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Studies of Educational Interventions and outcomes in Diabetic Adults: A MetaAnalysis Revisited blood pressure elderly buy 1mg terazosin overnight delivery. Intervention Strategies to kamaliya arrhythmia order terazosin 1mg with amex Improve Adherence among Hypertensives: Review and Recommendations blood pressure chart software free order terazosin 5mg. Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality. Collaborative Management to Achieve Treatment Guidelines: Impact on Depression in Primary Care. Compliance With National Asthma Management Guidelines and Specialty Care: A Health Maintenance Organization Experience. Requiring Physicians to Respond to Computerized Reminders Improves Their Compliance with Preventive Care Protocols. An Overview of Interventions to Improve Compliance with Appointment Keeping for Medical Services. Improvement of Hypertension Care by a Structured Treatment and Teaching Programme. The Determinants of Hypertension Awareness, Treatment, and Control in an Insured Population. The Effect of Patient-Carried Reminder Cards on the Performance of Health Maintenance Measures. Crossing the Quality Chasm: A New Health System for the 21st Century 2 Improving the 21st-Century Health Care System As discussed in Chapter 1, the American health care system is in need of major restructuring. As a statement of purpose for the health care system as a whole, the committee endorses and adopts the phrasing of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). It is helpful to translate this general statement into a more specific agenda for improvement-a list of performance characteristics that, if addressed and improved, would lead to better achievement of that overarching purpose. Recommendation 2: All health care organizations, professional groups, and private and public purchasers should pursue six major aims; specifically, health care should be safe, effective, patient-centered, timely, efficient, and equitable. The committee believes substantial improvements in safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity are achievable throughout the health care sector. This opportunity for improvement is not confined to any sector, form of payment, type of organization, or clinical discipline. Problems in health care quality affect all Americans today, and all can benefit from a rededication to improving quality, regardless of where they receive their care. The committee applauds the Administration and Congress for their current efforts to establish a mechanism for tracking the quality of care. Section 913(a)(2) of the act states: "Beginning in fiscal year 2003, the Secretary, acting through the Director, shall submit to Congress an annual report on national trends in the quality of health care provided to the American people. Fortunately, many of these encounters are effective and result in good outcomes, but such is not always the case. The following scenario, based on the composite experience of a number of patients, illustrates some of the serious problems facing patients and clinicians, problems that persist despite the widespread dedication of clinicians to providing high-quality care. Martinez, a divorced working mother in her early 50s with two children in junior high school, was new in town and had to choose an insurance plan. She had difficulty knowing which plan to select for her family, but she chose CityCare because its cost was comparable to that of other options, and it had pediatric as well as adult practices nearby. After receiving some recommendations from a neighbor and several coworkers, she called several of the offices to sign up. Although she knew nothing about the practice she finally found, she assumed it would be adequate. When she called for an appointment, she was told that the first available nonurgent appointment was in 2 months; she hoped she would not run out of her blood pressure medication in the interim. When she went for her first appointment, she was asked to complete a patient history form in the waiting room. She had difficulty remembering dates and significant past events and doses of her medications. Martinez called a site listed in her provider directory and was given an appointment for a mammogram in 6 weeks.

