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But defeats at North Point and Fort McHenry prevented the British from capturing Baltimore allergy shots benadryl cheap benadryl 25 mg amex. During the bombardment of Fort McHenry on the night of September 13 allergy medicine kidney disease order benadryl 25mg without prescription, 1814 allergy forecast hartford ct purchase 25 mg benadryl otc, a Maryland lawyer, Francis Scott Key, was inspired to write the "Star Spangled Banner". At sea, Marylanders, sailing in the speedy Baltimore clippers, terrorized British shipping to the coasts of England, accounting for 556 British vessels, almost a third of the total taken by American vessels. Commodores John Rodgers and Stephen Decatur also distinguished themselves as naval commanders. A national "pike" was completed to Ohio and two canals, the Chesapeake and Ohio and the Chesapeake and Delaware, and a railroad, the Baltimore and Ohio, were put in operation. Morse ran an experimental telegraph line from Washington to Baltimore and on May 24, 1844, the message "What Hath God Wrought" flashed over the wire. In 1845, the Naval Academy was founded at Annapolis as Commander Franklin Buchanan and an academic staff of eight assembled some forty-odd midshipmen in Fort Severn. In Baltimore, Edgar Allan Poe produced some of his greatest poems and short stories until his untimely death in 1849 brought an end to his brilliant but tragic career. Having attained a population of 169, 000 by 1850, Baltimore was erected as a separate political unit by the Constitution of 1851. Growing industrial and commercial ties bound the State to the North and West, as well as to the South. On April 19, 1861, some Baltimoreans attacked the Sixth Massachusetts Regiment on its way through the city to Washington. Enraged poetical comment on the event by James Ryder Randall, a Marylander living in New Orleans, produced the State song, "Maryland, My Maryland. It was important to the national government to keep the State in the Union or Washington would be surrounded by enemy territory and completely cut off from the Northern States. But this did not prevent the Confederates from recruiting many volunteers in Maryland. McClellan permitted Lee to retreat across the Potomac without further molestation. It was while "Stonewall" Jackson was leading his troops through Frederick on the way to Antietam that the Barbara Fritchie incident-subject of the famous poem of John Greenleaf Whittier-is said to have occurred. On the political front, President Lincoln seized upon this as the proper moment for issuing the Emancipation Proclamation. General Early defeated the Union Forces at the Battle of Monocacy on July 9 and advanced to the outskirts of Washington. At the Battle of Fort Stevens, which Lincoln witnessed on July 11, the Union lines held. It was during this third invasion of Maryland that large indemnities were levied on Hagerstown and Frederick. John Wilkes Booth, a native of Harford County, assassinated Lincoln on April 14, 1865, and made his escape through Southern Maryland into Virginia. The Late Nineteenth Century the last half of the Nineteenth Century was relatively uneventful in Maryland. Many Marylanders helped in the South, while Baltimoreans turned again to Southern markets for commercial outlets. The growth of industrial enterprise and fortunes made large philanthropies possible. Among these were the gift to establish a library, conservatory of music and art gallery by the one-time Baltimore resident George Peabody (1866); the endowment of a university by the merchant Johns Hopkins (1876); and the gift of a free public library by the merchant Enoch Pratt (1882). The scattered public schools of the pre-war period were consolidated into a strong centrally administered educational system and public education became a reality. Few Marylanders saw action in the Spanish-American War, the most notable being Admiral Winfield Scott Schley of Frederick County, who was in active command at Santiago when the Spanish fleet was destroyed. The First and Fifth Regiments were mustered into Federal service shortly after the declaration of war, but saw no action. The Twentieth Century the story of Maryland in the Twentieth Century is more one of steady growth and progress rather than dramatic events or heroic accomplishments. In World War I, approximately 75, 000 Maryland citizens served in the armed forces. Both the 29th and 79th Infantry Divisions fought with distinction in the Meuse-Argonne offensive of 1918. The Federal government found Maryland a convenient location for many of its military establishments. Meade on more than 7, 500 acres near Odenton and established its proving ground at Aberdeen and an arsenal at Edgewood. In 1918, Maryland became the first state to adopt the Executive Budget System now so widely used. At Port Deposit, the Navy built an extensive training center called Bainbridge, and the Naval Air Station on the Patuxent River at Cedar Point to serve as an aviation testing facility easily accessible to Washington. The 29th Infantry Division again served with distinction in France during 1944 and 1945. It fought on the Omaha Beachhead, in Normandy, against the Siegfried Line, and in the advance to the Elbe River. Medical units from the Johns Hopkins and University of Maryland Hospitals performed outstanding service in many theatres of operations. The Federal government also built "Shangri-La" as a presidential retreat in Western Maryland. Renamed "Camp David" by President Eisenhower, the lodge has recently been the focus of world-wide attention as the scene of the meetings between the President and the Soviet Council Chairman, Nikita Khrushchev. The thousands of dwelling units erected since 1945 have provided many families better housing than ever before, but they have also created problems of water supply and sewage disposal. With practically every family owning one or more automobiles, many cities and towns are plagued with traffic and parking problems, and the State has been compelled to launch into a gigantic road and bridge building program which will require about fifteen years and more than a billion dollars to complete. Outstanding among them is the Chesapeake Bay Bridge, crossing four miles of water and allowing clearance for craft to a height of 187 feet. It was completed July 30, 1952, at a cost of $45, 000, 000 and is the largest continuous over-water steel structure in the world. Another remarkable engineering feat, the Baltimore Harbor Tunnel, was opened to traffic at midnight November 29, 1957. Built at a cost of $130, 000, 000, it is 6, 300 feet long and has in all, sixteen miles of approach expressways that enable the motorist to speed rapidly through one of the most highly congested areas of Baltimore. The Blue Star Highway, extending from the Chesapeake Bay Bridge to the Delaware line, was completed in 1956. The Washington National Pike, one of the most beautiful highways in the country, has been finished between Rockville and Frederick. Motorists may now travel about two-thirds of the distance between Annapolis and Washington on the John Hanson Highway, while segments of the Baltimore Beltway and the Washington Circumferential Highway are already in use. Since then the State has spent millions of dollars erecting new buildings and improving existing facilities.
