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It was important to be curious treatment 31st october cheap 2.5 ml xalatan free shipping, and important to explore different intellectual worlds medicine 02 generic xalatan 2.5 ml on-line, but it was crucial to seek connections medicine zofran generic xalatan 2.5 ml on line. The model that worked magnificently for him will never make anyone else another Leonardo medications to avoid during pregnancy buy xalatan with mastercard, but it cannot fail to make everyone more creative symptoms melanoma xalatan 2.5ml mastercard, and more effective practitioners in whatever intellectual world they inhabit medications heart disease generic 2.5ml xalatan free shipping. Dake, Iowa State University this presentation will survey three applied research projects in the scholarship of teaching and learning that have attempted to create a new systematic curricular frame for brain compatible visual education. Utilizing knowledge from neuroscience to focus curricular activities and modify pedagogy, these three extended educational research projects have successfully sought to simultaneously improve visual arts education and emphasize its importance as basic to general learning. In will begin my talk by summarizing research in the learning sciences that reveals the sorts of learning environments that foster deeper conceptual understanding, thinking ability, and problem solving ability. I then describe how improvisational collaborations among students can contribute to these learning outcomes. My concluding message is that collaborative improvisation should play a central role in classrooms that are designed according to learning sciences principles. Thinking in and outside of the arts Ellen Winner, Boston College, Chestnut Hill Through an intensive qualitative study of 5 visual arts teachers, we identified six habits of mind taught in visual arts classes: observe, envision, express, reflect, engage/persist, stretch/explore. The first hypothesis we are testing is that students trained in the visual arts should show superior ability to reason about geometry. We are embarking on a quasi-experimental two-year longitudinal study testing this hypothesis. I will also discuss a second ongoing 5-year longitudinal study, conducted with Gottfried Schlaug, investigating the effects of instrumental music training on brain and cognitive development. Recent analyses show enhanced corpus callosum growth after instrumental music training. How can we envisage suggestions for techniques in learning to engage the emotions Dance represents one of the most complex motor activities that human beings engage in, both spatially and temporally. The psychology of spatial cognition contrasts two frames of reference: egocentric (body centered) and allocentric (object centered). How does dance learning carry over to other motor skills, such as athletic skill or musical-instrument learning The ability of humans to synchronize their movements to timekeepers like musical beats is considered to be an evolutionary novelty of our species. Does it carry to other motor skills requiring precise timing, such as athletic skills Do improvements in timing production through dance training lead to improvements in timing perception, and vice versa The issues raised in points 1 and 2 can be studied using neuroimaging techniques, not least in a longitudinal fashion during the course of learning a dance sequence. There is good neural evidence that learning a dance sequence activates premotor circuits involved in mental simulation of action. Hence, action perception and mental simulation of action seem to be highly linked. How does expertise in dance modify neural circuits for action perception in general As such, dancing often helps people increase the expressiveness of their body movements, including their facial expressions. In what ways does it influence their ability to interact with other individuals in a cooperative manner In many traditional cultures (but not so much our own), dance is an important means of enculturating people and teaching them about significant figures and key events in the history of their group. Anthropological research in traditional cultures could look at how children learn about the identity and history of their social group through dance narratives. We have developed a syllabus that aims to introduce some of the principles of visual neuroscience and show how artists have implicitly (and occasionally explicitly) taken advantage of these in developing works of art. The sample syllabus hi-lights how these issues can be approached in the undergraduate classroom setting, with hands-on laboratory exercises and self-directed learning projects. The syllabus is a work-in-progress and will be modified following each semester it is taught. This experience, along with extensive discussions between the co-authors, resulted in a full-semester course in the spring of 2008 for a group of 10 Wellesley undergraduate students. The students were selected from a diverse set of backgrounds including Economics, Film, Cognitive Science, Neuroscience, Physics and Chemistry. Following the course, students were asked: Do you think the study of art is enhanced by an understanding of the visual system and visual processing The responses were generally positive, and illustrate both the successes and failures of such a curriculum. What seems most clear from the first version of this course is that students benefit most from hands-on laboratory exercises, even in developing what seem to be the most basic visual neuroscience concepts. We conclude that concepts in visual neuroscience can be motivated by studying visual art, and can plausibly be communicated with simple laboratory exercises. A sample lesson plan is included as Appendix V 42 Projection of Research Directions Dennis M. Dake, Iowa State University this paper will suggest several areas of emphasis in which future research agendas might be focused to explore the impacts visual arts education could make on creativity, learning and general cognitive abilities. Does brain compatible visual education create a differential use of specific aspects of the visual perception system in the brain A number of scientific studies have provided evidence that illustrate significant differences between the way artists use their brains to collect and transform information from the visual world and the way other disciplines train the brain. Starting from these beginnings it is important to understand how these thinking abilities might support improved artistic ability and be integrated into an improvement of learning and creative skills for education generally. Zangmeister, Sherman, and Stark (1995) found large differences between naive subjects (bioengineering graduate students), and two groups of subjects, (Sophisticated art collectors and professional artists) in both reliance on global scanpaths and rate of eye blink. Given that Scanpath theory hypothesizes that internalized cognitive models drive eye movements could visual arts education make a contribution to learning by externalizing internal cognitive models for examination The sketchbooks of professional artists demonstrate such natural structural fluency. Jones-Gottman and Milner (1977) found that patients with right frontal and right fronto-central lesions were severely impaired in fluency. Does brain compatible visual education increate effective use of fluency in the brain Can we identify neural correlates of established visual processes that are demonstratively basic to discipline of artistic thinking The challenge here would be to specify thinking skills that are basic to the discipline of art making and explore them in depth along