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autoirishlitdiscourses · 3 years

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Discourse of Wednesday, 19 May 2021

You have a happy holiday break! I'm sorry I didn't anticipate at the third stanza; and picked for went picking; was hanged; and didn't take it you're referring to the YouTube video from the professor send out are considered to meet downtown at a coffee shop on Sunday or Monday would work for the Croppies 6 p. If you have questions about these things might be to ask you, provided that each of the better ways to do it through GOLD. Got it! Choose either of the things that interest you can better achieve an even better, and how the poem's rhythm and tension than they probably would have liked generally lost points for discussion to motivate me to print and scan and email your grade I'd just like to be sure you know when I need the class and led them through some very good work here. I'm glad to be leveraged carefully. This page copyright 2013 by Mooney. You have some very perceptive. If you have questions, OK?

Really good delivery; you may have noticed that the semi-competent mouth-breathing campus technical administrators decided to use silence effectively in your paper depends on where you found it there and did this without being so long to get an add code I've actually never had this problem, as well. Here's a breakdown on your main payoff—then restructure your paper are yours and which are quite strong. Remember that one thing that leaves me feeling unsatisfied about your nervousness can help you to each section and from me later that day, and I'll schedule a room, but you'll be master here? I suspect that you were on track throughout your time. My mapping from percentages to letter grades/to papers, so you need me to hold two people who decide they want to deal with and critique?

I assure you that I have is to say that I do not have started reading Godot yet if they're cuing off of his lecture pace rather than the assignment write-up midterm is tomorrow at 10 p. But I think that the exceptions are more relaxed and have some very, very good job this week has basically evaporated I'll put you at C. Doing this effectively if the maximum possible discussion credit if you go back to you, you'll want to recite and discuss this particular grad-school-length paper.

Here is what you want to put these two texts and what it means and how you can let me know if you want to dig into the final itself midterm, recitation, and you've also demonstrated that you're working with: what are your criteria for determining what the larger context of your argument, but the usage in literature in English X-rays, which is more that the best person to ask the College of Letters & Science, at. At the same time, to be their advocate so that the writer has a pork kidney for breakfast, writes odes on hawthorns, having specific points in the future. You picked a longer-than-required selection and delivered it in then. I taught them during my office hours and am happy to talk about this, I think, would be to resolve the primary course text s with which the soldiers crowned Jesus in the storyline.

In a lot going on. Hi! You might also get you a five-digit code, which is what you intend to respond to a specific claim in your section is optional next week the writing process, but forget which one. You may have required a bit more practice but your writing is generally taken to mean by passionate, insightful, moving delivery and wait for an O'Casey recitation. Thank you. Section participation. That is to blame to It seems _______________ is to pick them up today, but I think that you have any questions, OK? An excellent job an impassioned and fluid, impassioned delivery of Lucky's discourse here, and then looking at their level of familiarity with the exception of many poems that we did not read it this way.

He said in the formula below, I would say the smartest way to think about Fluther's point of criticism made by the rules is generally a better one that he read would be helpful in the term very unlikely even a perfect job, but there are also some editing problems here—it's just that I set the bar for anyone to assume that I think this could be read, and you display an excellent opportunity to do this as the student writes in her discussion of the essay. Again, well-structured manner; integrated historical scholarship with excellent close readings by a piece of writing a first-decade artworks because Ulysses has and did a very close to convenient and painless as possible; if you do not grade you have to schedule a time in a genuinely serious and unavoidable emergency family death, serious injury, natural disaster, etc. More importantly, though, and b it avoids analysis in an earlier discussion, but I don't know that I have you down for McCabe. Make sure you carefully evaluate whose viewpoint we're getting Bloom's thoughts about it anyway, but if you can't make it, because I'm leaving town for the quarter, in another pattern.

Looks like everything's working now. You picked a difficult and complicated thing to do with the poem by Patrick Kavanagh Patrick Kavanagh Patrick Kavanagh, Innocence Wherever you are perfectly capable of being paid to serve as fully and clearly as it turns out that you are perfectly capable of learning to use the standard deviation was 11. Pullet p. I really enjoyed having you in lecture 22 Oct: The Lovers 1928; probably others that don't change the way that is not fantastic, but I'm also happy to give you a five-digit student ID codes, for instance. Of course, let me know and I'll see you on the exam! I just sent you about the text, and you demonstrate a very good job of tracing some important thematic elements. So, the condition that I hope you have sophisticated and deserve to represent them even better quality, and is often incompatible with trying to say about what you're getting out of his travel on the section website. Another way to meet. Standing in front of the entire thing; perusing the index might pay off. If you haven't yet made a huge number of questions and frame them. That's fine and I'll have to be as successful as you revise that draft. One of the Catholic doctrines on temptation, which is a move that would be different if tie operated differently. If we're getting Gertie's thoughts are usually businesslike, or the student really wants to have to pander to my office this afternoon and have too many emails shortly before each paper is well-structured manner; integrated historical scholarship with excellent close readings by the time limit you've sketched an outline with more specificity before a presentation. I also said this in terms of which I think that the paper just barely pulls you over the Thanksgiving holiday. She twentythree. For one thing that may not be able to give you a copy of The Butcher Boy; you adapted to the aspects of the text in question before lecture is over tomorrow, you're welcome to refine your ideas, not blonde, hair. Go above and beyond the length requirements. So you can point people to talk about what it means to have a thesis yet or didn't when you know that you're perfectly capable of being responses to suffering. You've got a really strong essay in a timely fashion in order to pass. There are any changes made I will still expect you to prioritize and get you feedback as quickly as possible when you were trying to satisfy an essential element from the in-depth examination—I've marked some places. Grading Rubric for Analytical Papers I expect that you should nominate them! You relate the various strands you're tracing to each other. Here's a breakdown on your recitation tomorrow. You added the before night in section this quarter! 4% of your material you emphasize I think that what your overall logico-narrative that is, or in the play, it would help you to place at the beginning of section, but in your writing stage. Covers general guidelines for participating in course texts, and recall problems.

I felt like you were absent we talked earlier today, but think explicitly about what specifically has changed by the email servers that the professor's miss three sections and you had a B his grade based on the time of the Gabler course edition. /Excellent delivery, and quite engaging, and yes the grade definitions—GauchoSpace does not meet basic standards for a ten-digit student ID codes, for instance his sculpture is perhaps one of three groups and the Stars to Downton Abbey for a job and knee surgery. What do you analyze your points because it assumes that alternate options have been an easy task, you/must/email me and make sure that you haven't found it on just a tiny hair under B. If, after all, this is.

Just let me know when you don't feel comfortable talking to me in an even more specifically in your future work. It will need to buy yourself some breathing room. If you're interested in this particular question, which is probably most easily found on the day before Thanksgiving. That's been reflected in the Ulysses lectures which, given Ulysses, 7. Good luck on the most part though it might have been, both because it assumes that alternate options have been more students who often come in late and/or have a good sense of the two revolutions, separated by 127 years? Your Grade Is Calculated in Excruciating Detail. Making a wise topic to topic is acceptable what it meant to be as successful as you finish preparing would be a hard skill to learn and I hope that they only discussed a single person. Thank you for doing a large number of points. I'm still trying to say, a professor in our society means that a potentially productive ways to approach the question of how they did that than leave it.

What I suspect that much of this, and that not doing so by 10 p. I can just post what you've sent; just start writing. I'll see you in section during Thanksgiving week instead of scaling back what you're doing it is, in relation to do this and anyone asks you specific questions that are not allowed to pass beyond merely reciting twelve lines, but you are also possibilities for other ways to put this would result in an analysis of things well here: you need to have you as quickly as spaces show up on posting links to the poem and connect it to one or more people see some aspect of Plough into relief. You did a good selection, gave what was overall a very graceful job of walking a rather difficult, and everything looks really good question, but to aim to do. Let me know what you really mop up on time. I'm happy to do this as written, would be helpful. Other unforeseeable, catastrophic events that they will have an excellent holiday weekend this quarter, and I'll see you then. I cannot fully explain to anyone else, because it mirrors the hyper-aware emotional state that Bloom ponders Roentgen rays in the outside world.

Nevertheless, the average score would be to think about your evaluative criteria, which at least represents itself as a result of a small observation: I will count that as part of the poem's sense of the woman herself cannot effectively protect herself from the closing of the handout linked above was prepared for a text, and campus will be there on time will result in a room tomorrow in SH 1415. How to Get An A paper, and so it is likely to be expressed in your hand.

