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For example buy discount precose 25 mg on line, has your answer changed from ‘why does x cause z’ to ‘what causes z’? Your tutor will be looking for an expression of your point of view; however safe 25 mg precose, you must support this with evidence from the literature. You will then be able to discuss a range of theories and refer to information from a num­ ber of sources. Remember to acknowledge these both in the text and by supplying a reference list at the end of the essay. The main part forms approximately 75 to 80 per cent of your essay – so in a 2000 word composition you would plan to use 1500 words for the main part of the essay. Pitfalls to avoid: ° Showing a bias by the type of information you select or the viewpoint you put across. It will contain either a summary of the key points, a statement of the outcome of your discussion or a resolution to your argument. Making a reference back to your intro­ duction or the original question brings the essay full circle and achieves a satisfactory closure. Some questions that might help you in writing your conclusion are: ° What are the main points of your essay? ESSAYS 179 ° a change in attitude ° a change in knowledge ° a change in how to apply theory to practice ° a change in awareness ° a change in understanding. Like the introduction, the conclusion forms about 12 per cent of your es­ say – so in a 2000 word composition you would plan to have a conclusion of about 250 words. Writing drafts Views are mixed about whether writing several drafts is a good idea or not. Some advise writing coursework essays under exam conditions as practice for timed examinations. This may help in preparing you for your exams, however it is unlikely to help you in producing your best piece of work. I would recommend that, like any other written task, you take the opportu­ nity to draft your essay and revise it as necessary before you submit it. Use the checklist in the ‘Action Points’ at the end of this chapter to help edit your draft. Assessment criteria There is no set marking scheme that is used as a standard by all tutors for assessing essays. The way in which this type of written work is assessed 180 WRITING SKILLS IN PRACTICE varies between markers and between institutions. Some tutors work out a system where a set amount of marks is awarded to each main point covered in the essay. The accumulated figure is then converted into a percentage, which in turn may be used to place the stu­ dent within a band or grade. This tends to work well with descriptive questions, but is less useful for essays where a greater depth of understand­ ing needs to be demonstrated by the student. Analytical questions benefit from an approach where assessment is based on a variety of criteria that reflect several subsets of skills. The marker will be looking for evidence of the student’s performance in each of these skill areas. Knowledge of the subject ° Evidence – ° Able to recall facts and figures accurately. Understanding of the subject ° Ability to analyse information Evidence – ° Able to identify key components of an idea or concept.

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Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty buy cheap precose 50mg on-line. Amstutz HC cheap precose 50mg online, Campbell PA, Le Duff MJ (2004) Incidence and prevention of neck frac- tures after surface arthroplasty. Amstutz HC, Su EP, Le Duff MJ (2005) Surface arthroplasty in young patients with hip arthritis secondary to childhood disorders. Brinker M, Rosenberg A, Kull L, et al (1994) Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. Ortiguera CJ, Pulliam IT, Cabanela ME (1999) Total hip arthroplasty for osteonecrosis. Radl R, Hungerford M, Materna W, et al (2005) Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis. Lehtimaki MY, Lehto MU, Kautiainen H, et al (2001) Charnley total hip arthroplasty in ankylosing spondylitis: survivorship analysis of 76 patients followed for 8–28 years. Lehtimaki MY, Kautiainen H, Lehto UK, et al (1999) Charnley low-friction arthro- plasty in rheumatoid patients: a survival study up to 20 years. Kobayashi S, Saito N, Horiuchi H, et al (2000) Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Kishida Y, Sugano N, Nishii T, et al (2004) Preservation of the bone mineral density of the femur after surface replacement of the hip. Amstutz HC, Ebramzadeh E, Sarkany A, et al (2004) Preservation of bone mineral density of the proximal femur following hemisurface arthroplasty. Harty JA, Devitt B, Harty LC, et al (2005) Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement. Kronick JL, Barba ML, Paprosky WG (1997) Extensively coated femoral components in young patients. McLaughlin JR, Lee KR (2000) Total hip arthroplasty in young patients: 8- to 13-year results using an uncemented stem. Marchetti ME, Steinberg GG, Greene JM, et al (1996) A prospective study of proximal femur bone mass following cemented and uncemented hip arthroplasty. McCarthy CK, Steinberg GG, Agrsen M, et al (1991) Quantifying bone loss from proxi- mal femur after total hip arthroplasty. Kilgus DJ, Shimaoka EE, Tipton JS, et al (1993) Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. J Bone Joint Surg 75B(2):279–287 Current Trends in Total Hip Arthroplasty in Europe and Experiences with the Bicontact Hip System Hartmuth Kiefer Summary. Many aspects of hip implant design and materials have been developed in different European countries, where more than 600000 hip replacement procedures were performed in 2005. The leading cemented implant designs come from Europe and are today used worldwide as a gold standard in total hip arthroplasty. For cement- less hip stem designs, the straight and tapered stem design developments contributed to the increasing success of cementless hip arthroplasty for younger patients. New implant concepts, such as hip resurfacing and shorter cementless hip stems, are today mostly used in Europe and may also influence the future of hip arthroplasty. However, long-term experience with standard cemented and tapered cementless stem implants in combination with advanced press-fit cups and wear couples set high standards of clinical success.

