A remembraunce of the precious vertues of the right honourable and reuerend iudge bipolar depression symptoms in women aripiprazola 20mg otc, Sir Iames Dier anxiety from marijuana buy aripiprazola 15 mg amex, Knight depression unipolaire definition cheap aripiprazola 15 mg overnight delivery, Lord cheefe Iustice of the Common Pleas depression tattoos purchase aripiprazola 15mg on line. A remembraunce of the life depression or something else test buy aripiprazola 15 mg on-line, death anxiety young living buy aripiprazola 10 mg low price, and vertues, of the most noble and honourable Lord Thomas late Erle of Sussex. A remembraunce of the wel imployed life, [and] godly end, of George Available for free at Connexions <cnx. A discourse containing a louing inuitation both honourable, and protable to all such as shall be aduenturers, either in person, or purse, for the aduancement of his Maiesties most hopeful plantation in the Nevv-found-land, lately vndertaken. A replie to Iesuit Fishers answere to certain questions propou[n]ded by his most gratious Matie: King Iames. The planters plea, or, the grounds of plantations examined, and vsuall objections answered. A discoverie of Brownisme, or, A brief declaration of some of the errors and abhominations daily practiced and increased among the English company of the seperation remayning for the present at Amsterdam in Holland. Exastichon hieron, sive jconum quarundam extranearum (numero 258) explicatio breviuscula & clara. A brief discovery of the dangerous principles of John Horne (a priest in Lin) and Thomas Moore junior. An epistle of consolation from the fresh springs of life, and owings forth of the Fathers love (through his servant) as a tender salutation extended to the whole ock and family of God; even to the lowest of his babes and servants, whose hearts are sincere and tender towards him: for their encouragement now in these suering and trying times. The he-goats horn broken, or, Innocency elevated against insolency & Viro, favore regio, et meritis suis honoratissimo, amplissimoque domino Available for free at Connexions <cnx. The apostate incendiary rebuked, and the people called Quakers vindicated from Romish hirarchy and imposition. Enthusiasm above atheism, or, Divine inspiration and immediate illumination (by God Himself) asserted. A brief account of some of the late and present suerings of the people called Quakers. The accuser of our brethren cast down in righteous judgment against that spirit of hellish jealousie. The Christianity of the people commonly called Quakers vindicated from antichristian opposition. The copy of a letter, lately written in meeter, by a yonge gentilwoman: to her unconstant lover. The humble address of the Widow Whitrowe to King William: with a faithful warning to the inhabitants of England. Alas poore scholler, whither wilt thou goe, or, Strange altrations which at this time be. The incomparable poem Gondibert vindicated from the wit-combats of four esquires, Clinias, Dametas, Sancho, and Jack Pudding. An essay upon the victory obtained by His Royal Highness the Duke of York, against the Dutch, upon June 3, 1655. The humble salutation and faithful greeting of the Widow Whitrowe to King Available for free at Connexions <cnx. Mathematicall magick, or, the vvonders that may be performed by mechanicall geometry. Ecclesiastes, or, A discourse concerning the gift of preaching as it fals under the rules of art. A catholicon, that is, A generall preservative or remedie against the pseudocatholike religion. And are to be sold in Pauls Churchyard at the signe of the Crowne by Simon Waterson [London, 1603]). And are to be sold in Pauls Church-yard [London] at the signe of the Sunne by Richard Bankeworth, [1607]). And are to be sold in Pauls Churchyard [London] by Richard Bankevvorth at the signe of the Sunne,[1607]). Hexapla in Danielem, that is, A six-fold commentarie vpon the most diuine prophesie of Daniel. A treatise of Salomons mariage, or, A congratulation for the happie and hopefull mariage betweene the most illustrious and noble Prince Frederike the V. Count Palatine of Rhine, Elector of the Sacred Romane Empire, and Arch-Sewer, and in the vacancie thereof Vicar Generall: Duke of Bauaria, &c. An antilogie, or, Counterplea to An apologicall (he should haue said) apologeticall epistle published by a fauorite of the Romane separation, and (as is supposed) one of the Ignatian A sermon preached before the king, upon the nineteenth of March, 1670/1. A declaration and publication of the most worthy Prince of Orange, contaynyng the cause of his necessary defence against the Duke of Alba. A supplication to the Kings Maiestie of Spayne, made by the Prince of Orange, the by which is declared the originall beginning of al states of Holland and Zeland, with all other his faithfull subiectes of the low Countreys, presently suppressed by the tyranny of the Duke of Alba and Spaniards: Maiesties speedy redresse and remedie. The declaration of His Highnes William Henry, by the grace of God Prince of Orange, &c. A declaration of the sense of the archbishops and bishops, now in and about London, upon the occasion of their attendances in Parliament. A key into the language of America, or, An help to the language of the natives in that part of America called New-England. A paraenetick, or, Humble addresse to the Parliament and assembly for (not loose, but) Christian libertie. The blovdy tenent, of persecution, for cause of conscience, discussed, in a conference betweene trvth and peace. Virgo triumphans, or, Virginia in generall, but the south part therof in Virginia, more especially the south part thereof, richly and truly valued. Protestant religion, and for restoring the lawes and liberties of England, Scotland and Ireland. The hirelings ministry none of Christs, or, A discourse touching the propagating the Gospel of Christ Jesus. Cultus evangelicus, or, A brief discourse concerning the spirituality and simplicity of New-Testament worship. A seasonable vvatch-vvord unto Christians against the dreams & dreamers of this generation. The Scriptures genuine interpreter asserted, or, A discourse concerning the right interpretation of Scripture. A true coppie of a discourse written by a gentleman, employed in the late voyage of Spaine and Portingale. A letetr [sic] vvritten by Captaine Edvvard Winne, to the right honourable, Sir George Caluert, Knight, his Maiesties principall secretary. Good nevves from New-England, or, A true relation of things very remarkable at the plantation of Plimoth in Nevv-England. The danger of tolerating levellers in a civil state, or, An historicall narration of the dangerous pernicious practices and opinions wherewith Samuel Gorton and his levelling accomplices so much disturbed and molested the severall plantations in New-England. A declaration of former passages and proceedings betwixt the English and the Narrowgansets, with their confederates. A short story of the rise, reign, and ruin of the Antinomians, Familists, and libertines that infected the churches of New-England and how they were