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For example in treatment order 2mg ropinirole visa, Delano and Snell (2006) used social stories as an intervention to increase social interactions in three elementary students symptoms zithromax ropinirole 2 mg mastercard, in a controlled resource room medicine in motion ropinirole 1 mg free shipping. The results of the study showed that the three participants demonstrated improvement in the resource room; however world medicine cheap ropinirole 0.25mg online, two out of three generalized their social behaviors to the mainstream classroom. Another type of intervention is through increasing fluency of appropriate social behaviors through exposure and practice using ‘‘social scripts,’’ where adolescents may carry index cards that include various responses for different situations. They met for two hours a week for a period of 14 weeks wherethey were taught social skills through role-play. The members practiced the new skill in pairs, one pair at a time, while the rest of the group watched and gave feedback. After the intervention took place, maintenance probes occurred once a month for 5 months. Teaching started by reading novels about monsters that encounter social difficulties and progressed to adult modeling. The children then practiced and played games within the group setting and then moved on to new situations to encourage generalization (Owens et al. Each collaborative activity required verbal and non-verbal communication, collaboration, joint problem solving, joint creativity and joint attention to the task. A variety of peer related strategies have been developed to improve the social functioning of children on the autism spectrum. Peer-mediated strategies typically involve the use of socially competent peers to model and reinforce appropriate social behavior (DiSavlo& Oswald, 2002). Participants included three 8 and 9-year-old boys with autism who were high functioning in terms oflanguage and intellectual abilities butlacked social competence, and all otherchildren in a third-grade classroom. Tutoring sessions resulted inan increase in interaction from 80 to 120 secondsper 5-minute sample for the threechildren with autism. Additionally there was an increase in themean interaction time of peers,and the children with autism displayed improved academic achievement (DiSavlo& Oswald, 2002). These children had adequate language skills and couldread at the kindergarten level, but suffered from weak social competence. The results indicated that the childrenwith autism increased their social interaction by 36% and 38% respectively during the treatmentphase, as compared with thebaseline phase, in which children attended regular classes but were not assigned a buddy (DiSalvo& Oswald, 2002). Various interventions were found to be effective in teaching social skills to children on the spectrum; however, little research combined the use of social stories and peer mediated intervention, especially in Lebanon. Thus, a combined intervention consisting of social stories and peer mediated intervention will be used to remediate social skills in this case study. Thus, it has imperative for general education teachers and special educators to become acquainted with effective r strategies to help these students experience successful inclusion. Peer mediated interventions in the form of peer tutoring and cooperative learning, tend to improve social competence and increase participation (Barbetta, Delquadri, Kamps, Leonard, 2002). An increase in the amount of time engaged in social interactions was fairly documented (Constantino, Friesen, Przybeck, & Todd, 2000). Social stories, on the other hand, are short tales that describe specific social situations and appropriate responses (Gray, 1998). Lastly, stories teach the child how to identify social cues that are prerequisites to specific desirable behaviors (Greenway, 2000). Empirical evidence on the effectiveness of social stories in school settings is somewhat limited (Hanley-Hochdorfer, 2010). What are the observable changes during the intervention period and hypothesized explanations Hypothesis It was hypothesized that using an intervention composed of peer mediated intervention on academic tasks and reading social stories improves targeted social skills in this particular first grader. It was hypothesized that there will be an improvement in the teachers rating scale after completing the intervention. Peer mediated intervention involves the use of socially competent peers to model and reinforce appropriate social behaviors in natural settings. The secondary participants included three of his classmates from Grade 1 who were considered typically developing peers (both socially active and average to high achievers academically); his homeroom teachers, special educator, and mother. Peer participation