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COURSE CONTENT Content is a broad concept meant to include all aspects of knowledge purchase renagel 400 mg amex, skills and attitudes relevant to the course and to the intellectual experiences of students and their teachers in a course buy renagel 400mg with visa. While not always easy to achieve cheap 400mg renagel, we feel that course content should be made explicit and that this will then put you in a better position to make informed and coherent decisions in your planning cheap 400mg renagel free shipping. There are several different criteria for selecting content that may be more or less relevant to your work. Academic criteria These criteria focus attention on theoretical, methodologi- cal and value positions. For example: Content should be a means of enhancing the intellectual development of students, not an end in itself. Content that is solely concerned with technical matters has a limited place in university education; content must also involve moral and ethical considerations. Content should contribute to a deep rather than to a surface view of knowledge. Psychological criteria These criteria relate to the application of psychological principles – especially of learning theory – to teaching: Content should be carefully integrated to avoid fragmentation and consequential loss of opportunities for students to develop ‘deep’ approaches to learning (see Chapter 1). Content selection must provide opportunities to emphasise and to develop higher-level intellectual skills such as reasoning, problem-solving, critical thinking and creativity. Content should provide opportunities for the devel- opment of attitudes and values. Content should be selected to assist in the develop- ment of students as independent lifelong learners. Practical criteria These criteria concern the feasibility of teaching something and may relate to resource considerations: Content may be derived from one or two major texts because of a lack of suitable alternative materials. Content should be influenced by the availability of teaching resources: library materials, information- technology resources, people, patients, physical environment, etc. Student criteria These criteria relate to the characteristics of the students you teach. We consider these criteria to be so important that a full section is devoted to them. Student criteria may affect the choice of content (and ways of teaching and assessing) in a variety of ways: 92 Content may be selected to reflect the background, needs and interests of all students. Content should be matched to the intellectual and maturity level of students. How you actually go about selecting content will largely be determined by the kind of person you are (especially by your views about the relative importance of your role as a teacher, the role of students and course content), and the norms and practices in the discipline you teach. STUDENTS Taking account of student characteristics, needs, and interests is the most difficult part of course planning. The reason for this is that teachers now face increasingly heterogeneous groups of students and, at the same time, must take account of legislative requirements to address specific issues such as occupational health and equal opportunities. It is no longer enough to state that planners need to ‘take account of students’ and then to proceed as if they did not exist. Experience shows that students can provide invaluable assistance in course planning by consulting them formally and informally. Institutional responsibilities – which we would encourage you to influence positively – might include: tutorial assistance in the English language, especially for non-native speakers and international students; bridging courses and foundation courses to assist in the process of adjustment to higher education. In addition to accommodating the wide range of personalities, learning styles, social backgrounds, expectations and academic achievement of normal or direct-entry students from school you must also be prepared to teach students from other backgrounds and with ‘different’ characteristics than your own. Five examples of current concern which we will briefly discuss are: women, mature-age students, students with a disability, first-year students and international students. In medical schools in many countries woman are forming an increasingly high proportion of student intakes. However, as the proportion of women in senior clinical and academic positions remains a minority the propensity for bias remains.

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Below baggy comfortable clothes generic 400mg renagel with amex, his body seemed emaciated from the progressive ALS buy 400mg renagel otc. Nevertheless generic renagel 800mg visa, he retained firm control of what he offered intellectually purchase renagel 400 mg, his mind sharp and astute. But he was beginning to lose con- trol of his voice—it had a gruffer edge than previously. The house was filled with Nancy’s artwork, crafted in a studio on an upper floor he had not visited in a long time. Burton, that he would no longer want to live when he became ventilator-dependent. He had soon moved to the ventilator and found it manageable, no longer wanting to die. He could communicate through various devices operated by his hands, then his eyes. Yet as his disease progressed—his mind still active but his body shutting down, as happens in ALS—Mr. Burton would, at his request, turn off his ventilator and, appropriately medicated for comfort, he would slip away. Al- Appendix 1 / 279 most three years after our interview, he decided it was time. Nancy climbed into bed with her husband for the last time, the house hushed except for the soft sounds of Mozart. Tom Norton Early seventies; white; married to Nelda, with many grown children and grand- children; some college; retired business executive; high income; motor neuron disease (neurologic condition causing weakness in foot and leg); uses cane. Eleanor Peters* Mid forties; black; several grandchildren; master’s degree; works for state voca- tional rehabilitation agency; polio as child; uses power wheelchair. Boris Petrov Mid forties; white, divorced, has girlfriend; surgeon in former Soviet Union but can no longer operate; volunteers helping other Russian immigrants; low income; thromboangiitis obliterans causing multiple amputations; uses power wheelchair. Petrov’s primary care physi- cian says he is doing “great,” exercising daily at a community center. Stella Richards Mid sixties; black; widowed, with one grown daughter; some college; retired ac- countant; middle income; spondylolisthesis (back problem); uses walker. Candy Stoops Late thirties; married with one young son; some college; retired administrative assistant; upper-middle income; myasthenia gravis; does not use mobility aids but has “slow days. Several years later, she’s attending school half-time and working as an administrative assistant half-time. Cynthia Walker* Mid thirties; white; married, with several young children; completed college; runs day care in home; arthritis (rheumatoid); periodically uses crutches. The list is not exhaus- tive, and the contact information is current as of July 2002. I grouped resources into four broad categories: health care professionals and providers; federal agencies and national organizations; links to information on the Internet; and state assistive technology projects. Other useful information emerges continu- ally, especially through disease-specific organizations and the Internet. Ap- pearance on this list does not imply an endorsement of specific organizations. Each person seeking information will have his or her own specific needs, and some sources will be more useful to individuals than other sources. Box 31220 Bethesda, MD 20824–1220 Phone: (301) 652–2682 TDD: (800) 377–8555 Fax: (301) 652–7711 http://www. Department of Justice ADA Information 950 Pennsylvania Avenue, NW Civil Rights Division Disability Rights Section—NYAVE Washington, D. Equal Employment Opportunity Commission 1801 L Street, NW Washington, D.