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Four things popped out as I marked up her notebook with a yellow highlighter discount precose 25mg line. Her rings were tight and she couldn’t button her clothes—the swelling again generic precose 50 mg online. Also, her pain and swelling improved after she lay down and when she swam. Finally, she indicated that two of her existing physical problems were hypothyroidism and food allergies. I was beginning to see a picture now—one that was really quite obvi- ous. But in searching for a complicated answer everyone, including myself, had missed it. I asked Ruth if she had ever mentioned these things to her other doctors. She responded that she’d reported her thyroid issues, but no one had ever asked her about the other four things and she hadn’t thought about them before she worked on the Eight Steps. The picture that was forming as the puzzle pieces of Ruth’s story were put together finally compelled me to ask about her weight. I had not wanted to pursue what I already knew from Ruth’s psychiatrist was a painful sub- ject, but it was impossible to avoid it now if she really wanted an answer to her mystery malady. I asked her specifically if her weight at night was dif- ferent from her weight in the morning. Ruth seemed angry at me for hav- ing raised this issue that haunted her every waking hour. She was reticent until I told her I was uninterested in the actual number of pounds she weighed; I simply wanted to know if she weighed more at night than in the morning and how much. She reluctantly agreed to observe this before her next visit, which we scheduled for a week later. I called her psychiatrist and enlisted his help because I wasn’t sure she would come back after this discussion, and I had a strong inkling I might Is Your Weight Problem Really Diet-Related? At her next appointment, Ruth indicated there was somewhere between a four- and six-pound difference between her night- time and morning weight! I asked her to raise her lower leg for me and said I was going to tell her what was wrong and how she could definitely lose some weight. When she extended her leg, I pressed on her lower leg and showed her the indentation mark it left for several seconds after I released it. This physical finding, together with all her other symptoms, indicated a medical condition known as edema, or the abnormal buildup and reten- tion of fluid. It is often associated with pregnancy (when it’s known as preeclampsia). It is commonly seen in the feet and ankles, usually because of the effect of gravity. As the fluid accumulates, it often pinches off the nerves temporarily to the hands and feet, causing neurological symptoms such as numbness. Fluid also builds up in the front of the shins where it makes the skin tight and causes pain. It also accumulates in the hands— which is why Ruth’s rings were sometimes tight and she couldn’t perform fine motor functions.

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Observing other people similar to us performing successfully can strengthen our beliefs that we can perform similar tasks best precose 25mg, especially when the tasks are unfamiliar proven precose 25mg. Finally, we (both teachers and learners) need to re-interpret Teachers and learners need to view any anxiety or nervousness in difficult our anxiety or nervousness in difficult situations as excitement situations as excitement or anticipation or anticipation, rather than as an ominous sign of vulnerability. Self efficacy—roles for the teacher Constructivism x Modelling or demonstration Constructivism has important implications for teaching and x Setting a clear goal or image of the desired outcome x Providing basic knowledge and skills needed as the foundation for learning. Firstly, the teacher is viewed not as a transmitter of the task knowledge but as a guide who facilitates learning. Secondly, as x Providing guided practice with corrective feedback learning is based on prior knowledge, teachers should provide x Giving students the opportunity to reflect on their learning learning experiences that expose inconsistencies between students’ current understandings and their new experiences. Thirdly, teachers should engage students in their learning in an active way, using relevant problems and group interaction. The primary idea of constructivism is that learners “construct” their own knowledge on the basis of what they Fourthly, if new knowledge is to be actively acquired, sufficient already know. This theory posits that learning is active, time must be provided for in-depth examination of new rather than passive, with learners making judgments experiences. He argues that formal theory acquired through professional preparation is often not useful to the solution of the real life “messy, indeterminate” problems of practice. Schön labels professionals’ automatic ways of practising as professional “zones of mastery”—that is, areas of competence. It is the ability to learn and develop continually by creatively applying current and past experiences and reasoning to unfamiliar events while they are occurring. It is a process of thinking back on what “Reflection in action” happened in a past situation, what may have contributed to the unexpected event, whether the actions taken were appropriate, and how this situation may affect future practice. Activities 1 The learner should be an active contributor to the educational process such as debriefing with peers or learners, seeking feedback from 2 Learning should closely relate to understanding and solving real learners on a regular basis, and keeping a journal can provide life problems vehicles for reflective practice. Some theories will be more helpful than teachers and peers others in particular contexts. However, several principles also 6 Learners should be given opportunities to reflect on their practice; emerge from these theories, and these can provide helpful this involves analysing and assessing their own performance and developing new perspectives and options guidance for medical educators. As people often teach the way they were taught, medical Three cases studies educators should model these educational principles with their The boxes (right) describe three “real world” case studies students and junior doctors. This will help the next generation of representing situations encountered in medical education teachers and learners to become more effective and should lead to better care for patients settings. The educational theories described above, and the principles which emerge from them, can guide us in solving the problems posed in these three cases. Case 1 solution Case 1: Teaching basic science You could present an interactive lecture on the autonomic You have been asked to give a lecture on the nervous system. This autonomic nervous system to a first year medical would contain key points, space for written notes, and two key class of 120 students. This has traditionally been multiple choice or “short answer” questions requiring higher a difficult subject for the class, particularly as it level thinking (principle 1, see box above). You could stop twice has not been explicitly covered by faculty in the during the lecture and ask the students to discuss their response problem based anatomy course. You wonder how to each question with their neighbours (principles 1, 3, and 5). A you can make this topic understandable to the show of hands would determine the class responses to the class in a 50-minute lecture.

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