You might think productively about, and dropped that in as soon as I pop back to you until you've sat down and start writing in order to be directly to the people who makes regular substantial contributions in a solid job here, although the multiple starts ate up time that you'll have a low A on an English minor, etc. Thanks for your argument, but it's often helpful to look for cues that this is unfortunate because they haven't impacted your grade, you two after another group for several reasons, too is it that's interesting about the text of the poems you choose and owned it. Passages for close reading of Ulysses that we didn't read: the twelfth line.

Eavan Boland, or if you arrange a time to reschedule. All in all, from very short IDs, and some of the text, and producing some of my previous students have jobs and sports and family emergencies and about his paper in my opinion, to come to that but it's more or less a third of a text, but is perhaps not, too.

You were clearly a bit too quickly, and to engage in your delivery was a productive discussion. I'm sorry to take this into account when grading your paper to be over. Again, I do not use GauchoSpace to calculate grades, preferring to leave your luggage in my margin notes in some of your future writing assignments. Well done on this you connected it effectively to comments and passages from The Butcher Boy; Stephen Dedalus's rather morbid and misogynist fixation on the surface.

#Irish literature #automatically generated text #Patrick Mooney #Python #Markov chains

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managementstrategy · 5 years

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ManagementStrategy

A frame by which output requirements can notify input needs can be known as'designing down'. One of the well known inputs are:Quality of teachers frequently characterized by their level of certification instead of by their capacity to produce their pupils acquire and carry out specific abilities;Quality of these buildings often rated by the ManagementStrategy in them compared to their appropriateness as facilitators to a procedure for learning and transformation and Quality of pupils frequently perceived through lenses of some evaluation system that is little adapting to exactly what the student will develop along the institutional experience. In character the inputs in the quantity and quality has to be derived from the'voice of customer' and institutional vision on quality than anything else.Management of educational throughput is a intricate program since it requires perpendicular alignment in addition to horizontal integration of modes of thinking because of action. There is need to join the Strategy Plan to surgeries from goals and across sections and the sectors of the organization. The rankings of person competences that are in principle, degree head, head of department and upwards have different job descriptions and classroom practitioner,' proven' to facilitate good learning in the institution. These assumptions are joined to a range of standing and emergent policy plan that is supposed positively exploit the skills or to support. Inconsistencies in the policies may constrain the delivery of excellent instruction and in their implementations. 'Direction' may sound a rather inappropriate language for how the institution addresses the outcomes of the processes. Educational outputs incorporate the extant, the medium and close range effects of a educational experience. This includes the reflections ManagementStrategy on the reactions and responses of the students. There is a need to distinguish outputs from instructional outcomes. Educational outputs are somewhat more of the fairly and instant results of the education delivery system. Outcomes of an instructional system and expertise are tough to claim and winnow in an exclusive fashion. Results are a delayed feature and their manifestation embodies the influence of additional learning from society and the environment the individual brushed with because the instructional relationship. Outcomes reflect. It's important that the institutional process in the classroom does not restrict itself to affecting content It must focus on developing mastery, systems thinking and critical thinking skills. This trans formative strategy has consequences on school and topic didactic . The following section compares six quality control models, evaluating their biases and so, assesses their ability of improving quality of instructional delivery.

You may have a very good evaluation management process and instrument to ensure the effectiveness of your testing. However, test management alone will not ensure customer satisfaction. Total Quality Management is a means to not only deliver high-quality products and services but to achieve increased customer satisfaction levels.In this post, we have coated the definition of quality management, its importance, the ManagementStrategy of total excellent management, quality management principles, quality management illustration and the tool for comprehensive excellent management.It has been said many times that if the high levels of management are not supporting the implementation of any QMS, it is likely to fail. While this may not always be a truth, it is true that the more involved the top levels of management are from the QMS, the better the likelihood of succeeding, and the better. If best management -- who is responsible for controlling the cash flow of the business -- may see the advantage of the system, it's a lot more likely to be used to its fullest advantage.It is significant that people throughout the organization create value, particularly in our ever-growing competitive world. The QMS has to focus to assist them become engaged in the processes to construct value within them, to guarantee that. By having empowered and engaged people in the business, this can act as a driving force behind fulfilling the objectives of the organization.Trying to comprehend, control and improve an overall system may often be complicated, which may make any attempts doomed to failure. By taking a look at the overall system as smaller interrelated processes you are able to focus your efforts toward more predictable and consistent results on the individual procedures of the system. Assessing and enhancing the individual procedures can be a much simpler and much more effective approach to control and enhance the entire system.Companies that remain stagnant within an ever-more-competitive marketplace will be overtaken by their competition, and in order to counteract this pressure the company must improve in order to drive down cost and maintain market share. This permits the enterprise to react to changes in requirements that are external or internal to create new opportunities. The whole idea of owning an excellent policy works toward development. Objectives have to be proposed and SMART (Specific, Measurable, Attainable, Realistic, Time- ManagementStrategy ), and also won't function without dedication to change.It is stated that you are more inclined to get the wanted effects by basing decisions on evaluation and analysis of data rather than a gut instinct of the circumstance. This is why there's a focus on monitoring & measurement in the ISO 9001 requirements (in reality, 4 of 6 compulsory documented processes are out of this segment ). To be able to be aware that a process is functioning properly we need adequate data, and as a way to plan and evaluate improvements this information is much more significant. Because of this, maintaining good records becomes crucial to ease many of the other Quality Management Principles.Because the interaction with interested parties such as clients, employees and providers can help determine the performance of an organization, it is critical to manage these relationships.

On handling the relationships with the provider community, the focus is, but maintaining the relationships of all parties is important to optimize their impact and make success. Successful businesses see these relationships as partnerships rather than just customer/supplier interactions.By understanding these overall principles, and ManagementStrategy a focus on them in to your QMS, you'll find it easier to implement the requirements and discover that the final result will be more focused on your needs as a firm. Just how much easier will the implementation be if you also ensure that your procedures focus on exactly the very same principles as the prerequisites if you're aligning your Quality Management System to the requirements of ISO 9001, and just how much will your system be? How do you dismiss the fundamentals behind the system if you want to make certain your QMS will operate so you see the maximum benefit.Though the quality movement can be tracked back to the late 13th century, true quality management systems were initially developed by an American and executed in Japan from the 1950s. Aimed at communicating to supervisors how quality may be increased within an organization, the original fourteen factors focused on two major concepts:Frequent, systemic causes of errors (caused or shared with numerous employees, machines, or goods ), such as inferior product or service design, unsuitable materials, poor physical conditions, improper bills of lading, etc.. ) And exceptional causes of errors (due to individual personnel, products or equipment), for example lack of suitable skill or training, poor lot of substances, from purchase gear, etc.. Other influential individuals, such as Joseph M. Juran, that identified quality as"fitness for use" also began to work with ManagementStrategy associations. He had been responsible for the development of a detailed strategy that concentrated on the characteristic of a product for its whole life cycle, all the way to the end consumer from design. He believed , by dissecting each part and process of quality, companies could produce a product that consumers could rely on one hundred percent of the time.By putting so much focus on quality and the satisfaction of the customers, the Japanese market started to dominate the production market. From the 1980s, American companies had begun to realize they would want to make changes to be able to survive against their competitors. Ford Motor Company was the first to jump in. They predicted on Deming to help them change their company to a quality-oriented business.

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jorgethomasus · 7 years

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Use Fake Doctors Medical Report as Your Escape Card

Do you want an escape card to skip work/school? We’ve all been there! You require a few days off to go accomplish something, so you call in sick. But now your boss wants a doctor’s report as a proof of your sickness. Do not worry, there are dozens of online services offering fake doctor’s reports. You can use these reports as an escape card to skip the tasks you do not want to do.

There are many types of fake doctors medical reports on the web, the fake excuse collection incorporates; dental practitioner excuse letter, children’s clinic excuse note, fake mental health document and return back to work note. The rundown additionally incorporates both free and premium fake cardiologist note, eye specialist excuse letter, OB/GYN excuse note, medical nonappearance report, and free oral surgery excuse letter etc. A phony excuse report from a specialist can prove to be useful if you can’t get an excuse report slip from your specialist.

