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Because a reference should start with the individual or organization with responsibility for the intellectual content of a publication: • Begin a reference to a part of a book with information about the book; follow it with the information about the part • Begin a reference to a contribution with information about the contribution best 10 mg rizatriptan, followed by the word "In:" and information about the book itself buy rizatriptan 10 mg free shipping. If traditional page numbers are not present, calculate the extent of the part or contribution using the best means possible, i. Since screen size and print fonts vary, precede the estimated number of screens and pages with the word about and place extent information in square brackets, such as [about 3 screens]. For parts and contributions that contain hyperlinks, however, such as the last sample citation in example 44, it will not be possible to provide the length. An R afer the component name means that it is required in the citation; an O afer the name means it is optional. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Names in non-roman alphabets (Cyrillic, Greek, Arabic, Hebrew, Korean) or character-based languages (Chinese, Japanese). Romanization, a form of transliteration, means using the roman (Latin) alphabet to represent the letters or characters of another alphabet. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. An organization such as a university, society, association, corporation, or governmental body may serve as an author. International Union of Pure and Applied Chemistry, Organic and Biomolecular Chemistry Division. American College of Surgeons, Committee on Trauma, Ad Hoc Subcommittee on Outcomes, Working Group. American Academy of Pediatrics, Committee on Pediatric Emergency Medicine; American College of Emergency Physicians, Pediatric Committee. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Follow the same rules as used for author names, but end the list of names with a comma and the specifc role, that is, editor or translator. Separate the surname from the given name or initials by a comma; follow initials with a period; separate successive names by a semicolon and a space. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Marubini E (Istituto di Statistica Medica e Biometria, Universita degli Studi di Milano, Milan, Italy), Rebora P, Reina G. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Moskva becomes Moscow Wien becomes Vienna Italia becomes Italy Espana becomes Spain Examples for Author Affiliation 12. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Place it within the square brackets for the translation and end title information with a period. Book titles containing a Greek letter, chemical formula, or another special character. Occasionally a publication does not appear to have any title; the book or other document simply begins with the text. In this circumstance: • Construct a title from the frst few words of the text • Use enough words to make the constructed title meaningful • Place the constructed title in square brackets Examples for Book Title 13. Specific Rules for Edition • Abbreviation rules for editions • Non-English words for editions • First editions • Both an edition and a version Box 25. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Examples: ĉ or ç becomes c ⚬ Do not convert numbers or words for numbers to arabic ordinals as is the practice for English language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Word for Word for Word for Language Word for Editor Producer Translator Illustrator editeur German redakteur produzent ubersetzer illustrator herausgeber produzentin dolmetscher Italian redattore produttore traduttore disegnatore curatore editore Russian redaktor rezhisser perevodchik konstruktor izdatel Spanish redactor productor traductor ilustrador editor productora Box 31. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. If you abbreviate a word in one reference in a list of references, abbreviate the same word in all references. Place all translated publisher names in square brackets unless the translation is given in the publication.

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The use of flightless silky chickens is recommended to prevent the chickens from roosting on the aviary enclosures buy 10mg rizatriptan otc. Evaluating and Treating Flock Problems Ants can transmit some parasites such as the prov- entricular worm Dispharynx buy discount rizatriptan 10mg. Ants may reduce food consumption by swarming food bowls or may build nests in the nest boxes. Control procedures should Emergency Care include baiting of nests and trails, keeping facilities clean and avoiding foods with high sugar and fat An experienced aviculturist is usually the first indi- content, which attract ants. The incidence of mites vidual involved in providing emergency care to a sick and lice is low in captive psittacine birds but they or injured bird. The client should be well schooled in may be introduced into an aviary by free-ranging providing first aid and recognizing signs of illness birds. This ian should assist the aviculturist in preparing a first mite is nocturnal and hides in crevices in the aviary aid kit, in