HHS University Partnership Program. Emory University participates in the Department of Health and Human Services University Partnership Program. Emory University Partners. Goizueta Business School. Evening MBA program. Weekend Executive MBA program. Modular Executive MBA program. Law School - - on that page, click the . Classes explicitly stating 'no discounts' are ineligible. Applications and Proof of Eligibility. Applicants wishing to claim the HHS University Partnership Program benefit should apply in the usual way. Please visit the program websites for more details and application information. Additionally, applicants wishing to claim the tuition discount and other partnership benefits should submit the following information as proof of eligibility. HHS employees should submit a copy of their most recent pay stubs, or a letter from their supervisor or HR department verifying HHS employment status, on HHS letterhead. Dependents should submit a copy of the employee’s most recent pay stub or a letter, as well as proof of the dependent relationship, such as a marriage license or birth certificate. Dependents should submit a copy of the contractor status letter, as well as proof of the dependent relationship, such as a marriage license or birth certificate..
Can I change my schedule? Emory's Evening MBA is unique in that you can choose to flex your program structure at the beginning of any semester. Goizueta's Evening MBA is the #1 part-time program in the #1 state to do business. Our preeminent program is structured for working professionals. Business school admissions data and analysis. Many business school applicants wonder how many MBA applications they should submit? Students of the Wharton Executive MBA program in San Francisco meet in one of the rooms used for study groups in the historic Folger Building.
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Paradise Cheer - Paradise Gymnastics. We're sorry, this page is currently unavailable. Schedule & Pricing (2) . Trampoline & Tumbling (T&T) Power Tumbling; Recreational Cheer; Tumbling for. Paradise Valley High School Cheer. Paradise Valley High School Cheer Team. Dallas cowboys summer cheer camp at atlantis paradise island 1. JOIN THE DALLAS COWBOYS CHEERLEADERS FOR A FANTASY CHEER SUMMER CAMP AT THE. Collier County, FL : Immokalee Area CRAThe Collier County Community Redevelopment Agency (CRA) is currently focusing its redevelopment efforts on the area of Immokalee - designated by the Collier County Board of County Commissioners as a redevelopment area under the authority of Florida Statutes Chapter 1. Part III, Community Redevelopment Act. Chapter 1. 63, Part II of the Florida Statutes provides Collier County with the means to achieve growth management objectives by redirecting growth to areas where urban services are provided, or if the services exist but are inadequate, the means to improve the services, thereby revitalizing the once viable neighborhood or business district and encouraging the provision of affordable quality housing within the urban center. The Collier County Comprehensive Plan provides the rationale for the establishment of this redevelopment area in Collier County. For the past several years, staff from the. This community is very different in character but similar in their need to bring in more investment and to improve the public perception of the area. Although this community was established as a redevelopment area using the same criteria, this community has it's own set of goals, objectives and vision for the future. Public meetings, workshop and hearings are ongoing to continue to involve the residents, business owners and property owners. The Advisory board is composed of citizens, residents, property owners and business owners or persons engaged in business in the area has been created and appointments made by the CRA for this redevelopment area. The role of the advisory board will be to make recommendations to the CRA on project priorities and budgetary issues. Immokalee Overlay District. This area plan is a guide for the physical and economic revitalization and enhancement of the Immokalee Community. The plan enhances the existing Main Street project, the federal Enterprise Community designation, the Regional Airport Industrial Park and Lake Trafford which all serve as catalysts for revitalizing the community and improving the housing stock. Excerpts of the Plan follows. Located in northeastern Collier County, the Immokalee Community is located approximately 4. County seat of Naples. This rural un- incorporated area is primarily agricultural. There is one major roadway - Immokalee Road (CR 8. Naples. State Road 2. Community from the northern counties of Lee and Hendry. Although there are approximately 1. The remaining land is a mixture of residential, commercial and industrial uses. The estimated 1. 99. Immokalee is 1. 7, 8. However, the population nearly doubles during the winter months due to the agricultural industry. This increase occurs when the harvest season for vegetables and citrus is at its peak. The 1. 99. 8 projected peak season population for Immokalee is 3. The Immokalee population is considerably different from Collier County as a whole. The 1. 99. 0 median age in Immokalee is estimated at 2. Collier County median age is estimated 4. In 1. 99. 0, 6. 5% of Immokalee's population was of Hispanic origin, which may be of any race, in comparison to 8% of the remainder of Collier County's population being of Hispanic origin.
