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Page 167 of 385 Medicine Cardiovascular Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to antibacterial eye drops order nitrofurantoin 50mg fast delivery formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint infection app order generic nitrofurantoin canada. Ejection - Initial strong antibiotics for sinus infection generic nitrofurantoin 50 mg amex, shorter, rapid ejection followed by longer phase of reduced ejection i. Abnormal lipid metabolism or excessive intake or saturated fats and cholesterol b. Defined as a brief discomfort, has predictable characteristics and is relieved promptly - no change in this pattern b. Typical - sudden onset of discomfort, usually of brief duration, lasting three to five minutes, maybe 5 to 15 minutes; never 30 minutes to 2 hours b. Defined as impaired diastolic filling of the heart caused by increased intrapericardiac pressure B. Resuscitation - to provide efforts to return spontaneous pulse and breathing to the patient in full cardiac arrest b. Communications and transfer of data to the physician Termination of resuscitation efforts 1. Patient has a cardiac rhythm of asystole or agonal rhythm at the time the decision to terminate is made and this rhythm persists until the arrest is actually terminated g. Victims of blunt trauma in arrest whose presenting rhythm is asystole, or who develop asystole while on scene Page 194 of 385 2. Ventricular - Blood from left ventricle passes into right ventricle Patent Ductus Arteriosus 1. Malformations lead to altered cardiac function and hemodynamics Specific Diseases 1. Adjunctive prehospital therapy Integration Apply pathophysiological principles to the assessment of a patient with cardiovascular disease Formulation of field impression; decisions based on: 1. Introduction-Pathophysiology, incidence, toxic agents, risk factors, methods of transmission, complications B. Management for a patient with exposure to/use of Barbiturates/sedatives/ hypnotics a. Patient education and prevention of toxicological emergencies and drug and alcohol abuse Page 208 of 385 Medicine Respiratory Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Non-pharmacological - Continuous positive airway pressure Monitoring and devices used in pulmonary care 5. Specific illness/injuries: causes, assessment findings and management for each condition A. Bronchopulmonary dysplasia Communication and documentation for patients with a respiratory condition or emergency V. Transport decisions Patient education and prevention of complications or future respiratory emergencies. Page 215 of 385 Medicine Hematology Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Definitions, Pathophysiology, epidemiology, mortality and morbidity, and complications B. Page 218 of 385 Medicine Genitourinary/Renal Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Uremic frost Management for a patient with acute renal condition, chronic renal conditions with acute exacerbations or dialysis problems, or end stage renal disease. Transport decisions Patient education and prevention Page 224 of 385 Medicine Gynecology Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Transport decisions Page 227 of 385 Medicine Non-Traumatic Musculoskeletal Disorders Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Articulating surfaces-joints, bursa, disc, etc General assessment findings and symptoms A. Prehospital Management Soft tissue infections (Fascitis, Gangrene, Paronychia, Flexor tenosynovitis of the hand) Consider age-related variations in pediatric and geriatric patients A. Page 229 of 385 Medicine Diseases of the Eyes, Ears, Nose, and Throat Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Mouth, oral cavity, oropharynx, larynx General assessment findings and symptoms A. Specific assessment findings and symptoms Specific management considerations Conditions 1. Generally speaking, the heart pumps blood out of the left ventricle, around the circulatory system and back to the right side of the heart. The negative intrathoracic pressure created by normal ventilation assists venous return. With every breath, muscle contractions in the chest and diaphragm reduce the pressure within the lungs and chest cavity. That same low pressure created within the chest during inspiration sucks blood into the cavity and right atrium. Heart is squeezed through direct compression between the sternum and the spinal column. Harder and faster compressions increase the pressure to a greater degree Negative Intrathoracic Pressure 1. Since patients in cardiac arrest are not breathing, they do not produce negative inspiratory pressure to assist the circulatory system. When a greater amount of negative pressure can be achieved in the chest, a greater amount of blood will be returned to the heart b. Postresuscitation support - Refer to the current American Heart Association guidelines A. Page 242 of 385 Trauma Trauma Overview Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage. When practical, log roll the supine patient on their side to allow for an appropriate assessment of the posterior body. Location of normal bronchovesicular and bronchial breath sounds in the chest and the meaning of abnomal locations. Fluid choice a) Types of fluid (Refer to American College of Surgeons guidelines) i) Advantages ii) Disadvantages Role of hydrostatic pressure iii) iv) Role of colloid oncotic pressure b) Blood substitute products c) Blood administration in the field c. Products and characteristics of blood Blood clotting Arterial bleeding Venous bleeding Location of bleeding a. Some low velocity wounds self-seal not allow atmospheric air into the chest but air from inspiration into the chest can occur in the same patient.
