By N. Orknarok. Wells College.
World Investment Report 2000: Cross-border Mergers and Acquisitions and Development 50mg fertomid sale. International Investment Policies for Development (For more information visit http://www purchase fertomid 50 mg overnight delivery. International Investment Rule-Making: Stocktaking, Challenges and the Way Forward. Issues in International Investment Agreements (For more information visit http://www. Government Public enterprise Private enterprise Academic or research institution International organization Media Not-for-profit organization Other (specify) ________________ 3. The High Contracting Parties undertake to respect Respect and to ensure respect for the present Convention in all for the Convention1 circumstances. In addition to the provisions which shall be Application implemented in peacetime, the present Convention shall apply to all of the Convention cases of declared war or of any other armed conflict which may arise between two or more of the High Contracting Parties, even if the state of war is not recognized by one of them. The Convention shall also apply to all cases of partial or total occupation of the territory of a High Contracting Party, even if the said occupation meets with no armed resistance. Although one of the Powers in conflict may not be a party to the present Convention,the Powers who are parties thereto shall remain bound by it in their mutual relations. They shall furthermore be bound by the Convention in relation to the said Power, if the latter accepts and applies the provisions thereof. To this end, the following acts are and shall remain prohib- ited at any time and in any place whatsoever with respect to the above-mentioned persons: a) violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture; b) taking of hostages; c) outrages upon personal dignity, in particular, humiliating and degrading treatment; d) the passing of sentences and the carrying out of executions without previous judgment pronounced by a regularly constituted court affording all the judicial guarantees which are recognized as indispensable by civilized peoples. An impartial humanitarian body, such as the International Committee of the Red Cross, may offer its services to the Parties to the conflict. The Parties to the conflict should further endeavour to bring into force, by means of special agreements, all or part of the other provisions of the present Convention. The application of the preceding provisions shall not affect the legal status of the Parties to the conflict. Prisoners of war, in the sense of the present of war Convention, are persons belonging to one of the following categories, who have fallen into the power of the enemy: 1) Members of the armed forces of a Party to the conflict as well as members of militias or volunteer corps forming part of such armed forces. The following shall likewise be treated as prisoners of war under the present Convention: 1) Persons belonging, or having belonged, to the armed forces of the occupied country, if the occupying Power considers it necessary by reason of such allegiance to intern them, even though it has originally liberated them while hostilities were going on outside the territory it occupies, in particular where such persons have made an unsuccessful attempt to rejoin the armed forces to which they belong and which are engaged in combat, or where they fail to comply with a summons made to them with a view to internment. Where such diplomatic relations exist, the Parties to a conflict on whom these persons depend shall be allowed to perform towards them the functions of a Protecting Power as provided in the present Convention,without prejudice to the functions which these Parties normally exercise in conformity with diplomatic and consular usage and treaties. This Article shall in no way affect the status of medical personnel and chaplains as provided for in Article 33 of the present Convention. Should any doubt arise as to whether persons having committed a belligerent act and having fallen into the hands of the enemy belong to any of the categories enumerated in Article 4, such persons shall enjoy the protection of the present Convention until such time as their status has been determined by a competent tribunal. No special agreement shall adversely affect the situation of prisoners of war, as defined by the present Convention, nor restrict the rights which it confers upon them. Prisoners of war shall continue to have the benefit of such agreements as long as the Convention is applicable to them, except where express provisions to the contrary are contained in the aforesaid or in subsequent agreements, or where more favourable measures have been taken with regard to them by one or other of the Parties to the conflict. For this purpose, the Protecting Powers may appoint, apart from their diplomatic or consular staff, delegates from amongst their own nationals or the nationals of other neutral Powers. The said delegates shall be subject to the approval of the Power with which they are to carry out their duties. The Parties to the conflict shall facilitate to the greatest extent possible the task of the representatives or delegates of the Protecting Powers. The representatives or delegates of the Protecting Powers shall not in any case exceed their mission under the present Convention. They shall, in particular, take account of the imperative necessities of security of the State wherein they carry out their duties. When prisoners of war do not benefit or cease to benefit, no matter for what reason, by the activities of a Protecting Power or of an organization provided for in the first paragraph above, the Detaining Power shall request a neutral State, or such an organization, to undertake the functions performed under the present Convention by a Protecting Power designated by the Parties to a conflict. If protection cannot be arranged accordingly, the Detaining Power shall request or shall accept, subject to the provisions of this Article, the offer of the services of a humanitarian organization, such as the International Committee of the Red Cross,to assume the humanitarian functions performed by Protecting Powers under the present Convention. No derogation from the preceding provisions shall be made by special agreements between Powers one of which is restricted, even temporarily, in its freedom to negotiate with the other Power or its allies by reason of military events, more particularly where the whole, or a substantial part, of the territory of the said Power is occupied. Whenever in the present Convention mention is made of a Protecting Power, such mention applies to substitute organizations in the sense of the present Article. For this purpose, each of the Protecting Powers may, either at the invitation of one Party or on its own initiative, propose to the Parties to the conflict a meeting of their representatives, and in particular of the authorities responsible for prisoners of war, possibly on neutral territory suitably chosen. The Parties to the conflict shall be bound to give effect to the proposals made to them for this purpose. The Protecting Powers may, if necessary, propose for approval by the Parties to the conflict a person belonging to a neutral Power, or delegated by the International Committee of the Red Cross, who shall be invited to take part in such a meeting.
