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Why is it sensible to blood pressure medication overdose death buy exforge 80 mg low cost engineer the hypersynthesis of the methylase before attempting the same for its restriction enzyme partner? Why is it unlikely that the recognition sequence of any restriction-modification system will be larger than about eight base pairs? Cosmids: A Type of Plasmid Gene-Cloning Vector that is Packageable in vitro in Bacteriophage Lambda Heads pulse pressure emedicine buy exforge no prescription, J arrhythmia khan academy generic exforge 80 mg free shipping. Enzymes and Enzymology of Genetic Engineering Enzymatic Breakage and Joining of Deoxyribonucleic Acid, B. Nature of ColE1 Plasmid Replication in Escherichia coli in the Presence of Chloramphenicol, D. A Suggested Nomenclature for Bacterial Host Modification and Restriction Systems and Their Enzymes, H. Transformation and Selecting Transformants the Inosinic Acid Pyrophosphorylase Activity of Mouse Fibroblasts Partially Resistant to 8-Azaguanine, J. Injected Nuclei in Frog Oocytes Provide a Living Cell System for the Study of Transcriptional Control, J. Transfer of Purified Herpes Virus Thymidine Kinase Gene to Cultured Mouse Cells, M. Selection for Animal Cells that Express the Escherichia coli Gene Coding for Xanthine-guanine Phosphoribosyl-transferase, R. Expression of Genes Transferred into Monocot and Dicot Plant Cells by Electroporation, M. Two Dominant-acting Selectable Markers for Gene Transfer Studies in Mammalian Cells, S. Molecular Weight Estimation and Separation of Ribonucleic Acid by Electrophoresis in Agarose-acrylamide Composite Gels, A. Interesting and Useful Techniques Screening lambda-gt Recombinant Clones by Hybridization to Single Plaques in situ, W. We will continue here with descriptions of more advanced manipulations, which, for the most part, are technological aspects of genetic engineering. Finding Clones from a Known Amino Acid Sequence Sometimes the protein product of a gene is available in pure form. An oligonucleotide with this sequence can then be used to screen a collection of clones, which is called a library, to detect those containing complementary sequences. Occasionally, a clone is found in the libraries which hybridizes to the screening oligonucleotide, but which is not the correct clone. This results from the chance occurrence of a sequence complementary to the probing oligonucleotide. These incorrect positives can be detected by screening with a second oligonucleotide that should hybridize to a different part of the gene encoding the protein in question. Only one codon specifies an internal methionine, while the cysteine, histidine, and lysine are each specified by only two possible codons. The eight necessary oligonucleotides can be synthesized simultaneously by machine by incorporating either of the two ambiguous nucleotides at the necessary positions. This is accomplished simply by supplying at the correct time a mixture of the two nucleotides to the synthesis solution. Purification of the protein necessary for the oligonucleotide probing approach often is straightforward. The protein in the correct band in the gel can be eluted and a portion of its amino terminal sequence determined by gas phase and mass spectrometry. As little as 10 -12 moles of protein are sufficient for determining enough of the sequence that oligonucleotide probes can be designed to identify clones carrying the gene. Finding Clones Using Antibodies Against a Protein Cloning a gene becomes easier than described above if sufficient quantities of its gene product are available to permit raising antibodies against the protein. As in screening with oligonucleotides, a replica plate is made, cells on the plate are grown, and the controllable promoter is induced. The colony from the corresponding position on the replica plate can then be picked and studied. Molecules of one particular antibody type bind to just one particular shape found in some other macromolecule. Almost any protein can be used as an antigen to elicit the synthesis of antibodies. Thus antibodies provide highly selective agents for the detection of specific proteins. The antibody selectivity for binding to the correct shape compared to binding to incorrect shapes is roughly the same as the hybridization selectivity of nucleic acids. Although radioactive antibody could be used to detect antigen synthesized by candidate clones, it is not efficient, for different antibodies would then have to be made radioactive for the detection of different proteins. The A protein from Staphylococcus aureus provides a more general detection method. This protein binds to a portion of the antibody molecule so that one sample of radioactive or enzymatically tagged Staphylococcus aureus A protein suffices for the detection of many different antibody-protein complexes (Fig. The protein on the filter paper can be incubated with antibodies specific for the protein that were raised in mice. Then rabbit antibodies that have been raised against mouse antibodies can be added. Their location can be marked by adding colorless substrate for alkaline phosphatase whose hydrolysis product is highly colored and insoluble. The product shows the location of protein to which the mouse antibody bound, to which, in turn, the rabbit antibodies containing alkaline phosphatase bound. Southern, Northern, and Western Transfers Here we will cover in greater detail the topic of Southern transfers that were mentioned and briefly described in Chapter 2. At the same time, since the concepts are almost the same, we will also mention the so-called Northern and Western transfers. Southern transfers once were a necessary step in chromosome mapping, but their use has been superseded by techniques based on the polymerase chain reaction. After electrophoretic separation according to size, the fragments are denatured and electrophoretically transferred to a membrane before hybridization with radioactive probe. A heterozygous individual shows both bands in a Southern transfer probed with the segment S. The portion of the membrane carrying the fragment will then become radioactively labeled, and can be detected by autoradiography. This part of the process is analogous to plaque and colony screening described in the previous chapter. This simple technique, named a Southern transfer for Southern who first devised it, can be used in the analysis of chromosome structure. Not only can the changing sizes of the maturing species be monitored, but fates of specific regions that are removed can also be followed by probing with appropriate sequences. A pattern of proteins that have been separated by electrophoresis is transferred to paper or a membrane and then specific proteins are visualized. Then the paper with the immobilized proteins is incubated with the radioactive nucleic acid which binds to the immobilized protein.
