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By: Jonathan Handy

bulletConsultant in Intensive Care Medicine,Royal Marsden Hospital,Honorary Senior Lecturer,Imperial College London

Since this publication is aimed at people working with children and adolescents in a variety of settings treatment 4 pimples cheap lopinavir 250mg line, sensitivity and clear communication are required treatment zenkers diverticulum generic 250 mg lopinavir overnight delivery. This section explains technical words and related terms used within this document treatment emergent adverse event lopinavir 250mg lowest price. Program managers and researchers who gather this information in order to medicine yoga order 250 mg lopinavir mastercard develop and evaluate appropriate responses to the needs of children and adolescents must maintain high ethical standards in order to protect and respect them. Observing ethical standards is important for all information gathering that involves people, including program monitoring and evaluation and research studies. However, extra precautions are needed to protect young people, who are especially vulnerable to exploitation, abuse, and other harmful outcomes. Children and adolescents may suffer harm because they have less power and access to resources than adults. Thus, strategies used to gather information among adults cannot typically be used among children and adolescents without additional safeguards. This publication draws attention to commonly accepted principles of medical ethics and human rights as applied to the special needs of young people, and suggests measures that an adult working with children and adolescents must implement to prevent unintentional harm. Working ethically with children and adolescents to recognize and respond to their needs also requires program managers and researchers to seek out the views of children and adolescents when they are gathering information. This publication is intended to address a wide range of information-gathering activities that recognize and include the views of children and adolescents. This publication was developed in response to a growing need for practical guidance on collecting information from and about young people. However, they apply equally well to gathering information from young people to address other health and social welfare conditions and difficult circumstances, such as those who have experienced abuse, trafficking, or displacement. The process began with an Expert Consultation meeting, which took place in November 2003. Ethical Approaches to Gathering Information from Children and Adolescents in International Settings: Guidelines and Resources is thus an initial step in the development of a new and rapidly evolving area of iv! Ethical Approaches to Gathering Information from Children and Adolescents in International Settings Preface work focused on gathering information from children and adolescents, which is gaining increased attention. This document aims to provide guidance through a maze of ethical issues that require consideration when working with young people. It is not a methodological handbook describing approaches to working with young people. Although methodological and ethical concerns may often overlap, for example when considering interview techniques suitable for use with children, investigators should refer to other sources for specific methodological guidance (see Annex 1 for additional resources). Ethical practice often requires finding a balance among several different sets of demands. The issues are presented in order to explore possible responses and promote discussion and collaboration among people who address them from different perspectives. Promote discussion of ethical issues when working with children and adolescents among people of different backgrounds and training who gather information for different purposes. Part 2 introduces practical guidance for observing high ethical standards at specific stages of an information-gathering activity involving children and adolescents. Part 3 summarizes the main recommendations and suggests roles for various staff members involved in activities gathering information from children and adolescents. Key information from Parts 1 and 2 are highlighted in the summary on pages viii and ix. Ethical Approaches to Gathering Information from Children and Adolescents in International Settings Using this publication Key to symbols "Lessons from experience" are indicated by this symbol. They are not examples of best practices: some frankly identify missed opportunities or oversights and trace the lessons that they learned. They offer the perspectives of children, adolescents, and adults who have considered ethical questions. Sometimes considerations in this publication overlap, and material in a different section will be relevant to the question being discussed. This publication does not provide general training on research ethics, participatory methods, or conducting community assessments.

