VALIDATION OF THE STEP BY STEP APPROACH.pdf

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VALIDATION OF THE STEP BY STEP APPROACH.pdf

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The Message of a Master http://www.RetrieveALover.com Page 1 The Message of a Master By John McDonald A Gift to You by Retrievealover.com © Cucan Pemo All Rights Reserved. http://www.RetrieveALover.com This ebook is a FREE Bonus Version. Feel free to pass to all your friends and loved ones! The Message of a Master http://www.RetrieveALover.com Page 2 Table of Contents A Note from the Publisher ………………………………………………….3 Chapter I ……………………………………………………………………….7 Chapter II ………………………………………………………………………10 Chapter III …………………………………………………………………… 12 Chapter IV …………………………………………………………………… 15 Chapter V ………………………………………………………………………18 Chapter VI …………………………………………………………………… 21 Chapter VII …………………………………………………………………….23 Chapter VIII ……………………………………………………………………25 Chapter IX …………………………………………………………………… 27 Chapter X ………………………………………………………………………29 Chapter XI …………………………………………………………………… 32 Chapter XII …………………………………………………………………….35 Chapter XIII ……………………………………………………………………38 Chapter XIV ………………………………………………………………… .41 Chapter XV …………………………….………………………………………45 Appendix A ……………………………….………………………………… 48 Appendix B …………………………………………………………………….50 The Message of a Master http://www.RetrieveALover.com Page 3 A Note from the Publisher Dear friend, This book had come into my possession in the most unexpected way during a time when I was going through a failing relationship and when I was down to the lowest point of my life. It was during this period that I met a very wise man (whom I will call Friend here) through an Indian search engine and in a forum. Unlike others whom all encouraged me to move on and let go of the relationship, he asked me what my heart told me regarding this. And my reply was, my heart was still with my love. He then proceeded to teach me a set of principles which he condensed into an amazingly effective and simple 4-Step Strategy to being back my love. It was by far the most potent and the most effective of all that I had learned to retrieve my partner, despite having a strong rival and competitor around. I even continued using the same “Formula” to create fulfillment and happiness in my relationship with my lover, exactly as I had wanted it. For more details you can read about it in here at http://www.RetrieveALover.com After giving me what I needed to learn and know, my Friend urged me to read this book, which is a 1929 classic by John Mcdonald, and said that this would be a perfect companion to all that I had learned. As I read through this amazing book, I could not put it down, and I read it not once, not twice, not even three times but many, many times! In brief, it introduces a system of practice which will enable one to become a powerful wish-maker and master of his or her environment and conditions. As you read this book keep what John Mcdonald had advised in his book in mind: “Take these teachings for just what they mean to you individually. If some statements do not appeal to you at this time, make no effort to force yourself to accept them. What you might reject or fail to understand now will no doubt appear plain and become valuable to you later, as your capacity to receive increases.” The Message of a Master http://www.RetrieveALover.com Page 4 I was so excited with my newfound knowledge that I emailed my Friend: “I want to get this out to as many people as possible. What do you think?” He replied with just this short message: “What did your heart tell you?” I thought to myself: “Yes! Why not?” And this was how this ebook was borned. Drop me a note on how this book has helped you or VALIDATION OF THE “STEP-BY-STEP" APPROACH IN THE MANAGEMENT OF YOUNG FEBRILE INFANTS Collected by Dr Khanh T Huynh Definition “STEP BY STEP” Algorithm • developed by a European group of pediatric emergency physicians • identify a low risk group of infants who could be safely managed as outpatients without lumbar puncture nor empirical antibiotic treatment Aim • Prospectively validate the Step-by-Step approach/2016 • Compare it with the Rochester/ 1994 criteria and the Labscore/ 10 years ago Study design and Prospective study Who? Where? When? Infants ≤90 days with fever without source 11 European pediatric emergency departments 2012-2014 Sensitivity and Predictive Value for ruling out IBI Number of infants misclassified Step by Step ??? and ??? ??? Rochester 81.6% and 98.3% 16 Lab-score 59.8% and 98.1% 35 Data Collection Subjects: patient on arrival at the PED, relevant medical history, results of laboratory tests, diagnosis, treatment, and site of care (managed as outpatient or admitted) Collect: Age