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Discussions with the family focus on honoring patient wishes and attending to family fears and concerns about the end of life diabetic cookbooks purchase 25 mg acarbose with amex. Prepares family and other caregivers regarding how to recognize and manage common symptoms c diabetic diet 500 calories purchase 50mg acarbose free shipping. Reviews and confirms treatment decisions diabetes 500 effective 50mg acarbose, including potential transitions in care settings diabetes test when pregnant buy discount acarbose 25mg, and documents patient wishes and preferences d. Provides information and support to the family and others who are providing care to the patient 7. The care plan addresses the focus on end-of-life care and treatments to meet the physical, emotional, social, and spiritual needs of patients and families. Cultural and spiritual preferences of the patient and family are particularly relevant when developing this plan. Reassessment and revision of the plan occurs regularly, with the frequency identified in agency or program policies. Care of the patient at the end of life is time- and detail intensive, requiring expert clinical, psychological, social, and spiritual attention to the process as it evolves. Post-death care is delivered in a manner that honors patient and family cultural and spiritual beliefs, values, and practices. Clinical Practice Guidelines for Quality Palliative Care, 4th edition 47 Domain 7 a. Post-death care is in accordance with agency practice, local laws, and state regulations. Information and educational resources regarding grief, including the potential physical manifestations of grief c. Rituals that acknowledge loss and transition, provide opportunity for remembrance, and establish a sense of community 7. Grief and bereavement support and interventions are in accordance with developmental, cultural, and spiritual needs and the expectations and preferences of the family. Grieving children are referred to pediatric grief specialists, programs, and camps based on their age and needs. Emotional support services are also made available to ancillary team members involved in supporting palliative care patients. Operational Implications Caring for patients nearing the end of life may take place in any setting (eg, hospital, nursing home, assisted living facility, hospice inpatient facility, or at home). Decisions regarding preference and need for transitions in care settings may be required. Attention to patient comfort and wishes, as well as support to family members during the dying process are paramount operational concerns. Care near the end of life is often more intense than care earlier in the disease process, requiring increased visit length and frequency, as well as timely telephone response, to adequately care for patients and their families. Essential Palliative Care Skills Needed by All Clinicians Clinicians in all care settings who learn the hospice eligibility criteria can make timely referrals to hospice. In addition, clinicians can improve patient care by learning how to assess and manage physical symptoms common among patients nearing the end of life. All clinicians must have the knowledge and skills to talk to patients and families about dying. The evidence tables in the systematic review describe the key findings of each included review. The perinatal and neonatology teams provide training for all staff in palliative care, and a team of prenatal/neonatal clinicians, including social work, physicians, nurses, child life, and chaplaincy, have become the leaders for this care. This team has developed protocols for symptom management, and converted a hospital room dedicated to imminently dying infants to provide privacy and support. Practice Example D7-B A large renal dialysis group has several dialysis centers located in urban and rural settings. They identify that few of their patients are referred to hospice, and most are dying in acute care settings (often in intensive care). They receive complaints from families who felt ill-prepared for the sudden death of their loved one.

In such a circumstance diabetes type 2 and fatigue purchase 25mg acarbose overnight delivery, an eyewitness may not be asked to identify a perpetrator until months after the commission of the crime-and often after repeated probes of her or his memory by diabetes fruit acarbose 25mg lowest price, for example diabetes symptoms nails order 50mg acarbose with amex, police diabetes in dogs with cushing disease 25 mg acarbose overnight delivery, family members, and others. The police may, for example, use photo arrays and confirmatory single photographs to clarify the legal identity (birth name/government name) of an individual who is well known to a witness, but only by a street name. In such examples, a witness may know (and may have known) the perpetrator for years but may only be able to identify him by a common generally, the International Association of Chiefs of Police, "National Summit on Wrongful Convictions: Building a Systemic Approach to Prevent Wrongful Convictions, " August 2013. This chapter reviews the eyewitness identification procedures commonly used by the police and concludes with a brief discussion of situations in which citizens engage in identifying perpetrators without police assistance. An officer might create an array by selecting photographs of persons deemed to resemble the perpetrator. Officers might also create photo arrays by cutting six square holes in a folder and taping the photographs to the back of the folder so that the faces of the fillers (non-suspects) and suspect are displayed together. When such photographs are presented simultaneously as a two by three matrix, this type of array is referred to as a "six pack. Department of Justice, Eyewitness Evidence: A Guide for Law Enforcement, 7 one of the earliest efforts to establish standardized procedures for police-arranged eyewitness identification. The guide set forth rigorous criteria and basic procedures to promote accuracy in eyewitness evidence. Today, many police departments use computer systems to access image databases and assemble photo arrays. If an officer determines that a photograph in the array is suggestive or otherwise inappropriate, she or he can reject one or more fillers and instruct the system Executive Research Forum, "A National Survey of Eyewitness Identification Procedures in Law Enforcement Agencies, " March 2013, p. Departments may conduct the procedure without revealing to the witness how many photographs she or he will view. In recent decades, many police