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See the geometry processor control register and vertex shader registers for a description of how to blood pressure medication over prescribed buy discount exforge 80 mg configure the vertex storer pulse pressure young order exforge 80 mg with visa. For example heart attack stent best order exforge, any coordinate that is non-numeric, an x or y coordinate that is infinity, or where the area is zero. The driver creates a master tile list containing sets of commands that perform tasks such as beginning new tiles and calling polygon lists. The driver must allocate the initial memory, consisting of an array of the selected number of polygon lists. When this heap is exhausted, an interrupt is generated, and the driver must allocate more memory for the heap. The vertex loader fetches the required vertices from memory for each primitive in the polygon list. The triangle setup unit takes data from the vertex loader and polygon list reader and uses vertex data to compute coefficients for edge equations and varying interpolation equations. The rasterizer takes coefficients and equations from the triangle setup unit and uses these to divide polygons into fragments. The blending unit blends the calculated fragment value into the current frame buffer value at that position. The buffers perform various tests on the fragments, for example, Z tests and stencil tests. The writeback unit writes the content of the tile buffer to system memory after the tile is completely rendered. Table 52: Pixel Processor Rendering Tasks Description To prepare the primitive for rendering by calculating various data that is required to rasterize and shade the primitive. Fragments that could be visible proceed to the fragment shading stage, and fragments that are certain not to be visible are discarded. After blending, the fragment becomes a fragment at a certain position in the tile buffer. If no other fragment overwrites that position, the fragment becomes a fragment in the final frame. Multi-sampling techniques to obtain better quality final images can be applied to the fragment at this stage. When the internal tile buffer is completely rendered, it is written to the frame buffer in main memory. Processing Task Triangle setup Rasterization Fragment shading Blending Producing the frame buffer content Pixel Processor Fragment Shader the fragment shader is a programmable unit that calculates the appearance of each fragment of a primitive. They circulate in the loop until the access router determines that they can be removed. Table 53: Level 2 Cache Controller Tasks Description Memory requests enter by the arbiter and keep circulating in a loop until the access router determines they can be taken out of the loop. For each request, the tag accessor performs a cache lookup to see if data is in the cache. It is fully pipelined and permits one tag operation to be performed per clock cycle. The access router passes data for each request to the read buffer, write buffer or replay buffer. These request collisions, also called bad-hits, continue to loop around the system until the access router determines when they can be taken out of the loop. Only incremental bursts are supported, there is no support for unaligned, fixed, and wrapping bursts. Known as address translation or virtual memory, this enables the processor to work using addresses that differ from the physical addresses in the memory system. Chapter 6 also has information on the Power Down Request and Power Up Request registers. To comply with the power domain requirements, there are separate power rails to supply the power for each domain. Battery Powered Mode To maintain critical information over the time during power off, the device provides the battery power mode. Like the low-power mode, power dissipation depends on the components that are running and their frequencies. Manages the system during the sleep mode and wake-up the system based on various triggering mechanisms. Table 62: Pipeline Interconnect standard Endianness Program counter width Support for load/store exclusive Fault tolerance Hardware multiplier/divider/barrel shifter Debug Fast interrupt MicroBlaze Implementation Features Feature 5-stage. SysOsc starts to oscillate as soon as the voltage is high enough for the block to function. If less than 4 bytes have to be written, then the 4 bytes must be read first, modified, and the entire 4 bytes must be written back. Scan Clear Functionality Zeroization is a process in which zeros are shifted through all of the storage elements and then verified that the shift occurred correctly. When a scan clear engine is started, the completion status signal from the engine transitions from 1 to 0. In this case, the power island needs to be isolated before the block is put in the scan mode to start the scan clear functionality. Leverage the explicit reset input to clear state in registers that have this feature (this is recommended, but not required). The use of explicit resets for clearing instead of using scan on these registers requires them to be applied on chains that are included in the scan test rather than in the scan clear. In either case, the flip-flops on the local and global registers are excluded from clearing functions. If for any reason this is not acceptable for the security lock-down, the reset to the flip-flops with the self-clearing feature that are not cleared through scan has to be asserted after the scan clear function on the rest of the flops is completed. A captured error can only be cleared if a 1 is explicitly written to each corresponding error status bit. For each of the errors that are processed by the error handling logic, you can decide what action should be taken when the error occurs. Power masters in the system are entities that can trigger the power down or power up of all islands including themselves. The power masters can also be slaves because their islands can be individually powered down. The requests are initiated by user software enabling the service request and subsequently asserting the associated trigger for the service. In the case of a simultaneous power down request, the order for processing power-down requests is that the islands are powered down before the domains.
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To display the Search Result page blood pressure medication muscle weakness order 80mg exforge with amex, refer to pulse pressure medical definition buy exforge with a visa "Finding and Viewing Providers" in this section blood pressure normal low pulse order exforge overnight delivery. You should consider entering a quick code for the provider in the Quick Code field. The quick code serves as an alias for the provider, enabling you to quickly enter information for a provider in the relevant sections of an investigation or document data entry page. Rather than searching for a provider by name, you can type a short quick code and instantly display the information for a provider. In sections supporting single values, click the field you want and type the information you want. In sections supporting multiple values (generally indicated by a gray table atop a set of fields), click the Type list box and choose the type you want. Also note that the Address and Phone and Email sections require you to indicate the use of the address and telephone number (such Home, Primary Work Place, etc. Note: When adding or editing information in sections supporting multiple values, you must click the Add or Update button to complete your data entry. Editing Provider Information You can change information about a provider, such as updating an address or correcting a misspelled name. To indicate a reason for edit, do one of the following: Click Typographical error correction or additional information to indicate a change due to error correction or additional information. Click A change to existing information for non typographical reasons to indicate a change to something that was not a typographical error. View the provider using the procedure described in "Finding and Viewing Providers. Note: You cannot search for inactive providers, or re-activate providers whom you have inactivated. Description this section contains descriptive and procedural information about the following functions: Adding an organization Editing organization information Inactivating an organization 2. Access the Organizations Search Results page using the procedure described in "Finding and Viewing Organizations. Enter all the available information for the organization in the fields provided on the page. In sections supporting single values, enter the information or make a selection from the drop down list in the fields provided. In sections supporting multiple values, click the Type list box and select a type from the drop down list. Also note that the Address and Telephone sections require an indication of the Use of the address and telephone number (such Home, Primary Work Place, etc. Find and view the organization you want to change using the procedure described in "Finding and Viewing Organizations. Note: In sections where multiple values display, click Edit for the value you need to change. When you are finished making changes, click Update to update an existing value in a section where multiple values display. Note: You must have the appropriate security permissions to inactive organizations. Access the View Organization page using the procedure described in "Finding and Viewing Organizations. Description this section contains descriptive and procedural information about the following functions: Adding a place Editing place information Inactivating a place 2. Access the Place Search Results page using the procedure described in "Finding and Viewing Places. Enter all the available information for the place in the fields provided on the page. Field Name Quick Code Description of Control Quick Entry Code is a state assigned code for a place that is used as a short cut for representing a place and the details associated with a place. Text entry box that permits users to enter additional descriptive information about the place. Census Tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Place Type General Comments Place Name Address Information As Of Type Use Street Address 1 Street Address 2 City State Zip Census Tract Field Name County Address Comments Add Address button Description of Control County where the place is located. The user must use this button to add the address to the Address table before submitting the Place record. Find and view the place you want to change using the procedure described in "Finding and Viewing Places. To indicate a reason for edit, do one of the following: Select Typographical error correction or additional information to indicate a change due to error correction or additional information. Access the View Place page using the procedure described in "Finding and Viewing Places. Description this section contains descriptive and procedural information about the following functions: Understanding documents Reviewing documents 3. However, they cannot search for patients since they do not have access to the patient registry. Similarly, remote users can search for provider information, but cannot add new providers to the system. For lab reports submitted electronically, the system displays a note at the top of the page indicating that the lab report was submitted electronically. Once any report (lab report or case report) enters your work queue, you can perform the following functions: View the report. You use the Documents Requiring Review queue to view new the new documents in your work queue. Once you view the documents, you can determine on your next course of action based on the available information. In some cases, you may find enough compelling information to initiate an investigation based on the lab report, morbidity report, or case report. In other cases, a document may not contain any information to warrant further investigation. In this event, you can simply mark the document as Reviewed and go on to the next item on the list. By marking the document as reviewed, you indicate to the system that it warrants no further action. You can access the document from the Events tab in the View File page for the patient. The Documents Requiring Review page displays a list of lab reports, morbidity reports, case reports associated with your program area and jurisdiction Note: Choose Next and Previous to move through the list of documents.