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A bottleneck makes portions of difficult to blood pressure medication bystolic side effects terazosin 1 mg lowest price reach from some starting locations blood pressure medication osteoporosis purchase terazosin 1 mg without a prescription, limiting the speed of convergence heart attack remind for you 5 mg terazosin free shipping. As usual, P is the irreducible and aperiodic transition matrix for a Markov chain on with stationary distribution. In this case, 2 E Q(S, S c) is the size of the boundary S of S, the collection of edges having one vertex in S and one vertex in S c. If the walk is lazy, then Q(x, y) = (4 E)-1 1{{x, y}E}, and the bottleneck ratio equals (S) = 2 S /(xS deg(x)). Denote by S the restriction of to S, so that S (A) = (A S), and define µS to be conditioned on S: µS (A) = From Remark 4. Consider the graph consisting of two d-dimensional tori "glued" together at a single vertex v; see Figure 7. Denote by V1 and V2 the sets of vertices in the right and left tori, respectively. Let be the set of all proper q-colorings of a graph G, and let be the uniform distribution on. The feasible colors at vertex v are all colors not present among the neighbors of v. We show, by example, that quite different behavior may occur if the maximal degree is not bounded. Let v denote the root vertex and let S be the set of proper colorings such that v has color 1: S:= {x: x(v) = 1}. The number of such (x, y) pairs is therefore equal to (q-1)(q-2)n-1, since there are (q -1) possibilities for the color y(v) and (q -2) possibilities for the color (identical in both x and y) of each of the n-1 leaves. In fact, this argument shows that if n/(q log q), then tmix is super-polynomial in n. Let S consist of the right-hand side of the tree, that is, vr and all of its descendants. Since there is only one edge from S to S c, Q(S, S c) = (vr)P (vr, v0) = 3 2n - 2 1 1 =, 3 2n - 2 We write v for the length of the shortest path from v to v0. Distinguishing Statistics One way to produce a lower bound on the mixing time tmix is to find a statistic f (a real-valued function) on such that the distance between the distribution of f (Xt) and the distribution of f under the stationary distribution can be bounded from below. Let µ and be two probability distributions on, and let f be a real-valued function defined on. We write Eµ to indicate expectations of random variables (on sample space) with respect to the probability distribution µ: Eµ (f):= x f (x)µ(x). Let µ and be two probability distributions on, and let f be a real-valued function on. When µ is a probability distribution on and f:, write µf -1 for the probability distribution defined by (µf -1)(A):= µ(f -1 (A)) for A. When X is an -valued random variable with distribution µ, then f (X) has distribution µf -1 on. Let µ and be probability distributions on, and let f: be a function on, where is a finite set. Since it follows that µf -1 (B) - f -1 (B) = µ(f -1 (B)) - (f -1 (B)), max µf -1 (B) - f -1 (B) max µ(A) - (A). If is a probability distribution on a finite subset of R, the translation of by c is the probability distribution c on + c defined by c (x) = (x - c). Let m:= x x(x), m:= x x(x) be the mean of and, respectively, and assume that m > m. First we record a simple lemma concerning the coupon collector problem introduced in Section 2. Consider the coupon collecting problem with n distinct coupon types, and let Ij (t) be the indicator of the event that the j-th coupon has not been n collected by time t. The random variables Ij (t) are negatively correlated, and letting p = 1 t 1 - n, we have for t 0 E(Rt) = np, n Var(Rt) np(1 - p).

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Regardless of how dependent on notes the speaker may be heart attack zippy cheap terazosin 5mg free shipping, here is one constant word of advice: know exactly how you are going to arteria opinie 2012 best terazosin 2 mg begin your speech blood pressure kit walgreens purchase terazosin 2mg without a prescription. Not just an idea, but verbatim, with every inflection, every gesture, every eye contact with the audience. The first few sentences should be so ingrained, that you could perform it during an earthquake without batting an eye. The ending impression your speech leaves with the audience is greatly affected by how effective the ending is. A confident and decisive beginning will draw the audience to you; a confident logical ending will be very effective in preserving a lasting impression on the audience. Avoid writing or printing on two sides; flipping a page or card is distracting to the audience. Be sure you can glance at the notes, get your information, and look up to have eye contact with the audience. Rehearse your speech ­ aloud and ideally with a colleague or fellow student as an audience. There are some students who record a rehearsal speech so they can get a real sense of what the audience will hear. If you are using presentation aids, rehearse with them for timing and familiarity so you only have to glance at the screen or easel. Phrase the speech as you will phrase it in the Rehearse a few days before you are to deliver your speech Use the note sheets or cards you will be using for delivery Practice with the presentation aids you will be using Time your speech and cut or expand it if needed Rehearse with a colleague or an audience if possible If you can, rehearse in the room with the podium you will use Plan what you will do with your hands Plan and practice your opening and closing carefully, so you can deliver them exactly Stress is an important dragon to slay - or at least tame - in your life. Fear and stress result in psychological and physical manifestations that can affect a speech. Remember, as noted above, rushing gives the impression that the speaker thinks the message is not worth the time. Among the simplest and most effective is to do a moderate amount of exercise prior to the speech, even as basic as walking. Exercising helps to naturally chemically relieve the tension; and helps deepen the breathing that supports the voice. Physical exercises will likely help relaxing for better posture and hand and body gestures. As part of the relaxation process, actors "warm up" physically before performances and often do relaxation exercises to help concentration and relieve stress. You have a responsibility as a speaker to "deliver" information that will help your audience or enlighten them in some way. Like voice and