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By: Andrew D Bersten, MB, BS, MD, FANZCA, FJFICM

  • Department of Critical Care Medicine, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, Australia

That afternoon during demonstrations in support of the International Parliamentary Assembly that was being held in a hotel in downtown Santiago asthma treatment nice order salmeterol 25 mcg visa, a group of students gathered at the Loreto Bridge asthma definition 0f buy salmeterol 25 mcg line. Army troops who were patrolling center of the city were in position on the 959 southern side of the bridge asthma symptoms for baby generic salmeterol 25mcg with visa, blocking the students asthma symptoms heart generic 25 mcg salmeterol otc. Eyewitnesses say that at a particular moment the soldiers began to cross the bridge and to fire into the air to disperse the students. Some eyewitnesses say they saw a shotgun in the hands of a solider, or that they heard it among the rifle shots. The evidence presented and the credible testimony that the demonstration was peaceful, enable this Commission to come to the conviction that Ronald Wood was killed by government agents who used excessive force and thus violated his right to life. The Commission nonetheless holds the conviction that Guadalupe del Carmen Chamorro died a victim of the political violence that characterized that period. Early on the morning of July 2 he was in the street when he was hit by a fatal bullet through his chest. A number of witnesses have testified that he was in the street with other young people when a military patrol appeared. Bearing in mind the evidence in this case and other testimony on how troops acted in operations to maintain public order during day long demonstrations, the Commission holds the conviction that Ivбn Aqueveque was killed by government agents who used excessive force and violated his human rights. He normally lived in the United States, but he had been in Chile for six weeks at the time he was killed. In the early morning of July 2, 1986, the first day of the National General Strike, he and other young people went to set up a barricade-bonfire. One of the patrol members was carrying some of the flammable materials that the young people had left behind. Subsequently, in a confusing incident that has been disputed in the courts, the two people arrested were set on fire. They were then put onto a military vehicle and left far from 960 the site of their arrest. Private citizens later provided help, and police officers picked them up and had them taken in a private car to a hospital where they received treatment. Having examined and analyzed all the evidence in the case and the different accounts presented to the court, this Commission holds the conviction that Rodrigo Rojas suffered a grave human rights violation inasmuch as he was killed as a direct consequence of the unlawful actions or omissions of soldiers, whatever may have been the degree and nature of individual responsibility of those involved. Testimony received by the Commission indicates that the shots were fired indiscriminately by a nearby military patrol. Reports that unrest or acts of violence were taking place at that time and place have not been verified. The evidence presented leads the Commission to come to the conviction that the death of the minor Nadia del Carmen Fuentes was the result of the use of excessive force by soldiers and that they violated her human rights. Testimony gathered by the Commission indicates that the shots were fired by troops who were driving around in a military truck. Whether or not clashes or disturbances were actually taking place is confusing since accounts are contradictory and unverified. This testimony and the background information on procedures used by the military during this National Strike lead this Commission to the conviction that the human rights of Francisco Lуpez were violated by government agents who used excessive force. Many witnesses have testified that unidentified civilians who were driving a utility vehicle fired shots at the demonstrations. Considering these events and the context, this Commission holds the conviction that politically motivated private citizens violated his human rights. Nevertheless, the incident and its context enables this Commission to come to the conviction that Rubйn Alejandro Contreras died a victim of the political violence taking place at that time. The accounts examined by the Commission make it possible to establish that shots were fired at the demonstrators, but where the shots came from cannot be determined. Hence this Commission holds the conviction that Josй Eduardo Valdivia suffered a human rights violation at the hands of politically motivated private citizens who were presumably opposed to the protest. The Commission was unable to determine whether street disturbances were taking place and if so, how significant they were. Nevertheless, on the basis of the various accounts by witnesses and the way he died (from a bullet wound), the Commission presumes that Eduardo Vielma suffered a human rights violation at the hands of government agents who used excessive force. Various witnesses have testified that unidentified individuals fired their weapons from a private automobile. These facts and the context in which the events took place, have led this 962 Commission to the conviction that Miguel Angel Hernбndez died a victim of human rights violations committed by politically motivated private citizens.