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Case Study: Communication Following the 1995 Oklahoma City Bombing Following the 1995 Oklahoma City Bombing blood pressure medication starting with x buy exforge 80 mg visa, the media hypertension guideline exforge 80 mg with mastercard, without prior coordination hypertension disorder trusted 80mg exforge, directed volunteers with medical training to report to the disaster site. Integrate communication specialists into the planning process early, and assign responsibility to supervise and coordinate each communication area (eg, media, family communications, interfacility transfers, etc). Develop pre-event standard message sheets in order to communicate effectively with families and the media. Organizational leaders must be comfortable with the post disaster event communication plan, as well as the devices developed to support them during the turbulent times surrounding the event. Measures of success should be developed and then tested to know when the plan is ready. Only then can planners and responders best prepare for the communication challenges found in the chaos of a disaster. Understand the most important therapeutic drug classes to consider for the surge supply list (and offer advice on selecting agents to stock them). It is important to identify/enumerate equipment and resupply requirements (logistics) to accommodate surge capacity. Discuss/organize/categorize potential surge requirements as space, staff, and stuff, although not necessarily in that order. Of these must-have items, how much/many do you have, and how much/many will you need during a surge? If yes, what are their cleaning requirements (personnel, time) and are these items sufficiently available? What are the needs related to surge requirements, and what are the access and supply lines? What patient tracking systems are in place, and do they need to be modified for surge? Will there be a set time and/or condition that will define the need for retriage of patients or reallocation of resources? What system will best deliver the care that has been designated (eg, staffing ratios, expanded job descriptions, etc)? For example, benzodiazepines can be substituted for propofol since they are less expensive, widely available, and can be given as intermittent boluses as well as infusions. Most aspects of the plan can be developed using an all-hazards approach, but this is where delineation between infectious and noninfectious surge has the most impact. Planning Template for Week 1 Moderate Flu Pandemic region newly sick hospital staff newly sick # Staff dep. Formula to Calculate Departmental Absence Rates total department staff X X total department staff absentee rate 0. Institutional Assumptions and Plan to the extent possible, hospitalized patients will be located at hospital (or medical center). Because supplies and trained staff to support the use of such complex drug therapies are likely to be impacted during a disaster, we suggest a narrow critical care formulary-this offers the greatest potential benefit to the largest numbers of patients, and at relatively reasonable costs. Numerous gaps in knowledge were encountered in researching and developing the list, given the limited published resources available. Discuss the planning process with regard to ethical problems that one might encounter. Discuss the planning process with regard to medical decision making (population-based versus individual-based decision making). Discuss the planning process with regard to personnel-related ethical issues (ie, not enough personnel to care for the patients either because of an absolute shortage or, in some cases, because some healthcare professionals will decline to be involved secondary to a fear of their own safety). Understand the necessity of support for those who provide care, and their families, in disaster situations. Decide what the responsibilities of the healthcare professionals will be and the responsibility of the organization as a whole to the professional. What are the potential clinical issues that may invoke ethical concerns, and how can/should these be codified? Decisions should be made explicitly with stakeholder views in mind and there should be opportunities for stakeholders to be engaged in the decision-making process. For example, decision making related to staff deployment should include the input of affected staff. For example, there should be a communication plan developed in advance to ensure that information can be effectively disseminated to affected stakeholders and that stakeholders know where to go for needed information. Decisions should be based on reasons (ie, evidence, principles, values) that stakeholders can agree are relevant to meeting healthcare needs in a pandemic influenza crisis, and they should be made by people who are credible and accountable. For example, decision makers should provide a rationale for prioritizing particular groups for antiviral medication and for limiting access to elective surgeries and other services. For example, if elective surgeries are cancelled or postponed, there should be a formal mechanism for stakeholders to voice any concerns they may have with the decision. Inclusiveness Openness and transparency reasonableness responsiveness a adapted with permission through a Creative Commons attribute License. When setting priorities, it is essential that the public recognize the legitimacy, fairness, and equity in the process. During a disaster, medical circumstances may develop that can limit personal liberties, along with attendant ethical concerns. Decide whether this is a single institution or a regional issue and how you will cooperate. Develop guidelines on the rationing and triage process for those responsible for this process.