The 1. 99. 0 Household Median Income in Immokalee was $1. Collier County's median household income of $3. According to the 1. Low & Moderate Income Census Tract Data Analytics. The special warfare combatant-craft crewmen (SWCC, pronounced 'Swick') is a United States Navy special operations force that operates and maintains an inventory of small craft used to support special operations missions. To amend the Civil Rights Act of 1964 to strengthen and improve Federal civil rights laws, to provide for damages in cases of intentional employment discrimination, to clarify provisions regarding disparate impact. Civil Rights Act of 1964 - CRA - Title VII - Equal Employment Opportunities - 42 US Code Chapter 21. U. S. Census 4. 5% of the population was below poverty level. Immokalee has long been considered isolated from the coastal county both in location and demographics. Immokalee's development is based on its agriculture resources, which made Immokalee the leading producer of winter vegetables in the United States. However, as the economics of agriculture changed, the social problems associated with low wages, an unskilled labor force, and a transient multicultural population grew. One of the results has been a lack of reinvestment into the area. The economy of rural Southwest Florida has been and continues to be based primarily on agriculture, which has not kept pace with job growth throughout the state of Florida. Rural Florida continues to have lower earned income, higher unemployment, lower property values and fewer opportunities for employment. Regionally, the major economic contributors are retirement, tourism, construction, agriculture and the environment. Although tourism has a major impact on the regional urban economy, the Immokalee Community has yet to reap the benefits from this industry. Immokalee Awards. The Immokalee Community was designated as a Federal Champion Community in 1. Florida Main Street area in 1. Federal Enterprise Community in 1. During the application process for the Empowerment Zone/Enterprise Community grant, a series of community meetings were held with several hundred community residents attending. Based on the community input and the consensus reached at these meetings, a Strategic Plan was written. The Plan identifies four areas of concern: Accessibility and appropriateness of education and training; Diversification of the economic base and availability of higher wage jobs; The availability of decent and affordable housing; and Community image and pride The Immokalee Redevelopment Area Plan incorporates the goals and strategies identified in the Enterprise Strategic Plan as the basis for the redevelopment plan. Conditions of Blight. In order to designate the Immoklaee area as a redevelopment area, a finding of . This finding was made on March 1. Resolution 2. 00. The following describe the conditions in Immokalee at the time that the finding of blight was made: 1. Predominance of defective or inadequate street layout: The Immokalee Redevelopment Area is characterized by a defective or inadequate street layout. Most Immokalee residents walk or bicycle to work, school and shopping. Few adequate bicycle and pedestrian facilities are available throughout the Immokalee study area. Problems include: Inadequate street layout and design; Lack of shoulders and guardrails along streets adjacent to deep and wide drainage swales; Poor access to commercial and industrial parking and access problems; Few sidewalks available for a predominately pedestrian population; and A general lack of neighborhood inter connectivity. The major arterial roadways are State Road 2. Immokalee Road and New Market Road (SR 2. A). State Road 2. The four- lane segment is called Main Street and is the focus of redevelopment and economic revitalization. It is the only segment with on- street parking and sidewalks on both sides. The two lane segments of State Road 2. Main Street are two lanes with no sidewalks. New Market Road is a two- lane facility with 1. The remaining right- of- way and truck parking is limestone. Vegetable and fruit packinghouses and the State Farmers Market are located along this street. Trucks are encouraged to use this street as a bypass road to avoid the downtown area and to pick up goods for transport. The roadway is in poor condition and maintenance costs are high due to damage by trucks dragging limestone on roadway. Although many people walk or bicycle to work in this area, pathway facilities are unavailable. Immokalee Road intersects with SR 2. Main Street. North Main Street, it narrows to two lanes and has a sidewalk on the west side only. Major problems exist along many of the local roads. There are few sidewalks. Typical local street widths are less than twenty feed required in