Severe asthma is asthma that requires Step 4 or 5 treatment generic fertomid 50mg with visa, to maintain symptom control buy fertomid 50mg line. How to investigate uncontrolled asthma in primary care This flow-chart shows the most common problems first, but the steps can be carried out in a different order, depending on resources and clinical context. The aim is to reduce the burden to the patient and their risk of exacerbations, airway damage, and medication side-effects. The patient’s own goals regarding their asthma and its treatment should also be identified. Population-level recommendations about ‘preferred’ asthma treatments represent the best treatment for most patients in a population. Patient-level treatment decisions should take into account any individual characteristics or phenotype that predict the patient’s likely response to treatment, together with the patient’s preferences and practical issues such as inhaler technique, adherence, and cost. A partnership between the patient and their health care providers is important for effective asthma management. Training health care providers in communication skills may lead to increased patient satisfaction, better health outcomes, and reduced use of health care resources. Health literacy – that is, the patient’s ability to obtain, process and understand basic health information to make appropriate health decisions – should be taken into account in asthma management and education. Before starting initial controller treatment • Record evidence for the diagnosis of asthma, if possible • Document symptom control and risk factors • Assess lung function, when possible • Train the patient to use the inhaler correctly, and check their technique • Schedule a follow-up visit After starting initial controller treatment • Review response after 2–3 months, or according to clinical urgency • See Box 7 for ongoing treatment and other key management issues • Consider step down when asthma has been well-controlled for 3 months 13 Box 7. Other options: Add-on tiotropium by soft-mist inhaler for adults (≥18 years) with a history of exacerbations. Patients should preferably be seen 1–3 months after starting treatment and every 3–12 months after that, except in pregnancy when they should be reviewed every 4–6 weeks. The frequency of review depends on the patient’s initial level of control, their response to previous treatment, and their ability and willingness to engage in self-management with an action plan. Stepping up asthma treatment Asthma is a variable condition, and periodic adjustment of controller treatment by the clinician and/or patient may be needed. Stepping down treatment when asthma is well-controlled Consider stepping down treatment once good asthma control has been achieved and maintained for 3 months, to find the lowest treatment that controls both symptoms and exacerbations, and minimizes side-effects. To ensure effective inhaler use: • Choose the most appropriate device for the patient before prescribing: consider medication, physical problems e. Check and improve adherence with asthma medications Around 50% of adults and children do not take controller medications as prescribed. Some examples with consistent high quality evidence are: • Smoking cessation advice: at every visit, strongly encourage smokers to quit. Advise parents and carers to exclude smoking in rooms/cars used by children with asthma • Physical activity: encourage people with asthma to engage in regular physical activity because of its general health benefits. Although allergens may contribute to asthma symptoms in sensitized patients, allergen avoidance is not recommended as a general strategy for asthma. These strategies are often complex and expensive, and there are no validated methods for identifying those who are likely to benefit. For baby and mother, the advantages of actively treating asthma markedly outweigh any potential risks of usual controller and reliever medications. For some patients, treatment with intranasal corticosteroids improves asthma control. Obesity: to avoid over- or under-treatment, it is important to document the diagnosis of asthma in the obese. Weight reduction should be included in the treatment plan for obese patients with asthma; even 5–10% weight loss can improve asthma control. The elderly: comorbidities and their treatment should be considered and may complicate asthma management. Factors such as arthritis, eyesight, inspiratory flow, and complexity of treatment regimens should be considered when choosing medications and inhaler devices. Symptomatic reflux should be treated for its general health benefits, but there is no benefit from treating asymptomatic reflux in asthma. Anxiety and depression: these are commonly seen in people with asthma, and are associated with worse symptoms and quality of life. Patients should be assisted to distinguish between symptoms of anxiety and of asthma. Food allergy and anaphylaxis: food allergy is rarely a trigger for asthma symptoms. Good asthma control is essential; patients should also have an anaphylaxis plan and be trained in appropriate avoidance strategies and use of injectable epinephrine. Surgery: whenever possible, good asthma control should be achieved pre- operatively. Ensure that controller therapy is maintained throughout the peri- operative period. The management of worsening asthma and exacerbations should be considered as a continuum, from self-management by the patient with a written asthma action plan, through to management of more severe symptoms in primary care, the emergency department and in hospital.
