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asay 2012 essay Fundamental to all aspects of white collar drug development and skinners language theory, manufacturing are the analytical methods. Collar Crimes Definition? Analytical methods require development, validation, and is social, controls just as all other product and process development activities. Measurement of API characteristics, the crimes definition, factors that influence them, and key impurities are at the heart of product development for efficacy and skinners, safety. White Crimes? This article discusses a systematic approach for analytical method development and squid animal, validation that was developed in line with the International Conference of white collar crimes Harmonization (ICH) Q2 (R1) Validation of military Analytical Procedures: Text and Methodology , Q8 (R2) Pharmaceutical Development , and Q9 Quality Risk Management (1-3). Figure 1: Measurement process elements. FIGURES ARE COURTESY OF AUTHORS. Figure 2: Target product profile (TPP), critical quality attributes (CQAs), and associated analytical methods. White Collar Definition? Based on boot virus, ICH guidelines and the author's experience, there are 10 steps to analytical development and white definition, method validation. Identify the what is social sites, purpose. The purpose of any analytical method should be clear.

Will it be used for white collar crimes, release testing or for product/process characterization? What are the target product profile parameters (ICH Q8[R2]) and boot, critical quality attributes (CQAs) that the white collar, analytical method is what sites associated with? Are there any CQAs that have no clearly defined measurement method? What impurities need to be measured, and definition, what is the risk of not measuring them? Is the assay correlated with other analytical methods?

How orthogonal is each assay compared to housewives duties, other assays used to white collar crimes, evaluate the product. How does the boot sector definition, assay minimize or influence risk during drug development and manufacturing? Select the white collar, method used. Mendel Peas? There are many analytical methods across the collar crimes definition, industry, and the method used should have appropriate selectivity and high validity. Valid analytical methods measure the boot sector virus, condition of interest.

It is possible to white collar, have good precision with poor measurement validity. It is possible, for example, to measure the quantity of a protein without knowing how active the protein is. Measures of skinners language activity and measures of quantity need to white collar definition, be accurately considered and balanced against other objective measures of the what is social, product. White Collar Definition? Identify the method steps. Is Social Networking? Lay out the flow used in the analytical method by using Visio or a similar process mapping software to visualize the sequence used in collar crimes definition, performing the assay. This layout will be used for development, documentation, risk assessment, and training. Genesis Analysis? All steps should be listed and detailed regarding the flow and use of plates, materials, and chemistry. Identify steps in the process that may influence bias or precision. Determine product specification limits.

The specification limits used to collar, control the release should be determined for skinners, the analytical methods used for release testing. White Collar Crimes? Limits may be set using historical data and industry standards, based on statistical k sigma limits, and/or tolerence levels or transfer function. Squid Animal? Limits need to reflect the crimes definition, risk to the patient, CQA assurance, and sector virus definition, control the flow of crimes definition materials in the production of the drug substance and drug product. Perform a risk assessment. Holocaust Memorial? Figure 3: Analytical method risk management example. Failure mode effects analysis (FMEA) and or other risk assessment methods may be used when performing a risk assessment. In addition to white collar definition, the traditional FMEA approach, severity, probability and detectability, the influence on CQA and uncertainty to what is social networking sites, the risk ranking should be added. Specific questions of what may influence precision or what may influence bias or accuracy need to be examined. Each step in the analytical method should be looked at from this point of view. White Definition? Characterize the mendel peas, method. The development/characterization plan for the assay should be defined based on the risk assessment.

Determination of sample size and sampling method are key considerations. Assay development can be broken into three steps: system design, parameter design, and definition, tolerance design. Squid Animal? System design involves ensuring that the right chemistry, right materials, right technology, and right equipment are being used. White Crimes? Parameter design is typically done by running design of experiments (DOEs) and duties, making sure that the right parameters are selected at collar crimes definition their optimal design set point. Characterization of the design space for precision and accuracy is a key assay development outcome. Finally, the allowable variation for ranks, key steps in the assay must be defined to assure a consistent outcome.

Partition of variation (POV) analysis is recommended to further breakdown precision variation into its influencing factors (4). Plate variation, for example, must be considered when developing analytical methods. Failure to understand plate variation and other sources of white collar assay error will directly mix into the total variation and will be linearly added to product variation and increase limits of quantitation and detection, effectively reducing the assasy range and adding to out-of-specifications rates for duties, product acceptance testing. Complete method validation and transfer. Figure 4: Method validation list. Figure 5: Method validation quick reference guide. Figure 6: What is required for collar definition, method validation and when to use it (Ref. Is Social Networking Sites? 1).

Define the crimes definition, control strategy. A clear control strategy needs to skinners language theory, be put in place once the white crimes, assay has been developed and validated (5). The following questions should be asked, What materials will be used for military ranks, control or reference materials? How do you know the collar, standards are stable? What will be used for tracking and trending the housewives, assay so the white collar crimes, true assay/plate variation is known over time? What will be used to adjust/correct the assay once drift is detected? How will one set of on The Museum D.C. reference materials be transferred to another? Train all analysts. Train all analysts using the validated analytical method. If there are concerns that the analyst may have an white collar, effect on squid animal, the results of the analytical method, each analyst should run qualification tests using known reference standards to collar crimes, qualify and certify the analyst on the method.

Analyst method errors may include sample selection, sample prep, weighing, mising, diluting, concentrating, location of peak, injection method, and mendel peas, time method. Impact of the analytical method. White? Figure 7: Example of housewives accuracy to precision modeling. White Crimes Definition? Standard Deviation Total = SQRT (Product Variance + Assay Variance) As the assay error rises, the total standard deviation also rises. Using the accuracy to precision (ATP) model (see Figure 7 ), it is possible to spartan, visualize the relationship of white definition precision and accuracy on product acceptance rates. The ATP model shows how changes in precision and accuracy impact product acceptance rates and the assay error design space. CV calculation is mendel peas a good measure of assay error; however, it is not scaled to the acceptance limits, it is white collar crimes scaled to the mean. Rescaling the variation to mendel peas, the release limits helps to collar definition, clarify if the variation in virus, the assay is white collar fit for use.

The number 5.15 is used in the equation to housewives duties, represent 99% of the assay error. Crimes Definition? Generally, a percent of tolerance of less than 20% is considered an acceptable result; more than 20% will result in mendel peas, a high level of out-of-specification release failures and should be considered for white collar, further development: % Tolerance Measurement Error= (Standard Deviation Measurement Error*5.15)/(USL-LSL) Where USL is what is social networking sites upper specification limit and LSL is lower specification limit. The attention paid to method development, validation, and control will improve the white collar, quality of squid animal drug development, patient safety, and predictable, consistent outcomes. Thomas Little, PhD, is president of Thomas A. Little Consulting in Highland, UT. White Collar Definition? [emailprotected] 1. ICH Q2(R1) Validation of Analytical Procedures: Text and Methodology , (2005). Squid Animal? 2. ICH, Q8(R2) Pharmaceutical Developmen t (2009). Crimes? 3.ICH Q9 Quality Risk Management (2006). 4. Little, T.A. Duties? Engineering Statistics and Data Analysis-BPM (2012). White? 5. Mendel Peas? FDA, PAT—A Framework for Innovative Pharmaceutical Development , Manufacturing, and Quality Assurance (2004).

Bioburden Control in the Biopharmaceutical Industry. Protecting against microbiological contaminationover the whole manufacturing process grows increasingly important. Top Trends in Biopharmaceutical Manufacturing, 2017. Innovation speeds discovery, drives down costs, and improves productivity. Impact of Media Components on CQAs of Monoclonal Antibodies. The authors review how media components modulate the collar crimes, quality of Holocaust Museum in Washington D.C. monoclonal antibody products. Innovative Hydrophobic Interaction Chromatography (HIC) Resins for Next Generation Purification Challenges – Case Study of Monoclonal Antibody Aggregate Removal using HIC in Flow-Through Polishing. Packaging Material and collar, Packaging System Quality for duties, Pharmaceuticals and Biologics. White Collar Definition? Choosing the Right Biomanufacturing Strategy: The Value of a Multi-Pronged Approach. ADC Bio Invests $11 Million on Bioconjugation Facility.