confuted by the assembly of ministers there. The last blast of the trompet of Godis vvorde aganis the vsurpit auctoritie of Iohne Knox and his Caluiniane brether intrudit precheouris etc. The design of part of the book of Ecclesiastes, or, the unreasonableness of mens restless contentions for the present enjoyments. The times mended, or, A rectied account of time, by a new luni-solar year, the true way to number our days. An appendix to the Life of the Right Revd Father in God Seth, Lord Bishop of Salisbury. A paraphrase upon the Canticles, and some select hymns of the New and Old Testament. A short collection of the most remarkable passages from the originall to the dissolution of the Virgina company. Hypotyposis hygiainonton logon, a form of sound words, or, A scriptureThe true honor of navigation and navigators, or, holy meditations for sea-men. Whyte dyed black, or, A discouery of many most foule blemishes, impos- tures, and deceiptes, which D. A letter sent to the Honourable George Lord Digby in Flushing from a worthy gentleman in Windsor, January the 24, 1641. Eleutherosis tes aletheias, truth asserted by the doctrine and practice of the apostles, seconded by the testimony of synods, fathers, and doctors, from the apostles to this day. A parallel betweene Robert late Earle of Essex, and George late Duke of Buckingham. The state of Christendom, or, A most exact and curious discovery of many secret passages and hidden mysteries of the times. A sermon preached before the Kings Maiestie on Sunday the seventeenth of February last, at White-Hall. Bishop Wrens petition to the Parliament in defence of episcopacie in the behalf of himself and the rest of the bishops. The dvtie of Sir Francis Wortley deliniated in his piovs pitty and christian commiseration of the sorrowes and suerings of the most vertuous yet unfortunate Lady Elisabeth Queene Available for free at Connexions <cnx. Pamphilia, to Amphilanthus: A Sonnet Sequence from the Countesse of Mountgomeries Urania. Sir Thomas Wrothe his sad encomion, vpon his dearest consort, Dame Margaret Wrothe. Newly and diligently corrected with many proper ballades newly amended, and also added therunto which haue not before bene imprinted. Certaine serious thoughts which at severall times & upon sundry occasions have stollen themselves into verse and now into the publike view. Peter in York, March the 8th, 1685/6, before the Right Honourable Sir Edward Nevill and Sir Henry Bedingeld. A sermon preached before the Right Honourable the lord mayor and aldermen of the city of London. A sermon preached before the Right Honourable the Lord Mayor and aldermen at Guild-Hall Chappel, February 4, 1682. The great advertisement, that a religious life is the best way to present happiness. A hopefull way to cure that horrid sinne of swearing, or, An help to save swearers if willing to be saved. Philarguromastix, or, the arraignment of covetousnesse, and ambition, in our great and greedy cormorants. The whole duty of a Christian, or, the character of a true beleever, that walks in some measure answerable to the Gospel, his Christian profession, and the millions of mercies he hath received. The prevention of poverty, together with the Cure of melancholy, alias discontent, or, the best and surest way to wealth and happiness. The impartial monitor, about following the fashions, or, the sweet fruit of sharp reprehension. Armour of proof, or, A soveraign antidote, against the contagion of evil A sermon preached before the Queen at White-Hall, on Easter-Day, 1693. The blemish of government, the shame of religion, the disgrace of mankind, or, A charge drawn up against drunkards. The discouerie and conquest of the prouinces of Peru, and the nauigation in the South Sea, along that coast. Its code generation tools and scaolding make it ideal for fast and exible prototype development. Developing simple features for a web application follows a very specic process in Ruby on Rails, and, since Rails handles a lot of the steps along the way for you, you save time. For example, forms that allow you to modify data in a database can be auto-generated by Rails. Ruby on Rails was chosen as our development platform because it oered a rapid prototyping environment, with a structured framework for documentation. As a Mozilla Firefox plug-in, Zotero is limited to users of that browser that have installed the plug-in. Even so, Zotero oers a quick and easy way to demonstrate some ashy reading tools for the next phase of development. The advantages of using Fedora Commons (outlined below) seem to outweigh the advantages of using eXist. Solr does a very fast job of this, as it is based on the quick Lucene Java search library. If we wished to attach a series of images to a documents object, for example, this is easily accomplished in Fedora. This ability would allow us to display dierent versions of the same document should we wish to implement this feature. We made contact with the developers of RubyFedora, a code library to make integration between Ruby on Rails and Fedora Commons much easier. From this starting point, involving a once-o investment of $800 million, the federal government went on to create a variety of foundations that either receive conditional grants for disbursement over a nite number of years or to create perpetual endowments that use the income generated by the endowment to fund their disbursement programs and operations. All of this activity and planning on our behalf should prompt researchers in the humanities to ask exactly what (cyber)infrastructure is or could be so that we might understand how it might be revolutionary and whether we want this revolution. As Peter Freeman puts it in an article on designing and dening cyberinfrastructure, gyerinfrstruture the eye of the eholder. How is the call for information infrastructure drawing on our understanding of the infrastructure we know Third, I will look at the dangers in general and especially the issue of the turn from research to research infrastructure. I will argue that we need to be careful about dening the dierence and avoid moving into the realm of infrastructure those things we are still studying. In fact, this quote is centered, bolded, italicized and in blue on the web page just in case we miss it. We are used to considering roads, sewers, and power as infrastructure and we have expectations about their funding and maintenance; how do those known types of infrastructure turn our imagination when it comes to virtual infrastructure
