Sustiva

Michael A. Belfort, MBBCH, MD, PhD

  • Professor, Department of Obstetrics and Gynecology
  • University of Utah School of Medicine
  • Salt Lake City, Utah
  • Director of Perinatal Research
  • Director of Fetal Therapy
  • HCA Healthcare
  • Nashville, Tennessee

Simulators have shown to be as effective as live actor-patients for teaching purposes [13] symptoms sleep apnea . The foremost is the fact that all these tools can be supplemental to clinical teaching but not a replacement medicine for pink eye . Secondly medicine under tongue , setting up of a virtual learning environment or a simulation laboratory is costly and time taking medications mexico , making it especially unsuited for the low and middle income countries. Thirdly, while virtual simulators will maintain the tenet of both non-contact with patient and social distancing amongst students, mannequin simulators will flout social distancing needs amongst students precluding their use currently. Other important barriers that have prevented medical educators to dissipate e-teaching (during these emergent times and otherwise) include time constraints, poor technical skills, inadequate infrastructure and absence of institutional strategies. Proposed solutions include improved educator skills (which may not be feasible in the short-term, therefore tagging with people who already have these skills may help), inculcation of a positive attitude, and incentives/ reward for the time devoted to the development and delivery of online content [14]. While it may appear impressive to talk about online/ digital/simulation-based learning, the fact remains that in India, we are still far away from such modalities [15]. A mandatory component of formative assessment also needs to be included to ensure attainment of learning objectives. Having a common curriculum and rotation schedule for all colleges of India could prove to be a blessing in disguise, allowing us to have centrally prepared material. Many colleges in the public sector and some in private sector have good equipment which can be put to use. Availability of scattered expertise across institutions can be collated for better results. There have been some recent publications from India to highlight the role of social media as a tool for engaging students [16,17]. Similarly, existing professional networks can be used for webinars on important topics. In addition to the use of above tools, there may be a few measures that may smartly squeeze some moments of clinical learning for the medical students. These include modification of the academic roster (preponing scholarly work and deferring clinical rotations to a later time frame) which may be feasible at certain medical centers as per their learning goals. Also, students may be involved in the tele-health consultations (which have become far commoner during this pandemic). Most importantly, they may serve as educators to their peers, patients and communities by developing educational materials and videos, thus influencing behaviors in a positive way to prevent the spread of the pandemic. Medical educators may guide in identification of these topics and moderate such discussions. Many e-learning activities are already being conducted, albeit a formative assessment component needs to be integrated into the framework. Available Platforms* · Cloud ­ computing platforms like Zoom, G-Suite which allow video conferencing. The most reasonable strategy will be for every medical school to model continued pre-clinical and clinical teachings to match with the available resources. Such delays are demotivating for the exam-going students and may put their career path on the back foot, if the closures extend. In universities where the final year medical students have been selected for a residency, early graduation should be considered a viable option. The medical education systems are already emphasizing the need for achievement of core competencies rather than mere completion of a stipulated time period in a subject. This will not only provide a boost to the students but also add to the healthcare work-force, who can step up per the demands of the situation. In India, the same situation of transition applies to the final year residents who are at the cusp of their post-graduation. An early post-graduation for these residents based on sturdy assessment merits a thought. Nevertheless, an important point to contemplate is the method of summative assessment to be employed while maintaining social distancing. Medical educators/faculty · Prepare resource material for online power point presentations, videos, webinars, webcasts.