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The patient in the vignette would fall into this "intermediate" risk category antibiotic mouthwash over the counter 50 mg nitrofurantoin mastercard, but she is already showing clinical improvement over the short timeframe since her injury occurred antibiotics while breastfeeding order nitrofurantoin visa. Immediate admission to antibiotics gram negative purchase nitrofurantoin 50mg with amex the hospital for a 24-hour period is unnecessary at this time. While there is no definite consensus regarding the optimal observation period for children following minor closed head injury, some experts have recommended an observation period of 4 to 6 hours. For the patient in the vignette, hospitalization for a prolonged period of clinical observation is not likely to be needed if her symptoms continue to improve and therefore is not the best next step in her management at this time. As the patient is displaying no focal neurologic deficits, is only at intermediate risk for a clinically significant traumatic brain injury, and is already displaying clinical improvement, neurosurgical consultation is not warranted at this time. Identification of children at very low risk of clinically important brain injuries after head trauma: a prospective cohort study. Effect on the duration of emergency department observation on computed tomography use in children with minor blunt head trauma. His mother informs you that 9 days ago he was in contact with a child who has now been diagnosed with varicella. Passive immunoprophylaxis after exposure to varicella is indicated in individuals likely to develop infection if exposed and likely to have complications if they develop infection. Severe disease can occur in immunocompromised hosts and complications can include bacterial superinfection, pneumonitis, hepatitis, and encephalitis. The clinical manifestations and epidemiology of varicella have been altered with routine vaccination. In unvaccinated individuals, varicella manifests as a generalized vesicular rash with at least 250 lesions in various stages of development (Item C18). Vaccinated individuals who experience breakthrough disease have far fewer lesions (median of less than 50) that can be maculopapular instead of vesicular. After primary infection, varicella-zoster virus remains latent in sensory ganglia. Herpes zoster is typically a vesicular rash distributed over 1 to 3 dermatomes and can be associated with local pain or neuralgia. In immunocompromised patients, however, herpes zoster can become a disseminated infection, with lesions in multiple dermatomes and organ involvement. Candidates for immunoprophylaxis include immunocompromised patients, certain neonates, and pregnant women. Immunocompromised patients include individuals with a congenital or acquired T-lymphocyte immunodeficiency, neoplasms affecting the bone marrow or lymphatic system, those who have received a hematopoietic stem cell transplant, and those receiving immunosuppressive therapy including prednisone at a dose of 2 mg/kg per day or more for 14 days. Prior to 2012, immune globulin was administered only up to 96 hours after the exposure. Given the revision in the allowable time frame for administration, the patient in the vignette who was exposed 9 days ago would still be a candidate for varicella-zoster immune globulin. Based on expert opinion, intravenous immune globulin can be used for candidates as passive immunoprophylaxis if the varicella-specific formulation cannot be obtained. Acyclovir can also be used for postexposure prophylaxis, starting at 7 days after exposure, when passive immunoprophylaxis is not available. Of note, acyclovir may modify disease in healthy children, though data are lacking regarding its efficacy in immunocompromised children. While ganciclovir is effective against varicella-zoster virus, it is typically used for disease due to cytomegalovirus. Additionally, ganciclovir has poor oral bioavailability and therefore is not used as an oral agent for prophylaxis. When an individual lacking immunity is exposed to a person with varicella but does not meet criteria for receipt of immunoglobulin, varicella vaccine can be used for postexposure prophylaxis if the individual is 12 months of age or older and the vaccine is not contraindicated. The treatment of constipation involves the use of behavioral, dietary, and medical therapies. Medical therapy may include various medications, each with a different mechanism of action (Item C19A ). Prebiotics, sugars that help to support an active and healthy gut microbiome, are not currently the standard of care for the treatment of constipation. Appropriate management should address dietary changes, behavioral modification, medical management, and parental education. Dietary recommendations include maximizing fiber, increasing the consumption of poorly absorbed carbohydrates (prune and pear juice), and ensuring appropriate fluid intake for age. Many children have significant behavioral issues surrounding toileting, including withholding. Toilet sitting after meals maximizes the benefit of the gastrocolic reflex, and is achievable for most families. If needed, medical management can be added by selecting the appropriate medication from Table C19A, based on the severity of the constipation. Functional constipation in childhood: current pharmacotherapy and future perspectives. Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Her parents express concern that the girl toe walks on the left side and has an unusual gait. The girl was delivered at term and has appropriately met all developmental milestones. She has been well, other than experiencing several "colds" over the past few months. She has limited abduction and internal rotation of the left hip, and her left leg appears to be shorter than the right. Hip radiographs should be obtained for the child in this vignette to evaluate hip joint morphology. Children with mild dysplasia may have subtle radiographic findings, such as flattening of the acetabulum and clinically normal hips. Affected hips are typically unstable on physical examination in the newborn period. In rare cases, physical examination and ultrasound are normal in young infants, and dysplasia is identified later. On physical examination, children with a dislocated hip have a positive Galeazzi sign; with the knee and hip flexed, the thigh will appear shorter on the affected side because of the superior position of the femoral head. For both maneuvers, the hip and knee are flexed to 90 degrees, with the hip adducted. In the case of a dislocatable hip, the Barlow maneuver, which applies posterior pressure to the knee while maintaining hip adduction, will cause the examiner to feel a "clunk" as the hip shifts posteriorly. The test result is positive when the examiner can feel a dislocated hip clunk back into place.