Sex Duration and Degree and Fever General Appearance Figure Approach evaluates: General appearance of the infant Age Urinalysis Blood biomarkers: PCT, CRP, ANC Figure 2: Included & excluded patients Table 1: Clinical Characteristics Table 2: Bacterial Infections Diagnosed Figure 3: Risk factor Table 3: Baterial infection / low risk patients Table 4: Results Conclusions The Step-by-Step approach: Highest sensitivity Useful tool for the management of the febrile infant in the ED However: Not 100% sensitive , no perfect tool exists Should use caution especially / infants with very short fever Strongly advise for an initial period of close observation and monitoring in the ED, even when all the complementary test values are normal Citation Gomez, Borja, Santiago Mintegi, Silvia Bressant, Liviana Da Dalt, Alain Gervaix, and Laurence Lacroix "Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants." Pediatrics 138.2 (May2016) AAP Gateway Web 11 Aug 2016 Thanks for your attention Random House, Inc. Academic Dept. 1745 Broadway, New York, NY 10019 WEBSITES: www.randomhouse.com/highschool • www.rhimagazine.com • www.randomhouse.com/academic • www.commonreads.com QUERIES: rhacademic@randomhouse.com R A N D O M H O U S E , I N C . T E A C H E R ’ S G U I D E The Immortal Life of Henrietta Lacks By Rebecca Skloot Broadway | TR | 978-1-4000-5218-9 400pp. | $16.00/$18.00 Can. Also Available in Audio and eBook Reading Level: 9th Grade “Using [The Immortal Life of Henrietta Lacks] in the classroom will deepen your students’ understanding of nonfiction, science, medicine, and history—but more than that, it will prepare them to engage thoughtfully with the profound moral and ethical dilemmas posed by emergent technologies and the world we share.” —Amy Jurskis, Tri-Cities High School, East Point, Georgia “Skloot narrates the science lucidly, tracks the racial politics of medicine thoughtfully, and tells the Lacks family’s often painful story with grace . . . Science writing is often just about the ‘facts.’ Skloot’s book, her first, is far deeper, braver, and more wonderful. . . . Made my hair stand on end.” —The New York Times Book Review “Heartbreaking and powerful, unsettling yet compelling, The Immortal Life of Henrietta Lacks is a richly textured story of the hidden costs of scientific progress. Deftly weaving together history, journalism and biography, Rebecca Skloot’s sensitive account tells of the enduring, deeply personal sacrifice of this African American woman and her family and, at long last, restores a human face to the cell line that propelled 20th century biomedicine. A stunning illustration of how race, gender and disease intersect to produce a unique form of social vulnerability, this is a poignant, necessary and brilliant book.” —Alondra Nelson, Associate Professor of Sociology, Columbia University; editor of Technicolor: Race, Technology and Everyday Life “The Immortal Life of Henrietta Lacks is an ideal book for classroom discussions in bioethics, history of science, and journalism. Author Rebecca Skloot does an exceptional job of raising critical issues that should encourage both scholars and students to reevaluate the research decision making process, the way research subjects are treated, and the balance of power in this country as determined by race, economics, and even education. An incredibly readable and smart text that should be a part of countless university discussions.” —Deborah Blum, Helen Firstbrook Franklin Professor of Journalism, University of Wisconsin-Madison; author of The Poisoner’s Handbook: Murder and The Birth of Forensic Medicine in Jazz Age New York This book is a popular common reading selection at high schools, colleges/universities, and “One City, One Book” Programs. To view the complete list, go to: http://tinyurl.com/3xwrwze Winner of Several Awards Including: 2010 CHICAGO TRIBUNE HEARTLAND PRIZE FOR NONFICTION 2010 WELLCOME TRUST BOOK PRIZE THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE’S YOUNG ADULT SCIENCE BOOK AWARD Selected for More than Sixty Best of the Year Lists Including: AMERICAN LIBRARY ASSOCIATION NOTABLE BOOK BOOKLIST TOP OF THE LIST—BEST NONFICTION BOOK KIRKUS REVIEWS BEST NONFICTION BOOK OF THE YEAR LIBRARY JOURNAL TOP TEN BOOK OF THE YEAR INCLUDES COMMON CORE STATE STANDARDS I n 1950, Henrietta Lacks, a young mother of five children, entered the colored ward of The Johns Hopkins Hospital to begin treatment for an extremely aggressive strain DISCUSSION Open Access Legal implications of the step-by-step principle Caroline von Kries 1* and Gerd Winter 2* Abstract Purpose: The ‘step-by step’ principle was introduced into the European Union legislation on genetically modified organisms as a means to cope