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The Board determines qualifications for practice by (1) its own written examination; or (2) endorsement of licenses obtained in a reciprocating state; or (3) endorsement of a certificate of the National Board of Medical Examiners allergy treatment er cheap benadryl 25mg online. The Board passes upon the qualifications of candidates for licenses to allergy forecast vermont purchase benadryl online now practice veterinary medicine in the State and examines such persons allergy symptoms milk discount benadryl 25 mg free shipping. It may conduct hearings and pass upon complaints of illegal or unethical practices and may institute proceedings in the courts against those engaged in illegal practice (Code 1957, Art. Pullen, Clerk to the Board 900 Maryland Trust Building, Baltimore 2 Telephone: Plaza 2-1630 the Courts of the Province were first authorized to examine persons seeking to practice law in 1715 (Acts 1715, chap. The examination of attorneys remained as a function of the several courts of the State until 1898, when the Legislature created the State Board of Law Examiners. The Board is composed of three members appointed by the Judges of the Court of Appeals. Twice yearly, in the City of Baltimore during the months of March and July, the Board examines all persons wishing to practice law in the State. It also passes upon the petitions of attorneys from other states and territories desiring admittance to the Maryland Bar in accordance with rule fourteen of the Board. The Board passes upon appeals from the findings and recommendations of the Character Committees of the various counties and the City of Baltimore. In addition, it accredits universities and colleges in the State of Maryland for pre-legal training and prescribes the necessary courses of study for law students. Students expecting to study law in anticipation of practicing in Maryland must register their intentions with the Board. The Court of Appeals formulates the rules of the Board, but the Board may prescribe rules for the conduct of examinations, providing such rules do not conflict with those made by the Court (Code 1957, Art. At present the Governor appoints three Certified Public Accountants, one each year, for threeyear terms, together with one attorney for a two-year term, and one economist, selected from a list of three names submitted by the President of the Johns Hopkins University, for a two-year term. This Board examines applicants for certificates as Certified Public Accountants and passes on applications by Certified Public Accountants of other states for special certificates of registration (commonly called reciprocal certificates) entitling the holders to practice as Certified Public Accountants in Maryland. The Governor may for sufficient cause revoke any such certificate, after notice to the holder and a reasonable opportunity for a hearing (Code 1957, Art. State Office Building, Annapolis Telephone: Colonial 8-3371 the General Assembly established the State Board of Funeral Directors and Embalmers in 1902. The Governor, with the consent of the Senate appoints the nine members of the Board for two-year terms. Every person carrying on the business of funeral directing and embalming in the State must register with, and procure a license from, the Board. The Board must renew licenses annually, and it has the power to suspend or revoke any license. The Board makes regulations for the enforcement of provisions in the laws regarding funeral directing and embalming. In general, the laws deal with qualifications and examinations of applicants for license and registration. Preston Street, Baltimore 1 Telephone: Vernon 7-9000 the General Assembly created the Board of Pharmacy in 1902. The Governor appoints five members, one annually, from a list of pharmacists submitted by the Maryland Pharmaceutical Association. Two members must be residents of Baltimore City, two, residents of the counties of the State, and one, resident anywhere within the State. This Board licenses pharmacists by examination and reciprocity and issues permits for the operation of retail pharmacies and for the manufacture of drugs, medicines, toilet articles, dentifrices, and cosmetics. In cooperation with the State Department of Health, the Board enforces the pharmacy and drug laws of the State. Druggists and pharmacists are required to keep in their places of business a suitable book or file in which to preserve for a period of not less than five years every prescription compounded or dispensed (Code 1957, Art. Preston Street, Baltimore 1 Telephone: Vernon 7-9000 the State Board of Barber Examiners, created in 1904, examines and registers all applicants for barber licenses in the State of Maryland. It has authority to appoint sub-boards to assist in its inspection and licensing activities. All expenses of the Board are met by a special fund, the revenues of which are derived from fees collected under the provisions of the law. All surplus revenues of the Board at the end of the year must be paid into the State Treasury (Code 1957, Art. Preston Street, Baltimore 1 Telephone: Vernon 7-9000 this Board, created by the General Assembly of 1904, consists of five members appointed by the Governor for three-year terms. As vacancies occur, the Maryland State Nurses Association submits to the Governor the names of five of its members from which he selects appointees. The Board examines all applicants for registration as "Registered Nurse" and as "Licensed Practical Nurse" and issues the proper certificates. It keeps a register of the names of all "Registered Nurses" and all "Licensed Practical Nurses" which is open at all reasonable times to public scrutiny. The Board visits hospitals and schools of nursing and approves the programs in nursing education carried on in these schools (Code 1957, Art. The Board cooperates with the National League for Nursing in the preparation of its State Board Test Pool Licensing Examinations and uses these examinations. The Board administers the optometry laws of the State and regulates the practice of optometry. Applicants for examination must be 21 years of age or over and graduates of colleges of optometry or university schools of optometry accredited by the American Optometric Association and the International Association of Boards of Examiners in Optometry, and approved by the Board. Two examinations are held each year, usually in January and July, in the following subjects: anatomy, physiology, theoretic optics, pathology, physiological optics, practical optics, theoretical optometry, perimetry, diagnosis, prescription determination, contact lenses, practical optometry, orthoptics, visual training, and optometric jurisprudence. For just cause, the Board may revoke any certificate of registration or examination (Code 1957, Art. Mulberry Street, Baltimore 1 Telephone: Saratoga 7-5309 the Board of Osteopathic Examiners, established in 1914, consists of five members appointed by the Governor for three-year terms from a full list of members in good standing of the Maryland Osteopathic Association (Code 1957, Art. The Maryland Board of Osteopathic Examiners investigates the credentials of an applicant for permission to practice osteopathy within the State and issues or refuses licenses. It holds two meetings each year to examine these applicants whose credentials will not warrant issuing of a license through the Previous Practice or Reciprocity Acts. The Board cooperates with municipal and State officials in enforcing the laws regulating the practice. One must be a member of the Board of Medical Examiners and the other three must be selected from the membership of the Maryland Pedic Association. Applicants must have at least two years of education in a recognized college of arts or sciences and be graduates of a school or college of chiropody classified "A" or "B" by the National Association of Chiropodists. The examinations, which may be written, oral, or practical, are given in January and July of each year. The Board also issues annual licenses to all chiropodists engaged in active practice within the State. The Board may revoke the license of any chiropodist, after a hearing, who is charged with malpractice or unethical conduct (Code 1957, Art. Preston Street, Baltimore 1 Telephone: Vernon 7-9000 the Board of Hairdressers and Beauty Culturists, created in 1935, consists of three members appointed by the Governor for three-year terms.
