors V, X, and platelet aggregation are the other mechanisms of action for estrogen therapy. Danazol: Danazol is suitable in cases with recurrent symptoms and in patients waiting for hysterectomy. The dose varies from 200400 mg daily in 4 divided doses continuously for 3 months. A smaller dose tends to minimize the blood loss and a higher dose produces amenorrhea (see p. It improves anemia, and is helpful when used before endometrial ablation (see below). Reduction of blood loss is upto 97 Anti-fibrinolytic agents (Tranexamic acid) reduces menstrual blood loss by 50 percent. It should be done following ultrasonography for detection of endometrial pathology. The indication is an urgent one, if the bleeding is acyclic and where endometrial pathology is suspected. Ideally hysteroscopy and directed biopsy should be considered both for the purpose of diagnosis and therapy. Presently, dilatation and curettage should be used neither as a diagnostic tool nor for the purpose of therapy. It is employed as an elective alternative to hysterectomy or when hysterectomy has been medically contraindicated. Uterine thermal balloon for destruction of endometrium is currently used with satisfactory results. Endometrium is destroyed using a thermal balloon with hot normal saline (87°C) for 810 minutes. This procedure is suitable for women who are not suitable for general anesthetic or long duration surgery. Novasure: Endometrial ablation is done using a bipolar radio frequency mounted on an expandable frame. Radio frequency energy vaporizes or coagulates the endometrium up to the myometrium. Resectoscope loop must remove the basal layer of endometrium along with superficial layer of myometrium, otherwise regeneration of endometrium causes failure of operation. Results of Endometrial Ablation or Resection Overall success with these methods is 7080 percent. About 3040 percent women become amenorrheic and another 50 percent will have significant decrease in blood loss. Uterine artery embolization is commonly done in women with large uterine fibroid (> 3 cm) with heavy bleeding. However, hysterectomy is justified when the conservative treatment fails or contraindicated and the blood loss impairs the health and quality of life. Presence of endometrial hyperplasia and atypia on endometrial histology is an indication for hysterectomy. Hysterectomy may be done depending on the route by vaginal, abdominal, or laparoscopic assisted vaginal method. In this regard, the factors to consider are: uterine size, mobility, descent, previous surgery, and presence of comorbidities (obesity, diabetes, heart disease, or hypertension). Healthy ovaries may be preserved at the time of hysterectomy especially those under 45 years of age. Polyp, adenomyosis, leiomyoma, malignancy and coagulopathy, hyperplasia, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified are the different etiological factors expressed by one (or more) letters. Myometrial heterogeneity, myometrial cysts, asymmetric myometrial thickness, and subendometrial echogenic linear striations are suggestive features to the diagnosis of adenomyosis. These are polycystic ovarian syndrome, hypothyroidism, hyperthyroidism, hyperprolactinemia, obesity or due to hypothalamic dysfunction (stress, weight loss). Medical history should include: Age of the patient, patterns of abnormal uterine bleeding, severity, associated pain, family history and use of medication. General and physical examination: Pallor, edema, neck glands, thyroid, and systemic examination, and pelvic examination (per speculum, Pap smear, and bimanual examination) are included. Complete hemogram, platelet count, prothrombin time, and partial thromboplastin time need to be done (Flowchart p.