the Collier County Land Development Code and open storm water systems are adjacent to roadways without paved shoulders or guardrails. CRA management consulting provides senior industry executives with innovative strategies that optimize decision-making. The Florida Department of Transportation (FDOT) has updated the Florida Transportation Plan (FTP) and the Strategic Intermodal System (SIS) Policy Plan. The FTP defines Florida’s future transportation vision and. This unit provides a number of services to the public. Hours of operation are Monday through Friday from 8:00 a.m. All public records requests must come to the Records Unit. The Records telephone number is 954-797. For example, south of State Road 2. Street, there are deep, wide drainage ditches on both sides of the roadway. There are no sidewalks and no guardrails to safeguard pedestrians and motorists. The roadway width is eighteen feet and there are not enough rights of way to construct pathway facilities without converting the open swales to a covered storm water system. In addition, many residential neighborhoods are not linked to none another and most of the commercial areas are not linked to one another. The Immokalee Regional Airport and Industrial Park lack adequate water and sewer service and storm water management facilities to sufficiently handle the projected future development. County Road 8. 46 that leads to Airpark Blvd. This facility does not adequately address the projected increase in truck traffic due to the future development of the airport and industrial park. Faulty lot layout in relation to size, adequacy, accessibility, or usefulness: The majority of commercial lots are zoned General Commercial District (C- 4) or Heavy Commercial District (C- 5). In the C- 4 and C- 5 zoning district, a minimum lot size of 1. Many of the commercial lots in these zoning districts do not meet the minimum width required for commercial development. Some do not meet either of the lot width or lot square footage requirements. Existing buildings are frequently non- conforming with regards to required minimum lot width, size, setbacks, and buffers. The Residential Multiple Family - 6 (RMF- 6) zoning district has a minimum requirement of 6,5. The majority of lots are non- conforming and rebuilding on these lots may require the owner to seek a variance from the development standards. In the South Immokalee area over 5. The majority of these lots are zoned C- 4 or RMF- 6. A majority of the mobile home parks in the Immokalee community were developed in the 1. The Collier County Land Development Code requires a minimum lot size of 6,0. Village Residential (VR) and Mobile Home (MH) zoning districts. It is common in the Immokalee Community to have intensive commercial uses located adjacent to residential uses without adequate buffering between the uses. Unsanitary or unsafe conditions: According to 1. Census Data, 1. 2 percent of Immokalee area households lack complete plumbing for exclusive use. In the entire county, this figure is 0. In occupied housing units in Immokalee, according to the 1. U. S. Census, 6. 8 percent of the owner occupied units and 1. This figure is . 0. Alpha Centauri - Wikipedia, the free encyclopedia. Alpha Centauri. Proxima is at the slightly smaller distance of 1. Sun, making it the closest star to the Sun, even though it is not visible to the naked eye. The separation of Proxima from Alpha Centauri AB is about 0. AU). Proxima b, an Earth- sizedexoplanet in the habitable zone of Proxima Centauri, has been detected. The next- brightest star in the night sky is Arcturus. Alpha Centauri is a multiple- star system, with its two main stars being Alpha Centauri A (. As viewed from Earth, it is located at an angular separation of 2. Proxima Centauri would appear to the naked eye as a separate star from . Alpha Centauri AB and Proxima Centauri form a visualdouble star. Direct evidence that Proxima Centauri has an elliptical orbit typical of binary stars has yet to be found. Some older references use the confusing and now discontinued designation of A. Because the distance between the Sun and Alpha Centauri AB does not differ significantly from either star, gravitationally this binary system is considered as if it were one object. It is a solar- like main- sequence star with a similar yellowish colour. From the determined mutual orbital parameters, Alpha Centauri A is about 1. Read the latest local news, from Kansas City and the KC area, and around the country and world by The Kansas City Star and KansasCity.com.Sun, with a radius about 2. The projected rotational velocity( v. When considered among the individual brightest stars in the sky (excluding the Sun), Alpha Centauri A is the fourth brightest at an apparent visual magnitude of +0.