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Finally allergy forecast burlington vt best order for benadryl, the global type of aphasia represents a combination of these two: patients have trouble following commands allergy testing edmonds wa 25 mg benadryl free shipping, speech is effortful and sparse allergy forecast worcester ma buy generic benadryl 25mg, and what the patient says is more or less incoherent. In ideational apraxia, both miming and actual use are defective, whereas with ideomotor apraxia the patient, although unable to mime, has no trouble correctly employing the actual implement. Dressing apraxia is casually assessed by observing the patient put on clothing: when present, patients may put their arms in the wrong sleeve or perhaps attempt to put their shirt on backwards (Hecaen et al. In each form, despite the fact that relevant elementary sensory abilities are intact there is an inability to recognize things. Visual agnosia, or the inability to recognize an object by sight, is tested by pointing to a common object, such as a comb, and asking patients not only to name it, but also to describe its use. Tactile agnosia represents an inability to recognize an object by touch: with the eyes closed, the patient is given a common object, such as a key, and asked both to identify it and to describe its use. Testing is accomplished simply by asking the patient to read something, perhaps a headline, and then to write something, such as an address. Aprosodia must be distinguished from flattened affect and parkinsonian hypomimia, and this differential was discussed above previously in this chapter under Mood and affect. First, draw a line horizontally across a piece of paper, at least 15 cm long (Tegner and Levander 1991) and then place the paper directly in front of, and square to, the patient. Next, draw numerous short marks in a random fashion on a piece of paper, placing the paper squarely in front of the patient and asking the patient Apraxia Apraxia may be ideational/ideomotor, constructional, or dressing. Ideational and ideomotor apraxia (DeJong 1979; Heilman 1973) are tested by first asking the patient to mime using a common implement, such as a comb or a pair of scissors, and then, if the patient has any difficulty in performing the p 01. Finally, position a blank piece of paper in front of the patient with the instruction to draw a clock face on it, with all the numbers, from one to twelve, on the drawing. These constitute, respectively, the line bisection, line cancellation, and clock-drawing tests, and visual neglect is said to be present if the line is bisected off the midline, a significant percentage of the random lines on one side are not cancelled out, or the numerals on the clock face are bunched to one side. Enhancement is accomplished by the intravenous injection of an iodinated contrast material, which, as it has a high attenuation coefficient, makes the tissue into which it extravasates appear more dense. Visual extinction may be tested immediately after performing confrontation testing of the visual fields. While retaining the same position with respect to the patient, the physician holds both hands outstretched laterally to the edge of the peripheral fields and then simultaneously wiggles both index fingers, asking the patient to point to the finger/fingers that are moving. When visual extinction is present, the patient notes the motion of only one finger. When tactile extinction is present, only one hand will be reported as touched during simultaneous stimulation. A voxel (from volume element) is a specific three-dimensional volume of tissue, each voxel subsequently being represented on the scan by a pixel (from picture element). Early-generation scanners allowed for only a limited number of voxels; consequently, tissue resolution was poor and the corresponding scan created by the pixels was fuzzy and relatively unedifying. Each proton spins at a very fast rate, thus creating a magnetic field and, as it were, becoming a very small magnet itself. In such a situation, if a radio pulse of appropriate frequency is fired at the protons, they will absorb this energy, with the result that they begin to spin with an eccentric axis, no longer in parallel alignment to the external magnetic field. Over a variable period of time, however, the protons fall back into line, in so doing releasing the energy absorbed from the p 01. The speed with which the protons undergo realignment is determined by various factors, including the availability of nearby tissues that may absorb energy and the presence of any surrounding magnetic inhomogeneities or tissues that, of themselves, have magnetic properties. The appearance of various tissues and abnormalities differs on each of these sequences. Overall, T1-weighted scans provide the sharpest delineation of structures, but are less sensitive to pathology. Gradient echo scanning is reserved for situations wherein one suspects that the patient has had, in the distant past, intracerebral hemorrhage. In this situation, blood has degraded to hemosiderin, and T2*-weighted scanning is exquisitely sensitive for this, displaying an area of greatly reduced signal intensity. This last contraindication deserves special attention as some patients may not be aware of the presence of a metallic ocular foreign body. After 24 hours, this area becomes better defined and, with the development of vasogenic edema, a mass effect on surrounding structures develops, peaking at from 35 days. Edema gradually resolves over 24 weeks, and eventually a fairly circumscribed area of radiolucency appears, corresponding to the residual encephalomalacia. Contrast enhancement generally appears after 3 days, and resolves in a matter of weeks. Gadolinium enhancement becomes apparent within a matter of days, and resolves in from 1 to 2 months. The late subacute phase ensues and lasts for months; during this phase red blood cells rupture and methemoglobin is released into the extracellular space, creating increased signal intensity on both T1- and T2-weighted scans. Finally, during the chronic stage, there is degradation of methemoglobin and chronic deposition of hemosiderin, with low signal intensity on both T1 and T2 scans and a virtual black hole on gradient echo scans. Over the following weeks this gradually resolves to an area of isodensity and, eventually, after months, an area of radiolucency appears. It was initially felt that this hyperacute phase lasted several hours; however, recent studies have indicated that intracellular hemoglobin may begin to degrade to deoxyhemoglobin early on, within these first few hours. In the following acute phase, spanning the next few days, there is unequivocal degeneration of intracellular oxyhemoglobin into deoxyhemoglobin, and the bleed now appears as an area of decreased signal intensity on T2-weighted scans. Importantly, lacunae must be distinguished from prominent VirchowRobin spaces (Heier et al. Furthermore, recently activated plaques may be detected by gadolinium enhancement before there is any clinical evidence of their presence (Kermode et al. In the case of meningiomas, the administration of contrast is especially important (Vassilouthis and Ambrose 1979; Zimmerman et al. For the most part, they manifest as subependymal nodular heterotopias, either laminar or band heterotopias in the white matter itself, or areas of cortical dysplasia or microdysgenesis. Herpes simplex encephalitis usually affects first the mesial temporal structures, producing an increased signal intensity on T2-weighted scanning (Tien et al. Pairing of these wires, and the electrodes from which they stem, allows one to construct numerous different channels. With digital machines, there are, of course, no pens or paper tracings; however, this terminology has stayed with us. In a standard recording, the sheet moves at a constant rate of 30 mm/s, and the sensitivity of the pen is set such that an impulse of 50 V causes a deflection of 7 mm. The specific arrangement of electrodes on the scalp is known as an array, and the international 1020 system described by Jasper (1958) remains a world-wide standard (Epstein et al. In this system, imaginary lines are drawn on the head between specific landmarks.