The results suggest that individual susceptibility can be important in determining the outcome in exposed individuals antibiotics how do they work cheap 300mg clindamycin otc. No epidemiological studies have been reported in which host factors determined by these methods were adjusted for (Wu et al antibiotic walmart 300mg clindamycin visa. The proportion of babies born to highly infectious mothers who also became carriers decreased from 86-96% to 12-14% antibiotics for upper sinus infection generic clindamycin 150 mg on-line. The average annual incidence of hepatocellular carcinoma in children aged 6-14 decreased significantly from 0 yeast infection 9 year old purchase 300mg clindamycin free shipping. Cases of liver cancer were ascertained by record linkage and from medical records covering 1986-89. A multivariate loglinear model was used to test for statistical significance and to estimate relative risks. The follow-up period represented 1 404 566 person-years (average, 3 years and 1O months), and 302 cases were ascertained, to give an overall incidence rate of liver cancer of 22 per 100 000 person-years. The relative risk for primary liver cancer was18% (95% confidence interval, 14-23) among chronically infected men, 0. In China, some 40% of carriers of H8V were infected by perinatal transmission from their mothers. The effectiveness of vaccination has been reported to be 70% in some areas of China and as much as 90% in others. In Africa, introduction of the vaccine into the routine programme for infant vaccination reduced the carriage rate by 94%. In the Gambia, protection was shown to be maintained up to the age of 9 years, which is well past the age at which the risk of becoming a carrier is high; thus, these children effectively have lifelong protection against H8V-associated liver cancer (Wild & Hall, 2000). This implies reinforcing the control of blood and blood products and the use of sterile medical equipment. However, a reduction in intake of aflatoxin 81 or a reduction in the concentration of aflatoxin M1 in milk or milk products is unlikely to result in an observable reduction in the rate of liver cancer in most developed countries. In these populations, alcohol consumption may account for most cases of liver cancer without viral markers. No effective treatment has been developed for these persons (Torresi & Locarnini, 2000). Thus, it has b~en suggested that oltipraz, a drug that modifies the metaboljsm of aflatoxin and:J:ias a number of other biological properties (reviewed by Kensler et al. The experimental basis for this proposal is the demonstration of remarkable anticancer activity against aflatoxin 8 1-induced hepatocarcinogenesis in rats (see section 2. Oltipraz has also been evaluated as a chemopreventive agent for cancers of the colon, liver, bladder, and skin (reviewed by Kensler & Helzlsouer, 1985; Kensler et al. In rats, continuous administration of oltipraz significantly reduced the formation of aflatoxin-albumin adducts and the occurrence of liver neoplasms (Kensler et al. The results of pilot studies for these trials showed reasonably good compliance with the regimen and mild toxicity, with no observed interaction with the H8V status of the individual (Jacobson et al. The results of another pilot trial showed that low daily doses of oltipraz induced phase-2 conjugation of aflatoxin, as measured by an increase in the urinary excretion of aflatoxin mercapturic acid, with no reduction in the concentration of aflatoxin M1. Aflatoxin-albumin adducts were also identified in serum from 104 volunteers in the United Kingdom. Since the last evaluation by the Committee, additional studies have shown that a mutation in codon 249 of P53 is found regularly in a proportion of cases of liver cancer in certain countries and not in others. Several studies showed that these mutations are poorly correlated with another marker of aflatoxin intake, the presence of aflatoxin 8 1 adducts, in hepatocellular carcinoma tissue (Hsie et al. Many of the reports focus on mutations and not on the full spectrum of genetic alterations in P53that characterizes hepatocellular carcinoma. The report indicated that intake of aflatoxin was common in that part of India (Katiyar et al. Loss of heterozygosity at 4q was found in 50%, at 1p in 46%, at 16q in 42%, and at 13q in 38%. Mutation at codon 249 was found in seven cases from Qidong (all those with a P53 mutation} and in three of five from Shanghai (Rashid et al. Seven of 21 samples of tissue from patients with hepatocellular carcinoma in Tongan, China, had point mutations at codon 249 resulting in a G to T transversion. Because liver tissue was required for these comparisons, the controls were patients with liver or biliary-tract conditions, including hepatic metastases from other primary cancers (Lunn et al. In a small correlation study, the P53 mutation patterns in 31 cases of hepatocellular carcinoma from northern and southern Jiang-Su Province in China were compared.