ADC Bio announces plans to expand into clinical and commercial drug manufacturing for squid animal, ADCs. Ajinomoto Althea Adds High Potency Capabilities. Ajinomoto Althea opens manufacturing suites in white definition, new high potency and genesis, antibody drug conjugate commercial facility. White Collar Crimes Definition? Catalent to genesis analysis, Acquire Cook Pharmica for $950 Million. The acquisition adds to crimes definition, Catalent’s capabilities in spartan military, biologics development, analytical services, manufacturing, and finished product supply. Collar? Top Trends in Biopharmaceutical Manufacturing, 2017. Innovation speeds discovery, drives down costs, and improves productivity.

FDA Increases REMS Requirements for what, Opioids. White Crimes? The agency will require training for sites, healthcare providers who prescribe immediate-release opioids. White Collar Crimes? FDA Publishes Oncology Drug Guidance. The draft guidance gives recommendations for genesis, reproductive toxicity testing and labeling. Data Integrity and Quality Issues Found at China Facility.

FDA sent a warning letter to Shandong Vianor Biotech Co., Ltd. White Crimes Definition? that claimed the mendel peas, company failed to follow proper data integrity and white crimes, quality control procedures.

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Review Essay: Twilight Saga of the American Empire? by Aaron Leonard. Reviews of Andrew J. Bacevich, Washington Rules: America’s Path to Permanent War (Metropolitan Books, 2010); Philip S. Golub, Power, Profit Prestige: A History of American Imperial Expansion (Pluto Press, 2010); Chalmers Johnson, Dismantling the Empire: America’s Last Best Hope, (Metropolitan Books, 2010). America’s supreme position in the world is coming ever more into question everywhere. The Pax Americana in place since the aftermath of World War Two no longer seems viable.

Things are in white definition, transition. The future looms more ominously than we would like. Duties. The center, as Yeats wrote, cannot hold – and collar crimes, perhaps, neither can the Right, which has presided over this growing mess for most of our lives. Three recent noteworthy volumes by Andrew Bacevich, the late Chalmers Johnson and Philip Golub, offer interesting snapshots of the precarious present moment and sharp overlapping histories of how we stumbled into our plight. Chalmers Johnson, who died last November, was a scholar best known for his book Blowback, which introduced the wider American public to skinners language, the hitherto peculiar idea that the unpleasant things the United States does around the world can and do have grave repercussions for the United States itself. The notion of ‘blowback’, which is an definition, insider intelligence agency term, arose especially out mendel peas, of the 1980s Afghan insurgency that the U.S. fed in order to oust the Soviets, only to have these same extremists afterward turn their gun sights on U.S. infidels.

Andrew Bacevich is a retired U.S. Army Colonel, former instructor at white collar definition West Point, and history professor at housewives Boston University. Bacevich, formerly a self-confessed unquestioning functionary, hit a personal and anguished crossroads as the collar crimes second Iraq War got under way, finding himself opposed to is social networking sites, the extremely ill-advised U.S. White Collar Definition. course of action. What Is Social Networking. He also, tragically, lost a son in that war. Philip Golub is a professor of collar crimes, International Relations at the American University in Paris and a long-time contributing editor at the monthly Le Monde Diplomatique. Bacevich and Johnson, as former true believers in establishment shibboleths, retain an abiding respect for what they see as the allure of the ideals of America, however great the shortfalls from reality, but both men argue ruefully that at this current moment those ideals are being cast aaway altogether.

Their books have different focal points; Bacevich’s being the housewives Washington power structure since World War II while Johnson writes on the parlous state of the U.S. empire. Regardless, there is a pronounced and unavoidable overlap. They both denounce and dissect the rash global war that Bush, Rumsfeld, Cheney and their neocon comrades launched in the fall of 2001. Crimes. Bacevich notes, “By the time Barack Obama succeeded George W. Skinners Theory. Bush as president in January 2009, the phrase global war on terror had become an epithet, redolent with deception, stupidity, and monumental waste. Soon thereafter it faded from the lexicon of American politics.”(166) As no small consequence, he argues, there is an ebbing in real U.S. power. The authors argue that for collar crimes definition, the United States to genesis analysis, advance safely into white crimes definition the future, it urgently needs to undo the imperial character that openly has come to constitute it. They are not especially optimistic about mendel peas, remedies. Bacevich opens his book with a personally candid chapter called “Slow Learner” where he describes his eye-opening tour of East Berlin near the end of the Cold War. He tells how he realized that the Soviet powerhouse the West was living in white definition, mortal terror of was in reality a fragile shell afflicted by archaic rules, disintegrating infrastructure, and economic stagnation.

Similarly, Johnson notes, “To the dying days of the Cold War, every estimate of Soviet strategic nuclear forces overstated [emphasis in the original] the rate at which Moscow was modernizing its weaponry.”(77) These realizations, and housewives duties, the post-collapse revelations of the abysmal shape of the Soviet economy, were staggering ones for white crimes, his world-view. Given that the magnitude of the Soviet threat was hyped and hyper-hyped — though the brinksmanship was quite real — one becomes haunted by skinners language theory the question: all this fear and trembling (and endless spending) for what? Bacevich takes us on a brisk tour of U.S. foreign policy from the end of World War II down to today. Along the way we meet the likes of the Strategic Air Command’s, Curtis LeMay, the CIA’s, Allen Dulles, the Defense Department’s, Robert McNamara, Donald Rumsfeld and David Petraeus. White. All these eminent gentlemen come in for well-warranted and penetrating ridicule. When Bacevich, a veteran, writes about the what is social networking U.S. in Vietnam one is struck by white collar how this experience still casts a large cautioning shadow for him but not for the Bush White House. Vietnam was a major defeat for the U.S. and yet its hotly disputed legacy continues to (mis)inform and shape policy.

Thomas Ricks’ book, The Gamble, on language theory the surge in Iraq has some stunning quotes from the military and diplomatic leaders showing how frightened they were of a catastrophic defeat in 2006. One gets a keen sense of how Vietnam is both a reference point and a negative catalyst amplifying the U.S.’s constraints. One can only imagine the impact within U.S. society if American casualty figures from crimes, Iraq or Afghanistan were in the tens of thousands, as they had been during the Vietnam war. Duties. This alone underscores the white collar definition limits the U.S. Ranks. has in projecting its power as it moves into the new millennium. To be an empire means fielding an imperial army.

The U.S. right now is experiencing some dangerously unacknowledged constraints in its ability to do that. It is worth remembering this fact when Johnson writes that George W. Bush and his administration “drove the white collar crimes definition country as close to the precipice as was humanely possible.”(3) It is shocking to consider the launching of housewives duties, two major wars in the span of two years along with the threats against Syria and beyond at the triumphalist conclusion of the initial U.S. invasion of Iraq — to say nothing of emboldening of Israel to drive into Lebanon in 2006 and then the saber rattling at Iran. The U.S. made quick work of invading, toppling regimes and killing thousands of people, but found itself incapable of constructing the kind of white crimes, pliant pro-Western regimes they hankered after. It brings to genesis, mind Eric Hobsbawn’s observation, “Arms have often established empires, but it take more than arms to maintain them, as witness the old saw dating back to Napoleon: ‘You can do anything with bayonets except sit on them.’” (53). Crimes. The U.S. is only now beginning to skinners language, extract itself from Iraq, and to a lesser degree, Afghanistan. All this will have lasting repercussions, hitherto denied, for the projection of power. Events of 9/11, Bacevich writes, constituted “a moment that created an opening to pose first-order questions.”(73) Though he does not elaborate what those question might be the framework of his book suggests: Why did this attack happen? Who are these enemies that despise the U.S. to such a degree that they would do something so atrocious? Why is the twenty-first century still affected by a religion based on the seventh-century?

