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Celexa

By B. Treslott. Bowdoin College. 2018.

Early in 1939 discount 10mg celexa otc, his liberal convictions drove cation of a tourniquet to a rabbit’s hind leg pro- him to move himself and his family to London buy celexa 10mg without prescription, duced arterial spasm extending up to the renal where his first-hand experience of air-raid surgery vessels purchase celexa 40mg with mastercard. Now I have it from one of the best of them to the Nuffield Chair of Orthopedic Surgery in that Trueta and his colleagues were very nearly Oxford and held this post until 1966 quality 20 mg celexa. He was thus right, but they overstressed the shutting down of able to reorganize the Wingfield Morris Hospital the cortical, as opposed to the medullary, circula- as the Nuffield Orthopedic Centre and produce a tion. I quote: “the standing of Trueta, Barclay steady stream of publications on almost every et al. His international But perhaps one remembers this great man best reputation was recognized by an honorary DSc as the embodiment of the Spirit of Catalonia (the from the University of Oxford, and an honorary title of a work of filial piety that he published in fellowship of the Royal Colleges of Surgeons of 1946). It was always a pleasure to see his fine England and of Canada, and of the American figure and handsome, vivacious face, and to listen College of Surgeons. He was an Officier de la to him, even though he never quite understood Légion d’Honneur and honorary fellow of many that going at top speed in a foreign tongue was other orthopedic associations round the world. But there were 335 Who’s Who in Orthopedics occasions when he was almost wildly elated. Trueta had had it first-hand the night orthopedic research in our era no longer seems before. But he was involved in so much we became bored with it, having a sizeable war more. But his faith was Research Centre and was one of the first in this unquenchable, so it was inevitable that on retire- country to respond to the consequences of the ment he returned to his native land: inevitable and thalidomide disaster. He pioneered a unit to deal well-nigh incredible that when in the UK for the with skeletal complications of hemophilia and, in treatment of his last illness, he dragged himself collaboration with the department of hematology, home to die in peace in the country he loved so established principles of management that are passionately. He organized and person- ally inaugurated by several visits to that country an educational exchange with the Republic of When Joseph Trueta took the chair in orthopedic the Sudan, a program that has continued uninter- surgery at Oxford, there already lay behind him ruptedly to this day. By 1939, his first career in Barcelona begin the last of his careers, once again in had ended. While still maintaining a busy clinical he called “the sad privilege” of his responsibility practice, he wrote a biography of G. Girdle- for the first urban population in history to be mas- stone, whom he admired above all, prepared his sively attacked from the air. His second career, as own memoirs, read history and lectured his way an emigré in an Oxford laboratory unraveling around the world. Gradually, as the political some of the complexities of the renal circulation, climate in his country changed, the people of Cat- was brief but characteristically fruitful and is now alonia saw him for the patriot he had always been, embalmed in the textbooks of physiology. It was and before he died the reconciliation between the in his third incarnation as Oxford’s professor that great surgeon and the country that he had fled his remarkable experience was built upon, broad- nearly 40 years before was completed by his ened and generously shared with anyone who acceptance of the highest honor the King of Spain cared to join him. And more significant yet of the everything at once, bombarding himself with extraordinary regard in which he was held, the questions, which sprang to his mind even from the citizens of Barcelona crowded the great church of most mundane of clinical problems. He was the Santa Maria del Mar to hear his funeral mass and very master of the art of digression, and yet to listen to the music of Pablo Casals, his old capable of directing his energy to laboratory friend and fellow exile. The discipline he pedics, the breadth of Joseph Trueta’s interests offered, that we should combine most intimately and influence, his sense of the drama of life and our therapeutic and research roles, was not a new even perhaps his splendid misuse of the spoken one, but it has more theoretical adherents than it English language all conspired to keep him a little has practitioners. He taught it by precept and apart from “The Establishment,” which, with thereby caught the imagination of many of those another side of his personality, he so earnestly who came from all over the world to work with wished to join. He had little formal order in his life, was When Joseph and Amelia Trueta brought their always tremendously busy but somehow had time young family to England and were befriended by for everyone. Girdlestone, there was started a process that Trueta’s long investigation, with generations of now links in a mutual experience some hundreds collaborators, into the vascular contribution to of men and women in many countries of the osteogenesis, the vascular anatomy of bone, world. They remember the debonair, provocative the orderly and the disorderly function of the and profoundly civilized man who enlarged our epiphysis, cartilage growth, repair and decay, concept of the orthopedic surgeon to include the 336 Who’s Who in Orthopedics orthopedic scientist, and who by his example per- Orthopedic Centre at Headington, which was to sonified both. He generated Spanish Civil War, which was so relevant to what a sense of authority, which was totally divorced was about to break on Britain.