agencies and prosecutors have adopted sequential presentation of photographs, based on the belief that this approach improves the performance of an eyewitness. Currently, however, there is no consensus among law enforcement professionals as to whether the sequential presentation procedure is superior to the simultaneous procedure (see Chapter 5). The District of Columbia Metropolitan Police Department, for example, does not endorse either simultaneous or sequential procedures in its Procedures for Obtaining Pretrial Eyewitness Identification. However, the committee is unable to determine the percentage of police departments that have adopted policies for eyewitness identification procedures and instituted training in these procedures. In cases where such a double-blind procedure is Metropolitan Police-District of Columbia, General Order-Procedures for Obtaining Pretrial Eyewitness Identification, April 18, 2013. In one common "blinded" procedure, the officer places each photo in a separate envelope or folder and then shuffles the envelopes/folders so that only the witness sees the images therein. Additional recommendations to minimize the possibility of biasing feedback to the witness include requiring that the officer read instructions to the witness from a pre-printed form. Based upon information presented to the committee, it appears that police departments do not always document identification procedures in instances when an identification is not made. Further, if a witness does make an identification, practices differ as to how such information is documented and preserved. Some agencies, for example, require officers to document this information in a written report. Fillers are selected for their physical similarities to the suspect (gender, race, hair length and color, facial hair, height, skin tone, and other distinguishing features). Traditionally, the suspect and fillers are seated or stood in a row, and the witness views the lineup from behind a two-way mirror. Live lineups are used in some jurisdictions, but they are not the predominant method used by law enforcement. First, in certain circumstances, legal counsel may be required at a lineup, thereby making it less attractive to police and prosecutors. Second, in smaller jurisdictions, it may be difficult to obtain suitable fillers. This evidence has influenced how scientists carry out their experiments, resulting in the use of blind or double-blind procedures to control for this form of bias. Blind assessmentb has been used since the late 18th century; an early medical trial in 1835 used double-blind assessment, and psychologists started using blinding in the 20th century.

When deciding which main points metabolic disease in newborns symptoms buy acarbose 25 mg with mastercard, facts diabetes insipidus foundation acarbose 25 mg discount, and examples to include blood glucose 70 cheap acarbose 25mg, you should simply ask yourself whether they are relevant not only to the topic you have selected diabetes medications herbal purchase acarbose 50 mg with visa, but also whether they support the goal you outlined in your purpose statement. The general purpose statement of a speech may be to inform, to persuade, to inspire, to celebrate, to mourn, or to entertain. Thus, it is common to frame a specific purpose statement around formulating the purpose statements the specific purpose statement is a tool that you will use as you write your talk, but it is unlikely that it will appear verbatim in your speech. Instead, you will want to convert the specific purpose statement into a thesis statement that you will share with your audience. A thesis statement encapsulates the main points of a speech in just a sentence or two, and it is designed to give audiences a quick preview of what the entire speech will be about. The thesis statement for a speech, like the thesis of a researchbased essay, should be easily identifiable and ought to very succinctly sum up the main points you will present. Moreover, the thesis statement should reflect the general purpose of your speech; if your purpose is to persuade or educate, for instance, the thesis should alert audience members to this goal. The bog turtle enthusiast might prepare the following thesis statement based on her specific purpose statement: Bog turtle habitats are sensitive to a variety of activities, but land development is particularly harmful to unstable habitats. The Clarke County Zoning Commission Once you have finished the important work of deciding what your speech will be about, as well as formulating the purpose statement and crafting the thesis, you should turn your attention to writing the body of your speech. All of your main points are contained in the body, and normally this section is prepared well before you ever write the introduction or conclusion. The body of your speech will consume the largest amount of time to present; and it is the opportunity for you to elaborate on facts, evidence, examples, and opinions that support your thesis statement and do the work you have outlined in the specific purpose statement. Combining these various elements into a cohesive and compelling speech, however, is not without its difficulties, the first of which is deciding which elements to include and how they ought to be organized to best suit your purpose. In other words, the main points are what your audience should remember from your talk. Unlike facts or examples, main points are broad and can be encapsulated in just a sentence or two and represent the big ideas you want to convey to your audience. In general, speeches contain two to seven main points (Bower, 1990) that collectively lead to some understanding by the end of the speech. For informative speeches, main points might include historical details that advance a particular understanding of an event. For a persuasive speech, however, your main points may be your separate arguments that, when combined, help to make your case. Parallel structure refers to main points that are worded using the same structure, perhaps by starting with a common introductory clause (Verderber, Verderber, & Sellnow, 2008). All of these things make up the sub-points, which are used to help prove the main points. Before you do so, however, it is helpful to consider how you will organize the ideas. From presenting historical information in chronological order as part of an informative speech to drawing a comparison between two ideas in a persuasive speech to offering up problems and solutions, there are many ways in which speakers can craft effective speeches. These are referred to as organizational