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Public schools should encourage educational innovation in the private sector and welcome the competition arteriographic embolization digoxin 0.25mg cheap. Place more emphasis on individual children than on standardized testing arrhythmia ablation is a treatment for quizlet purchase digoxin 0.25 mg line, the overuse of which often runs antithetical to fostering an atmosphere of a personalized education blood pressure homeostasis generic digoxin 0.25 mg otc. This would allow educators to decrease the percentage of time allotted to preparing for standardized tests and allow a greater flexibility in the curricula hypertension 16070 0.25 mg digoxin fast delivery, including inviting parental suggestions. When a child is homeschooled, he or she has the benefit of receiving individualized instruction to become a more virtuous and moral human being (Ryan & Bohlin, 1999). Support implementation with fidelity of research-based social/emotional learning programs and similar interventions (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Become more focused on the good of the overall student population in the school district rather than only those who attend public school specifically. Offer district facilities, when possible, so that parents can use public school equipment to enhance the homeschooling experience for their children. Train teachers how to best help youngsters who either entered public school from a homeschooling environment or who are homeschooled for some classes but not for others. The training would involve the participation of teachers and families who had worked with such a transition and address what the keys are for success in these adjustments. Facilitate learning from homeschooling by holding joint conferences with homeschooling advocates regarding what public school districts and homeschooling families can learn from one another to maximize educational outcomes. Some schools give students the option of either attending their school or using the same textbooks in a home-based environment. It also offers advantages to the family because it makes schooling more affordable for them and more personalized. Leaders need to care about the education that all children receive, not merely those who attend public schools. They need to make it easier for homeschooled youth in their area to participate in extracurricular activities and homeschool without excessive red tape from the school. Contact the homeschool associations and families, encouraging them to send their children to take courses at their schools that would be difficult to teach at home. Realize that homeschooling is a very helpful and practical option for parents who encounter some rather unique situations with their children, such as children who have special needs, who have been bullied persistently, who have disabilities, or whose parents must move frequently. Contact homeschool teachers and ask if they would be willing to tutor struggling public school students, given their expertise in instructing students one on one. Uncommon wisdom: True tales of what our lives as doctors have taught us about love, faith and healing. The academic achievement of minority students: Perspectives, practices, and prescriptions. A meta-analysis of the effects of attending religious schools and religiosity on Black and Hispanic academic achievement. The effects of Black and Hispanic twelfth graders living in intact families and being religious on their academic achievement. Effects of parental involvement and family structure on the academic achievement of adolescents. The relationship between parental involvement and urban secondary school student academic achievement: A meta-analysis. The salience of the subtle aspects of parental involvement and encouraging that involvement: Implications for school-based programs. A meta-analysis on the effects and contributions of public, public charter, and religious schools on student outcomes. Education for children with mental retardation: Parent activism, public policy, and family ideology in the 1950s. Making assessment matter: Using test results to differentiate reading instruction. Challenging the gifted child: An open approach to working with advanced young readers. Teaching and Technology in Support of Personalized Learning Personalizing Curriculum: Curation and Creation Karen L.