The report is intended to give you the best reason to miss school, work or travel. The issue emerges when you can’t get the excuse report from the genuine specialist. Getting a genuine online report from the specialist is very tough, if you don’t have a standard specialist or therapeutic faculty to counsel or if you have a condition that does not warrant its issuance. So depending upon a fake medical report is dependably the best alternative to pick.

How can I create a fake medical report?

Are you fed up and stressed because of your work hours? Or your boss always manages to ruin your day? It is time to take an action! Just create fake medical reports and you are done with all the tasks. Follow the steps below to have your escape card:

Choose the template

The primary thing that you have to do is to search for a format that would match with your report. You will require one that would give you wanted time off. You simply need to take the risk and pick a medical excuse, for instance, you can utilize the medical reason of having shingles. As a great many people know, shingles is a type of chicken pox that grown-ups get. Your manager would not need you to come back to work since you will be infectious. It is constantly great to pick an infectious ailment while faking a sickness in light of the fact that, in such case, even your boss won’t need you to join the work environment.

You should ensure that the formats you utilize include space for each and every information that you need your employer to know about. Along with that, you have to plan your absence from work a few days in advance. You need to cover your bases because your livelihood is on the line.

Fill out the form

The fake doctor’s templates that are available online for work/school are exceptionally easy to fill out, it requires the specialist’s and the patient’s name, provider’s identification, the time and date of visit, comments, restrictions (if any) and signature along with date.

You excuse forms will have to look great and that’s why you need to spend the time to make sure that you proofread everything before submitting it to your boss for his review. The specialist’s name should be same as any local doctor’s name so as to divert the mind of your employer from any doubts that he may have. The best excuse that I suggest is those of illnesses that are easy to catch, but are very contagious.

The templates that are available online are also awesome for the students who need to avoid school. I have found that students frequently require a break from their work and school obligations. It is difficult to be so worried constantly. You need to round out the frame painstakingly by putting center around each minor detail. Keep in mind, never utilize a fake specialist’s name on the note because your manager or teacher can check it.

And print the report

The note should be printed on high-quality paper, not the cheap stuff you might buy in a 1000-sheet package at any local shop or stationary. Have you ever seen a real doctor’s report on that flimsy white stuff? Probably not. So make sure to use a high-quality paper while printing your report.

Where can I get a doctors report template?

There are a few choices, despite the fact that some of them are quite hazardous. Let’s take a look at all of them:

Steal one

You may have this thought after viewing a terrible film or TV show where it is very easy to do so. Reconsider. On TV or in the motion pictures, it’s easy to roam around a hospital or doctor’s office, easily sneak into a vacant office, and lift a prescription pad or some stationery.

Sadly, in reality, it is quite difficult. That kind of printed material is once in a while left unguarded, and specialists’ workplaces and doctor’s facilities are dependably vigilant for individuals who should be there, doing things they shouldn’t do. If you do so, you’re not looking at an issue at work – you’re looking at an issue in court. So I don’t prescribe utilizing this thought as it can be exceptionally dangerous.

Make your own

It is really a very difficult task to make your own fake notes and it is even more difficult to make it appear 100% authentic. When you have to work in a little time away, the exact opposite thing you need to do is invest energy before the PC dealing with a produced note. Rather, you need to unwind before the TV, sleeping or level out relaxing by the pool. A superior choice is to arrange an excuse from our site.

Download it, but from a reliable online site

This is dependably the best choice because of many reasons. One of the reasons is expertise, a reliable company that deals with fake notes have years of involvement in recognizing what points of interest must go into the excuse notes. They’ll have totally credible reports or therapeutic notes with logos, appropriate wording, even watermarks and sometimes.

Besides, they’ll offer complete packages of fake notes from an extensive variety of doctors, dental practitioners, hospitals, doctor’s facilities and authorities; some websites even have things like religious excuses, jury duty notices and funeral pamphlets so you can pick what fits your circumstance best. At long last, they recognize what works, with all the input they’ve gotten from satisfied clients. That way you can make certain that the notes you’re purchasing have worked for others, and will also work for you.

What is the use of fake doctors report?

Doctors are frequently requested to give medical records of their patients. These solicitations originate from an assortment of sources – e.g., bosses, government offices and administrative bodies. Information may be given as a report, a paper, a letter and a certificate. So it is not in any way unbalanced or suspicious if you demonstrate the fake report at your office by a specialist.

The fake specialist’s report should serve as a bogus proof of your excuse because of which you missed the school on a specific date to improve the further system of making up the exam if it was missed that day, or simply having make up classes or to relax. A Doctor’s Note is imperative for a patient to demonstrate that they had profound reasons not to come to class or work on a specific day since they needed to see a specialist.

These forms will prove to be useful to the individuals who need to affirm that the kid’s nonappearance at school is disclosed by the need to visit a doctor or dental specialist. So, if you trust that you can cheat your kid’s teachers, you can most likely utilize it.

Can I use free fake doctors medical report?

That sounds simple and absolutely not as risky as real burglary would be. True, but it’s not going to do the trap. The issue is that HRs, managers, instructors and heads see a considerable measure of excuse notes, both authentic and fake. And the reason is that the “free specialists excuse notes” are free to download –they’re truly not authentic looking.

Next to no care went into the readiness of free notes. There’s presumably almost no detail on them, and chances are that the individual you’re giving your fake doctor report to has as of now observed that identical letter sometime before. You may not be in court subsequent to utilizing one of those shabby downloadable excuse letters, yet you might be at the unemployment office.

Make it work

Since it is ethically and legitimately wrong to utilize fake doctor’s report, businesses are rapidly finding out about different fake online medicinal letters and other employees naughtiness through online gatherings, clinic insurance authorities, and workshops. So an employee has to careful while using such notes.

This also implies that the company or doctor offering the fake hospital center letter or doctor’s report may not be considered responsible for any legitimate methods emerging from the utilization of such letters. Basic variables, for example, one’s position in the organization, how frequent the fake dr. frame is utilized and one’s level of professionalism may influence how best or fruitful you utilize the fake dr notes.

Having said that, a great number of organizations that offer best fake dr notes online additionally give fundamental support to validate their offerings. Few trusted online organizations also provide money back guarantee to their clients. In the event that you need to have the best fake notes ever, visit our home page now!

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from BestFakeDoctorsNotes.net https://www.bestfakedoctorsnotes.net/report/ from Best Fake Doctors Notes https://bestfakedoctorsnotes.tumblr.com/post/160796625511

#Best Fake Doctors Notes

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scienceblogtumbler · 4 years

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Lab grown and do-it-yourself: two emerging routes to an artificial pancreas

by Steve Gillman

A ‘bio-artificial’ pancreas grown in a lab with the aid of placental stem cells, and a DIY insulin-monitoring and release system are being developed to give people with insulin-dependent diabetes an alternative to waiting for a pancreas transplant.

The human body has cells within the pancreas that regulate the level of sugar in the blood, but for some unclear reason the immune system occasionally attacks and kills them. When this happens a person develops Type 1 diabetes – a condition where the body no longer has the ability to produce insulin, the enzyme that sends sugar around the body to fuel essential functions.

‘Type 1 diabetes can lead to very serious complications and even to mortality,’ said Dr Ekaterine Berishvili, a diabetes expert from the University of Geneva in Switzerland.

Without a fully functioning pancreas, a person with diabetes risks prolonged high blood-glucose levels that can result in long-term health impacts, like blindness and lost limbs, while going too low can result in fainting or worse – death. To remain healthy, a person with Type 1 diabetes must inject insulin several times a day alongside constant monitoring of blood glucose levels, traditionally through finger prick blood tests.

Pancreas transplants are the closest thing to a cure and, according to Dr Berishvili, they have about an 80% success rate, but they cannot be offered to everyone because of the costs and availability of the organ from donors. This often sees the treatment mostly used for the most severe cases and in countries where this invasive surgery can safely be carried out.

Dr Berishvili is also the coordinator of the VANGUARD project, which aims to develop an artificial pancreas by using stem cells and gene-editing technology (CRISPR) to grow a transplant in a laboratory – one that is much cheaper, easier to transplant and could be made more available to people with Type 1 diabetes.

‘The bio-artificial pancreas we are generating is engineered purely from biological materials,’ she said, adding that it is made up of a deconstructed donor’s pancreas and stem cells extracted from placentas.

‘From one placenta we can get material for 25 artificial pancreases,’ Dr Berishvili said.

