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Faculty Evaluations of Residents In addition to daily feedback on performance allergy testing abilene tx desloratadine 5mg with amex, faculty will provide in-person feedback to each resident at the mid-point of each monthly rotation allergy testing victoria 5 mg desloratadine visa. If faculty members do not offer face-to-face feedback, it is the right and responsibility of the resident to ask for such feedback. Any difficulties obtaining feedback should be brought to the attention of the Program Director. Faculty members are also expected to complete timely written monthly feedback in the form of the electronic Faculty Evaluation of Residents. These evaluations are available to the resident to review as soon as they are completed. Additional nursing evaluations may also be done by advanced practice nurses and other allied health professionals. Residents are evaluated by patients in the continuity clinic using the Patient Evaluation. These evaluations are reviewed by the Pediatric Chief, the Program Director and the Clerkship Director at the end of each clerkship so that group and individual feedback can be provided. Attending physicians, consultants, mentors, lecturers, and preceptors all contribute to resident evaluations. The aggregate evaluation report for January-June rotations is prepared for the Program Director by the Residency Coordinator in August and for July-December rotations in February. These evaluations are shared with the faculty member and the Chair as part of the Annual Faculty Review process. Outside of the calendar year evaluation period, the Residency Coordinator screens resident evaluations of faculty for issues warranting the immediate attention of the Program Director. Resident Evaluations of Rotations Residents evaluate each rotation at the end of the experience. Aggregate data is shared with the division director or rotation head once a year as part of the continuous curricular review process. A summary of that review is prepared and brought to a small group of faculty including the rotation director and residents in order to set goals for rotational improvement for the next improvement cycle. The Residency Coordinator screens rotation evaluations for issues warranting the immediate attention of the Program Director. Resident Evaluations of the Program Residents will evaluate conferences and educational activities. Additional information on Resident, Faculty and Program Evaluation can be found in the University of Kansas Graduate Medical Education Policy and Procedure Manual. There are a number of examples where this feedback has brought about significant and sometimes immediate changes in the structure of the Program in both educational and patient care arenas. In addition to formal evaluations, residents are encouraged to bring up any concerns about the residency at any time. Only by addressing problems in a timely manner can the high standards of the residency Program be maintained. So that residents do not feel intimidated or fear retaliation for expressing concerns about the Program, a variety of group and individual forums for addressing concerns exist in the Program. The Program Directors, Residency Coordinator and Pediatric Chief meet with all the residents on a weekly basis and additionally with each class individually once a month. Residents are welcome to bring concerns to the Program Director or Associate/Assistant Directors, Department Chair, Advisors, Residency Coordinator, Pediatric Chief, or Resident Class Representatives on Pediatric Residency Committee at any time. July-August will be a review of emergency topics (what to do on call) that is repeated yearly. Topics will be presented in a casebased format with board review questions incorporated as often as possible. Residents are expected to be active participants in their learning by asking questions and participating in topic discussions. The weekly schedule will be distributed one week in advance so that residents can read about each topic in advance of the lecture. Advisor: Associate Program Directors Format: Case-based conference focused on collaborative inter-professional experiences targeted to improve clinical teams, communication and patient safety.

Continuity Clinic permits the opportunity of delivering both acute and chronic care as well as well child supervision and anticipatory guidance allergy eye drops otc order desloratadine 5 mg on-line. Residents are encouraged to give their business cards to their patients so that the patients may identify them as their primary care provider allergy treatment for cats purchase 5mg desloratadine with visa. Continuity for patients and residents will be enhanced by the maintenance of a designated continuity clinic halfday as much as possible during a given year. Each half-day is assigned a general pediatrician who serves as the preceptor for that clinic. That preceptor will be responsible for that clinic unless it conflicts with attending time or time or out of office time. Residents will start the year with abbreviated templates and work up to 6 patients. For the second half of the year, a 7th appointment slot is added at the end of the clinic template. There is an additional 7th appointment slot added at the end of the clinic template. There is an additional 9th appointment slot added at the end of the clinic template. Occasionally a second half day per week clinic is added during rotations when this is possible in order to get clinic numbers up. Calendars are regularly distributed via email and are available in the Physician Scheduler system as well as on Google Drive. Schedules are prepared as far in advance as possible and are typically open three months ahead. For that reason, it is very important for vacation requests to be submitted as early as possible so that clinics can be closed without bumping patients. If a resident has a conflict with a clinic after patients have been scheduled they may be asked to find alternative appointments for patients that may including asking a colleague to cover the scheduled clinic or the opening of an alternate clinic for the resident with the conflict. These circumstances arise when residents do not check the clinic calendars for each and every possible conflict (post call, vacation, tests, certification classes, rotational conflicts, etc. Clinics will be moved or cancelled as needed for specific rotations, conflicting clinics, redistribution of clinics on busy days and vacations. Other cancellations needed by