And so on. Of course these sobering kinds of white collar crimes, questions were never asked. Rather we got the Rumsfeld defense department touting the impact new technology would have in fighting easy wars. The book quotes Lt. Gen. Military. Robert Wagner on the Rumsfeld war-fighting doctrine, “Our operations in crimes, Afghanistan and ranks, Iraq [have demonstrated] operational attributes that an adaptive joint force must possess in white collar, the modern Battlespace.” (176) Bacevich correctly calls such utterances as, “jargon tricked out as profundities.” Bacevich is not in the thrall to General David Petraeus either. He points out language, that what happened in Iraq under Petraeus and the surge was a matter of white, good timing in which an important section of the Sunni population broke with Al Queda, at the same time as the Shia drew closer to theory, Iran. It was in that context that the security work of the population undertaken in the surge was able to collar crimes definition, get some purchase — it hardly qualifies as victory. He offers a revealing quotation from Chairman Petraeus, “Perceptions of reality more so than objective reality, are crucial to the decisions of statesmen.”(194)

This is nothing more than a restating of the crudest concept of American pragmatism, i.e., if it seems true, it is. This concept, however, requires some exploration. A good example of housewives, ‘generating perception’ can be seen in Obama’s August 2010 statement declaring an end to the combat mission in crimes, Iraq, “[U.S. forces] defeated a regime that had terrorized its people. Together with Iraqis and coalition partners who made huge sacrifices of their own, our troops fought block by block to help Iraq seize the networking chance for a better future. They shifted tactics to protect the Iraqi people, trained Iraqi Security Forces, and took out white collar crimes, terrorist leaders. Because of our troops and civilians — and because of the resilience of the Iraqi people — Iraq has the skinners language theory opportunity to embrace a new destiny.” Of course the white definition actual situation is quite different. It is the story of a brazen imperial adventure that unsuccessfully attempted to is social networking, redraw the map of the Middle East that has left in collar definition, its wake an underlying instability in that country, lead to skinners theory, major geopolitical shifts in the region (a more powerful Iran for crimes definition, one), and analysis, the real loss of American power and legitimacy. All efforts by Petraeus, Obama, and other like to cast success as failure, cannot dispel that underlying reality. The central thesis in Bacevich’s book is that there are in place “Washington Rules,” consisting of a credo, that U.S. alone must lead in the world, and a trinity: “global military presence, global power projection, and global interventionism.”(12-14). These haughty rules are at crimes the heart of the problem that needs to housewives duties, change if the white collar U.S. is to military ranks, advance into the future in tune with what Bacevich feels are the country’s founding principles.

What he does not explore much is the underlying need of the white crimes U.S. elites to dominate the world economically. At one point Bacevich offers a revealing quote from Obama from December 2009, “The United States of language theory, America has underwritten global security for collar definition, over six decades — a time that, for all its problems, has seen walls come down, and markets open, and billions lifted from poverty, unparalleled scientific progress and advancing frontiers of human liberty.” Obama’s key point is the opening of markets, i.e., the U.S. is not projecting power for the sake of it or because it is on some type of self-perpetuating dynamic (though there are elements of that), but in order to reap rewards in skinners, wealth. Definition. It is from this that the what is social larger policy springs. That is collar crimes not to say it only resides in the drive for profit, or to say that politics does not play an independent role at times, but it is the case that something is driving this, and it is the drive for accumulation. For his part Johnson addresses the underlying economic interests. He writes, “The fact that we did not modernize or replace our capital assets is one of the main reason why, by the turn of the twenty-first century, our manufacturing base had all but evaporated.” (145) This is a strikingly simplistic assertion.

The drive to extract surplus value — which can only be got from labor power in its myriad forms — is what drove manufacture to places like Indonesia and China. This underscores how the decline of U.S. hegemony is part of a larger transformation going on. Housewives. In that regard Frederic Jameson in his Valences of Dialectics is worth pondering. Jameson points out that Marx — in contrast to some of the more “triumphalist” passages in Capital, “tirelessly insisted on the significance of the world market as the ultimate horizon of capitalism.” (370) It is beyond the scope of white crimes definition, this essay to delve fully into spartan military this, but the strength of American power cannot be understood outside the overall process of capital accumulation, a process that continues in its increasingly globalized character at the same time it is crashing against it own limits. In that regard the banking crisis of 2008 seems more a bellwether of things to come.

Here we address Chalmers Johnson’s central thesis. He writes, “The real reason for crimes, constructing [a] new ring of American bases along the equator is to analysis, expand our empire and white crimes, reinforce our military domination of the world. (119)” So far so good, but then he tells us, “If the U.S. Is Social Sites. nuclear stockpile consisted of several hundred weapons rather than several thousand, would the United States find itself appreciably more vulnerable to nuclear blackmail or attack? Were the United States, sixty-plus years after the end of World War II, finally to withdraw its forces from Germany, Italy, and the rest of Europe, would Americans sleep less easily in their beds at night?” Here we see Johnson at crimes definition once reject the what sites situation, but accept the rationale. The U.S. can still have a preeminent place in the world, but with a much smaller imperial footprint. In that respect Johnson (among others) offers England at the point it began to white collar definition, shed its empire as a positive model. This is an artful reimagining. England did not just give up its empire. Through the course of two horrific world wars it militarily lost it.

That it was not quite as catastrophic as the fall of some empires is historically specific. Had it not been for the peculiar mix of the United States — driven by its own national interests — coming to its rescue during World War II and theory, the need to contain the Soviet Union, the fate of crimes, England would likely have been messier. That did not happen so there is not much use speculating what that would have looked like. However it underscores this process of ‘shedding’ an empire tends to be a wrenching and potentially calamitous process. The bigger point though is that the suggestion that one can peacefully shed an empire and convert into something idealized suggests wanting to look at the monstrousness of all this and walk away saying this doesn’t have to be a monster, that this isn’t of a piece. The “American Century” has been a parade of horrors: Korea, the invasion of the Dominican Republic, Haiti, Vietnam, Grenada, Panama, the Iraq I, Afghanistan, Iraq II, along with coups, assassination and other dirty work.

Yet neither Bacevich or Johnson want to housewives, entertain the idea that the definition problem — rather than Washington Rules or the military industrial complex — is the American ideal itself. The idea of military, America as a ‘shining city on the hill’ that exists as humanity’s highest achievement — stands against the actuality that that achievement has always been driven by rapacity. It led to the expropriation and near elimination of the native population, the enslavement of multiple generations of slaves, the white crimes grabbing of country-sized swaths of land from Mexico, taking the genesis Philippines and Hawaii, down to the ‘empire of bases’ today from Germany to Okinawa, to Colombia to Guam. A frank look at this would suggest we aim to achieve something higher. White Collar. What that is exactly is not at all clear, but such are the questions that people of good will like Chalmers Johnson and mendel peas, Andrew Bacevich ought to be asking. Golub is not burdened with such illusions. His book fills in a lot of the spaces that Bacevich Johnson step or gloss over. Golub is not approaching things from the point of the rarefied “American Experience.” He levels a harsher and more honest critique. He writes, “Even a cursory glance shows that from the crimes definition 1950s until today, the squid animal United States has either been at war, supporting war-making or sustaining predatory states almost constantly in one part of the world or another of the ‘Far Empire.’” (78) He outlines the countries, from the Philippines to the Congo, to Laos to Panama, where the U.S. has stuck its predatory nose.

Yet there is an underlying idealism (both philosophically and popularly understood) in his analysis. Golub favorably quotes Hannah Arendt, speaking about the collar crimes definition US. in the Vietnam that it, “sought to demonstrate the will and ability…to have its way in world affairs,’…“to behave like the greatest power in the world for analysis, no other reason than to convince the world of this simple fact.’”(130) In many ways Golub flattens out the concepts of Power, Profit and Prestige, rather than constructing a dialectical array. The Arendt quote suggests that prestige is an end in itself. Rather than an augmenting factor in service of larger aims, i.e, the white crimes drive for spartan military ranks, profit for the overall ability to accumulate. White Collar Definition. One is reminded of the quote in the Autobiography of Malcolm X, “To the hustler, reputation is everything.” True, but that reputation is in service of something, the business of hustling. In the end Golub comes to a conclusion close to Johnson’s that the squid animal U.S. can somehow decide to stop being imperialist, “An ordered pluralism cannot emerge if the U.S. does not disengage from empire.” Given the history of the collar crimes last century, and the U.S.’s history in particular one is left scratching their head as to the basis, even remotely, of spartan, such a sunny prospect.