Two parts

Vanguard’s researchers first divide donated pancreases into their two parts, one that releases enzymes that help digest food and another part that produces insulin as well as other hormones. The researchers do this so they can isolate the insulin producing cells.

They then combine these cells with donated red blood vessels to ensure oxygen and nutrient flow. Next, they add two types of stem cells – some are used to increase the chances that a bio-artificial pancreas is accepted by the recipient, others are used as a type of glue to hold all the biological material together.

From this, Vanguard researchers can grow fully functioning artificial pancreases that could eventually replace the organs in people that are not producing insulin.

‘We are hoping that at the end of the (project’s) five-year period (in 2024) we will have the product that can already go to the regulatory agencies to be approved for the clinical trials,’ Dr Berishvili said, adding she is very positive that this can happen based on early results.

One potential delay remains out of their control. Vanguard will be using CRIPSR genome editing to fine tune, cut and amplify the cells to increase the chances the bioartificial pancreas is accepted by its host and then works. This could create some unforeseen regulatory barriers and delay clinical trials until some clarity emerges.

‘The bio-artificial pancreas we are generating is engineered purely from biological materials.’

Dr Ekaterine Berishvili, University of Geneva, Switzerland

Do-it-yourself

And this is not the only area where regulatory boundaries have held back the development of promising treatments for people with diabetes. External artificial pancreases that use devices attached to the body now exist, but this hasn’t always been the case.

Six years ago, before commercial versions were available, members of the diabetes community came together to build their own solution – in something called a ‘Do-it-Yourself Artificial Pancreas System’ (DIYAPS).

According to Dr Shane O’Donnell, a post-doc researcher at University College Dublin, Ireland, the idea for DIYAPS was first developed by Dana Lewis, who has Type 1 diabetes, and her husband, Scott Leibrand, when they realised they already had everything to make the system and didn’t have to wait for a commercial product that was still years away.

‘All they needed was an insulin pump and a continuous blood glucose monitor system,’ he said, items to which many people with type 1 diabetes have access to. The trick was to make the two devices talk to each other through Bluetooth and combine it with a decision-making algorithm that they developed. This allowed the insulin pump to get a signal from the glucose monitor system and then adjust the needed dose when blood sugar levels were predicted to go too high or low.

The resulting system allows someone’s blood sugar levels to be automatically brought back under control if they go to dangerous levels. Lewis and Leibrand, alongside a growing community, have made the instructions for building your own DIYAPS open source so that anyone can make one.

Dr O’Donnell says this solution comes as a huge mental and physical relief to those with a DIYAPS because managing the disease involves constant calculations to maintain healthy blood sugar levels, like complex counting of carbohydrates and considering additional variables like exercise or stress.

Now, Dr O’Donnell wants to establish a solid evidence base for how well DIYAPS have worked compared to existing commercial products through a project called OPEN. Since this grassroots system has been around for a number of years, it can be studied at scale.

Proof

He is gathering the proof that might help the technology be more accepted by policymakers and the market, allowing this type of technology to reach more people.

The project is working with Dana Lewis to get access to DIYAPS community data and first-hand experience with this home-brew technology – and it’s already providing useful insights.

‘We spoke to a caregiver who had been waking up at least three times a night just to check on their child’s glucose levels and they were doing this so frequently they were getting seizures from lack of sleep,’ Dr O’Donnell said, adding that they no longer have to do this because of DIYAPS.

But this artificial pancreas is still not perfect. According to Dr O’Donnell, the systems are still experimental and those who build their own are doing so at their own risk.

‘There’s no customer service if things goes wrong,’ he said, adding that this element causes some healthcare professionals to be reluctant when endorsing DIYAPS to patients because they want to avoid any potential liability.

‘We’re trying to build the evidence base to reassure and inform healthcare professionals who are increasingly going to be confronted with DIYAPS,’ he said, adding that is an important step in improving treatment for people with Type 1 diabetes.

Dr O’Donnell says those who have built their own DIYAPS are managing their Type 1 diabetes much better than they would without them, reporting healthier blood sugar levels than the average patient, which he says shows the real potential this technology will have.

‘There are children growing up now that will only know artificial pancreas systems,’ he said.

The research in this article was funded by the EU. If you liked this article, please consider sharing it on social media.

Published by Horizon

source https://horizon.scienceblog.com/1362/lab-grown-and-do-it-yourself-two-emerging-routes-to-an-artificial-pancreas/

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brajeshupadhyay · 4 years

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'Won't betray Hippocratic oath': In the face of deficient PPE kits, spike in cases, Punjab doctors put up tough fight against coronavirus

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Every time Dr Jagdeep Dhillon (name changed) doffs his PPE kit after finishing a COVID-19 duty at Government Medical College, Amritsar, he takes back two concerns -- the exposure in case PPE kits were substandard and the likely effects on his elderly parents back home.

His concerns assume significance with 3,500 pilgrims returning to the state from Maharashtra’s Nanded, 173 of them testing positive for coronavirus, taking the state’s total cases to 585 on Friday. Seventy-six of these pilgrims are in Amritsar, a city where 75 new cases were reported on Sunday.

Dr Sameer Singla handing out discharge papers to patients at Gian Sagar Hospital, in SAS Nagar.

Dhillon says some PPE kits being provided were substandard and did not comply with the guidelines prescribed by the Ministry of Health and Family Welfare. “Some doctors complained that the kits were not impermeable and others found that the equipment did not fully cover their bodies,” he said. A local level fund used to procure equipment as and when needed does not quell the worry over the quality. “It’s like sending doctors on a suicide mission.”

Dr Surinder Bakshi (name changed), a resident doctor at Amritsar’s Guru Nanak Dev Hospital, echoes Dhillon’s concern. “There is no shortage of PPE kits and other equipment, but there have been instances of a quality deficit. During a week’s dealing with those admitted with symptoms of COVID-19, he said he received kits on some days through which air blown on it was passing through.

Wearing a PPE kit, Dhillon says, tests the limits of the medical worker’s endurance. For the eight hours of duty, the kit cannot be removed, despite profuse sweating and dehydration. “The protective equipment cannot be touched from outside or removed under any circumstance. “On the day of my first COVID duty, I felt headache, dizziness and with the heat, it became a challenge to not reach out to a water bottle and drink from it,” he adds.

Moreover, doctors don and doff the PPE kit in the doctor’s room within the ward, in the absence of a demarcated area to do the same, increasing the time of exposure while having no equipment on for protection. “Imagine wearing a plastic bag all over your body,” Bakshi says, adding that staff can feel nausea and wearing a PPE kit for such long periods may not even be possible for those suffering from claustrophobia.

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Bakshi lamented the risks that a haphazard roster posed, under which doctors are posted in COVID-19 wards and their respective departments. He cited a case at GMCH-32 Chandigarh in which an operation theatre attendant tested positive and so did three women resident doctors from the anaesthesia department.

“Our college posted doctors from all departments on COVID duty, be it medicine, surgery, orthopaedic, etc. And after serving there, doctors serve in other departments and are not given PPE kits or N95 masks. Aren’t doctors in non-COVID wards also at risk?” Bakshi too said that often doctors outside the coronavirus wards are only given FFPS-1 or FFPs-2 masks, meant to be used in case of high air pollution and dust.

This assumes significance even as a Supreme Court ruling asked the government on Thursday to update guidelines on the rational use of PPE to ensure that all healthcare staff involved in working in “non-COVID areas” also be provided full PPE kits.

Dhillon added that a new roster requires doctors from various departments to serve for seven days each in the green zone, emergency and flu corner and blue areas. Another combined period of seven days in the yellow, orange and red zones came into effect on 28 April.

“Earlier, we had to serve in the isolation ward at least once a week and then go to the emergency or OPD the next day,” he said. “A roster demarcating zones and duties was being followed in GMCH Faridkot and GMC Patiala from the time that they had only one patient each. We are implementing it now after we put up a fight and approached health authorities,” the resident doctor says.

The new rules that came into effect on Thursday also required that those serving in COVID wards should undergo a 14-day quarantine. Before this, there was no isolation facility for the medical staff. Dhillon, who lives with elderly parents suffering from diabetes and hypertension, feels like he is living alone even when he goes back home.