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They found cord blood lead levels were higher than maternal blood lead levels at delivery in 33% of the cases heart attack is recognized by order exforge 80 mg online, predominantly influenced by older maternal age and lower milk consumption blood pressure youth order exforge uk. The authors sug gested that the measurable influence of maternal blood lead on delivery cord blood lead is limited to blood pressure medication for kidney transplant patients exforge 80mg online the four to eight weeks prior to delivery. Also, many factors suspected of influencing bone lead also influenced cord blood lead, some of them independently of their effect on maternal delivery blood lead. They found that higher maternal blood pressure and alcohol consumption were associated with higher cord lead relative to the lead of the mother. With 1 additional day of lead-glazed ceramic use per week in the peripartum period, the mean cord blood lead level increased by 0. The models suggested that the contributions from endogenous (bone) and exogenous (environmental) sources were relatively equal, and that maternal plasma lead varies independently from maternal whole blood lead. Common risk factors for pregnant women include recent immigration status, practicing pica, occupational exposure, use of alternative remedies or cosmetics, use of traditional lead glazed pottery, and nutritional status. Pica during pregnancy appears to occur more frequently in sections of the South and in immigrant communities where this behavior is a culturally acceptable practice. Lead-based paint is less likely to be an important exposure source for pregnant women than it is for children, except during renovation or remodeling of homes built before 1978. Sources of lead exposure in the United States vary by population subgroup and geogra phy; therefore, public health agencies should be consulted for community-specific risk data. Fetal exposure to lead through maternal bone lead mobilization is possible for women with significant prior lead exposure; however, most women with blood lead levels typical in the United States are unlikely to contribute substantial burdens to their infants. Information on the distribution of blood lead levels in preg nant women in the United States is derived from cross-sectional surveys, case reports, and epidemiological studies. From the direct, albeit limited, information on the distribution of blood lead levels in pregnant wom en, along with the available complementary information on blood lead levels in women of childbearing age and in occupational settings, it is evident that the risk factors for lead exposure in pregnant women differ from those described in young children. Health care providers and public health departments need to understand the risk factors specific to pregnant women in order to identify sources of lead in pregnant women, provide patient education and counseling, and intervene to prevent or reduce exposures. Occupational lead exposure and nutritional status are also important risk factors warranting assessment. Certain culturally specific practices, such as the use of alternative remedies or imported cosmetics and the use of traditional lead glazed pottery for cooking and storing food, are important risk factors for lead exposure in pregnant women (Centers for Disease Control and Prevention 2004; Saper et al. Some popula tion groups, such as immigrants, are more likely to be at risk for exposure from these sources. Shannon (2003) identified seven severely lead poisoned women who were exposed to sources of lead including ingestion of soil, pottery, or paint chips; household renovations; and use of herbal remedies. Lead-based paint is less likely to be an important exposure source for pregnant women than it is for children, except during renovation or remodeling in homes built before 1978. Although not an issue for most women with blood lead levels typical in the United States, fetal exposure to lead through maternal bone lead mobilization may be a concern for women with significant lead exposure earlier in life, either in the United States or in their countries of origin. The geometric mean blood lead level among women aged 20-49 years (N = 4,393) was 1. A number of factors were associated with higher blood lead levels including higher maternal age, Black or Hispanic race/ethnicity, living in the Northeast region or in urban areas, lower educational level, poverty, lower hematocrit, alcohol use, cigarette smoking, and higher serum protoporphyrin level. Number of live births, breastfeeding history, year house was built, and type of drinking water were not significantly associated with differences in blood lead. Subjects in the first phase of the survey (1988-1991) had significantly higher weighted mean blood lead levels (2. Further analyses performed by the authors (unpub lished) specific to women 20-49 years of age (N = 755) found that the geometric mean blood lead level was 1. Blood lead was positively associated with: age; non-Hispan ic Black, White, or Asian race/ethnicity, compared to Hispanic; foreign birth; and former and current smoking. After multivariable adjustment, Asian race/ethnic ity was the strongest predictor of blood lead level. In a separate study focused solely on immigrant mothers who gave birth in New York City in 2003, Graber et al. Because testing practices vary by employer and clini cian, reporting practices vary by state, and all lead exposed women may not be tested, these data should not be used to estimate population-based rates of specific blood lead levels in the general population of women (Centers for Disease Control and Prevention 2007). Women with a friend or relative identified with lead exposure above background levels are also more likely to have increased blood lead levels (Handley et al. Nutrition may play a role in the extent to which lead is absorbed and the extent of bone turnover. An understanding of these factors is useful in assessing the sources of lead exposures in pregnant women and in developing interventions to prevent and/or interrupt lead exposure. Figure 4-1 presents common risk factors for lead exposure by pregnant women in the United States. Recent Immigration to the United States A number of studies have identified immigrant status as a primary risk factor for lead poisoning in women and young children in the United States (Klitzman et al. Immigrant status is a risk fac tor for blood lead levels much higher than concurrent blood lead levels in U. First, women from countries where relatively high lead exposure is endemic may carry high cumulative body burdens of lead. Second, immigrants may transport lead-containing products, cultural practices, and behaviors with them from their countries of origin. Third, some recent immigrants may live in poor conditions that increase their risk for exposure to lead-based paint and other lead hazards from renovation and repair. In addition, since immigrant women may face cultural, linguistic, economic, and legal barriers to early prenatal care, these risk factors may be compounded by delays in identification and manage ment of lead poisoning. Of these 75 women, 99% were foreign born (68% were from Mexico) and 73% reported using imported products during pregnancy, including foods, spices, herbal medicines, pottery, and cosmetics. Ninety percent of individuals were foreign born, the majority being from Mexico (57%), with a median time in the United States of 6 years (range 1 month to 20 years). Overall, thirteen (39%) reported pica behavior; 7 (21%) reported using imported pottery for cooking; and 8 (24%) reported consuming imported spices, tea, and/or food. Other sources identified included vitamins and supplements, lead-based paint hazards, and previous history of exposure to lead. These data from an inner-city medical clinic suggest that prenatal lead exposure dispropor tionately occurs during the pregnancies of immigrant women from certain countries and occurs at a preva lence high enough to warrant universal blood lead testing (see Case Study 4-1). This study identified home-prepared grasshoppers (chapulines) sent from Oaxaca as a source of lead exposure. Prenatal Lead Exposure in New York City Immigrant Communities: the Elmhurst Queens Experience Of the 124,345 babies born in New York City in 2003, 52% were to mothers who were born out side of the United States (New York Vital Statistics).