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In severe intoxication a delirium may ensue allergy testing metals purchase genuine benadryl on line, with confusion allergy symptoms eye pain generic benadryl 25mg on-line, incoherence allergy medicine safe pregnancy generic benadryl 25mg with mastercard, and disorientation. Abnormal movements, such as bruxism, chorea (Lundh and Tunving 1981), and, in some cases, generalized dystonia, may occur; intracerebral hemorrhage has also been reported (Harrington et al. The temperature rises, there may be extreme diaphoresis, and patients may experience nausea, vomiting, abdominal cramping, and diarrhea. Arrhythmias may appear, and with severe elevations of blood pressure there may be a hypertensive encephalopathy. Regardless of the degree of intoxication, most patients recover within hours to a day or so. In some cases, delusions and hallucinations, rather than being fleeting, may dominate the clinical picture of the intoxication, and in some of these cases, such symptoms may persist beyond the resolution of the intoxication, thus yielding a stimulant-induced psychosis. Although this is typically seen only with intravenous stimulant use, it has been reported after high-dosage oral use. In some cases there may be bizarre delusions, including Schneiderian first rank symptoms (Janowsky and Risch 1979). This amphetamine-induced psychosis generally clears within a matter of days or weeks, but it may occasionally last many months. With the development of tolerance, patients require ever larger doses to achieve euphoria, in some cases up to several grams daily. Some patients may develop an abusive pattern of use, however, and continue to seek intoxication despite suffering social or legal consequences. Withdrawal symptomatology, if severe and accompanied by suicidal ideation, may require hospitalization. Hospitalization is often required to break the pattern of use, and long-term involvement with groups such as Cocaine Anonymous or Narcotics Anonymous may be helpful. Both the free base and crack preparations evaporate with heating and thus may be smoked. Etiology It appears that the euphoria seen with stimulants occurs secondary to dopamine release within the ventral striatum (Drevets et al. Clinical features Differential diagnosis Intoxication with cocaine may be clinically indistinguishable from stimulant intoxication, and the differential may rest on history or drug screening. Lacking a history (as is often the case, given the deceit and denial seen in many cases), the elation and talkativeness of the intoxication may suggest mania, and the irritability, fatigue, and sleep disturbance of withdrawal may suggest depression. Drug screening is helpful here; however, observation in a controlled environment will also tell the tale, as the symptoms resolve over the expected time period. The stimulant-induced psychosis represents one of the toxic psychoses, discussed in Section 7. The onset of intoxication varies according to the preparation used; after snorting, peak levels are reached within 3060 minutes, whereas after intravenous injection or smoking, peak levels occur within seconds, creating a much more intense intoxication. During intoxication (Kleber and Gawin 1984), patients become euphoric, hyperalert, talkative, and grandiose. Hyperactivity is common, and with higher doses agitation may occur (Fischman et al. With mild intoxication libido increases, and in males there may be delayed ejaculation; with more severe intoxication, however, there may be erectile dysfunction. In severe intoxication, especially after intravenous use or smoking, a delirium may occur, with confusion, incoherence, lability, and delusions and hallucinations. Other symptoms and signs include mydriasis, hypertension, headache, nausea and vomiting, tachycardia, and arrhythmias or cardiac arrest (Hsue et al. In severe cases one may utilize an antipsychotic such as haloperidol, in a dose of approximately 5 mg, either as the concentrate or parenterally, with repeat doses every hour or so until the patient is calm, limiting side-effects occur or a maximum dose of approximate 20 mg is reached. Stimulant psychosis may be treated with an antipsychotic, such as haloperidol (510 mg) or risperidone (24 mg), with the understanding that the medication may, given the natural course of the disorder, be eventually discontinued. Clear-cut withdrawal, however, does occur with chronic use and indeed may appear after only a few days of heavy use. This withdrawal reaches a maximum of severity within a few days and then gradually remits over days or weeks. Unfortunately, this tolerance applies only to the euphoriant effects of cocaine and not to its potentially lethal cardiovascular effects. After approximately two or more years of frequent cocaine use, intoxications may become characterized by delusions of persecution and of reference, and by auditory hallucinations (Brady et al. Although initially these symptoms tend to resolve shortly after the intoxication resolves (Brady et al. The intervals between binges vary widely, from only a few days to up to weeks or months. Etiology Within the central nervous system cocaine both inhibits the reuptake and facilitates the release of monoamines by pre-synaptic neurons. Although both serotonin and norepinephrine are involved, it appears that the euphoriant effects of cocaine are related to the increased concentration of dopamine at the terminals of the mesolimbic and mesocortical dopaminergic pathways. Differential diagnosis A clinical differentiation of cocaine intoxication from stimulant intoxication may not be possible, and the differential often rests on history or a drug screen. Withdrawal may suggest depression and, when the history of cocaine use is unavailable, the differential may rest on observation in a controlled environment, which will reveal the fairly rapid resolution of symptoms. The diagnosis of a persistent cocaine psychosis is generally straightforward as it is difficult to hide the history of chronic cocaine addiction. If, however, this history is not available, then the differential for psychosis, as discussed in Section 7. Even in cases of severe intoxication with delirium, observation, given the brevity of the intoxication, is again generally all that is required; if, however, agitation is severe, one may give a dose of parenteral haloperidol in a dose of 510 mg. Patients with severe withdrawal and suicidal ideation may require hospitalization to protect themselves; hospitalization may also be required in cases of cocaine abuse or addiction to effect a period of abstinence, during which other measures may be initiated. The overall goal of treatment of cocaine abuse or addiction is abstinence from cocaine and other substances, such as alcohol, benzodiazepines, and opioids. Patients may be referred to organizations such as Cocaine Anonymous or Narcotics Anonymous, and some may undergo cognitive behavioral therapy. Abusive use, with legal, social, and medical consequences, may also occur with snorting but is more common when cocaine is taken intravenously or smoked. Cocaine is one of the most, perhaps the most, addictive substances in the world, and craving may develop rapidly, leading to chronic, frequent use and the development of tolerance and withdrawal. When addiction does set in, the pattern of cocaine use may be either continuous or episodic. Continuous use is characterized by daily intoxication, either via snorting, injection, or smoking. Patients may experience vivid memories, and commonplace events may appear exceedingly meaningful. Visual illusions and hallucinations are common, and a minority may experience synesthesiae or simple auditory hallucinations; importantly, patients maintain insight during intoxication and recognize the hallucinations as being unreal. Mild degrees of tachycardia, elevated blood pressure, mydriasis, fine tremor, hyperreflexia, and poor coordination may be seen, and the temperature may be elevated.