diction, understanding what makes a speech effective without practice is insufficient. Merely knowing the best form for a golf swing is useless unless put into practice; and practice reinforces the knowledge. Comprehending the rules for driving on the road is moot (and/or dangerous) if the rules are not obeyed in practice. If you look up the word "deliver, " you will find it means more than to just "give. A speech reminds us that words, like children, have the power to make dance the dullest beanbag of a heart. For each topic, think of a setting in which a speech on that topic might be delivered. Next, determine what type(s) of delivery (manuscript, memorized, impromptu, extemporaneous) would be most appropriate for the topic and setting. What guidelines did you find most useful in the section about what to wear for your speech? What type of equipment is available in the space(s) where you plan to give your speeches? List three methods you would personally use to reduce your anxiety before your speeches. Practice the use of inflection to indicate the punctuation, the energy, and the characters. Pronunciation Bring in several books or publications of a variety of types and disciplines.

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Although changes to arteria y vena poplitea cheap 1 mg terazosin free shipping organizational culture and provider workflows are not inconsequential blood pressure medication and grapefruit generic terazosin 2mg with mastercard, the financial outlays required to blood pressure checker order 2 mg terazosin bring about these changes are likely to be relatively modest. Although subsequent sections of this chapter address these topics in greater detail, these activities collectively rest on the ability to identify family caregivers who are now largely invisible in systems of care. Establishing approaches to systematically identify and meaningfully support family caregivers will require resources and motivation to undertake changes in provider practice. Financing arrangements could reward providers for the explicit identification and support of family caregivers. Likewise, performance standards should hold providers accountable for supporting family caregivers when the plan of care rests on their involvement. Inclusion of Family Caregiver-Reported Experiences in Quality Measurement Recent initiatives to reward the provision of high-value care have elevated the prominence of performance measurement in care delivery and payment reform. Although the report concluded that many measures provide useful information, the large number and lack of focus, consistency, and organization were recognized as limiting effectiveness in measuring and improving health system performance. Against this backdrop, there is a growing appreciation that the utility of performance measures rests on measuring elements of care that matter, that are outcomes oriented, and that reflect system performance (Blumenthal and McGinnis, 2015). For those with complex care needs or multiple chronic conditions, technical quality may not align with the care or outcomes that matter most based on individual values, priorities, and goals of care (Boyd et al. For many older adults, high-quality care involves supporting their family caregiversby respecting their values and preferences without imposing financial burden, physical strain, or undue anxiety regarding lack of experience or knowledge to perform tasks expected of them. Although the number of health care performance measures has dramatically increased in recent years, so too has recognition of the gaps of existing measures in important domains of quality. Although the field is rapidly evolving, the perspectives of family caregivers have not been extensively included in performance measurement to date (Gage and Albaroudi, 2015). A theme throughout this work is that it is both individuals and families who engage in the planning, delivery, and evaluation of care across all levels of performance measurement. A conceptual framework has been agreed upon by a multistakeholder committee that includes Caregiver Support as 1 of 11 measurement domains. In its description of this domain, financial, emotional, and technical support are listed as examples of measures that apply to both paid and unpaid caregivers. Other characteristics that fall under the Caregiver Support domain include caregiver assessment, training and skill building, respite care, and supports for well-being. This effort will be important to achieving better outcomes for the care receiver and caregiver, as well as for improving system properties that influence quality and efficiency of care delivery. Moreover, consensus processes for measure identification, selection, and prioritization takes time-years in many instances. The inclusion of caregiver perspectives in performance measures would send a strong signal to providers that for some older adults-especially those with complex care needs-caregivers are a key element in care planning and delivery, and that their experiences provide important insight in the quality of service delivery. Specifically, the system integrates critical clinical and social data (individual support needs) to predict adverse events in vulnerable people and help facilitate the delivery of targeted interventions. The Office of the National Coordinator for Health Information Technology defines consumers to include individuals, their families, and other caregivers (Ricciardi et al. The role of family members and friends in the use of these systems has not been well defined. Department of Veterans Affairs, for example, is currently modifying "My HealtheVet" to allow veterans to delegate electronic access to a caregiver. Implementation barriers to proxy portal registration are numerous and include: lack of availability. Although most people want control over their electronic health information, preferences for sharing personal information vary widely (Caine et al. Current technology allows people to select who has permission to access their electronic health information as well as the limits of that access (Leventhal et al. For example, someone might authorize a paid caregiver to schedule appointments or refill prescribed medications but bar their access to personal health information. In one survey, veterans were twice as likely to support allowing someone to request prescription refills (87 percent) than to communicate with health care providers (40 percent) on their behalf (Zulman et al.