was based on individual voluntary participation onschool projects during enquiry lessons. Children who participated did so whenever they wanted to, without constraint, thus reflecting natural school interactions. Adam is a Lebanese student who lives with his family consisting of his parents and two siblings. Adam has been assessed three times; twice by educational psychologists and once by a speech therapist. Adam was selected to participate in this study because he displays weakness in social skills and he demonstrates the basic reading skills necessary to read the social stories. The primary benefit of using the A-B-A design is that the statement of change is strengthened when the behavior is maintained after stopping the intervention (Tillman & Burns, 2009). Following this phase was the intervention phase that took place during eight weeks. During the intervention phase, the researchers read a social story with Adam every Tuesday, and a cooperative group work activity took place every Friday. Materials and Instruments Social Stories Social Stories are individualized short stories that describe specific social situations and provide specific desired responses (Gray, 1998). The selected social stories were designed or chosen depending on the target skills that need remediation. Each booklet is 4 to 5 pages long; these pages include brief sentences and some pictures. The types of sentences used in the stories are the following: (a) descriptive sentences, which identify the contextual variables of the target situation (example: sometimes, recess is on the playground); (b) directive, which assist in describing a desired behavior in response to a social cue or situation (example: I will try to say things like good job or nice drawing); (c) prescriptive, which describe the reaction and feelings associated with the target situation (example: there are other kids who like to play with me during recess); (d) affirmative, which express shared belief within a given society (for example, this is a good habit) (Sansosti et al. It consists of 136 items that describe social skills commonly observed in the classroom. This type of observation is usually beneficial when the likelihood of the occurrence of particular behaviors is targeted (Steege& Watson, 2009). The purpose of the meeting was to provide the parents and teachers with the purpose of the study, and a description of the procedure. Parents were informed about the benefits of the intervention, and were given the option of withdrawing their son from the study at any time and for any reason. Additionally, the researchers observed Adam during the course of his usual school activities. After the first two weeks of initial observations (the baseline phase), a transition was made to the intervention phase. They were designed in accordance with research based guidelines and recommendations (Gray, 1993; Denning, 2007). Once a week, the teacher grouped Adam with 3 typically developing peers on a group project. The teacher took10 minutes to explain what the project was about and assigned roles for each group member. Cooperative learning groups were based on incidental teaching, making use of academic projects using simple peermodeling, with the use of direct instructions and guidance of the special educator. Each project required verbal and non-verbal communication, collaboration, joint problem solving, joint creativity and joint attention to the task. Implementation of the social stories and peer mediated intervention also took place for a period of eight weeks. A week after completing the intervention, Adam’s social behavior was observed both in the classroom and on the playground. The observer was required to mark the occurrence of targeted behaviors using 15 second partial interval recording (similar to that used during the baseline phase). Also, an informal interview was conducted with the teachers and parent in order to get more details on their feedback. Based on the collected data, the target skills that need remediation were identified. An analysis and synthesis of the documented data, in both the journal and graphs, was discussed. Lastly, a summary of the results collected from the rating scales filled by the teachers, observations conducted, and informal interviews was provided. Results Behavioral Changes Observed During Social Stories Sessions Adam was very cooperative throughout the story reading sessions. In almost every session, Adam would come to the classroom door and greet the researchers, ask permission to go to the library and read a book several times. Adam was capable of remembering the main investigator’s name (Noor) by the second week.


  • Is there a loss of memory about events that occurred before a specific experience (anterograde amnesia)?
  • Benadryl
  • Have high blood pressure that does get lower with medicine.