“I rigorously sanitise myself on reaching home, wash my own clothes and use different utensils. I enter my house through a separate entrance and stay in my room, hardly interacting with my parents,” he says. In the self-imposed isolation, Dhillon continues to read books, work on his thesis and keep in touch with colleagues from other parts of the state to stay updated about the situation at other hospitals in Punjab.

Bakshi, however, was lucky to get a place in a friend’s room in the college hostel, where he stayed during the week-long duration of his duty. “I isolated myself in that room, did my chores and food was brought from the mess and kept at the entrance. I have my wife and toddler son back home and I could not go back and risk their safety,” he says.

At the Gian Sagar Hospital, doctors and other medical staff are sent to the hostel for mandatory quarantine after serving in the COVID ward. “It has been a month since I’ve gone home. At the hostel too, people don’t meet each other and only interact from a distance,” senior surgery resident at SAS Nagar’s Gian Sagar Hospital Dr Sameer Singla said, adding that he bides his time by reading books and watching television.

Doctors tend to get homesick and he often motivates them over video calls. He added that apart from his duty hours, he remains available for help during the rest of the day and even hands out his contact details to discharged patients.

Four staffers of GMC Amritsar were given showcause notices on 24 April for releasing statements on the shortage of PPE kits earlier this month, The Print reported. Later, Amritsar MP Gurjeet Singh Aujla asked the deputy commissioner to probe the allegations, while the Punjab Nursing Association also said that the 2,000 PPE kits procured from the fund provided by Aujla and Rajya Sabha MP Shawait Malik were “of sub-standard material and not safe for staff”.

Sources had told Times of India that the hospital had ordered 2,000 PPE kits and 2,500 N95 masks from a Delhi-based company and that 650 of these kits had already been used.

“I have lost faith in the system. Medical workers are not heard and then letters of complaint are lost in the system. If we talk to the media, we are given showcause notices. Our attention should be on treating patients and not writing letters or worrying about faulty equipment and schedules. Imagine if while dealing with the outbreak, our safety is compromised and doctors are lost,” Bakshi says.

In SAS Nagar, a shortage of equipment was not faced as of Thursday. However, four people posted from surgery and some medicine residents gave letters about faulty kits their respective department heads, Singla said. SAS Nagar was among the five industrial districts, apart from Jalandhar, Patiala, Ludhiana and Amritsar, that accounted for 73 percent of the total confirmed cases as on Wednesday.

Moreover, MBBS interns and resident doctors assisting the efforts to contain the coronavirus infection also faced the issue of a meagre stipend of Rs 9,000 a month, whereas states like Assam pay as much as Rs 21,000 monthly. Only on 24 April did the state government announce that the stipend was increased to Rs 15,000.

Even as the coronavirus outbreak continues to have dire consequences, doctors continue their attempts to keep the patients’ morale high.

“The first time I was posted, a 65-year-old diabetic patient came with breathing problems. He asked me if COVID-19 patients survived at GMC Amritsar and told me, ‘please save my life. I have only one son and I want to see him again’. The patient was later put on a ventilator, revived after a cardiac arrest, but he ultimately died. Our profession is such that we have been trained to cope with death, but this scenario is a different and a very stressful one,” Dhillon recounts. At the COVID ward at Gian Sagar, Singla recently distributed toys and chocolates sent by the government amid the 6-7 children admitted there.

Despite authorities’ action and no signs of abatement of the coronavirus, Dhillon and the 53 medicine department resident doctors at GMC, Amritsar continue to report to duty with enthusiasm.

“We work despite such demoralising notices and actions of authorities. There is no one to tell us that we’re doing a good job. But we have taken the Hippocratic oath and the thought to betray it even in such trying times does not cross my mind,” he adds.

According to Singla, who took the duty of the COVID-19 ward in-charge, the question of not attending to patients will never come to his mind irrespective of how long it takes for the outbreak to abate. “People have to help us and each other out by following the lockdown and social distancing guidelines. The disease is highly contagious, but not untreatable. So panic needs to be avoided,” he says.

So far, 1,102 confirmed cases have been reported from all the 22 districts in Punjab. As of Sunday, the districts which have the most number of cases include 218 from Amritsar, 124 from Jalandhar, 111 from Ludhiana and 95 from SAS Nagar.

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ulrichfoester · 4 years

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Navigating Pain Relief With and Without Opioids

Pain is a cruel master. When it strikes, there is nothing beyond it. No life, no relationships, no you. There are only the pain and the need to get it to stop, no matter what.

According to recent estimates from the CDC, 1 in 5 Americans is currently living with chronic pain. That’s about 50 million people in the United States alone. And of those 50 million, nearly half reported experiencing chronic pain so intense it interfered with their daily functioning.

Once upon a time, the standard protocol was to treat chronic pain sufferers with opioids. But, unless you’ve been living under a rock, you’ve probably read and seen more horrific reports of the ravages of the opioid epidemic than you care to recall. On an average day in America, more than 130 lives are lost to opioid addiction.

The result has been a significant crackdown, led by the US federal government, on the dispensing of opioids for all but the most severe, short-term pain. But what of the tens of millions of people in the US whose pain simply isn’t going to go away, whether due to the lingering effects of traumatic injury or the ravages of chronic disease?

How can we best navigate pain relief, both with and without opioids? How can we relieve the suffering of those who have chronic pain, without falling prey to opioid addiction?

A Public Health Emergency?

There can be no question that the old way of using opioids was not only ineffective, it was downright dangerous. For far too long, doctors were dispensing prescription narcotics like Halloween candy, with little understanding or recognition of the mechanisms of addiction.

This has created not only a crisis for individual and family health, but for public health as well. In addition to the scores of precious lives being cut short, often in their prime, every day in America, opioid addiction is also taking a devastating toll on entire communities. Not only is opioid addiction limiting people’s ability to work, but it’s also impacting some people’s ability to maintain stable housing. As the severity of the addiction grows, relationships suffer, and addicts may easily find themselves on the streets, without friends or family to turn to.

Without access to housing, adequate medical care, and social or familial support, addicts are at increased risk of physical and mental illness, including the risk of acquiring, and spreading, communicable diseases, from hepatitis and tuberculosis to HIV. The National Institutes of Health estimated that, in 2013 alone, the opioid epidemic cost the national economy nearly $80 billion. That’s billion with a b.

It’s little wonder, then, that the opioid epidemic is currently being treated as a public health emergency. To save lives and relieve the tremendous financial burden of opioid addiction, the federal government has instituted sweeping reforms to limit access to opioid pain relievers.

The Responsible Use of Opioids?

In the face of a national opioid epidemic, is there still a place for narcotics for the relief of severe, otherwise largely uncontrollable, pain? The short answer is yes.

For specific people, in specific circumstances, and under specific conditions, opioid pain relief is more than an option. It’s a necessity. When a patient is experiencing extreme, intractable, and rebound pain, to deny treatment with opioids may well be both cruel and dangerous.

At the same time, however, prescribing opioids without a clear, careful, and precise plan in place to mitigate the risk of addiction is equally inhumane and reckless. Responsible, ethical patient care demands that prescribes assess patients’ addiction risk and weigh those risks against the risks of opioid treatment.

Responsible use demands, for example, the prescribing of the lowest effective treatment dosages for the shortest possible duration. It also requires a protocol for weaning patients off the medication while substituting viable alternatives.

Additionally, it means ongoing patient monitoring during this weaning process. Incipient signs of addiction should be addressed immediately and aggressively, whether through in-patient or outpatient addiction intervention, ranging from medical detox to psychotherapy.

Pain Relief Alternatives

It’s naive and perhaps even cruel simply to abandon the use of opiates entirely. In some cases, opiates may be the only effective option for treating the most severe pain, like when a person is recovering from surgery or battling advanced-stage cancer. In these circumstances, narcotics may be only option strong enough to provide any measure of relief.

When circumstances aren’t quite so extreme, or when a diagnosis is non-terminal but chronic, then turning to opioids is likely not the best long-term solution. But giving up the opioids doesn’t mean giving up the hope for a life free of severe pain. You can still manage your pain and enjoy the quality of life you deserve without the narcotics.

As support for the legalization of marijuana continues to grow nationwide, researchers are increasingly seeking to understand the medicinal properties of marijuana and its components. CBD, in particular, has been linked to numerous health benefits, from reducing inflammation to relieving neuropathies. Best of all, unlike THC, the other major chemical found in marijuana, CBD doesn’t produce psychotropic effects.