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If cardiac arrest should subsequently occur buy celexa 10 mg with amex, the rhythm will be analysed at the earliest opportunity 40mg celexa, enabling defibrillation with the minimum delay 40 mg celexa with mastercard. Sequence of actions with an AED Once cardiac arrest has been confirmed it may be necessary for an assistant to perform basic life support while the Safety factors equipment is prepared and the adhesive electrodes are ● All removable metal objects order 10 mg celexa free shipping, such as chains and medallions, attached to the patient’s chest. The area of contact may need should be removed from the shock pathway—that is, from the front of the chest. Body jewellery that cannot be removed will to be shaved if it is particularly hairy, and a small safety razor need to be left in place. Although this may cause some minor should be carried with the machine for this purpose. Most machines have motion sensors that can ● The patient’s chest should be checked for the presence of detect any interference by a rescuer and will advise no contact self-medication patches on the front of the chest (these may deflect energy away from the heart) between shocks. If two rescuers are present one metal surfaces that connect the patient to the operator. It is should go for help and to collect the AED while the other important to recognise that volatile atmospheres, such as petrol or aviation fumes, can ignite with a spark assesses the patient. One electrode should be placed at the upper right sternal border directly below the right clavicle. The other should be placed lateral to the left nipple with the top margin of the pad approximately 7cm below the axilla. The correct position is usually indicated on the electrode packet or shown in a diagram on the AED itself. It may be necessary to dry the chest if the patient has been sweating noticeably or shave hair from the chest in the area where the pads are applied. ECG analysis Other factors is usually performed automatically, but some machines ● Use screens to provide some dignity for the require activation by pressing an “analyse” button. Do not check for a pulse or other signs of a circulation between the three shocks. This will be timed by the machine, after clinical experience with automated external defibrillators. Alternatively, this procedure may start automatically, ● Davies CS, Colquhoun MC, Graham S, Evans, T, Chamberlain D. Defibrillators in public places: the introduction of a national Shocks should be repeated as indicated by the AED. Check the patient every minute to ensure that signs ● International guidelines 2000 for cardiopulmonary of a circulation are still present. Use of automated external defibrillators by the AED scheme so that data may be extracted from the a US airline. Ensure all supplies are replenished ready for the ● Resuscitation Council (UK). The diagram of the algorithm for the use of AEDs is adapted from ● Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman Resuscitation Guidelines 2000, London: Resuscitation Council (UK), RG. PEA was formerly known as electromechanical dissociation but, by international agreement, PEA is now the preferred term. In the community, VF is the commonest mode of cardiac arrest, particularly in patients with coronary disease, as Asystole: baseline drift is present. The ECG is rarely a completely straight line in asystole described in Chapter 2. Asystole is the initial rhythm in about 10% of patients and PEA accounts for an even smaller proportion, probably less than 5%. The situation is different in hospital, where the primary mechanism of cardiac arrest is more often asystole or PEA. These rhythms are much more difficult to treat than VF and carry a much worse prognosis. Asystolic cardiac arrest Suppression of all natural or artificial cardiac pacemakers in asystolic cardiac arrest leads to ventricular standstill.