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And the surface of the egg must be designed to blood pressure medication bruising generic terazosin 1 mg line trap the sperm and prevent their escape zofran arrhythmia cheap 1mg terazosin mastercard. The researchers at Johns Hopkins concluded that the sperm and egg stick together because of adhesive molecules on the surfaces of each blood pressure chart infants purchase terazosin 2 mg without a prescription. The mechanical force of its tail is so weak that a sperm cannot break even one chemical bond. If they start to soften the zona just at the tip of the sperm and the sides remain stuck, then the weak, flailing sperm can get oriented in the right direction and make it through the zonaprovided that its bonds to the zona dissolve as it moves in. Although this new version of the saga of the egg and the sperm broke through cultural expectations, the researchers who made the discovery continued to write papers and abstracts as if the sperm were the active party who attacks, binds, penetrates, and enters the egg. The only difference was that sperm were now seen as performing these actions weakly. They began to describe the zona as an aggressive sperm catcher, covered 40Far less is known about the physiology of sperm than comparable female substances, which some feminists claim is no accident. Greater scientific scrutiny of female reproduction has long enabled the burden of birth control to be placed on women. The experiments made use of glass pipettes, a manometer, and a simple microscope, all of which have been available for more than one hundred years. Since the thrust [of the sperm] is much smaller than the force needed to break a single affinity bond, the first bond made upon the tip-first meeting of the sperm and zona can result in the capture of the sperm. Gerald Schatten and Helen Schatten set out to show that, contrary to conventional wisdom, the "egg is not merely a large, yolk-filled sphere into which the sperm burrows to endow new life. Rather, recent research suggests the almost heretical view that sperm and egg are mutually active partners. The filament may grow as much as twenty times longer than the sperm head itself before its tip reaches the egg and sticks. And why not focus, as the Hopkins lab did, on the stickiness of the egg, rather than the stickiness of the sperm? Cone, "The Mechanics of the Sperm-Egg Interaction at the Zona Pellucida, " Biophysical Journal 54, no. Lab members were somewhat familiar with work on metaphors in the biology of female reproduction. Richard Cone, who runs the lab, is my husband, and he talked with them about my earlier research on the subject from time to time. Therefore, I assume that any awareness the lab members may have had about how underlying metaphor might be guiding this particular research was fairly inchoate. But it is soon interrupted by the sudden and swift migration of the egg nucleus, which rushes toward the sperm with a velocity triple that of the movement of chromosomes during cell division, crossing the entire egg in about a minute. This work, which Paul Wassarmanconducted on the sperm and eggs of mice, focuses on identifying the specific molecules in the egg coat (the zona pellucida) that are involved in egg-sperm interaction. At first glance, his descriptions seem to fit the model of an egalitarian relationship. In fact, the author reiterates the point later in the article: "Many sperm can bind to and penetrate the zona pellucida, or outer coat, of an unfertilized mouse egg, but only one sperm will eventually fuse with the thin plasma membrane surrounding the egg proper (inner sphere), fertilizing the egg and giving rise to a new embryo. Each sperm, which has a large number of egg-binding proteins on its surface, binds to many sperm receptors on the egg. More specifically, a site on each of the egg-binding proteins fits a complementary site on a sperm receptor, much as a key fits a lock. Could this imagery not be reversed, letting the sperm (the lock) wait until the egg produces the key? Or could we speak of two halves of a locket matching, and regard the matching itself as the action that initiates the fertilization? Usually in biological research, the protein member of the pair of binding molecules is called the receptor, and physically it has a pocket in it rather like a lock. Typically, molecules on the sperm would be called receptors and molecules on the egg would be called ligands. While he notes that "the zona pellucida has at times been viewed by investigators as a nuisance, a barrier to sperm and hence an impediment to fertilization, " his new research reveals that the egg coat "serves as a sophisticated biological security system that screens incoming sperm, selects only those compatible with fertilization and development, prepares sperm for fusion with the egg and later protects the resulting embryo from polyspermy [a lethal condition caused by fusion of more than one sperm with a single egg]. It is the sperm as a cell that has motility, and the egg as a cell that has relative immotility. The egg selects an appropriatemate, prepares him for fusion, and then protects the resulting offspring from harm.

