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Internal rotation is most likely to cause pain as a result of pelvic or retroperitoneal disease or both womens health jackson mi purchase dostinex 0.5 mg on-line. The hip is actively flexed usually against resistance women's health center westwood purchase dostinex 0.5 mg line, thus tensing the psoas muscle (dotted arrow) pregnancy outside the uterus buy 0.25mg dostinex with mastercard. The standard method to elicit rebound is to palpate deeply womens health 5 minute breakfast cheap dostinex 0.5 mg line, then suddenly remove the palpating hand. Although this sign aids in the determination of the presence of an intraperitoneal inflammatory process, it is not necessary to cause extra discomfort or stress, particularly in younger children; it is not recommended. Peritoneal irritation can also be detected by maneuvers such as asking the child to jump, cough, or tapping the feet while observing for facial signs of discomfort. Other areas of inflammation can be detected by maneuvers that move muscles adjacent to the inflammation. A positive Carnett test occurs when pain is unchanged or increased when the supine patient tenses the abdominal wall by lifting the head and shoulders off the examining table. Carnett sign is a sensitive tool to discriminate abdominal wall pain from visceral pain. An inflammatory mass, such as an inflamed appendix, a psoas abscess, or a perinephric abscess, in contact with the psoas muscle is the cause of this pain. Likewise, the obturator sign is pain with flexion of the thigh at right angles to the trunk and external rotation of the same leg while the patient is in the supine position. This sign results from contact of an inflammatory mass with the obturator muscle. Percussion at the costovertebral angle elicits pain in the presence of renal or perinephric inflammation. If a more thorough examination or an intravaginal examination is needed in prepubertal girls, it should generally be performed with the patient under anesthesia. If an imaging study or colonoscopy is planned, a rectal examination may be unnecessary. If constipation is suspected as the cause for pain, rectal examination should be performed but should be the last part of the physical examination and should be performed only once. The child should be relaxed and should be given an honest explanation of the procedure. The examiner should use plenty of lubricant and should perform the rectal examination very gently. Lateralizing pain, masses, and the presence and character of stool in the rectum are assessed. The stool should always be tested for blood except in children with gastrostomy or nasogastric tubes since it will invariably be positive and can be misleading. Clues to an organic and at times more serious cause of abdominal pain are noted in Table 10. Furthermore, peritoneal signs, which suggest a "surgical abdomen," most often caused by peritonitis are noted in Table 10. Family history is also positive for dysfunctional pain syndromes (constipation, irritable bowel, dysmenorrhea, and lactase deficiency). However, a striking lymphocytosis may suggest gastroenteritis or a systemic illness. Overreliance on the complete blood count alone can cause delay in reaching the correct diagnosis. Laboratory Evaluation After a careful history is obtained and thorough physical examination is performed, the diagnosis or a short list of possible diagnoses should be apparent. Urinalysis the urinalysis is an important and useful laboratory test in the evaluation of abdominal pain. The presence of ketones and a high specific gravity suggest poor food intake and dehydration. A pregnancy test should be performed on postpubertal girls, regardless of sexual activity history. The presence of both white cells and bacteria indicates a urinary tract infection; either finding alone may not be sufficient for that diagnosis. White blood cells may be present in the urine from irritation caused by an inflammatory mass adjacent to the bladder or ureter; hematuria may be seen with nephrolithiasis. Complete Blood Cell Count the hemoglobin and hematocrit levels can reveal anemia caused by acute or chronic blood loss (as with ulcers, inflammatory bowel disease, Meckel diverticula) or the anemia of chronic disease (as with systemic lupus erythematosus, inflammatory bowel disease).