residents for other reasons are to be made at least two months in advance and only with the permission of the Pediatric Chief. Timely return of vacation requests will help to assure that clinics are closed when residents are on vacation. Last minute changes and cancellations of clinic after distribution of the clinics for the quarter should be avoided whenever possible. Last minute absences for circumstances such as personal or family illness should be reported as early as possible to the Residency Coordinator who will work with the Pediatric Chief and the Continuity Preceptors to arrange for coverage for the absent resident. Projections for clinic numbers are done in December and again in March so as to have time to make changes in the schedule in order to assure compliance with the expectations for continuity clinic. The preceptor is expected to be immediately available to the residents for the duration of the clinic. The preceptor will oversee clinic flow to make sure that appointment schedules are met as closely as possible. The faculty preceptor must see every patient seen by residents in their first six months of residency training. During that first six months of training, the preceptor must discuss every patient with the resident and see every patient to repeat the key elements of the history and physical. For residents past the first six months of training, the preceptor should review patient management decisions and content of anticipatory guidance provided by the resident physician prior to the patients leaving the clinic. Faculty members are responsible for completing the charge documentation on all patients but resident participation in coding and billing is strongly encouraged. Faculty will review resident charts, document their findings, attest the resident note and complete final coding and billing in a timely fashion. Resident Responsibilities: Continuity Clinic is to take precedence over all other clinical activities. Each resident is expected to arrive in clinic at the appropriate starting time and remain there as long as there are patients to be seen. Resident will huddle with their clinic nurse to discuss scheduled patients, determine plans for late patients and plan for any potential clinical issues.

A thorough knowledge of the anatomy of the central sulcus and precentral gyrus-the primary motor area allergy symptoms weather changes discount desloratadine 5 mg free shipping, is crucial to localize the lesions around this region allergy shots dallas generic desloratadine 5 mg. Central sulcus and the precentral gyrus are best identified on the axial and sagittal images. A: T2-weighted image shows a cavernoma at the junction of right superior frontal gyrus and precentral gyrus. C, D: A cystic lesion in the precentral gyrus over the lateral convexity displayed in axial and sagittal planes. Central sulcus lies posterior and parallel to the precentral sulcus and it usually does not unite with the sylvian fissure unlike the precentral sulcus. Thus, the opercular (lower) ends of the precentral gyrus and postcentral gyrus (primary sensory cortex) unite to form the subcentral gyrus (4,5). Central sulcus makes a small dip in the medial surface and is often the first sulcus anterior to marginal sulcus. The region on either side of the central sulcus on the medial side forms the paracentral lobule which carries motor and sensory representation for contralateral lower extremity. On volume acquisition images, inferior precentral gyrus may be identified by tracing the inferior frontal sulcus posteriorly. Between the parietooccipital sulcus and the calcarine fissure lie the cuneus-a wedge-shaped region in medial occipital lobe. Precuneus lie anterior to this, between the parieto-occipital sulcus and the marginal sulcus. On axial images, parieto-occipital sulcus is more readily visualized on multiple slices because of the oblique orientation of the parieto-occipital sulcus. Calcarine fissure becomes shallow as it courses posteriorly and does not quite extend to the occipital pole. The parieto-occipital sulcus is generally deeper and reaches dorsal surface, and can normally be somewhat asymmetric in depth and configuration (12). Temporal Lobe Temporal lobe epilepsy remains the most common surgically remediable medically refractory epilepsy syndrome. Broadly, temporal lobe epilepsy is categorized as mesial temporal epilepsy and lateral temporal epilepsy syndromes based on presumed anatomic origin of epileptogenicity. Temporal lobe on its outer surface is limited superiorly from the frontal lobe by sylvian fissure. The posterior limits of temporal lobe are poorly defined by an imaginary line from the preoccipital notch of the basal aspect of temporal lobe to the superior aspect of parieto-occipital sulcus. Lateral temporal region consists of three major gyri, namely the superior, middle, and inferior temporal gyri divided by the superior and inferior temporal sulci. Fusiform gyrus is limited laterally from inferior temporal gyrus by lateral occipito-temporal sulcus and separated medially from Visual Area: the Calcarine Cortex Calcarine cortex, the primary visual area is located in the inferior and superior lips of the calcarine fissure in the occipital lobes. Calcarine fissure can be readily identified on the sagittal and coronal images. Dotted lines on coronal images indicate region of visual cortex on the right side. A­C: Residual tumor with postoperative changes noted in the right precuneus region displayed in sagittal, axial, and coronal planes. Note that the lesion is anterior to the parieto-occipital sulcus and posterior to the marginal sulcus. D­F: T2 weighted image shows hyperintensity (arrows) of the cortex and subcortical white matter in the left occipital lobe; lesion is inferior to calcarine fissure in anterior images (D) but involves calcarine fissure, cuneus and lateral occipital gyrus in posterior sections (F). Temporal structures medial to the collateral sulcus are referred to as mesial temporal structures (13­17). The term hippocampal formation is often used to denote the hippocampus proper along with dentate gyrus. Hippocampus derives its name from its morphologic resemblance to "seahorse," best appreciated on sagittal images. It has three parts, namely head, body, and tail of hippocampus, from anterior to posterior. The head and body of hippocampus extend posteriorly along the inferomedial border of temporal horns of lateral ventricles. Head of hippocampus is the most voluminous part and occupies the anterior end of hippocampus.