being prepared to provide post-examina- and nest boxes during the day. These mites are blood tion nursing care and in having the necessary sup- feeders and can kill chicks by exsanguination. For plies to safely and effectively transport a sick bird the control of mites inhabiting nest boxes, five per- (Table 2. The experienced avicultur- cent carbaryl powder has been used successfully ist should know how to administer stabilizing ther- without apparent harm to chicks or adults. Helping the aviculturist handle emer- Rodents: Rats may enter an aviary at night and gency problems will encourage the involvement of a spread infectious agents, disturb nesting birds or veterinarian in the management of the collection actually kill some smaller species. The aviculturist should visually evaluate each bird every day during routine feeding procedures. Fresh excrement should be evaluated for color, consistency and amount of feces, with collection of representative tissues from all or- urine and urates (see Chapter 8). Managing Disease Outbreaks Many state diagnostic laboratories have free or rela- tively inexpensive fees for histopathology services. Rapid action early in a disease outbreak can prevent However, the period of time that elapses before these catastrophic losses. Isolation and appropriate ther- results can be obtained may allow an infectious agent apy is warranted with an individual sick bird. When histopathology avicultural setting, maintaining flock health must be results are needed quickly, it is best to advise the the priority, and containing an infectious agent, de- aviculturist to spend the extra money and send sam- termining its source and implementing control proce- ples to a private laboratory. The more complete the medical disease outbreak, all materials that cannot be prop- examination (blood work, cultures, radiographs, en- erly cleaned (eg, perches, wooden nest boxes) should doscopy), the more likely the veterinarian is to be be removed and destroyed. The remainder of the able to identify the problem and to make specific facility should be steam-cleaned several times. In recommendations to prevent further illness in the any given medical situation, repairing management flock. Sick birds should be immediately removed flaws and using biological control measures are supe- from the collection and a thorough diagnostic evalu- rior to drug therapy. If the bird dies, a complete necropsy An easily and completely cleanable isolation area for new and sick birds should be available, and protocols should be established for managing this area. Evaluating Reproductive Failures Resident Bird Examination Annual examinations of all birds in a collection can be used to detect flock problems, establish and con- firm the accuracy of identification systems and col- lect data that may lead to the removal of unproduc- tive individuals. The veterinarian work- birds represented as proven breeders, carries with it ing in unison with the aviculturist may be able to a degree of risk. Birds are often culled because they determine correctable physical, hormonal, nutri- failed to breed, and the novice aviculturist frequently tional, behavioral and psychological causes of repro- adds someone else’s problems to his collection. A review of the potential health problems identified during the previous breeding season and appropriate Dealing with birds that are to be removed from a testing of nonproductive birds can provide informa- collection can challenge the ethics of the veterinar- tion that is critical to identifying the source of a ian. Estimating the age of a ductive success or due to poorly understood medical bird may be helpful in understanding reproductive problems (such as cloacal papillomatosis) is unac- failure. It is never advisable for the same vet- Obtain detailed histories erinarian to represent both the buyer and the seller Review health and production records in a bird transaction. Perform complete physical examination including cloacal mucosa Perform diagnostic tests as dictated by the findings Incubation and Pediatrics Use laparoscopy to verify gender and visually evaluate the repro- Veterinarians should be involved in evaluation of ductive system and other organ systems incubation failures and management of the psit- Evaluate husbandry practices tacine nursery. Successful incubation entails exten- – Is diet appropriate, balanced and accepted? Ideally, Evaluate behavior all fertile eggs that fail to hatch should be examined – Is one bird in a pair or in a colony exhibiting excessive in an attempt to detect patterns of mortality, which aggression? Culling Culling is a vital technique to improve the quality of captive breeding stock. Decisions to remove a bird from a breeding program can be emotionally difficult, especially when dealing with tame birds that are considered pets and with species that are endan- gered. In reality, maintaining breeding birds that are not vigorous, that fail to adapt to captivity or that are of poor genetic lineage is a detriment to the future of aviculture and to the species. A fertile six-day-old Red-bellied Parrot egg is being candled in the nest (courtesy of Isabel Taylor). Silvio Mattacchione and Co, 141 ida, Avicultural Breeding and Re- Pickering, Ontario, Canada, Silvio 2.

