The updated Residency Curriculum offers an international consensus on what residents in ophthalmology should be taught blood pressure of 90 60 purchase triamterene 75mg otc. Sixteen global committees blood pressure elevated order triamterene 75 mg on line, divided by subspecialty and guided by individual subspecialty chairs, updated the existing guidelines and references, reinforcing essential cognitive and technical ophthalmic skills. Refractive Surgery, previously a subset of Cornea, External Diseases, and Refractive Surgery, is now a stand-alone section. Within each training level "Must Know" items are identified by two asterisks (**). These levels of standardization act as a foundation for developing clear and defined milestones and provide benchmarks to gauge progress and performance. Adaptability is important because causes of blindness and reduced vision differ widely, and curricular components essential in one geographical locale may be less important in other regions. Similarly, economic and social developments vary globally, and treatments and techniques considered indispensable for one region might be unattainable or unimportant for others. Standards may need to be modified according to local priorities, goals, needs, culture, governmental policies, social systems, financial constraints, varying use of allied care personnel, and differing tangible resources. The International Fellowships were established to help young ophthalmologists from developing nations improve their practical skills and broaden their perspectives of ophthalmology. The Helmerich one-year fellowships offer advanced subspecialty training to ophthalmologists to help transmit new knowledge to the home country. The Conferences cover modern educational theory, methods, and tools with interactive workshops and discussion groups. To see a complete list of 2006 task force members, please go to: icocurriculum. It is not designed to be all-inclusive but rather a guideline for the training of ophthalmic specialists. We hope you will enjoy reading, and more importantly, using, the curriculum in your teaching and assessing of ophthalmic knowledge and skills. Online comments and recommendations for future updates are actively encouraged and solicited through: icocurriculum. The Residency Curriculum was initially published in 2006, under the title "Principles and Guidelines of a Curriculum for Education of the Ophthalmic Specialist. Optics and Refraction, previously listed as two separate sections, have been combined into one section. Ophthalmic Practice and Ethics is now called Ethics and Professionalism in Ophthalmology. Stratification the updated Residency Curriculum builds upon the Basic, Standard, and Advanced levels of training by incorporating a new fourth level, "Very Advanced," which corresponds to a "subspecialist" or "fellowship" level of training. Must Know the updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner "Must Know" at each level. Uveitis and Ocular Inflammation Ocular Oncology Low Vision Rehabilitation Ethics and Professionalism in Ophthalmology Community Eye Health Appendix Chair, Section Chairs, and Committee Members Section Reviewers References D. Specialist training is designed to provide a structured learning program facilitating the acquisition of core competencies as well as specialized cognitive and technical skills at a level appropriate for an ophthalmic specialist who has been fully prepared to begin their career as an independent consultant in ophthalmology. Stratification of Levels Basic Level Goals = Year 1 Standard Level Goals = Year 2 Advanced Level Goals = Year 3 Very Advanced Level Goals = Subspecialist the curriculum is intended to be adaptable and flexible, depending upon the needs of the region. While stratifying the curricula by level (ie, Basic, Standard, Advanced, and Very Advanced) is somewhat artificial, it defines clear milestones for learners to progress up the ladder of expertise acquisition. Differentiating various proficiency levels allows local customization of expectation based upon local resources, ability, and geography. For example, in some locations clinical needs are urgent, and marked abbreviations of the training program will be necessary to provide the region with sufficient numbers of practitioners. Years 1, 2, 3, and Subspecialist Though Years 1, 2, 3, and Subspecialist correspond with Basic, Standard, Advanced, and Very Advanced Level Goals respectively, the listing of years are for clarification purposes only and not as a recommendation for duration of training, which is subject to local requirements and regulations. Very Advanced: Subspecialist Level of Training the Very Advanced level has been included to provide a comparison to the three other levels of training (ie, Basic, Standard, Advanced). The Very Advanced level represents postresidency acquisition of additional skills and knowledge (eg, fellowship training). Individuals who reach the Very Advanced: Subspecialist level of training are expected to have accomplished the goals of the Basic, Standard, and Advanced levels of the curriculum. Prioritization of Content: "Must Know" the updated Residency Curriculum prioritizes and identifies cognitive and technical skills the learner "Must Know" at each level.