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Referring to blood pressure instruments buy terazosin 2 mg visa your personal interest in this topic in the introduction also helps you set the stage for additional anecdotes or examples from your personal experience later in the speech blood pressure chart high buy 1 mg terazosin fast delivery. Eleven years ago arrhythmia murmur buy terazosin 1 mg online, while giving birth to my first child, I hemorrhaged and was transfused with seven pints of blood. One speaker used an effective startling statistic to help introduce a speech on the dangers of heart disease: According to the Center for Disease Control, in the United States 26. By referring to the previous speeches, you enhance your credibility by showing your knowledge of the previous speech, and you have the opportunity to either compare or contrast your speech to the previous speeches. Edward Kennedy, at the 1980 Democratic National Convention, began his speech with a short tribute and acknowledgement to the previous speaker, member of Congress Barbara Mikulski: Thanks very much, Barbara Mikulski, for your very eloquent, your eloquent introduction. Distinguished legislator, great spokeswoman for economic democracy and social justice in this country, I thank you for your eloquent introduction. For your speech, then, you can use an analogy to show a connection between your speech topic (something new and different for the audience) and something that is known by your audience. Analogies can be effective because they use ideas, information and values of the audience to draw a connection to your speech topic-and to you as a speaker. One very common (and often misquoted) analogy comes from the 1919 Supreme Court case of Schenck v United States. Justice Oliver Wendell use startling statistics One of the key considerations in choosing an appropriate topic for your speech is that you have a personal interest in that topic. An effective attention getter then, can be your description of that personal interest. By noting your personal interest, you will demonstrate your credibility by showing your knowledge and experience with this topic, and because you have a personal interest, you are more likely to present this information Startling statistics startle an audience and catch its attention, and encourage that audience to listen further as you present the context of the surprising statistic. Long-time radio announcer Paul Harvey is well known for the catch phrase "And now, the rest of the story. When you startle the audience, you set them up to want to hear the "rest of the story. Startling an audience with an irrelevant statistic diminishes the speech and decreases your credibility. Third, make sure you then present "the 9-5 Chapter 9 Introductions & Conclusions Using questions that lead to positive answers can also enhance your connection to and credibility with the audience. Starting a speech with a question whether rhetorical or actual does require thought and practice on your part. Remember-even if you think the question is rhetorical, your audience may not know this and may answer the question. Too often, speakers will use a question as an introduction-but then give the audience no time to either think about the answer or answer the question. You also need to be careful to use eye contact in asking questions, since you are above all asking for audience involvement, and your eye contact requests that involvement. Even when you use a less than well-known figure, the quotation can be effective if it nicely sets up your speech topic and is something to which your audience can relate. You need to place the quotation in the context of your speech (as well as meet the other required functions of an introduction, of course). Second, it is easy to fall into a bad (and somewhat lazy) habit of simply finding a quotation and using it to start every speech. Third, simply using a quotation is no guarantee that your audience will find that quotation interesting or apt for the speech, and may also find the author of the quotation to be lacking in credibility-or your audience may simply not like the author of the quotation. Finally, beware of overlylong quotations (three or more sentences): Remember, this is just part of the introduction, not a main point of the speech. In his farewell address, former President Ronald Reagan (1989) Using rhetorical questions in speeches is a great way to keep the audience involved. Rhetorical questions are designed to allow you as speaker to get the audience to think about your topic without actually speaking the answer to the question. Rhetorical questions allow you as speaker to maintain the most control over a speech situation, and allow you to guard against an inappropriate or even offensive response.