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The following types of books are subject to allergy forecast rochester mn order benadryl 25mg visa the manufacturing clause: Books written in the English language (except U allergy headache buy 25mg benadryl with visa. Another determining factor is the nationality and domicile of the author at the time of first publication; the place of publication is generally immaterial except when a book was: First published in the United States; or First published in a U allergy shots inflammation buy generic benadryl on-line. Exception: It was possible to secure ad interim copyright in an English-language book published abroad without the required notice. However, to secure the full original term of copyright in the United States, such books had to be manufactured and published in this country with the statutory or U. Exceptions: For information concerning works under ad interim copyright when a country joined the U. Also, when an author of a book was stateless on the date of first publication, renewal registration is possible regardless of the former or prospective citizenship or domicile of the author, or the place of manufacture or first publication. If the book was manufactured abroad, copyright in the United States was lost upon publication; ad interim copyright could not be secured, and renewal registration is not possible. For an explanation of what constitutes simultaneous publication, see Section 2116. If the illustration was produced by lithographic or photoengraving processes it must be manufactured in the United States. For information about renewal registration of nondramatic literary works prepared for oral delivery, see Section 2122. Therefore, a renewal claim in a published sound recording cannot extend to the recorded literary work. Periodicals are subject to the manufacturing clause with regard to the textual content, and the guidelines for "books" are applicable to renewal claims in periodicals that were not registered for the original term. If the periodical issue was not registered for the original term, the renewal registration must identify the proprietary or individual author. Copyright Office will generally request information that supports the author facts. Likewise, when an issue of a periodical is published in two or more separate editions containing different copyrightable content, separate renewal registrations are required. In such cases, if the periodical was created as a work made for hire, the renewal copyright may be claimed by the proprietor on that statutory basis. If the periodical was not made for hire, the renewal copyright may be claimed on behalf of the individual author. In either case, the renewal registration should be limited to the material created by the employer for hire or individual author. Copyright Office began to register claims in computer programs in 1964 as "books" in class A. To be registrable for the renewal term, a computer program must meet the following requirements: It was published in copies. If the computer program was not registered for the original term and it seems unlikely that it was actually distributed to the public in the form deposited, or it seems unlikely that it was actually published, the Office may inquire about publication and may require a brief explanation of the way in which the program was first made available to the public and the form in which the copies were published. The literary expression consists of sufficient creative authorship to support a claim to copyright. When a program was first published in the form of punched cards or magnetic tape, the work did not have "pages" so the requirement that the notice must appear in books either on the title page or the page immediately following could not be met. In such cases, the Office will take into consideration the nature of any intervening material in determining whether the location of the notice is acceptable. Certain classes of works could be registered in unpublished form for the original term; others had to be published to be registrable. Works within Class K (prints and pictorial illustrations) are subject to the manufacturing clause. For renewal registration purposes, this type of work includes all published cartographic representations of area, such as terrestrial maps and atlases, marine charts, celestial maps, and such three-dimensional works as globes and relief models. To be registrable for the renewal term, a map should contain original cartographic material, such as drawings or pictorial representations of area based on original surveying or cartographic field work, or compilations resulting from the selection and ordering of essentially cartographic elements, such as roads, lakes or rivers, cities, political or geographic boundaries. The copyright notice may consist of any acceptable form of the word "copyright" or the copyright symbol, along with the name of the copyright proprietor. An acceptable notice may also include the initials, monogram, mark, or symbol in place of the name of the copyright proprietor if the name of the proprietor appears on some permanently accessible portion of the work. All of the elements should appear together and be positioned in such manner and location as to give reasonable notice of the copyright claim. If maps appear on multiple pages as in a "book, " the notice should include the year date and appear on the title page or the page immediately following. For renewal registration purposes, this type of work includes published and unpublished pictorial or graphic works, such as paintings, drawings, cartoons, etchings, engravings, and two-dimensional abstract or representational designs, and sculptural material, such as statuary, carving in relief, and three-dimensional abstract or representational designs. These works may be embodied in a variety of forms including ornamental or useful articles. To be registrable for the renewal term, a work of art should contain original pictorial, graphic, or sculptural material. In certain cases, the unrestricted public exhibition of a work of art may constitute a publication of the work. For renewal registration purposes, this type of work includes published and unpublished two-dimensional drawings and three-dimensional plastic works designed for a scientific or technical use, such as architectural blueprints, mechanical drawings, engineering diagrams, and anatomical models. To be registrable for the renewal term, such works should contain original graphic, pictorial or sculptural material. The copyright notice should be legible and permanently affixed to the work itself and the required elements should appear together. For information concerning the required elements and location of the notice, see Section 2121. For renewal registration purposes, this type of work includes published and unpublished still photographic prints. To be registrable for the renewal term, a photograph should contain original photographic authorship in the various elements involved in its composition, such as time and light exposure, camera angle, or arrangement and disposition of the subjects depicted. Generally a photograph is not considered published until copies have actually been placed on sale, sold, or publicly distributed. While photographs are not subject to the manufacturing clause, a lithographic or photoengraving reproduction is subject to this provision. For renewal registration purposes, a published reproduction of a photograph produced by lithography, photoengraving, rotogravure, collotype, mezzotint, or other similar process of reproduction is not registrable as a "photograph, " but it may be registrable as a "print" or "pictorial illustration" if it meets manufacturing requirements. When the photograph is reproduced and first published as a contribution to a collection, the U. Copyright Office will inquire about the reproduction process and will refuse renewal registration if the photographic reproduction or the published collection did not meet manufacturing requirements at the time of first publication. The notice may be located on any accessible part of a single-page work or on a margin or permanent mounting, provided that it is visible and not concealed. However, if the notice satisfies the notice requirement of Section 19, but not 9(c), renewal registration may still be possible.