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Furthermore blood pressure medication plendil trusted triamterene 75mg, we will incur additional costs associated with operating as a public company heart attack grill death discount 75mg triamterene amex. Accordingly, we will need to obtain substantial additional funding in connection with our continuing operations. If we are unable to raise capital when needed or on acceptable terms, we could be forced to delay, reduce or eliminate our research and development programs or any future commercialization efforts. We believe that our cash and cash equivalents as of December 31, 2019 will enable us to fund our operating expenses and capital expenditure requirements into the third quarter of 2021. However, we have based this estimate on assumptions that may prove to be wrong, and our operating plan may change as a result of many factors currently unknown to us. As a result, we could deplete our capital resources sooner than we currently expect. Identifying potential product candidates and conducting preclinical testing and clinical trials is a time-consuming, expensive and uncertain process that takes years to complete, and we may never generate the necessary data or results required to obtain regulatory approval and achieve product sales. In addition, our product candidates, if approved, may not achieve commercial success. Commercial revenues, if any, will not be derived unless and until we can achieve sales of products, which we do not anticipate for many years, if at all. Accordingly, we will need to continue to rely on additional financing to achieve our business objectives. Adequate additional financing may not be available to us on acceptable terms, or at all. In addition, we may seek additional capital due to favorable market conditions or strategic considerations, even if we believe we have sufficient funds for our current or future operating plans. If adequate funds are not available to us on a timely basis, we may be required to delay, limit, reduce or terminate preclinical studies, clinical trials or other development activities for one or more of our product candidates or discovery stage programs or delay, limit, reduce or terminate our establishment of sales and marketing capabilities or other activities that may be necessary to commercialize our product candidates. Raising additional capital may cause dilution to our stockholders, restrict our operations or require us to relinquish rights to our technologies or product candidates. Until such time, if ever, as we can generate substantial product revenues, we expect to finance our cash needs through a combination of equity offerings, debt financings, collaborations, strategic alliances and marketing, distribution or licensing arrangements. Debt financing and preferred equity financing, if available, may involve agreements that include covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, selling or licensing our assets, making capital expenditures or declaring dividends. If we raise additional funds through collaborations, strategic alliances or marketing, distribution or licensing arrangements with third parties, we may have to relinquish valuable rights to our technologies, future revenue streams, research programs or product candidates or grant licenses on terms that may not be favorable to us. If we are unable to raise additional funds through equity or debt financings when needed, we may be required to delay, limit, reduce or terminate our product development or future commercialization efforts or grant rights to develop and market product candidates that we would otherwise prefer to develop and market ourselves. Our limited operating history may make it difficult for stockholders to evaluate the success of our business to date and to assess our future viability. Our operations to date have been limited to organizing and staffing our company, business planning, raising capital, developing our technology, identifying drug targets and potential product candidates, undertaking preclinical studies and conducting one early-stage clinical trial. We have not yet demonstrated our ability to successfully develop any product candidate, obtain regulatory approvals, manufacture a commercial scale product or arrange for a third party to do so on our behalf, or conduct sales and marketing activities necessary for successful product commercialization. Consequently, any predictions stockholders make about our future success or viability may not be as accurate as they could be if we had a longer operating history or a history of successfully developing and commercializing products. In addition, as our business grows, we may encounter unforeseen expenses, difficulties, complications, delays and other known and unknown factors. We will need to transition at some point from a company with a research and development focus to a company capable of supporting commercial activities. We expect our financial condition and operating results to fluctuate significantly from quarter-to-quarter and year-to-year due to a variety of factors, many of which are beyond our control. Accordingly, stockholders should not rely upon the results of any quarterly or annual periods as indications of future operating performance. However, we have based this estimate on assumptions that may prove to be wrong, and we could exhaust our available capital resources sooner than we expect. In the future, if we are unable to obtain sufficient funding to support our operations, we could be forced to delay, reduce or eliminate all of our research and development programs, product portfolio expansion or commercialization efforts, and our financial condition and results of operations will be materially and adversely affected and we may be unable to continue as a going concern.