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The government proved its case with six former members of the Mafia pregnancy after vasectomy buy 0.25mg dostinex free shipping, including Peter Savino menopause questionnaire 0.5 mg dostinex mastercard. Savino was allowed to testify via closed circuit television because he was in the Federal Witness Protection Program and was in the final stages of an inoperable breast cancer news 2014 order dostinex cheap online, fatal cancer womens health leadership trust purchase 0.5 mg dostinex overnight delivery. The accused has a right "to be present in his own person whenever his presence has a relation, reasonably substantial, to the fullness of his opportunity to defend against the charge. Once lost, the right to be present can be reclaimed if the defendant is willing to conduct himself consistently with the decorum and respect inherent in judicial proceedings. A military judge faced with a disorderly and disruptive accused has three constitutionally-permissible responses: (1) Bind and gag the accused as a last resort, thereby keeping him present; (2) Cite the accused for criminal contempt; (3) Remove the accused from the courtroom until he promises to conduct himself properly. Trial may continue in the absence of the accused when the accused voluntarily absents himself from trial. The accused testified at trial and was asked during cross-examination, "Do you admit here today that you are the only witness in this court who has heard the testimony of every other witness? The Court held that the question did not constitute error, but if it did, it was waived and did not constitute plain error. In summation, the prosecutor commented that the defendant had the benefit of getting to listen to all other witnesses before testifying, giving the defendant a "big advantage. Crawford returned to the historical roots of the Confrontation Clause, which is a procedural guarantee "not that evidence be reliable, but that reliability be assessed in a particular manner; by testing in the crucible of cross-examination. The Crawford Court declined to provide a comprehensive definition of "testimonial. The Clause does not bar admission of a statement so long as the declarant is present at trial to defend or explain it. Thus, a statement properly admitted under a hearsay exception may violate confrontational rights. Similarly, a violation of the hearsay rules may not infringe upon the Sixth Amendment. These categories, or "formulations," were (a) "Ex parte in-court testimony or its functional equivalent-that is, material such as affidavits, custodial examinations, prior testimony that the defendant was unable to cross-examine, or similar pretrial statements that declarants would reasonably expect to be used prosecutorially. The Court held that statements made to the police at the scene of a domestic dispute, but after the actual incident, were testimonial and could not be admitted where the victim did not testify at trial, but that statements made in response to questions from a 911 operator immediately after the domestic assault occurred (and assailant had just left the premises) were nontestimonial, and thus could be admitted at trial even though the victim did not testify. They are testimonial when the circumstances objectively indicate that there is no such ongoing emergency and that the primary purpose of the interrogation is to establish or prove past events potentially relevant to later criminal prosecution. The Michigan Court of Appeals affirmed, the Michigan Supreme Court returned the case for reconsideration. Once medical services arrived, the police called 25-13 Chapter 25 Confrontation Clause [Back to Beginning of Chapter] for backup and went in search of Bryant, though they did not find him that day. The case was reversed on appeal, post-Crawford, when the statements were found testimonial. Further, the victim went into greater detail about the circumstances of what happened. Despite this, court relied on an objective analysis of the encounter between the two individuals. The teacher brought the injuries to the attention of a lead teacher at the school, asked the child about the injuries. The statements were admitted as residual hearsay under Ohio Rule of Evidence 807, over defense objection. In particular, Justice Alito noted factors such as the lack of investigative purpose on the part of the listeners and declarant; the informality of the conversation; the fact that the listeners were teachers, not police; the potential that the listeners were responding to an ongoing emergent situation involving child abuse; and the very young age of the declarant. The lab analysts issued three sworn "certificates of analysis" attesting to the results of their analysis. In accordance with state law, the certificates were introduced at trial as "prima facie evidence of the composition, quality, and the net weight of the narcotic. Melendez-Diaz objected to the admission of the statements as a violation of his right of confrontation, citing Crawford. The Verde court concluded that a drug analysis certificate is "akin to a business or official record" and was thus not testimonial under Crawford. After the Massachusetts Supreme Judicial Court denied review without comment, Melendez-Diaz appealed to the U.