Recently Slavoj Zizek writing in, Living in the End Times, noted “The American Century is over crimes definition and we are entering a period characterized by the formation of multiple centers of global capitalism: the U.S., Europe, China possibly Latin America, each of them representing capitalism with a specific local twist” (168)… This is language theory why the present situation is potentially more dangerous than it may appear.” Bacevich understands this on a basic level when he writes, “Promising prosperity and peace, the Washington rules are propelling the white collar definition United States toward insolvency and perpetual war. Over the theory horizon a shipwreck of epic proportions awaits.” (250). For his part Johnson tells us that, “If we do not learn from their examples, our decline and fall is foreordained.” This is a dire assessment. We need to envision a world different from the one we currently occupy. Whether that is ultimately a better one rests on many things, not the least of which is how we understand the white world we actually inhabit. These books offer keen insights and analysis towards that. The need to ask first order questions remains.

Aaron, I don’t know if our country is going in the right direction or the wrong direction, I am not sure anyone does. Losing manufacturing was a big mistake, incentive give aways, and military footprints. Yes, lets learn by the mistakes made before us. Duties. Great Read. The Frankfurt School and the New Right. Kim Scipes: Black Subjugation in America: Review of Theodore W. Allen, Edward E. Baptist, and white collar, Sven Beckert.

George Lundskow: White Like Them: Review of Arlie Russell Hochschild, Nancy Isenberg, and J. D. Vance.

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case study pneumonia Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. Chapter VI.11. Pulmonary Infections. Return to Table of definition, Contents. A previously healthy 4 year old boy is brought to an urgent care center by his mother for difficulty breathing for what, one day. Three days prior he had developed a runny nose, cough, and collar crimes low grade fevers with a temperature maximum of 101 degrees F (38.3 degrees C).

He continued to housewives take liquids well, but his solid intake has decreased. His temperature this morning was 103 degrees F (39.4 degrees C) and he was breathing fast and working hard to white collar crimes definition breathe. He does not have any ill contacts. He has never been hospitalized or had any surgeries. He was born at term without any complications. He is not taking medications other than acetaminophen. His immunizations are up to what is social sites date for his age (except he had not received the pneumococcal conjugate vaccine). His parents and 10 year old sister are healthy and the remainder of his family history is non-contributory. There are no smokers in the household, and he has not traveled recently. White. He does not have a history of choking or vomiting.

He has not had frequent ear or skin infections. He does not have a history of foul-smelling stools. Exam: VS T 40 degrees C (104 degrees F), P 130, RR 40, BP 100/70, oxygen saturation 87% in room air. His height and weight are in the 50th percentile for his age. He is is social sites, awake and alert, in moderate distress. His conjunctiva and TMs are normal. His nasal mucosa is collar crimes definition, erythematous with yellowish discharge.

His lips and squid animal mucous membranes are dry. Crimes. His neck is supple, with several small anterior cervical lymph nodes. Lungs: Moderate subcostal, intercostal, and supraclavicular retractions, symmetric expansion, dullness to percussion at squid animal, the right base, increased vocal fremitus over the right base, decreased air entry over right lower lobe with crackles, no wheezes. Heart: Tachycardia, regular rhythm without murmur. Pulses are 2+, and capillary refill time is collar crimes definition, 3 seconds.

His abdomen, skin, and neurological examinations are unremarkable. CBC WBC 20,000, 70% segs, 11% bands, 15% lymphs, 3% monos, 1% eos. Hemoglobin 12.4, platelet count 280,000. Chest x-ray (CXR): Right lower lobe opacity consistent with a round pneumonia (technically air/space disease, commonly called infiltrates by spartan ranks most physicians). Because of the hypoxia, he is white definition, given supplemental oxygen (with subsequent improvement in skinners language theory oxygen saturation), as hospitalization arrangements are made. A 20 cc/kg infusion of normal saline was given through an intravenous (IV) line and then maintenance fluids are started. White Definition. A blood culture is obtained and he is military, started on IV cefuroxime. He improves over white crimes definition, the next day. Spartan. His respiratory distress slowly resolves and he is weaned off supplemental oxygen over the next two days.

His blood culture shows no growth. He is definition, discharged home on high dose amoxicillin for a total of 10 days of theory, therapy. His discharge diagnosis is probably pneumococcal pneumonia. Acute childhood respiratory infections cause significant morbidity and mortality worldwide. Mortality is white collar definition, high in developing countries with up to one-third of deaths in children less than 5 years caused by acute respiratory infections (ARI) (1). The disparity in mortality is due to the severity of infection (perhaps due to differences in nutrition, overall health, immunization practices, and medical care availability) since the incidence of acute respiratory infections is similar between developed and spartan developing countries with infants experiencing about 4-8 episodes per year (1).

In the US, mortality from ARIs has declined since 1968 (1,2). There are 2 basic classification systems used for collar crimes, acute respiratory tract infections: the case-management classification system used by the World Health Organization (WHO) and what networking the traditional clinical classification system (1). Crimes Definition. The case management system divides ARIs by analysis symptoms (i.e., stridor, wheezing, and white definition no wheezing) and mendel peas their severity (i.e., mild, moderate, severe, and very severe). White. The traditional system classifies ARIs by upper respiratory tract infections (e.g., acute otitis media, pharyngitis), middle respiratory tract infections (e.g., croup and epiglottitis), and lower respiratory tract infections (e.g., bronchiolitis, bronchitis, pneumonia). Therefore, studies evaluating ARIs are not uniform and use different definitions from clinical findings alone to clinical findings in duties combination with other various ancillary tests (e.g., chest radiography). Of the acute respiratory infections, pneumonia has the highest mortality rate accounting for approximately 70% of the worldwide 4.5 million deaths from acute respiratory infections (4).

Although mortality from pneumonia in children in the United States has declined by 97% between 1939 and 1996 (5), pneumonia continues to be a leading cause of morbidity in children. The risk of acquiring pneumonia is highest in children less than 5 years of age (1). The etiology of pneumonia varies and depends on: the age of the child, where the pneumonia was acquired (i.e., community vs. nosocomial), local epidemiology (e.g., influenza epidemics), host factors (e.g., immunologic status, recent or intercurrent antibiotic use, vaccination, and crimes definition overall health status of the child), and environmental factors (e.g., travel, season of the year, daycare, or crowded living conditions) (4,6-9). Determination of the precise etiology of mendel peas, pneumonia often requires invasive testing (e.g., lung biopsy), and therefore, this is done infrequently. Rather the etiology of white collar crimes, pneumonia is usually based on generalizations in squid animal the relevant clinical setting.

In the neonatal period, the most common cause of bacterial pneumonia is group B beta-hemolytic streptococci (GBS) and gram negative enteric bacilli (e.g., E.coli), the white collar same organisms associated with neonatal sepsis (4). In infants and children outside of the neonatal period, viruses are the most common cause of pneumonia (4,6,10-11) and respiratory syncytial virus (RSV) is mendel peas, one of the most common causes in infancy, especially in premature infants (9,12). Of the bacterial pathogens, Streptococcus pneumoniae (pneumococcus) occurs most frequently (6,9,11,13); however, the studies isolating S. pneumoniae were performed prior to white the licensure of the pneumococcal conjugate vaccine (6). Outcome analysis of the 7-valent pneumococcal conjugate vaccine demonstrated that up to analysis 33% of chest radiograph confirmed pneumonia were prevented in crimes immunized patients compared to those who were not immunized (14). Therefore, a different bacterial pathogen may supersede S. pneumoniae as the most common cause of bacterial pneumonia in genesis the coming years. Other organisms to consider are Chlamydia trachomatis in infants 3-19 months of age (4) and Mycoplasma and Chlamydia pneumoniae in children and adolescents (8-9,11-12). In special cases, for example, patients with neuromuscular impairment and impaired swallowing, aspiration pneumonia with anaerobic bacteria should be considered (15). Collar. The etiology of pneumonia varies in other conditions including immunosuppressed patients, nosocomial infections, cystic fibrosis patients, and anatomic airway anomalies (e.g., tracheostomies). In addition, the etiology of pneumonia is complicated since mixed infections (e.g., viral-bacterial) can occur in 16-34% of patients (7,11,13). The lower respiratory tract in healthy persons is sterile (16).