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If purchase celexa 20mg line, however celexa 10 mg line, you have read other work in relation to your research but not actu- ally referred to them when writing up your report discount celexa 10 mg mastercard, you might wish to include them in a bibliography purchase celexa 20mg with mastercard. However, make sure they are still relevant to your work – including books to make your bibliography look longer and more impressive is a tactic which won’t impress examiners. Example list of references Appendices If you have constructed a questionnaire for your research, or produced an interview schedule or a code of ethics, it may be useful to include them in your report as an appen- HOW TO REPORT YOUR FINDINGS/ 139 dix. In general, appendices do not count towards your to- tal amount of words so it is a useful way of including ma- terial without taking up space that can be used for other information. However, do not try filling up your report with irrelevant appendices as this will not impress exam- iners. When including material you must make sure that it is relevant – ask yourself whether the examiner will gain a deeper understanding of your work by reading the appen- dix. Other information which could be included as an appendix are recruitment leaflets or letters; practical details about each research participant; sample transcripts (if permission has been sought); list of inter- view dates; relevant tables and graphs or charts which are too bulky for the main report. X It is obvious that ideas and sentences have been ta- ken from other sources. Most academic journals do not pay for ar- ticles they publish, but many professional or trade publi- cations do pay for your contribution, if published. However, competition can be fierce and your article will have to stand out from the crowd if you want to be suc- cessful. The following steps will help you to do this: X Choose a topical, original piece of research. X Do your market research – find out which journal pub- lishes articles in your subject area. X Check on submission guidelines – produce an article in the correct style and format and of the right length. X Read several copies of the journal to get an idea about the preferences of editors. X If you are thinking about writing for a trade publica- tion, approach the editors by letter, asking if they might be interested in an article. X Produce a succinct, clear, interesting and well-written article – ask friends, tutors or colleagues to read it and provide comments. X Make sure there are no mistakes, remembering to check the bibliography. X If it is your first article, gain advice from someone who has had work published. Also you might find it easier to write an article with someone else – some tutors or HOW TO REPORT YOUR FINDINGS/ 141 supervisors will be willing to do this as it helps their publication record if their name appears on another article. You may find that you will do most of the work, but it is very useful to have someone read your article and change sections which do not work or read well. It is also useful to have people comment on your methodology or analysis assumptions which could be criticised by other researchers. ORAL PRESENTATIONS Another method of presenting your research findings is through an oral presentation. This may be at a university or college to other students or tutors, at a conference to other researchers or work colleagues, or in a work place to colleagues, employers or funding bodies. Many re- searchers find that it is better to provide both a written report and an oral presentation as this is the most effective way of enabling a wider audience to find out about the re- search, especially if you also reproduce your written re- port on-line. If you want people to take notice of your results, you need to produce a good presentation. PowerPoint is a useful presentation graphics program which enables you to create slides that can be shared live or on-line. You can enhance your presentation with ani- mation, artwork and diagrams which make it more inter- esting for your audience. Acknowledge that this is your first Everybody gets nervous when they presentation and people will tend to first start giving presentations and help you along.

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He knew that he had unique gifts of expression His eldest brother John discount 20mg celexa overnight delivery, a distinguished pedia- and presentation purchase 40 mg celexa otc, but rarely explained and never trician purchase 40mg celexa free shipping, died before him cheap celexa 10 mg fast delivery. A second brother, Martin, mentioned the hours of hard work, the patience lives in London. His son Richard and his daugh- and the dogged persistence that had produced ter Mary, from his first marriage to Janie, have such results. His insistence on the “drawer” both inherited his interest and skill in music. His method of writing papers and lectures was not second wife, Violet, brought great joy into his theoretical; his own work was always put away later years, supported him in his travels and cared for later review and polishing, many times. Pencil for him with amazing optimism and energy and paper were his tools; a lecture or a chapter of during his final illness. The “spontaneity” and the “readability,” the clarity, the memorable phrases, and even Alan Apley devoted most of his indefatigable the jokes, were carefully orchestrated and timed. How fortu- 14 Who’s Who in Orthopedics nate it was that he lived long enough to dedicate five full decades to this. Alan’s internationally famous “Pyrford Post- graduate Course,” held twice each year, was attended by well over 5,000 orthopedic trainees and surgeons from the UK and countless other countries. It may be less well known that he organized and lectured at annual satellite courses for 18 years in New York and for 15 years in Toronto. Having yearned to be an actor, he did have some theatrical training, and his presenta- tions at home and abroad reflected this flair. His dramatic delivery gave clarity and impact, which was seasoned with a delightful sense of humor. He served in this capacity in seven universities in the United States, four in Christopher George Canada, four in Australia and 22 in other coun- tries throughout the world. His internationally acclaimed textbooks have 1922–1979 been used by hundreds of thousands of students and orthopedic surgeons worldwide. It is under- Born in 1922 into a medical family, Christopher standable that he became a legend in his own Attenborough was first educated at Marlborough time, and is entirely appropriate that the sixth and College and then went to Trinity College, Cam- seventh editions have been coauthored by Louis bridge, followed by King’s College Hospital, Solomon as Apley’s System of Orthopedics and qualifying in 1944. He has been facile soon posted to the East Indies fleet, where he princeps, easily the first, and his magnificent con- served as a surgeon lieutenant in destroyers, tributions as a teacher will live on through his including HMS Vigilant when it went into inspiring books. Singapore at the end of the war, and he was in the detachment that released the prisoners of war from Changi Prison. His exceptional hospital for 6 months before returning to England ability with written and spoken words displayed in 1947, continuing his training at King’s College a clear and well-ordered mind, which enabled him Hospital under Sir Cecil Wakeley and others. Anyone year at the Metropolitan Hospital as orthopedic who worked closely with him in any of his many registrar preceded his appointment in January distinguished roles soon became aware of these 1952 as first assistant to the orthopedic and acci- remarkable qualities. He could extract the essence dent department of the London Hospital under from a paper or a discussion, pick out the salient Sir Reginald Watson-Jones and Sir Henry points, and give a fair and unbiased opinion, Osmond-Clarke. When Christopher published an article it was He will also be remembered for his innate an event. He never wrote “pot boilers” but con- sense of humor, which made him a wonderful fined his publications to important contributions companion. Thus in 1953 he pub- a committee, in a large or a small group, at work lished in The Journal of Bone and Joint Surgery or at play, it was always fun to be with him. In 1966 he 15 Who’s Who in Orthopedics described his operation for severe congenital enjoyed drawing and gardening, he was captain talipes equinovarus, which still maintains a great of the bell ringers in his village church, and he influence on the treatment of that condition. Nevertheless, in the He was appointed orthopedic consultant to the seclusion of his Sussex home he did many hours Bromley Group of hospitals in 1956. His years in of painstaking research, notably into better Bromley were extremely busy so that he was not designs of joint replacements and in modifying able to get about to meetings, nor did he have those already produced, because—being a per- much time for research. He took on a great burden fectionist—he was never satisfied that he had of children with chronic diseases in particular, achieved the final design. He Christopher’s career written in terms of techni- attended the Cheyne Hospital and the Sydenham cal or orthopedic success is insufficient, because Children’s Hospital.