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The psychological understanding of how propaganda can move people to arteriosclerotic cardiovascular disease purchase exforge canada action is of a very high order blood pressure headache discount exforge 80mg on line, as are the technical skills deployed in the video and sound editing blood pressure chart for senior citizens cheap exforge 80 mg on-line. This step marks the beginning of a transition from individual propaganda analysis to analysis of a potential propaganda program. Type: Radio Television Print (specific type) Newspaper/Magazine Internet Other 2. Individual product analysis feeds the program analysis and can clarify missing information. Part of the challenge of counterpropaganda is deciding whether or not to execute a counterpropaganda program. In an active sense (due to constraints, silence may be an option), it may be far more damaging to initiate a weak counterpropaganda plan and have it fail than to employ the silent option. Preventative actions take the form of propaganda awareness programs that inform and expose military (U. This information is normally disseminated through a unit chain of command concerning facts about an ongoing or upcoming operation. Command information seeks to keep Soldiers as informed as possible about their missions, roles, and expected end state. Extended duration operations also see the use of different media dedicated to command information. This component would also serve to expose military personnel to potential propaganda and therefore reduce their potential susceptibility. This action is especially critical before a major deployment to set conditions favorable for the introduction of forces. Opponent propaganda personnel use a wide variety of themes against friendly forces. If they are unable to effectively counter the propaganda in a reasonable amount of time, the supported unit may suffer more damage to its credibility through a late counterpropaganda program, as opposed to not countering the propaganda at all. If sufficient resources do not exist, planners should not hesitate to request assistance immediately from the supported unit. Planners must be forthright in advising the supported unit of their ability to successfully counter opponent propaganda. A detailed evaluation of all planning considerations should be used in advising the supported unit. There is no "correct" or "best" technique; the techniques must be based upon the situation at hand. This technique is a point-for-point rebuttal of opponent propaganda allegations or themes. Personnel use this technique when they are confident that they can refute the propaganda with complete accuracy. Although the report was over forty pages in length and was not published for several years after the rumor first appeared, the report serves as an example of detailed direct refutation. Each version of the rumor is laboriously examined and refuted through the use of factual information. In its concluding paragraph, the report stated that "this myth derives its credibility from the fact that it speaks to widespread, largely unconscious anxieties about mutilation and death that have been stimulated by the dramatic advances made in the field of organ transplantation in recent years. This technique is often seen in courtroom trials where one side seeks to lower the credibility of "expert" witnesses. An advantage of using this technique is that indirect refutation does not bring added publicity or credibility to the propaganda by repeating certain aspects. When seeking to lower the credibility of the source of the propaganda, personnel should avoid "name calling," as this may potentially damage the credibility of the supported force. Recently, the chairman of Microsoft, Bill Gates, used this technique in a subtle fashion by appearing in a series of television commercials following the negative outcome of the antitrust trial against his company. He appeared in a relaxed setting, seated in an armchair, and spoke of the positive impact that Microsoft had on the lives of most Americans. He spoke at length of the commitment of Microsoft to the youth of America and to American families in general. He did, however, attempt to damage the credibility of the ruling by highlighting the positive impact of Microsoft on Americans, and insinuating the question, "How could a company which is so dedicated to Americans be treated so badly by the courts? A critical factor in succeeding with this technique is to select an important topic to use as the diversion. His use of this technique was successful in part due to his control of what the international media was allowed to see and report upon within the Former Republic of Yugoslavia. Jamming, physical destruction, and occupation of media outlets are some examples of this technique. Restrictive measures must be evaluated for their potential negative feedback potential before being implemented. In addition, these measures are often used by repressive regimes, inviting the inevitable comparison. The leaflets attempted to hold out the hopes of new super weapons, new sources of manpower, and the hope of German victory. Allied psychological warfare personnel obtained copies of the Skorpion and soon made subtle changes and prepared pseudo Skorpion leaflets-exact copies with an allied slant to the information. The allies then airdropped millions of these pseudo Skorpion leaflets on German troops in the field. One pseudo Skorpion authorized German Soldiers to shoot their officers if they did not display sufficient "National Socialist zeal. This technique does not specifically address potential themes that the opponent may use in a propaganda program against the force, but seeks to remove or reduce potential vulnerabilities before they can be exploited. This technique uses war gaming in analyzing the different possible outcomes from a planned event, from best-case scenario to worst-case. A detailed knowledge of opponent propaganda techniques and themes assists greatly when using this technique. Personnel may elect to use minimization if the supported unit feels that it cannot remain silent on an issue. The attempt was to regain some element of trust among Bosnian Serbs and add credibility to the product as a whole.
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Do the total dollars now funding the outcome/goal of interest meet or exceed a reasonable threshold heart attack hereditary buy exforge 80mg line, relative to arteria y vena poplitea best buy exforge other health and well-being outcomes? It offers guidance to blood pressure chart for male and female buy cheap exforge 80mg on-line County policymakers in their pursuit of Health in All Policies, an approach that aligns county funding, across departments and services, with needs and desired health outcomes. Challenges include the following issues: Inefficient uses of the health care system remain despite improvements. Highlights need to rebalance investments in health care use and drivers of health Residents encounter challenges in navigating health and human services. Offers insight into why some residents may use costly emergency services when primary care is a better option Spending on health and human services is low. Inefficient health service uses signals a broader concern for access to health and human services that contributes to inequities in health and well-being Systemic inequities in health drivers place some communities farther behind in building healthy futures. Align information about what is being spent on these health services and information on reach, effectiveness, and impact on reducing inequities. Require all nongovernmental organizations receiving County funding to identify their role(s) in promoting health and well-being and reducing inequities. Update the County website to coordinate information on what influences health across sectors. Offer resources organized by the health drivers to better support populations with health issues in more integrated ways. To inform this path forward, the authors of this report used primary and secondary data to describe both the health needs of county residents and drivers of health within the county, inclusive of the social, economic, built, natural, and health service environments. This report integrates these findings, an analysis of budget documents, and a review framework to foster aligned and integrated planning and budgeting across the county to promote health and well-being. Findings from the assessment indicate a shared interest among leaders and residents of promising practices from other communities to situate recommendations in a Health in All Policies to embrace a holistic strategy for health and well-being in the county. Inefficient uses of the health care system are identified, highlighting a need to rebalance investments in health care use and drivers of health. Recommendations are provided for several paths forward for the county to pursue a more integrated policy approach to influence health and well-being outcomes. Professor of Cell Biology University of Connecticut Health Center 263 Farmington Ave. It provides a rapid warning to the nervous system to initiate a motor response to minimize physical harm. Lack of the ability to experience pain, as in the rare condition congenital insensitivity to pain with anhidrosis (Axelrod and Hilz 2003), can cause very serious health problems such as self-mutilation, auto-amputation, and corneal scarring. Up until the twentieth century there was a vigorous and heated debate about the nature of pain. One side held that sensory stimuli, which activate ordinary sense organs, such as those for warmth or touch, would initiate pain through the same sense organs if the stimuli were strong enough. The other held that there was a separate set of specialized sense organs that were specific for pain. It was not until the twentieth century that the debate was settled when it was shown conclusively that there were specialized sensory organs that signaled pain. For example when we hear music we may think it is beautiful or we may eat a food and think it has a horrible taste. One can make a distinction between the sensory information we receive and how we perceive that information. Pain is a perception that is a process that allows