Bacteria access the respiratory tract by mendel peas inhalation, microaspiration, or by crimes definition hematogenous spread. If bacteria gain access to alveoli, host immunologic systems begin to work on eliminating bacteria. There are 2 major mechanisms by which lung defenses work to keep the airways sterile: physical defenses (i.e., mucociliary clearance and lymphatic drainage) and mechanisms that destroy bacteria (i.e., opsonization, specific immunoglobulin G antibody (IgG), alveolar macrophage ingestion, or complement mediated bacterial lysis) (17). What Networking Sites. If these mechanisms fail, polymorphonuclear leukocytes (PMNs) are recruited with a resultant inflammatory response. Collar Definition. Perpetuation of this inflammatory response leads to pneumonia. There are 4 major histologic steps seen in pneumococcal pneumonia described by Tuomanen, et al (18): engorgement, red hepatization, grey hepatization, and housewives resolution. Engorgement is white definition, associated with presence of bacteria in the alveoli and an associated serous exudate.

This then progresses to red hepatization secondary to leakage of erythrocytes into the alveoli. The next phase, grey hepatization, results from leukocyte migration to the affected area with intravascular fibrin deposition disrupting perfusion to the area. The final phase results in resolution, with phagocytosis of pneumococci and clearance of fibrin and other debris. Outside of the neonatal period, pneumonia is suspected in genesis patients with clinical signs and symptoms suggestive of impairment of the lower respiratory tract. Distinguishing bacterial from other causes of pneumonia cannot be accomplished by clinical findings alone (7). Symptoms of pneumonia are nonspecific and include: fever, ill appearance, cough, fatigue, decreased appetite and definition sometimes, abdominal pain. Signs of lower respiratory tract involvement include: tachypnea (greater than 50 breaths/minute in children less than 12 months, and greater than 40 breaths/minute for older children) (4), cyanosis, increased work of breathing (i.e., use of analysis, accessory muscles, grunting), pleuritic pain, and abnormal auscultatory findings. These signs do not differentiate a viral from bacterial process. A chest radiograph is white collar crimes, used to verify the housewives duties clinical suspicion of white collar, pneumonia and characterize the disease process, but may not be performed on every patient. Viral respiratory tract infections are often associated with hyperinflation, perihilar peribronchial infiltrates, segmental or lobar atelectasis, and hilar adenopathy (19). Lobar consolidation and fluffy alveolar infiltrates with air bronchograms are more characteristic of bacterial infection (13).

However, there is overlap between these two groups (13). Computed tomography and ultrasound of the chest are used in special circumstances (e.g., evaluate for what sites, pleural effusion, adenopathy, improved imaging of lung architecture) but these are not routinely obtained (4). Commonly used screening laboratory tests such as white blood cell count with differential, erythrocyte sedimentation rate (ESR), and the C-reactive protein (CRP) are not accurate in differentiating between bacterial, viral, mixed, or idiopathic causes of childhood pneumonia (7). Determination of precise etiology of pneumonia is difficult due to collar crimes the lack of sensitive and specific tests. Many clinicians treat pneumonia empirically with minimal laboratory or radiographic evaluation and thus up to 80% of non-bacterial pneumonia may be treated with antibiotics (6).

This approach is satisfactory when clinical risk is deemed to be low. When a more precise diagnosis is required, more invasive techniques are required. Skinners. Bacteria found in the blood, pleural fluid (thoracentesis), or lung tissue is considered diagnostic in a patient presumed to have pneumonia (4). Blood cultures are only positive in 1-8% of pneumonia (11) but continue to white crimes definition be recommended (4). Some question the necessity of squid animal, blood culture after cost-based analyses (6, 11).

Transthoracic needle aspirates, transtracheal aspirates, and open lung biopsy (the gold standard for diagnosis) are rarely performed due to the risk involved for these procedures (11,20), except in severe cases or in immunocompromised hosts (4). Sputum is often contaminated with organisms unrelated to the specific etiology (16) and is difficult to obtain in children less than 8 years old (4). A sputum sample that may be helpful is characterized by collar crimes many polymorphonuclear cells and a bacteria of single morphology on what is social sites, gram stain (4). Crimes Definition. Bronchoalveolar lavage from bronchoscopy is difficult to mendel peas interpret as well. The results are non-specific (i.e., higher neutrophil counts than lymphocyte counts in patients with infection) and the organism found may or may not be the etiologic agent (16). Bacterial serology and bacterial antigen testing are often difficult to interpret (4,6). Bacterial cultures of the nasopharynx or throat correlate poorly with lung tissue cultures and white collar crimes definition are not helpful in establishing a diagnosis (16). Specific viral antigen testing, along with cultures for suspected pathogens, serologies for analysis, Mycoplasma and Chlamydia, and PPD skin testing for tuberculosis may be helpful (6). Pneumonia is treated with antimicrobials when the clinical suspicion for bacterial etiology is high. Greater pneumonia severity and findings that are consistent with bacterial pneumonia (e.g., lobar consolidation, leukocytosis, high fever) are more likely to warrant antimicrobial treatment.

Young infants, unreliable parents, poor access to medical care, and more severe infections often require hospitalization. Treatment of collar, pneumonia is often empirically based and thus, information on antibiotic resistance patterns and mechanisms of resistance is important to mendel peas determine the crimes definition most appropriate treatment. For S. pneumoniae, the skinners language most common mechanism of resistance to penicillins is alteration of penicillin-binding sites that can be overcome with higher doses of the drug (6). For macrolides, alteration to the 50S ribosomal binding site of the macrolide inhibits binding of the antibiotic and thus, prevents protein synthesis inhibition (6). Crimes. In addition, there is also an increase in skinners language efflux pumps for macrolides and white definition this property can be overcome by using macrolides that achieve high tissue concentrations at the site of mendel peas, infection (e.g. azithromycin) (6). Penicillin resistant pneumococci are often resistant to white multiple drugs including macrolides and trimethoprim-sulfamethoxazole (21).

Therefore, high-dose amoxicillin and/or azithromycin are recommended for empiric treatment of community-acquired pneumonia in children (6,8-9,11-12,20). Some clinicians will use clinical factors and ranks ancillary tests in aggregate such as age, exposures, CXR pattern, fever, and white leukocytosis, to stratify the risk to favor pneumococcus (high dose amoxicillin would be better) or Mycoplasma/Chlamydia (macrolide would be better). For those children requiring hospitalization, a second or third generation cephalosporin, occasionally in combination with a macrolide, is military, generally recommended (8,20). Most treatment regimens are continued for a total of 7-14 days although this is based on little evidence (4). Pneumonia due to Staphylococcus aureus is uncommon, but particularly severe. S. aureus pneumonia usually results from inhalation of organisms, but it may also occur in patients with a cutaneous source (e.g., impetigo, boils, abscesses) with hematogenous spread or staphylococcal bacteremia from collar crimes, another source (e.g. osteomyelitis, central line infection). If S. aureus pneumonia is suspected, vancomycin should be started empirically. Squid Animal. Culture and sensitivity data permits changing to an alternate antibiotic later.

Pleural effusion (empyema), pneumothorax, and pneumatoceles often complicate S. aureus pneumonia. Pleural effusions can be classified in several ways. They can be a transudate or an exudate based on their protein content. Crimes Definition. A subpulmonic effusion versus an empyema is more clinically relevant. The former implies a transudate which is usually sterile, while the term empyema is usually used to describe pus (purulent exudate) with a positive gram stain and culture. The overall outcome in children with pneumonia is what is social networking sites, excellent. The majority of children will recover without complications (11). Follow up chest radiographs are not required routinely, but should be performed for patients with complicated pneumonia, persistent respiratory problems, pleural involvement, and white crimes neonates (4,22).

About 80% of infiltrates on CXR will resolve by squid animal 3-4 weeks and the remainder will usually resolve by 3 months (22). Collar Definition. Recurrent pneumonia with radiologic clearance between episodes requires further evaluation (e.g., immunodeficiencies, gastroesophageal reflux, pulmonary anomalies, etc.) (4). Bronchiolitis is the theory leading cause of hospitalization for respiratory tract infections in young children (4,23-25). Collar Crimes Definition. Respiratory syncytial virus (RSV) is the primary cause of bronchiolitis, but parainfluenza virus, human metapneumovirus, and adenovirus may also cause bronchiolitis (23-24). In the United States, the housewives majority of white crimes definition, RSV infections occur during the months of November to March (4,23). RSV infections account for a significant amount of duties, morbidity and health care expense in white crimes the young age group (24). RSV is transmitted by direct contact with large droplets or fomites. What Networking Sites. Transmission can be limited by white collar crimes definition good handwashing (23). RSV bronchiolitis results from the spread of RSV to what sites the lower respiratory tract after an incubation period 2-8 days where the virus undergoes replication in the nasopharynx (23).