They are particularly valid for the arrest and subsequent disappearance of the Communist party leadership in 1976 medications and grapefruit interactions . With regard to the Mapuche prisoners and others whose death or disappearance was not the work of the security services and not 649 in accord with the logic of their activity medicine 101 , the perpetrators had a number of motivations conventional medicine , such as getting even for political feuds of the recent past medications prescribed for ptsd , or anti-Mapuche discrimination, or purely personal passions. Killing habitual criminals reflects a distorted notion of the duty to impose order. There have been even more notorious examples of this notion in other parts of the world. In early 1974 arrests were more indiscriminate, and torture was used without restraint in an effort to gather quickly as much information as possible on underground political activity. There were some instances of mistaken identity, when the disappeared person was taken to be someone else whom they were seeking. Sometimes the only reason for the disappearance of a prisoner was that he or she had been apprehended together with the activist being pursued. Such was the case of Maria Olga Flores Barraza, who disappeared after being arrested with her husband, the Communist leader Bernardo Araya, who is also disappeared. In some instances, relatives visiting prisoners in acknowledged detention sites were arrested for trying to pass messages during their visit and then disappeared. Likewise there were cases of staff or guards of the intelligence services who were accused of being traitors and were therefore killed by agents of the service in which they worked. On the other hand, some political prisoners agreed to collaborate and then tried to ingratiate themselves with their parties, which then killed them in punishment. There were also a few rare instances in which someone powerful in the government, the armed forces, or the police, prevented a prisoner from being killed. Finally there were situations in which the prisoner survived due to strange and complex relations with his or her captors, which are difficult to explain outside of the secret environment of violence and degradation existing in secret prison sites. Some people disappeared after being seized as they were trying to seek asylum in an embassy. The only apparent reason was to punish them for the attempt and to intimidate others who might have attempted to do the same. As already noted, sometimes relatives or friends of those being sought were arrested. Hence the very presence of witnesses could be avoided and it became easier to conceal what had happened. Starting in 1975 and even more in 1976, the prevailing method of work seems to have been to first locate the victim, study his or her habits, and then carefully select the manner, time, and place for the arrest. Nevertheless the Joint Command did not exercise the same kind of caution in making arrests even into 1976, and hence relatives or neighbors were often not only aware of what had happened but of the identity of those making the arrest. In addition to information gathered through interrogating other prisoners and capturing documents, the intelligence services acquired sophisticated methods of intercepting private communications. Sometimes different agents were responsible for the various tasks of locating persons, following them, studying their habits, and seizing them. When those making the arrest identified themselves to those being arrested or their families at the moment of arrest, they often gave false names or falsely claimed to represent a particular institution. The main object of torture was to obtain information from the victims-either to bend their resistance or to assure that what they had already said was true. A second purpose was to break their resistance or their physical or moral integrity, so as to directly instill fear into others who could see or hear the torture and to intimidate other persons who might hear 651 about it. Mistreatment, including beatings, humiliations, insults, degrading conditions of confinement, being held blindfolded and poorly fed for a long time, went along with torture and contributed toward the same aims. Such mistreatment, even if it did not fall directly into the category of torture, should be regarded as those other forms of cruel, inhuman, or degrading treatment that are likewise categorically prohibited by international human rights law. Often mistreatment or torture were practiced not as part of a particular interrogation process, but were rather the expression of the cruelty or base passions of an agent or a guard. Observations are made on the practices of the other intelligence services when they diverge from the general practice. These sites had permanent installations for applying such methods and personnel trained to use them. These people were not the same as the officers who took charge of the interrogation, although these officers might take part in applying torture and indeed did so directly. Such methods were: * the "grill," that is, applying electrical current to prisoners while they were tied to a metal bed spring.