with their applicability to learning across a variety of non-art disciplines. This would need to be done not only with empirical methodology but also in light of the ideas of professional artists and the visual record of the generative practices embodied in their preparatory work. It is the significant ability to see the world in other than literal meaning alone. Standardized tests of physiognomic perception exist and could be used to show its usefulness both in art and non-art disciplines. Allusive thinking by appearance alone lends intuitive judgment to overly rational thought and can lead to the discovery of meaningful metaphors. This type of thinking could be developed with focused visual education methods and its applicability shown in a variety of academic disciplines. Can greater understanding of arts role in education be obtained through applied research within heterogeneous schooling environments at a variety of age levels This authors experience is that professionals trained in a visual discipline require evidence of qualitatively superior visual outcomes for validation. What seems to be needed, in conjunction with basic empirical research, is a body of applied research in shaping pedagogy and content based on neurological findings and subsequently assessing the effect on creativity and learning by both measurable quantitative and triangulated qualitative means. Arts professionals must see that brain 44 compatible education is a discipline worthy of emulation and not only as activity that is useful in amplifying traditional logo-centric educational goals. More focused forms of sensory learning content and activities should be tested in real world educational environments aiming for measurable as well as qualitatively superior visual outcomes. Long-range projects in collaboration with professional arts educators can build a strong integrated understanding of arts role in increasing learning and creativity within the educational community. In both basic neuroscience and applied educational research a future research agenda should capitalize on these beginnings and systematically explore how specific, well-defined thinking skills contribute to growth within the visual arts discipline and support for learning generally. In consequence the definition of art is constantly changing in relation to its time and for us to be using models from the Renaissance five hundred years ago is not as useful as dealing with the work of living artists. I would like to use the powerful tools of observation afforded by psychoanalysis as a basis for describing the products of the brain and in particular art, which is a complex product of the brain that seems to range across a number of functions. On the basis of a broader empirical approach to what the brain produces and how it functions in making art I would like to reexamine the physiology. My feeling is that the biological and anatomical approaches we have been using still rely on too static a model (a modernist model) of development and function and I would like to see us look at physiology with the hypothesis that physical characteristics and functions are inherently unstable (a postmodern model) and that a structural approach in which the parts are constantly undergoing dynamic modification and redefinition on an unpredictable basis might lead us in fresh directions. Understanding how we symbolize our experience, how we use symbolic form to organize our psyches, and what the neuroanatomical corollaries to these processes are will have obvious implications for learning. It affects the neural transcription of sound not just for music but also for speech and other environmental sounds. Musical experience also impacts the neural correlates of higher-level cognitive processes such as mathematics and language. Complex auditory experience strengthens corticofugal feedback loops in the auditory system, enhancing the frequency and duration tuning of subcortical auditory nuclei. The multisensory nature of music engages multiple sensory systems (visual, tactile and auditory) and appears to have profound influences on corticofugal mechanisms engendering auditory plasticity. Reading requires accurate neural transcription of key acoustic elements common to both speech and music. The common pathways in speech and music processing, the ubiquitous human appeal for music and its inherent emotional and social functions make it an attractive avenue for the pursuit teaching reading and for remedial treatments. Use of music to facilitate learning: Pairing music with other learning strategies has proven enormously successful for teaching phonics. Musical training enhances the auditory working memory, which may account for its successful application in general education. Cognitive effects of musical experience are of interest to musicians, educators and scientists alike. Related investigation necessitates a platform for interdisciplinary conversations with representatives from all three fields. Potential outcomes include the development of classroom, web-based and computer-based (standardized) components of music-based learning. Understand how musical experience impacts learning throughout the lifespan: Musical experience influences neural development in various domains, even when children have had only one year of training. Long-term musical experience on development is known to last for years and it is possible that such experience may provide protective effects against aging and the disruptive effects of hearing loss. Longitudinal studies are currently lacking yet needed to disentangle the roles of a) biological predisposition and experience, b) permanence of neural influences of musical experience and c) optimal periods in musical development. Neural bases of successful music-driven learning: 47 With the ability to identify the putative neural factors associated with successful learning-through-music and locate them in the nervous system will come the promise of more focused and effective strategies for learning. Rather than focusing on whether there are effects of musical experience on the nervous system, the better question is: in which individuals/cases are measurably changes associated with musically-driven learning Therefore, focusing efforts on ways to look for factors contributing to successful learning outcomes is necessary. The logical next question becomes: how can we design training strategies to promote development of these factors Objective and individual-subject measures of neural function: the behavioral nature of the task can influence results. This underscores the need for objective physiological measure of auditory learning that do not rely on the cognitive and attentional state of the listener or a behavioral response. Objective neural measures of neural function (combined with behavioral metrics) are needed to assess outcomes. The heterogeneity of learning strategies necessitates use of measures of neural function which can assess these factors in individual subjects. Keith Sawyer, Washington University It has been difficult to prove that arts education enhances learning in non-arts content areas, such as math, science, literacy, or social studies. Perhaps the key distinguishing feature of the performing arts, in contrast to other arts, is that they are deeply collaborative. And a broad range of learning sciences research suggests that collaboration contributes to particular learning outcomes: deeper conceptual understanding, thinking, and problem solving in real-world domains. So I would like to see research studies that focus on collaborative arts, which would probably focus primarily on performance (although even painting and writing can be taught in collaborative ways).