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If the hydrocephalus is severe order 400 mg renagel fast delivery, Cushing’s triad of bradycardia cheap renagel 800 mg online, systemic hypertension trusted 400mg renagel, and irregular breathing patterns buy discount renagel 800 mg online, as well as autonomic dysfunction, may occur. Cushing’s triad is rare and often denotes very high ICP requiring emer- gency treatment (Table 2). DIAGNOSIS Historically, several imaging studies were commonly used before the advent of CT scans in 1976. Skull radiographs demonstrate several diagnostic signs, including cra- nial suture separation in infants, as well as a ‘‘beaten copper’’ appearance and enlarged sella in older children. Skull radiographs have since been supplanted by more modern imaging studies such as cranial ultrasonography, CT scanning, and 30 Avellino MR imaging that demonstrate increased ventricular size, the site of pathological obstruction, and may show transependymal resorption. TREATMENT The treatment of hydrocephalus can be divided into nonsurgical approaches and surgical approaches, which in turn can be divided into nonshunting or shunting procedures. The goals of any successful management of hydrocephalus are: (1) optimal neurological outcome and (2) preservation of cosmesis. The radiographic finding of normal-sized ventricles should not be considered the goal of any therapeutic modality. Nonsurgical Options There is no nonsurgical medical treatment that definitively treats hydrocephalus effectively. Even if CSF production were to be reduced by 33%, ICP would only modestly decrease by 1. Historically, acetazolamide and furose- mide have been used to treat hydrocephalus. Although both agents can decrease CSF production for a few days, they do not significantly reduce ventriculomegaly. Acetazolamide, a carbonic anhydrase inhibitor, is needed in large doses (25 mg=kg=day divided into three daily oral doses), and potential side effects include lethargy, poor feeding, tachypnea, diarrhea, nephrocalcinosis, and electrolyte imbal- ances (e. While acetazolamide has been used historically to treat premature infants with PHH, recent studies have shown it to be ineffective in avoidance of ven- tricular shunt placement and to be associated with increased neurological morbidity. Surgical—Nonshunting Options Whenever possible, the obstructing lesion that causes the hydrocephalus should be surgically removed. For example, the resection of tumors in the vicinity of the third and fourth ventricle often treats the secondary hydrocephalus. Unfortunately, in most cases of congenital hydrocephalus, the obstructive lesion is not amenable to surgical resection. By surgically creating an opening at the floor of the third ventricle, CSF can be diverted without placing a ventricular shunt. Recent studies report a high success rate for endoscopic third ventriculos- tomies among pediatric patients with hydrocephalus secondary to aqueductal steno- sis. While earlier studies demonstrated that third ventriculostomies are of intermediate value in patients with congenital aqueductal stenosis (i. Communicating hydrocephalus is not an indication for a third ventriculostomy. Surgical—CSF Shunts Table 3 lists common indications for ventricular shunt placement. Hydrocephalus 31 Table 3 Indications for Ventricular Shunt Placement Congenital hydrocephalus Persistent posthemorrhagic hydrocephalus Hydrocephalus associated with myelomeningocele Hydrocephalus associated with Dandy–Walker cyst Hydrocephalus associated with arachnoid cyst Hydrocephalus associated with posterior fossa tumor Treatment of trapped fourth ventricle secondary to intraventricular hemorrhage or meningitis Components The CSF shunts are usually silicone rubber tubes that divert CSF from the ventricles to other body cavities where normal physiologic processes can absorb the CSF. Shunts typically have three components: a proximal (ventricular) catheter, a one- way valve that permits flow out of the ventricular system, and a distal catheter that diverts the fluid to its eventual destination (i. Most shunts have built-in reservoirs that can be percutaneously aspirated for CSF. However, some shunts are flow -controlled, where the valve mechanism attempts to keep flow constant in the face of changing pressure differentials and patient position. Valves come in a variety of dif- ferent pressure and flow settings depending on the manufacturer.

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