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The report said that after the events at Fuenteovejuna medicine for high blood pressure , the government agents went to Calle Janaqueo No medicine pouch . That proved impossible because those who were inside the building put up armed resistance medicine - . The agents immediately began to shoot with the 50 millimeter machine mounted on a jeep that they had used against the building on Fuenteovejuna treatment anemia . The agents had previously gathered the neighbors, approximately eighty people, in a local church. The Commission 848 came to the conviction that both of these people were executed by government agents in violation of their human rights. The autopsy report states that he was hit by more than ten bullets and that the immediate cause of death was "a cranial and cerebral wound fired from a nine calibre bullet, which from the shape of the wound may have been inflicted with a mounted weapon. In view of the evidence it has received and statements by witnesses, the Commission has come to the conviction that security agents detected and followed Juan Espinoza, and that even though they could have arrested him, they executed him on a public thoroughfare; it therefore regards his death as a human rights violation committed by government agents. The agents shot back and the ensuing gun battle ended with the death of Enzo Muсoz and Hйctor Sobarzo. Enzo Muсoz and Hйctor Sobarzo parked the car at the Departamental Traffic Circle in front of the Don Camilo apartment complex. They shot at Enzo Muсoz and arrested Hйctor Sobarzo, put him in a vehicle, and shot him further on. This official account notes that some hours after the other gun battle and as part of the effort to investigate recent attacks in Callejуn Lo Ovalle, when the agents came to the 800 block and were carrying out a search, they had a gun battle with three men and a woman, in which Juan Varas and Ana Delgado were killed. The evidence gathered by the Commission, and particularly the fact that the official account of the deaths of Enzo Muсoz and Hйctor Sobarzo was false, has enabled the Commission to come to the conviction that these two people were executed by government agents who thus violated their human rights. Security agents had been following all of them, and hence they were quite clear on the activities in which they were engaged. The official reports issued on these cases all spoke of gun battles in which people were killed. With the various items of evidence it gathered, however, the Commission has come to the conviction that these people were executed. The first event took place on the morning of August 23, 1984 in Hualpencillo, an area near Concepciуn. Witnesses say that they shot him without ordering him to surrender, and that he offered no resistance. The bus had been followed from Talcahuano, and was halted in front of the fruit and vegetable market where there are always many people. Witnesses whom the Commission questioned said that Lagos and Herrera did not offer any resistance, and that they got off the bus unarmed, without hostages, and with their hands in the air. At that moment Mario Lagos was shot in the armpit, thus proving that his hands were up. The autopsy report on Nelson Herrera indicates that he was killed subsequently, with a shot to the head at short range, and while handcuffed as indicated by the marks on his wrists. Testimony examined by the Commission indicates that he did not offer any resistance when he was arrested. An official report also spoke of a gun battle in this case and mentioned a third person who fled from the scene. He tried to escape through the back of his house but he was surrounded, shot repeatedly, and died on the spot. A number of witnesses have said that he did not offer any resistance, and that the agents killed him when he was completely at their mercy. In view of statements from many witnesses whom it interviewed, as well as other evidence that has been gathered, and the implausibility of official accounts of how these events took place, this Commission is convinced that these seven people were executed by government agents in violation of their human rights. Expert examination has likewise shown that the weapon he supposedly used to fire two shots was not working well, since it had a broken trigger, and presumably it was not used. They shot back and a half-hour gun battle ensued, which ended when the house caught fire. Witnesses, however, say that on that day a large contingent of security forces came to this site, and they were backed up by a 852 jeep which had a mounted machine gun. The official claim that he had a mortar is implausible since he would have caused a great deal of damage and would have injured many agents, but that did not happen.