The infection results in infiltration of the respiratory epithelium with resultant inflammation and white collar definition necrosis, sloughing of the squid animal epithelium and increased mucus production causing airflow limitation in crimes definition the small airways leading to the hallmarks of the duties disease (23). Thus, affected infants have signs of airflow limitation including hyperinflation, atelectasis, and collar wheezing. The diagnosis is often made on clinical grounds during the RSV season. Diagnostic testing can be done by immunofluorescence and enzyme-linked immunoabsorbent assay (ELISA) tests if the diagnosis is unclear. What Networking Sites. Therapy is often supportive which may include: supplemental oxygen, fluids, and white collar crimes upright positioning. Aerosolized ribavirin is the only known proven therapy for RSV infection, but its expense, potential toxicity, difficulty of administration, and lack of conclusive evidence for its efficacy (24,26) limit its use. The use of bronchodilators and corticosteroids are controversial and skinners language may only be mildly effective at best (i.e., not been proven to be highly efficacious) (24-26).

For those with moderate to severe disease, helium-oxygen mixtures or nasal continuous positive airway pressure may be beneficial in white collar improving gas-exchange and symptomatology (27-30). Montelukast, a leukotriene antagonist, has recently been reported to make a difference in future wheezing episodes (31). Prophylaxis with palivizumab (RSV monoclonal antibody) or RSV-IVIG is given to select pediatric populations recommended by the American Academy of spartan, Pediatrics during RSV season to reduce RSV infection risk (32). Growing premature infants and infants with congenital heart disease and other chronic lung conditions are at increased risk for RSV pneumonia, apnea and collar respiratory failure. Healthy term infants with RSV usually develop mild bronchiolitis. Older children, teens and adults with RSV will usually have cold symptoms.

Bronchiolitis is usually a self limited disease and complete resolution takes about genesis, 4-8 weeks. In neonates and young infants, bronchiolitis may present with apnea and minimal respiratory symptoms, but the apnea is usually short-lived (33). Although bronchiolitis self-resolves, patients with RSV bronchiolitis may be predisposed to future episodes of wheezing (34). RSV infection can recur since there is an incomplete and poorly sustained immune response (23). In summary, bronchiolitis and pneumonia significantly impact the pediatric population. Determining likely etiologies of pneumonia and understanding effective treatment modalities will improve patient outcomes. Acknowledgments: I would like to thank Edward Fong, MD, Leslie Barton, MD and John Mark, MD for their critical review of the white collar crimes chapter. 1. Analysis. Which of the following is the most common cause of pneumonia outside of the white collar neonatal period? 2. S. pneumonia resistance to penicillins is due to: . . . Language. . . a. Production of beta-lactamase.

. . . . . b. Alteration of penicillin binding proteins. . . . . . c. Increased efflux pumps. . . . . . d. Low tissue bioavailability. 3. True/False: Nasopharyngeal and throat cultures are useful in determining etiology of bacterial pneumonia. 4. True/False: Lobar consolidation on chest x-ray provides conclusive evidence for bacterial pneumonia. 5. Which factor does not appear to affect the etiology of pneumonia?

. . . . . b. Vaccination status. . . . Collar Definition. . . c. Current antibiotic use. 6. The most common cause of bronchiolitis is: . . . Squid Animal. . . a. Respiratory syncytial virus. . Collar. . . Theory. . . b. Human Metapneumovirus. 7. True/False: Bronchiolitis may initially present with apnea and minimal respiratory symptoms. 8. Treatment of bronchiolitis should include all of the following except: a. Supplemental oxygen for infants with hypoxia. b. Crimes Definition. Intravenous fluids and close monitoring of nutritional status. c. Good handwashing. d. Antibiotics. 9. True/False: Corticosteroids and bronchodilators are highly efficacious therapies for RSV bronchiolitis. Pneumonia case presenting with abdominal pain: Yamamoto LG. Abdominal Pain with a Negative Abdominal Examination. In: Yamamoto LG, Inaba AS, DiMauro R (eds).

Radiology Cases In Pediatric Emergency Medicine, 1994, volume 1, case 3. Available online at: Staph pneumonia case: Yamamoto LG, Young LL. Tachypnea and Abdominal Pain. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1995, volume 2, case 5. Available online at: Series of pediatric chest radiographs: Yamamoto LG. Test Your Skill In Reading Pediatric Chest Radiographs. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1995, volume 3, case 20. Available online at:

Another series of pediatric chest radiographs: Yamamoto LG. Test Your Skill In Reading Pediatric Chest Radiographs. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1996, volume 4, case 5. Available online at: 1. Graham NMH. The Epidemiology of Acute Respiratory Infection in Children and Adults: A Global Perspective.

Epidemiol Rev 1990;12:149-178. 2. National Center for Health Statistics. Genesis Analysis. National Vital Statistics report ( 2001;49(1):14. 3. Dixon RE. Economic Costs of Respiratory Tract Infections in the United States. Am J Med 1985;78(6B): 45-51.

4. Definition. Miller MA, Ben-Ami T, Daum RS. Chapter 39-Bacterial Pneumonia in Neonates and genesis Older Children. In: Taussig LM, Landau LI (eds). Pediatric Respiratory Medicine, first edition. 1999, St. Louis: Mosby, pp. 595-664. 5. Dowell SF, Kupronis BA, Zell ER, Shay DK. Mortality From Pneumonia in Children in the United States, 1939 Through 1996. N Engl J Med 2000;342(19):1399-1407.

6. Bradley JS. Management of Community-Acquired Pediatric Pneumonia in an Era of Increasing Antibiotic Resistance and Conjugate Vaccines. Pediatr Infect Dis J 2002;21(6):592-598. 7. Collar Definition. Nohynek H, Valkeila E, Leinonen M, Eskola J. Erythrocyte Sedimentation Rate, White Blood Cell Count and Serum C-reactive Protein in Assessing Etiologic Diagnosis of Acute Lower Respiratory Infections in Children. Pediatr Infect Dis J 1995;14(6): 484-490.

8. Nelson J. Community-Acquired Pneumonia in Children: Guidelines for is social sites, Treatment. Pediatr Infect Dis J 2000;19(3):251-253. 9. Heiskanen-Kosma T, Korppi MN, Jokinen C, et al. Etiology of Childhood Pneumonia: Serologic Results of a Prospective, Population-Based Study. Pediatr Infect Dis J 1998;17(11):986-991. 10. White Crimes Definition. McIntosh K. Community-Acquired Pneumonia in Children. N Engl J Med 2002;346(6);429-437. 11. Ruuskanen O, Mertsolon J. Childhood Community-Acquired Pneumonia.

Sem Resp Infect 1999;14(2):163-172. 12. McCraken, GH Jr. Etiology and Treatment of Pneumonia. Pediatr Infect Dis J 2000;19(4):373-377. 13. Korppi M, Kiekara O, Heiskanen-Kosma T, Soimakallio S. Comparison of squid animal, Radiological Findings and Microbial Aetiology of Childhood Pneumonia. Acta Paediatr 1993;82: 360-363. 14.

Overturf GD, Committee on Infectious Diseases, American Academy of Pediatrics. Technical Report: Prevention of Pneumococcal Infections, Including the Use of Pneumococcal Conjugate and Polysaccharide Vaccines and Antibiotic Prophylaxis. Pediatrics 2000;106(2):367-376. 15. Collar Crimes. Brook I, Finegold SM. Analysis. Bacteriology of Aspiration Pneumonia in Children. Pediatrics 1980;65(6):1115-1120. 16.

Laurenzi GA, Potter RT, Kass EH. Bacteriologic Flora of the white crimes Lower Respiratory Tract. N Engl J Med 1961;265:1271-1278. 17. Green GM, Kass EH.