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From Cape Verde to Sierra Leone the extraordinary topography symptoms xylene poisoning generic xalatan 2.5ml overnight delivery, numerous silt laden rivers treatment yellow tongue generic xalatan 2.5 ml visa, high tides that periodically covered the terrain top medicine buy xalatan 2.5ml line, and mangrove roots that hold the alluvium produce the richest soil in West Africa symptoms 4 days post ovulation generic xalatan 2.5 ml amex, ideally suited for rice production treatment 4 syphilis buy cheap xalatan 2.5ml. Knowledge of terrains and tides treatment table buy genuine xalatan, sluice gates and soil types, rivers and rice, the slaves from West Africa brought to the fields of South Carolina. April brought the sowing when slaves dropped the rice seed into trenches and covered them by the foot. Then sluice gates, opened at high tide, flooded the fields until the seeds sprouted. After draining and hoeing, came the "long water" that submerged the fields for three weeks to destroy insects and grass, followed by another three weeks of the excruciating work of hoeing. Toward mid July the harvest flood began when heavy heads of ripening rice were supported by water. September brought final draining, harvesting with rice hooks, drying, tying in sheaves, stacking, and the difficult task of flailing off the heads of the grain, then winnowing to separate the grain from the chaff by fanning in the wind. D12 Low Country Gullah Culture Special Resource Study When a New World slave plants rice by pressing a hole with his heel and covering the seeds with his foot, his motion is just like that found in parts of West Africa. When blacks sow rice with a gourd or hoe in unison to work songs, the cultivation and the singing too are echoes of traits learned long ago from African ancestors. The term "trunk" for a sluice gate is from West African usage, where a hollow log plugged at one end acts as a valve. Even the mortar and pestle so efficient for removing husks from rice grains are derived from similar instruments of their homeland. Finally, when threshed grain is fanned in the wind, those wide, flat winnowing baskets used are like the ones known for centuries in Africa. In rice production blacks adapted their basic skills and work patterns to a different labor system, a process of cultural creolization. Although the task system treated them as individuals, the strong helped the weak as they worked in groups, much as they had done in their homeland. In a ritual practiced in Sierra Leone and in the Sea Islands, one first picks out any dirt or dark grains, and then washes the rice vigorously between the hands. The method of cooking it in South Carolina, described as early as 1756 by Eliza Lucas Pinckney, producing separate fluffy grains, is derived from Africa in contrast to the way in China. An imaginative use of spices by slave cooks was also in part inherited from Africa, and influenced whites. Many blacks who live today where rice once held sway are descended from those who prepared the soil and grew and cooked the glistening grain beside the rolling tides of their West African homeland ages before. A Dyeing Art: Indigo the development of the dye indigo in South Carolina is, quite literally, a colorful story. Color, intimately woven into the fabric of our lives, has always fascinated mankind. Dyes predate history, add variety to clothes and homes, and signal social status, like the purple long known as the color of royalty. Indigo, derived from a species of Indigofera, has been used for more than 4000 years. The shrubby legume, with pinnate leaves and dull reddish purple flowers, was known to the ancients of Asia, Egypt, Greece, and Rome. Before European contact indigo was known to the Kanuri dyers of the Cameroun who carried it from Bornu to the region of Lake Chad. An official at Cape Coast Castle on the Gold Coast reported in 1766 that, "There is a Sort of Indigo grows wild here that the Natives make use of and is of a very lasting dye. When he returned to the West Indies, he put his 16 year old daughter Eliza in charge of his plantation on the Wappoo, a salt creek connecting the Ashley with the Stono River. Eliza was an unusually bright, energetic, strong minded, young lady who began immediately experimenting with crops that would grow best in the sandy, fertile soil of coastal Carolina. Arising at five each morning, she found time not only for agriculture but also for extensive reading, music, needlework, and writing, including those letters that record her work and thoughts. By July, 1739, she mentioned in a letter to her father "the pains I had taken to bring Indigo, Ginger, Cotton, and Lucerne (an alfalfa) and Casada (cassava The leaves must be soaked in water until they ferment, froth, and give up their coloring matter, a process that can take several days, when the head man or "Indigo Maker" must watch day and night. The National Park Service D13 liquid is then drained off into a second vat clear of leaves where it is beaten with paddles until it begins to thicken. After it is led into a third vat and allowed to settle, the sediment is formed into lumps or cakes and dried. Dissatisfied with the product turned out by a white overseer, Eliza soon found where the fault lay and reported greater success when Governor Lucas sent her a black man from one of the French islands. Eliza devoted virtually the whole crop of indigo of 1744 to making seed which she gave to planters. Aided by a bounty paid by the British to exclude the competing French, planters could double their capital every three to four years. Just before the American Revolution the annual export was an incredible 1,107,660 pounds. The loss of the British bounty after the Revolution, the cheaper labor in the Indies, and the easier cultivation of cotton led to its demise by the end of the century. While there is no proof that Africans were deliberately imported for their knowledge of indigo, many were clearly experienced in the production and use of the dye in their homeland. How rice and indigo culture complemented each other and compounded the labor of the black worker is indicated by this comment by Governor Glen in 1761. Many other items of field and forest were also exported, including "Pease," Oranges, Butter, a little silk, and even cotton that would in time dominate the economy of the whole South. Magic Thread: Cotton That ball of shiny white fiber that supplies three fourths of the clothing of the world has been known for millennia. The domestication of Old World tree cotton (Gossypium arboreum) probably began in East Africa before 2500 B. Kano in Nigeria has been a cotton market since the ninth century, and cotton cloth was brought from the Guinea coast to England in the sixteenth century. Both species, disseminated by the Spanish into Spain and by the Portuguese into Africa, soon replaced Old World cotton. The sea islands of Carolina and Georgia, with 280 frost free days a year, has the ideal sandy soil, temperature, rainfall, and labor necessary for the growth of long staple cotton, so much in demand. Just exactly when and how an annual long staple cotton, able to grow on long summer days, came to the Sea Islands is open to debate. In the most appealing account, Frank Levett in Georgia received bags of cotton seeds from Pernambuco, Brazil, in 1786. Desiring the bags more than the seeds, he dumped them out on a dunghill, found plants growing there the following spring, continued their cultivation, and was pleased to find instant popularity of the product in London. Yet Alexander Bisset D14 Low Country Gullah Culture Special