us to interpret a certain type of sensory information. Sometimes the link between the sensory information and the perception is suppressed, for example, during battle soldiers have reported a lack of pain despite severe injuries. Physiologists distinguish between pain and nociception; where nociception refers to signals arriving in the central nervous system resulting from activation of specialized sensory receptors called nociceptors that provide information about tissue damage. Pain then is the unpleasant emotional experience that usually accompanies nociception. Two types of nociceptive pain are usually distinguished: pain emanating from the skin and deeper tissues. Somatic pain is usually well localized whereas visceral pain is harder to pinpoint. In contrast to nociceptive pain neuropathic pain results from damage to the nervous system and two types of neuropathic pain have been distinguished. Peripheral Neuropathic pain is pain resulting from a wound or damage to a primary nociceptor. Historically, to learn something about the stimuli that activate nociceptors large numbers of randomly selected nerve fibers that innervate the skin were typically studied. Large peripheral nerves in mammals are actually compound nerves composed of bundles of thousands of individual nerve fibers enclosed in a loose connective tissue sheath. The 1-1 conduction velocity with which the individual nerve fibers within a bundle transmit action potentials to and from the nervous system can vary more than 100-fold, making it of interest to know the conduction velocity of the fibers that carry the signal from nociceptors to the brain. The electrical activity of an individual nerve fiber from a nerve bundle can be isolated and recorded from using a variety of methods, one of which is shown in Figure 1-1. These sensory neurons have an axon that projects to peripheral tissues, such as the skin, and are responsible for our sensation of our bodies. The trigeminal ganglion is analogous to the dorsal root ganglia of the spinal cord and is responsible for sensation in the face. The conduction velocity of the impaled neuron in Figure 1-1 was measured by using a brief voltage pulse applied to the extracellular stimulating electrodes to evoke action potentials in the nerve fibers composing the nerve bundle. By knowing the distance from the stimulating electrodes to the recording site, and the time it takes the action potential to reach the recording site following application of the voltage pulse, the conduction velocity can easily be calculated. Many of the afferent (sensory) neurons isolated in this way respond to lowintensity mechanical or thermal stimulation, that is, stimuli that in individuals evoke an innocuous or non-painful sensation. In addition, these fibers exhibit the full range of conduction velocities exhibited by the nerve. Relatively high thresholds for activation distinguish some of the neurons recorded this way, i. We have all probably experienced that pain can be caused by thermal, mechanical and chemical stimuli that produce tissue injury. Several possibilities might explain how these different stimuli could result in the sensation of pain. One possibility is that individual nociceptors are sensitive to all of these different stimuli. Another is that there are several different types of nociceptors with each being sensitive to a specific stimulus. As we shall see below it turns out that both possibilities are found in nature: some nociceptors are sensitive to a specific stimulus while others are sensitive to multiple types of stimuli. Classification of nociceptors by the conduction velocity of their axons the nerve fibers (axons) within a compound nerve include both afferent nerves and efferent (motor and autonomic) nerves.
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Eliminating serogroup A meningococcal meningitis epidemics as a public health problem in Africa zicam and blood pressure medication proven 80mg exforge. Safety arrhythmia general anesthesia order 80 mg exforge otc, immunogenicity arteria e veia order exforge 80mg line, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Yaounde declaration on elimination of meningococcal meningitis type A epidemics as a public health problem in Africa. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. General considerations in the production and use of brain tissue and purified chicken-embryo rabies vaccines for human use. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomized, double-blind controlled study. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Global immunization profile Population data in thousand1 2007 Total population Live births Surviving infants Pop. In general, vaccines are recommended for the youngest age group at risk of developing the disease whose members are known to respond to the immunization without adverse effects. We want to ensure that Stanford graduates are prepared for a lifetime of meaningful work. Trainees have myriad opportunities to learn about, explore, and find their fit in sectors such as Academia & Education, Banking & Finance, Biotech/Pharmaceutical Research, Consulting, Data Science, Government, Healthcare, Law, Medical Devices, Media & Communications, Non-Profit and more. First Floor, Medical School Office Building 1265 Welch Road 650-721-1893 bioscicaereers@stanford. Coaches can help you with all of your career exploration and job search needs and concerns. Fairs provide students with an opportunity to meet face-to-face with employers from various industries and explore potential career fields of interest. We take an integrated partnership approach that incorporates individual trainees, trainee/student group leaders, faculty, alumni, and employers into the decisions we make and the curriculum and services we provide. Established in 2004, BioSci Careers supports the professional and career development of over 3000 trainees-biosciences graduate students and postdoctoral scholars, medical students and residents. Their academic training prepares them for a wide range of exciting career opportunities. BioSci Careers is pleased to provide relevant guidance and support for their decision-making, career planning and development. From academia and clinical practice to industry, government, and non-profit roles, BioSci Careers prepares trainees for positions of leadership and excellence in fields and sectors of their choice. Trainees have myriad opportunities to learn about, explore and find their fit in sectors such as Academia & Education, Banking & Finance, Biotech/ Pharmaceutical Research, Consulting, Data Science, Government, Healthcare, Law, Medical Devices, Media & Communications, Non-Profit and more. We believe that individuals do their best-and provide their most meaningful, substantial contributions to society-when their professional activities are aligned with their own definitions of meaningful work, and when they are encouraged and provided outlets to pursue that work. As you engage in your career exploration and search for opportunities, take time to consider what kinds of activities, challenges, and employment sectors are meaningful to you. The natural tendency of many PhDs and postdocs is to consider careers both in and beyond academia throughout their graduate and postdoctoral training. In addition, employment conditions continue to evolve and may present new opportunities, as new market needs or occupations emerge. Graduate training is an opportunity to develop a broad and transferable skill set that can take you on multiple career paths. Resources: the worksheet on page 9 will help you reflect on your definition of meaningful work. Students engage in the Meaningful Work model to build a network of alumni, employers, career coaches, and peers by following three critical steps that are based in design thinking. Design different pathways and learn to tell your story by learning to articulate your skills, values, knowledge, and interests. By empathizing, defining and reflecting, you can begin to connect and link your experiences with your life and career goals. Prototype and test different pathways by engaging with your personal and professional networks and mentorship opportunities. Pursue opportunities with confidence by understanding the steps and strategies needed to find and apply for desired positions, develop your brand in print and in the digital environment, and continue to venture off the Farm. By evaluating your options, developing skills, and continuing you to grow, you will be better prepared for the opportunities waiting for you. Connect with meaning, opportunity, and community throughout your efforts to design, venture, and pursue your pathways. The essence of career design is finding a fit between who you are and an environment that suits you. Reflect on your interests, personality, values, strengths, preferred work environment, goals, and life circumstances. Assessments can help you clarify your interests, gain vocabulary for cover letters and interviews, and establish a starting point for your career exploration. It also provides input on work settings and careers where your personality type might be either a complement or a challenge. CliftonStrengths Formerly known as the StrengthsQuest, this assessment provides you with a customized report that lists your top five strengths, along with action items for development and suggestions about how you can use your talents to achieve academic, career, and personal success. Career Coaching Our coaches are trained to help you interpret the results of these tests, so you can make the most of this information. Understanding your values is an important part of your career decision making process. PhD Skills and Expertise In the course of a PhD, students develop a wide range of skills and knowledge areas that often go unmentioned in coursework and curricula. Your training is highly valuable in the public and private sectors: research universities, teaching-focused colleges and universities, non-profit organizations, government research centers and think tanks, established companies, and startups, just to name a few. Below are some possible fields that draw on the skills you developed during graduate studies. For a deeper dive into the skills related to Biosciences career options, see biosciences.