Most public health work is done in silos and is not coordinated mood disorder nos criteria aripiprazola 20 mg discount, even within an agency land depression definition aripiprazola 15 mg cheap. This can be done in the short-term by building off current efforts and solici ng involvement from even more sectors depression symptoms singapore purchase aripiprazola 10mg line. Organiza ons can also support the work of current diverse partnerships to strengthen their reach and impact on the community bipolar depression dsm code order aripiprazola 15mg without prescription. Longer-term opportuni es include incen vizing government agencies to improve their collec ve impact mood disorder dsm 4 code buy aripiprazola 15mg line, with more collabora on among City departments and with more City-County-State efforts gun depression definition buy cheap aripiprazola 20 mg line. The system also needs to consistently outreach to communi es on public health issues. One way to achieve this goal is to establish and use standards for community involvement across the public health system. At the same me, organiza ons need to develop and/or update data sharing agreements. Longer-term opportuni es exist to obtain more and be er data by developing a chronic disease surveillance system. Advocacy groups ac vely communicate with policy and decision makers to propose policy sugges ons to improve public health and to document consequences of pieces of legisla on. Communica on about the regulatory and enforcement roles and responsibili es of the different City Departments is also not clear to many people, including public health stakeholders. Social media can be used in the short term to educate and inform specific popula ons and recruit them to get more involved in public health efforts. Par cipants spoke about the need for a comprehensive resource guide for health and human services in Chicago. In the short term, agencies could work with current resources such as Purple Binder and Now Pow websites that provide informa on on services, including health care, child care, job training and affordable housing. A long-term opportunity to build and sustain a resource and referral service is to expand 311 for City services to support referrals to health and human services offered by non-City agencies. Opportuni es exist to collaborate with United Way and the Illinois Alliance of Informa on and Referral Systems on this work. Health technology is advancing through mobile apps and ideas that reach out to the consumer, which make this an exci ng area for growth. More data are being collected measuring community health status, individual health and social determinants of health. Many people do not know how to access the wide range of data and lack of data infrastructure perpetuates this problem. Older providers are less comfortable with technology, limi ng their ability to access these tools to help improve pa ent care. Par cipants in the assessment process applauded the visible role health equity is taking in the Healthy Chicago 2. Policies are now priori zing health equity, with a focus on legal strategies that address issues of marginalized popula ons. Efforts need to educate the public health system to show how everyone will benefit when health equity is achieved. Long term, partners recognize opportuni es to call upon funders to support health equity by funding grants that address root causes and social determinants of health, rather than categories of health programming. Other public health efforts, such as coali ons, are not being measured or assessed. Short-term opportuni es exist to publicize these data sites and encourage their use in programming and evalua on. As these data sites con nue to expand with more social determinants of health and asset data, the system will be able to engage broader sectors of the public health system. More long-term opportuni es to improve the effec veness of interven ons and evalua on will emerge as more system partners fully implement performance and quality improvement efforts. A more comprehensive approach needs to be developed to disseminate research findings across the whole public health system. The Center also houses the Ins tute for Faith and Public Health Leadership, which brings faith and public health leaders together to learn how to collaborate and integrate community health and engagement approaches addressing health equity. Most notable are healthcare provider shortages, including primary care, oral health and mental health. Funding for health department workforce is decreasing, limi ng the programs and services offered. In addi on to the workforce capacity, par cipants men oned lack of consistent trainings as a problem. Short term, training centers may be able to add more classes/sessions to their schedules. Long term, the system needs to work together to assess training needs across the public health workforce and iden fy funding to develop new classes to meet these needs. Par cipants also suggested educa ng providers and students in the health profession about challenges their pa ent popula ons have in accessing care so they can provide more effec ve care. This resourcefulness is a major strength of the system, as is the camaraderie among organiza ons serving similar popula ons. Some of the areas where assistance is available include technical assistance on specific public health issues, policy and technical wri ng. Without stable and adequate funding, the workforce is not sufficient to fully address the ten essen al public health services. Without resources, innova on, especially with surveillance systems, may be stymied. The system can also reach out to na onal organiza ons with specific focus for assistance with special data or innova ve prac ces. Longer term opportuni es include coming together to advocate for a larger budget for public health efforts and funding to support coali on building. The purpose of this work is to iden fy overarching strategic issues the public health system needs to address to move toward the Healthy Chicago 2. Process: As in all phases of the plan, it is extremely important to engage broad public health stakeholders when developing strategic issues. The first session was held on April 13, 2015 at the Partnership for Healthy Chicago mee ng. Par cipants at these mee ngs proposed addi onal strategic issues and then voted for their top priori es through the use of five s ckers, which they could divide up in any manner. Through this process, ten priority ac on areas emerged (listed alphabe cally)*: 1. Violence and Injury Preven on *The names of the ac on areas in the Healthy Chicago 2. The vision calls for collabora ve stakeholders, which is the focus of the Partnership and Community Engagement ac on area. The other nine ac on areas also acknowledge that collabora on/engagement is a key component of health equity efforts. The vision states that "all residents" will have equitable access and opportuni es to be healthy. To ensure that everyone has access, priority ac on areas focus on high priority popula ons. Research, especially community-based par cipatory research, helps iden fy more evidence-based and evidence-informed prac ces to move toward health equity. People also were concerned about accessing social service programs and other social supports and programs to help keep them healthy. Discussions also suggested more workforce training to be er serve marginalized popula ons. These changes were primarily noted as opportuni es to get more people access to health insurance and comprehensive coverage. However, people had concerns that the system is solely focused on the newly insured while segments of the