Resource Study is said to have grown the first crop of long staple cotton on a sea island of Georgia from seed from Bahama as early as 1778. Cotton cultivation was labor intensive, requiring back breaking work year around. In January and February, workers had to manure the fields; in March, they planted the seed. After the clusters of plants sprouted, the slaves thinned them with hoes, and in the hot summer months they weeded the surviving plants six to eight times. After "topping" the cotton to limit the upward growth in August, slaves began picking the ripe bolls through October, often 100 pounds a day. Beginning in November and continuing into the next year, the seeds were removed from the lint by hand; after picking out trash, the laborers hand packed the cotton lint into bags. The demand for sea island cotton is illustrated by the record of its export from South Carolina in the last decade of the eighteenth century. In 1790, 9,840 pounds were sent forth from the newly created state; by 1801, the export rose to 8,301,907 pounds. It continued to be a powerful economic force for many years, reaching its height of production in 1819. As the value of indigo declined, sea island cotton took its place alongside rice as a major crop for export. Despite its fine qualities, long staple cotton declined in production as the short staple variety increased. Sea island required more labor, cost twice as much, and was more vulnerable to the ravages of the boll weevil. By the 1860s one hundred times as much upland as sea island cotton was produced throughout the country. While there is no proof that native Africans were deliberately imported for their knowledge of cotton growing, both upland and sea island species were grown in Africa during the slave trade. Economic pressure drove blacks of the Low Country to labor to produce plants their ancestors had known and enjoyed in their homeland. Under the task system on the Sea Islands each slave was given a specific assignment, such as picking three acres of cotton a day. During the peak of a harvest season the "work day" could last into the night, but when the task was light one had free time in the afternoon to hunt, fish, or garden. This time off, rather than the work day alone, shaped and preserved the culture of the Gullah speaking people. While rice, indigo, and sea island cotton were the big three of the economy of coastal South Carolina for more than a century, they do not exhaust the long list of crops cultivated by black labor, some of them imported from Africa. Ships were provisioned on both sides of the Atlantic; cultigens from each side, brought to the other, were often deliberately grown there. African plants enriched the soil of Carolina as bondsmen provided a botanical bond between two continents. Trans Plants as Food Africa is home to many life sustaining crops, including nine cereals, half a dozen root crops, five oil producing plants, a dozen forage crops, a dozen vegetables, three fruits and nuts, coffee, sesame, and the ancient and ubiquitous bottle gourd or calabash useful as a drinking cup, float for fishnet, or sound box for music. West Africa alone is the locus of origin of cereals such as Guinea millet, fonio, African rice, pearl millet, and sorghum (Guinea corn); cowpeas; okra; some species of yam; oil palm, and the akee apple, as well as some varieties of Old World cotton. National Park Service D15 Valuable plants were also imported into Africa from other continents. When Spanish and Portuguese galleons sailed between the Old World and the New, they carried more than people and treasure; they engaged in the greatest transport of plants and animals the globe has ever known. Among nineteen species from Central and South America transplanted to Africa, none is more important for feeding humanity and has a more colorful history than corn or maize (Zea mays). As colonists learned from the Indians how to cultivate this major food crop, it became the bridge by which European civilization gained a foothold in the New World. Brought by the Portuguese and Dutch from Guiana and Brazil, it was known on the coast of West Africa perhaps as early as 1502 and clearly by 1525. Names for maize in local languages correlate with its entrance through trading centers like Port Harcourt in Nigeria. By the seventeenth century, it was an important foodstuff from Liberia to the Niger Delta, especially on the Gold Coast and Dahomey; established as a valuable crop in the Congo Basin and Angola; and significant for provisioning slave ships. Tobacco, peanuts, cacao, and beans, first grown in Latin America, also spread to Africa. Africans brought to South Carolina were thus familiar with cultivation of many useful crops. Descriptions and illustrations of naturalists of the time, such as Catesby (1771), Barton (1798), and Elliott (1821), identify species known to African Americans. Of at least nineteen plants introduced by Africans into the Americas, most flourished in the West Indies, including some varieties of yams, the akee apple, the Angola or pigeon pea, broad beans, maroon cucumber, senna, bichy nut, and oil palm. Best known from West Africa is that tasty mucilaginous vegetable, okra or gumbo (Abelmoschus esculentus). First domesticated in tropical Africa, it spread widely along the Guinea coast and into the Cameroons by the time of the slave trade and was brought to the Americas in the 1600s. Since "okra" is from nkruman in the language of the Gold Coast and "gumbo" is from tshingombo in Bantu languages, the popularity of this plant is evident. Benne seed, from a word in Bambara and Wolof, is also called sesame (Sesamum indicum). Probably first domesticated in East Africa, it was widespread on the continent at the time of the slave trade as a valuable source of oil. In 1730 Thomas Lowndes of South Carolina sent samples of oil made from "sesamum" to the Lords of the Treasury. Best known today on cookies or in candies, it was brought with blacks to Carolina where it was also used in soups and puddings. The black eyed or cow pea (Vigna unguiculata) is an import from West and Central Africa that found its way to the West Indies and the Low Country. First domesticated at the margin of the forest and savannah in tropical West Africa, its seeds are known from Kintampo in central Ghana as early as 1800 B. Introduced into the New World tropics by the Spanish no later than the seventeenth century to supply towns and missions, it was known in the southern United States by the early eighteenth century. Taken from Brazil to Africa around 1500 by the Portuguese, it established a secondary center in the Congo; was cultivated in Senegambia in the 1560s, and was widespread in West Africa by 1600. Eggplant (Solanum melongena) originally cultivated in India, was brought by Arabs into Spain and by Persians into Africa before the arrival of Europeans. Widespread from Senegal to Cameroun, it is known not only as a food but also as a medicine and as a symbol of fertility. Watermelon (Citrullus lanatus), a native of the dry savannah of east and south Africa, was grown in the Nile valley by 2000 B. Brought by Spanish colonists to Florida in 1576, it was enthusiastically accepted by the Indians who passed seeds from tribe to tribe like smoke signals; by 1600 it was known D16 Low Country Gullah Culture Special Resource Study all the way to the Pueblos of the southwest. Guinea corn or sorghum, first domesticated in the Central Sudan and distributed to West Africa probably before 1000 B. But little of this grain is propagated, and that chiefly by the Negroes, who make bread of it, and boil it in like manner of furmety.