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Because increased monitoring can be burdensome for small systems wide pulse pressure young cheap 2 mg terazosin otc, operational monitoring can be used to blood pressure chart 40 year old male order 5mg terazosin with visa determine if the system is performing as expected heart attack normal blood pressure buy terazosin 1mg without a prescription. By using instrumentation and remote monitoring technologies, small schemes can produce real-time data to ensure the system is functioning according to water quality objectives. With an operational monitoring model in place, ongoing sampling serves only as confirmation of the operational data, and frequency of regulatory sampling could be reduced. In the case where indoor uses are allowed, turbidity meters are often employed as a measure of system performance. While the quantitative impact of increased graywater use is expected to be modest, even under the most aggressive growth assumptions, much of the growth in graywater use is expected to take place in areas where municipal water reuse will likely not be practiced-unsewered urban areas and rural and remote areas, as exemplified in several case studies [Australia-Sydney]. However, it has a growing role for improving water efficiency in new buildings and developments and also for major modifications to existing facilities. On-site water treatment systems may qualify for up to 10 points in the water efficiency category through water efficient design, construction, and longterm operation and maintenance features that promote water conservation and efficiency as follows: Water Efficient Landscaping, 2 to 4 points Innovative Wastewater Technologies, 2 points Water Use Reduction, 2 to 4 points runoff while providing water that can be used for nonpotable purposes. The Fay School students now monitor building energy and building water consumption from a digital readout in each new dormitory building. Battery Park City in lower Manhattan, New York City, is a collection of eight high-rise structures with 2 10 million ft of floor area that serves 10, 000 residents plus 35, 000 daily transient workers. Water for toilet flushing, cooling, laundry, and irrigation comes from six on-site treatment systems. Potable water is supplied by New York City and the on-site treatment systems overflow to a combined wastewater/stormwater outfall. In an industrial setting, the Frito-Lay manufacturing facility in Casa Grande, Ariz. Reclaimed water, along with other major alternative water sources, such as harvested rainwater and collected stormwater runoff, offer the opportunity to maximize landscape irrigation and reduce potable water use at many industrial and commercial institutions and at multi-family residential developments. In the south and southwest United States, air conditioning condensate collection and reuse may represent another significant alternate water resource. On-site treatment systems can be designed to treat municipal wastewater, graywater, harvested rainwater, and stormwater. Regardless of water source selected for use, care must be taken to differentiate pipes on the private side of the municipal utility boxes, appropriately color code on-site pipes, and adopt a cross-connection control program for the different water sources. An on-site treatment system may also help qualify for an Innovation in Design Process maximum credit of one point. One item that can receive a score under water reuse is a rainwater (rooftop) harvesting system. The harvested rainwater resource may then be combined with an on-site graywater treatment system, a high-quality wastewater treatment system, or with the use of a municipal reclaimed water system source. While this practice is contrary to the conventional practice of avoiding dilution of biologically degradable material in the sewage that is used by municipal wastewater treatment processes, the on-site treatment system allows multiple objectives of reducing effluent discharges and reducing stormwater 2-36 2012 Guidelines for Water Reuse Chapter 2 Planning and Management Considerations 2. Because rainfall is generally the most significant factor in managing stormwater, capture and harvesting of rainfall and associated runoff present opportunities for stormwater use benefits. However, stormwater harvesting requires an effective means of stormwater capture and retention that also supports the concurrent need for flood control. While the benefits of stormwater harvesting are clear, there are currently no federal regulations governing rainwater harvesting for nonpotable use, and the policies and regulations enacted at the state and local levels vary widely from one location to another. Regulations are particularly fragmented with regard to water conservation, as the permissible uses for harvested water tend to vary depending on the climate and reliability of the water supply. There are local plumbing codes, and some states, including Georgia, have published Rainwater Harvesting Guidelines, but not all states have formally defined rainwater harvesting as a practice distinct from water recycling (Georgia Department of Community Affairs, 2009). In recent years, cities and counties looking to promote water conservation have begun issuing policies that better define harvested water and its acceptable uses. In January 2010, Los Angeles County issued a policy providing a clear, regulatory definition of "rainfall/nonpotable cistern water" and drawing a specific distinction between harvested water and graywater or recycled water. The supplement is a separate document from the Uniform Plumbing and Mechanical Codes and establishes requirements for green building and water efficiency applicable to plumbing and mechanical systems. Water reuse can have both positive and adverse impacts on surrounding and downstream ecosystems. Elimination or reduction of a surface water discharge by reclamation and reuse generally reduces adverse water quality impacts to the receiving water. However, development of water reuse systems may have unintended environmental impacts related to land use, stream flow, and groundwater quality. Where an investigation of environmental impacts is required, it may be subject to state policies.