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The fact that the couple never shared the photos with anyone else is also irrelevant allergy testing boise 25 mg benadryl for sale. On August 1st allergy associates order discount benadryl online, John submitted an application to allergy and asthma associates buy cheap benadryl 25mg online register these 750 photographs (together with the correct filing fee and the proper deposit copies) and stated that 100 images were published on April 1st, 50 were published on May 1st, and 600 were published on June 1st. The Office issued a group registration with an effective date of registration of August 1st. However, John would not be able to claim these remedies for the photos from the bridal shower, because those images were published on April 1st and registered more than three months later on August 1st. It also provides guidance for preparing the list of titles that must be included with the submission. This will require a new filing fee and deposit and will result in a later effective date of registration. In exceptional cases, the Office may waive the online filing requirement, subject to such conditions that the Associate Register of Copyrights and Director of the Office of Registration Policy and Practice may impose on the applicant. In the case of published photographs, the list also must specify the month and year of publication for each photo. Copyright Office strongly discourages applicants from stating "untitled, " "no title, " or the like, because interested parties typically search for works by title and it may be impossible to locate a particular photo unless a meaningful title has been provided. The Office will use the list to examine and document the claim, particularly in cases where the applicant does not provide title or publication information in the application itself. For example, the Office may use the list to count the number of photos that are included in the deposit to confirm that it matches the number of photos claimed in the application. In the case of published photographs, the list may be used to identify the month and year of publication for each photo in the group. In addition, the Office may use the list to locate and retrieve the deposit in the event it is needed for litigation or other legitimate purposes. The title and file name for a particular photograph may be exactly the same or entirely different. If they do not match each other, the registration specialist may ask the applicant to exclude that photo from the claim, or he or she may simply refuse registration. Applicants are also encouraged to prepare this list before they complete the online application. Doing so will make it easier to complete the "title" section of the application, which is discussed in Section 1114. Guidance for completing the template is provided in the help text and video tutorials that accompany each application. Applicants may access these resources using the following links: Template / help text / video tutorial for unpublished photographs Template / help text / video tutorial for published photographs As discussed in Section 1114. The file name for the list should include the case number that has been assigned to the application, and the title that has been assigned to the group of photographs. For example, if the title of the group is "Baxter Wedding Photos, " if the case number is 1-6283927239, and if the list will be submitted in Excel format, then the file should be named using the following convention: Baxter wedding photos case number 1-6283927239. If the photographs are unpublished, the applicant should select the option for "Unpublished Photographs" from the drop down menu on the Type of Group screen. If the photographs have been published, the applicant should select the option for "Published Photographs. This information should be provided on the Title screen in the space marked "Title of Group. And in the case of published photographs, the list must specify the month and year of publication for each photo. Copyright Office encourages applicants to include the month, day, and year of publication, although the specific day on which a particular photograph was published is not required for purposes of registration. If the applicant does not include this information, the actual publication date may be need to be proven in court in the event that photo is infringed. Likewise, applicants are encouraged but not required to enter this same information in the application itself. For step-by-step instructions on how to copy the information from the title list and paste it into the application, consult the help text and video tutorials that accompany each application. If the applicant provides title and publication information in the application, that information will appear on the certificate of registration and in the online public record for the claim. This will improve the quality of the record by making this information more accessible to the public. If the registration is issued within five years after the publication of a particular photograph, the certificate will create a legal presumption that the photo was published in the month and year specified in that record. If the applicant provides titles and publication information in the title list, but does not include that information in the application, that information will not appear on the certificate or the online public record (although the Office will keep a copy of the list in its files). In such cases, the registration specialist will add an annotation to the record, such as: "Regarding title: Deposit contains complete list of titles that correspond to the individual photographs included in this group. To do so, the applicant should select the appropriate number from the drop down menu marked "Number of Photos in Group. Copyright Office will use this information to verify that the number of photos specified in the title list matches the number of files that have been received. This information should be provided on the Title screen in the Year of Completion field. If the photos were taken in the same year, the applicant should enter that year in the space provided. If the photos were taken over an extended period of time, the applicant should provide the year of creation for the most recent photo in the group. For example, if the photos were taken in 2016, 2017, and 2018, the applicant should state "2018. This information should be provided on the Title screen in the fields marked "Earliest Publication Date in Group" and "Latest Publication Date in Group. The "latest publication date" is the most recent date that the photos were published during the year specified in the application. For example, if the photos were published in 2018 on March 1st, 2nd, and 3rd, the applicant should enter "03/01/2018" and "03/03/2018" in the spaces provided. Example: Photos Published through the Authorized Distribution of One or More Copies of the Work Lois Lang is a commercial photographer. On February 27th Lois sent an electronic proof sheet to her client, and stated that the images could not be used without her permission. On February 28th the client selected 30 photos for potential use in their advertising campaign. After retouching the images, Lois sent the client 5 digital prints on March 1st, 10 digital prints on March 2nd, and 15 digital prints on March 3rd. The fact that the client used three of the photos on April 1st, 2nd, and 3rd (but did not use any of the others) is irrelevant to the publication status of the works. Lois may register these 30 photos using the group registration option for published photographs. When completing the application, Lois should enter "03/01/2018" in the field marked "earliest publication date" and "03/03/2018" in the field marked "latest publication date. Although Lois sent her client a copy of these works, the client did not have permission to use those images. Thus, if Lois decided to register these photos, she should use the group registration option for unpublished photographs.