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Exceptions were added to symptoms after conception discount lopinavir 250mg without a prescription the child care rules to medicine glossary generic lopinavir 250 mg online allow a grace period for immunizations symptoms zoning out purchase lopinavir 250mg without a prescription. The Lead Agency may not terminate assistance prior to treatment jaundice discount 250mg lopinavir overnight delivery the end of the 12-month period if a family experiences a temporary job loss or a temporary change in participation in a training or educational activity. A temporary change in eligible activity includes, at a minimum, any time-limited absence from work for an employed parent due to such reasons as the need to care for a family member or an illness; any interruption in work for a seasonal worker who is not working; any student holiday or break for a parent participating in a training or educational program; any reduction in work, training, or education hours, as long as the parent is still working or attending a training or educational program; any other cessation of work or attendance at a training or educational program that does not exceed 3 months or a longer period of time established by the Lead Agency; any changes in age, including turning 13 years old during the 12-month eligibility period; and any changes in residency within the state, territory, or tribal service area. The Child Care Certificate Program will conduct a redetermination for continued eligibility every twelve (12) months from date of application, or when family circumstances indicate a change. Parent/Guardian is required to notify and provide any change in household income or size within ten (10) calendar days of the change. In cases where the change affects eligibility, the child care agency and parent/guardian will receive a ten (10) calendar day notice that their eligibility will phase out in ninety (90) days. Check and describe any circumstances in which the Lead Agency chooses to discontinue assistance prior to the next 12-month redetermination. Excessive unexplained absences despite multiple attempts by the Lead Agency or designated entity to contact the family and provider, including the prior notification of a possible discontinuation of assistance. Define the number of unexplained absences identified as excessive: the Lead Agency does not terminate eligibility. Substantiated fraud or intentional program violations that invalidate prior determinations of eligibility. Describe the violations that lead to discontinued assistance and provide the citation for this policy or procedure. Note: Responses should exclude reporting requirements for a graduated phase-out, which were described in question 3. If the Lead Agency chooses the option to terminate assistance, as described in section 3. Check and describe any additional reporting requirements required by the Lead Agency during the 12-month eligibility period. Describe: the Lead Agency requires a parent/guardian to notify and provide any change in household income or size within ten (10) calendar days of the change. Describe: the provider contract includes a clause that states that funds are subject to availability. Any additional reporting requirements that the Lead Agency chooses, as its option to require from parents during the 12-month eligibility period, shall not require an office visit. In addition, the Lead Agency must offer a range of notification options to accommodate families. Describe: d) Families must have the option to voluntarily report changes on an ongoing basis during the 12-month eligibility period. The Lead Agency allows the voluntary reporting of changes in income and employment as well as residency details, including changes in household size and composition which may result in an adjustment to the parent co-payment based upon the newly reported income and/or program eligibility. Examples include developing strategies to inform families and their providers of an upcoming redetermination and that information required of the family, pre-populating subsidy renewal forms, having parents confirm that the information is accurate, and/or asking only for the information necessary to make an eligibility redetermination. In addition, states and territories can offer a variety of family-friendly methods for submitting documentation for eligibility redetermination. The Lead Agency allows parents to submit applications and verification via mail, fax or in person. In addition to income and the size of the family, the Lead Agency may use other factors when determining family contributions/co-payments. Note: To help families transition off of child care assistance, Lead Agencies may gradually adjust co-pay amounts for families determined to be eligible under a graduated phase-out. The Income Eligibility Limits and Parent Co-Pay Fee Tables are updated each Federal Fiscal Year and are implemented on October 1st for each corresponding year. The fee is a dollar amount and: the fee is per child, with the same fee for each child. The contribution schedule varies because it is set locally/regionally (as indicated in 1. Describe: the fee is a percent of income and: the fee is per child, with the same percentage applied for each child. The fee is per child, and a discounted percentage is applied for two or more children. Describe: Lower co-payments for a higher quality of care, as defined by the state/territory. Does the Lead Agency waive family contributions/co-payments for any of the following?

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Individuals who can take ownership of the effort can come from various disciplines and may include physicians medications 2 buy cheap lopinavir 250mg line, nurse managers pretreatment cheap lopinavir 250mg, physical or occupational therapists treatment juvenile arthritis purchase lopinavir 250 mg with visa, pharmacists 5 asa medications generic lopinavir 250mg line, or staff members with a particular interest and expertise in fall prevention. Some or all of these staff should make up the interdisciplinary Implementation Team that will guide the improvement effort, as described in section 2. Assess your organization to identify who the potential advocates of fall prevention are likely to be. Would any individuals in that part of the organization be willing to take ownership? In addition to the Implementation Team, improvement projects require resources of various kinds, depending on the size and scope of the program. Launching an effort without first ensuring adequate resources can derail your program at almost every step. Needed resources are likely to include staff time for team meetings and initiatives, leadership time to monitor and support team efforts, training and education time, and more tangible resources such as new care products and communication materials. Cultivating local expertise in fall prevention is particularly key in hospitals that do not have a content expert readily available. Consider creating a checklist to identify resource needs, such as funds, staff education programs, and information technology support. At the beginning of the program, the list of resources needed is likely to be broad and will require refinement as the improvement efforts progress. In developing the list, consider the resources already in place, such as a data system for reporting fall rates and staff education programs. A detailed approach to determining current prevention practices is described in section 2. At this early stage of determining whether change is needed, the assessment of resources can be at a more general level. This tool can be found in the Tools and Resources section (Tool 1E, Resource Needs Assessment). Take the time to develop a list of resources that are likely to be needed as part of a fall prevention program. You should not move ahead with full-scale organizational change until you are confident of organizational readiness. To the extent that readiness is not yet evident, or is only partial, it is critical to address those areas. At a minimum, the facility must have one senior leader who understands the importance of this effort and is committed to supporting the effort both in terms of resources and necessary changes to work processes. In addition, evidence of a broader commitment to patient safety is an essential component. If any of these elements are missing, you will need to first build support and readiness before launching a full-scale change effort. Section 1: Assess Readiness 12 Some ways to build support and readiness may include: a. Trying the changes in a single receptive unit to demonstrate success to the rest of the organization and build the case for change; b. Holding one-on-one meetings with key formal and informal leaders to present information about the need for change and persuade them that the improvement efforts will pay off; c. Collecting and sharing data on fall rates in your facility to establish program relevance; d. Checklist for assessing readiness for change the Organizational Readiness Checklist and other end-of-chapter checklists are designed to provide toolkit users with ways to check their progress through the assessment and implementation steps discussed in the toolkit. They may be useful in ensuring that toolkit users have not skipped essential steps. The checklist for assessing readiness for change can be found in Tools and Resources (Tool 1F, Organizational Readiness Checklist). Being ready for change is a necessary, but not sufficient, prerequisite to changing your organization`s approach to fall prevention. Even when a health care organization is armed with the best evidence-based information, willing staff members, and good intentions, the implementation of new clinical and operational practices still requires additional careful organizational planning.