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Children with neutropenia are at markedly increased risk for invasive bacterial infections and the presence of a central venous device further increases that risk home antibiotics for dogs nitrofurantoin 50 mg with mastercard. The occurrence of even a single fever event in a child with neutropenia is a medical emergency and that child should be considered to antibiotics for forehead acne cheap nitrofurantoin master card have bacteremia until proven otherwise infection 2 levels purchase generic nitrofurantoin. Immunocompromised patients with neutropenia may be unable to mount a normal immune response to severe infections and may not exhibit the expected physical examination findings. They should rapidly have their central venous device accessed, have blood cultures sent, and receive a broadspectrum parenteral antibiotic through their central venous device. Initial antibiotic coverage should include common gram-positive and gram-negative organisms, including Pseudomonas. Cefepime is a fourth-generation cephalosporin that would provide appropriate antibacterial coverage for children with febrile neutropenia. The boy in the vignette presented with the history of a single fever at home, and a leukocyte count of 560/L (0. His absolute neutrophil count is less than 200/L and therefore he has very severe neutropenia. Despite his well appearance, the boy may have bacteremia and should be treated accordingly. Although ceftriaxone, a third-generation cephalosporin, provides some coverage for gram-positive organisms and good coverage for gram-negative organisms, it does not provide coverage for Pseudomonas infections. Ceftriaxone would be a reasonable choice for a non-neutropenic, well-appearing patient with fever and a central venous device, but would not provide adequate coverage for a patient with febrile neutropenia. Oral amoxicillin/clavulanate would not provide any antibiotic application to the interior of a central venous device and would therefore not be appropriate therapy in this case. Reassurance would not be appropriate for a child with neutropenic fever, even for a single documented fever at home. Neither of these children requires endocarditis prophylaxis for dental procedures because neither child has cyanotic congenital heart disease or undergone any cardiac procedures involving a device or prosthetic material. Patients may also present acutely ill with high fever, new findings of cardiac valve regurgitation, and congestive heart failure. Blood cultures (2 obtained separately) are crucial in determining the causative organism. Echocardiography is used to evaluate the valves for lesions, such as vegetations or abscesses, in patients with bacteremia. The modified Duke criteria (C238B, C238C ) can be used to help identify patients with endocarditis. Infective endocarditis in childhood: 2015 update a scientific statement from the American Heart Association. Prevention of infective endocarditis: guidelines from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. On examination, you note erythema along the inferior fornix of the eyes bilaterally. Symptoms can last for up to 2 weeks, typically worsening in the first 4 to 7 days. It is best treated with cool compresses and artificial tears, which helps relieve the discomfort. Antibacterial and corticosteroid eye drops are ineffective and contraindicated in viral conjunctivitis. Viral conjunctivitis caused by adenovirus is highly contagious and may be associated with a viral prodrome and other symptoms of an upper respiratory tract infection. While it is contagious, symptoms are also self-limiting and exclusion from school or daycare is not indicated. Hyperacute bacterial conjunctivitis caused by Neisseria gonorrhoeae or Neisseria meningitidis is characterized by rapid onset with copious purulent drainage, eyelid edema, pseudomembrane formation, and preauricular adenopathy. It should be treated promptly with intravenous antibiotics and typically requires hospitalization and consultation with an ophthalmologist. Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis, and other bacteria can also cause conjunctivitis, but infections with these bacteria are often self-limited or easily treated with topical antibacterial drops. Allergic conjunctivitis also takes several forms: it can be an acute reaction to an environmental allergen (eg, cat dander) or be more subtle (eg, as in seasonal allergies), depending on the trigger. Compared to viral conjunctivitis, pruritus is a more prevalent symptom in allergic conjunctivitis. Topical or systemic antihistamines are first-line therapies and are effective in reducing symptoms in most patients. Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis. She reports she has been in a sexual relationship with a 17-year-old adolescent boy for a month, but after an argument last night, he informed her that he has hepatitis B. She admits they frequently had sex without condoms and smoked marijuana and tobacco often, but she denies any intravenous drug use and has never witnessed him using any intravenous drugs. She reports that during the month they were together, he appeared healthy with no obvious signs of illness. She met him at a club and does not know much more about him other than his name and phone number. Her sclera are clear, mucosa are moist and pink, lungs are clear to auscultation, and her abdomen is nontender with no hepatomegaly. Checking her chart, you see that she completed an appropriate primary hepatitis B vaccination series as an infant, and has no significant medical conditions or past medical history. Around 30 million new infections occur annually, and 5% to 10% of infected individuals will not develop protective antibodies and progress from acute to chronic hepatitis B. Ninety percent of infants infected at birth and 25% to 50% of children younger than 5 years of age when they become infected will develop chronic hepatitis B. This results in almost a quarter billion people worldwide living with chronic hepatitis B. Since universal hepatitis B vaccination began in the United States in 1991, the incidence of hepatitis B has fallen dramatically in children and young adults, and is almost 1,000 times lower now than it was in the 1980s. In countries in Africa, Asia, the Caribbean, most of Eastern Europe, and parts of South America where hepatitis B is endemic, perinatal transmission is primarily responsible for pediatric infections. In the United States and other nonendemic countries, most pediatric cases occur in patients belonging to or exposed to high-risk groups. Item C240lists the pediatric patients who should be screened for hepatitis B because of increased exposure and risk of acquiring infection. Hepatitis B surface antigen indicates the presence of hepatitis B virus because surface antigens are part of the outer envelope of the virus. If all 3 tests are negative, the patient does not have hepatitis B, but is also not immune and should be vaccinated with a 3-dose series, even if previously vaccinated. Nonimmune individuals should begin an age-appropriate hepatitis B vaccination series as soon as possible after exposure to hepatitis B. For newborns, vaccination should start within 12 hours of birth and within 24 hours of exposure for all others. If hepatitis B infection develops despite immunoprophylaxis, treatment is basically supportive.