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The three pacific coastal prefectures of iwate blood pressure chart female buy cheap exforge 80 mg online, miyagi arrhythmia gerd order 80 mg exforge with amex, and Fukushima suffered most of the damage blood pressure variability normal buy exforge 80 mg overnight delivery. The only hospital in the town (126 beds) became inoperable after the torrent of water flooded everything up to the fourth floor. The disaster was complicated further when the safety mechanism at the nuclear power plant located in Fukushima failed to shut down the plant after the earthquake, leading to an uncontrollable elevation in its core temperature, a hydrogen explosion, and ultimately, a nuclear meltdown. This rapid medical response to the disaster was made possible by the lessons learned from previous domestic natural disasters, including the kobe earthquake in 1995 (magnitude 7. This differed from previous earthquake disasters in Japan (eg, the aforementioned kobe earthquake), where patients with crush injuries and acute trauma were the most vulnerable population. Therefore, aside from the relatively few cases of aspiration pneumonitis, hypothermia, and trauma among survivors of the tsunami, the care of the ambulatory population with chronic illnesses became the primary goal for healthcare professionals. The diversity of these healthcare professionals was necessary to address the array of medical needs. These aftershocks have often slowed the pace of rescue missions, as they have presented major threats to the safety of the people in the field. The threat of shortages in medical supplies also became an issue during the acute phase. For example, concern grew about a levothyroxine shortage because the earthquake had directly affected the factory that produced 95% of the levothyroxine supply in Japan. Twitter and Facebook were powerful and valuable modes of communication, as these services allowed mass communication to take place at an extremely fast pace. This disaster hit a region of Japan that had been experiencing a chronic shortage of healthcare professionals for years. These two appendix 11 the 2011 Japan earThquake and Tsunami: Lessons Learned From the Loss oF medicaL inFrasTrucTure 229 variables are becoming the center of debate as the discussion continues on the reconstruction of the communities and their healthcare systems. Lastly, psychiatric and emotional care was in high demand, both among the local people and volunteer relief workers. This appears to have created extra emotional stress for these volunteers; thus, careful monitoring of their psychological states and emotional health has been conducted. This disaster reconfirmed the importance of emotional care for both local residents and responding volunteers. Future disaster planning must focus on rapid deployment of portable medical and critical care capabilities. This disaster highlighted the need to prepare for multiple, simultaneous disasters. Local responders and leaders need to look around for secondary disasters that may occur. The ongoing level of support after the immediate disaster is a challenge for rebuilding critical care capabilities. Both relief workers and the local population require protection from posttraumatic stress disorder and other sequelae. Mount Sinai Hospital is able to provide care for 150% of the normal iCu capacity (=8 additional beds or a total critical care census of 24). Should this level of surge be required, significant alterations in models of care and reduction in deferrable services will be needed to assist in staffing 232 appendix 12 Mount Sinai HoSpital iCu diSaSter reSponSe plan critical care areas. Should a surge beyond 150% be required, overflow into the postanesthesia care unit (paCu) is planned with the possible addition of up to 12 critical care beds. Expansion of Critical Care Space and Capacity Satellite critical care areas will be developed to manage the anticipated increase in the volume of patients during a pandemic. During a pandemic, this bed meeting will expand to occur 7 days per week and additional meetings will be held as required. Based on recommendations from the iCu team and bed meeting participants, a recommendation to open critical care overflow areas will be made to the Flu Management executive Committee who will, in turn, make the final decision on expansion and subsequent processes for deferring related hospital activity. Critical Care Expansion Scenarios and Activity Triggers decisions to surge into alternate areas outside of the 16-bed iCu will be made in real time and will be based on available resources and patient needs. Sixteen ventilated patients will be cared for in the current iCu area located on the 18th floor with the goal to have the most acutely ill patients cared for on this unit. For surge to 150% critical care capacity (with 4 additional beds opened to =8 critical care overflow beds, or 24 critical care beds across the organization). Should this level of surge be required, significant alterations in patient care delivery models will be required. Whenever possible, to assist with appropriate staffing, 4 patients will be cohorted in the paCu. Management of Surge once a pandemic has been declared and increases in the volume of critically ill patients approach maximum capacity, the iCu will implement the following measures to support the surge: 1. Multiple bed moves will not occur under pandemic conditions due to staffing limitations and patient status. Maintain medical step-down unit and/or surgical step-down unit for the care of level 2 patients. While de-escalation of deferrable surgical procedures will occur during a pandemic, priority 1 surgical cases will continue and, due to patient complexity, may require this level of care. Consider clinical closures on medical-surgical units so staff from these areas can be redeployed as necessary to assist in the care of patients in overflow critical care areas. Patient Accommodation as it is anticipated that patients with and without the flu will require critical care services, and due to difficulty in determining who may be incubating the illness, patients will not be cohorted according to flu versus non-flu in critical care areas. Staff caring for patients in either unit will be required to adhere to required isolation precautions as per infection Control directives. Should the paCu be required for critical care surge, social distancing will be used in the early stages of use of the area (a distance of 6 feet should be maintained). However, multiple patient moves will not occur during a pandemic due to anticipated limitations in staff resources and infection control reasons. Supplement A3 on page 259 details communication and responsibility processes for off-service obstetric patients. Gestational viability will be determined based on neonatology and other resource availability and as per directives from the Child Health network. Critical Care Admission Criteria the Critical Care team will follow the provincial guidelines/criteria for admission to critical care, as well as criteria for the triage of iCu patients. Clinical care will be consistent with practices used under normal circumstances to address patient needs and enhance clinical outcomes (Supplement A4 on page 261). Mechanical Ventilation protocol - General principles usual pressure-limited protocols will be utilized. High frequency oscillation will be used for influenza patients as available and as required. Critical Care Patient Triage a process for the triage of critical care patients will be developed at the provincial level. Discharge Criteria discharge criteria in the critical care areas will be most dependent on ventilator requirements. Palliative Medication Options Symptom/Patient Assumptions Secretions (assuming 100% of patients) Palliative Medication Options 1st choice in ~80% will be scopolamine 0.