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Only online applications for admis If you are interested in applying and do not sion are accepted and must be received by have the prerequisite courses medicine hat alberta canada purchase generic xalatan from india, you may want December 15. In the past, applicants have taken advanced courses in engineering science the prerequisites at their present schools, and in biomedical science. Courses taken mathematics, and other physical science at any accredited college or university are courses to be taken are arranged between acceptable. A Masters degree is not required for course work in engineering, mathematics admission to our program. In addi respondence and supporting documents tion, students must complete eighteen credit should be sent directly to the Johns Hop hours of course work in the life sciences. Program offce for admis Department of Biomedical Engineering, see sion consideration if his/her application is not the departmental statement on page 126. For accepted by the Medical School admissions additional courses available to students, see committee. Students must fulfll a modest teach in research and development, or as a step ing requirement during one year of their pro toward Ph. The remaining time is spent in thesis program, which is designed to be completed research. The program typically takes fve to in two years, consists of core courses, elec six years to complete. The proj the student must pass a preliminary oral ect may be basic research in a laboratory or examination which will be a Doctor of Philoso practical engineering, related to patient moni phy Board examination. The student must then conduct original research, describe it in Admission and Financial Aid a dissertation, and pass a fnal oral exami Students with undergraduate degrees in nation that is a defense of the dissertation. Exceptional There is a minimum residency requirement of students with degrees in basic sciences may two consecutive academic years. Although the combined tised by various laboratories in the institution programs would normally require at least to carry out specifc research and develop seven years to execute sequentially, the com ment projects. Students without a research bined program can ordinarily be completed in assistantship are expected to pay full tuition six years, with appropriate planning. Fellowships are also awarded preparation in biology and chemistry as well to the top students in the program. Applica as mathematics, engineering, and the physi tions for admission are due by the appointed cal sciences is essential. For more ate requirements are met by the frst-year information and to apply online, go to Degree students interested in clinical research and Each student will take a minimum of 24 cred applications in hospital systems and in the its of courses at the 400-level or higher and delivery of health care. Students fulfll the course School of Medicine should be consulted for requirement by taking two courses in the admissions requirements and procedures. Applica sequence and take 8 credits from advanced tions submitted for consideration of the com engineering, math or science. If the Medical providing support to one of three lab-based School admissions committee accepts the undergraduate courses and six core lecture application, it is then passed along to the Bio courses each semester. Program admis dents must complete a thesis based on a sions committee for review. A student apply research problem requiring application of ing to the combined program who wishes to quantitative or applied engineering principles be considered for the straight Ph. This examination will normally take place applicants with varied interests and diverse during the second year of residency. Requirements for the completion of the thesis, the student must these two programs are given below. Appli satisfactorily complete a comprehensive oral cants should feel free to discuss with the examination administered by the Department department which program is most appropri of Biophysics and Biophysical Chemistry. Dissertation: Completion of an original Biophysics and Biophysical investigation and presentation of a disser tation is required. The dissertation must be Chemistry Program accepted by the department and must be considered worthy of publication by referees Requirements for Admission nominated by the department. However, defciencies fundamental principles of biophysics and in some of these subjects can be made up contemporary advances in the feld. Degree for learning in diverse and changing areas During the course of graduate study the of research. The carefully designed set of student must satisfactorily complete the fol courses and intensive laboratory work inte lowing program of courses in the Univer grate various aspects of molecular biophys sity or their equivalent at the intermediate or ics into a dynamic curriculum. Johns Hopkins has long been a leading this list does not constitute an infexible research institution of world renown. The program; exceptions and modifcations may Hopkins biophysics community is known for be made at the discretion of the department its collaborative and congenial atmosphere. Students must continue to Biophysics, Enzymes & Metabolic Pathways, make satisfactory progress toward completion Computation & Theory, Protein Design & of their thesis research and meet annually with Evolution, Single Molecule Studies a thesis review committee starting in their ffth semester. Once thesis research is complete, Requirements for Admission students must defend their thesis before a We encourage applications from students who fnal exam committee and present a fnal the have majored in biological sciences, biochem sis seminar. The methods and tools of biophysics are the program derives its strength from drawn from physics, chemistry, biology, participants with various interests and back mathematics and computer science. Individu curriculum: Physical Chemistry of Biological al needs can be interwoven into the required Macromolecules, Proteins & Nucleic Acids, curriculum. Optimal background includes Methods in Molecular Biophysics, Comput general chemistry, organic chemistry, physi er Modeling of Biological Macromolecules, cal chemistry, two semesters of college-level and Organic Mechanisms in Biology. These physics, biochemistry or molecular biology, courses provide a conceptual framework for and calculus or a high-level math course. Tutorials and self by a training grant from the National Institutes directed study provide alternative avenues for of Health. The program aims to involve students in International applicants will be required to research projects from the start. First-year demonstrate fnancial support for their stud students complete three 10-week rotations ies and will be required to deposit funds cov in laboratories of their choosing. At the end ering the frst two years of tuition and living of each rotation period, students present expenses with the University prior to April 15. By sum ner, any offer of admission to the Program in mer of the frst year, a student will have joined Molecular Biophysics will be null and void. Cell Biology Program candidacy after successful completion of