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Reactive arthritis is more common in adolescents and adults than in younger children and has a 3:1 male to bacteria for septic tanks 50mg nitrofurantoin fast delivery female predominance antibiotics running out cheap nitrofurantoin 50mg visa. It is typically a mono- or oligoarthritis and is often accompanied by other signs of inflammation including enthesitis the infection 0 origins movie generic 50 mg nitrofurantoin overnight delivery, dactylitis, uveitis, conjunctivitis, urethritis, or rash. Synovial fluid is typically sterile with signs of inflammation including elevated leukocyte counts. Reactive arthritis is best treated with nonsteroidal anti-inflammatory medications, with the addition of intra-articular or systemic corticosteroids only in refractory cases. Intra-articular and systemic antibiotics are not indicated, though if a preceding or concurrent infection is identified, appropriate antibiotic treatment may be warranted. Reactive arthritis must be distinguished from other causes of arthritis in children, including juvenile idiopathic arthritis, septic arthritis, lyme arthritis, systemic lupus erythematosus, and toxic synovitis. If the diagnosis of septic arthritis is a serious consideration, synovial fluid analysis must be performed, because a delay in treatment can lead to joint damage. Ultrasonography, radiography, or magnetic resonance imaging can also aid in diagnosis. She was born at term to a primigravida mother via normal spontaneous vaginal delivery. There is no history of diaphoresis, apnea, cyanosis, or loss of consciousness; however, the infant appears dyspneic during feedings and takes 25 to 30 minutes to drink a 4-ounce bottle of formula. There have been no sick contacts and she has had no upper respiratory symptoms or fever. She is alert and in no acute distress, with mild agitation and crying during your examination. You note inspiratory stridor associated with suprasternal and substernal retractions. Her cardiac examination reveals mild tachycardia but no murmur with a heart rate of 160 beats/min. The abdomen is soft and nontender, with a liver edge palpable at the right costal margin. Laryngomalacia is a medial prolapse of the epiglottis, aryepiglottic folds, or arytenoid cartilages, which obstructs the airway, thereby creating airway noise and variable degrees of respiratory compromise (Item C69 ). Risk factors include hypotonia, redundant laryngeal tissue, and inadequate cartilaginous support. Symptoms of laryngomalacia are usually noted within the first 1 to 4 weeks after birth. Symptoms may progress until approximately 6 months of age, with most cases then resolving spontaneously by age 12 to 18 months. Severely affected infants may experience difficulty in feeding, failure to gain weight, cyanotic episodes, and/or obstructive sleep apnea. The diagnosis of laryngomalacia may be made clinically and confirmed with direct flexible fiberoptic laryngoscopy. In severe cases with significant obstruction or growth failure, surgical management with supraglottoplasty or tracheostomy may be considered to restore airway patency. Tracheomalacia often affects the distal one-third of the trachea, but full-segment malacia may also occur. Episodes of airway obstruction are more likely to occur during periods of increased airflow (crying, eating, coughing). In infants, the normally poorly supportive tracheal cartilage may contribute to collapse of the tracheal wall and narrowing of the tracheal lumen. Acquired narrowing and/or collapsibility of the trachea may also result from infection, mass effect, innominate artery compression, vascular ring formation, chronic pulmonary aspiration, or as sequelae to a tracheoesophageal fistula. Croup is typically preceded by a viral prodrome, and is often attributable to parainfluenza, though multiple other viral illnesses may be causative. Presenting symptoms include hoarseness, stridor, a barking "seal-like" cough, and low-grade fever. Anterior/posterior radiographs of the airway reveal a narrowing at the subglottis ("steeple sign"). Children with laryngomalacia or tracheomalacia may present with recurrent "croup," and the diagnosis of an airway anomaly may be overlooked. Although vascular rings can present with symptoms similar to those seen in the infant described in the vignette, laryngomalacia is a more common cause on congenital stridor. It is important to consider these diagnoses in patients with recurrent symptomatology. Risk factors for short- and long-term morbidity in children with esophageal atresia. Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach. Laryngomalacia: factors that influence disease severity and outcomes of management. The physical examination is normal, with the exception of a round patch of nearly complete hair loss on the parietal scalp. In the absence of scale, evidence of inflammation (erythema or pustule formation), or "black-dot" hairs (the remnants of broken hairs within follicles), tinea capitis is unlikely and antifungal therapy is not indicated (Item C70A). Some patients develop folliculitis (Item C70B) that occasionally is treated with a topical or oral antibiotic. Cognitive behavioral therapy may be used for those who have hair-pulling disorder (trichotillomania), characterized by a patch of incomplete alopecia within which hairs of differing lengths may be seen (Item C70C). Item C70A: Tinea capitis: patches of hair loss within which one may see scale, "black-dot" hairs (yellow arrows), or pustules (red arrows). Courtesy of D Krowchuk Item C70C: Trichotillomania: an area of incomplete hair loss is seen within which hairs of differing lengths are present. Genetic susceptibility (approximately 15% of patients have an affected first-degree relative) and environmental insults (physical or emotional stress, hormones, infection) contribute to the disease process. Associated autoimmune diseases, particularly thyroiditis, occur rarely in affected children. The typical presentation of alopecia areata is the sudden appearance of one or a few round or oval well-defined patches of hair loss; the scalp is normal. At the periphery of patches of alopecia, one may observe short hairs that are broader distally than proximally (exclamationpoint hairs). Some patients develop numerous areas of hair loss or a circumferential loss of hair involving the temporal, parietal, and occipital scalp (the ophiasis pattern). In a minority of patients (approximately 10%), the disease progresses to loss of all or nearly all scalp (alopecia totalis) or body (alopecia universalis) hair (Item C70D). For those with a few small patches of hair loss, most will regrow hair within 1 year. The prognosis is more guarded for those who have extensive hair loss, the ophiasis pattern, a coexisting autoimmune disorder, or a family history of alopecia areata.