  • Surgery such as tonsillectomy and adenoidectomy
  • Chest x-ray
  • Abnormal secretions
  • Pulmonary arteriovenous (in a lung, the pulmonary artery and vein are connected, allowing the blood to bypass the oxygenation process in the lung (pulmonary arteriovenous fistula)
  • Atrial myxoma
  • Weakness and numbness around the hand
  • Deslanoside

Exposure Assessment Records the park shall establish and maintain an accurate record of all exposure measurements treatment of diabetes order ropinirole online now. Medical Surveillance Records the park will establish and maintain audiometric test records for each worker subject to the medical surveillance alternative medicine cheap ropinirole 1mg mastercard. This should include tester identification medicine hollywood undead 0.25mg ropinirole free shipping, conditions of the test medicine 6 clinic buy 2mg ropinirole visa, the etiology of any significant threshold shift and the identification of the reviewer. On termination of employment, the employer should provide a copy of the training record to the worker. Engineering controls, such as enclosure of the operation, general and local exhaust ventilation and substitution of less toxic materials, will be implemented to the extent feasible to control airborne exposure to harmful dusts, fogs, fumes, mists, gases, smokes, sprays or vapors. Scope: this program applies to all employees and volunteers of the National Park Service who use respirators in the course of their duties. Parks shall implement engineering and administrative controls, including enclosure of the operation, general and local exhaust ventilation, work practice controls and substitution of less-toxic materials to control airborne exposure to harmful dusts, fogs, fumes, mists, gases, smokes, sprays or vapors. Engineering and administrative controls will be evaluated and implemented to the extent feasible before respirators are used to control personal exposures. Parks shall develop and implement a written respiratory protection program including park and work-site-specific procedures for protecting workers from hazardous inhalation exposures. Parks shall provide a medical evaluation to determine the employee’s ability to use a respirator before the employee is fit-tested or required to use a respirator in the workplace. The evaluation will be conducted by a physician or other healthcare professional licensed to provide such services. Tests shall be conducted to ensure the effective fit of all tight fitting facepiece respirators. Parks shall provide effective training to employees who are required to use respirators. The training must be comprehensive, understandable and recur annually (or more often if necessary) to ensure safe use. Conditions and procedures for voluntary use of respirators under non-hazardous conditions should be established. This is to ensure that employees are informed about the limitations of respirators and that their use does not present a hazard. The park shall establish and maintain records of exposure evaluations, personal exposure monitoring, personnel training and written information regarding medical evaluations and fit-testing. The program shall be reviewed at least annually and be updated as necessary to reflect those changes in workplace conditions that affect respirator use. Respiratory Protection Prevention Program Implementation Action Items Step 1 Designate a Respiratory Protection Program Administrator. For other hazards, exposure assessment may be conducted using objective data, mathematical modeling or personal exposure monitoring. Step 3 Implement Engineering and Administrative Controls to Eliminate or Reduce Exposure to Employees. Guidance for appropriate selection of respirators is found in Appendix B, Respirator Selection Guide. See Appendix E, Safe Use of Respirators, and Appendix F, Determining Cartridge and Canister Change-Out Schedules. Fit tests may be qualitative or quantitative; however, some respirators and some uses will require quantitative fit-testing. Written Respiratory Protection Program Written Program Requirements Each Park shall develop and implement a written respiratory protection program with work-site-specific procedures and requirements for respirator use. Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations. Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding and otherwise maintaining respirators. Procedures to ensure adequate air quality, quantity and flow of breathing air for atmosphere-supplying respirators. Training of employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations (see also hazard communication). Training of employees in the proper use of respirators (including placement and removal, any limitations on their use and their maintenance). They also need to know what protective measures are available to prevent adverse effects from occurring. The park will provide this needed information through implementation of a Hazard Communication Program. Scope: this program applies to all respiratory hazards and respirator use by park employees and volunteers. Responsibilities the Respiratory Protection Program Administrator