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Initially 2 mg is given (or less in the elderly or debilitated) allergy testing huntsville al purchase discount benadryl on line, followed by 2 mg every 2 hours until the tremor is controlled and the patient is calm allergy virus generic 25mg benadryl. The next day the patient is placed on a regular total daily dose that is roughly equivalent to allergy nonoxynol 9 symptoms purchase benadryl on line the total amount that was required on the first day, with this total dose divided into three or four doses; provision is also made for ongoing as-needed doses of 1 or 2 mg every 2 hours for breakthrough tremor, and on succeeding days the total daily dose is increased until eventually the regular dose is sufficient to control tremor without the need for any further as-needed doses. At this point, as-needed doses are discontinued and the patient is then placed on a tapering dose whereby the total daily dose is decreased every succeeding day by an amount that is approximately equal to 20 percent of the total required for control; in this fashion the dose may be tapered and then discontinued over about 4 or 5 days. Other benzodiazepines may also be considered, such as chlordiazepoxide (2550 mg) or diazepam (510 mg); however, these agents have long half-lives and active metabolites making them more difficult to use. Regardless of which benzodiazepine is used, such a program generally requires admission. Most outpatients are simply unable to discipline themselves to follow the program and will either abort it, take enough of the benzodiazepine to cause intoxication, or resume drinking. In otherwise healthy patients with normal hepatic function, one may begin with carbamazepine in a dose of 200 mg three or four times daily or with divalproex in a total daily loading dose of 20 mg/kg, divided into two or three doses; subsequent dose adjustments may then be made based on the clinical response, side-effects, and blood levels. Some clinicians, however, may elect to continue divalproex for a matter of months. As noted earlier, among alcoholics the withdrawal syndrome may persist in a smoldering fashion for up to 6 months, and in such cases, after discharge, the temptation to drink or take sedatives to quell these symptoms, particularly the insomnia, may be very strong. Continuing divalproex has been shown to be useful in this regard, and may therefore actually increase the chances of long-term sobriety. It is therefore probably reasonable to treat these patients with lorazepam, as described for alcohol withdrawal, either throughout the course of the withdrawal or, if a combination strategy is used, for the first few days, after which carbamazepine or divalproex may be used alone. Patients should be treated with intravenous lorazepam in doses of 2 mg every 12 hours until they are lightly sedated, and massive doses may be required to accomplish this. Once patients are comfortable and the autonomic signs are well controlled, the dose of lorazepam may then be gingerly tapered, generally in daily decrements approximately equivalent to 10 percent of the total daily dose required for initial control. In many cases, lorazepam, although capable of calming patients and quelling tremor and other autonomic symptoms, does not control hallucinations and delusions, and in these cases an antipsychotic should be considered, such as haloperidol or risperidone. Once symptoms are controlled, the antipsychotic should be continued in approximately the same total daily dose (divided into two or three doses) until the symptoms have been well controlled for at least a few consecutive days, after which the drug may generally be tapered and discontinued over the following few days. Further suggestions for the overall treatment of delirium are discussed in Section 5. In addition to the routine laboratory tests described earlier, a careful search should be made for other illnesses, such as pneumonia, pancreatitis, gastrointestinal bleeding, hepatic failure, etc. Diaphoresis, vomiting, and diarrhea may cause dehydration, and massive fluid replacement may be required. In those rare cases of delirium tremens sine tremore, antipsychotics alone, coupled with other measures discussed in Section 5. Although some alcoholics are able to stop drinking by an extraordinary act of will, this is rare and the vast majority will continue to drink unless they receive help. Pharmacologic treatment of alcoholism, utilizing acamprosate, naltrexone, topiramate, disulfiram, or divalproex, although at times helpful, is adjunctive only and cannot replace psychosocial treatments. Various psychotherapies, such as cognitive behavioral therapy, have been utilized, and in some cases are successful. Alcoholics Anonymous is the oldest treatment approach to alcoholism and, if participated in fully, has an excellent success rate. Patients must be told that much will be expected of them but that, if they persist, they will become sober. Alcoholics Anonymous meetings are available around the world, and in the United States contact may be made by simply calling directory assistance in virtually any city. Naltrexone, given only to patients with normal hepatic function, is used orally in a dose of 50 mg daily, and p 21. Topiramate is used in total daily doses of approximately 100200 mg (Johnson et al. Disulfiram is begun in a dose of 500 mg daily, with the dose reduced to 250 mg daily after 1 or 2 weeks; patients should be given a graphic description of the toxic reaction that they may expect should they ingest even a miniscule amount of alcohol, and, given the potential toxicity of disulfiram, treatment is generally maintained for only a matter of months. Divalproex neither reduces the urge to drink nor the intoxication that occurs with drinking, but may, in doses similar to those used for alcohol withdrawal, reduce lingering withdrawal symptomatology. Out of naltrexone, acamprosate, and topiramate, all other things being equal, it is probably reasonable to begin with naltrexone. The place of divalproex is not as yet clear; however, if it has been used during treatment of alcohol withdrawal, and one can predict a lingering withdrawal, it is reasonable to continue it. Although these medications may be helpful, patients must not be allowed to think that their use can substitute for involvement in psychosocial treatments. The overall role of the physician in the treatment of alcoholism per se is generally limited to treatment of some of the complications of alcoholism. As a general rule, in prescribing medications for these or any other conditions, potentially intoxicating drugs, such as benzodiazepines or opioids, should be avoided as they may trigger off a desire to drink; exceptions to this rule are few. Alcoholism is a chronic disease and hence relapses are to be expected; these occur most frequently in the first 6 months of treatment. This classification is useful as it allows one to make a rough prediction as to when withdrawal, withdrawal seizures, or withdrawal delirium is likely to occur. The barbiturates, meprobamate, and chloral hydrate, once commonly abused, have been supplanted by the benzodiazepines, among which alprazolam, lorazepam, and diazepam are most popular. Clinical features As indicated, the clinical features of sedativehypnotic use are similar to those of alcohol, and thus one may see sedativehypnotic intoxication, blackouts, tolerance, withdrawal, withdrawal seizures, and withdrawal delirium. When mild, sedativehypnotic intoxication with barbiturates (Curran 1938, 1944; Isbell et al. With moderate intoxication, reaction time is slowed, lethargy and drowsiness appear, and patients often develop nystagmus, dysarthria, and ataxia; falls may occur, with possible head injury. With severe intoxication stupor or coma may occur, with respiratory depression and death. Sedativehypnotic blackouts are quite similar to those seen with alcohol; although possible with long-acting Table 21. Tolerance may appear with long-term use and at times may be quite remarkable: some patients may end up taking hundreds of milligrams of diazepam daily, with little or no evidence of sedation. The onset of the withdrawal syndrome varies according to the half-life of the agent: roughly speaking, for shortacting agents withdrawal starts in less than a day; for intermediate-acting agents, 23 days; and for long-acting agents, 26 days. Roughly speaking, for short- and intermediateacting agents, symptoms peak within 13 days and persist for 12 weeks, whereas for long-acting agents the peak arrives in 57 days and the syndrome may persist for up to 2 or 3 weeks. As with alcohol withdrawal, some patients may experience lingering, low-level withdrawal symptoms for weeks or months after withdrawing from benzodiazepines (Ashton 1984; Shader et al. In addition to this typical picture of withdrawal, a recent report described the occurrence of stuporous catatonia as a withdrawal phenomenon of benzodiazepines (Rosebush and Mazurek 1996). Sedativehypnotic withdrawal seizures typically occur within the context of withdrawal symptomatology and, although these may occur with benzodiazepines. Sedativehypnotic withdrawal delirium, noted with benzodiazepines (such as alprazolam [Levy 1984; Zipursky et al. In the natural course of events, the delirium tends to clear in anywhere from days to a couple of weeks. Sedativehypnotic abuse is said to occur when patients continue to seek intoxication despite experiencing blackouts and social or legal consequences, and the onset of addiction is heralded by the development of craving, tolerance, and withdrawal phenomena, such as a withdrawal syndrome, seizures, or delirium. Presumably, with prolonged use, down-regulation of these receptors occurs, with the consequent development of tolerance and withdrawal phenomena.