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Initially oral antibiotics for acne while pregnant cheap nitrofurantoin american express, participants have difficulty with this task virus writing class discount 50mg nitrofurantoin with visa, responding slowly and inaccurately when the central and peripheral cues conflict antibiotics for acne while nursing buy 50 mg nitrofurantoin mastercard. As a result, experts demonstrate reduced interference in both latencies and errors. Neuroimaging studies have even documented the shifting patterns of brain activity that correspond to the development of automatic task performance (Bush et al. During initial performance on interference tasks, participants recruit brain regions related to conflict detection and response control. With extensive practice, however, activation in these regions decreases, presumably because an automatic task requires less executive supervision. For example, when participants are continuously challenged by variable task requirements or increasing demands, prac- tice can lead to more extensive recruitment of prefrontal brain regions (Olesen, Westerberg, & Klingberg, 2004; Weissman, Woldorff, Hazlett, & Mangun, 2002). In some cases, then, training leads participants to work harder, in cognitive terms, as they learn to marshal the attention and control necessary for optimal performance. When will training promote automaticity in a judgment task, and when will it promote control? A probable moderator is task com- plexity (Birnboim, 2003; Green & Bavelier, 2003). As Birnboim (2003) wrote, "automatic processing relies on a reduction of stimulus information to its perceptual and motor features" (p. When complexity renders this kind of reduction impossible, controlled processing may be required to "extract more meaningful information" (p. Consistent with this argument, Green and Bavelier (2003) have shown that practice on a visually complex video game (i. Task complexity has tremendous relevance for the officer en- gaged in a potentially hostile encounter. On a reduced scale, our paradigm attempts to simulate this visual and cognitive chal- lenge. To respond correctly, participants must engage in a careful, controlled search for a small cue amid a complex stimulus array. In our task-as in a police encounter- even highly trained experts may need to fully engage executive control processes to identify the object and execute the appropriate response (Weissman et al. This training-based reduction in bias, which we might call a "police as experts" pattern, serves as our primary hypothesis (H1). The necessity of a slow, effortful, and controlled search for the object leaves open the possibility that even experts will inadvertently process racial information. Research suggests that racial cues are often perceived quickly, whether or not the participant intends to do so (Cunningham et al. By activating stereotypes, these cues may interfere with the speed of the decision-making process. To examine this possibility, the present research extends past work in two critical ways. Latency-the time necessary for a participant to respond correctly to a given target-should depend on the difficulty of processing the stimulus. The fact that stereotype-incongruent targets (unarmed Black targets and armed White targets) generally produce longer latencies suggests that participants have greater difficulty arriving at a correct decision for these stimuli. Community samples provide a crucial baseline against which we can compare the police. As we have already discussed, one of the most damaging consequences of officer-involved shootings in which a minority suspect is killed is the implication that police inappropriately use race when making the decision to fire. However, given the prevalence of bias in the decision to shoot (which has been documented in all types of people, from White college students to Black community members), how can we interpret the magnitude of any bias we might observe among the police? Inhabitants of the community served by a given police department provide a critical comparison. As members of a common culture, these individuals experience many of the same influences, whether very global. To fully characterize the presence of any bias among police, it is therefore critical to examine bias in the communities they serve. Although we have elaborated the hypothesis that police will demonstrate less bias than the community, particularly with respect to their error rates (H1), we note that the comparison between police and community presents two other possibilities. Of course, it is also possible that officers will show more pronounced bias than community members (H2) or that police and civilians will show relatively similar patterns of bias (H0). In line with the former hypothesis, Teahan (1975a, 1975b) presented evidence that police departments acculturate White officers into more prejudicial views during their first years on the job. Given these findings, we might reasonably expect a "police as profilers" pattern, with officers relying heavily on racial information when making their decisions to shoot. Finally, police officers and community members may show equivalent levels of racial bias in decisions to shoot. Inasmuch as police and community members are subject to the same general cognitive heuristics (Hamilton & Trolier, 1986) and sociocultural influences (Devine & Elliot, 1995), the two groups may demon- strate similar patterns of behavior in the video game simulation. Because of this difference in processing, we predict a divergence between measures of bias that are based on errors and measures that are based on reaction times. By contrast, H2 and H0 offer no clear reason to predict differences between officers and civilians in terms of cognitive processing, and (accordingly) they offer no reason to expect a divergence between error-rate and reaction-time measures. Three samples of participants completed a 100-trial video game simulation in which armed and unarmed White and Black men appeared in a variety of background images. Partici- pants were instructed that any armed target posed an imminent threat and should be shot as quickly as possible. The speed and accuracy with which these decisions were made served as our primary dependent variables, and performance was compared across three samples: officers from the Denver Police Department, civilians drawn from the communities those officers served, and a group of officers from across the country attending a 2-day police training seminar. For the purposes of law enforcement, the city of Denver is divided into six districts. With the help of the command staff, officers were recruited for this study from four of these districts during roll call. Participation was completely voluntary, and officers were assured that there would be no way to identify individual performance on the task and that the command staff would not be informed of who did and did not participate. Our goal was to recruit primarily patrol officers, and, in this effort, we were successful: 84% of the sample listed patrol as their job category. Investigative officers accounted for 9% of the sample, administrative officers for 2% of the sample, with the remaining 5% of the officers from a mixture of other job categories. A total of 124 officers participated in the study (9 female, 114 male, 1 missing gender; 85 White, 16 Black, 19 Latina/o, 3 other, 1 missing ethnicity; mean age 37. For these areas, a bilingual research assistant recruited and instructed the participants. Eight participants were dropped from the analyses: 2 because of a computer malfunction and 6 because they had fewer than five correct trials for at least one of the four cells of the simulation design. Thus, the reported results for this sample are based on 127 civilians (51 female, 73 male, 3 missing gender; 39 White, 16 Black, 63 Latina/o, 9 other; mean age 35. To collect the national police sample, we attended a training seminar for officers. This was one of several seminars that officers voluntarily attend to obtain additional training in some particular area of law enforcement.