with uncertainty about environmental risks from the release of genetically modified organisms into the environment. The approval process is orientated along the stepwise reduction of containment which reflects a precautionary approach towards the risks of genetically modified organism release. Thus, the gradual reduction of containment should keep pace with the gradual generation of risk-related knowledge. This paper strives to clarify the meaning, legal status and practical importance of the principle. It also looks at whether non-European Union countries have adopted the principle as well, and how they practice it. Methods: The article is based on research of the relevant legal texts, court cases and legal literature. In addition, a number of dossiers of applications for the European Union authorisation of release and placing on the market of genetically modified seed were analysed. Results and conclusions: Although ‘step-by-step’ is not a precise legal rule it does have legal meaning as a principle guiding the risk assessment and management of genetically modified organism introduction into the environment. Assuming a process of gradual reduction of containment and scaling up of release ranging from closed systems via experimental release to cultivation the ‘step-by-step principle’ requires that the knowledge on environmental risks of genetically modified organisms should be generated on stages previous to the ones where the risk can result in damage. The analysis of the legislation of China, the United States of America and Brazil showed a differentiated approach towards the step-by-step principle. Keywords: step-by-step principle , release, placing on the market, monitoring, EFSA Analysis ’Step-by-step’ in the relevant legal texts The ‘step-by-step’ principle was introduced by Directive 2001/18/EC [1] where it a ppears as numbers (24) and (25) of the preamble: ’(2 4) The introduction of GMOs into the environ- ment should be carried out according to the “step by step” principle. This means that the containment of GMOs is reduced and the scale of release increased gradually, step by step, but only if evaluation of the earlier steps in terms of protection of human health and the environment indicates that the next step can be taken. (25) No GMOs, as or in products, intended for deliberate release are to be considered for placing on the market without first having been subjected to satisfactory field testing at the research and develop- ment stage in ecosystems which could be affecte d by their use.’ Directives must be transposed into Member State law allowing them some legislatory discretion. In German law, for example, ‘step-by-step’ is framed in a rather broad language requiring that the risk assessment shall be based on experiences made on previous steps (GenTVfV 1996 Sec. 5 (2), 6 (2) [2]). Contrastingly, the Austrian Gentechnikgesetz [2] establishes ‘step-by-step’ as a binding precondition of authorisations. See Section 3 (3) which reads: ’The release of GMOs may only be performed step by step meaning that the contain ment of the GMOs may stepwise be unclenched and [...]... more ounces to the ton out of our crushings than they ever heard of on the Rand, too." "Might I ask," interposed the other, "who may 'they' be?" Thorpe hesitated, and knitted his brows in the effort to remember names "Oh, there are a lot of them," he said, vaguely "I think I told you of the way that Kaffir crowd pretended to think well of me, and let me believe they were going to take me up, and then,... seemed in all likelihood an exaggeration But handsome he undoubtedly was—tall without suggesting the thought of height to the observer, erect yet graceful, powerfully built, while preserving the effect of slenderness His face in repose had the outline of the more youthful guardsmantype—regular, finely-cut, impassive to hardness When he talked, or followed with interest the talk of others, it revealed... look Their faces, dusky red on the side of the glow from the fire, pallid where the electric light fell slantwise upon them from above, had for a moment a mysterious something in common Then the tension of the glance was relaxed— and on the instant no two men in London looked less alike Lord Plowden was familiarly spoken of as a handsome man Thorpe had even heard him called the handsomest man in England—though... grandfather was Lord Chancellor of England, and your father was a General in the Crimea My grandfather kept a small second-hand book- shop, and my father followed him in the business In one sense, that puts us ten thousand miles apart But in another sense, we'll say that we like each other, and that there are ways in which we can be of immense use to each other, and that