MegaPath is a leading cloud communications and connectivity company delivering business phone and internet, unified communications, secure networks, and hosted IT. Arcturus at an apparent visual magnitude of . It is a main- sequence star of spectral type K1 V, making it more an orange colour than the primary star. The projected rotational velocity ( v. The light curve of B varies on a short time scale and there has been at least one observed flare. Proxima usually appears as a deep- red star of an apparent visual magnitude of 1. Listed as V6. 45 Cen in the General Catalogue of Variable Stars (G. C. V. S.) Version 4. UV Ceti- type flare star can unexpectedly brighten rapidly by as much as 0. The first of these is that bright Star in the sterne of Argo which they call Canobus. The second is in the end of Eridanus. The finding was made incidentally while observing a passing comet from his station in Puducherry. Alpha Centauri was only the second binary star system to be discovered, preceded only by Alpha Crucis. The parallax of Alpha Centauri was subsequently determined by Henderson from many exacting positional observations of the AB system between April 1. May 1. 83. 3. He withheld his results, however, because he suspected they were too large to be true, but eventually published them in 1. Friedrich Wilhelm Bessel released his own accurately determined parallax for 6. Cygni in 1. 83. 8. Pourbaix (2. 00. 2), have regularly refined the precision of any new published orbital elements. Innes discovered Proxima Centauri in 1. This showed the large proper motion and parallax of the star was similar in both size and direction to those of Alpha Centauri AB, suggesting immediately it was part of the system and slightly closer to Earth than Alpha Centauri AB. Lying 4. 2. 4 light- years away, Proxima Centauri is the nearest star to the Sun. All current derived distances for the three stars are from the parallaxes obtained from the Hipparcos star catalogue (HIP). The A component is held stationary and the relative orbital motion of the B component is shown. The apparent orbit (thin ellipse) is the shape of the orbit as seen by an observer on Earth. The true orbit is the shape of the orbit viewed perpendicular to the plane of the orbital motion. According to the radial velocity vs. The orbit is divided here into 8. With the orbital period of 7. Alpha Centauri A and B have absolute magnitudes of +4. Stellar evolution theory implies both stars are slightly older than the Sun at 5 to 6 billion years, as derived by both mass and their spectral characteristics. Observed stellar positions in 2. PA of 2. 45. 7. Furthest orbital separation at apastron last occurred in May 1. The apparent distance between the two stars is rapidly decreasing, at least until 2. Proxima is likely gravitationally bound to Alpha Centauri AB, orbiting it with a period between 1. Grey dot is projection of Proxima Centauri, located at the same distance as Alpha Centauri AB. Proxima is a red dwarf of spectral class M6 Ve with an absolute magnitude of +1. Sun's luminosity. By mass, Proxima is calculated as 0. Over the centuries, this causes the apparent stellar positions to slowly change. Such motions define the high- proper- motion stars. Most assumed that all stars were immortal and permanently fixed on the celestial sphere, as stated in the works of the philosopher Aristotle. Using the Hipparcos Star Catalogue (HIP) data, the mean individual proper motions are . These motions are about one- fifth and twice, respectively, the diameter of the full Moon. By about 2. 9,7. 00 AD, in the present- day constellation of Hydra, Alpha Centauri will be 1. Even during the time of this nearest approach, however, the apparent magnitude of Alpha Centauri will still not surpass that of Sirius, which will brighten incrementally over the next 6. Earth for the next 2. Here this once bright yellow star will fall below naked- eye visibility somewhere in the faint present day southern constellation of Telescopium. This unusual location results from the fact that Alpha Centauri's orbit around the galactic centre is highly tilted with respect to the plane of the Milky Way. Beta Centauri is in reality far more distant than Alpha Centauri. Planets. From these readings, the radial velocity of the parent star relative to the Earth is varying with an amplitude of about 2 metres (6. This planet would most likely orbit Alpha Centauri B with an orbital period of 2. The median average