Public Interest Law Initiative


By B. Will. University of California, Merced.

Essex trusted 480 mg bactrim antibiotic yeast infection prevention, in the grave of Thomas Fuller buy bactrim 480 mg without a prescription infection jobs, a former rector of the parish, whose daughter he married. From In the same grave are the bodies of six of his chil- the same parish records comes the information dren, none of whom lived more than 3 years. The that Mary, the daughter of Dorcas Havers, the following extracts from Lilly Butler’s funeral widow, was buried at the same church on May 6, sermon give some estimation of his character: 1702, only a week after her father’s interment. He was a most respectful, dutiful son to his aged Father, Another entry records the burial of a Clopton frequent and liberal in making his acknowledgments to Havers, presumably the doctor’s son, on Novem- him for his ingenuous and chargeable Education, and ber 7, 1709. Having engaged himself in an honourable and Improvement in this last Age than Physick, so no part useful Calling, he faithfully pursued the Designs of it, of that has been more tempting, or more successfully as one who remembered the account he must give to pursued than Anatomy. The Dissections of many pre- the Maker of those Bodies he had undertaken the care ceding Ages turn’d to a small account; so that many of of, and truly Watched for their Lives. He took a great the most admirable Contrivances of Nature and of the deal of Pains to improve himself in that Knowledge greatest Wonders in the lesser World, were inobserv’d; which was necessary to qualify him for a laudable till the Curiosity of some ingenious Men, animated discharge of so great a Trust.... His Countenance with the hopes of some new Discoveries, put them upon was grave and serious, without any lines of Sorrowness farther Enquiries; in which their Industry and Felicity or Affectation; his Speech was soft and obliging, carried them so far, that the Existence of some parts without any Air of conceit or Flattery; his Behaviour before unknown, the Nature, Structure and Use of gentile and courteous, without any Appearance of Art others, began to appear. Observations of our Age about some of the Parts have been very accurate, we have been only coasting about Dr. Luke and said that others; particularly about the internal Fabrick, and “he was not only esteemed by his Patients for his some other things of the Bones our Searchers have been great abilities and care and diligence, but exceed- careless, our Notice slight and transient: not but that ingly beloved too for his amiable Temper, his they deserve our strictest Enquiry and serious Remarks; obliging Tenderness and his most winning and for I do not see but the Almighty Architect has equally excellent Virtues. And how curious the Hand of his ingenious theory that the “porosity” decreased Heaven has been in the Framing and Ordering of this from the cavity towards the outside of the bone Timber-work of our Bodies, may perhaps appear a little because the amount of lubricating medullary oil from this Discourse. It seems very likely that Anthony van The particular concern of the present paper is to Leeuwenhoek, the pioneer microscopist, had give the original description of the “canals,” already observed these “canals” in bone, for in his which is to be found on page 43 of the English letter published in the Philosophical Transactions editions and on page 47 of the Latin edition pub- of the Royal Society on September 21, 1674, he lished in Amsterdam in 1731: makes the following statement: “I have several times endeavoured to observe the parts of a Bone, In the Bones, thro’ and between the Plates, are formed and at first I imagin’d, I saw on the surface of the Pores, besides those which are made for the Passage of Shinbone of a Cow several small veins (which the Blood-Vessels, which are of two sorts; some pene- bone I still keep by me); but I have not found trate the Laminae, and are transverse, looking from the it since in any other bone”... And that I may not be thought to pretend makes no other comment on this observation and to the discovery of what no other mens Eyes can so it must remain doubtful whether the structures discern, because they are generally very difficult to be he saw were actually those that later became observ’d, unless it be the transverse Pores in the inter- nal Lamell, I have the pieces of two Bones, which I known as Haversian canals. Havers was no copyist and he rightly not arranged in any kind of pattern, but have a named his work as Osteologia nova. That his “seeming irregularity,” which tends to preserve canals contained blood vessels and not merely the necessary strength of the bone tissue. The lon- medullary oil as he contended and that they had gitudinal pores are more difficult to see, but are probably been known previously to Leeuwenhoek best observed in the ribs. Havers assumed that the does not detract from the merits or the originality use of these pores was solely for the diffusion of of his observations at a time when the dissemina- the “Medullary Oil” for, he says: “About these tion of scientific knowledge was of necessity passages I was particularly strict in my enquiry, restricted. Nor must we minimize the importance whether they were not formed for Blood-Vessels, of his discovery of the penetrating periosteal tending either to or from the Marrow: and fibers afterwards known as Sharpey’s fibers although some of the Medullary Veins have Pores, (1848). These fibers he describes as “fibrillae or by which they penetrate into the substance of the threads,” and that he appears at times to regard Bone, yet I made my self certain, that these Pores, them as being nervous in function is probably due for the generality of them which I examined, had more to his usage of the term “nerve” in its orig- no Vessels which passed into them. That Portal13 