popula on. Medicaid expansion and Medicaid Managed Care requirements also offer some opportuni es for more people to have access to care; however, group par cipants noted that the complexity of these programs, coupled with changing rules and regula ons, may deter seeking care. Local Public Health System Assessment: Func oning related to access to care is addressed in two of the Ten Public Health Essen al Services. Group par cipants scored the public health system func oning of Essen al Service: #7-Link people to needed personal health services and assure the provision of health care when otherwise unavailable-at a moderate level. Linking people to services is one of the most common ac vi es of community-based organiza ons and many do a great job. However, the public health system does not have one comprehensive and defini ve home for resources. Therefore, organiza ons o en create their own, which requires me and effort and is duplica ve. Organiza ons do not have the capacity to always follow up to assure the client accessed the service and received the care they needed, especially when people need oral health care and behavioral health services. A competent workforce improves access to care by providing evidence-based, culturally-effec ve care. Improvements in workforce training, assessment and leadership development will improve the competency of providers, staff and public health workers. People men oned health care resources, such as Federally Qualified Health Centers and School-Based Health Centers, as essen al community ins tu ons that focus on community-based care and increase access to care. Par cipants and survey respondents indicated a need for more safety net services to be er reach popula ons and communi es with limited access and worse health outcomes. Survey respondents in high hardship communi es indicated difficulty accessing health services in their community; only 50% agreed with the state- Community Health Status Assessment: Data strongly support the importance of a focus on access to care. However, rates are higher for non-Hispanic blacks and strongly correlate to high hardship community areas. Avoidable emergency department visits increased between 2009 and 2011, with the highest rate of increase for non-Hispanic blacks. By improving these components, marginalized popula ons will obtain health care that is designed more for their needs and structured to be more user-friendly. Community Health Status Assessment: Substance-related disorders, mood disorders and schizophrenic disorders were the second, third and fourth most common diagnoses of hospital discharges in 2011 (not including birth and delivery). Rates for non-Hispanic blacks were significantly higher than other race/ethnic popula ons for all these diagnoses. The average number of days adults reported that their mental health; including stress, depression and problems with emo ons; was not good in the past 30 days decreased from 9. More than 9% of Chicagoans reported 14 or more mentally unhealthy days, defined as frequent mental distress. The percentage of students in 2013 who reported they felt so sad or hopeless almost every day for two weeks remained about the same as 2001, at 33% and 34%, respec vely. Ac on Area #2: Behavioral Health Community Themes and Strengths: Focus group and community conversa on par cipants expressed their concerns about limited access to mental health services in Chicago, which they felt were exacerbated by the 2012 consolida on of 12 City-operated mental health clinics. Mental health problems, especially coping with persistent stress many experience in their daily lives, resonated as par cipants discussed other issues. These provisions to improve access, however, do not sufficiently cover the behavioral health needs of Chicago residents; some important services for these popula ons are not covered by Medicaid and advocates are not convinced plans have sufficient capacity to serve all residents in need. Increased morbidity and mortality is an ongoing threat of a system that cannot provide adequate coverage to popula ons in need. Healthy People 2020: Na onal data es mate 13 million American adults have a severe mental illness, substan a ng its posi on as one of the most common causes of disability. Substance abuse disorders impact 22 million people, with most being unaware of their problem and its impacts on their health and quality of life. Ac on Area #3: Chronic Disease Preven on and Control Community Themes and Strengths: Both the in-person discussions and survey ques ons obtained feedback on access to resources that impact chronic disease, including healthy foods and opportuni es to get physical ac vity. Across all hardship quar les, survey respondents iden fied access to healthy foods as a priority to make Chicago healthier, second only to issues of safety. All communi es ranked healthy food access as either the first or second priority in making their own neighborhood healthier. People iden fied that access to opportuni es for physical ac vity, such as walking and biking, varied among communi es. Par cipants widely supported bringing the Complete Streets model to all neighborhoods as an interven on that would help increase ac vity levels. Focus group par cipants thought that more people would use local parks and be physically ac ve if these loca ons could be made safer. Forces of Change Assessment: Many stakeholders had concerns about the ongoing lack of healthy food in many low-income Chicago neighborhoods. Access to farmers markets and community gardens is growing; however, federal food policies do not fully support efforts to improve healthy ea ng. Without improvement in access to healthy foods, obesity rates and incidence of chronic diseases will likely increase and management of chronic diseases will be more difficult and require more medical a en on. Local Public Health System Assessment: the public health system work on chronic disease connects to the majority of essen al public health services. New City ordinances are now in place to reduce the sale of flavored cigare es (Chicago Mun. In part because of the innova ve policy and enforcement efforts for tobacco use preven on and control, system members scored these two essen al services as being performed at the significant level. Community Health Status Assessment: Chronic diseases make up six of the ten leading causes of mortality, accoun ng for 64% of all deaths in Chicago in 2011.