Experience generic rizatriptan 10 mg on line, either by education or work experience discount rizatriptan 10mg with visa, in the field of pathology is noted. The program directors read the applicant’s personal statement and evaluate it based on the following: • Command of the English language • Stated genuine interest in Pathology • Overall quality of the statement • Dean’s Letter • Medical Transcripts • Letters of reference • Any potential items for concern Additional Screening If the program director is unable after the secondary screening to make a decision on whether or not to invite a candidate, the application will be sent to one of the other program director or another member of the Resident Education Committee for their review. After receiving feedback from the committee reviewer, the program director will decide whether or not to extend an invitation to the candidate. Each candidate that is selected for interview will be invited via email by the residency program coordinator. Once the applicant is schedule, they will be sent an email with an interview confirmation and instructions for the interview day. Interview Process Six to 8 interview dates are selected and up to 8 candidates may be interviewed per interview day. At the beginning of each interview day an overview of the institution and program is presented. Five faculty members, including the two program directors and one chief resident interview the applicants. Each interviewer is given all application materials for each applicant to be interviewed in their scheduled day. Each interviewer is asked to complete a resident candidate evaluation form and also an individual ranking Pathology Resident Manual Page 20 form for each candidate they interview. Interviewers are asked to assign them a quartile based on every applicant they have ever interviewed. In February an annual ranking meeting is held with all faculty and resident interviewers and any other faculty who wish to attend. After initial grouping into ‘Upper, Middle, or Lower Thirds’, the final rank list determined by the committee. A list of faculty members who will evaluate residents on each rotation has been developed and a tracking mechanism is used to insure that all evaluations have been obtained. Resident evaluations are reviewed by the Program Director and are summarized for the Resident Education Committee Meeting and at least annually at a meeting attended by all clinical faculty members. If a problem with performance is identified for any resident, the Program Director or designee immediately meets with the resident to discuss the issues and develop a plan of action. If there are no problems with the performance, the residents review and sign their evaluations at the time of evaluation release or at the six- month review meeting with the Program Director. Clinical faculty members meet at the end of the academic year to decide on promotion for each resident. All evaluations, performance on exams, attendance at conferences and overall performance are discussed with each resident at the 6-month evaluation meetings with the Program Director. At that time, residents are asked to write a self-assessment and goals for the following 6 months. Each resident is asked at every 6 month evaluation to provide suggestions for program improvement. The Program Director completes a summative evaluation for each resident finishing the program. The final evaluation summarizes all aspects of the resident’s education and training, verifies that the resident is competent in the six general competencies and confirms that the resident has the ability to practice without direct supervision. Pathology Resident Manual Page 21 Faculty Evaluations Near the end of each month each resident receives electronically a rotation and a faculty evaluation form. If problems are identified, they are discussed immediately with the appropriate faculty member. Faculty members are given an overall assessment including the following: • clinical teaching • commitment to educational program • clinical knowledge • professionalism • scholarly activity The annual assessment is signed by the Department Chair and a copy is sent to the faculty member. Program Evaluations A formal resident training quality improvement program addresses individual resident performance improvement, faculty development and overall training program improvement as described below. Overall Goals of Resident Training Quality Improvement Program The Pathology Resident Training Quality Improvement Program provides a process for individual resident performance improvement as well as overall program improvement. Measurement tools are used to identify individual residents in need of remediation early in the program. A general remediation program has been developed and is tailored for the individual needs of each resident. In addition, several measurement tools are used to monitor and identify areas of potential improvement within the overall training program. The Resident Education Committee, consisting of six faculty members, the two Chief Residents, and the Program Director, is responsible for ensuring the quality of resident education in Anatomic and Clinical Pathology. Failure to attend at the required level is considered a problem with competency in professionalism. Specific areas of weakness identified by any of the above performance tools may result in repeating a rotation. More global unsatisfactory performance areas may result in placement on remediation. Examples of quality monitors and outcome measurement tools used to evaluate the quality of the training program include the following: • American Board of Pathology Specialty Exam – Outcome data over a 5 year period for different areas of pathology broken down into different areas of pathology are provided to the program annually.

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Robbins S generic rizatriptan 10mg with amex, Cotran R generic 10mg rizatriptan with visa, Kumar V, Inflammation - The with special reference to renal involvement. Two months posttransplant, graft dysfunction developed and was found to be caused by obstruction of the transplant ure- more definitive intervention, the ureteral stent was ter at the level of the bladder anastomosis. A ureteral removed during the cystoscopy, and the patient was stent was placed, graft function stabilized (serum cre- monitored closely for recurrence of graft dysfunction, atinine 0. With this support, the patient stabilized and general categorization according to transplant status eventually recovered, including his graft function, and introduced above. Under may affect the patient’s transplant candidacy signifi- all of these circumstances, renal dysfunction can occur, cantly, either by presenting a potential contraindication typically requiring complex management tailored to the to the desired nonrenal transplantation or by