of the likely orbits is 1. Its orbit would likely have an eccentricity of 0. If confirmed, this planet would be called Alpha Centauri Bc. Like the probably spurious Alpha Centauri Bb, it would be far too close to Alpha Centauri B to harbour life. Such planets could orbit Alpha Centauri A or Alpha Centauri B individually, or be on large orbits around the binary Alpha Centauri AB. Because both the principal stars are fairly similar to the Sun (for example, in age and metallicity), astronomers have been especially interested in making detailed searches for planets in the Alpha Centauri system. Several established planet- hunting teams have used various radial velocity or star transit methods in their searches around these two bright stars. Certain special assumptions, such as considering that Alpha Centauri A and B may have initially formed with a wider separation and later moved closer to each other (as might be possible if they formed in a dense star cluster) would permit an accretion- friendly environment farther from the star. In addition, the lack of any brown dwarfs or gas giants in close orbits around A or B make the likelihood of terrestrial planets greater than otherwise. Here, the comets provided the inner planets with their own source of water and various other ices. Such icy bodies probably also reside in Oort clouds of other planetary systems, when they are influenced gravitationally by either the gas giants or disruptions by passing nearby stars many of these icy bodies then travel starwards. For the slightly less luminous and cooler Alpha Centauri B, the habitable zone would lie closer at about 0. AU (1. 00 million km), approximately the distance that Venus is from the Sun. Detecting planets as small as three Earth- masses or smaller within two astronomical units of a . The Sun would be a yellow star of an apparent visual magnitude of +0. Cassiopeia, at the antipodal point of Alpha Centauri's current right ascension and declination, at 0. This place is close to the 3. Because of the placement of the Sun, an interstellar or alien observer would find the \/\/ of Cassiopeia had become a /\/\/ shape. Sirius lies less than a degree from Betelgeuse in the otherwise unmodified Orion and is with . Procyon is also displaced into the middle of Gemini, outshining Pollux, whereas both Vega and Altair are shifted northwestward relative to Deneb (which barely moves, due to its great distance), giving the Summer Triangle a more equilateral appearance. View from Proxima b. Depending on the binary's orbital position, the bright stars would appear noticeably divisible to the naked eye, or occasionally, but briefly, as a single unresolved star. Based on the calculated absolute magnitudes, the visual apparent magnitudes of Alpha Centauri A and B would be . Near apoapse, the disc would shrink to 6. A, 4. 3 arc seconds for B, being too small to resolve by naked eye. In any case, the dazzling surface brightness could make the discs harder to resolve than a similarly sized less bright object. For example, some theoretical planet orbiting about 1. AU from Alpha Centauri A (so that the star appears roughly as bright as the Sun viewed from the Earth) would see Alpha Centauri B orbit the entire sky once roughly every one year and three months (or 1. Added to this would be the changing apparent position of Alpha Centauri B during its long eighty- year elliptical orbit with respect to Alpha Centauri A (The average speed, at 4,5 degrees per Earth year, is comparable in speed to Uranus here. With the eccentricity of the orbit, the maximum speed near periapse, about 1. Earth year, is faster than Saturn, but slower than Jupiter. The minimum speed near apoapse, about 1,8 degrees per Earth year, is slower than Neptune.). Depending on its and planet. These visual apparent magnitudes are much dimmer than the apparent magnitude of the Sun as viewed from the Earth (. The difference of 5. Alpha Centauri B would appear, on a linear scale, 2. Alpha Centauri A (or the Sun viewed from the Earth), but also 1. Moon as seen from the Earth (. Thus Alpha Centauri A would appear between 8. Sun but some 5. 80 to 6. Moon. During such planet's orbital period of 0. Solar System's planets. Age of Empires II: The Conquerors update. Las clasificaciones te ayudan a conocer el tipo de contenido de una aplicaci. From Microsoft: This patch updates Age of Empires II: The Age of Kings to version 2.0a. Please consult the read-me file for instructions and fixes.