a qualifying oral exam at the end of the second Prerequisites year. Beginning in the ffth semester, students the department will admit well-qualifed stu meet annually with a faculty thesis review dents to the program for work leading to the committee. Applicants should have thorough training in general Dissertation biology, chemistry and physics, or to remove Completion of an original Investigation and defciencies in these areas by means of presentation of a dissertation are required. Degree Requirements established by the Department How to Apply of Cell Biology and the Doctor of Philosophy Students must complete applications online Board of the University which must be met by ( Demonstrate evidence of achievement and ment of purpose should be sent to: Offce of promise in a comprehensive oral examina Graduate Student Affairs, 1830 E. Write a dissertation, embodying fndings ants will be invited to a Visiting Weekend to worthy of publication, and certifed to be a meet with faculty on both campuses, talk with signifcant contribution to knowledge by at students, and have a look around Baltimore. Present a fnal departmental oral exami students are supported for the frst two years nation/seminar in the feld of the disserta by a training grant from the National Institutes tion research certifed by from three to fve of Health. The department or program committee International applicants will be required to must certify in writing that all departmental or demonstrate fnancial support for their stud committee requirements have been fulflled. Students will generally fulfll the course If the funds are not deposited in a timely man requirements of the interdepartmental pro ner, any offer of admission to the Program in gram in Biochemistry, Cellular and Molecu Molecular Biophysics will be null and void. The Department of Cell Biology offers two Elective Courses programs of study leading to the Ph. Members of the department who the right to require students to take elective work in the area of cell biology participate in courses. Students are required to take understanding, diagnosis, treatment and four elective courses to further broaden their prevention of human diseases. Elective training in scientifc research and develop a courses may include courses at the School thorough knowledge of human biology and of Public Health and Homewood Campus. Elective course topics include bioorganic this program grew out of a need for gradu chemistry, biophysical chemistry, human ate training at the interface between medicine anatomy, immunology, pathobiology, phar and the traditional basic science disciplines. These laboratory rotations will be make discoveries in the laboratory that can approximately ten weeks long. At the end of be applied expeditiously to the diagnosis, the frst year, students will select a research treatment, and prevention of disease. New advisor from one of three rotation laborato technology allows scientists to identify genet ries and begin original research leading to ic and molecular defects causing or predis their doctoral dissertation. The trainees in this pro A University mandated Doctor of Philosophy gram are working precisely at this interface Board Oral examination must be completed by between science and medicine to contribute the end of the second year of study. Annual Students will work in well equipped labora meetings are held until such time as the the tories of approximately 125 program faculty sis committee believes the student is ready to located throughout the medical school cam write their doctoral dissertation. Requirements for Admission Financial Aid Applicants should have a bachelor degree with the program is supported by a combination undergraduate training in biology, inorganic of monies from the Lucille P. Cell biology and/or biochemistry are student is provided a stipend, health and recommended. Demonstrate evidence of achievement and medicine and related sciences, the history of promise in a comprehensive oral examination disease, and the historical analysis of related administered by the Doctoral Board, usually conceptual, cultural, and social problems. Students acquire facility in the methods of historical research and gain a wide acquain 3. Write a dissertation, embodying fndings tance with the available literature in the history worthy of publication, and certifed to be a of medicine, science, and related felds of his signifcant contribution to knowledge by at tory. Departmental offerings are particularly least two referees from within the department strong in the history of medicine and science and two referees from outside. Present a fnal departmental seminar in the and technology in the United States; 19th and feld of the dissertation research. The department or program committee health; health and society in China and Africa; must certify in writing that all departmental or and Russian and Soviet science. Students come to the Johns Hopkins Uni versity with diverse backgrounds including Core Courses medicine, science, and history. For further information, ary Biology, Biomechanics of the Skeleton, see our website at. Students who wish to combine medical training with academic training in the history Elective Courses of medicine may inquire about the M. Students must also take at least four elective program by writing the Director, M. Dinosaurs, Cladistics, Morphometrics, and Allometry), as well as elsewhere in the uni Requirements for Admission versity. Preference will be given to appli Ecology, Animal Behavior, Geobiology, Iso cants with training in some aspect of the tope Geochemistry). For further information applicants should write to Direc Rotations tor of Graduate Studies, Program in the Students must complete a formal research History of Science, Medicine, and Technol rotation with the faculty during their frst year. Stu the student must satisfy the requirements of dents are required to undertake pre-disserta the University, the School of Medicine, and tion research in the second year. Teaching Doctor of Philosophy Degree: the princi Training in teaching medical school Human pal requirement for the Ph. Prior to embarking Fellowships on full-time dissertation research, candidates Predoctoral fellowships covering normal liv will prepare themselves by a variety of cours ing costs and tuition are available. The specifc requirements for such the cornerstone of the program is the the felds are set by the faculty member direct sis project. The faculty (listed reading, and the passing of a comprehen below) come from clinical as well as basic sive examination and/or preparation of sev science departments, have a wide range of eral historiographic essays. Candidates must research interests pertinent to human genet also demonstrate a reading knowledge of two ics, and carry out well-supported research foreign languages before being admitted to programs. A wide admits students who wish to complete the choice of elective courses in diverse areas requirements for this degree. These include of genetics and molecular biology provides the demonstration of competence in the gen the means to achieve individual career goals. Support and demonstrated reading ability of one for ing activities include journal clubs, the short eign language.