Individual decision on each case By the beginning of October medicine used during the civil war , the Commission had established a schedule and laid down a procedure whereby each of the lawyers could prepare information on the cases he or she had been assigned to investigate under the supervision of the Commission members medicine used for adhd . At this point the lawyers focused on drawing up a written report in accordance with Commission guidelines in order to give an account of all the evidence they had gathered in each case and to suggest that the Commission adopt a particular conclusion medications 4h2 . In sessions lasting until mid-January 1991 symptoms ruptured ovarian cyst , the Commission individually examined about 3,400 cases, until it had reached agreement over how it was going to present each case in which human rights had been gravely violated or in which people had been killed as a result of political violence. In other cases it concluded that it had not been able to come to such a determination or that the case was beyond its competence. In only a small number of instances did it reach agreement by a simple majority, and in none of these cases were the differences over matters of principle. Hence the Commission agreed to leave dissenting opinions only in its minutes and to omit them in this report. As a result of the time available to the Commission for completing its tasks some of its official inquiries remained unanswered and consequently a number of cases were left unresolved. Hence in this report the Commission recommends that the government continue to investigate these situations to determine whether they also constituted grave human rights violations. An account of the truth about individuals and the country as a whole As it was weighing information, the Commission was also deciding the structure and characteristics of the present report. In order to provide an account of the episodes in which the Commission concluded that grave violations of human rights had taken place, the staff first had to provide concise accounts of these cases and present them in draft form to the Commission. Hence what is written in the accounts are basically those elements that directly or indirectly led the Commission to conclude that a grave human 36 rights violation had taken place. This procedure has enabled the Commission to identify every single victim of grave human rights violations, as well as the people who were killed as a result of political violence, and to indicate its conclusion and reasoning in each case. The examination of these particular situations served as the basis for the overviews which outline the major features of events in each period considered in this report. These overviews highlight the most common and relevant features of the events, the organizations involved, who the victims were, and the methods used in these violations, such as the location, treatment, and disposal of dead bodies. Testimony given by important actors of that period and by people who were involved in organizations and groups which violated human rights, as well as the contributions of those who have studied these matters, were very important for drawing up this overview. The Commission was also charged with providing evidence that might make it possible to determine the fate of the victims and their whereabouts. Whether it could be accomplished was basically dependent on whether people who could offer evidence were willing to appear voluntarily before the Commission. The information thus gathered can be found in this report as well as in what was presented to the courts, since whenever evidence concerning the whereabouts of the remains of someone who had disappeared after arrest was obtained, it was immediately submitted to the courts. Since this task was so important, the Commission did not want to finish its work without first sending out a confidential official request for any evidence that could directly or indirectly help determine what had happened to those persons identified as disappeared. These requests were sent to agencies or government bodies whose members were said to have participated in some action of arresting or imprisoning these persons and to those government figures who might have ordered investigations into such matters. Although almost all of these requests were answered, none of the answers offered any information that could substantially serve that purpose. The final volume [not included in the English translation] of this report is simply auxiliary in nature. It provides an alphabetical list of all of those persons whom this Commission has regarded as having suffered grave human rights violations or political violence. In other cases, the Commission decided to send the courts whatever evidence it gathered that seemed new, useful, or relevant for judicial investigations. Thus when the evidence the Commission gathered did not go beyond what was already in the possession of the courts, or when it did not seem relevant for a judicial investigation, it was not sent to the courts; the intention was to send only evidence that could make a difference. In no case did the Commission refrain from sending evidence because a criminal action might be ruled out, or because the amnesty law might go into effect. The Commission determined that such decisions were to be made by the courts, and hence it should not decide such circumstances on its own. In sending evidence to the courts, the Commission was careful to observe the norms laid down in its founding presidential decree, namely that the identity of those who wanted to testify confidentially should be protected. In no case has this concern hindered the Commission from sending to the courts all available evidence about sites where the remains of someone who disappeared after arrest might be found. Acknowledgement of harm inflicted and proposals for reparation and prevention As has been noted, from the beginning the Commission did not want to stop at presenting the truth about human rights violations. Hence the Commission discussed this matter with the relatives in each interview and testimony session.

References

  • Kandemir A, Guven S, Balasar M, et al: A prospective randomized comparison of micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (rirs) for the management of lower pole kidney stones, World J Urol 35:1771n1776, 2017.
  • Pinsky L, Krooth RS. Studies on the control of pyrimidine biosynthesis in human diploid cell strains. II. Effects of 5-azaorotic acid, barbituric acid, and pyrimidine precursors on cellular phenotype. Proc Natl Acad Sci USA 1967;57:1267.
  • Leigh PN, Rothwell JC, Traub M, Marsden CD. A patients with reflex myoclonus and muscle rigidity: 'Jerking stiff-man syndrome'. J Neurol Neurosurg Psychiatry. 1980;43:1125-1131.
  • Hoenshel RW, Pearson DB, Kleiner DM: The technique most commonly employed with the FM extractor [abstract]. J Athl Train 36:S70, 2001.
  • Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010; 67(1):1-8.