Estas no indican si la aplicaci. Las clasificaciones pueden variar por pa. This is the official 1.0c patch for Age of Empires 2: The Conquerors as released by Microsoft in 2001. Version: EN-US (English) Author Comments & Reviews ( All.The Simpsons: Tapped Out Treehouse of Horror XXIV content update is the thirty-third, and second Halloween, content update for The Simpsons: Tapped Out. Often compared with Franz Liszt, Mason & Hamlin Artist Jarrod Radnich has captured the top position on YouTube for solo piano performance, ranked #1 for classical. Teori perkembangan kognitif Jean Piaget (1896-1980). TEORI KOGNITIF-SOSIAL Albert Bandura 2. Latar Belakang A.Bandura Albert Bandura lahir pada 4 Desember 1925 di Mundare, kota kecil di Alberta, Canada. 1 TEORI KOGNITIF SOSIAL ALBERT BANDURA Didi Tarsidi Universitas Pendidikan. Http:// Teori Efikasi. TEORI KOGNITIF SOSIAL ALBERT BANDURA Didi Tarsidi Universitas Pendidikan Indonesia PENDAHULUAN Teori kognitif sosial, yang dikembangkan oleh Albert Bandura.
Teori Pembelajaran Sosial Albert Bandura Pdf PDFTEORI KOGNITIF SOSIAL - Direktori File UPI.. Duragesic Patch Defect Recall. Yet another Duragesic. A division of Ortho- Mc. Neil Janssen Pharmaceuticals named Pri. Cara voluntarily recalled two lots of 5. Duragesic. The recall was conducted . Food and Drug Administration). Potential leaks in the fentanyl reservoir were the reason for this latest recall. Defective Duragesic. The manufacturer of the Duragesic. Some of the fentanyl may have leaked into the pouches in which the patches were packaged. Deadly Risks Direct exposure to fentanyl can be extremely hazardous. Fentanyl is one of the strongest painkillers available . Fentanyl Transdermal official prescribing information for healthcare professionals. Includes: indications, dosage, adverse reactions, pharmacology and more.That's why 'microgram' doses are used rather than milligrams. A patient or a caregiver removing the packaging for a defective Duragesic. Soon thereafter, all lots of fentanyl- containing transdermal patches were recalled in the U. S. Each year, over a billion dollars in sales of Duragesic. Over four million prescriptions for Duragesic? If so, contact us to speak with a Duragesic. Let us help you win the compensation you need and deserve.