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However asthma symptoms 8 weeks purchase salmeterol 25mcg otc, it will be reasonable to asthma bronchitis salmeterol 25 mcg line invest in these pedagogical innovations over the long-term and develop a repository of the requisite sources beforehand asthma 504 order salmeterol 25 mcg on-line. It may also be the right time to asthma symptoms facts buy salmeterol 25 mcg on-line prepare a plan B for future exigencies by involving regulators, universities, educational experts and professional associations. Additionally, many students have the time now to catch up on their previous studies. Medical regulatory bodies and associations have the most important reason to connect and integrate education materials and methodologies. Whether online teaching becomes a standard mode of pre-clinical education, and virtual and simulation technology an integral part of clinical education is for time to see, but the seeds for a paradigm shift already seem to be have been sown. Calls for reform of medical education by the Carnegie foundation for the advancement of teaching: 1910 and 2010. Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome. Simulation in a disaster drill: Comparison of highfidelity simulators versus trained actors. Barriers and solutions to online learning in medical education - An integrative review. WhatsApp messenger as a tool to supplement medical education for medical students on clinical attachment. Correspondence to: Dr Vidushi Mahajan, Assistant Professor, Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India. Telemedicine is the delivery of health care services using information or communication technology. In the current pandemic scenario, telemedicine can supplement health-care delivery in the absence of in-person visit. With Indian Medical Association issuing an advisory against the use of telemedicine except in few situations, a lot of confusion exists in the mind of a pediatrician. Despite the uncertain situation, we have to remember that other diseases shall not stall in the face of a pandemic. Since telemedicine is an evolving subject, training of medical professionals, clear guidelines and good quality internet service systems will go a long way in increasing the acceptability of telemedicine in the Indian population. However, the patients face a tough dilemma of risk of infection during hospital visits vis-a-vis denial of adequate care because of these measures [1]. To ensure continued health services, the government has given guidelines for practicing telemedicine to aid continuous delivery of healthcare services to the public. Telemedicine is defined as the delivery of health care services, where distance is a critical factor, by all healthcare professionals using information or communication technology. It serves the purpose of exchange of valid information for diagnosis, treatment and prevention of disease and injury, research and evaluation, and lessens overcrowding in hospitals, especially in the time of a pandemic [2,3]. Telemedicine aims to ensure equitable services to everyone, is costeffective, provides safety to both patient and doctors during pandemics, and offers timely and faster care. Since children represent a vulnerable population, detailed guidance on the delivery of primary and emergent care via telemedicine services is the need of the hour. The use of telemedicine ranges from educational purposes such as teleconferencing and tele-proctoring, health care delivery, screening of diseases, and disaster management [3]. Telemedicine is widely used in areas of radiology, dermatology and pathology; but has had a limited role in other branches in the past. In 2018, the Bombay High Court had convicted a doctor couple who were guilty of criminal negligence and death of a lady after delivery because the doctor had not come and physically examined the patient. The Supreme Court at that time had advised doctors to limit the use of telemedicine and to use it only in emergencies [4]. Despite all its advantages, practicing telemedicine poses several challenges to clinicians as it is an evolving tool. Lack of Physical Examination Telemedicine has an inherent drawback since the patient is not actually present and a thorough physical examination is not possible. The limited examination, which is possible only through inspection, might be hampered by low video quality or lack of video facilities altogether. The younger the child (especially below 2 years), the more difficult it is to make a diagnosis based on history alone because of overlapping and nonspecific symptoms in children. To overcome this we can ask the patients to give a detailed description about their complaints and not merely state the issues.