is responsible for evaluating those tasks for which respiratory protection is thought to be necessary, determining the degree of hazard posed by the potential exposure, determining whether engineering or administrative controls are feasible, and specifying which respiratory protection device is to be used at each task. Supervisors will ensure each employee under his or her supervision using a respirator has received appropriate training in its use and an annual medical evaluation. Supervisors will ensure the availability of appropriate respirators and accessories, provide adequate storage facilities and encourage proper respirator equipment maintenance. Supervisors must be aware of tasks requiring the use of respiratory 7 protection and ensure all employees engaged in such work use the appropriate respirators at all times. It is the responsibility of each respirator wearer to wear his or her respirator when and where required and in the manner in which he or she was trained. Respirator wearers must report any malfunctions of the respirator to their supervisors immediately. The respirator wearer must also guard against mechanical damage to the respirator, clean the respirator as instructed and store the respirator in a clean, sanitary location. Engineering Controls Parks shall implement engineering and administrative controls, including enclosure of the operation, general and local exhaust ventilation, work practice controls and substitution of less-toxic materials to control airborne exposure to harmful dusts, fogs, fumes, mists, gases, smokes, sprays or vapors. Engineering and administrative controls will be evaluated and implemented to the extent feasible before respirators are used to control personal exposures. Supervisors will ensure the daily maintenance and function of ventilation systems used to control respiratory hazards in their shops. Ventilation systems will be evaluated at least annually to validate flow rates and capture velocities. Respiratory hazards have been evaluated at your park to determine proper selection of respirators. Your Park Respirator Selection Guide Engineering Hazardous Type of Controls in Agent Respirator Operation Location Place Criterion Cartridge Change-out Schedule Method Brake shoe Auto maint. Test will be conducted by the clinic as needed to determine the ability of the worker to use the respirator. Fit-testing will be conducted before workers are required to wear their respirators. The following people have been trained to conduct qualitative fit tests using the Bitrex or irritant smoke methods: John Brown, Safety Manager Jane Williams, Maintenance Division Supervisors will coordinate fit-testing with these individuals. Maintenance, Care and Storage of Respirators Section supervisors will ensure that workers properly care for and maintain their respirators. Respirators will be cleaned after each use according to the following procedures: 1. Disassemble facepieces by removing speaking diaphragms, demand and pressure-demand valve assemblies, hoses or any components recommended by the manufacturer. Wash components in warm (110F maximum) water with a mild detergent or with a cleaner recommended by the manufacturer. Rinse components thoroughly in clean, warm (110F maximum), preferably running water. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for two minutes in hypochlorite solution (50 ppm of chlorine) made by adding approximately 1 milliliter of laundry bleach to 1 liter of water at 110F, or other commercially available cleansers of equivalent disinfectant quality when used as directed, if their use is recommended or approved by the respirator manufacturer. Rinse components thoroughly in clean, warm 110F maximum), preferably running water. In addition, some disinfectants may cause deterioration of rubber or corrosion of metal parts if not completely removed. Reassemble facepiece, replacing filters, cartridges and canisters where necessary. Respirators will be stored in Ziploc-type bags in lockers or designated storage containers.

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This process should begin • Be mindful of your child’s social as early as possible so that and communication skills – the mentor and your child Emphasize employment options have an opportunity to get to that do not demand excessive know each other medications used for adhd 1 mg ropinirole for sale. Provide the social interactions or the need mentor with information on to interpret interpersonal hints treatment pneumonia discount ropinirole 2 mg overnight delivery. This looking for employment medicine prescription drugs cheap 2 mg ropinirole amex, a number resource is listed in the Learn More of agencies and organizations section medications to treat bipolar buy ropinirole 0.25 mg with mastercard. Many of these province that while a useful resource, the wide organizations also provide Autism Speaks Employment Took opportunities for mentoring and/or Kit is an American document and volunteering programs during the therefore the employment laws, high-school years. They include: Social Security references and other American-specifc services • Ontario