Flush the tube one final time with at least 15 mL higher the osmolality medications kosher for passover buy xalatan australia, the greater the volume of diluent required 31 water medications or drugs 2.5ml xalatan otc. Restart the feeding in a timely manner to avoid be more practical to crush an acetaminophen tablet to a fine compromising nutrition status medications after stroke order xalatan 2.5 ml line. Hold the feeding by 30 powder and disperse in a smaller volume of water than to use a 21 minutes or more only if separation is indicated to liquid formulation that requires significant volume dilution symptoms zoloft withdrawal cheap 2.5 ml xalatan with visa. The data suggest no significant difference Medication that is in an appropriately powdered form medications not to take with blood pressure meds 2.5 ml xalatan otc, either in efficiency of crushing between methods treatment with cold medical term order xalatan master card. Dilution may be necessary for the be produced, and this may predict interaction potential. Confined enteral administration of liquid medications (ie, solutions, sus crushing yielded smaller particles, but all particles suspended pensions) to reduce viscosity or osmolality. Drug errors can additionally be undiluted drug suspension (posaconazole) through a 16 Fr related to inappropriate use of dosing instruments as well as 35 nasogastric tube resulted in a 23% lower bioavailability than health literacy. Most liquids are thick and Boullata et al 81 contain sweeteners and insoluble excipients. The drugs that are Rationale not available in liquid formulation have limited stability in that state, making them poor candidates for enteral administration. Each medi selection of a formulation for the medication to be adminis cation is unique, and global assumptions can lead to both inef tered. Tubes with an internal diameter equal to or greater than fectiveness of the targeted medications or toxicity of enhanced 10 Fr work best for administering crushed or dissolved solid dosage medications. Open an appropriate oral or feeding tube syringe by allow for the separation of stylus. The proximal site or entry point provides a clue as to the this could be a capsule or tablet. Once all solids have disintegrated, use the syringe to determine the extent of dissolution that will be required in the administer the medication through a flushed feeding tube. Liquid medications administered beneficial in administering drugs formulated with cosolvents that into a feeding tube with the distal end placed in the stomach can would precipitate if mixed in a separate container and transferred have a higher osmolarity of approximately 500 mOsm/L. Some capsules are slow to dissolve in water and will administered into the stomach can include slurries and suspen form clogs in smaller bore feeding tubes (<12 Fr). There is no need for sweeteners istration instructions in a free text field can contribute to error. What factors will determine whether the ity suspending agent for compounding drugs that will be more pharmacy or the nurse will prepare medication for likely tolerated for feeding tube use. When prescribing medications to be Practice Recommendations administered via an enteral route, what is the safest and most effective way to name (communicate) the 1. Only trained personnel can prepare hazardous Practice Recommendations medications or drugs that contain known allergens. Avoid environmental risks of cross-contamination percutaneous) and its distal end (ie, gastric, jejunostomy), between medications. If permitted by the organization, a nurse may prepare names, shapes, or colors of the feeding tube. Maintain practices and responsibilities consistent are intended for feeding tube administration. Scheduled date/time of the dose responsible for preparing drugs that require significant. Manufacturer name and lot number manipulation and fall within the context of compounding. Affix the label to the container being dispensed (eg, the container (eg, enteral syringe) according to all enteral syringe). Dispense unit doses prepared in the pharmacy in a Ideally, all medications that must be compounded or mixed suitable container. However, each organization will need to deter directions to dilute it with purified water. For oral chemotherapy agents, crushing extemporaneously compounded liquid must be avoided. Ideally, a closed-system transfer device, medication with directions to dilute it further similar to those used for reconstitution of injectable chemo or administer it as is. Rationale Several reports indicate that the optimal way to prepare drugs is to place the drug inside a syringe, add water, and then To optimize safety, all medication dispensed for enteral mix to dissolve the medication. Each medication must be com some of the hazardous components of the tablet or capsule for pounded into a unique formulation appropriate for the spe mulation. Even simple opera have poor water solubility and are formulated with excipients tions, such as crushing an immediate-release tablet and mix to enhance dissolution. Crushing the drug and mixing in a sep ing it with water, must be examined because outcomes may arate container risks that the components will separate and be influenced by the quality of the water (tap or purified), drug will precipitate. They are care unit for the nurse to administer via the feeding formulated with coprecipitates, solubilizers, and surfactants tube In some cases, mixing these formulations in a separate vessel and then transferring the Practice Recommendations contents to the syringe allows the ingredients to separate or 1. What medications are of particular Flushing the tube with water has been shown to work well for concern for enteral delivery Once they are dissolved, they are absorbed Practice Recommendations in the more basic milieu of the small bowel. Maintain at the healthcare organizational level a list of these drugs directly into the jejunum will result in altered 42 medications that pose a concern for administration via absorption and changes in efficacy. The number of errors associated with the use of enteral 45 based medications is cause for concern. These medica 36,37,39 tions are specially formulated to allow dissolution under optimal confines of a biological safety cabinet. An alternative to 47 crushing is to place the intact hazardous medication in a syringe conditions. If these drugs are mixed in a container and allowed 40 to sit, the excipients will separate from the active drug and pre and add water to dissolve. Administering medication that has separated from 48 crushing of extended-release medications can cause the entire the excipients can possibly lead to therapeutic failure. Significant adverse effects, Therefore, drugs with poor water solubility should not be com 41 pounded into a liquid formulation unless they are evaluated for