course, Havers has since proved to be wrong, for 133 Who’s Who in Orthopedics should rather grudgingly recognize the originality Butler L (1741) The Character of Clopton Havers, of Havers and that he should stress his incomplete M. Memorials and Characters, acquaintance with contemporary literature must Together with Lives of Divers Eminent and Worthy Persons, 279. London not be taken in disparagement of the work of a Dictionnaire des Sciences Mi’dicales (1822) Biogra- man who, while in the active practice of his pro- phie Medicale 5:102. Paris, CLF Panckoucke fession, produced a work that breathed a new Eloy NFJ (1778) Dictionnaire historique de la Medec- spirit of experiment and speculation into the study ine 2:460. London Leewenhoek AVan (1674) Microscopical Observations about Blood, Milk, Bones, the Brain, Spitle, Cutic- ula. Philosophical Transactions 9:121 References Munk W (1878) The Roll of the Royal College of Physicians of London, 2nd edn, 1:477. London, Pub- Anon (1693) An Account of a Book, Osteologia nova, lished by the College or some Observations of the Bones, etc. London, read at their meetings, by the learned and accurate Harleian Society Author, Clopton Havers, M. Philosophical Trans- Payne JF (1885) Dictionary of National Biography actions, No 194:544 25:182 Anon (1898) Archaeologica medica. Edin- Urban & Schwarzenberg burgh, Archibald Constable and Company Butler L (1702) A Sermon Preach’d at the Funeral Young S (1890) Annals of the Barber–Surgeons 373. Furthermore, he was vitally interested and took a very active part in the organization of graduate training at this institution under the auspices of the Graduate School, Uni- versity of Minnesota, and was actively interested in the early development of the American Board of Orthopedic Surgery. Henderson contributed much to the growing specialty of orthopedic surgery. His outstanding efforts were in the treatment of fractures, particularly bone-grafting procedures for ununited fractures and for fractures of the neck of the femur.

Almost 25 percent of people with Notes to Pages 91–107 / 303 major mobility problems live in apartments or condominiums (vs cheap bactrim 480 mg visa antibiotic guidelines 2014. Just over 4 percent of persons reporting major mobility difficulties say they were denied housing within the last year because of their physical impairment (these age-and-sex adjusted rates come from the 1994–95 NHIS-D Phase II) buy cheap bactrim 960mg on-line antibiotics for dogs at tractor supply. Centers for Independent Living (CILs) are located in communities na- tionwide. Originating during the 1970s, many CILs help people with disabili- ties find community-based assistance with wide-ranging needs, including ADLs, IADLs, housing, vocational training, and employment. The 1994–95 NHIS-D Phase II asked specific questions about use of CIL services. This number of respondents is too small for meaningful analysis or derivation of population estimates. These rates come from the 1994–95 NHIS-D Phase I and look at people reporting assistance with ADLs. For IADLs, the percentages with paid help are 22 for minor, 23 for moderate, and 27 percent for major mobility difficulties. These rates come from the 1994–95 NHIS-D Phase I and look at people reporting assistance with ADLs. For IADLs, just over one third got help only from a spouse, parent, or child across the three groups with mobility difficulties, with roughly 20 per- cent not receiving any assistance with IADLs. These rates come from the 1994–95 NHIS-D Phase I and are adjusted for age group and sex. Among persons age 18–44, 74 percent of those without mobility difficulties are mar- ried, compared to only 57 percent of those with major mobility problems. In the same age range, 13 percent of persons without mobility difficulties are di- vorced, compared to 20 percent of those with major mobility difficulties (these figures come from the NHIS-D Phase I and are adjusted for age group and sex). Neither Phase I nor II of the NHIS-D directly asked how many children respondents had. The percentages responding that they had at least one living child were 31, 37, and 30 for people age 45–64 with mild, moderate, and major mobility prob- lems, respectively. Of people age 65+ with mild, moderate, and major mobility problems, 51, 47, and 61 percent, respectively, have at least one living child. Among people age 18–44, 91 percent with minor mobility difficulties have at least one living parent, as do 82 and 87 percent of those with moderate and major mobility problems, respectively (these rates are taken from the 1994–95 NHIS-D Phase II and adjusted for age group and sex). These rates come from the 1994–95 NHIS-D Phase II and are adjusted for age group and sex. Of working-age persons who had worked or still work, 12 to 13 percent are self-employed, regardless of mobility status (1994–95 NHIS-D and 1994–95 Family Resources supplement). Of persons still working, 6 to 8 per- cent have more than one job, regardless of mobility. For persons now age 65+, the percentage who had been self-employed is much higher than for younger persons: 33 for people with no difficulties; and 29 for mild, 32 for moderate, and 40 percent for major mobility difficulties. Additional information drawn from the 1994–95 NHIS-D Phase I rein- forces perceptions that poverty increases with worsening mobility impair- ments. About 3 percent of working-age people without impaired mobility re- port they receive welfare payments (primarily Aid to Families with Dependent Children; this survey was performed before “welfare reform” produced Tem- porary Aid to Needy Families), compared to 8 to 11 percent of persons with mobility difficulties. Only 11 percent of working-age people without mobility problems receive food stamps, compared to over 30 percent for those with im- paired mobility. The percentage of working-age people reporting disability pensions