Standard Level Goals the principal aim is to link ophthalmic pathology with specific patient-based areas of residency training (eg arteria spinalis buy 75mg triamterene otc, oculoplastics hypertension 24 order triamterene 75mg visa, cornea, glaucoma, retina, ophthalmic oncology). The subspecialties emphasized should vary according to the prevalence of ophthalmic disease and the particular expertise of the ophthalmology department and associated ophthalmic pathology laboratory. Teaching can be conducted through regular face-to-face consultation sessions or clinicopathologic conferences. During their training, residents should get a minimum of 36 hours (ie, 1 hour per month) of experience in evaluating pathological specimens with a specialist who has expertise in ophthalmic pathology. Teaching clinicopathologic correlations can be supplemented with demonstrations through advanced imaging techniques (eg, ultrasonography, optical coherence tomography, magnetic resonance imaging), which produce images that are similar to gross pathologic specimens and histopathologic sections and have the ability to differentiate pathologic processes. Advanced Level Goals Chairs in ophthalmology should provide residents with a special interest in ophthalmic pathology the opportunity to participate in grossing, sectioning, processing, and examination of specimens. Very Advanced Level Goals Chairs in both ophthalmology and pathology need to identify promising residents to receive special training and to work with the clinical faculty and laboratory staff to develop subspecialty expertise in ophthalmic pathology. Describe the professional duties and specific and unique aspects of professionalism of ophthalmic pathology, and the significance of ophthalmic pathology to the practice of ophthalmology. Describe basic ocular anatomy and histology of the major structures of the eye and its adnexa: a. Describe basic pathophysiology of the common disease processes of the eye and its adnexa, and identify the major histologic findings: a. Neoplasm and proliferation (eg, basal and squamous cell carcinoma, uveal melanoma, retinoblastoma)** 4. Describe common methods of specimen acquisition and handling for ophthalmic pathology, especially handling methods that avoid artifacts and ensure representative sampling: a. Surgical biopsy, with special emphasis on the eyelids and conjunctiva, cornea, and vitreous** b. Describe basic information necessary to communicate to the ophthalmic pathologist regarding study of these specimens. Describe common indications for frozen sections in ophthalmic pathology (eg, complete resection margins in basal and squamous cell carcinoma, demonstration of lipid in sebaceous gland carcinoma). Describe basic steps in handling and processing of gross specimens in the ophthalmic pathology laboratory through a site visit, with relevance to ophthalmic surgery. Process specimens for submitting to an ophthalmic pathology laboratory, and write the accompanying letter to the ophthalmic pathologist (eg, surgical biopsy, corneal button, enucleated eye, exenteration specimen). Read and interpret reports from these specimens written by the ophthalmic pathologist. Participate as an observer through a site visit in the macroscopic and microscopic examination of ophthalmic pathology specimens from active cases. Standard Level Goals: Year 2 and Year 3 these goals relate to the second and third years of ophthalmic residency training. Describe more advanced ocular anatomy (eg, common variants), and identify the histology of the major structures of the eye and its adnexa relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology). Describe the pathophysiology and identify the major histologic findings of common diseases of the eye (eg, keratitis, exfoliation syndrome, corneal and retinal dystrophies and degenerations, frequent neoplasms) relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology). Describe the pathophysiology and histology of potentially vision or life-threatening diseases (eg, temporal arteritis, endophthalmitis, retinoblastoma, ocular melanoma, extraocular or orbital spread of an intraocular or periorbital tumor, metastasis to the eye and orbit) relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology). Describe and interpret reports of more advanced techniques in ophthalmic histopathology (eg, cytology, special stains, transmission electron microscopy, immunohistochemistry, tumor free margins) relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology), including how the clinician communicates the need for these studies. Process appropriately more advanced specimens for submitting to an ophthalmic pathology laboratory, including writing of the accompanying letter to the ophthalmic pathologist (eg, impression cytology, fine needle aspiration biopsy, vitreous biopsy, evisceration, exenteration specimen). Participate under supervision through a site visit in a macroscopic and microscopic examination of ophthalmic specimens from active cases, working from low to high power. Advanced Level Goals: Year 2 and Year 3 these goals relate to the second and third years of ophthalmic residency training, for residents with a special interest in ophthalmic pathology. Describe less common ocular anatomy (eg, pars plana cysts), and identify the histology of the minor structures (eg, ciliary sulcus) of the eye and its adnexa relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology). Describe the pathophysiology of less common disease processes of the eye (eg, most common syndromes, less common corneal and retinal dystrophies and degenerations and ocular neoplasms, ocular lesions in acquired immune deficiency syndrome) relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology), and identify their major histologic findings. Describe and interpret reports of advanced techniques in ophthalmic pathology (eg, flow cytometry, molecular genetics) relevant to specific clinical rotation(s) (eg, oculoplastics, cornea, glaucoma, retina, ophthalmic oncology). Participate as an "at-the-elbow" observer during microscopic examination of active ophthalmology cases, including special stains. Participate in gross examination and cutting of common ophthalmic pathology specimens (eg, eyelid biopsies, corneas, whole globes), and take macroscopic and microscopic photographs to document pathologies.