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Influenza in 1847 raised the mortality more rapidly; the deaths from all causes asthma wheezing quality salmeterol 25mcg, in the first 4 weeks of that epidemic asthma 3d animation salmeterol 25 mcg for sale, were 1086 asthma definition 411 order salmeterol 25 mcg without a prescription, 1677 asthma definition nhlbi buy discount salmeterol 25mcg on line, 2454, and 2416; while, in the 4 first weeks of the cholera epidemic, the deaths Irom all causes have been the deaths from cholera are 783, from diarrhoea 224. The districts on tlie south side of the river still form the field on which the disease is most active. Cholera is, for the first time, more fatal to females than to males; the deaths having been 383 males, 401 females. On the afternoon of the 26th a violent thunder-storm occurred, the flashes of lightning were vivid and in quick sucRain was cession, followed by loud thunder at intervals of 15 to 20 seconds generally. The mortaUty from all causes increased little and, in the week following, the mortality from cholera declined. The registrars were requested to extend their returns; and the weekly tables were accompanied by such observations as, in the emergency, appeared likely to be useful and to save life. The following extracts from the Weekly Tables exhibit the progress and effects of the epidemic at its height:;;;;;;;; - Auniist ^lh~ltlh. Small-pox, scarlatina, and hooping-cough are comparatively quiescent; typlius is more fatal than it was. The excess of 901 deaths over the average is due to diarrhoea and cholera, which were fatal to 173 and 823 persons. The deaths from cholera during the last six weeks were 152, 339, 678, 783, 926, and 823. The decrease is gratifying; but it is right to observe that the improvement is chiefly confined to West London, Poplar, St. The deaths Irom all causes on the north side of the Thames (1118) were 89 more than tlie deaths (1029) of the previous week. Those ill which the epidemic has partially subsided should redouble their precautions. The epidemic of 1832 broke out in three successive eruptions; the first commencing in February, was at its maximum in - London Weekly Reports, 1849. It is satisfactory to find that the deaths of 819 out of the 823 persons who died last week of cholera are They were seen by qualified medical attendants. Tiie accounts of tiie sudden stoppage of the epidemic by prompt medical treatment But a mortality as high now as in 1832 and tlie house-to-house visitation are perliaps over-coloured. Medical men are called when the people If the families of the middle and higher classes were seen at intervals are dying; but it is then too late. The precise locality in which almost every victim of cholera lived is given in the present return under each district; would it not be practicable for the authorities to have all these and tiie neighbouring localities inspected? If this were done, and proper precautions taken, the tragedy of Albion-terrace, Wandsworth-road, where 17 persons died in two weeks in ten houses, could scarcely recur. The particulars of the 17 deaths will be found in the notes under Wandsworth and Clapham, Another case appears this week in the note under Hampstead. The Registrar of Hampstead adds, that, during the week, an aged man came with a friend to Hampstead for change of air, -breakfasted, dined, went to London to transact business at Ihe Bank of England, and after his return seemed " pretty well. This old minister was apparently tlie last of his fimily, for he had seen his mother, wife, and servants die before him in Albion-terrace, and could not fly from the poison which he carried in his breast. Such desolation could scarcely happen without great negligence on the part of the people themselves and on the part of the authorities. It is one of the characters of epidemic diseases, that in some years their fatality is inconsiderable, in other years excessive. Since 1832 and 1833, cases of cholera have appeared in the but tlie deaths in the second week of August during the past five years have fluctuated from Tables, I to 23. In the week ending Saturday, August i8th, the deaths in London were 2230; of which 1230 - - were by cholera, 188 by diarrhoea. The deaths from all causes in the last seven weeks were 1070, 1369, 1741, 1931, 1967, 1909, and 2230; the deaths from cholera, 152, 339, 678, 783, 926, 823, and 1230. The deaths from cliolera exceed those in the previous week by 407; but in that week the mortality declined. The population is about 2,206,000 so that nearly I in rooo of the inhabitants now die weekly. The deaths from all diseases, except cholera, are 1000, which is the average number of the season; and 539 were at ages under 15, 256 at the ages 15-60, 205 at the age of 60 and upwards. Of the 1230 persons who died from cholera, 318 were under the age of 15, 721 were 15-60, and 191 were 60 and upwards it carries off an excessive proportion of people in the prime of life. Of 6194 persons who have died of cholera in London since September 1848, 3524 have died on the south side of the Thames.