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You must learn to bacteria mod 164 buy nitrofurantoin 50 mg on line put the respondent at ease and to antibiotic journal articles best 50 mg nitrofurantoin establish the legitimacy of your call antibiotics for sinus infection during pregnancy generic nitrofurantoin 50 mg online. If a respondent has a disability, you must determine its severity and if it will prevent the respondent from completing in the interview. If the respondent has a person who can act as a proxy, you will need to secure their agreement to participate with the study respondent. Code the result appropriately and provide notes so that your supervisor can evaluate the case. Some of your calls will be with persons who have difficulty understanding your questions. Read questions slowly and distinctly and allow the respondent adequate time to answer. Repeat questions, if necessary, but be careful not to insult the respondent by suggesting that he/she does not understand. Some respondents will welcome the opportunity to talk to a neutral person about their health and family problems. You must know when to allow a respondent time to elaborate and when to re-focus him/her on the question. Some respondents will give answers that they believe you and/or the government expect; and they may expect you to help them with answers rather than give their own opinions or information. Some respondents may hesitate or decline to answer questions they consider intrusive or sensitive. Your professional handling of a sensitive issue can help to alleviate their fears. The more secure you feel about the confidentiality of the study, the more apt you will be to give a sense of security to the study respondent. However, if all else fails, you may simply offer them the option to decline answering a specific question. Encourage both family members and respondent to raise questions or concerns about the study. Encouraging them to ask questions, and your thorough and thoughtful responses to those questions, will help to alleviate their concerns. The interviewer should confirm the appointment with the respondent to avoid confusion Find an area where both you and the respondent can talk and write comfortably with minimal distractions. Make sure that the respondent understands the questions and that you are interpreting the responses accurately. Do this by restating what you think the respondent is telling you or asking him/her to restate the question you are asking. When the respondent strays from a question, try to use what he/she is saying to redirect the conversation back to the interview questions. If necessary, set time limits at the outset of the interview to encourage the respondent to stay on track. If necessary, read the interview questions to respondents who have visual impairments or limited reading ability. Communicate with other interviewers and the project director to share ideas about how to deal with difficult situations and to agree on consistent the following procedures are recommended for a successful interview: 2. If persons other than the respondent are present during the visit, address the respondent directly and do not encourage conversation with other parties. If necessary, ask that you and the respondent be left alone for a brief time to complete the questionnaire. Let the respondent know that you are willing to continue the interview after the interruptions are completed. Suggest that s/he call the number on the brochure for information and verification. Also point out that local health officials are aware of the survey, and offer to mail to the respondent a reproduction of newspaper clippings and/or endorsements. National Institutes of Health and local area health professionals to better understand the factors associated with heart and blood vessel diseases. We are doing an important research study and all the tests will be done free of charge. If applicable, remind that respondent that he/she was sent a letter about this selection process. Also explain that all information is held in strict confidence and that public reporting of the findings of this study will contain only statistical information. Explain that we will send a taxi to take him/her to and from the clinic appointment(s). Explain that we also have weekend appointments for people who cannot come to the clinic during the week. Due to the inconsistent availability of Field Center scanners (and the widespread ease of using the internet), it was decided that the web would be utilized as the primary means for Events Review. Because reviewers may need to resolve disagreements even after they enter their individual reviews online, the reviewers should not discard the paper review packet for any investigation until notified by the Coordinating Center, which will send out a periodic list of closed reviews whose packets may be discarded. After logging in, Reviewers will get a list of investigations that they have "open" (i. Only the physician reviewing any specific investigation will have access to its corresponding review forms. The list will contain the investigations assigned to that Physician Reviewer, categorized by type of review (ex/Local vs. This list of investigations will remain posted until the Coordinating Center sends the next set of cases to be reviewed. Even, un-bolded investigations, may be revised and resubmitted, which will replace the earlier submission with the most recent one. Scroll down to see multiple comments; if the investigation review in question also required a Mortality Review Form, then Review Comments may appear from that form as well. If a reviewer has information about a pre-baseline event, it should be conveyed to the Coordinating Center through a note in the "Comment" field, clearly distinguishing between pre-baseline and post-baseline dates. For death cases, the Mortality Review Form will be available after the morbid form has been submitted. The question by question instructions for each review form are separate from this document. If the investigation in question has already been reviewed by the other committee (Cardiac or Stroke Committee), the results of that prior review will appear on the Summary Report included in the review packet. For mortality reviews, only the committee associated with the cause of death should complete the mortality form for combination cardiac/cerebro cases. If the reviewer choose his/her own committee, then the Mortality Form will appear automatically after clicking on the submit button in the morbid form. But if the reviewer chooses the other committee, then he/she will not need to fill out the Mortality Review Form (instead, a message will automatically be sent to the Coordinating Center so that the Mortality Review is assigned to the appropriate committee).