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Instructions: Complete checklist to blood pressure ranges in pregnancy buy generic exforge 80 mg on-line assess resources available and resources needed heart attack cpr purchase exforge australia. Resource Needs Assessment Funds Needed: Yes/No Notes on What Is Needed Other resources: Education department Printing/copying Graphics/design Facilities and supplies Physical therapy/occupational therapy consultation on work practices Interdisciplinary implementation team Nonclinical time for team meetings and activities Information Technology support Specific products/tools arteria cerebral media generic exforge 80 mg overnight delivery. Instructions: Review document to identify if a barrier exists and if resolution is available. Instructions: Follow steps to identify antibiotic targets and plan and implement interventions. A Specific Questions Regarding Antibiotic Scenarios (examples included but not limited to) 1. Formulary changes, restrictions, and preauthorization of implicated antimicrobials 2. Flow and algorithms for empiric and streamlined regimens for specific diagnoses/pathogens 4. Instructions: Use this chart when considering sources of antibiotic data, including strengths and weaknesses. Includes descriptions, strengths, consideration, types of stewardship interventions for which metrics have monitoring potential, and resources/references. Courses cannot patterns have more than a 48-hour window between any two consecutive administrations. Considerations Does not take into account dose or frequency Does not take into account route of administration Monitoring Potential Antibiotic restriction Computer triggers Clinical prompts. Purpose: A poster showing the process of describing if choice of control group affects the association of antibiotics with Clostridium difficile-associated diarrhea. Ostrowsky, Montefiore Medical Center, for 2011 Society for Healthcare Epidemiology of America annual meeting. Intervention Type Formulary changes, restrictions, and preauthorization 1,2 Advantages Effective in decreasing targeted antibiotics Can influence choice of antibiotics before patients receive therapy Has education built into process of discussing therapy choice Audit and feedback to providers, including strategies for de-escalating and streamlining antibiotics Has been shown to improve antimicrobial use and outcomes Can be adapted to many hospital environments (including small facilities or facilities with limited resources) Can be done a few times per week Facilitates a team approach to patient care Allows intervention in cases of inadequate therapy Allows flexibility of therapy based on patient response and clinical status Disadvantages Less evidence as a means of reducing long-term antimicrobial use or outcomes, such as resistance May shift prescribing to alternative agents. Categories adapted from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program To Enhance Antimicrobial Stewardship. Instructions: Use when considering ways to monitor processes and outcomes related to targeted interventions. Traditional methods such as intravenous to oral switch programs and dose optimization may be used by a well-rounded antimicrobial stewardship team, but on their own will likely not be effective interventions directed at decreasing C. Categories adapted from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Antibiotic policy change catalyzed by patient experience; very new official policy, but education started September 2011. Had intended to target piperacillin/tazobactam, including de-escalation; more opportunities with ciprofloxacin. Ciprofloxacin policy verbalized in SeptemberNovember 2011 and officially implemented in December 2011. Overall limited resources (pharmacist part time); activities sporadic some months. Piperacillin/tazobactam restriction (mainly by infectious disease fellows) saved money; push toward cefepime/ceftriaxone; main outcome number of courses. Overall staffing problems (PharmD for both hospital sites, used pharmacy residents). Azithromycin first restricted, then unrestricted to move patients away from moxifloxacin; formal medication utilization review for fluoroquinolones (ciprofloxacin and moxifloxacin). Followup medication utilization review showed increase in azithromycin and decrease in moxifloxacin (by 25%) at both campuses. Piperacillin/tazobactam audit mainly on medicine services (teaching and nonteaching services). Education in conjunction with interventions (series of educational programs to different clinical services showing C. Instructions: Could be used as template for development of similar tool to be used at health care facilities. Instructions: Complete checklist, review responses to ascertain the level of leadership support, and consider which areas need strengthening to move forward. If Yes, describe: yes no If Yes, describe: yes no If Yes, describe: If No, what is the plan to obtain? Do we have a description of how improved patient outcomes bring about cost savings? Urine culture and susceptibility (C & S) tests are strongly recommended for any therapy changes. Follow up on all discharged patients to provide appropriate therapy based on culture and sensitivity results. Reserve fluoroquinolones for pyelonephritis and major systemic infections due to resistance development. At least once a year, susceptibility patterns will be reassessed and the need to change treatment recommendations evaluated. Avoiding treatment of asymptomatic bacteriuria is important for reducing the development of antibiotic resistance. Treatment of asymptomatic bacteriuria is not appropriate for: women (premenopausal, nonpregnant), diabetics, elderly people, nursing home residents, or patients with spinal cord injury or indwelling urethral catheters. Treatment of asymptomatic bacteriuria is appropriate for pregnant women and for patients undergoing urologic procedures in which mucosal bleeding is expected. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women. A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. The tracking forms give a way to track number of patients with criteria for review and then a way to document stewardship interventions. Instructions: this 2-page form may be tailored for possible use at your facility; review and adapt as appropriate. Instructions: this template may be tailored for possible use at your facility; review and adapt as appropriate. The total numbers of patients on oral azithromycin, ciprofloxacin, moxifloxacin, and various other antibiotic combinations. Analyses were conducted to determine the usage and mean duration of oral azithromycin before and after unrestriction. Comparison of Oral Azithromycin and Quinolone Usage at Campus, Before Unrestriction Campus No. Comparison of Oral Azithromycin and Quinolone Usage at Campus, After Unrestriction Campus Weiler No. The antibiotic stewardship program will continue to monitor oral azithromycin usage via pharmacist/house staff education on duration of therapy and prevent double atypical coverage for asthma, chronic obstructive pulmonary disease, or communityacquired pneumonia. Ethical Approaches to Gathering Information from Children and Adolescents in International Settings: Guidelines and Resources. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.