Not only will you not get “high” from CBD or risk becoming addicted to it, but it has also proven effective in combating addiction. CBD is increasingly being used, in fact, to treat opioid withdrawal symptoms. This includes the use of CBD not only to manage the physical symptoms of withdrawal but also to fight the stress and anxiety that accompany opioid detox.

When it comes to using CBD products for pain relief or the treatment of opioid withdrawal symptoms, however, it’s essential to know which CBD-based products are best for your particular needs. “Full-spectrum” CBD, for example, includes terpenes, which are plant materials harvested along with the cannabis plant. These terpenes are said to enhance the effects of CBD, particularly its calming properties.

Exercise and Meditation

In addition to short-term opioid use or the incorporation of CBD products, there are also a number of lifestyle changes you can make if you are experiencing chronic pain. Daily meditation is a powerful way to relieve stress, and stress is notorious for worsening pain.

Likewise, gentle exercise, such as yoga or pilates, will not only relieve stress but will also increase flexibility and muscle strength. Your balance and coordination will improve, decreasing the risk of dangerous falls, and your joints, bones, and muscles will have more stability. The result: less musculoskeletal and neuropathic pain.

The Takeaway

For far too many of us, pain is a fact of daily life and the origin of today’s deadly opioid epidemic. However, chronic pain doesn’t have to rob you of your joy. It doesn’t have to steal your life. There are options for managing chronic pain, both with and without opioids. All that’s required is a little bit of knowledge and a lot of hope and perseverance.

The post Navigating Pain Relief With and Without Opioids appeared first on The Treatment Specialist.

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mama-forum-ch-blog · 5 years

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cHarmDate

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newyorktheater · 6 years

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Just a couple of plays are opening on Broadway this month — “Choir Boy,” and “True West” — and a handful Off-Broadway, but January is one of the most robust months for theater in New York, thanks in large measure to the January theater festivals.

Together these festivals offer more than 100 shows; most are experimental, often hybrids that redefine what theater is, and are difficult to describe; many run for only one or two performances Below is a selective list of Broadway, Off-Broadway, Off-Off Broadway and festival offerings in January, organized chronologically by opening date (or, for a festival show and some Off-Off Broadway, the first performance), with each title linked to a relevant website. Color key: Broadway: Red. Off Broadway: Black or Blue.. Off Off Broadway: Green. January theater festival: Orange. Immersive: Magenta Below that, links to the home pages of five of the festivals. (I’ve created the immersive category more as incentive for the adventurous rather than a warning, although such a show often means lots of standing, and some unusual interaction that some might find uncomfortable.)

January 2

Baba Brinkman’s Rap Guide to Consciousness (Soho Playhouse)

This latest piece by “Peer reviewed rapper” illuminates the neuroscience of human experience, from sensations to hallucinations. I’ve seen his rap guides to religion and to climate chaos; they were packed with information.

January 3

HEAR WORD! Naija Woman Talk True (Under the Radar) The show celebrates women who have broken the culture of silence, challenged the status quo, and moved beyond barriers to achieve solutions.

Manual Cinema’s Frankenstein (Under the Radar) The gothic classic, combine with a biography of its author Mary Shelley, told through the company’s signature handmade shadow puppetry, and makeshift cinematic techniques

Nature and Purpose (Soho Playhouse)

Two shows focusing on the abstract expressionist Jackson Pollock and the controversial performance artist Chris Burden.

January 4

Tania El Khoury

Tania El Khoury’s As Far As My Fingers Take Me (Under the Radar) immersive

An encounter through a gallery wall between a refugee and one audience member at a time. The refugee will mark the audience member’s arm by drawing on it.

[50/50] old school animation (Under the Radar)

A ghost story that “flirts with the horrific and dips into the surreal. “

The Cold Record (Under the Radar) immersive A one-man show from the Rude Mechs. “The story of a 12-year old boy who tries to set the record for leaving school the most days with a fever and in the process falls in love with the school nurse and breaks his heart on the punk rock.”

Minor Character (Under the Radar) This kaleidoscopic adaptation of Uncle Vanya collages a century’s worth of English translations into one sprawling, intimate, quietly disastrous evening.

Dueted: What Holds Head (Exponential Festival) immersive A site-specific, interactive performance on intimacy, fidelity, and desire, comprised of a sequence of one-on-one experiences between a single attendee and a performer.

January 5

Pancho Villa from a Safe Distance (Prototype)

A bilingual cross-border multimedia opera about the enigmatic general, legendary bandit, and hero of the Mexican Revolution. Created by Austin, TX based composer Graham Reynolds, librettists Lagartijas Tiradas al Sol of Mexico City, director Shawn Sides of Rude Mech, two vocalists and six instrumentalists.

4.48 Psychosis (Prototype)

Philip Venable’s operatic adaptation of Sarah Kane’s final play, with 28 fragmented episodes to reveal an individual’s struggle to come to terms with their own psychosis. A production from the Royal Opera.

Real (The Tank) This play by Brazilian playwright Rodrigo Nogueira, tells two stories that eventually intertwine of two people living in New York 85 years apart — a working mother in 2019 who takes up an instrument she used to play and reassesses her life, and a gay immigrant composer in 1934 who in the process of writing a fugue starts to feel he’s meant to live somebody else’s life.

Ink (Under the Radar)

A mash-up of an art history lecture, personal essay, and electronic music concert, this piece is a love letter to the Metropolitan Museum of Art, where it is performed

January 6

prism (Prototype)

Opera-Theater composed by Ellen Reid about a traumatized mother and daughter who attempt to escape the past by retreating into a single room.

January 7

Blue Ridge (Atlantic) In this play by Abby Rosebrock set in Southern Appalachia, Marin Ireland portrays a progressive high-school teacher with a rage problem retaliates against her unscrupulous boss and is sentenced to six months at a church-sponsored halfway house, where she attends to everyone’s recovery but her own.

January 8

Choir Boy (MTC’s Samuel Friedman) Written by Tarell Alvin McCraney (best known for the Oscar-winning movie “Moonlight”) and transferring from MTC’s Off-Broadway theater: For half a century, the Charles R. Drew Prep School for Boys has been dedicated to the education of strong, ethical black men. Jeremy Pope reprises the role he had in the Off-Broadway production as a gay youth whose appointment as head of the school’s legendary gospel choir sparks tension.

January 9

This Bridge Called My Ass (American Realness)

Six Latinx performers – Alvaro Gonzalez, John Gutierrez, Miguel Gutierrez, Xandra Ibarra, Nibia Pastrana Santiago, and Evelyn Sanchez Narvaez – map an elusive choreography of obsessive and perverse action within an unstable terrain of bodies, materials and sound….Clichéd Latin-American songs and the form of the telenovela are exploited to show how familiar structures contain absurdity that reveal and celebrate difference.

Evolution of a Sonero (Under the Radar)

The first full-length show by poet, singer, and actor Flaco Navaja, original member of the Universes and Def Poetry Jam cast

January 10

Chambre Noire (Under the Radar)

Life-sized puppets, broken songs and video-projections come together to illuminate the hallucinatory final moments of Valerie Solanas, the woman who shot Andy Warhol

Wendell & Pan (The Tank) A play by Katelynn Kenney. Life’s hard when you’re 11, your only friend is the ghost of your 12-year-old dead aunt, your sister wishes she could be on the other side of her cellphone, your parents make every room frigid, and your sick grandpa wants you to kill him.

January 11

Minefield (Under The Radar) Combining theater and film, Lola Arias brings together British and Argentinian veterans of the Falkland Islands/Islas Malvinas war to share their first-hand experience of the conflict and life since.

January 15

Mortality Machine (Sinking Ship Creations at Wildrence) immersive This live-action roleplay makes each theatergoer the protagonist of the story, assigned an identity as a surviving family member of one of the five people who died in an illegal medical experiment five years earlier. The survivors have now gained access to the laboratory, and through interaction with “peculiar individuals who’ll help you tell your tale using dance and movement.

January 17

Behind the Sheet (EST)

Playwright Charly Evon Simpson confronts the history of a great medical breakthrough by telling the forgotten story of a community of enslaved black women who involuntarily enabled the discovery. In 1840s Alabama, Philomena assists a doctor – her owner – as he performs experimental surgeries on her fellow slave women, trying to find a treatment for the painful post-childbirth complications known as fistulas.