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Perhaps the most common adverse effect of antibiotics is the gastrointestinal symptoms they produce tick treatment for dogs frontline order nitrofurantoin with american express. If these symptoms are mild and tolerable they are probably not of concern antibiotics for dogs gums buy nitrofurantoin without a prescription, but if they are severe antimicrobial phone case purchase nitrofurantoin amex, the patient should stop the antibiotic and inform his/her physician. In rare cases, antibiotics can cause a severe diarrhea known as "pseudomembranous colitis. In this situation, the antibiotic should be stopped and the physician notified immediately. Patients should not try to treat themselves with an antidiarrheal medication or hope that a severe diarrhea problem will subside. Because antibiotics alter the normal bacteria in the body as well as the diseasecausing bacteria, they can cause other side effects. A yeast infection, most commonly in the mouth or vagina, is one such complication. To minimize the risk of both diarrhea and yeast from antibiotics, doctors commonly recommend daily ingestion of Lactobacillus acidophilus, popularly known as acidophilus. This can be important because with chronic sinusitis patients may need to be on antibiotics for an extended period of time. Acidophilus can be found in two forms; yogurt with active cultures, and capsule preparations. Doctors commonly recommend eating 8 ounces of 104 yogurt with active cultures daily while on antibiotics and to continue doing so for another week or two following completion of the course of antibiotics. Some brands of yogurt do not contain active cultures, so patients need to read the container carefully. Although yogurt is the preferred source of acidophilus, acidophilus capsules are an acceptable alternative if a patient has a milk allergy or for some reason cannot eat yogurt. Patients should be sure to inform their doctor if any of the following apply: impaired kidney function, rash when previously given an antibiotic, ulcerative colitis, mononucleosis (mono), anemia, abnormal liver function, myasthenia gravis, pregnancy, breast feeding, other medications, mitral valve prolapse, or prosthetic devices. A host of information has surfaced in the medical literature about appropriate antibiotic therapy for acute bacterial rhinosinusitis and chronic rhinosinusitis. While this is still a subject of ongoing debate, following is one proposed approach to antibiotic treatment. Antibiotics are designed to kill bacterial pathogens or prevent their growth, and studies suggest that their use shortens the course of an infection and helps prevent complications. However, excessive and inappropriate use has led to the development of resistance. Pathogens are adept at mutation, transformation, conjugation, and plasmid development. The end result is that Streptococcus pneumoniae and Hemophilus influenza are no longer readily eradicated by the usual course of therapy with antibiotics. Guidelines promoted by the American Rhinologic Society and the Sinus & Allergy Health Partnership established a new methodology for dealing with this problem. Similar firstline agents are recommended in the pediatric patient population, with the exception of the fluoroquinolones, which still have no pediatric indication. This should be expected, because uncomplicated sinusitis has a high probability of spontaneous resolution and nonbacterial (viral) cause. However, the choice of antibiotic for acute bacterial exacerbations is not different from that for acute bacterial sinusitis. If there are any maxillary dental problems, suspicion of anaerobes rises in patients with chronic sinusitis, making an agent with antianaerobic activity preferable. Pseudomonas aeruginosa and Staphylococci are more commonly isolated from patients with chronic sinusitis. Therefore, ciprofloxacin for pseudomonas and/or clindamycin for Staphylococci are antimicrobials that may be useful. In choosing empiric therapy, it is important for the sinus specialist to have knowledge of the antimicrobial susceptibility pattern of the organisms most likely to be associated with communityacquired bacterial sinusitis in their geographic area. Because beta lactamase producing strains of Hemophilus influenza and Moraxella catarhallis 106 are common in most areas of the United States, ampicillin, amoxicillin, cefuroxime axetil, and loracarbef would not be firstchoice agents. It is extremely difficult to distinguish mild bacterial sinusitis from viral sinusitis (the common cold) during the first 5 days. If antimicrobial therapy is believed appropriate for this type of patient, the best initial agents are either amoxicillin or doxycycline, both of which are inexpensive. Duration of therapy is very controversial, but earlier studies have shown that bacteria persists in large amounts in the sinus after symptoms of acute bacterial sinusitis have resolved. Alternatively, azithromycin is given for only 5 days because of its long halflife in tissues. Research has shown that some antibiotics, especially macrolides and to a lesser extent quinolones, have immunomodulating action as well as antibacterial activity. This may explain why symptoms of rhinosinusitis appear to respond to antibiotics in the absence of proven bacterial cause. Obviously, patients would request the same drug if they believe it had been effective in relieving symptoms of sinusitis, 90% which are viral. Clearly, more research is needed to define what is helpful from an immunomodulating standpoint in the treatment of both acute and chronic sinusitis. This specialist will usually perform a nasal endoscopic evaluation and possibly obtain a specimen for culture and sensitivity. Good secondline agents include augmentin, azithromycin, ceftin, cefuroxime, gadifloxacin, and moxifloxacin. Antibiotic prescribing was analyzed based on patient and physician characteristics. Multiple logistic regression modeling was then used to assess the independent contribution of these factors. Adults, non whites, females, patients with a concurrent condition such as acute bronchitis, acute otitis media, acute pharyngitis, acute sinusitis, or asthma, and patients requiring additional medications for their symptoms were more likely to be given antibiotics. In addition, family physicians, physicians who were not owners of their practices, and those practicing in nonmetropolitan areas were more likely to prescribe antibiotics. They suggest that greater efforts are needed to address some of the factors that influence prescribing practices. Therapy is aimed at relieving obstruction of the nose and sinuses, particularly at the osteomeatal complex.