Note: Neither expression is equivalent in meaning to the phrase jump someone-(sl retarded depression definition cheap aripiprazola 20mg line. Richard Roe -(legal) used as a name to designate an unidentified man mood disorder lectures cheap aripiprazola 15mg fast delivery, especially the second of two such persons: It was a matter material to said trial to determine whether or not John Doe had ever made a loan of money to Richard Roe slender anxiety generic aripiprazola 20 mg free shipping. Julian day calendar -(Astronomy) a system of numbering days consecutively from the arbitrarily selected point of the year 4713 B depressive disorder definition cheap 20 mg aripiprazola otc. Note: the expression is not antonymous in meaning to the phrase sit on the fence- be undecided in opinion or action: the French delegation depression symptoms quizzes aripiprazola 20mg lowest price, which has hitherto been sitting on the fence anxiety help order 20 mg aripiprazola, has suddenly become exceedingly active. The engine reached the other side, but the next eight cars crashed over the trestle. Note: Neither expression correlates in meaning with the phrase keep open house- offer hospitality and be ready to welcome and entertain guests at any time: the King kept open house every day, and all day long, for the good society of London. The ease that the children displayed with the technology was enough to amaze even a veteran. Note: the expression does not correlate in meaning with the phrase be dark on someone-(Austral. Note: the expression does not fully correlate in meaning with the phrase keep someone back from something- = keep someone away from something 1: We had a good view of the security staff struggling to keep the crowd back from the stage. Note: the expression is not antonymous in meaning to the phrase catch someone with his pants down-(sl. Note: Neither expression correlates in meaning with the phrase keep the home fires burning- keep things at home going as usual (while smb. Everyone started to stand, but the Governor motioned for them to keep their seats. Note: the expression is not antonymous in meaning to the phrase kill the rabbit-1. Note: the expression does not correlate in meaning with the phrase king of the sea-1. Millions of readers were immersed in the mysteries of the universe by reading his books. Bookmakers are not permitted to take up positions at will on racecourses under Greyhound Racing Association jurisdiction. I think we should put our heads together and see if we can somehow make them cheaper. Note: the expression does not fully correlate in meaning with the phrase knock someone off his feet-1. Note: the expression does not correlate in meaning with the phrase not know where to look-(also: not know which way to look) be quite embarrassed: I did not know where to look, feeling embarrassed at being so openly praised in front of my colleagues. Note: the expression does not correlate in meaning with the phrase one final word-(also: one final thing) used to introduce a parting comment or advice: "One final word, keep your chin up. Note: the expression is not equivalent in meaning to the phrase famous last words-1. A latent period of from ten to fourteen days intervenes between exposure and the development of the febrile symptoms. Note: the expression does not correlate in meaning with the phrase lay it on the line-(coll. Note: the expression does not correlate in meaning with the phrase put someone out of the way-remove smb. Note: the expression does not correlate in meaning with the phrase bring someone to grass-(Mining) carry an injured person to the surface from the mine: His son soon got him out, procured assistance, and he was brought to grass and carried to his home. Note: the expression does not fully correlate in meaning with the phrase put something away-1. Note: the expression does not fully correlate in meaning with the phrase set something up-1. Note: the expression does not correlate in meaning with the phrase Old Light men-(hist. Note: the expression does not correlate in meaning with the phrase string along with someone-(coll. Note: the expression does not fully correlate in meaning with the phrase leave someone out-1. Note: the expression does not fully correlate in meaning with the phrase lecture someone-1. Note: the expression is not antonymous in meaning to the phrase let up on someone- treat a person less harshly or severely: By the time Jon turned eight, our financial problems became so overwhelming that I began to let up on him. Note: the expression does not correlate in meaning with the phrase let oneself go-1. Note: the expression does not correlate in meaning with the phrase put someone in for something- enter a person for an examination, contest, etc. Note: Neither expression correlates in meaning with the phrase let something go-pay no attention to smth. Note: the expression does not correlate in meaning with the phrase hang it all-(exclam. Now different people in the State Department are trying to define what was written. Note: the expression does not correlate in meaning with the compound wildlife- wild animals and birds living in a natural undomesticated state: We showed the photos of the animal to locals who know the wildlife of the area, but nobody had ever seen this creature before. Note: the compound does not correlate in meaning with mailman- a person who delivers letters, etc. Note: the expression does not correlate in meaning with the phrase live line-(also: live wire) a cable or wire carrying electric current: Safe work procedures require the use of rubber gloves and other live line tools. Note: the expression does not correlate in meaning with the phrase sleight of hand-1. Note: the expression does not correlate in meaning with the phrase like a bull at a gate- used of smb. Note: a) the expression does not correlate in meaning with the phrase Little Englander-(hist. Little England beyond Wales -Pembrokeshire (former county and historic region of south Wales): I have never been able to speak Welsh fluently, and being from the South West (Pembrokeshire - little England beyond Wales) have had little Welsh heritage. Note: Neither expression correlates in meaning with the phrase like a cat on hot bricks-1. All his opinions were his own, and there is no recorded instance in his long career in which he sought or desired counsel from others. Note: the expression does not correlate in meaning with the phrase live on air- survive on very little food: Annick is one of those young Parisians who live on air and use the cafes as living rooms. Note: the expression does not correlate in meaning with the phrase do that small thing-(coll. Note: the expression does not correlate in meaning with the phrase live up to it-act in full accordance with principles, rules, etc. Bork argues that the Association has outlived its utility as the principal forum for addressing region-wide issues. Self-reliance and the desire to live within oneself have long defined the American character. Note: the expression does not correlate in meaning with the consonant compound longhand- ordinary handwriting, as distinguished from shorthand or typing: the clerk had to write all the evidence down in longhand. Note: Neither expression correlates in meaning with the phrase dead man walking- used of smb. Note: the expression does not correlate in meaning with the phrase see in a mirror, dimly-(the Bible) is used to say that humans have a fundamentally clouded, fractured, and limited perception of reality (also: see through a glass darkly): When St Paul says that "we see in a mirror dimly" he is reminding us about our inability to see clearly, and truly, in the world. He went in to look down his nose at them - it might give him some faint satisfaction. Note: the expression does not fully correlate in meaning with the phrase overlook something-1. Note: the expression does not correlate in meaning with the phrase look someone up and down-take in smb. Lord High Commissioner -the representative of the British Crown at the annual General Assembly of the Church of Scotland: the present building is still used as a residence by the reigning Monarch and by the Lord High Commissioner during the Assembly of the Church of Scotland. Note: the expression is not equivalent in meaning to the phrase High Commissioner- the head of the British diplomatic mission in a Commonwealth country: A High Commissioner from the United Kingdom would be appointed to take over from the Viceroy duties connected with the representation of Britain in India. Note: the compound does not correlate in meaning with the phrase down under world-(coll. Note: Neither expression fully correlates in meaning with the phrase mad as a cut snake-(Austral. Rainy is just very round and tight in her tummy, but very little udder development started. Note: the expression does not correlate in meaning with the phrase make a bags of something-(Irish coll. Everett made a cold bow, and, afflicted with sudden myopia, did not see the hand held out. Note: the expression is not equivalent in meaning to the phrase take a bow- bow to acknowledge an introduction, applause, etc. Note: the expression does not correlate in meaning with the phrase make do with something-(also: make something do) accept smth. Note: the expression does not correlate in meaning with the phrase make a movement-1. Note: the expression does not correlate in meaning with the phrase make a noise in the world- attain great fame or notoriety: He seemed a very lively young man, certain of his own abilities and eager to make a noise in the world. Note: the expression does not correlate in meaning with the phrase make the right noises-(also: make all the right noises) show concern, enthusiasm, etc. Note: the expression does not correlate in meaning with the phrase set the scene-(also: lay the scene) 1. Note: the expression does not correlate in meaning with the phrase do a show-(coll. Note: the expression does not correlate in meaning with the phrase make a time about something-(U. Dreschfeld made some observations on the symptoms, pathology, and treatment of this disease. Note: the expression is not equivalent in meaning to the phrase take exception to something- object to smth. Note: the expression does not correlate in meaning with the phrase make a play for something- make a conspicuous attempt to gain or acquire smth. McClung continued to enjoy the confidence and esteem of his townmen and held public positions. Note: the expression does not fully correlate in meaning with the phrase give way to something-1. Note: the expression does not correlate in meaning with the phrase man of blue blood- a man who comes of an ancient family; an aristocrat: Is he a man of blue blood We are worshipping him because of his ideas, what he stood for and what he preached. Note: the expression does not correlate in meaning with the phrase citizen of the world- a person who is at home anywhere in the world; one who has no national prejudices: He is a real citizen of the world, and it is his humanism and his universal values that have earned him such esteem in the international community. Certainly the great omnipotent, "man upstairs" has all the ability to do anything he wants, but does he exercise that ability Mediterranean disease Some of them were singing, some clapping their hands as they marked time to the tune which one lone fiddle squeaked out gaily. Edwards is a longtime faithful employee who was marked for advancement in the company. Jones was constantly berating his sensitive, gentle son for his lack of "manly behavior. Note: Neither expression fully correlates in meaning with the phrase match something-1. West Midlands -a metropolitan county of England: the biggest attraction of Dudley, located in West Midlands, is the Zoo situated in the grounds of Dudley Castle. Note: the expression does not correlate in meaning with the phrase Milky Way- galaxy: the current position of the solar system in the Milky Way suggests that another period of greater comet bombardment is not far away. Note: the expression does not correlate in meaning with the phrase mouse milk-(coll. Unlike a lost credit card, the money card has no value to anyone lacking your password. To say the least, I got more than I bargained for - an emotional connection with a brave and inspirational author.
Playing through the eighteen holes that afternoon depression unspecified purchase 15 mg aripiprazola visa, the "suit" told the administrator how the other kitchen schedulers were one dimensional anxiety wrap for dogs generic aripiprazola 20 mg line, and he could provide many more "services" to the hospital depression quotev purchase 15 mg aripiprazola, the "services" very sketchily described depression cherry generic aripiprazola 10 mg free shipping. The O-J-T-er promptly dropped the "rival suit" emergency medicine "management" contract changing the scoreboard to 11-9 in favor of the "suits mood disorder lithium discount aripiprazola 20mg on line. Although the terminology had not yet evolved mood disorder in toddler buy 20 mg aripiprazola mastercard, it was clear to the "rival suits," they were the first victims of the most treacherous and cowardly of acts as "the region" recorded its first drive by shooting, emergency medicine style. The "rival suits" stayed in a state of confusion and disarray until one of their "consultants" suggested they hire a marketing expert. And thus the marketing of the emergency medicine contract "management" groups became the latest development in the ever more complicated and overcrowded world of kitchen scheduling which was now called "management. The "suits" were hit with the rude awakening that the days of easy growth were over. The "suits" and "rival suits" needed new client lists with more blanks to fill in to keep up the days of heady growth. And so a highly competitive turf battle begat the crips and the bloods of emergency medicine with the rival gangs trying to emerge as dominant players, dominant kitchen schedulers of the same generics. Turf battles began to rage, and drive by shootings in emergency medicine became a daily occurrence. A particularly sly emergency medicine street gang from the uppermidwestern peninsula "region" were a bunch of soft, roly-poly "suits" known for their craftiness, and rather pejoratively referred to by the bloods as "The Croissants. But for practical purposes, one can simply refer to the emergency medicine "management" groups as the crips and the bloods. Good golfing weather sent up small craft warnings to the "management" groups, and during one fine week in May, there were six "fatal" drive by shootings in "the region," as the "management" contracts kept changing hands. The emergency medicine crips and bloods became fiercely territorial and expansionistic, and