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If you think back to blood pressure ear cheap 2mg terazosin otc the 2004 Presidential campaign you will find a number of red herrings blood pressure by age group generic 1mg terazosin mastercard. The implication was that by extension John Kerry was a rich elitist incapable of understanding the plight of working class and middle class individuals pulse pressure klabunde purchase terazosin 5 mg line. The fallacy is not just a bad inference about connection between cause and effect, but one that violates the cannons of reasoning about causation. We see two primary types of this fallacy: red herring (Irrelevant thesis) this fallacy occurs when we introduce an irrelevant issue into the argument. The phrase "red herring" comes from the supposed fox hunting slippery slope this fallacy occurs when we assume one action will initiate a chain of events culminating in an undesirable event later. Arguments falling prey to the slippery slope fallacy ignore the fact there are probably a number of other things that can happen between the initial event and the bottom of the slope. While there are many potential flaws in this argument as presented, for our purpose the most obvious is that there are many Americans who are Muslim and who are quite interested and concerned about America. I asked how old the roof was and the real estate agent responded: If we teach sex education in school, then students will have more sex. If students have more sex, we will have a rash of unplanned pregnancies and sexually transmitted diseases. Students will be forced to drop out of school and will never have the chance to succeed in life. Even more unlikely is the fact that merely learning about sex will force you to drop out of school. A fallacy of weak analogy occurs when there exists a poor connection between examples. Structurally, the fallacy looks like this: strawman this fallacy occurs when the actual argument appears to be refuted, but in reality a related point is addressed. The individual using a strawman argument will appear to be refuting the original point made but will actually be arguing a point not made in the original. The best strawman arguments will argue the new point to a conclusion that appears solid; however, because their point is not the original point, it is still a fallacy. Examples of the strawman fallacy are everywhere and can appear to be quite persuasive: A and B are similar. This fallacy often occurs when we try to compare two things that on the surface appear similar. The problem in this argument is that while humans and animals are alike in their living and breathing status, there are numerous other ways they differ. We commit a fallacy when we infer that based on this initial similarity, they are similar in all other ways as well. The other day while looking at houses, I heard another version of this argument from a real estate agent. The In this chapter we have examined what critical thinking is and how it involves more than simply being critical. We see arguments every day in advertising, use arguments to persuade others, and we use them to benefit us. Always critically think and examine any argument you confront, and remember that if it sounds too good to be true, it probably is a fallacious argument. Now that you know a bit more about how to do these things better, you should find that you can put together more persuasive arguments that avoid the pitfalls of fallacious thinking. And if you do hear a statement like this, you will be prepared to think critically about the statement, and will be in a position to make a more educated decision about the information. Statements similar to this were quite prevalent during the 2008 Presidential election and still appear on occasion. The assumption here is that if a person Chapter 6 critical thinking & reasoning Explain how listening differs from hearing and why listening is the first component of practicing critical thinking. List and discuss at least three ways that we use logic and argumentation in our daily lives. If I say, "There is plenty of pasta, so you should have some more, " am I implying or inferring that you have not eaten enough? Television commercials that use pictures of starving children and sad music as a way to get you to donate money are an example of what type of fallacy?