establishing specific needs of the individual patient. Some patients with renal dysfunction prior to non- highly multidisciplinary fashion, usually codirected by renal organ transplantation may be expected to recover a combination of intensivists, pediatric subspecialists, kidney function after nonrenal transplantation, likely and transplant surgeons and their teams. Such decisions young recipients of a preemptive transplant from a and plans are examples for the aforementioned complex living adult donor, this complication also appears to multidisciplinary, individualized, and communicative be driven by dramatic decreases in serum osmolality management approach for these patients and require associated with rapid clearance of uremic toxins from thorough consideration of medical prognosis, quality of the circulation when renal graft function is excellent life implications, and other, e. Even in older and bigger recipients, the frequency and volume of urine output measurements and replace- 18. Recovery of tubular abilities to concentrate the urine and reabsorb sodium usually takes several days, over which urine output replacement is gradu- 18. Of critical importance is the realization that the hourly urine output may actu- Table 18. Generally, circumstances, particularly when an adult allograft immunosuppressive therapy is in constant evolution is placed into an infant. This creates a tremendous to achieve the best possible antirejection prophylaxis Table 18. In this context, it has become Hypertension frequently occurs or worsens in the quite clear that immunosuppressive protocols cannot immediate posttransplant setting for several reasons, be administered in a one size fits all fashion: First-time including liberal fluid management (see above) and Caucasian recipients of a living donor kidney who have treatment with high doses of corticosteroids. While no evidence of presensitization appear to require less mild blood pressure elevations above the recipi- powerful antirejection prophylaxis than recipients of a ent’s pretransplant range may be temporarily desir- repeat transplant, especially one from a deceased donor, able to enhance perfusion of the new allograft, more recipients with evidence of presensitization, or recipi- pronounced hypertension, especially if it is causing ents who are African-American [20]. In this set- recent discovery of genetic polymorphisms and related ting, calcium channel antagonists are particularly safe phenomena affecting drug metabolism and exposure and effective, although attention needs to be paid to [7, 15] and immunological responsiveness [2] further the interference of some of these agents, particularly undermines the concept of a unified immunosuppres- verapamil, diltiazem, amlodipine, and nicardipine sive approach. Once transplant function programs to adapt flexible protocols that can be tailored has stabilized, the same group of agents may also be to each recipient’s perceived risk profile. Prophylaxis against bacterial, viral, and fungal patho- com/study/ped/annlrept/annlrept. Nonetheless, additional guidance in the selec- provided perioperatively to prevent wound infections tion of pediatric immunosuppressive regimens is also and then transitioned to a prophylactic regimen against derived from adult studies and from local practice and urinary tract infections and pneumocystis carinii. Specific guidelines have been developed for antiviral A typical protocol to be used initially in pediat- prophylaxis in the posttransplant setting [5]. Accordingly, a number carries a substantial long-term risk of nephrotoxicity of centers also recycle the full spectrum of infection [23, 28]. Similar principles apply to nonrenal transplant prophylaxis during and after episodes of acute rejection recipients [27, 31, 41, 51]. Many centers there- Transplantation fore perform a Doppler ultrasonographic evaluation or a nuclear scan of the transplant immediately after skin Gastrointestinal Prophylaxis closure or upon arrival in the postoperative care unit, Gastrointestinal prophylaxis against steroid-associated at least if there is no sufficient urine output attributable gastritis and ulcer disease is typically given in the form to the transplant. At our center, still have their native, oftentimes urine-producing, kid- recipients are tried off these agents once they are neys at the time of transplantation, making the precise taking all their medicines by mouth and if they are free determination of the source of urine output – i. Prophylaxis Against Thrombosis If blood flow to the transplant is adequate, acute Graft thrombosis is a significant cause of pediat- tubular necrosis should be suspected as alternative ric transplant loss [49, 56]. Risk factors include cause of initial nonfunction, especially in transplants hypercoagulopathy (e. In recipients who are not at states), antiphospholipid antibodies (seen in 30–50% particularly increased immunological risk, hyperacute of patients with systemic lupus erythematosus), prior rejection is very unlikely. Accordingly, hyper- coagulability should be corrected before the actual Delayed-Onset Graft Dysfunction transplant procedure whenever possible. Alternatively, In grafts with initially acceptable urine production consideration needs to be given to the prescription but a subsequent decrease in output, additional pos- of anticoagulation during and after the transplant, sibilities need to be considered. Both Initial Nonfunction of these complications can obviously also occur after Graft dysfunction immediately posttransplant is sug- transplantation of nonrenal organs. Accordingly, initial nonfunction requires imme- responses: Especially in presensitized recipients, acute Table 18. Goebel rejection can not only be cellular but also antibody- by a blood clot, and urinary leakage, e. Ultrasounds and nuclear of plasmapheresis and potentially other specific scans are useful tools to identify these problems. Moreover, cellular and humoral rejection can coex- Generally, the immediate posttransplant recovery of ist, and the recognition of humoral rejection requires these patients is highly organ-specific and accordingly special studies both on the biopsy material, i. As discussed at the beginning of dysfunction can occur early after renal transplantation this chapter and summarized in Table 18. Characteristic signs and accompanying children when they receive a nonrenal symptoms of this problem are summarized in Table organ transplant. Such readmissions who can develop recurrent massive proteinuria within pose a number of unique challenges, which are dis- hours or days of transplantation [17, 57]. Some indications may factor [17], rapid recognition of nephrotic-range pro- be entirely unrelated to the patients’ posttransplant teinuria (and exclusion of other possible causes of this status, e.

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