Fenwick (47) described psychogenic seizures as epileptic seizures generated by an action of mind allergy forecast delaware discount 5mg desloratadine visa, self-induced attacks allergy treatment runny nose purchase cheap desloratadine online. This use of the term psychogenic seizures, common in European epileptology, does not refer to nonepileptic events. Fenwick related seizure induction and inhibition in some individuals with or without typical reflex seizures to the neuronal excitation and inhibition accompanying mental activity. He also referred to the alumina cream model, with recruitment of group 2 neurons and evoked change in neuronal activity surrounding the seizure focus as factors in seizure occurrence, spread, and inhibition. Wolf (48) believed that two pathophysiologic theories have arisen in the discussion of reflex epilepsies. For primary reading epilepsy he observed that seizure evocation would depend on involvement of the multiple processes used for reading, an activity involving both hemispheres, with a functional rather than a topographic anatomy. The recruitment that produces these seizures, however, need not be confined to physically contiguous brain tissue or fixed neuronal links. Instead, it may depend on activity of a function-related network of both established and plastic links between brain regions, modified by the effects of factors such as arousal. Disorders of cortical development may be present in some patients with reflex seizures. Chapter 24: Epilepsy with Reflex Seizures 307 Recent detailed studies on subjects known to have visually induced seizures examined whether color modulation could be an independent factor in human epileptic photosensitivity. Among photosensitive epilepsy patients sensitive to flash and pattern stimulation, 25/43 were sensitive to color stimulation, particularly at frequencies below 30 per sec. Red was the most effective color and red-blue was the most provocative alternating stimulus. They concluded that "color sensitivity follows two different mechanisms: one, dependent on color modulation, plays a role at lower frequencies (5 to 30 Hz). Another, dependent on single-color light intensity modulation correlates to white light sensitivity and is activated at higher frequencies. Photosensitive epilepsy may be classified into two major groups, depending on whether the seizures are induced by flickering light. As in more typical photosensitive subjects, environmental triggers include television and video games. Many of these patients have idiopathic photosensitive occipital lobe epilepsy, a relatively benign, age-related syndrome without spontaneous seizures, although cases with occipital lesions have been reported, including patients with celiac disease. The visual stimulus triggers initial visual symptoms that may be followed by versive movements and motor seizures; however, migraine-like symptoms of throbbing headache, nausea, and sometimes vomiting are common and can lead to delayed or incorrect diagnosis. Photosensitivity with Spontaneous Seizures Jeavons and Harding (65) found that about one third of their photosensitive patients with environmentally precipitated attacks also had spontaneous seizures similar to those of pure photosensitive epilepsy. Photosensitive benign myoclonic epilepsy may also begin in infants, with a generally good prognosis though the events may be overlooked by the parents for some time before diagnosis (70). Photosensitivity also may occur with severe myoclonic epilepsy of infancy (Dravet syndrome) or with disesases associated with progressive myoclonic epilepsy like Lafora disease, Unverricht­Lundborg disease, and the neuronal ceroid lipofuscinoses (71). Pure photosensitive epilepsy may be treated by avoiding or modifying environmental light stimuli, increasing the distance from the television set, watching a small screen in a welllighted room, using a remote control so that the set need not be approached, and monocular viewing or the use of polarized spectacles to block one eye should provide protection (59,72). Drug treatment is needed if these measures are impractical or unsuccessful, if photosensitivity is severe, or if spontaneous attacks occur. The drug of choice is valproate, which in one study (75) abolished photosensitivity in 54% of patients and markedly reduced it in a further 24%. Lamotrigine, topiramate, ethosuximide, benzodiazepines such as clobazam (76), and levetiracetam (58) also may be useful. According to Jeavons (59), 40% of photosensitive patients have this variety of epilepsy, and television is the most common precipitating factor. Video games may trigger these seizures, although not all such events represent pure photosensitive epilepsy (60,61). Other typical environmental stimuli include discothиque lights and sunlight reflected from snow or the sea or interrupted by roadside structures or trees.