Education and training-related challenges include methods that have not kept pace with advances in the learning sciences2 and have an insufficient focus on areas critical to the diagnostic process hypertension pulmonary buy digoxin 0.25 mg without prescription. Numerous experts in health care professional education provided input to the committee; a common theme of this input was that health care professional education and training is not adequately preparing individuals to become skilled diagnosticians arteria iliaca communis cheap 0.25mg digoxin with mastercard. One of the criticisms is that current approaches to education do not take advantage of advances in the learning sciences excel blood pressure chart buy generic digoxin 0.25mg, which have found that learners need to develop a deep conceptual understanding of their content area and to have opportunities to reflect on their knowledge; furthermore pulse pressure in athletes 0.25 mg digoxin, educators need to consider factors such as the learning environment, building on prior knowledge, and focusing on learning in addition to teaching. This can lead to poorly calibrated clinicians who are unaware of their diagnostic performance and overly confident in their diagnoses (Berner and Graber, 2008). In addition, the authenticity of the learning environment can affect the acquisition of diagnostic skills, and a better alignment of training environments with clinical practice can improve the development of diagnostic skills. For example, clinicians often learn from case studies that reflect prototypical cases, but they are faced with the complexities of real patient cases in their clinical practice (Papa, 2014). However, the committee highlighted several areas that are important to the diagnostic process. In addition, current health care professional education and training underemphasizes clinical reasoning, including critical thinking skills and decision making in the diagnostic process (Brush, 2014; Durning, 2014; Richardson, 2014; ten Cate, 2014). Although diagnosticians are trained to make diagnoses, few programs the learning sciences study how people learn in order to optimize education and training. This lack of focus on clinical reasoning and on understanding the cognitive contributions to decision making represents a major gap in health care professional education for all diagnostic team members. Among the strategies proposed to improve clinical reasoning education and training are instruction and practice on generating and refining a differential diagnosis; developing an appreciation of how diagnostic errors occur and of the strategies to mitigate them; engaging in metacognition and debiasing strategies; and fostering intuition and progressive problem solving (Eva and Norman, 2005; Gigerenzer, 2000; Gigerenzer and Goldstein, 1996; Hirt and Markman, 1995; Hodges et al. Oversight processes, such as education and training program accreditation, licensure, and certification, can help ensure that health care professionals achieve and maintain competency in the diagnostic process. Many accreditation organizations already include skills important for diagnostic performance in their accreditation requirements, but diagnostic competencies need to be a larger priority within those requirements. Organizations responsible for health care professional licensure and certification can help ensure that individual health care professionals have achieved and maintain competency in the skills essential for diagnosis. For example, the American Board of Medical Specialties, which grants board certification in more than 150 medical specialties and subspecialties, could use its certification processes to assess competencies in the diagnostic process both in initial board certification and in maintenance of certification efforts. Because the diagnostic process occurs over time and can involve multiple health care professionals across different care settings, the free flow of information is critical. Only 30 percent of clinicians and hospitals are able to exchange clinical data with other clinicians electronically (Adler-Milstein and Jha, 2014). Among the federal efforts to improve interoperability are programs to support the development of flexible interoperability standards and meaningful use incentives. This recommendation is in line with the recent legislation that repealed the sustainable growth rate, which included a provision that declared it a national objective to "achieve widespread exchange of health information through interoperable certified electronic health records technology nationwide by December 31, 2018. Very few health care organizations have focused on the identification of diagnostic errors and near misses in clinical practice (Graber et al. In a presentation to the committee, Paul Epner reported that the Society to Improve Diagnosis in Medicine "know[s] of no effort initiated in any health system to routinely and effectively assess diagnostic performance" (Epner, 2014). These challenges make it difficult to identify, analyze, and learn from diagnostic errors in clinical practice. This is partly attributable to the lack of focus on diagnostic errors within national patient safety and quality improvement efforts. The neglect of diagnostic performance measures for accountability purposes means that hospitals today could meet standards for high-quality care and be rewarded through public reporting and pay-forperformance initiatives even if they have major challenges with diagnostic accuracy (Wachter, 2010). Identifying diagnostic errors within clinical practice is critical to improving the quality of diagnosis for patients; however, measurement has become an "unavoidable obstacle to progress" (Singh, 2013, p. Improving diagnosis will likely require a concerted effort among all health care organizations and across all settings of care to better identify diagnostic errors and near misses, to learn from them, and, ultimately, to take steps to improve the diagnostic process. In addition to identifying near misses and errors, health care organizations can also benefit from evaluating factors that are contributing to improved diagnostic performance. Given the nascent field of measurement of the diagnostic process, bottom-up experimentation will be necessary to develop approaches for monitoring the diagnostic process and identifying diagnostic errors and near misses. It is unlikely that any one specific method will be successful at identifying all diagnostic errors and near misses; some approaches may be more appropriate than others for specific organizational settings, types of diagnostic errors, or for identifying factors that contributed to these errors. It may be necessary for health care organizations to use a variety of methods to develop a better sense of their diagnostic performance (Shojania, 2010). It is important to note that many of these methods are just beginning to be applied to diagnostic error detection in clinical practice; very few are validated or available for widespread use in clinical practice (Bhise and Singh, 2015; Graber, 2013; Singh and Sittig, 2015). Beyond identifying diagnostic errors and near misses, organizational learning to improve diagnostic performance and reduce diagnostic errors will require a focus on understanding where in the diagnostic process these errors occurred, the work system factors that contributed to their occurrence, what the outcomes were, and how these errors may be prevented or mitigated.