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Although there is some debate about its scope blood pressure chart sg terazosin 2mg overnight delivery, the industry panelists generally accepted that an experimental use defense exists at common law offering some shelter from infringement litigation to blood pressure 152 over 90 generic 5 mg terazosin non-commercial research blood pressure chart age 65 purchase terazosin 1 mg on-line. Thomas 2/8 (Patent Session) at 30; Sung 2/8 (Patent Session) at 136-38; Caulfied 3/19 at 163. In their study of the biotechnology industry, Walsh, Arora, and Cohen noted that informal reliance on this defense by members of the research community has helped to prevent an anticommons or lack of access to existing patents from stifling follow-on innovation. One panelist stated, for example, that the need "to have access to a wide range of technologies to discover, create, manufacture and market a human therapeutic product" means the biotechnology industry is "highly vulnerable to. Some believe that this decision will chill university research, because researchers will no longer be able to rely on the exemption to overcome anticommons or access issues. For further discussion of anticommons and related issues deriving from the presence of multiple patents, see supra Ch. See Kirschner 2/26 at 241, 310-11; Caulfield 3/19 at 163-64; McGarey 11/6 at 153-54. See also Tom Horton, Patenting Our Lives and Our Genes: Where Does Congress Stand in the Coming Clash? He went on to note that one of those companies no longer receives royalties because its patent expired. The tragedy of the anticommons refers to a problem that might arise when multiple owners each have a right to exclude others from a scarce resource, and no one has an effective privilege of use. There are two mechanism s by which a go vernm ent might inadvertently create an antico mmons: (1) by creating too many con current fragments of intellectual property rights in potential future prod ucts; (2) by perm itting too many existing patent owners to stack licenses on to p of the future discoveries of users. The authors theorize that patenting of gene fragments and of receptors useful for screening potential pharmac eutical p roducts are two situations in wh ich too many c oncurrent fragments may result in an anticommons. If a tragedy of the anticommons were to emerge, it might endure because of the transaction costs of rearranging entitleme nts, hetero geneous interests of o wners, and cognitive biases amo ng researche rs, the authors suggest. The authors suggest that policy-makers should seek to ensure coherent boundaries of existing patents and to minimize restrictive licensing practices that interfere with product development. Otherwise, they conclude that more patent rights may lead paradoxically to fewer useful products for improving human health. And most of the players in this field are sophisticated enough to understand that, " he argued. Access to Existing Technologies Needed for Follow-On Innovation There is a debate among scholars as to the optimal balance of incentives to innovate between parties engaged in initial research and parties engaged in follow-on research. Some contend that broad patents maximize innovation by enabling the initial inventor to coordinate future follow-on R&D. They concluded that there is no evidence that biotechnology research has been significantly impeded. Licensing Practices for Biotechnology Research Tools the panelists discussed two licensing arrangements that have been used in the biotechnology industry to provide firms with access to research tools: reach-through license agreements and patent pools. They also offered some observations on the merits of exclusive licensing of research tools. The authors cite stem cell technology as an example of a technology to which a patent holder might prefer to restrict access. Usually, however, the licensee of the research tool does not need access to the research tool to make or sell its product. Rather, the licensee uses the research tool only to identify and develop the product. First, they can facilitate access to a wide range of research tools by reducing the up-front licensing costs. Patent Pools Patent pools involve "patents [from multiple patentees being] licensed in a package, either by one of the patent holders or by a new entity established for this purpose, usually to anyone willing to pay the associated royalties. Non-Exclusive Licensing of Patented Research Tools rather than exclusive, licenses. One panelist explained that firms prefer to grant nonexclusive licenses on their research tools, because it is impossible to know in advance whether any particular licensee will succeed in bringing a product to market. Organisation for Economic Co-operation and Development, Genetic Inventions, Intellectual Property Rights and Licensing Practices: Evidence and Policies 67 (2002) ("It is true that there is a growing interdependence among patents, that the claims of many patents are narrower, and that patents are held by multiple owners. Licensing transaction costs are burdensome and freedom of operation is restricted, thus increasing the potential for conflict among researchers.


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