13, 2008 -- Certain prescription skin patches containing the painkiller fentanyl are being recalled because of possible overdose risk. The voluntary recall applies to the following products. FDA Video: Fentanyl (Duragesic) Patches Recalled. FDA MedWatch Safety Alert. Fentanyl transdermal system CII Patches. Johnson & Johnson Duragesic Fentanyl Patch Recall Lawsuit. Fentanyl Transdermal - FDA prescribing information, side effects and uses. Fentanyl Transdermal system is indicated for the management of pain in opioid- tolerant patients, severe enough to require daily, around- the- clock, long- term opioid treatment and for which alternative treatment options are inadequate. Patients considered opioid- tolerant are those who are taking, for one week or longer, at least 6. Limitations of Use. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended- release opioid formulations, reserve Fentanyl Transdermal system for use in patients for whom alternative treatment options (e. Fentanyl Transdermal Dosage and Administration. Initial Dosing. Fentanyl Transdermal system should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain. Due to the risk of respiratory depression, Fentanyl Transdermal system is only indicated for use in patients who are already opioid- tolerant. Discontinue or taper all other extended- release opioids when beginning Fentanyl Transdermal system therapy. As Fentanyl Transdermal system is only for use in opioid- tolerant patients, do not begin any patient on Fentanyl Transdermal system as the first opioid. Patients considered opioid- tolerant are those who are taking at least 6. Initiate the dosing regimen for each patient individually, taking into account the patient's prior analgesic treatment experience and risk factors for addiction, abuse, and misuse . Monitor patients closely for respiratory depression, especially within the first 2. Fentanyl Transdermal system when serum concentrations from the initial patch will peak . As such, it is preferable to underestimate a patient’s 2. In a Fentanyl Transdermal system clinical trial, patients were converted from their prior opioid to Fentanyl Transdermal system using Table 1 as a guide for the initial Fentanyl Transdermal system dose. Consider the following when using the information in Table 1: This is not a table of equianalgesic doses. The conversion doses in this table are only for the conversion from one of the listed oral or parenteral opioid analgesics to Fentanyl Transdermal system. The table cannot be used to convert from fentanyl to another opioid. Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose. To convert patients from oral or parenteral opioids to Fentanyl Transdermal system, use Table 1. Do not use Table 1 to convert from Fentanyl Transdermal system to other therapies because this conversion to Fentanyl Transdermal system is conservative and will overestimate the dose of the new agent. Table 1. 1: DOSE CONVERSION TO Fentanyl Transdermal SYSTEMCurrent Analgesic. Daily Dosage (mg/day)Oral morphine. Intramuscular or Intravenous morphine. Oral oxycodone. 30- 6. Oral codeine. 15. Oral hydromorphone. Intravenous hydromorphone. Intramuscular meperidine. Oral methadone. 20- 4. Use of Table 1 for conversion to other analgesic therapies can overestimate the dose of the new agent. Fentanyl Patch Recall. Are you taking Fentanyl? The FDA has not yet determined if the fatal Fentanyl overdose risks are the product of a drug defect or the incorrect use of this powerful narcotic. Overdosage of the new analgesic agent is possible . Calculate the previous 2. Convert this amount to the equianalgesic oral morphine dose using a reliable reference. Refer to Table 2 for the range of 2. Fentanyl Transdermal system dose. Use this table to find the calculated 2. Fentanyl Transdermal system dose. Initiate Fentanyl Transdermal system treatment using the recommended dose and titrate patients upwards (no more frequently than 3 days after the initial dose and every 6 days thereafter) until analgesic efficacy is attained. Do not use Table 2 to convert from Fentanyl Transdermal system to other therapies because this conversion to Fentanyl Transdermal system is conservative and will overestimate the dose of the new agent. Table 2. 