All Medicare drug plans must give at least a standard level of coverage set by Medicare fertomid 50mg sale. Medicare drug plans may difer in the prescription drugs they cover cheap 50 mg fertomid overnight delivery, how much you have to pay, and which pharmacies you can use. If you decide to join a Medicare drug plan, compare plans in your Words in area and choose one that meets your needs. If you don’t join a red are Medicare drug plan when you’re frst eligible for Medicare, and defned you don’t have drug coverage that’s expected to pay, on average, on pages at least as much as standard Medicare prescription drug coverage 83–86. Te penalty is in addition to your premium each month for as long as you have a Medicare drug plan. If you don’t use a lot of prescription drugs now, you still may want to think about joining a Medicare drug plan to help lower your drug costs now and help protect against higher costs in the future. If you’re new to Medicare and already have other drug coverage, you have new options to think about. If you aren’t new to Medicare, you may want to look at your options to fnd drug coverage that meets your needs. You can join or switch Medicare drug plans between October 15– December 7 each year, with your coverage beginning January 1 of the following year. Te drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options. If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefts administrator, insurer, or plan provider before you make any changes to your current coverage. Doctor samples, discount cards, free clinics, or drug discount websites aren’t drug coverage. For details about how Medicare drug coverage may afect other coverage, see Section 4. All plans must cover the same categories of drugs, but generally plans can choose which specifc drugs are covered in each drug category. If you have limited income and resources, you may qualify for Extra Help from Medicare with paying your drug plan costs. Convenience Check with the plan to make sure the pharmacies in the plan are convenient to you. If you spend part of the year in another state, see if the plan will cover you there. You’ll need to join a prescription drug plan to get Medicare coverage for drugs for most chronic conditions, like high blood pressure. Part B covers certain drugs, like injections you get in a doctor’s ofce, certain oral cancer drugs, and drugs used with some types of durable medical equipment—like a nebulizer or external infusion pump. Under very limited circumstances, Part B covers certain drugs you get in a hospital outpatient setting. Generally, Medicare drug plans cover other vaccines, like the shingles vaccine, needed to prevent illness. Note: Medicare Part A (Hospital Insurance) or Part B generally doesn’t cover self-administered drugs you get in an outpatient setting like in an emergency room, observation unit, surgery center, or pain clinic. You’ll likely need to pay out-of-pocket for the entire cost of these drugs and send in a claim to your drug plan for a refund. For more information on how to compare plans and join one that meets your needs, see Section 5. Medicare drug plans have diferent coverage and costs, but all must ofer at least a standard level of coverage set by Medicare. How much you actually pay for Medicare drug coverage depends on which drugs you use, which Medicare drug plan you join, whether you go to a pharmacy in your plan’s network, and whether you get Extra Help paying for your drug costs. Your drug coverage costs are afected by: Monthly premium Words in red are Yea rly deductible defned Copayments or coinsurance on pages Coverage gap (also called the “donut hole”) 83–86. If that amount is more than what’s in your check, you’ll get a bill from Medicare each month. If you don’t pay your entire Part D premium (and the extra amount), you may be disenrolled from your Part D plan. You must pay both the extra amount and your plan’s premium each month to keep Medicare drug coverage. If you have to pay a higher amount for your Part D premium and you disagree, visit socialsecurity. Yearly deductible Te deductible is what you pay for your drugs before your plan begins to pay. Usually, the amount you pay for a covered drug is for a one-month supply of a drug.