Job Opportunity will differ from those in Ontario. Housing • the Hawkins Institute – A useful resource for families Housing needs in the Greater Toronto Area. Their services assistance with some tasks, and (and online tip sheets) range some may need 24-hour care. Ongoing expenses such as A good starting point when utilities, water, heating, trash planning housing and residential collection, cable, phone, etc. Are they ready to use skills related to cooking, Planning for a transition to Adult housekeeping, and self-care Independent living skills are not typically taught in school, so many parents begin teaching Models of housing independent living skills while children are in their early teens. One good starting point is Community Living Ontario, a non-proft I fnd this the most provincial association representing diffcult and schools are 117 local associations, which not preparing the students advocate for and assist people for this transition and with intellectual disabilities. The adult with Autism needs to feel comfortable in the setting and with the people who work with them. Some combine pathway to adulthood for your child housing and support services; will depend on their own unique with others the services are abilities and needs: arranged separately. Residential Model Characteristics Custodial Housing • 24-hour supervision • Basic assistance with daily living/self-care tasks • Medication supervision Supportive Housing • Focused on community integration • Personal support provided by staff members • Usually provided through a group-home setting but can include low-support self-contained apartments Supported Housing • Focused on community integration • Housing and support are separate with support services provided by outside service providers • Typically consists of independent apartments or housing co-operatives Source: Adapted from – ‘Canadian Mental Health Association Ontario Housing’ Stoddart Transitioning into Postsecondary Autism Ontario Higher Education Quality Resource type: Council of Ontario Information Database Resource type: Reference autismontario. Family Transitions Introduction Life with children can be to these changes, which can be complicated and flled with another source of unpredictability changes. Still, change jobs, household pets come many families do successfully and go, and siblings grow up navigate these transitions. Page 102 How to prepare for the move Topics covered this section provides information You can support your child by on some common transitions helping them understand what experienced in family life, including: will change and what will remain the same after the move. Try • New house/moving writing down the most signifcant things that will change and the • Siblings things that will stay the same (e. Small differences such as changes in fooring, the position of light switches and new noises may New House/Moving be important to your child. Making note of these differences in your new home can help you prepare Help your child understand your child in advance. Storybooks on moving When explaining the move, homes can also help ease the use terms that your child will transition to the new home. Try to create your own story about your think of examples that will make new house by including:86 the move meaningful to your child, especially positive changes such as: • Photos of the new house, getting a bigger backyard for their their room, kitchen and trampoline or garden; being closer neighbourhood, along with to mom or dad’s work so that they photos illustrating the moving spend less time driving and more process including boxes, time with the family; or getting moving trucks, and movers; away from loud noises that bother them. Taking some time of the house to accompany to consider and learn about your the photographs. Either way, children of stress is an important starting should understand that at the end point for parents wanting to of that day, they will be going to help improve the relationship the new home. As your 87 Siblings may experience: family settles into the new home, it is a good idea to keep as many • Embarrassment in front of other routines the same as possible, their friends or jealousy at including evening activities, school the amount of time parents routines and caregivers/babysitters. But few parents • Uncertainty over what role want to extend this sacrifce to they will play with their relationships with their other sibling as they transition children. Your local Autism Ontario can enjoy together, keeping chapter may provide a starting communication simple point for fnding a regular sibling and praising good play. Regularly scheduled separate time, Member/Caregiver such as one evening a week, a weekend morning, or Death is an uncomfortable extra time before bed can subject. If someone close has obsessive behaviour or an become ill, explain why they are increased reliance on routines. If an illness within the family progresses, there may be disruptions in For more information and tips normal routines. You may be able on speaking to your child about to help your child to understand the death of a family