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The Office will respond to allergy forecast westchester ny cheap benadryl 25 mg with visa the first request within four months after the date that the first request was received allergy medicine 4h2 quality 25 mg benadryl. If the deadline falls on a weekend or a federal holiday allergy treatment training discount 25mg benadryl overnight delivery, the deadline will be extended to the next federal work day. Copyright Office refuses to register a work after reviewing a first request for reconsideration, the applicant may submit a second request for reconsideration. The Review Board consists of the Register of Copyrights and the General Counsel of the U. Copyright Office (or their respective designees) and a third individual designated by the Register. In addition, the Board may consider any prior correspondence between the applicant and the Office, or may take administrative notice of matters of general knowledge or matters known to the Office or the Review Board. If the Board needs additional information to review the second request, it will notify the applicant in writing. The Review Board will not hear oral argument on a second request for reconsideration. A decision issued by the Review Board has no precedential value, nor is any decision binding upon the Board in any other appeal. This notification will be sent to the individual who submitted the second request for reconsideration, and the certificate of registration will be sent separately to the mailing address specified in the application. If the Review Board decides to uphold the refusal to register, it will notify the applicant in writing and will explain the reasons for its decision. This notification will be sent to the individual who submitted the second request for reconsideration. If the Review Board has been notified that the work is involved in litigation, the Review Board will send a copy of its decision to counsel of record for the parties in that dispute. The "effective date of registration" is the day on which the Office received an acceptable application, deposit copy(ies), and filing fee, which were later determined to be acceptable for registration. However, the applicant must serve a copy of the infringement complaint on the Register, and "[t]he Register may, at his or her option, become a party to the action with respect to the issue of registrability of the copyright claim by entering an appearance within sixty days after such service. Copyright Office maintains records of all documents and correspondence relating to a first or second request for reconsideration. The Office will not consider a second request for reconsideration if the applicant failed to submit the first request in a timely manner. If the deadline for submitting a first or second request falls on a weekend or a federal holiday, the deadline will be extended until the next federal work day. The deadline for submitting a first or second request may be suspended or waived, in whole or in part, by the Register of Copyrights upon a showing of good cause. A suspension or waiver may be granted only with respect to a specific request for reconsideration, and shall not be considered in connection with any other request from that applicant or any other applicant. The decision whether to approve or deny the request will be made at the discretion of the Office. The filing fee will not be refunded and the Office will not reinstate a request for reconsideration once it has been withdrawn. Copyright Office will focus on the type of authorship claimed in the application, such as "2-D artwork" or "text. That said, the Office may allow an applicant to amend the application during a first or second appeal if the failure to include this information was the result of an honest omission or mistake. The work contains artwork and a de minimis amount of text, but the applicant only asserted a claim in "text. On appeal, the applicant admits that the words are uncopyrightable, and states that the applicant inadvertently failed to include a claim in "2-d artwork. The topics discussed in this Chapter include: Correcting or amplifying the information in a copyright registration. Requests to remove and replace certain types of personally identifiable information that may appear in the online public record. For a discussion of the procedure for abandoning a registration, see Chapter 2300, Section 2311. For a discussion of the procedure for recording transfers or other documents pertaining to copyright, see Chapter 2300, Section 2309. A supplementary registration identifies an error or omission in a basic registration and places the correct information or additional information in the public record. Supplementary registrations may be used only to correct or amplify limited issues involving certain types of registrations, which are listed in Section 1802. Copyright Office issues a supplementary registration, it does not cancel or replace the basic registration or the registration number for that registration. Likewise, the Office will not change the information set forth in the basic registration or the public record for that registration. Instead, the Office assigns a separate registration number and effective date of registration to the supplementary registration. The basic registration and the supplementary registration coexist with each other in the public record, and the supplementary registration augments - but does not supersede - the information set forth in the basic registration. If there is no clear relationship between the applicant and the parties named in the basic registration, the Office may ask the applicant to submit a sworn declaration or other evidence demonstrating that the applicant is an author of the work, a party who is entitled to be named as a copyright claimant, an owner of one or more of the exclusive rights in the work, or an authorized agent of one of the foregoing parties. If the application for supplementary registration is approved, the Office will crossreference the records for the supplementary registration and the basic registration. Specifically, the Office will place a note in the public record for the basic registration that identifies the registration number and the effective date of registration for the supplementary registration. In addition, the Office will place a note in the public record for the supplementary registration that identifies the registration number and the year of registration for the basic registration. An application to correct or amplify the information set forth in a basic registration may be filed at any time after the registration has been issued by the U. A copyright registration or renewal registration for a work that was registered or first published on or before December 31, 1977. Copyright Office may decline to issue a supplementary registration for a basic registration for a work that was registered or first published on or before December 31, 1977, because those registrations have expired by now. Allowing interested parties to correct or amplify the information in a basic registration after the initial term expired creates a potential for error, mistake, or even fraud. A supplementary registration could have significant consequences in a legal dispute, given that a certificate of registration may create an evidentiary presumption concerning the facts stated in the certificate. In exceptional circumstances, the Office may issue a supplementary registration for a basic registration that covered the first twenty-eight years of the copyright term, but only if the proposed correction or amplification is supported by clear, convincing, and objective documentation. For general information concerning the practices and procedures for correcting or amending a renewal registration, see Chapter 2100, Section 2138. A supplementary registration may be used to correct or amplify the information in one basic registration or one renewal registration. The Office will not issue a supplementary registration that attempts to correct or amplify the information set forth in multiple registrations. However, there is no limit on the number of supplementary registrations that may be issued and cross-referenced with a basic registration or a renewal registration. Copyright Office will not issue a supplementary registration to correct or amplify the information in a pending application. If the applicant discovers an error or omission in a pending application, the applicant should not file an application for supplementary registration.