If medications are elected as part of the treatment strategy generic 50 mg fertomid free shipping, which already includes lifestyle changes such as increased physical activity and healthy eating patterns cheap fertomid 50 mg on-line, experts recommend a weight loss of 5-10% is needed within the first six months of maximal medication dose to reduce the complications and health risks associated with obesity. Patients who are not achieving the recommended minimum 5% weight loss after three months or who are experiencing adverse effects should be switched to an alternative medication or evaluated for bariatric surgery. Therefore, it is important for diabetes educators to be familiar with the available weight loss medications along with their mechanism of actions, dosages, adverse effects, contraindications and special considerations. A diabetes educator who is familiar with these medications can be an advocate for the patient and make suggestions for potential weight loss medications to the health care team when appropriate. It is important to note that weight loss medications may be particularly beneficial for weight loss maintenance in those patients who lose weight via intensive lifestyle strategies. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Consensus Statement By The American Association Of Clinical Endocrinologists And American College Of Endocrinology On The Comprehensive Type 2 Diabetes Management Algorithm – 2016 Executive Summary. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. They are written to enable nurses and midwives to reflect on the key points associated with medication management and the related principles, and thus support effective, safe and ethical practice. The professions’ responsibilities, activities and accountability involving medications are intrinsically linked to the individual’s scope of practice. It is, therefore, important to consider the guidelines outlined in this document in association with the Scope of Nursing and Midwifery Practice Framework (An Bord Altranais, 2000), which provides the foundation for this guidance document. The fundamental concepts of accountability, autonomy, competence and delegation that are considered in determining scope of practice also relate to the professions’ role in medication management. Medication management, broadly defined, is the facilitation of safe and effective use of prescription and over-the-counter medicinal products (Bulechek and McCloskey, 1999). The nursing, midwifery, medical and pharmaceutical professions are all participants in medication management and contribute to patient/service-user care. Medication management is a comprehensive intervention which encompasses the knowledge of nurses and midwives (and that of other health care professionals) and the activities that are performed to assist the patient/service-user in achieving the greatest benefit and best outcomes involving medications (Naegle, 1999). The responsibilities of medication management incorporate the assessment, planning, implementation and evaluation of the nursing and midwifery process in collaboration with other health care professionals in providing care. The nurse/midwife should have knowledge of the relevant statutes and legislation regarding the practices of prescribing, dispensing, storing, supplying and administering scheduled medicinal products. There is an obligation to practice according to the legislation governing nursing and midwifery practice, and the current standards and policies of regulatory bodies and health service providers1. Nurses and midwives should be aware of their legal and professional accountability with regard to medication management. It is acknowledged that local need may dictate specific policies and protocols authorising the practices of individuals involved with medicines. The health service provider and health care regulatory and professional organisations have a responsibility to the patient/service-user to assure safe and effective medication management practices. Consultation with the drugs and therapeutics committee (where available), or similar governance structures, and other relevant personnel is advised in determining local policies and protocols involving medicinal products. Medication management practices should be audited on a regular basis to ensure effective and safe patient/service-user care. More recently, the Irish Medicines Board Act (Miscellaneous Provisions) Act, 2006 (No. However, this authority is based upon the following conditions being satisfied: 1. The nurse/midwife is employed by a health service provider in a hospital, nursing home, clinic or other health service setting (including any case where the health service is provided in a private home). The medicinal product is one that would be given in the usual course of the service provided in the health service setting in which the nurse/midwife is employed. The prescription is issued in the usual course of the provision of that health service. In addition, the 2007 Regulations allow a health service provider to determine further conditions in limiting the prescriptive authority of the nurse/midwife. A specific schedule – Schedule 8 - has been devised, composed of four parts, which names the Schedule 2 and 3 drugs that a nurse/midwife is authorised to prescribe and also dictates administration routes and care settings or conditions2. Additional information concerning nurse and midwife prescribing is 2Refer to Appendix C for Schedule 8 details. The Irish Medicines Board (Miscellaneous Provisions) Act, 2006, the Medicinal Products (Prescription and Control of Supply) Regulations, 2003 and 2005 and the Misuse of Drugs Acts, 1977 and 1984, and subsequent regulations authorise the nurse/midwife to possess, supply and administer medicinal products to a patient/service-user. The Pharmacy Act, 2007, makes provision for the regulation of pharmacy, including authority for the sale and supply of medicinal products. The key factors to be considered when determining the scope of practice for nursing and midwifery care also apply to the scope of practice for medication management.