styles, or templates organizational styles When you speak about events that are linked together by time, it is sensible to engage the chronological organization style. In a chronological speech, main points are delivered according to when they happened and could be traced on a calendar or clock. Arranging main points in chronological order can be helpful when describing historical events to an audience as well as when the order of events is necessary to understand what you wish to convey. Informative speeches about a series of events most commonly engage the chronological style, as do many demonstrative speeches. For instance, a speech about Oprah Winfrey might be arranged chronologically (see textbox). Organizing the speech in this way illustrates the interconnectedness of life events. In a topical speech, main points are developed separately and are generally connected together within the introduction and conclusion. In other words, the topical style is crafted around main points and sub-points that are mutually exclusive but related to one another by virtue of the thesis.

At a minimum diabetes type 1 weight gain buy acarbose 25 mg with mastercard, patent challengers should be able to raise issues of novelty diabetes insipidus glucose discount 25 mg acarbose mastercard, nonobviousness diabetes vitamin d cheap 25 mg acarbose overnight delivery, written description managing diabetes 77 purchase acarbose 25 mg, enablement, and utility. For example, "[i]f the examiner does not produce a prima facie case [of obviousness], the applicant is under no obligation to submit evidence of nonobviousness. Patent applications have doubled in the last twelve years and are increasing at about 10% per year. An invention is "obvious" if it does not represent a sufficient step beyond the prior art. United States Patent and Trademark Office, Utility Examination Guidelines, 66 Fed. United States Patent and Trademark Office, Guidelines for Examination of Patent Applications under the 35 U. Lerner 2/20 at 157; James Langenfeld, Innovation, Competition, and Intellectual Property: Providing an Economic Framework (2/20/02) (slides) at 6, at. It does not seem sensible to treat an issued patent as though it had met some higher standard of patentability. We believe the "clear and convincing evidence" burden can undermine the ability of the court system to weed out questionable patents, 36 and therefore we recommend that legislation be enacted to amend the burden to a "preponderance of the evidence. The courts have developed a variety of tests to evaluate the obviousness of a claimed invention. Two in particular ­ Chambers 2/8 (Patent Law for Antitrust Lawyers) at 86 (hereinafter 2/8 (Patent Session)). In applying the "commercial success" test, 1) evaluate on a caseby-case basis whether commercial success is a valid indicator that the claimed invention is not obvious, and 2) place the burden on the patent holder to prove the claimed invention caused the commercial success. Under current standards, if the patent holder shows that the claimed features of the patent are coextensive with those of a successful product, then it is presumed that the invention ­ rather than other factors ­ caused the commercial success. The burden shifts to the challenger to present evidence to rebut that presumption. The patent holder is the best source of information on what has caused the commercial success of its product and should be required to show that, in fact, the claimed invention caused the commercial success. In applying the "suggestion" test, assume an ability to combine or modify prior art references that is consistent with the creativity and problem-solving skills that in fact are characteristic of those having ordinary skill in the art. The Supreme Court has advised that, in some circumstances, courts may consider the commercial success of a claimed invention to indicate that it was not obvious. For example, in some cases early in the twentieth century, courts found the commercial success of an invention that satisfied a long-felt need that had resisted the efforts of others to solve the problem tended to show the claimed invention was not obvious. Commercial success can result from many factors, however, some of which have nothing to do with the claimed invention. An undue reliance on commercial success to show nonobviousness can raise a number of competitive concerns. Commercially successful inventions may be more likely than others to occur even without the prospect of a patent. Patents on commercially successful products are more likely to confer market power than those on less successful products. The "suggestion test" thus asks a helpful question ­ that is, to what extent would the prior art "have suggested to one of ordinary skill in the art that this process should be carried out and would have a reasonable likelihood of success. Hearings participants expressed concern, however, with some recent applications of the suggestion test. Such an application of the suggestion test may have found that the claimed invention of the Selden patent ­ that is, putting a gasoline engine on a carriage ­ was not obvious, because there was no document that suggested that combination. The invention likely was obvious, however; "[e]verybody seemed to know that if you got a new engine of any kind, you would put it on a carriage. Requiring concrete suggestions beyond those actually needed by a person with ordinary skill in the art, 45 and failing to give weight to suggestions implicit from the art as a whole and from the nature of the problem to be solved, is likely to result in patents on obvious inventions and is likely to be unnecessarily detrimental to competition. Encourage the use of examiner inquiries under Rule 105 to obtain more complete information, and reformulate Rule 105 to permit reasonable follow-up. Some Hearings participants asserted that, far from holding back information, patent applicants tend to provide an examiner with numerous prior art citations, resulting in lots of "information, " but little "knowledge. As one panelist emphasized, "to get better quality and shrink the amount of work, " there is a need to seek more knowledge in the possession of applicants, who typically "know more about the technology than the examiner does, and [know] where you might find something that might be relevant. Recommendation 6: Consider Possible Harm to Competition ­ Along with Other Possible Benefits and Costs ­ Before Extending the Scope of Patentable Subject Matter. Section 101 of the Patent Act states, "Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent.