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Ammons (poetry) Maya Angelou (poetry menstruation dehydration order generic dostinex on-line, memoir women's health magazine big book of exercises purchase dostinex american express, essays) Gloria Anzaldъa (multi-genre) Massachusetts Curriculum Framework for English Language Arts and Literacy 167 John Ashbery (poetry) Jimmy Santiago Baca (poetry women's health center kearny nj buy dostinex 0.25mg cheap, fiction menopause 2014 purchase generic dostinex on-line, memoir) Amiri Baraka (poetry, drama, fiction, essays) Elizabeth Bishop (poetry) Robert Bly (poetry) Gwendolyn Brooks (poetry) Hortense Calisher (fiction) Hayden Carruth (poetry, essays) Michael Chabon (fiction) John Cheever (fiction) Marilyn Chin (poetry) Sandra Cisneros (fiction) Billy Collins (poetry) J. Doctorow (fiction) Anthony Doerr (fiction) Rita Dove (poetry, fiction, essays) Andre Dubus (fiction) Alan Dugan (poetry) Christopher Durang (drama) Bob Dylan (poetry) Louise Erdrich (fiction, poetry) Martнn Espada (poetry, essays) Richard Ford (fiction) Jonathan Franzen (fiction, essays, memoir) Charles Frazier (fiction) Nicholas Gage (fiction, memoir) Ernest J. Gaines (fiction) Louise Glьck (poetry) Kirsten Greenidge (drama) John Guare (drama) John Haines (poetry, essays) Alex Haley (fiction, biography) Donald Hall (poetry, fiction, drama, nonfiction) Robert Hayden (poetry, essays) Anthony Hecht (poetry, essays) David Henry Hwang (drama) Oscar Hijuelos (fiction) William Hoffman (fiction) John Irving (fiction) Ha Jin (fiction, poetry) Edward P. Annie Proulx (fiction, journalism) Thomas Pynchon (fiction) Anna Quindlen (fiction, journalism) Ishmael Reed (poetry, fiction, nonfiction) Adrienne Rich (poetry, essays) Marilynne Robinson (fiction, essays) Richard Rodriguez (fiction, essays) Luis Rodriguez (poetry, memoir, fiction) Philip Roth (fiction) Sarah Ruhl (drama) Richard Russo (fiction) May Sarton (fiction, poetry, memoir) Michael Shaara (fiction) Ntozake Shange (drama, poetry, fiction) John Patrick Shanley (drama) Sam Shepard (drama) Neil Simon (drama) Jane Smiley (fiction) Anna Deavere Smith (drama) Wallace Stegner (fiction, nonfiction) Mary TallMountain (poetry, fiction) Amy Tan (fiction, essays) John Kennedy Toole (fiction) Anne Tyler (fiction) John Updike (fiction, poetry, essays) Paula Vogel (drama) Kurt Vonnegut, Jr. Buckley (journalism, essays) James Carroll (essays, history, religion in society) Margaret Cheney (biography) Robert Coles (essays, criticism) Alistair Cooke (journalism) Stanley Crouch (journalism, music criticism) Jared Diamond (history) Joan Didion (essays) Annie Dillard (essays, nature) Barbara Ehrenreich (social science, cultural criticism) Gretel Ehrlich (science, travel) Loren Eiseley (anthropology, nature) Joseph Ellis (history) Barbara Fields (history) David Hackett Fischer (history and economics) Frances Fitzgerald (journalism, history) Eric Foner (history) Thomas Friedman (economics) Henry Louis Gates, Jr. Horton (history) Sue Hubbell (science) Michael Kammen (history) Tracy Kidder (social change, travel, New England) Elizabeth Kolbert (science) Paul Krugman (economics) Mark Kurlansky (history) Jane Jacobs (architecture, cities) William Least Heat-Moon (travel) Jill Lepore (history) Matthys Levy (science) Barry Lopez (science) J. Anthony Lukas (journalism, history) Pauline Maier (history) Norman Mailer (essays, journalism) William Manchester (history) Howard Mansfield (history, preservation, New England) Mary McCarthy (essays, criticism) Edward McClanahan (essays) David McCullough (history, biography) John McPhee (science) John Hanson Mitchell (nature, history, New England) N. Scott Momaday (memoir) Samuel Eliot Morison (history) Lance Morrow (journalism, essays) Bill Moyers (journalism, essays) Mary Beth Norton (history) Henry Petroski (science and technical subjects) Nathaniel Philbrick (history) Steven Pinker (science) Michael Pollan (science) Anna Quindlen (journalism, essays) Chet Raymo (science) Matt Ridley (science) Richard Rodriguez (essays, memoir) Oliver Sacks (science) Carl Sagan (science) Simon Schama (history) William Shirer (history) Sebastian Smee (art criticism) Dava Sobel (science) Shelby Steele (history) Alan Taylor (history) Studs Terkel (journalism, sociology) Paul Theroux (travel) Lewis Thomas (science) Hunter S. Thompson (cultural criticism) James Trefil (science) Barbara Tuchman (history) Laurel Thatcher Ulrich (history) Jonathan Weiner (science) Cornel West (cultural criticism) Walter Muir Whitehill (history) Gary Wills (history) E. Suggested Authors of Contemporary and Historical World Literature Grades 9­12, in addition to the grades 5­8 selections Contemporary and Historical World Literature32 Chinua Achebe (fiction, poetry, essays) S. Agnon (fiction) Ilse Aichinger (fiction, drama, poetry, nonfiction) Bella Akhmadulina (poetry, fiction, essays) Anna Akhmatova (poetry) Rafael Alberti (poetry, drama, memoir) Claribel Alegrнa (poetry, fiction, nonfiction) Isabel Allende (fiction, memoir) Kingsley Amis (fiction, nonfiction, poetry) Jerzy Andrzejewski (fiction) Jean Anouilh (drama) Fernando Arrabal (drama, fiction, poetry, nonfiction) Nadeem Aslam (fiction) Margaret Atwood (fiction, poetry, nonfiction) Alan Ayckbourn (drama) Isaac Babel (fiction, drama) John Banville (fiction, drama) Julian Barnes (fiction, nonfiction) James Berry (fiction) Heinrich Bцll (fiction) Jorge Luis Borges (fiction, poetry, essays) Joseph Brodsky (poetry, essays) Mikhail Bulgakov (fiction, drama) Dino Buzzati (fiction) A. Byatt (fiction, essays) Italo Calvino (fiction, essays) Karel Capek (fiction, drama) Peter Carey (fiction) Carlo Cassola (fiction) Constantine Cavafy (poetry) Camilo Josй Cela (fiction) Arthur C. Coetzee (fiction, essays) Julio Cortбzar (fiction) Anita Desai (fiction) Isak Dinesen (fiction, memoir) Roddy Doyle (fiction, drama) Margaret Drabble (fiction, nonfiction) Odysseas Elytis (poetry, essays) Brian Friel (drama) Athol Fugard (drama) Gabriel Garcнa Mбrquez (fiction) Federico Garcнa Lorca (poetry, drama) Jean Giraudoux (drama) Nadine Gordimer (fiction) Seamus Heaney (poetry, drama) Wolfgang Hildesheimer (fiction, drama) Ted Hughes (poetry) Kazuo Ishiguro (fiction) Juan Ramуn Jimйnez (poetry) Yury Kazakov (fiction) Thomas Keneally (fiction, drama, nonfiction) Milan Kundera (fiction, essays) Stanislaw Lem (fiction, essays) Doris Lessing (fiction, essays, memoir) Primo Levi (fiction, memoir, essays) Jakov Lind (fiction) Clarice Lispector (fiction) Louis MacNeice (poetry, drama, nonfiction) Naguib Mahfouz (fiction) Yann Martel (fiction) Ian McEwan (fiction, drama) Czeslaw Milosz (poetry, nonfiction) Gabriela Mistral (poetry) Alberto Moravia (fiction) John Mortimer (fiction, drama) Alice Munro (fiction) Haruki Murakami (fiction, nonfiction) Iris Murdoch (fiction, drama philosophy) V. Naipaul (fiction, essays) Pablo Neruda (poetry) Kenzaburo Oe (fiction, essays) Ben Okri (fiction, poetry, essays) Michael Ondaatje (fiction, poetry, nonfiction) John Osborne (drama) Orhan Pamuk (fiction) Alan Paton (fiction, essays) Cesare Pavese (fiction, poetry, essays) Octavio Paz (poetry) Harold Pinter (drama) Jacques Prйvert (poetry, drama) Alexander Pushkin (poetry, drama, fiction) Salvatore Quasimodo (poetry) Santha Rama Rau (fiction) Mordecai Richler (fiction, essays) Arthur Rimbaud (poetry) Pierre de Ronsard (poetry) 32 Many of these authors wrote partly or entirely in languages other than English. Some of their work may be accessible in the original to English learners or to students studying world languages in school. Others have been translated into English more than once, and teachers may wish to have students compare different translations of the same material as a close reading activity. Massachusetts Curriculum Framework for English Language Arts and Literacy 170 Arundhati Roy (fiction, essays) Salman Rushdie (fiction, essays) Josй Saramago (fiction) Ignazio Silone (fiction) Isaac Bashevis Singer (fiction, memoir) Alexander Solzhenitsyn (fiction, nonfiction) Wole Soyinka (poetry, drama, essays) Tom Stoppard (drama) Graham Swift (fiction) Dylan Thomas (poetry) Marina Tsvetaeva (poetry) Niccolт Tucci (fiction) Mario Vargas Llosa (fiction, drama, nonfiction) Paul Verlaine (poetry) Andrei Voznesensky (poetry) Derek Walcott (poetry, drama) Elie Wiesel (fiction, nonfiction) Yevgeny Yevtushenko (poetry) George Seferis (poetry) Lйopold Sйdar Senghor (poetry) Peter Shaffer (drama) Massachusetts Curriculum Framework for English Language Arts and Literacy 171 Appendix C: Glossary of Terms this glossary contains terms found in the Massachusetts Curriculum Framework for English Language Arts and Literacy as well as other terms related to reading and literature, writing, language, and discourse. Language of school and study, required for success in academic work; words and phrases used across subject areas. Word that describes somebody or something: for example, old, white, busy, careful, horrible. Form indicating a greater degree, used to compare two nouns: for example, better is the comparative form of good, and happier is the comparative form of happy. Form indicating the greatest degree, used to compare three or more nouns: for example, best is the superlative form of good, and happiest is the superlative form of happy. Modifier for a verb, an adjective, or another adverb; tells when, where, why, how, how often, or how much. Word part added to a stem to form a new word: for example, disrespectful is formed of the prefix dis- and the suffix -ful affixed to respect. Added to the beginning of a base word, root, or root word that changes the sense or meaning of the root or base: for example, the prefix dis- added to the root word comfort forms a word meaning the opposite of the original. Like assonance, consonance, and rhyme, alliteration is often used to create a musical quality in language, to emphasize certain words, or to unify a poem or song. Reference to a person, place, thing, or event presumed to be familiar to the audience. Principle that letters and combinations of letters have a predictable and systematic relationship to sounds of speech (phonemes). Written English is far from purely alphabetic because it includes many sounds that can be represented by different combinations of letters: for example, the "f" sound can be represented by f as in foot, ph as in phone, and gh as in enough, while gh signifies different sounds in ghost and thorough.