The Role of the Alveolar Macrophage in the Clearance of Bacteria from the Lung. J Exp Med 1964;119:167-175. 18. Tuomanen EI, Austrian R, Masure HR. Pathogenesis of Pneumococcal Infection. N Engl J Med 1995(19);332:1280-1284. 19. Wildin SR, Chonmaitree T, Swischuk LE.

Roentgenographic Features of Common Pediatric Viral Respiratory Tract Infections. Am J Dis Child 1988;142:43-46. 20. Hart CA, Duerden BI. Respiratory Infections. J Med Microbiol 2002;51:903-914. 21. Whitney CG, Farley MM, Hadler J, et al.

Increasing Prevalence of Multidrug-Resistant Streptococcus Pneumoniae in the United States. N Engl J Med 2000;343(26):1917-1924. 22. Squid Animal. Grossman LK, Wald ER, Nair P, Papiez J. Roentgenographic Follow-Up of Acute Pneumonia in white crimes definition Children. Housewives. Pediatrics 1979(1);63:30-31. 23. Hall CB.

Respiratory Syncytial Virus and Parainfluenza virus. N Engl J Med 2001;344(25):1917-1928. 24. Greenough A. Respiratory Syncytial Virus Infection: Clinical Features, Management, and Prophylaxis. Curr Opin in Pulm Med 2002;8:214-217. 25. Jartti T, van den Hoogen B, Garofalo RP, et al.

Metapneumovirus and white collar crimes Acute Wheezing in duties Children. Lancet 2002;360:1393-1394. 26. Patel H, Platt RW, Pekeles GS, Ducharme FM. A Randomized Controlled Trial of the Effectiveness of Nebulized Therapy with Epinephrine Compared with Albuterol and white collar definition Saline in Infants Hospitalized for Acute Viral Bronchiolitis. J Pediatr 2002(6);141:818-824.

27. Hollman G, Shen G, Zeng L, et al. Helium-Oxygen Improves Clinical Asthma Scores in Children with Acute Bronchiolitis. Skinners Language. Crit Care Med 1998;26(10):1731-1736. 28. Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Heliox Therapy in collar Infants with Acute Bronchiolitis. Pediatrics 2002(1);109:68-73.

29. Squid Animal. Beasley JM, Jones SEF. Collar. Continuous Positive Airway Pressure in Bronchiolitis. British Medical Journal 1981;283:1506-1508. 30.

Soong W, Hwang B, Tang R. Continuous Positive Airway Pressure by Nasal Prongs in Bronchiolitis. Pediatr Pulmonol 1993;16:163-166. 31. Bisgaard H for the Study Group on Montelukast and Respiratory Syncytial Virus. A Randomized Trial of Montelukast in Respiratory Syncytial Virus Postbronchiolitis. Am J Respir Crit Care Med 2003;167:379-383. 32. Halsey NA, Abramson JS, Chesney PJ, et al.

American Academy of Pediatrics: Prevention of what is social sites, Respiratory Syncytial Virus Infections: Indications for definition, the Use of language, Palivizumab and Update on the Use of RSV-IGIV. Pediatrics 1998;102(5):1211-1216. 33. Bruhn FW, Mokrohisky ST, McIntosh K. White. Apnea Associated with Respiratory Syncytial Virus Infection in Young Infants. J Pediatr 1977;90:382-386.

34. Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respiratory Syncytial Virus Bronchiolitis in Infancy is an Important Risk Factor for Asthma and is social networking sites Allergy at Age 7. Am J Respir Crit Care Med 2000;161:1501-1507. Answers to questions. 1.c. Overall, viruses cause the majority of pneumonias in white collar children; however, the incidence of viral pneumonia decreases with age, becoming less common in older children and adolescents.

4.False. Lobar pneumonias are more likely to skinners be of bacterial etiology, but this is not definitive since some lobar pneumonias will still be viral.

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Generic Format of a Formal Proposal. Important Note : The following section describes in detail how to develop a generic proposal. It is intended for those researchers who have minimal background in proposal development or those looking for reference information about proposal writing. Please be aware that some sponsors, such as NIH, have very specific guidelines for developing and submitting a proposal. Crimes. In all cases individual sponsor guidelines should be followed. There are three major components to the standard research proposal.

They are the text, the budget, and the supporting documents, referred to as the appendices, attachments or exhibits. This section outlines each piece of the proposal, and networking sites concludes with a discussion of certain variations in format required if one is seeking support for other kinds of academic programs. Most sponsoring agencies specify the format for the cover sheet, and some provide special forms to summarize basic administrative and fiscal data for crimes definition, the project. Generally, the genesis principal investigator, his or her department head, and an official representing the College sign the cover sheet. In addition, the cover sheet usually includes the College's reference number for the proposal, the name of the agency to which the proposal is being submitted, the title of the proposal, the proposed project period, the total funds requested, the name and address of the College unit submitting the proposal, and the date submitted. Some agencies want the cover sheet to specify whether the proposal is for a new or continuing project. The cover page must be signed by an authorized administrative official from the OSP. Follow the directions for completing a cover sheet exactly. While most sponsors require applicants to fill out an official cover page for the proposal, in the absence of that cover page, applicants should include a cover letter on Dartmouth College or DHMC stationery addressed to the sponsoring organization specifying the following information: Project Title Project Summary Total Cost of Project Funds Requested from Sponsor Name, Position, Address, Phone number, E-mail, and FAX number of principal investigator Signature block for Principal Investigator Signature block for Sponsored Projects Administrative Official Address, Phone Number, E-mail, and white FAX number of language, Office of collar crimes definition, Sponsored Projects. Although titles should be comprehensive enough to indicate the nature of the analysis proposed work, they should also be brief.

One good way to cut the length of titles is to avoid words that add nothing to a reader's understanding, such as Studies on. Investigations. or Research on Some Problems in. A good title is usually a compromise between conciseness and explicitness. The title page should include not only the title of the project, but also the submission date, who the proposal is being submitted to, and the name of the institution submitting the proposal, i.e., Submitted to collar crimes definition, the National Endowment for the Humanities by the Trustees of Dartmouth College. Every proposal, even very brief ones, should have an abstract. Some readers read only the abstract, and most readers rely on it to give them an military initial quick overview of the proposal and later to refresh their memory of the project's main points. Agencies often use the abstract alone in their compilations of research projects funded or in disseminating information about successful projects. The abstract speaks for the proposal when it is separated from it, provides the reader with a first impression of the crimes definition request, and, by acting as a summary, frequently provides the reader also with his last. Squid Animal. Thus it is the white collar most important single element in mendel peas the proposal.

To present the essential meaning of the white crimes definition proposal, the ranks abstract should summarize or address all the questions identified in the Section 3.2 of this manual, with the exception of the cost of the project. Collar Crimes Definition. The project cost is excluded from the abstract because the genesis analysis abstract is often subject to a wider public distribution than the rest of the proposal. Although it often appears at the beginning of the proposal, the abstract should be written last, as a concise summary (approximately 200 words) of the proposal. It should appear on a page by itself numbered with a small Roman numeral if the proposal has a table of contents and with an Arabic number if it does not. The convenience of the reader should be the white collar definition guiding consideration in producing a table of contents. Very brief proposals with few sections ordinarily do not need a table of contents. Genesis. Long and detailed proposals should list all major parts and collar crimes divisions, including the abstract and significant preliminary pages.

Subdivisions usually need not be listed. The table of contents may require a list of illustrations (or figures) and mendel peas a list of white crimes definition, tables. If all of these are included, they should follow the order presented in the text, and theory each should be numbered with lower-case Roman numerals. The table of collar definition, contents should be simply labeled Contents in the header of the page. The introduction to a proposal sets the ranks tone. The researcher must appear appropriately confident, organized, and clear as to the intent of the research to be undertaken. The introduction should begin with a capsule statement of what is being proposed and then should proceed to introduce the subject to someone unfamiliar with the collar crimes topic. One cannot assume that the proposal reviewer is familiar with the topic of the proposal. What Is Social. The introduction should briefly outline the white collar crimes definition goals and objectives of the project, how long it will take, and is social give enough background to enable the reviewer to place this particular research problem in a context of common knowledge. The introduction should very specifically and concisely state the importance of the research being proposed.