First diabetes diet hong kong proven acarbose 50mg, "What is empirically known about human response to color and how diabetes signs acarbose 50 mg online, if at all blood sugar readings buy acarbose 25mg free shipping, color influences human perception or behavior in a specific setting? To the second question diabetes type 1 advances order acarbose 50mg without a prescription, "Which color design guidelines for healthcare environments, if any, have been supported by scientific research findings? The answers may disappoint many, particularly practitioners in the healthcare design community because of the 27 expectations to identify theories, which could have had "supportable design implications for the use of color in healthcare design". Unfortunately, the results of the critical review of the pertinent literature on color produced very little scientific explanation for the issues at stake. Similarly to other fields, explanatory theories may help to predict outcomes of environmental interventions. Thus, analogous theories in color studies could, perhaps, predict how color might influence people in healthcare settings. Therefore, much of the knowledge about the implications of color in healthcare environments is based 28 on highly biased observations, and pseudo-scientific assertions. It is this inconsistent literature that has been spun to capriciously color trends in the healthcare market. Louis, Missouri Interior Designer: Directions in Design, 1997 28 Laboratory Anheuser Busch Eye Institute St. It addresses the chemical, physiological and psychological aspects of the study and application of color. It combines scientific explanations based on empirical studies with personal assumptions grounded in individual experiences and observations of human behaviors. The body of literature on color spans the disciplines of art, architecture, the physical sciences, behavioral sciences, and the combination of these fields. Obviously, some aspects of Color Theory are by definition objective, while individual reactions to color may be plainly subjective. First, since human reaction to color is based on freedom of choice it may preclude us from providing scientific explanation for much of our observations, because intentional human behavior cannot be explained in the same way we can explain natural phenomena. The reason is that color-selection, specification, and application are acts that are performed because of their meanings. While the definition of the term theory is not universally agreed upon, the volume of information that designers, artists, and color consultants consider as color theories have little in common with the attributes of explanatory theories as discussed, for example, by Rapoport (2000). Scholars distinguish between positive (analytic, predictive) theories and normative (creative) theories (Lang, 1987; Hillier, 1996). Theories in science are sets of general, abstract ideas through which we understand and explain the material phenomena the world offers to our experience. As Lang (1987) explains: "The scientific method provides rules for description and explanation, not for creation. A design may be derived from scientifically formulated positive theory, but this does not make it scientific. Normative theory is based on an ideology or world view even if this is not explicitly stated " (p. Because the design process is creative, it requires theories of possibility in the sense that they exist in art. However, because the design process is also predictive, it needs the analytic theories of actuality and possibility. Environmental design is based on a cyclical process that involves creative as well as predictive phases. The creative and predictive phases of the design process explain the need to use normative and analytic aspects of theories. The normative aspects of a theory tell the designer where to search for possible solutions in the creative phases, whereas the analytic aspects inform the designer how the solution will work. Like other theories in environmental design, color theories have too often been strongly normative and weakly analytic, that is, it has been too easy to use them to create guidelines and prescriptions for action, but they are too weak in predicting what the settings will be like when completed and how its colors will influence the users. The expectations for a "good theory" have been grounded in the idea that science is the only approach to explain and understand the world and the way it works. Replacing the intuitive design process, dominated by imagination, by using reason-based procedure, is not a new initiative.