other than Social Security or railroad retirement is 1 for people with no diffi- culties; and 4 for mild, 7 for moderate, and 6 percent for major mobility diffi- culties. The percentage of persons age 65+ reporting disability pensions is 2, 3, 4, and 5 for people with no mobility problems and minor, moderate, and major difficulties, respectively. Social Security amendments of 1956 introduced cash benefits for dis- abled workers between age 50–65; the 1958 amendments granted cash benefits to children and dependent spouses of disability recipients; the 1960 amend- ments extended benefits to workers under age 50; and the 1965 amendments changed the definition of “permanent disability” to one “expected to continue for at least 12 months” (Stone 1984, 78). Supplemental Security Income passed in 1972 and extended coverage to persons disabled before age 22 who had never worked (Pelka 1997, 285). People with short-term limitations can obtain cash benefits through state-sponsored temporary disability programs or through sickness or accident insurance purchased privately by individuals or their employers. Persons with work-related injuries receiving payments from employer-financed workers’ compensation programs run by states generally have their Social Security ben- efits cut by that amount. Cash from private long-term disability insurance or pensions purchased through employers or by workers themselves can supple- ment Social Security payments. The most common single rea- Notes to Pages 111–115 / 305 son was musculoskeletal problems such as arthritis (25 percent), followed by mental disorders (24 percent), circulatory conditions such as heart disease (12 percent), cancer (10 percent), and disorders involving the nervous system or sensory organs (8 percent).

Before doing so ensure that the student has not marked more than one answer correct! In most major medical examinations a computer will be used to score and analyse objective-type examinations cheap 480 mg bactrim mastercard antimicrobial shampoo. You must therefore be familiar with the process and be able to interpret the subsequent results purchase 480 mg bactrim visa infection movies. The computer programme will generally provide statistical data about the examination including a reliability coefficient for internal consistency, a mean and standard deviation for the class and analyses of individual items. Should you be 147 the person responsible for the examination you will need to know how to interpret this information in order to process the examination results and to help improve subsequent examinations. If you are not familiar with these aspects we strongly suggest you seek expert advice or consult one of the books on educational measurement listed at the end of the chapter. DIRECT OBSERVATION Direct observation of the student performing a technical or an interpersonal skill in the real, simulated or examination setting would appear to be the most valid way of assessing such skills. Unfortunately, the reliability of these observa- tions is likely to be seriously low. This is particularly so in the complex interpersonal area where no alternative form of assessment is available. Nevertheless, in professional courses it is essential to continue to make assessments of the student’s performance, not least to indicate to the student your commitment to these vital skills. In doing so, you would be well advised to use the information predominantly for feedback rather than for important decision-making. Various ways have been suggested by which these limitations might be minimised. One it to improve the method of scoring and another is to improve the performance of the observer. Evidence suggests that the reliability of a checklist decreases when there are more than four points on the scale. The assessor has to decide whether each component on the list is present/absent; adequate/inadequate; satisfactory/unsatis- factory. Only if each component is very clearly defined and readily observable can a checklist be reliable. The essential feature is that the observer is required to make a judgement along a scale which may be continuous or intermittent. They are widely used to assess behaviour or performance because no other methods are usually available, but the subjectivity of the assessment is an unavoidable problem. Because of this, multiple independent ratings of the same student undertaking the same activity are essential if any sort of justice is to be done. They are derived from published formats used to obtain information about ward performance of trainee doctors. The component skill being assessed is ‘Obtaining the data base’ and only one sub-component (obtaining information from the patient) is illustrated. The first is that there is an attempt to provide descriptive anchor points which may be helpful in clarifying for the observer what standards should be applied. In a study we undertook, it was the format most frequently preferred by experienced clinical raters. Improving the performance of the observer It has often been claimed that training of raters will improve reliability. This seems to make sense but what evidence there is shows that training makes remarkably little difference! A study of our own suggested that a better approach might be to select raters who are inherently more consistent than others. Common sense dictates that observers should be adequately briefed on the ratings form and that they should not be asked to rate aspects of the student’s performance that they have not observed. ORAL The oral or vice-voce examination has for centuries been the predominant method, and sometimes the only method, used for the clinical assessment of medical students. The traditional oral, which gives considerable freedom to the examiner to vary the questions asked from student to student and to exercise personal bias, has consistently been shown to be very unreliable.