As set forth in Paragraphs 11-15 allergy treatment 5mm order desloratadine pills in toronto, respondents failed to employ reasonable and appropriate measures to prevent unauthorized access to personal information in audio and transcript files allergy shots make you tired buy 5 mg desloratadine mastercard. The acts and practices of respondents as alleged in this complaint constitute unfair or deceptive acts or practices in or affecting commerce in violation of Section 5(a) of the Federal Trade Commission Act. At a minimum, this risk assessment should include consideration of risks in each area of relevant operation, including, but not limited to: (1) employee training and management; (2) information systems, including network and software design, information processing, storage, transmission, and disposal; and (3) prevention, detection, and response to attacks, intrusions, or other systems failures; C. The reporting period for the Assessments shall cover: (1) the first one hundred and eighty (180) days after service of the order for the initial Assessment, and (2) each two (2) year period thereafter for twenty (20) years after service of the order for the biennial Assessments. Each Assessment shall be prepared and completed within sixty (60) days after the end of the reporting period to which the Assessment applies. Respondents shall provide the initial Assessment to the Associate Director for Enforcement, Bureau of Consumer Protection, Federal Trade Commission, Washington, D. A, for a period of five (5) years from the date of preparation or dissemination, whichever is later, a print or electronic copy of each document relating to compliance with this order, including but not limited to: 1. Respondents shall deliver this order to such current personnel within thirty (30) days after service of this order, and to such future personnel within thirty (30) days after the person assumes such position or responsibilities. Respondents shall secure a signed and dated statement acknowledging receipt of this order, within thirty (30) days of delivery, from all persons receiving a copy of the order pursuant to this section. Such notice shall include: the name and address of each business that respondent Prasad or respondent Srivastava is B. Provided, however, that, with respect to any proposed change in the corporation about which respondents learn less than thirty (30) days prior to the date such action is to take place, respondents shall notify the Commission as soon as is practicable after obtaining such knowledge. This order will terminate on August 14, 2034, or twenty (20) years from the most recent date that the United States or the Federal Trade Commission files a complaint (with or without an accompanying consent decree) in federal court alleging any violation of the order, whichever comes later; provided, however, that the filing of such a complaint will not affect the duration of: A. Respondents are in the business of transcribing digital audio files for individuals and businesses in a variety of professions and industries. Respondents conduct their transcription business almost entirely online, where customers can upload audio files for transcription. Respondents rely almost exclusively on independent service providers to transcribe audio files that respondents assign to them. Respondents assign non-medical audio file transcriptions to at least 100 independent typists located in North America, and, between at least January 1, 2009, and May 1, 2012, automatically assigned all medical audio file transcriptions to Fedtrans Transcription Services, Inc. A major search engine therefore was able to reach the application and index thousands of medical transcript files that respondents had assigned to Fedtrans. The Fedtrans files, which were prepared over at least eight months, included personal information such as names, dates of birth, health care provider names, examination notes, medical histories, medications, and, in some cases, employment histories and marital status. Some of the files contained highly sensitive medical information, such as information about psychiatric disorders, alcohol use, drug abuse, and pregnancy loss, and notes of examinations of children. Information contained in the Fedtrans and other files can easily be misused to cause substantial consumer injury, such as identity theft, and unauthorized access can cause harm by disclosing sensitive private medical information. Respondents could have corrected their security failures using readily available, low-cost security measures. Accordingly, the complaint alleges that respondents failed to employ reasonable and appropriate measures to prevent unauthorized access to personal information in audio and transcript files, which caused, or are likely to cause, substantial injury to consumers that is not outweighed by countervailing benefits to consumers or competition and is not reasonably avoidable by consumers. Part I of the proposed order prohibits respondents from misrepresenting (1) the extent to which respondents use, maintain, and protect the privacy, confidentiality, security, or integrity of personal information collected from or about consumers. Part V requires dissemination of the order to all current and future principals, officers, directors, managers, employees, agents, and representatives having supervisory responsibilities relating to the subject matter of the order. It is not intended to constitute an official interpretation of the proposed order or to modify its terms in any way. Respondent Valeant is a corporation organized, existing, and doing business under and by virtue of the laws of the Province of British Columbia, Canada, with its headquarters at 2150 St. Respondent Precision is a corporation organized, existing, and doing business under and by virtue of the laws of the State of Delaware, with its headquarters at 900 Highland Corporate Drive, Suite #203, Cumberland, Rhode Island, 02864. Pursuant to an Agreement and Plan of Merger dated January 31, 2014, Valeant proposes to acquire Precision for approximately $475 million, plus an additional $25 million payable upon a sales-based milestone (the "Acquisition"). Branded and generic single-agent topical tretinoins are used to treat acne vulgaris, commonly known as acne. Valeant currently manufactures and markets the branded single-agent topical tretinoins Retin-A, Retin-A Micro, and Atralin, as well as generic Retin-A and generic Retin-A Micro. The only other suppliers of single-agent topical tretinoins are Mylan with a branded product, Avita, and Actavis, with one strength of generic Retin-A.

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