member or and prepare for these disruptions caregiver, a link to an information by using calendars to document sheet compiled by the National appointments or stays in hospital. One of the biggest concerns shared by all parents of children with How to approach the subject disabilities is: What will happen to of death my child after I am gone In fact, creating the life cycle of plants or insects, a plan with the appropriate experts can be helpful to explain the (lawyer, fnancial planner), can concept of death. In general when signifcantly reduce a source of explaining death to a child with stress in your life. Some key points to where an account is set up 90 consider include: to support one individual (the benefciary) but is in the name of another person • When composing a will, consider (the trustee) who must use having it legally written and the money or assets of the trust registered with a lawyer. This in it are still able to fulfll may involve pictures, stories, or their responsibilities. Using a calendar to support groups where you may be outline how days will be spent can able to connect with other parents also be useful. For parents who have decided to separate it can be benefcial to search recent online blogs to read the stories of other parents and/or join a local parent group for single parents. These groups can help you talk with other parents who have separated and offer support during a diffcult time. There are few specifc resources for these situations, and those that do exist may not ft your unique circumstances or the needs of your child. Choose games in which the child Siblings may become frustrated has to wait for a turn before taking when playing with their brother one. Part of this really fast turn and then letting him frustration may have to do with have his turn for longer. Be sure to their sibling’s underdeveloped turn label with gestures and pointing to taking skills. Parents and siblings let him know whose turn it is, for can use these tips to help promote example, Your turn” (point to him) turn taking. These activities can be tried at Turn taking is an important skill for home and at school. It is the beginning having only one item necessitates of social interaction between the sharing and taking turns! Activity Making It Interactive Use Words to Label Ball Play catch, roll/bounce back ball, throw, bounce, and forth, throw ball into a catch box or pail Music Take turns hitting the drum, bang, music, drum (use one shaking the bell, pushing drumstick, buttons to activate music musical toy) Stacking Take turns stacking ring, on, off rings and removing rings Blocks Build one tower together; on, block, off, down take blocks off one at a time Page 109 Activity Making It Interactive Use Words to Label Shape sorter Take turns putting one shape in, out, shape in/taking one shape out Craft Use one crayon, one on, colour, paint activities paintbrush, one marker Take turns colouring, painting, etc. Doll and Take turns with one doll, brush, eat, hug, dolly, accessories one brush, one spoon, one eat, drink, bottle, milk bottle, etc. Sensory Development Introduction Individuals on the autism spectrum frustrating parts of their childhoods. Understanding what types of the world around them is that their sensations are most likely to cause brains have trouble processing your child discomfort can help you sensory information. This can cause avoid or manage the situations that discomfort, distress and confusion stress your child. In most children more take in the range of sensory normal” eating habits develop issues our son has. In this Encountering these behaviours section, we discuss: three times a day or more can be stressful and parents may also • Food worry about their impacts on your child’s growth and health. Depending on the cause More information on of your child’s eating problem, a understanding eating number of different approaches problems may help to improve challenging eating habits or behaviours. If you want to Learn More about eating problems and how to Some of these include:94 address them, the resources provided in the Learn More • Offering appropriate serving section include information on sizes (not overcrowding a plate) factors that may contribute and making food attractive to eating problems, such as (e. Also included are • Involving your child in food references which suggest questions preparation if possible to consider prior to talking to your child’s doctor about eating. Having a routine – caused by reactions to certain consistent mealtimes, for example – textures and touch sensations are and sticking to it is important. Since many parents you begin to suspect that your have had to manage this issue with child’s eating problems are due their children, there are many tips to a physical problem such as a and suggestions for overcoming or diffculty swallowing, diarrhea working around texture sensitivities. Some of the more common appointment with your child’s 96 ones include: doctor as soon as possible. Family members also • Overly sensitive body parts need to be aware of how their (complaints of pain during hugs or kisses could be upsetting.