The final paragraph of your editorial shows that you are as biased against Jewish aliens hypertension blood pressure discount digoxin 0.25 mg otc, and with as little reason prehypertension cdc purchase 0.25mg digoxin mastercard, as is Mr hypertensive urgency buy digoxin 0.25 mg with amex. You did not mention the word blood pressure of 90/50 cheap 0.25 mg digoxin,Jew openly in your creed, and your sneering references to ,these not yet Americanized New Yorkers, is,stranger than any nightmare, when it is published on the page of a newspaper that gives more than a column to a report of a public meeting of these very,not yet Americanized New Yorkers. A Micro-Chronology of Jewish Eugenics 135 play is a jewel, and we expect, nay, we demand, fairer treatment at the hands of our fellow-citizens than is expressed by the innuendo and sarcasm of your leader. Judt (Ignacy Maurycy Judt): "The classification of the Jews as race among the Semitic tribes is not rationally grounded. The false identification of philological classifications with racial breakdowns has led to confusion. When I speak of Aryans, I by no means have in mind their blood, their hair, or their skulls. Jewish eugenicist Arthur Ruppin: "In our view, social opinion is fully capable of fulfilling its intended function of restraining the psychically or physically hindered from having children. From a letter to the Editor of the New York Times: "[Israel] Zangwills mission here, to prepare the way for the Jews to go to Uganda, lacks full knowledge of conditions, and therefore does not deserve our sympathy. Not Uganda, but America, is the land for the final preparation of the Jew which will befit him to return to the Land of Israel. A preservation of national integrity is impossible except by a preservation of racial purity, and for that purpose we are in need of a territory of our own. If you should ask me in a sense of revolt and outrage: but surely in that case you want segregation at all costs! I would answer that one must not be afraid of words and not of the word,segregation. The Jewish Quarterly Review publishes an article by Jewish-British journalist Lucien Wolf (1857-1930) entitled "The Zionist Peril," in which Wolf characterizes Zionism as "an attempt to turn back the course of modern history, which hereto, on its political side, has had for its main object to secure for the Jewish people an equal place with their fellow-citizens of other creeds in the countries in which they dwell, and a common lot with them in the main stream of human progress. A second factor acting as a,guardian of the races is constituted by the further elimination of racially alien children whom 3. A Micro-Chronology of Jewish Eugenics 137 sexual selection determines shall henceforth be expelled by virtue of their birth. In observing the struggle for existence, particularly in the animal world, we encounter acts that far outshadow in viciousness and unfairness the most extreme spawn of the phantasy as judged by our ethical concepts. But seen from the lofty viewpoint of the teachings of evolution, this,viciousness reveals itself as the expression of the deepest wisdom. When a surgeon calmly amputates a limb, intending to preserve the body of a patient from a general infection who is ill because of his heredity so as to preserve his life and spiritual development, a fool observing the operation would experience horror over the,viciousness of the physician. American inventor Max Levy (1857-1926): "I see no reason why the Jews, any more than any other man or animal, should be above the conditions which govern the development of species. The influence of the environment upon the origin and development of species has been clearly set forth by Spencer, Huxley, Darwin, and other exponents of the theory of evolution, and the same class of considerations that effects the physical development of species is clearly shown to exert an equally powerful influence on the development of civilization. Thus, Jewish history is no longer the product of some extraterrestrial God influencing the masses, who are merely passive plasma for a moral and self-defining divine artist, but rather are the product of the abilities and demands that individual people brought with them and kept alive by virtue of inheritance. A Micro-Chronology of Jewish Eugenics 139 senness, which was then stubbornly inherited because it titillated the vanity of the community. The prohibition of mixed marriages was the chief racestructuring factor that activated inheritance in its supreme efficacy even as these advantages were passed on from generation to generation and steadily accrued thanks to inbreeding.