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What are the risks or other consequences associated with initially assuming one person antibiotics make acne better cheap nitrofurantoin 50 mg overnight delivery, not the other antibiotic 500mg purchase 50 mg nitrofurantoin with mastercard, is the perpetrator? We need to virus headache buy generic nitrofurantoin pills recognize that our first impressions could be wrong and our impressions could be impacted by our implicit biases. The domestic violence role play reminds us to recognize that what we "see" might be impacted by our implicit biases. As we have discussed, it is difficult to rid ourselves of our implicit biases that took a lifetime to develop. If you recognize the activation of an implicit bias, you can override it by implementing a "controlled," that is, an unbiased response. Officer Taylor runs the tags for warrants on all cars he passes that contain young Hispanic males and not on other vehicles. Meehan and Ponder (2002) found that police were more likely to run warrant checks on African Americans than Whites in these neighborhoods, but less likely to find warrants on the African Americans compared to the Whites. Potentialresponse: misses the drivers He with warrants who are not young, Hispanic males. Display Slide #102: Meehan and Ponder (2002) Skill #1: Recognize your implicit biases and implement "controlled (unbiased) responses. Develop his own criteria that he will use for running tags that is race/ethnicity-free. He might develop an objective criterion that he will use when he goes to a 2-car crash scene. For instance, he will first approach the person who looks most injured or, if there are no injuries, he will approach the person who seems not to be at fault. The lessons from these exercises are: (1) Recognize your implicit biases, challenge what you think you see. Recognize your implicit biases: That is, if you enter a domestic violence scene and have an immediate sense that the male is the perpetrator, be sure to challenge what you think you see. Implement controlled responses: That is, recognize your implicit bias and proceed in a bias-free manner. This skill-to recognize your biases-is related to what officers refer to as their "gut reactions. It is true that officers see things that others do not and draw conclusions that others would not have, based on their experience and training. Beware, however, that those "gut reactions" might also reflect your implicit biases. Are you picking up on behavioral cues and contextual elements that others would miss, or are you being impacted by the biases that we all have? Focus on the facts at hand and gather the additional information you need to understand the situation. Display Slide #104: Ski/11 Again Again, the first skill we have been talking about: Recognize your implicit biases and implement controlled (unbiased) responses. A key point about our discussion of biases is that this is an "affliction" of humans, certainly not just police. Above we cautioned you to recognize your own implicit biases and make sure that, when your biases are activated, you implement controlled (unbiased) behavior. Black Man in Car Discussion Consider the following call for service: Skill #2: Avoid "Profiling by Proxy" A woman, in an all-White neighborhood, calls 91-1 to report a "suspicious man in a car" out in front of her house. It appears that the only thing "suspicious" is that this man is Black; the caller is unable to articulate or identify any behaviors that indicate criminal activity. Note to Instructors: Divide the class into Identify three possible response options and list small groups of four (or so) recruits each. The instructor would move to the next group to get a different option and stop when no group has a new option. The instructor should avoid imposing his/her own preferred response on the discussion, but rather hear all of the options without judgment (unless there is an agency policy or practice that precludes a particular option). Reflect on the lesson in the previous unit, perceptions of biased policing can reduce perceived legitimacy of police, cooperation, etc. The recruits might be aware that walking up to the front door of that caller is not advisable in some neighborhoods; they might choose to call her or have the dispatcher make the call to find out if there is additional information that might indicate criminal behavior. If none, the officer could reinforce the woman for calling, but educate her as to what to look for in the future - behavior that indicates criminal activity. Another stated "con" might be that the person may, in fact, commit a crime after the officer leaves. Here the instructors can point out that police must do their jobs based on the information they have and not based on conjectures about "what if. Pro: the person the point of this discussion is not to designate one action as "the right one," but rather to have you think through such situations, analyzing your options and weighing the consequences. This includes having empathy for the person who could be the subject of your interventions. In discussions of this scenario nationwide, many officers are immediately inclined to have empathy for the woman caller. While people will react differently, some men of color will be quite angry at having to, as one chief put it, "justify their existence on the White streets of America. Con: the caller may not be fully satisfied with the action; the man in the car may perceive that a police car is driving by because he is a Black man in a White neighborhood. You have been selected and are being trained so that you can exercise critical judgment. You get the same call, but this time the description given by the woman is consistent with a description of a person in a vehicle who committed a home burglary in the area. Note to Instructors: Instructors engage the trainees in a discussion of possible responses. Reinforce the following response: "I am sorry that you feel that way, I stopped you because. Then you need to return to business, because an argument on the side of the road will likely not be fruitful. While created prior to the actual incident, this case scenario is similar to the facts of that incident. Recall that we: DisplaySlide #109: Reduce Ambiguity >>>- Prejudge people who are "ambiguous stimuli" Attribute group stereotypes, biases to them Do not always know we are doing this Skills #4 and #5: Reduce Ambiguity n #4: When feasible, "slow it down" cJ#5: Engage with community members Understanding that we are at risk for allowing stereotypes and biases to influence our behavior especially when we are in an uncertain situation-not quite knowing what to expect-produces our next two skills. Veteran officers and law enforcement trainers promote the technique of consciously slowing down a police response when it is viable to do so. Slowing down the response allows officers to analyze the legitimacy of their initial impressions and use their observational and analytical skills to effectively assess the situation and devise the appropriate response.