The suggestion is that 2 medications that help control bleeding buy 0.25 mg ropinirole with visa, in the past treatment episode data set buy on line ropinirole, pleural plaques were considered compensatable because it was believed that people suffered ill-health as a result of the condition and that it is now generally considered that pleural plaques are asymptomatic and not 68w medications cheapest generic ropinirole uk, therefore medicine zolpidem generic 2mg ropinirole amex, actionable. Thus, a person pursuing a claim for physical injury may also be entitled to compensation for mental distress arising as a consequence of the physical injury. However, successful claims for purely psychiatric injuries require pursuers to establish that they suffered something beyond the normal emotional responses to an incident such as grief, distress or fear (Scottish Law Commission 2004). Although the House of Lords judgement in the Johnston case is not binding in Scotland, it is persuasive and has already been influential in a Court of Session case (Helen Wright v Stoddard International plc). Indeed, in this case, Lord Uist reserved his opinion on the question of damages for pleural plaques until the House of Lords decision had been issued and then issued a supplementary opinion of his own. In his judgement, Lord Uist used the House of Lords ruling to conclude that pleural plaques cause no harm at all. It has been suggested that any increased costs to the insurance industry will be passed on to business and consumers in the form of increased insurance premiums. It has also been suggested that such increased costs could put businesses within Scotland at a competitive disadvantage to their English and Welsh counterparts. The Scottish Government has stated that: Only when the insurance industry has considered the legislation as introduced, and taken a view on the risks it presents, would any quantification of increased cost of insurance premiums be possible. The insurance industry has observed that such uncertainty will have an adverse 6 impact on the competitiveness of Scottish business, and went as far as to suggest that the instability created by the proposed legislative change could be sufficient to lead insurers to exit 7 the Scottish liability insurance market altogether. Most asbestos-related cases are funded on a speculative fee arrangement (no win, no fee) (Explanatory Notes, para 13). Those law firms that operate in the personal injury/speculative fee arrangement market are likely to benefit financially from the legislation. However, it should be noted that pleural plaque cases are not as lucrative as those involving the more serious asbestos related conditions and that the sums involved are comparatively minor. Thompsons Solicitors is one of the key players in the field of personal injury and employment 8 rights law and consistently wins over 150 million every year in compensation for clients. Concern has been expressed as to the validity of the consultation process on the grounds that it appears to have been driven by a potential beneficiary of the decision to legislate. On the other hand, it is perfectly legitimate for any organisation to lobby Parliament and Government on any aspect of public policy, especially where the work of the organisation provides it with expertise in a relevant area. The following chart, based on data provided in the Financial Memorandum, illustrates how average settlement awards are estimated to be divided in pleural plaque cases. However, opposition to these proposals has been expressed outside Parliament, most strongly by those in the insurance industry. In addition, a number of local authorities (North Lanarkshire 8 Thompsons Solicitors, the Firm An Introduction. Despite this, Scottish Ministers remain convinced of the need to take forward a Bill to ensure that the HoL Judgement does not have effect in Scotland” (Policy Memorandum, para 21). The central argument in support of the Bill is that workers were negligently exposed to asbestos by their employers and that pleural plaques constitute a physical injury which has a detrimental impact on the health and well-being of those concerned, and is considered likely to precede the development of mesothelioma. It is argued, by those who support the introduction of legislation, that pleural plaques cause irreversible damage to the lining of the lung which, if the damage was to visible tissue, would constitute an actionable injury. One 10 observer described the debate as one sided, over-emotional and ill-informed”. It was suggested that legislating in this way may constitute a departure from the existing principle whereby anxiety in the absence of harm does not give rise to a claim for damages and that other potential litigants, such as those negligently exposed to radiation, contaminated food and stress at work (described by some in the insurance industry as ‘the worried well’) may increase in number. Anxiety over possible degenerative changes in the spine and noise induced hearing loss are two examples of conditions to which, it is suggested, 12 the current proposals could foreseeably be extended. The Scottish Government, however, considers that pleural plaques should be treated as a material personal injury for which damages may be awarded and that the anxiety felt by people with pleural plaques comes from the known risks associated with asbestos (Policy Memorandum, para 25). On the specific issue of opening the floodgates to claims for other conditions, the Scottish Government has responded that the Bill is drafted in such a way as to make the minimum incursion into the law, is concerned with only three asbestos related conditions and