Wroblewski BM order 960mg bactrim overnight delivery antibiotic zeocin, Fleming PA purchase 480mg bactrim with amex antibiotics for acne names, Siney PD (1999) Charnley low-frictional torque arthro- plasty of the hip. Bettin D, Greitemann B, Polster J, et al (1995) Long term results of uncemented Judet hip endoprostheses. Keisu KS, Mathiesen EB, Lindgren JU (2001) The uncemented fully textured Lord hip prosthesis: a 10- to 15-year followup study. Swanson TV (2005) The tapered press fit total hip arthroplasty: a European alternative. Weller S, Rupf G, Ungethum M, et al (1988) The Bicontact Hip System (in German). Malchau H, Garellick G, Eisler T, et al (2005) Presidential guest address. The Swedish Hip Registry: increasing the sensitivity by patient outcome data. Espehaug B, Furnes O, Havelin LI, et al (2006) Registration completeness in the Norwegian Arthroplasty Register. Eskelinen A, Remes V, Helenius I, et al (2006) Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid- to long-term follow-up study from the Finnish Arthroplasty Register. Pedersen AB, Johnsen SP, Overgaard S, et al (2006) Total hip arthroplasty in Denmark: incidence of primary operations and revisions during 1996–2002 and estimated future demands. Mittelmeier H, Heisel J (1992) Sixteen-years’ experience with ceramic hip prostheses. Willmann G (1998) Ceramics for total hip replacement: what a surgeon should know. Engh CA Jr, Young AM, Engh CA Sr, et al (2003) Clinical consequences of stress shielding after porous-coated total hip arthroplasty. D’Antonio JA, Capello WN, Manley MT, et al (2001) Hydroxyapatite femoral stems for total hip arthroplasty: 10- to 13-year followup. Kawamura H, Dunbar MJ, Murray P, et al (2001) The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. Archibeck MJ, Berger RA, Jacobs JJ, et al (2001) Second-generation cementless total hip arthroplasty. Daniel J, Pynsent PB, McMinn DJ (2004) Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. Morrey BF, Adams RA, Kessler M (2000) A conservative femoral replacement for total hip arthroplasty. Kiefer H, Othman A (2005) Orthopilot total hip arthroplasty workflow and surgery. Weller S, Braun A, Gekeler J, et al (1998) The Bicontact hip implant system. Gruen TA, McNeice GM, Amstutz HC (1979) Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Asmuth T, Bachmann J, Eingartner C, et al (1998) Results with the cementless Bicon- tact stem: multicenter study of 553 cases. Weller S, Braun A, Gellrich JC, Gross U (1999) Importance of prosthesis design and surface structure for primary and secondary stability of uncemented hip joint pros- theses. Volkmann R, Eingartner C, Winter E, et al (1998) Mid term results in 500 titanium alloy straight femoral shaft prostheses—cemented and cementless technique. Eingartner C, Volkmann R, Winter E, et al (2000) Results of an uncemented straight femoral shaft prosthesis after 9 years of follow-up. Eingartner C, Volkmann R, Winter E, et al (2001) Results of a cemented titanium alloy straight femoral shaft prosthesis after 10 years of follow-up. Eingartner C, Heigele T, Dieter J, et al (2003) Long term results with the BiCONTACT System: aspects to investigate and to learn from. Eingartner C, Heigele T, Volkmann R, et al (2006) Long-term results of an uncemented straight femoral shaft prosthesis.

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