in one tenmile radius, there were two incidents within a span of thirty minutes. Actually, no one really noticed since the generics, the actual working doctors attired in "scrubs," never seemed to change, regardless of which crip or blood held the "management" contract. The only notable difference in "the region" was the size of the hospital administrators, the O-J-T-ers. With so many rich luncheons to go to with the marketers, replete with caviar and Dom Perignon, the O-J-T-ers were beginning to look a little porked out from their afternoon cholesterol stress tests. Their country club extravagance, a true occupational hazard, began to take its toll, and at one luncheon an O-J-T-er suddenly collapsed. He bled from the edges of his tongue, a truly disgusting sight, and one of the marketers developed such an aversion to Beluga and Perignon he had to seek other employment. They waited for the ambulance, but by the time the Econoline arrived, the well-fed, coronary occluded O-J-Ter was already in rigor mortis. The Rape of Emergency Medicine Page 59 the marketers became dismayed by the fact they were always offering the same generics to the same hospitals, and wanted to know if a subset of physicians working in the emergency rooms might become "their" doctors. Somehow, the highly competitive crips and bloods had to set themselves apart from the other major gangs in the booming kitchen scheduling marketplace. It would be quite a coup to have a Steinerman or Mahoney bound exclusively to work in "their hospital" which seemed an impossible feat at the time. The "suits" pondered the problem like Talmudic scholars, and the answer sprung from a most unlikely source, one of the attorneys in their growing legal departments, a specialist in contract law. He suggested making the "scrubs" sign what was called a noncompete clause, forbidding them to work for the "rival suits. He knew first hand the problems of the Rolodex, feeling revolving-door physicians for everyone made good business sense. But after some study, the "suits" came up with a noncompete clause that was pure genius. In order to work, the "scrubs" had to sign an agreement not to work for any "rival suit" in the same hospital for a period of two years. In case any of the "suits" were victims of a drive by, they could forbid the generics from jumping ship and working there for anyone else. The noncompete clause, a simple spoil-sport measure, gridlocked physicians into and out of different hospitals. The "scrubs" knew the crips and the bloods had quite a nasty streak, with a growing legal phalanx to sledgehammer them with the newest aspect of the delivery of emergency care to the American public and their children. And thus the Rolodex containing the names of physicians with active, unrevoked, state medical licenses who were willing to work in an emergency room, to cover, to fill in a blank, became even more complicated. A current Rolodex now had to include the hospitals, what kind, where, and when the "scrubs" had signed a noncompete clause. The Rolodex became the most important part of "management" in the information age. Now known in emergency medicine circles as the "recruitment department," the Rolodex was an important piece of "proprietary information," a trade secret not to be shared as the scheduling kitchens fortified themselves like Fort Ticonderoga. The Rolodex contained the names of residents and, unknown to the general medical world until this time, a reservoir of knockabout misfits with M. The noncompete clause consisted of a hundred words hidden in the "whereases" section in the fine print of the single-spaced, Byzantine agreements, not that the medical or surgical residents read anything they signed anyway. The ball and chain noncompete clauses paved the way for the "suits" to cut the heart out of the new specialty. This little piece of chicanery, demanding physician fealty in writing to create an ineligibility status of fine physicians to work in certain community hospitals, was a brilliant marketing strategy, given the whole-hearted tacit approval of the thumbs up their asses at the American Academy of Emergency Physicians. On the other hand, many of the founding members of the American Academy were the first leaders of the crips and the bloods. To these original shills of emergency medicine, the deep complicity in the duplicity, wheeler dealerism, and fiscal coups of any kind were simply good medicine, good emergency medicine. The Rape of Emergency Medicine Page 62 Chapter Six: the Anderson Syndrome "The only missing clotting factor is silk. It was Valerie Longo who first introduced Norman Lyle to Dan Anderson, Valerie was a well-known, competent, critical-care nurse at the General, rotating through the intensive and coronary care units and the emergency room. She worked for several hospitals on call, and although she was a little bossy, the critical-care units in Boston liked having Valerie for an evening shift; and when they had her, they almost always asked if she could work a double. She was energetic, a very meticulous organizer, and during her break time no less, she would rummage through the bedlam of the supply room, placing order in the linen and medicine closets. Valerie, then, singlehandedly decided to place all premixed intravenous solutions in different cabinets rather than all next to one other to decrease the risk of such understandable errors in the future. She took night courses toward a masters degree of science in nursing, a common educational mistake among many sincere young men and women wishing to get ahead. She took hour after semester hour of coursework in communication skills, shocking everyone one day by announcing she was an expert in "effectively communicating" with abusive, hostile, even violent patients, requesting to be called for her professional consultation if any such human beings happened to stroll into the emergency room. It took about an hour and half for the next noble savage with an attitude to arrive at the General, and Valerie Longo, R. Steinerman was a resident at the time, and watched Valerie take charge, barking out orders to the other nurses, demanding a cup of coffee and a doughnut, and preparing to offer the provisions to the elderly woman who was kicking and screaming obscenities, and refusing to get out of her automobile at the front door of the emergency department. Going out the door, the lion tamer explained to the nurses that offering coffee and doughnuts to a hostile patient often breaks the ice, allowing them "to begin a dialogue of effective communication. Valerie was gone about ten minutes, and the ruckus outside seemed to have subsided when the loud crack was heard. She was never called again for abusive patients although she continued to teach a very poplar graduate school course on dealing with violent behavior. Valerie also fell secretly in love with Norman, an unrequited love because Lyle, who never stepped out, remained forever bonded to the former Carolyn Skanks via the kitchen table, but it was nevertheless an exciting and ongoing fantasy for Valerie. She