any legislation about any other conditions would need to be argued on its merits and approved by Parliament (Policy Memorandum, Annex A). The Industrial Injuries Advisory Council, the body which provides advice to the Secretary of State for Work and Pensions about industrial injuries benefit, is currently undertaking a review of asbestos and pleural plaques. The review will consider whether pleural plaques should be designated a prescribed disease and advise the Secretary of State accordingly. The review follows a 2005 examination of the evidence in relation to asbestos-related diseases which concluded that that there is a lack of evidence that pleural plaques cause impairment of lung function sufficient to cause disability” (Department for Work and Pensions 2005). A number of other changes have recently been made to the law and to court procedure in respect of mesothelioma cases. These include changes to personal injuries practice in the 13 Court of Session in 2003, the Compensation Act 2006, and the Rights of Relatives to Damages (Mesothelioma) (Scotland) Act 2007. Leuven Leuven k To provide guidance on how to explore the possibility of an environmental aetiology in Belgium patients with interstitial lung disease. Fax: 32 16347124 k To describe the main causes of the mineral pneumoconioses, including silicosis and E-mail: ben. Summary Occupational and environmental exposures can lie at the root of a wide range of inter stitial lung diseases and should always be considered when making a diagnosis. These diseases can be the direct result of cumulative exposure to the causative agent, or their occurrence may be mainly related to individual susceptibility. As lifestyles and employment patterns change, the traditional pneumoconioses are being supplemented with diseases that may result from newer technologies and exposure profiles. Key points Occupational diseases of the parenchyma instance smoking), medication use, work, hob k An occupational or j often pose a difficult diagnostic challenge. Both recent and remote exposures should always be should always be considered in patients with should be considered [1]. Pathology may be an ing is a skill in itself, and it may be useful to interstitial lung disease. It could include the following be associated with the presence of significant Time numbers of silicotic noduli. The term asbestosis should only be used to the layout of the workplace (make a diagram). Silicosis is caused by exposure to free crystalline Mixed exposures to silica or asbestos should silica (SiO2). Exposure occurs ceptibility does play a role in the occurrence and mainly in mines or foundries, but many other clinical course of the mineral pneumoconioses, occupations involve work with quartz-containing these disorders result mainly from excessive materials, such as sand or other minerals [7]. The cumulative exposures to the offending mineral pathological hallmark of silicosis consists of the dusts. However, in some parenchymal lung dis silicotic nodule, which may often appear first in eases, individual host susceptibility – rather than hilar or mediastinal lymph nodes. Finding sili cotic nodules must always raise the suspicion of exposure intensity – is the main determinant of silicosis, and certainly constitutes a serious chal occurrence [11]. Individual host susceptibility is obviously a the occurrence of silicotic noduli may also be an major factor in extrinsic allergic alveolitis (or important factor in attributing an occupational hypersensitivity pneumonitis). This disease is aetiology in cases of bronchopulmonary cancer, generally caused by exposure of a susceptible since occupational exposure to free crystalline sil individual to aerosolised antigenic material of ica is a recognised cause of human cancer. On biological origin, such as microbial spores, avian the other hand, the absence of characteristic sil antigens or other proteins. The discovery of spe icotic nodules should not necessarily exclude a cific (precipitating) immunoglobulin G antibod diagnosis of silica-induced lung disease. On the other hand, in patients with a long-standing low-grade exposure and a silent progression towards chronic fibrosis, the typical pathological features may no longer be evident and the dif ferential diagnosis with idiopathic pulmonary fibrosis becomes more difficult. Some synthetic chemicals, most notably some isocyanates, may also cause a clinical picture typical of hypersen sitivity pneumonitis. The pulmonary presentation of chronic beryl lium lung disease is virtually indistinguishable from that of sarcoidosis [12]. Because chronic beryllium disease results from a cellular immune response against beryllium, the diagnosis of beryl liosis can be made with an in vitro lymphocyte proliferation test using a beryllium salt. Other exposures to minerals, most notably talc, and metallic agents [13, 14], including aluminium, may also lead to parenchymal lung disease with sarcoid-like granulomas. Consequently, a poten tial exposure to beryllium or other substances must always be considered even in cases of pathologically documented "sarcoidosis" [15]. Hard-metal lung disease is a rare condition, at least in typical cases, by the presence of Figure caused by cobalt-containing particles [16]. Repro may present clinically as hypersensitivity pneu choalveolar lavage and in lung tissue (giant cell duced from [22] with permission monitis. Silicosis is a disease of the lung parenchyma a) that is generally caused by a brief occupational exposure to free crystalline silica. Interstitial lung disease more than 40 years after a 5 year occupational exposure to talc.

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