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He died there of a cranial encephalic trauma with intracranial hemorrhage asthma questionnaire cheap salmeterol 25mcg with mastercard, as the death certificate states asthma treatment doctor generic 25mcg salmeterol overnight delivery. The police version was that outbreaks of violence were taking place asthma treatment not working effective 25mcg salmeterol, and hence official forces had to asthma treatment in qatar purchase 25 mcg salmeterol with amex step in. According to credible accounts, when the demonstration was over, someone who had arrived shortly before followed Jaime Quilбn in a car and fatally shot him in the back. According to evidence examined by the Commission, Jaime Quilбn was actively involved in activities of opposition to the government. This Commission therefore holds the conviction that Jaime Quilбn died as the result of a human rights violation by a politically motivated private citizen. Introduction this Commission has regarded unpremeditated killings committed by government agents while on duty defined as use of undue force (as explained in Part One, Chapter Two of this report) as violations of human rights that fall within the scope of its mandate. Killings committed by government agents that are not politically motivated and when they are not exercising their functions, which are defined as abuses of power (as explained in Part One, Chapter Two) have been regarded as human rights violations only when they have been committed with the acquiescence or tolerance of officials or when such officials have taken measures to assure the perpetrator of impunity. This section deals with cases of use of undue force and abuse of power that constituted human rights violations which the Commission has been able to verify in the course of its investigations, even though they have no political overtones. The Commission believes that the most 967 significant characteristic of the killings of that nature that took place in 1973 was that they were part of a general framework of political violence during that time. Hence it has opted to include them along with the other cases of fatal human rights violations committed during the months following the change of government, and therefore they will not be included in this section. However, all cases of that nature that took place during the period from 1978 to 1990 are included, as are those from the previous period covering the years 1974 to 1977. Cases in which the Commission came to a conviction that persons had been killed as a result of the use of undue force or the abuse of power with acquiescence of officials a. A note on methodology Because so little evidence and material on which to base a judgment could be gathered, and because these are isolated incidents and hence difficult to analyze in context, cases of killings due to these causes are treated differently from others on which the Commission came to a conviction. Only the names of the victims are listed in this part of the report; their cases are not described one by one. Nevertheless, their names are listed in the final volume of this report [not translated into English] on an equal footing with all the other cases on which the Commission came to a conviction. The kinds of deaths due to use of excessive force include: * Those caused when government agents, often without any prior warning, shot at unarmed passers-by, who instinctively fled when they saw the agents approaching; * Those caused by disproportionate forms of repression, 968 mainly government agents firing their weapons, often without prior warning, at people who were simply holding public demonstrations or handing out literature in opposition to the military regime; * Those caused by government agents firing their weapons, often without prior warning, at people who were simply violating curfew and who presented no other indication of danger; * Those caused by government agents firing their weapons, also often without any prior warning, at people who were caught committing a crime when there was no reasonable need for such a measure. It should be noted that in such cases the armed forces and police generally discharged those responsible and passed the evidence over to the military courts. That fact, however, has no bearing on whether they are to be classified as human rights violations. The cases of death caused by imprudent use of force investigated by the Commission were primarily the result of shots fired into the air by government agents that hit people who had nothing to do with the prevailing situation. The Commission came to the conviction that five people had died under such circumstances. Their actions therefore had nothing to do with their assigned duties, and they could rely on the acquiescence of officials whose duty it was to prevent such acts. Reactions of major sectors of society to the human rights violations that occurred between 1978 and 1990 1. First subphase ­ Reaction of major sectors of society to human rights violations between 1978 and the first protests in mid-1983 a. An incipient but clear opposition began to manifest itself in the realms of politics, labor, schools, and so forth. From this point onward, opposition to the military regime was to be channeled along two distinct and opposed lines: the route that accepted all forms of struggle to challenge the military regime and the nonviolent route. The attack on the Agas supermarket in 1979, the attack on the "flame of freedom" in which a policeman was killed, the murder of Lieutenant Colonel Roger Vergara, and several other attacks demonstrated the determination of some small but well-organized segments of society to take the armed route. In doing so, they did not respect the right to life and physical integrity of those whom they identified as government agents or private citizens who might accidentally suffer the consequences of their actions. In addition, some sectors and individuals who were not part of the opposition made it clear that they were opposed to the human rights violations that were being committed. They generally regarded them as excesses for which the government was not directly at fault. Society as a whole did not yet react significantly in open solidarity with the victims of human rights violations. The prevailing attitude was rather one of indifference or unbelief, despite a gradual but slow growth in awareness on the matter.

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