There the court said: Before leaving the matter of the first two counts we would state in the hope it will be of use to the magistrate on future occasions blood pressure zantac digoxin 0.25mg fast delivery, as pointed out by the Court of Appeal in Henry and Manning v Republic 53 criminal appeal rep 150 blood pressure medication can you stop buy digoxin 0.25mg lowest price, it has been said again and again that in cases of alleged sexual offences it is really dangerous to convict on the evidence of the woman or girl alone heart attack low vs diamond discount 0.25mg digoxin mastercard. It is dangerous because human experience has shown that girls and women sometimes tell an entirely false story which is very easy to fabricate prehypertension pregnancy discount 0.25 mg digoxin overnight delivery, but extremely difficult to refute. In every case of an alleged sexual offence the magistrate should warn himself that he has to look at the particular facts of the particular case and if, having given full weight to the warning, he comes to the conclusion that in the particular case the woman or girl without any real doubt is speaking the truth then the fact that there is no corroboration need not stop his convicting. In the present case, the court rightly pointed out that the same caution is not required of the evidence of women and girls in other offences, and that the court found no scientific proof or research findings to show that women and girls will, as a general rule, give false testimony or fabricate cases against men 7 Sexual and Other Forms of Violence Against Adult Women 207 in sexual offences and yet courts had consistently held that in sexual offences testimony of women and girls should be treated differently. Ratio Decidendi a) the requirement for corroboration in sexual offences affecting adult women and girls is unconstitutional to the extent that the requirement is against them qua women or girls. It consequently held that treating female witnesses differently in sexual cases cannot be justified. The complainant (victim) told the court that she had been engaged to get married to the accused person and dowry had duly been paid in accordance with the customary law governing the parties. The accused hired some people, who kidnapped her, took her to his house, locked the door and raped her while her two abductors held her down on the floor. In defence, the accused denied the offence and raised the defence of mistake of fact or honest belief under section 9(1) of the Penal Code of Uganda. Issues and resolution the fact that the accused person had the victim abducted and brought to his house, where he locked her in and had sexual intercourse with her, was not disputed. The accused claimed that he acted under the honest and mistaken belief that the victim was his wife, since he had paid dowry for her. It was his case that a husband cannot rape his wife under the laws of Uganda, implying that once a woman got married, she gave an express and irrevocable consent to the husband to have sex all the time and that the question of consent does not arise. Moreover, the evidence demonstrated that the complainant never consented to sexual intercourse. The judge stated that even if the parties had been married under customary law, the facts and circumstances of the case would render the defendant guilty of rape. He noted that the provision in the Penal Code that deals with rape does not make an exception for married persons. He observed that some other jurisdictions have constituted the offence of marital rape to counter the outdated presumption of consent by virtue of marriage. The judge stated that the existence of a valid marriage or honest belief of a valid marriage is no longer a defence for rape in Uganda in view of the 1995 constitution, which provides for equal rights in marriage and full and equal dignity of the person. These provisions, he explained, exclude the operation of section 9(1) of the Penal Code to the situation in this case. The appellant was dissatisfied and appealed to the Court of Appeal, but his appeal was dismissed as it did not raise any points of law to warrant intervention by the Court of Appeal. The prosecution case in the trial court was that the complainant, a student at Mlingano Secondary School, lived with her grandmother in the same village where the appellant, a traditional healer and local medicine man, also lived. Prior to the date of the incident, the complainant/victim fell sick and the appellant was approached so that he could treat her. What followed thereafter borders on rituals and sorcery, as the victim was taken to various places. The appellant spread a piece of cloth on the ground, asked her to sleep on it and he raped her. When the appellant was through with the sexual encounter, which he had earlier told her was part of the treatment, he warned her not to disclose the rape to anyone. The matter was reported to the authorities and the appellant was arrested and charged. He called witnesses, who testified on the sickness of the complainant but not on the alleged rape incident. Issues and resolutions There were three grounds for appeal, namely that: the charge as framed was defective in that the specific ingredient of an offence under section 130(3) of the Penal Code, as amended, was not stated. It is trite law that a charge should disclose the nature of the offence so that an accused person may know the nature of the case he has to answer.