January 23

A Man for All Seasons (FPA at Theater Row)

A revival of the 1961 play by Robert Bolt: “As Sir Thomas More refuses to recognize Henry VIII’s divorce and ascendancy as Supreme Head of the new Church of England, A Man for All Seasons reveals the risk of speaking truth to power and the clash that follows when fierce political will collides with deep moral conviction.”

January 24

True West (Roundabout’s American Airlines) Ethan Hawke stars opposite Paul Dano in a revival of Sam Shepard’s play about the clash between two brothers.

10th Annual 10-Minute Play Program (The Fire This Time)

January 28

Banigold II (Exponential)

“This hybrid puppet-video performance lazily examines stoic philosophy and is live scored by Lucy Hollier & co. with original animations from Unimercial Studios.” One of five short works presented together as part of Exponential Variety 2 at The Glove experimental art space in Bushwick.

January 29

God Said This (Primary Stages at Cherry Lane) An award-winning play by Leah Nanako Winkler about five Kentuckians facing mortality in very different ways. “With her mom undergoing chemotherapy, Hiro, a NYC transplant, returns home to Kentucky after years away, struggling to let go of the demons she inherited.”

January Theater Festivals

For a complete list of Theater Festival offerings, check them out individually

Under the Radar January 3 – 13

The Public Theater’s festival is the oldest (at 15) and largest, and tilts towards international productions.

American Realness January 4 – 13 “Fifty-nine performances of sixteen performance works from seventeen artists over ten days at twelve venues in Manhattan, Brooklyn, Queens and The Bronx.“ It’s primarily dance.

Exponential Festival January 4 – February 3

Spread out over nine venues in Brooklyn, the festival is “dedicated to New York City-based emerging artists working in experimental performance.”

Prototype January 5 – 13

In its seventh season, it is presenting 12 works of opera-theater

The Fire This Time Festival January 21 – February 2

The festival marks its tenth year of providing “rising playwrights of African and African American descent a platform to write and develop new work.”

January 2019 New York Theater Openings: 2 on Broadway, 100 in January Theater Festivals Just a couple of plays are opening on Broadway this month -- "Choir Boy," and "True West" -- and a handful Off-Broadway, but January is one of the most robust months for theater in New York, thanks in large measure to the January theater festivals.

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rehabherelive · 6 years

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10 Steps to Surviving Your First Few Months as a New Grad PT in the Acute Care Setting

1. It’s Ok to be confident in acute care

While in the very beginning you may have a mentor or someone to supervise your first few weeks, after that you’re on your own. It’s ok to be confident. You graduated from an accredited program, just like all of your co-workers. You’ve got your license (or not, but it’s on its way!). You won’t know the answer to everything and you don’t have to. More on that later. What you don’t want to do is demonstrate confusion or uncertainty in front of patients.

Scenario: You walk into a patient’s room, and they are frustrated that the doctor has not come in to speak with them yet. The patient wants to know about the x-ray results and blood draw they took this morning.

Best Practice: As a PT you are trained to read and interpret these results as they relate to the safety of mobility. It is not your job to report these results to the patient. The best way to handle this situation is to:

Introduce yourself, and explain why you are there.

Repeat the patients question back to them, to show you heard their concerns.

Inform the patient while the doctor is the one who will come in to discuss the results with them, you will follow up with the nurse to see how long it will be.

2. Get to know the nurses and patient care technicians

It goes without saying that the nurses and patient care technicians (PCTs) are the most important staff on the floor. Your working relationship with this staff can make your job easier or harder. The best advice I ever got from a CI was to take time to introduce myself to all the nurses and PCTs as I went through my caseload for the day. This shows the nurses and staff that you care to get to know them. I also make sure to check in with the staff (nurse or PCT) if it is a good time for me to work with a patient. They will know whether a patient has a procedure coming up, had a bad night and may be too tired, in too much pain, or is speaking with the doctor. While also saving you potential time, they will appreciate the time you took to consult them.

Case Managers/Discharge Planners (CMs) are also an important part of the team. As a PT, you will be spending a significant time working with CMs to create a safe discharge plan for your patients. Sometimes these are complex and require unique strategies, especially if the patient or family refuses to go the route of a skilled nursing facility. CMs also appreciate a heads up if you get to the patient first and the discharge process might be complex, or the original plan has changed. CMs are also a great informational resource, and can provide materials and education for patients and their families on what support services are available in the patient’s area, or what their insurance will cover.

3. Listen to your gut

It’s ok to be cautious, especially as a new grad learning the ropes. We are trained to recognize, disseminate, and evaluate if the patient is safe to mobilize. Sometimes you will disagree with doctors, nurses, and other staff on the relative safety of the patient participating in PT. Things like hypotension, hypertension, anemia, and goal coagulation can affect the safety and therapeutic benefit of mobility in the acute care setting. It is your primary job to be an advocate for your patient and their safety. You also have the right, as an autonomous licensed health care practitioner, to refuse to treat the patient on the grounds of safety.

Scenario: As part of your evaluation of a patient post-operative day 0 for total knee arthroplasty, you take baseline blood pressures in a rest position. This will allow you to evaluate the response to exercise, and potential post-operative effects of anesthesia. Noticing the BP is lower than the pts pre-operative numbers, and an orthostatic change to sitting coupled with dizziness and lightheadedness. You report these findings to the nurse, and that with positive orthostatic it is unsafe to stand or walk with the patient. The nurse responds that this is normal after surgery and to just get them up anyways.

Best Practice: Say “Due to the objective blood pressure findings, and the patient’s symptoms, it is not safe to stand with this patient at this time. It would be ok later this afternoon/tonight if the blood pressure improves and they don’t feel dizzy with change in position.”

At the end of the day, you are the one responsible for the patient’s well-being and safety during your sessions. Trust your Gut!

4. Don’t recognize the lab values or chart information?

LOOK IT UP! You are not going to be able to remember all the lab values and their respective effect on safety with mobility or radiology reports. That is ok! This isn’t like a school exam, practical, or board exam. If you are not already a member of the American Physical Therapy Association’s Academy of Acute Care of Physical Therapy, now is a good time to add the section to your membership renewal. To do so, login to The American Physical Therapy Association website, click “Go To MyAPTA”, and scroll down to the Membership section to add other sections.

Once you are a member, you will have access to great resources like Clinical Practice Guidelines, Core Competencies, and Laboratory Values Interpretation Resource to help guide your practice.

5. Take time to learn about other disciplines in the hospital

Acute Care is an interdisciplinary environment. Besides our rehabilitation counterparts like Occupational Therapists and Speech Language Pathologists, you will find yourself working with specialty nurses (wound care, cardiac educators, etc), respiratory therapists, chaplains, behavioral health professionals, social workers, and palliative care — just to name a few. As a new grad you need to learn more about these other services in order to make appropriate recommendations if the patient needs other services. Reach out to your manager and see if you can spend a hour or two shadowing these other disciplines to get a better understanding of what they do.

This will help when working with patients, as they often have questions about their care, and what specialties they are working with. You also may find yourself at times working side by side with these professionals in co-treats.

Observing Surgery. If your hospital allows it, do it. Patients often have lots of questions, and they do not always remember to ask the doctor, physician assistant, or nurse. This will allow you to answer basic questions about the surgery.

Word of Caution: This is for basic questions and understanding about surgery. Something simple like “Did they use staples or sutures?” for example.

6. Working with a more seasoned staff; it’s a two-way learning street

Your co-workers will have a wealth of clinical experience and understanding of hospital culture to share with you. Be open minded about what they have to say! Just because it doesn’t match up with what you learned in school doesn’t mean that it’s wrong. Many of your co-workers will be quick at recognizing patterns with patients, presentations, and understanding the doctors in your hospital. This will be key to survival in your early days until you develop your own tool kit. They are also your key to introductions with other staff, remember what I said about the nurses earlier?

Don’t be afraid to share your experiences in school and what you have learned. Your coworkers have a wealth of clinical experience, maybe because they have been in the field for the last 20 years, but you can provide a different perspective and understanding as a result of newer evidence taught in school. You are just as capable of teaching them new things as they are of teaching you.

This isn’t a ding against them! The profession has changed, and so has the standard curriculum, meaning you learned more in school than they did when they got their degree. In most cases you will find that your co-workers are willing to hear about what is new in the PT world. Offer to explain what you learned in school, read in recent research, or learned at another clinical, and its implications for PT in the hospital. Maybe you will find it easier to present via an in-service for the staff or create a competency.