brings us close together You need... peremptory The answer which came back brought a flash of wonderment to his eyes He hurriedly unlocked and opened the door "I saw the lights in what I made out to be the Board Room," said the newcomer, as he entered "I assumed it must be you Hope I don't interrupt anything." "Nothing could have given me greater pleasure, Lord Plowden," replied the other, leading the way back to the inner apartment "In... have ear-marked in my mind one hundred thousand of them to be yours." Lord Plowden's face paled at the significance of these words "It is too much—you don't reflect what it is you are saying," he murmured confusedly "Not a bit of it," the other reassured him "Everything that I've said goes." The peer, trembling a little, rose to his feet "It is a preposterously big reward for the merest act of courtesy,"... must be nearly seven o'clock; although the allotment work had kept the clerks later than usual that day, everybody connected with the offices had certainly gone home He realized that his nerves had played him a trick in giving that alarmed momentary start—and [...]... large breed called the Rudgwick, was one of the largest in England There appears to be a doubt as to whether the coloured pig was descended from the spotted Berkshire or the black and white Essex They were of medium size, of good quality generally, but of somewhat heavy bone." The generally accepted view is that the Essex sheeted pig was descended from importations from the county of Sussex These sheeted... were left entirely to the judges, who naturally were led to favour pigs of the type which they bred There was thus a greater amount of uncertainty as to the success of an exhibitor's stock than at the present time This uncertainty— save as to the members of the Show Committees or their friends—was increased by the unfair system of withholding from the knowledge of the average exhibitor the names of. .. those selected to judge The necessity of some definition, if only of colour, quickly became obvious At first classes were established for pigs of certain colours; then the prizes were offered for pigs of certain breeds, which were more or less loosely defined Now at the chief shows the pigs exhibited in the various classes must be qualified for entry in the herd books of the particular breeds At the. .. and whose estate was situated in Essex In Sidney's book The Pig, we read, "West Sussex, Hampshire, Berkshire, Dorset, Shropshire and Wales had indigenous black or red and black breeds of swine; and between the whites, the blacks and the reds the parti-colours were produced which have since in a great degree disappeared under the influence of prizes, generally awarded to pure breeds of single colours."... in the bone and offal They feed remarkably fast and are of an excellent quality of meat The sows are good breeders, and bring litters of from eight to twelve; but they have the character of being bad nurses." If this allegation were true at the time it was written, it is not at the present time as the Half-Blacks or sheeted sows are both prolific and first-rate mothers Malden describes the Sussex:... call these sheeted pigs Hampshires is not on the surface, since the oldest writers on pigs give to the county of Sussex the credit of being their original home The description given by Sidney of the Hampshire pig is that "it is a coarse and useful black pig, inferior to the Berkshire, and not in the same refined class as the Essex." Richardson writes "The Hampshire breed is not infrequently confounded... have been used in the production of the pig which in their time was looked upon as the domesticated and improved pig of the period This difficulty extends even to the present day So far as is known there exists no actual proof that the domesticated hog has been evolved in any particular way other than by continued selection of those animals for breeding purposes which possessed in the greatest degree... Shows have become extinct These were the Small White and the Small Black breeds the sole cause of their disappearance being the unsuitability of ... low risk patients Table 4: Results Conclusions The Step- by -Step approach: Highest sensitivity Useful tool for the management of the febrile infant in the ED However: Not 100% sensitive , no perfect... Silvia Bressant, Liviana Da Dalt, Alain Gervaix, and Laurence Lacroix "Validation of the Step- by -Step Approach in the Management of Young Febrile Infants." Pediatrics 138.2 (May2016) AAP Gateway...Definition STEP BY STEP Algorithm • developed by a European group of pediatric emergency physicians • identify a low risk group of infants who could be safely managed

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