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Once the diagnosis is made menopause mood swings purchase cheap dostinex, appropriate treatment should start with a proper clean-out followed by maintenance therapy women's health center wv purchase dostinex 0.5mg free shipping. The clinician should not be fooled by the symptom of tenesmus pregnancy 6 months order dostinex with a visa, where the patient has a feeling of constantly needing to pass stools despite having an presence or absence of anorexia and nausea than do direct questions about appetite or nausea menstrual 35 day cycle order cheap dostinex online. Vomiting associated with acute pain is usually related to intestinal disease, such as ileus, gastroenteritis, or acute problems of the gastrointestinal tract that warrant surgery. The three general localizations of midline "visceral" abdominal pain are epigastric (1), periumbilical (2), and hypogastric (3). The child who seems only mildly ill but moves with great care, if at all, is assumed to have an inflammatory process until it is proven otherwise. Older children should be asked to get onto the examination table with as little assistance as possible. If the child does this easily, the probability of an acute intraabdominal inflammatory process is quite low. Outer bulky clothing should be removed to allow good exposure of the abdomen without the child having to feel vulnerable. The examination must be performed in a relaxed, friendly manner with attention fully focused on the child. A conversation with the child about family, friends, pets, school, sports, music, or other specific interests of that child diverts attention (distraction) from the examination and increases cooperation. The absence of fever does not exclude the diagnosis of acute appendicitis or other problems necessitating surgical intervention. Tachycardia may reflect anxiety or may be caused by dehydration, shock, fever, or pain. Tachypnea suggests a metabolic acidosis (shock, diabetes mellitus, or toxic ingestion), an intrapulmonary process, sepsis, or fever. The vital signs must be viewed in context but may be the first clue to a serious illness. Examination of the head, neck, chest, and extremities may precede the abdominal examination. In children too young to describe the location of the pain, a careful examination of the ears is important, but can be performed at the end of the examination. Streptococcal pharyngitis or mononucleosis is sometimes accompanied by severe abdominal pain. Affected children will present with fever, appear ill, and have tender cervical adenopathy and an obvious tonsillitis, pharyngitis, or both. Decreased breath sounds and/or rales in a lower-lung lobe, especially on the right side, may indicate pneumonia. Children with lower lobe bacterial pneumonia present with severe abdominal pain, high fever, tachypnea, and, on occasion, vomiting. This presentation could mimic that of a child with peritonitis; however, the abdominal findings are not consistent with the diagnosis of an acute intraabdominal process, and examination of the lungs should demonstrate the pneumonia. The abdominal examination should be performed systematically and with the child as comfortable as possible. Inguinal and femoral hernias are often overlooked but a common cause of abdominal pain. Next, the child should be asked to indicate with one finger the point of greatest pain. The point may be a vague circle in the area of the umbilicus, but if the child specifies a defined spot, the examiner should avoid that area until the remainder of the abdomen has been palpated. The examiner must warm both hands and the stethoscope before touching the patient. Auscultation of the chest can simply be extended to the abdomen, with the examiner assuring the child that the stethoscope did not hurt on the chest. Tenesmus can be seen in the setting of proctocolitis or inflammatory bowel disease and is often misinterpreted by the patient as constipation. The presence of headache, sore throat, and other generalized aches and pains moves the examiner away from a diagnosis of an acute problem warranting surgery and strongly suggests a viral flu-like illness.