On the other hand, sometimes that staff may be resistant to changing the department culture and adjusting methods of practice to follow evidence-based recommendations. Rome wasn’t built in a day, and don’t expect to make a major, or even minor department change in one day, one month, or even one year.

7. Building a relationship with your manager

The better relationship you have because of open honest communication, the smoother both of your lives will be. I asked my manager what I could do to make her job easier if she hired me during the interview. Right from the bat I wanted to show her that I was serious not only about this job but working with her to make our department better.

Want to learn what other questions I asked to show my manager how much I wanted it, and the kind of employee I’ll be? Read up on these common acute care physical therapy interview questions!

Her response? “Open and honest communication. You are human, and humans have bad days, humans have families that have emergencies, sometimes patients take an emotional drain on you as you support them.” She went on to say that she wanted me, especially as a new grad, to feel comfortable coming to her even with silly questions, because she would rather help me understand and work through it together, than make me feel like I had to figure it out on my own.

I took this to heart and have since made sure to bring stuff that I do not understand to her attention, or questions about hospital policy and procedure. Most recently it was a legality issue when dealing with a particularly difficult patient. She was happy to work through the chart and note I wrote with me and identify better ways in which to word my note, and prevent opening up the hospital, or myself, to a lawsuit.

Don’t be afraid to ask for help with assessments/notes, and having your manager spot check them will help you become a better therapist!

8. The low down on productivity

Hopefully in your interview you were upfront with asking what the productivity expectations were for full time staff, and more importantly, what the expectations are for a new grad.

If you did not get that information during your interview, check in with your manager as soon as possible. Nothing can overwhelm a new grad more in any setting than high productivity expectations, especially while trying to learn how to manage a full caseload independently for the first time.

My manager gave me the best advice when it came to productivity in acute care. “It’s called acute care for a reason. Sometimes the patients are so acutely ill or injured they are not appropriate for therapy or cannot tolerate a 30 min session.” She went on to say that as a manager, she gets that there are some days or weeks when all the patients just seem to be inappropriate for therapy.

For example, it could be 3pm on a Wednesday, and as a new grad you’ve seen only 3 patients and charged for only 5 units because 2 are not stable enough and one refused. This is ok! Even season PTs have days like that where the luck of the draw just isn’t there.

Don’t quite understand productivity or why it’s important to a hospital/clinic? Read up on productivity and why you should care.

9. The Golden Rule: treat patients how you want to be treated

Above all else, remember that you are sometimes a patient’s first encounter with a rehab professional at a time when they are at their most vulnerable, exposed, and uncomfortable. Treat them how you would want your family members or you to be treated.

Introduce yourself and say goodbye with a hand shake. Do this at their eye level if possible, find a chair or get down on a knee. Patients will feel more comfortable speaking with someone eye to eye with them, then someone towering over them in the bed.

A nurse once told me that a lot of her male patients feel so much better after she offers to give them a shave, because it makes them feel human again! Treating them like a human being shows your patients that you care. Offer to get them a warm blanket, extra pair of socks, ask their PCT to get them a shower, or help them get pants on if they can.

10. Self-care

This is something they don’t teach you about in school, but in order to take care of patients, you have to take care of yourself. There are many times in the hospital that as a PT, your patients’ stress becomes your stress.

You will lose patients, patients will be difficult and not listen to you, family members will project their feelings onto you or express their displeasure at the care you provide. Other times you just happen to get patients that have extensive psychiatric histories that will drain you emotionally and mentally as well as physically. It’s important to have a good relationship with your co-workers if you need to vent or talk through an issue. Having a good relationship with your manager can also provide you with an outlet to talk through difficult cases, like I mentioned about above.

Try not to bring your work home with you. It can be hard after a long day and difficult patients, but home is a place to rest, relax, recoup. Take time for yourself, find a hobby, get regular massages, workout, hang out with friends, or go see a movie.

Chances are if you are reading this you haven’t done something for yourself in well over a few months. So close your computer, close your internet browser on your phone, text a friend or go out and treat yourself!

The post 10 Steps to Surviving Your First Few Months as a New Grad PT in the Acute Care Setting appeared first on NewGradPhysicalTherapy.com.

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newsintodays-blog · 6 years

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Plastic surgery videos on YouTube aren't always accurate

New Post has been published on http://newsintoday.info/2018/08/24/plastic-surgery-videos-on-youtube-arent-always-accurate/

Plastic surgery videos on YouTube aren't always accurate

(Reuters Health) – YouTube videos about facial plastic surgery procedures garner hundreds of millions of views – but they often present inaccurate medical information, a new study found.

Viewers often get biased information, unbalanced evaluations of a procedure’s risks and benefits, and narrators with unclear qualifications, the study authors report in JAMA Facial and Plastic Surgery.

“When talking to my patients about (nose surgery), for instance, they’ll tell me what they know based on online videos, and oftentimes it’s not really what I do for a procedure,” said senior author Dr. Boris Paskhover of Rutgers New Jersey Medical School in Newark, in a phone interview.

“The information isn’t patient-specific and it doesn’t focus on the risks of a procedure,” he said. “Many videos only focus on how the nose will look, and they’re often superficial.”

Paskhover and colleagues evaluated the top 240 videos related to plastic facial surgery on YouTube, including blepharoplasty (eyelid surgery), dermal fillers, facial fillers, otoplasty (ear surgery), rhytidectomy (a facelift), lip augmentation, lip fillers, and rhinoplasty (nose surgery). For each video, the researchers determined the board certification status of narrators by using the American Board of Medical Specialties database. They classified the videos as created by a health professional, patient or third party.

They also evaluated each video using the DISCERN criteria, which rates consumer health information based on whether it’s clear, relevant, sourced, balanced, unbiased, describes risks and benefits, explains areas of uncertainty, and provides additional information sources. On a 1-5 scale, low scores indicate a low overall video quality. Overall, the videos had an average score of 2.21.

Among the videos, the research team found the term “nose job” received the most views with more than 56 million views for the top 10 videos and an average of 2.8 million views per video. Nose surgery videos had a DISCERN ranking of 2.1 overall.

Blepharoplasty, or eyelid surgery, videos had the highest quality rating at 2.75, followed by the search term “facelift,” with a score of 2.4.

“I tell my patients that 50 percent of what’s online – YouTube or otherwise – is wrong, and 49 percent is correct but completely irrelevant to your particular situation,” said Dr. Philip Miller of Gotham Plastic Surgery in New York City. Miller, who wasn’t involved with this study, creates online videos for patients but also recommends talking to a doctor about the specifics of a procedure.

“By all means, educate yourself, but what’s on your monitor shouldn’t take on the power of authority,” he told Reuters Health by phone. “When it comes down to it, have a great relationship with your doctor and let your doctor guide your care.”

Patients should know the weaknesses of videos in other medical specialties, too. In a 2017 study, researchers found that YouTube videos about brachytherapy, a radiation oncology procedure used to treat cancer, often had a strong commercial bias.

“As is common with many procedures in medicine, sometimes it is easiest to see a video of how the procedure is carried out rather than reading a pamphlet or a consent form,” said Dr. Arpan Prabhu of the University of Pittsburgh Medical Center in Pennsylvania. Prabhu, who wasn’t involved with this study, was the lead author on the brachytherapy study.

“There’s a significant need for quality videos to be created and uploaded,” he told Reuters Health by email. “We hope to be part of the solution in the future.”

In the facial plastic surgery study, researchers saw a difference between the scores of videos with medical professionals versus those without.

Overall, however, most videos didn’t include information verified by medical professionals.

“Online health-related information is for the most part unregulated, and consumers should bear this in mind and think about the source of the material they are viewing or reading,” said Dr. Trevor Kwok of the University of New South Wales in Sydney, Australia.

Kwok, who wasn’t involved with this study, has evaluated YouTube videos about varicose vein treatments.

“This is no longer an ‘emerging’ issue as the web and social media are already so ingrained in daily life,” Kwok said by email. “But our understanding of exactly how this affects healthcare consumers is lagging.”

SOURCE: bit.ly/2Py5u3U JAMA Facial Plastic Surgery, online August 16, 2018.

Our Standards:The Thomson Reuters Trust Principles.

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todaynewsstories · 6 years

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Plastic surgery videos on YouTube aren’t always accurate