The introduction may introduce the white collar definition concept of squid animal, how this project's approach and resulting work will advance the field of knowledge and collar prove an important contribution to other related research. It may also be helpful to state what the proposal does not expect to accomplish or address. The introduction may also specify the order and arrangement of the sections included in the proposal. Goals and is social networking sites objectives are not the same and white collar crimes definition should be dealt with separately. Is Social Networking Sites. The goal of the project is what one hopes to accomplish as a result of the completed project. Objectives are statements of white collar crimes definition, precise outcomes that can be measured in support of the project's goals. Properly written objectives should be specific, measurable, and time bound. Unless specifically requested by the sponsor, do not include milestone activities. These are more appropriate to periodical technical reports that are usually requested during the life of the sponsored research project. Ability of the Project Staff to Undertake this Project. Sponsors want assurance that the funds invested in a project will yield results.

One indicator of success is the researcher's professional reputation and past experiences in managing sponsored research projects. A background discussion of the housewives researcher's own previous work, including evidence of the researcher's competence in the field, previous related work undertaken, and how this new proposal will continue or enhance that previous work should be included as background information. Some sponsors also want to know who has funded the definition previous work. A researcher is encouraged to discuss their own previous publications that relate to the present proposal. Description of Relevant Institutional Resources. It is useful to think of this section of the proposal as an opportunity for the researcher to assure the proposed sponsor that the networking institution is solidly in support of the research proposal, has the resources to devote to the project's undertaking, and is willing to commit a portion of those resources to this project. Some administrative areas have a boiler plate already developed that outlines the institution's demonstrated competence in the pertinent research area, unique or unusual research facilities or instruments available to the project staff, and support services and staff available to assist the project. Discussions of work done by others should give the reviewer a clear impression of white collar crimes, how this project will build upon what has already been done.

Additionally, a review of the literature will highlight how the project under consideration differs from other related projects. It is important to establish what is original in the project's approach, what circumstances have changed since related work was done, or what is housewives, unique about the time and white crimes place of the currently proposed research. Literature reviews should be selective and critical. Reviewers do not want to read through a voluminous working bibliography they want to what is social, know the especially pertinent works and a fair evaluation of them. A list of works, neither evaluated nor studied, contributes almost nothing to the proposal.

The style of the bibliographical item itself depends on the discipline. White Collar Crimes. The main consideration is analysis, consistency. Whatever style is white collar crimes, chosen, the style should be followed scrupulously throughout the proposal. A project must always be considered as an allocation of resources toward a specified goal. Using this definition as a framework, the project description is the heart of the proposal and is the primary concern of the technical reviewers. It should persuasively describe what is to be undertaken and how it will be accomplished. The comprehensive explanation of the proposed research is addressed not to the general reader but to other specialists in the field. Some points to consider when writing this section of the proposal: Be realistic in skinners language designing the definition program of work. Military. Overly optimistic notions of what the project can accomplish in one, two, or three years or of its effects on the world will only detract from the proposal's chances of being approved. The proposal should distinguish clearly between long-range research goals and white the short-range objectives for which funding is being sought.

Develop a clear timeline and squid animal activities that will be accomplished during each phase of the project. Try to white collar crimes, be as detailed as possible about the schedule of the proposed work. When will the first step be completed? When can subsequent steps be started? For complex projects a calendar detailing the projected sequence and skinners language interrelationship of events often gives the sponsor assurance that the white crimes investigator is capable of careful step-by-step planning.

Project management tools, such as GANTT and genesis analysis PERT charts, can be used effectively for white collar crimes definition, this purpose. Be explicit and concrete in outlining any assumptions or hypotheses on which the research rests. Be clear about the housewives duties focus of the research. In defining the white collar crimes limits of the project, especially in exploratory or experimental work, it is helpful to pose the specific question or questions the project is intending to housewives duties, answer. Be specific about the means of evaluating the white data or the conclusions. Try to imagine the squid animal questions or objections of a hostile critic and collar crimes definition show that the research plan anticipates them. Be certain that the connection between the research objectives and the research method is evident.

The reviewer must see this connection if the proposal is to analysis, be given any further consideration. White Collar. It is duties, better here to risk stating the obvious than to risk the reviewer assuming that the approach and white collar crimes definition methodology have not been carefully developed and thought out. Plan of Action, Methodology, and housewives duties Design. Methodology of a project is clearly and directly related to the project description. While the description outlines in more general terms what the project is about and how long it will take to complete, the action plan spells out in specific steps and procedures how the collar research will take place.

This section of the proposal typically answers four important questions in exacting detail: The time frame in which the project will take place. How long it will take to accomplish the goals of the project. Where the genesis analysis project work will be performed. How the researcher will accomplish each aspect of the collar work.

The plan or methods section will be the longest section of the technical narrative and will present a description of the work to be done in accomplishing the project objectives. It should account for all activities and individuals to be involved in mendel peas the project. This section of the proposal often includes a time chart or flow chart showing the order of activities to take place. Two commonly used project management tools are: Program Evaluation and Review Technique (PERT): PERT is a project management technique for determining how much time a project needs before it is completed.

Each activity is assigned a best, worst, and most probable completion time estimate. These estimates are used to determine the average completion time. The average times are used to figure the critical path and the standard deviation of completion times for the entire project. GANTT (Bar) Chart: A GANTT chart is a graphic display of activity duration. It is also referred to as a bar chart. Activities are listed with other tabular information on the left side with time intervals over the bars. Activity duration is shown in the form of horizontal bars. In determining the collar definition total length of the project, it is important to remember to incorporate interview and hiring schedules into the total time needed to complete the project.

If new staff are to be hired, particularly when they are coming from outside the Dartmouth community or Upper Valley area, it may well mean an additional four months added to the project's timetable. Sponsors will want to ranks, know if any project activities will be happening during the start-up months, what those activities are, who will be doing them, and white crimes how those activities will be funded. Explicit detailed scheduling presents a more organized and well thought-out plan, than vague statements such as 'staff will be hired'. The explanation should specify how many persons at skinners language theory what percentage of time and at collar crimes what administrative level will be participating in the project. If the program is complex and involves people from other departments or colleges, the duties organization of the staff and the lines of responsibility should be made clear. Project position descriptions should be included in the appendices.

A plan for staff training is white collar crimes definition, another area frequently overlooked in proposal development. Again, a sponsor will want to language, be assured that once hired, and where applicable, staff will be trained in a manner that is consistent with national standards for the work to white definition, be performed, staff will have the opportunity to thoroughly learn the skills needed to squid animal, successfully do the work of the project, and the training will support the efficient use of project funds. If a consultant is to be used to accomplish specific project tasks, the researcher should provide a description of the work to white definition, be performed and the length of time the project will need the consultant's services. Many sponsors request that applicants supply information on both active and pending support. Faculty should include a complete list of current sponsored projects including. Project titles Funding sources Duration of projects, Total approved budgets. This information should be included in the appropriate spaces on required application forms or, in the absence of housewives, any required form, typed neatly on a separately numbered page in the appendix to the proposal. Faculty should also list the same information about pending applications. This is particularly important when applying to Federal programs where possible sources of support may come from several different funding agencies.

Private foundations often want to know if the proposal under consideration has also been submitted to other foundations for support. Information pertaining to resources available to the PI for the conduct of the project should be described in detail. Examples of such resources include: lab space, equipment, animal facilities, library resources, and collar crimes computer systems. Well-planned research proposals include a method of evaluating the success of the project. Evaluation represents the logical conclusion to the proposal and sends a clear message that the researcher has not only thought through the execution of the project, but is analysis, also concerned that the stated goals have been achieved. Collar Crimes. Most sponsors asks that an evaluation methodology and outcome statement be part of the submitted proposal. These two parts of the evaluation are known as product and process evaluation. Product evaluation judges the end result of the project. To write an effective product evaluation section, the researcher must first have had clearly defined and measurable objectives for the project. The process evaluation measures how well the execution of the project matched the plan initially proposed. Did each step outlined in the initial plan support the development of the final product?

Were changes to the plan incorporated to accommodate new data, or to compensate for some aspect of the initial plan that did not work? While the evaluation stage to many proposals may seem anticlimactic, a well developed evaluation process can force the researcher to housewives, more carefully articulate the project 's objectives.