1: RECOMMENDED INITIAL Fentanyl Transdermal SYSTEM DOSE BASED UPON DAILY ORAL MORPHINE DOSEOral 2. Morphine (mg/day)Fentanyl Transdermal System. Dose (mcg/hour)6. NOTE: In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to Fentanyl Transdermal system. Table 2 should not be used to convert from Fentanyl Transdermal system to other therapies because this conversion to Fentanyl Transdermal system is conservative. Use of Table 2 for conversion to other analgesic therapies can overestimate the dose of the new agent. Overdosage of the new analgesic agent is possible . In patients with mild to moderate hepatic impairment, start with one half of the usual dosage of Fentanyl Transdermal system. Closely monitor for signs of sedation and respiratory depression, including at each dosage increase . In patients with mild to moderate renal impairment, start with one half of the usual dosage of Fentanyl Transdermal system. Closely monitor for signs of sedation and respiratory depression, including at each dosage increase . Continually reevaluate patients receiving Fentanyl Transdermal system to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration. During chronic therapy, periodically reassess the continued need for opioid analgesics. The dosing interval for Fentanyl Transdermal system is 7. Do not increase the Fentanyl Transdermal system dose for the first time until at least 3 days after the initial application. Titrate the dose based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application. It may take up to 6 days for fentanyl levels to reach equilibrium on a new dose . Therefore, evaluate patients for further titration after no less than two 3- day applications before any further increase in dosage is made. Base dosage increments on the daily dosage of supplementary opioids, using the ratio of 4. Fentanyl Transdermal system dose. If unacceptable opioid- related adverse reactions are observed, the subsequent doses may be reduced. Adjust the dose to obtain an appropriate balance between management of pain and opioid- related adverse reactions. A small proportion of adult patients may not achieve adequate analgesia using a 7. An increase in the Fentanyl Transdermal system dose should be evaluated before changing dosing intervals in order to maintain patients on a 7. Dosing intervals less than every 7. Administration of Fentanyl Transdermal System. Fentanyl Transdermal system patches are for transdermal use, only. Proper handling of Fentanyl Transdermal system is necessary in order to prevent serious adverse outcomes, including death, associated with accidental secondary exposure to Fentanyl Transdermal system. In young children and persons with cognitive impairment, adhesion should be monitored and the upper back is the preferred location to minimize the potential of inappropriate patch removal. Hair at the application site may be clipped (not shaved) prior to system application. If the site of Fentanyl Transdermal system application must be cleansed prior to application of the patch, do so with clear water. Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics. Allow the skin to dry completely prior to patch application. Patients should apply Fentanyl Transdermal system immediately upon removal from the sealed package. The patch must not be altered (e. Fentanyl Transdermal system should not be used if the blister seal is broken or if the patch is cut or damaged. The transdermal system is pressed firmly in place with the palm of the hand for 3. Each Fentanyl Transdermal system patch may be worn continuously for 7. The next patch is applied to a different skin site after removal of the previous transdermal system. If problems with adhesion of the Fentanyl Transdermal system patch occur, the edges of the patch may be taped with first aid tape. If problems with adhesion persist, the patch may be overlayed with a transparent adhesive film dressing. If the patch falls off before 7. A new patch may be applied to a different skin site. Patients (or caregivers who apply Fentanyl Transdermal system) should wash their hands immediately with soap and water after applying Fentanyl Transdermal system. Contact with unwashed or unclothed application sites can result in secondary exposure to Fentanyl Transdermal system and should be avoided. Examples of accidental exposure include transfer of a Fentanyl Transdermal system patch from an adult’s body to a child while hugging, sharing the same bed as the patient, accidental sitting on a patch and possible accidental exposure of a caregiver’s skin to the medication in the patch while applying or removing the patch. Instruct patients, family members, and caregivers to keep patches in a secure location out of the reach of children and of others for whom Fentanyl Transdermal system was not prescribed. Avoidance of Heat. Instruct patients to avoid exposing the Fentanyl Transdermal system application site and surrounding area to direct external heat sources, such as heating pads or electric blankets, heat or tanning lamps, sunbathing, hot baths, saunas, hot tubs, and heated water beds, while wearing the system . Upon system removal, 1. Withdrawal symptoms are possible in some patients after conversion or dose adjustment . It is not known at what dose level Fentanyl Transdermal system may be discontinued without producing the signs and symptoms of opioid withdrawal. Dosage Forms and Strengths. Fentanyl Transdermal system is available as: Fentanyl Transdermal System 1. Fentanyl Transdermal System 2. Fentanyl Transdermal System 5. Fentanyl Transdermal System 7. Fentanyl Transdermal System 1. This lowest dosage is designated as 1. Contraindications. |
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