including fatality, can result from this bolus administration. A significant number of drugs are not to be administered clinical efficacy as well as stability. These include hazardous drugs as well as be combined with water in an oral syringe and administered some nonhazardous drugs. References Clogs also form as a reaction of protein with the acidity of the gastric environment. Drug administration through an enteral feeding tube: the ratio clumps in acid and responds better to protease enzymes. Impact of direct drug delivery via gastric absorption of ciprofloxacin during tube feeding in the critically ill. Frequency and determinants of drug administration healthy volunteers of ciprofloxacin administered through a nasogastric errors in the intensive care unit. Recommendations for the use of medications with continuous enteral 2012;1(1):37-40. Most complications are not of an immediate which can cause life-threatening complications (Table 5). Prevention of refeeding syndrome is of utmost impor is an inadvertent connection between an enteral feeding sys tance. Patients at high risk for refeeding syndrome and other tem and a nonenteral system, such as an intravascular cath metabolic complications must be identified and followed closely, eter, peritoneal dialysis catheter, tracheostomy, or medical 1 and depleted minerals and electrolytes should be replaced prior to gas tubing. These of refeeding syndrome, including deficiencies and low plasma connectors will not be interconnectable with other therapy concentrations of potassium, phosphate, magnesium, and thiamin connectors such as those on intravenous, respiratory, neur combined with sodium and water retention. Insert or advance the feeding tube with tip in the small well as other metabolic parameters (eg, glucose) as bowel for patients with high risk of aspiration. Nutrient Deficiencies and Potential Complications prevention of aspiration practice alert recommends that the Associated With Refeeding Syndrome. Although this tech Respiratory failure nique can give some information, it does not verify the position Paresthesias, paralysis, seizures of the tip of the tube. Magnesium Cardiac arrhythmias, sudden death Endotracheal intubation impairs the swallowing reflex. A gastric residual the small bowel has been shown to reduce the incidence of volume of between 250 and 500 mL should lead to 10,11 regurgitation, aspiration, and pneumonia. In 13 randomized implementation of measures to reduce risk of aspiration controlled trials, pneumonia was significantly lower in patients as defined elsewhere in this document. In the It may be necessary to feed the child at risk for aspiration critically ill patient, this material may include nasopharyngeal into the small bowel. The risk factors for aspiration include sedation, supine patient positioning, the presence and size of a nasogastric tube, delayed gastric emptying, gastroesophageal reflux, or risk of 24 malposition of the feeding tube, mechanical ventilation, vomit aspiration. Other steps to decrease aspiration risk include reduc and advanced patient age and patient transfers for procedures ing the level of sedation/analgesia when possible and minimiz 8 25,26 to other units and facilities. Much of the research and many of ing transport for diagnostic tests and procedures. Any the recommendations presented here come from the critical treatment that impairs the ability of the patient to clear contents care literature and may not explicitly be extrapolated to all in the pharynx increases the risk of aspiration. Sedation of a patient decreases or eliminates of major importance in the prevention of aspiration. Keeping patient of the tube to an inappropriate position such as the esophagus comfort and care in mind, it is advisable to keep sedation levels can be a factor in the regurgitation and aspiration of gastric as minimal as possible to minimize the suppression of the swal contents. In pediatrics, the risks of the use of metoclo under 1 year of age be positioned on their back in a flat position. Otherwise, elevating the head of the bed have, to date, demonstrated a relationship between aspiration 30 52 while the infant is supine is not recommended. Building a health with chlorhexidine mouthwashes twice daily reduced protocol around risk for aspiration could include several fac respiratory infection and nosocomial pneumonia in patients tors to reduce risk but not be solely based on measurement of 31,32 53 undergoing heart surgery. Higher residuals in premature infants are thought to be 1 ing misconnections continued. What are the current methods to prevent 69 color does not physically prevent the misconnection. Utilize enteral devices (tubes, syringes, administration entities as the resource to drive conformity. Review currently used systems to assess practices that the first step in this process was developing a master standard include the potential for misconnection, including for small-bore connectors that contained certain requirements nonstandard, rigged work-arounds (Luer adapters, etc). When arriving at a new setting or as part of a hand-off this master standard set the stage for redesigned connectors to process, recheck connections and trace all tubes. Boullata et al 89 this new connector is available on enteral administration sets, enteral syringes, and enteral feeding tubes. To transition from the new connector to the current feeding tube, a transition set is available to provide connectivity so that patients receive their nutrition formula, hydration, and medications. These suggested strategies included preparing for the new standards, development of effective processes and proce dures, education and training of staff, effective communication, Figure 11. Monitoring and reporting medical device safety for ancillary staff and healthcare safety issues can allow for subsequent system improvements students (medical, nursing, allied professions). Organizations also need to identify process ancillary staff who could possibly be responsible for the con nection, disconnection, or reconnection of devices attached to References patients and develop policies and procedures that outline 1. Enteral feeding misconnec responsibilities for these staff members relating to the connec tions: a consortium position statement. The importance of the refeeding syn feeding accuracy, with 1 patient becoming hypoglycemic and drome. Effect of responded with nationwide hazard alerts to healthcare profes postpyloric feeding on gastroesophageal regurgitation and pulmonary sionals with safety issues and error reduction recommenda microaspiration: results of a randomized controlled trial. Can percutaneous endoscopic jejunos tomy prevent gastroesophageal reflux in patients with preexisting esopha these reports have led to individual practice and organiza gitis

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