liked being physically around Lyle, and loved to hear him speak, or softly sing vespers or evensong Gregorian chants in his office with his rich baritone. After Valerie introduced Lyle to Dan Anderson, he and Anderson had a short-term business relationship. Anderson knew of Valerie from his nurses, and when she called to request a meeting with him concerning a contract to provide emergency medicine doctors to his hospital, Dan Anderson was actually quite pleased. He had a somewhat blunt frontier style, taking the Rape of Emergency Medicine Page 65 little to no shit from the staff doctors. He helped obstetrics out of the dark ages, removing the medieval torture chambers otherwise known as delivery rooms, replacing them with a more civilized state of the art "birthing center. The "declaration" of many a head-injured child was determined by the first few minutes of make or break care, and in fact, many critical patients had their fate determined within that first "Golden Hour" in the emergency department. He could see the vast opportunity it held to give patients appropriate initial care, initial care so crucial to a successful outcome, but he saw the emergency physician was clearly the weakest link in the evolving emergency-medical-care system. The paramedics gave advanced care in the Econolines before even reaching the hospital, but most of the time, the "on call" physician was unsuitable. The staff doctors did, however, express their desire to be relieved of all emergency-room coverage forever if this was at all possible without fully abrogating their own responsibilities. Anderson told them he was doing his best with the hospital attorneys to bust the one-year contract with Pyramid, Inc. Besides, the staff physicians would have been wholly incapable of understanding it, even the Rape of Emergency Medicine Page 67 had Anderson known, and everyone was certainly incapable of believing it. He had over a hundred, glossy advertisements from different contract groups and individuals throughout the country offering to serve the "emergency needs of your hospital. He also noted the return addresses were always from areas like One Successful Road or Executiveland, U. These overpackaged junk mailings were known in the emergency medicine trade as "glossies. Our physicians take an active role on hospital committees, and heavily involve themselves in the community. They are trained personable professionals who want to be active participants in the development of your hospital emergency medical-care system. They have the extensive resources of our dedicated management group at their fingertips. It seemed that every other word and each little ditty had a circled, superscripted symbol next to it; every cute little expression for quality was registered, service marked, copyrighted, or trademarked, and the rhetoric in all the glossies went on and on, always ending with that magic word, the buzz word of the eighties, "Yes, Mr. Anderson readily saw the bottom line of their group was clearly nothing other than the bottom line, and although he knew he was being conned with semi-truths and not-so-white lies, he needed to do something quickly. Goldman listened intently to Anderson, empathizing with his woes, and sometimes expressing disbelief that such a thing could be happening. Goldman took the contract, reassuring Anderson that Monk and Walsh would be traded for future draft picks, and the following week all ties were broken with Pyramid, Inc. Anderson called Goldman who bullshitted for a while saying Monk had improved greatly after attending the cardiogram seminars, and Walsh had stopped drinking. Goldman finally relented, saying they would be replaced, but Goldman had overcommitted his resources, and had run out of docs with unrevoked licenses. It was mid-July, the most difficult of the fill-in-the-blank months, July being the traditional New Year for all of medicine. His pledge drivers were on overtime running through their Rolodexes of possible "scrubs. They felt Anderson might be losing his edge because the story was simply too unbelievable. This musical-chair policy of emergency medicine "management" groups became very well known in hospital circles. Administrators learned to be very careful before firing and replacing groups, and ending up with exactly the same doctors after the honeymoon and noncompete periods were over. The "suits" quickly learned about the Anderson Syndrome, and knew the initial marketing and staged presentation of their "management" groups was everything. Whatever happened afterwards was secondary, and no matter how shady or outright crooked the emergency medicine "management" group turned out to be, no matter how falsely they represented themselves or the quality of their merchandise, the group would remain the incumbents for some facesaving time. The Anderson Syndrome was to play a pivotal role in the unraveling saga of the growth of organized emergency medicine. After the emergency medicine "management" contract was signed with the hospital, the crips and the bloods knew they had a stranglehold on the administrator, and devoted their resources to procuring new contracts by bushwhacking other unsuspecting O-J-T-ers. After only two weeks back at the DuPage Community Hospital, Monk crash landed again. Monk came in early one Monday morning to attend a Morbidity and Mortality conference. Morbidity and Mortality conference, also known as M and M, consisted of a thorough review of a particular case, usually one that had been botched, and was attended by medical students, nurses, and the entire variety of medical specialists. Nowhere were pathologists, surgeons, internists, pediatricians, emergency physicians, radiologists, and even public health specialists gathered together but at M and M. They were there to release their rancor, not their angst, but their invective as they challenged other physicians to defend their actions; M and M conferences were a great time to gang up on the primary "actor" who fucked up. M and M days were also nicknamed D and D, Death and Doughnuts, because the conferences were held early in the morning, the patients invariably met a sticky end, and a most impressive variety of doughnuts was served. Pathology and surgery, much more than internal medicine, knew how to throw a conference. The primary actor sat on a stool on an empty stage, listening as the case was presented in the way it had unfolded. The spleen is the most vulnerable organ in blunt abdominal trauma, pediatric or adult. For a ruptured spleen, early recognition is necessary, and surgery in adults is almost invariably required. Her blood pressure was somewhat low and pulse rapid, both early warning signs of impending shock, but she was conscious, alert and oriented. Taking away the pain also removed her only symptom, the pain itself, leaving her to hemorrhage painlessly. The medicine constricted her blood vessel walls forcing reluctant red blood cells out of their natural piping into the rising lake of blood sitting in her belly.
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