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These hot spots are primarily in Districts 2 and 3 medicine in the civil war buy lopinavir 250 mg with visa, but also observed in Districts 1 treatment urinary incontinence safe lopinavir 250mg, 4 symptoms neuropathy discount lopinavir 250 mg with visa, 5 medications with dextromethorphan buy discount lopinavir 250mg on line, and 8. As observed with the housing overcrowding hot spot map, these hot spots are primarily clustered in the northwest part of the County. As illustrated by the red, these "hot spots" of communities with high rates of severely overcrowded housing and noncitizen immigrants are primarily in District 2 and primarily clustered in the northwest part of the County. Connecting Drivers of Health with Health Outcomes: Examples for Children and Noncitizen Immigrants 191 Figure 7. Communities with a high percentage of households reporting high housing cost burden were defined as census tracts at or above the 80th percentile, i. Communities with fewer households reporting high housing cost burden were defined as census tracts below the 80th percentile, i. Communities with a low percentage of noncitizen immigrants were defined as tracts below the 80th percentile, i. Communities with a high percentage of severely overcrowded households were defined as census tracts at or above the 80th percentile, i. Communities with fewer severely overcrowded households were defined as census tracts below the 80th percentile, i. Connecting Drivers of Health with Health Outcomes: Examples for Children and Noncitizen Immigrants 193 Summary this chapter is intended to highlight key linkages of drivers of health and health outcomes for two high profile subgroups: children and noncitizen immigrants. Our goal for this chapter is to facilitate discussions about the needs of these groups given the demographic changes in the County. These analyses are also intended to spur further thinking and analyses about other subgroups and the drivers of health that may be most salient to them. This chapter also can be used as the County progresses toward Health in All Policies, and must consider holistic policies and resource allocation to address drivers of health together. For children, our examination of drivers of health impacting receipt of preventive care highlight the social factors that can create barriers to preventative care for children. These districts also have a high prevalence of social factors that can create barriers to preventative care for children, including poverty, lack of health insurance, transportation barriers, and a shortage of health care providers. These factors likely play a role in childhood health disparities in the County, but further analysis is needed to understand the magnitude of these relationships. Additionally, childhood overweight and obesity, which can lead to chronic health conditions in children and adults, is a priority public health concern in the County. The prevalence of childhood overweight and obesity in the County has increased over time and is particularly high in Hispanic youth. Health behaviors that may contribute to weight gain, including poor dietary intake and low physical activity are also on the rise in the County. Poor food environments exist in some areas of the County, but it is not clear how strong of a relationship exists between the food environment, health behaviors, and childhood obesity; understanding the associations between these factors deserves further attention in the County. Our closer look into noncitizen immigrants demonstrated the multiple drivers of health shaping the health of this subpopulation. Noncitizen immigrants are an extremely vulnerable subgroup in the County given their high rates of poverty and housing cost burden and low rates of educational attainment. Data limitations hindered our ability to make strong linkages between health outcomes and drivers of health, but our exploration of drivers of health highlight key concerns. These challenges are pronounced in District 2, where there are clusters of noncitizen immigrant communities living in overcrowded housing with high cost burdens. This may reflect greater need or may reflect worse access to primary care, which can help to better manage nonurgent health problems and prevent health conditions from getting worse and requiring hospitalization. When examining common reasons for adult hospitalizations, we found that five of the ten most common reasons for hospitalizations were related to birth and complications of birth for residents of communities with a high percentage of noncitizen immigrants. Lack of access to, or utilization of, preventive care, potentially due to lack of health insurance, may be driving these higher rates of hospitalization for these diagnoses. Examine unique needs and health conditions of the working poor, by better linking social, built, economic and environmental drivers in data analysis and policy development. Cross department, linked data systems that measure priority health concerns and also include health driver information.

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