Similarly antimicrobial 220 order clindamycin 150 mg fast delivery,De and Mandal (1956) showed that superphosphate at the rate of 67 kg/ha of P O 2 5 incerased nitrogen-fixation only in soils relatively poor in this nutrient antibiotic rocephin buy cheap clindamycin 150 mg on-line. El-Nawawy et al (1972) demonstrated that the nitrogen fixed by the)bdueogreentad that the growth and/or nitrogen fixed by the blue-green alga T infection 2 tips order clindamycin 150mg mastercard. It plays a particularly important role in the maintenance of plasma membrane antibiotic resistance definition buy clindamycin 150mg with amex, salt formation with colloids and cell wall materials. It has been shown that calcium is required for Anabaena cylindrica whether the alga grows with molecular or combined nitrogen and at least 20 ppm of calcium are needed for optimum growth and this element cannot be replaced by strontium (Allen and Arnon,1955). Trace elements Cobalt is an essential element for nitrogen-fixation by Nostoc muscorum and Calothrix sp although the requirement is very small, (0. Molybdenum is essential for the growth of seven species of blue-green algae in medium without combined nitrogen. It has been shown that the optimum concentration required for Anabaena cylindrica in a nitrate medium is 0. Nostoc commune responded to added molybdenum reaching a maximum at about 4 x 103 mg/l after which a decline in algal growth occurred (Taha and El-Rafai, 1962). Nostoc commune G when inoculated into a boron-free medium cannot develop naturally and requires boron for good growth. Cell counts in boron-free cultures show relatively small numbers; chlorosis starts slowly during the 3rd week and by the end of the 8th week the alga becomes comnpletely white. Manganese is needed as a trace element in the medium for good growth of some blue-green algae. The quantities required differ depending upon the type of the alga and the environmental conditions under which it grows. It has been shown that the presence of manganese in the medium stimulates intensely both nitrogen-fixation and photosynthesis in the culture of Anabaena ossillaroides and Hapalosiphon fontinalis f. Light Stewart (1975) has cited numerous studies on the relationship between light and nitrogenase, both with free-living blue-green algae and with lichens. Generally there is a correlation between nitrogen-fixation and acetylene reduction in natural ecosystems. The relationship is also complicated by other factors such as the effect of desiccation, while in aquatic systems light intensities may be excessive at the water surface. Under controlled laboratory conditions it is still debateable as to whether algae grow better when given a dark period each day or whether maximum growth per unit of time is obtained when the cells are continuously illuminated. Allen and Arnon (1955) showed that the rate of growth of Anabaena cylindrica was essentially the same when the alga was grown under 11 hours or 13 hours of darkness or 24 hours of light each day. However, Ukai et al (1958) found a light intensity of 8 000 lux and a temperature of 32°C suitable for optimum steady growth of Tolypothrix tenuis without causing any sign of bleaching. Half saturation of growth was observed at light intensities of 1 000 and 1 500 and 2 500 lux at 26, 32 and 38°C, respectively. They also showed that the apparent half-saturation of nitrogenfixation was obtained at an intensity lower than the lowest examined i. The best algal growth occurs under continuous illumination and the nitrogen-fixing capacity increases with increasing light intensity (Fogg and Than-Tun, 1960). Granhall (1970) reported that the reduction of acetylene by the bluegreen alga Nostoc punctiforme isolated from Swedish soils, was at light intensities below 100 lux and the highest saturation level for the process was about 3 000 lux. Nitrogenfixation by hot spring algae was noted in Alaska and in Yellowstone National Park where the upper limit of temperature was near to 60°C. Blue-green algae dominant at 40-60°C include species of Mastigocladus (Stewart, 1975). In hot springs in Japan, potential nitrogen-fixing species of Anabaena Calothrix Cylindrospermum, Hapalosiphon, Mastigocladus, Nostoc and Scytonema all occur at temperatures ranging from 30-50°C. At the low temperature extreme, in the Antarctic, blue-green algae are abundant, and the most common genera in this habitat are Nostoc, Scytonema hofmanni, Anacystis and Coccochloris. HapaZosiphon fontinalis, Anabaena variabilis and Calothrix elenkinii grew at pH 7.