With higher R blood pressure chart and pulse discount triamterene 75mg overnight delivery, we may have two or more aliased signals at point y as well as the correct signal blood pressure 10070 discount 75 mg triamterene overnight delivery, and we can write I1 (y) I2 (y) C1 (y)S(y) C2 (y)S(y) C1 (y C2 (y Y)S(y Y)S(y Y) Y). C1 (y C1 (y nA Y)S(y nA Y)S(y nA Y) nA Y) where nA is the number of aliased signals which is spatially variant and depends on the size of the object being imaged. We can formalise this in terms of image intensities Ij(x,y) for each of j coil elements: Ij (x, y) nA n 0 Cj (x, y n Y)S(x, y n Y) If there are L coil elements, we can write L simultaneous equations as above, most conveniently represented in a matrix equation as I1 (x, y) I2 (x, y). This is always possible if there are at least as many coil elements as the maximum number of aliased signals and if the coil sensitivities are sufficiently unique. Notice that since R nA for the majority of images, it is possible for R to be greater than the number of elements in the coil. These central lines are extracted for each coil element and used on their own to reconstruct low resolution, unaliased, images from each coil element which may then be used to provide sensitivity maps. The full time saving by the reduction factor R is not achieved because of the additional lines required for calibration. It uses combinations of array coil element sensitivities to create virtual phase encoding. In practice this means using arrays of coils and combining the various elements to obtain the required sinusoidal variations in response across space. By combining the coils differently a modified response (k 1) is obtained and when added to the effect of the gradient produces a line of virtual phase encoding with k 3. In this example then, we can halve the number of phaseencode gradient steps required, and therefore halve the number of excitations required and halve the scan time. The array element images are divided by the body coil image (to remove sensitivity variations due to anatomy rather than coil response). Then various image processing steps (thresholding, filtering, extrapolation, smoothing) are performed to produce the sensitivity map for each coil. Grey areas represent the coil sensitivity profiles multiplied by their respective weights. In this example 2 lines of k-space can be acquired per gradient, the original with k 0 and one additional with k 1. Arrowed lines are acquired with gradients, the interspersed (non-arrowed) lines are computed from combinations of the coil element signals. In order to generate the rotational nature of phase encoding, we need to add sine and cosine functions (see appendices A2 and A5). The centre of k-space is more highly sampled and we can talk of an inner and an outer reduction factor. Errors in the generation of the coefficients will result in image artefacts (see also figure 17. A separate sub-k-space is filled for each array element, which is then reconstructed, giving an image for each element. For example in a typical short-axis cine of the heart, the chest wall, lungs, spine and muscles do not vary (much) from one frame to another. Once we have the first frame, these voxels do not need to be re-sampled during the rest of the cine. The remaining voxels can therefore be sampled quicker and provide better temporal and/or spatial resolution. If we take the Fourier transform of this line through time, we find ourselves in x-f space, which shows the spectrum of motional frequencies. In the middle are all the voxels which do not change through the frames of the cine acquisition: out to the edges are the faster moving voxels which represent the ventricle walls and moving blood. By skipping some of the kspace points for some of the time-points, k-t space is undersampled. With the appropriate linear combination of coil signals we can therefore acquire purely gradient-phase-encoded signals or we can calculate additional virtual lines of k-space without having to acquire them. Combining the training data with the undersampled dynamic data allows the reconstructor to produce the final cine images. By using the coil sensitivities of a multi-element receive coil, k-t space is undersampled even more, allowing speed-up factors up to 8. The reduced scan time can be traded for more slices (better coverage), higher spatial resolution, better temporal resolution, or a 358 17. For example, velocity mapping through the aorta can be achieved in a 10 s breath-hold instead of a 3 min scan time, or 6 slices may be acquired instead of only one in the same 3 min scan time. In dynamic contrast enhanced imaging, the anatomy is not changing position but certain voxels will show higher intensity during the injection of gadolinium.
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