By O. Hamlar. Bismarck State College.

The longer litigation persists and the closer it gets to trial discount rosuvastatin 5 mg, the more facts will be known to both sides that require explana- tion as to why they do or do not add up to the defendant’s liability generic rosuvastatin 20mg otc. Ultimately, if one must go to trial, the audience that hears and judges what is the best or most credible story will be the court and jury or arbitrator(s). Whatever attempts are made along the way to dispose of the case before trial will require a nonfiction narrative that is more believable than your opponent’s story, that makes better sense of what is known and not known factually than a contrary explanation pointing to your liability. Stories you tell along the way to trial must be consistent with each other even if the latest spin is, as expected, more detailed than earlier versions you present. Conflicting stories or interpretations of facts will, if they are known to court or jury, hurt your credibility and increase the risk of a finding of liability against you. With this sketch of the big litigation picture in mind, let us turn to rules of the game and then discuss what you should do from the time you are first forced to play the game. THE IMPORTANCE OF THE RULES IN THE LITIGATION GAME To win or avoid losing in any game other than one of pure chance, a player must be generally familiar with the rules of that game and the moves, likely and actual, of other players in it. That familiarity should not be on the detailed nuances of the rules, which is the responsibility of your lawyers, but on the importance and dynamics of the interplay between them. Rules of litigation fall into three categories: substan- tive, procedural, and evidentiary. The Substantive Liability Rule of Negligence and Its Four Constituent Elements of Duty, Breach, Causation, and Compensable Injury Substantive rules are those that define the conditions necessary to find liability. When it comes to professional liability or medical mal- practice, the most common substantive rule is negligence. Negligence 16 Hiestand is comprised of four essential elements, and the absence of any one element defeats liability. The first element is that a defendant must be shown to owe a duty to the plaintiff. This means that there must be a defined and accepted standard of care that the defendant is required to adhere to in treating the plaintiff, something the defendant should not have done that he or she did or some act that he or she did that should not have been done. Standards of care can be found in statutes, regulations, court decisions, published professional articles, and tes- timony by expert medical witnesses.

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Because current is flowing into the cell at one place cheap 5 mg rosuvastatin visa, it must flow out of the cell in another The Initiation of Nerve Impulses place 20mg rosuvastatin free shipping. It does this at a region of the receptor membrane (4) called the impulse initiation region (or coding region) be- Figure 4. The threshold (colored line) is a critical produce action potentials at a frequency related to the level of depolarization; membrane potential changes be- strength of the current caused by the stimulus. These cur- low this level are caused by the local excitatory currents rents, called local excitatory currents, provide the link be- and vary in proportion to them, while the membrane ac- tween the formation of the generator potential and the ex- tivity above the threshold level consists of locally pro- citation of the nerve fiber membrane. The lower trace shows a series of In complex sensory organs that contain a great many in- different stimuli applied to the receptor, and the upper dividual receptors, the generator potential may be called a trace shows the resulting electrical events in the impulse receptor potential, and it may arise from several sources initiation region. Often the receptor potential is given a No stimulus is given at A, and the membrane voltage is at special name related to the function of the receptor; for ex- the resting potential. At B, a small stimulus is applied, pro- ample, in the ear it is called the cochlear microphonic, ducing a generator potential too small to bring the impulse while an electroretinogram may be recorded from the eye. As in all ex- importance in the transduction process because it is the citable and all-or-none nerve membranes, the action poten- step in which information related to stimulus intensity and tial is immediately followed by repolarization, often to a duration is transduced. The strength (intensity) of the stim- level that transiently hyperpolarizes the membrane poten- ulus applied (in Fig. Since the brief stimulus has been removed by this time, no Varying the intensity of the stimulation will correspond- further action potentials are produced. A longer stimulus of ingly vary the generator potential, although the changes the same intensity (D) produces repetitive action potentials will not usually be directly proportional to the intensity. C, A brief, but intense, stimulus can cause a single action po- lus intensities and durations. D, Maintaining this stimulus leads to a train of action po- stimulus, the membrane is at rest. E, Increasing the stimulus intensity leads to an increase in duces a generator potential too small to cause membrane excita- the action potential firing rate.

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However cheap rosuvastatin 10mg free shipping, even when Although exercise is often recommended as treatment for activity is optimal cheap rosuvastatin 20mg line, it is apparent that genetic contribu- postsurgical ileus, uncomplicated constipation, or irritable tions to bone mass are greater than exercise. However, of the population variance is genetic, and 25% is due to chronic dynamic exercise does substantially decrease the different levels of activity. In addition, the predominant risk for colon cancer, possibly via increases in food and fiber contribution of estrogen to homeostasis of bone in young intake, with consequent acceleration of colonic transit. These exceptionally active women are typically very thin and exhibit low levels of Chronic Exercise Increases Appetite Slightly circulating estrogens, low trabecular bone mass, and a Less Than Caloric Expenditure in Obese People high fracture risk (Fig. Exercise also plays a role in the treatment of os- Obesity is common in sedentary societies. Controlled clinical trials find that appropriate, creases the risk for hypertension, heart disease, and dia- regular exercise decreases joint pain and degree of disabil- betes and is characterized, at a descriptive level, as an ex- ity, although it fails to influence the requirement for anti- cess of caloric intake over energy expenditure. In rheumatoid arthritis, ex- exercise enhances energy expenditure, increasing physical ercise also increases muscle strength and functional activity is a mainstay of treatment for obesity. For exceptionally active people, exercise expendi- in either rheumatoid arthritis or osteoarthritis is not known. At high levels of activity, appetite and food intake match caloric expenditure (Fig. The biologi- GASTROINTESTINAL, METABOLIC, cal factors that allow this precise balance have never been AND ENDOCRINE RESPONSES defined. In obese people, modest increases in physical ac- The effects of exercise on gastrointestinal (GI) function re- tivity increase energy expenditure more than food intake, main poorly understood. However, chronic physical activ- so progressive weight loss can be instituted if exercise can ity plays a major role in the control of obesity and type 2 be regularized (see Fig. Frank hypoglycemia rarely oc- curs in healthy people during even the most prolonged or in- Lean tense physical activity. When it does, it is usually in association with the depletion of muscle and hepatic stores 2,500 and a failure to supplement carbohydrate orally. Exercise suppresses insulin secretion by increasing sym- pathetic tone at the pancreatic islets. Despite acutely Obese (initially falling levels of circulating insulin, both non-insulin-de- stable weight) pendent and insulin-dependent muscle glucose uptake in- crease during exercise.