The disorder may have presented when the child was much younger arrhythmia in fetus order digoxin 0.25 mg with mastercard, so that the original consultation will have taken place primarily between the doctor and parents blood pressure medication vitamin k discount 0.25 mg digoxin. As the responsibility for management moves to the young Transition to adult services Theyoungpersonwithachronicconditionmusteven tuallyleavepaediatricandadolescentservicesforadult services prehypertension high blood pressure generic digoxin 0.25 mg with amex. Thisofteninvolveschangingfromatreatment model based around close contact between the ado lescent and healthcare professionals (unlimited tele phone advice from clinical nurse specialists arteria ductus deferentis discount digoxin 0.25mg on line, possibly homevisits,frequentappointments)andinvolvement withparentsandotherfamilymembers,toonewhere theyarelikelytobeseeninfrequentlyinabusyadult 1 2 3 Adolescent medicine 497 4 person, information needs to be provided about medications and treatment appropriate for his/her development. The implications of their condition on the rest of theirhealthneedstobeconsidered. Thismayinclude sexual health, future vocational development, includ ingtheneedfordisclosureandtheirrightsunderthe DisabilityDiscriminationAct. Let the suggestions come from the adolescent Negotiate short-term treatment goals. Search for factors that motivate the young person Plan the regimen with the adolescent. Some may respond to a written contract that both sides agree to stick to Most of what is said has been shown to be forgotten once they leave the room! Check level of knowledge on each occasion Find out what has been going well and why. Youngpeopleandtheirparentsneedbothinforma tion about the transfer process and time to prepare. Transitionalcareencompassesthispreparationwhich, by definition, addresses the medical, psychosocial and educational/vocational needs as a young person moves from child to adultcentred services. Itishelpful if an identified healthcare professional, often a nurse specialist, is responsible for coordinating transition arrangements. Whereas transitional care starts in early adoles cence,someflexibilityinageoftransferisdesirable,so that it can occur when the young person is develop mentallyreadyandhasthenecessarymaturitytocope withadultservices. Transfer may be via an adolescent or young adult service with clinics run by both adolescent and adult teams together. Such bridging arrangements have many advantages, but require a sufficient number of patientsandmedicalstaffableandwillingtoprovide thisservice. Alternatively, transfer may be successfully accomplished if there is good communication between teams, although it usuallyinvolvesaradicalchangeinethosfortheado lescentandfamily. The generalpractitioner maybea source of continuity between changing specialty practitioners. Fatigue, headache and other somatic symptoms Fatigue,headache,abdominalpain,backacheanddiz ziness are common in adolescence. International surveysofadolescentsinEuroperevealthattwothirds report morning fatigue more than once a week, 25% haveaheadacheand15%stomachache,backacheor sleepproblemsmorethanonceaweek. Inmany,these symptoms appear to be a feature of adolescence, althoughorganicdiseasemustbeexcludedbyhistory, examination and, occasionally, investigation. Adolescents do not always understand the risks involvedandmaybehaveasiftheyareimmunefrom harm. Participatingintheseactivitiesmayalsodeflect attention away from themselves to mask shyness or anxiety. Thismaybebecause ofalackofknowledge,lackofaccesstocontraception, inability to negotiate obtaining contraception, being drunkorhighondrugsorunabletoresistbeingpres surisedbytheirpartner. Occasionally, the symptoms are so severe and persistent that they considerably affect quality of life, with impairment of school attendance, academic resultsandpeerrelationships. Further investigation and assessment will be required and multidisciplinary rehabilitation and cog nitive behavioural therapy within the family may be beneficial. Themanagementofsomaticsymptomsand chronic fatigue syndrome are considered further in Chapter23. Management of sexually transmitted infections Takingasexualhistoryfromanadolescentshouldbe approachedsensitively,inadevelopmentallyappropri ate manner, giving the young person warning of the topic, as well as why the questions are being asked. In England, in responsetothehighratesofchlamydiaintheunder 25yearold age group, there is a national chlamydia screening programme enabling them to test them selveswitheasytousekits. Chlamydia can be treated with azithromycinordoxycycline,gonorrhoeawithacepha losporin. Mental health problems the prevalence of mental health problems in adoles centsisestimatedtobeabout11%.

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