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The advantage of short stations is that more tasks can be assessed in a given time giving cost-benefit advantages in terms of reliability buy 20mg celexa visa. Should you wish to consider introducing such an approach you should read the articles given in the references buy discount celexa 40mg line. Observation of a well run OSCE and advice from an experienced OSCE organiser will pay enormous divi- dends generic 40 mg celexa free shipping. SELF-ASSESSMENT By ‘self-assessment’ we mean an assessment system which involves the students in establishing the criteria and standards they will apply to their work and then in making judgements about the degree to which they have been met celexa 10 mg. We believe that the skill of being able to make realistic evaluations of the quality of one’s work is an attribute that every graduate should have. Yet, in conventional courses, few opportunities are provided for self-assessment skills to be learnt and developed. The introduction of self-assessment practices into existing courses have been shown to be feasible and desirable. Whether marks generated in this way should count towards a final grade is an undecided issue. Work reported in the literature suggests that so long as the assessment scheme is well designed and students grade themselves on achievement (and not effort), they will generate marks which are reasonably consistent with staff marks. Thus, there is little doubt that self-assessment, used primarily to improve the students’ understanding of their own ability and performance, is worthwhile educationally 153 154 155 and encourages openness and honesty about the assess- ment. If you wish to embark on a trial scheme you must first set about the task of establishing criteria and standards. This can be done at a series of small group meetings attended by staff and students. Both must agree on the criteria to be applied to the students’ work, To help focus on this task you might have students reflect on questions such as: How would you distinguish good from inadequate work? Once criteria have been specified, students use them to judge their own performance. Marks are awarded with reference to each criterion and a statement justifying the mark should be included. An alternative is to contrast their own mark with one given to them by a peer. The teacher may also mark a randomsample to establish controls and to discourage cheating or self-delusion. We urge you to give this approach to assessment very serious consideration indeed. In our view, it is among the most educationally promising ideas in recent years, and we suggest you study the book by Boud listed at the end of this chapter. THE LEARNING PORTFOLIO All assessment methods require that students present evidence of their learning, yet in most cases (with theses and project work being notable exceptions) it is the teacher who controls the character of that evidence. Requiring students to respond to objective tests, write essays and participate in clinical examinations for example, does this. If we really believe in student-centred learning then we must work hard to ensure that our assessment practices reflect, encourage and rewardthis belief. In Chapter 1, we noted that assessment in student-centred learning needs to be more flexible with greater emphasis on student responsibility. The learning portfolio is one way of reinforcingstudent-centred learning. The portfolioclearly has validity as an assessment method in this situation, but its reliability for summative purposes has yet to be deter- 156 mined. This should not, however, discourage you from experimenting with learning portfolios with your students. A learning portfolio is a collection of evidence presented by students to demonstrate what learning has taken place. In the portfolio, the student assembles, presents, explains, and evaluates his or her learning in relation to the objectives of the course and his or her own purposes and goals. Used for many years in disciplines like the fine arts and architecture, portfolios are now being used more widely and are being strongly advocated as an approach to the revalidation (re-certification) of practising doctors in the UK. A learning portfolio might have several parts, such as: An introductory statement defining what the objectives are and what the student hopes to accomplish. A presentation of items of evidence to show what learning has taken place.

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