21 Ocak 2011 Cuma

12 Ocak 2011 Çarşamba

laguna beach dui attorney

Barry Simons leads a "Team" of dedicated professionals who have litigated thousands of DUI cases in Courtrooms throughout Southern California and before the DMV. They have taught and written extensively on the law and science of DUI and collectively represent the most respected and recognized leaders in DUI Defense. The team is made up of (4) lawyers, specially trained Paralegals and Investigators. Our Firm also provides access to the top experts in Forensic Toxicology and Pharmacology who work with us to analyze the important scientific issues in your case.

Dean Emeritus for the National College for DUI Defense
Board Certified in DUI Defense
Author of California Driving Law
Top-rated by Martindale-Hubbell: "A-V"
Listed in Bar Register of Preeminent Lawyers
Southern California DUI Super Lawyer 2007, 2010

Barry is a nationally known expert in DUI Defense who has spent over 35 years fighting for drivers' rights in Orange County's Courts. He is a Founding Member, Fellow and the former Dean of the National College for DUI Defense. He is one of only 5 attorneys in the State of California to hold Board Certification in DUI Defense under standards certified by the American Bar Association. He has served as Vice-Chair of the DUI Advocacy Comm. of the National Assn. of Criminal Defense Attorneys. He is currently on the Bd. Of Directors of the California Association of DUI Lawyers and has qualified as a Specialist Member. He is rated "Preeminent" by Martindale-Hubbell and has been selected to "Who's Who In American Law".

Barry has been awarded the coveted peer review rating of AV ("very high to preeminent" in legal ability and ethics) by the Martindale-Hubbell International Law Directory. A lawyer must be admitted to the bar for 10 years or more to receive an AV® rating. In 2010 he was selected a Superlawyer in DUI Defense for Southern California and was listed as a top rated DUI Lawyer by OC Metro Magazine. Barry also is rated 10.0/10.0 in DUI Defense (The Highest Rating) from AVVO Lawyer rating service.

Barry has also been a leader in challenging the DMV with Writs and Appeals. In 1998 he established relaxed standards required at DMV Hearings to challenge alcohol-testing procedures in DUI Cases. (Robertson v Zolin) In 1999 he forced the D.M.V. to announce that they would cancel 4,700 drunk driving suspensions after exposing the OC Crime Lab's use of unapproved breath testing machines (Trautman v DMV). In 2002 he exposed the O.C. Crime Lab's use of unapproved Blood Testing methods between 1996 - 2002 (Bite v Gourley) invalidating blood test suspensions for all of his clients during that entire period.

He followed in 2003 with Baker v Gourley which established the rule that DMV can't rely on police opinions of intoxication to suspend drivers' licenses. His class action suit against the entire Irvine Police Department for failing to give DUI arrestees a choice between blood/breath and urine tests resulted in the decision in Nelson v. City of Irvine in the Federal Ninth Circuit Court of Appeals, which was upheld by the U.S. Supreme Court. In that case he established for the first time that an arrestee has a constitutional right to choose a breath test and that the police cannot compel a blood test from a driver who wants a breath test, except under unusual circumstances. He has co-authored Amicus Curiae Briefs for the United States Supreme Court in the cases of Illinois v. Lidster challenging police use of "Roadblocks" and Stogner v. California which successfully challenged extending time barred criminal prosecutions.

Barry has presented his cases and lectured at seminars for DUI attorneys throughout the US on subjects including scientific evidence, legal motions, DMV practice and procedure and the interstate implications of DUI license suspensions. His drunk driving cases include successful challenges in both trial and appellate courts to DUI Roadblocks, Preliminary Alcohol Screening Devices, DMV procedures and practices and refusals to take chemical tests. He is a "Co-Author" to California Drunk Driving Law, the "Bible" of DUI Defense.

wychbury medical group

Wychbury Medical Group

Latest practice news

Book your Flu Vaccination
The practice is now offering appointments for flu vaccination. Please contact the surgery to make your appointment.

Texting Service
The practice has started a texting service. We hope this will be a benefit to our patients. Initially this will be used as an appointment reminder service to patients. You will not be able to contact the practice using this system at present. For this system to be a success please let the surgery know your mobile number. There are contact sheets to fill in over all 3 sites. There is an option to opt-out of this service. Please speak to reception for further details.

Accreditation of the practice's clinical records The practice is working towards accreditation for Quality Clinical Records. This process ensures that the practice has Information Quality Assurances in place in line with NHS Connecting for Health Guidance. To acheive this accreditation a Primary Care Trust assessment team will visit the practice and it may be necessary for the visiting clinician to view a number of patient records. If you do not wish your record to be viewed as part of the assessment or require further information on the project, please ask at the reception desk.

Blood Pressure Monitoring

Did you know there is a blood pressure machine in the waiting room for patients to use? It will give you a printout of your blood pressure which may be useful for when you see the doctor, practice nurse, or even just for your own information.. If you need any help to use the machine, please ask at reception.

The practice has a number of blood pressure machines available for home loan. If you would like to take advantage of this service, please ask at reception. The machines can be borrowed for up to a week at a time.

microsoft exchange email archiving

Internet-based support for your e-mail

Microsoft Exchange Hosted Archive (EHA) provides a centralized, easily accessible, and multi-functioning e-mail and IM repository to help organizations manage increasingly complex retention, compliance, e-discovery, and regulatory requirements. Storage is unlimited and can be used for retention periods up to 10 years.

How Archiving Works with Exchange Hosted Services

Service components

Support to help satisfy industry and regulatory retention requirements
Exchange Hosted Archive has many features that aid in compliance including multiple retention periods, legal hold, supervision by keyword or percentage and immutable storage.
Granular reporting and auditing capabilities
Any good security policy encompasses granular audits and logging of system transactions. EHA has numerous auditing reports available in addition to several traceable administrative and user events.
Rapid search and retrieval
Indexed storage enables fast retrieval of messages for e-discovery and other investigations.
Fully functional backup e-mail system
If primary e-mail systems go down, users and administrators will still have access to archived e-mail and can send and receive new messages in real time.

Service benefits

Lowers total cost of ownership compared to 3rd party archive solutions
Eliminates up-front capital investment
Easily integrates with existing e-mail infrastructure
Allows a predictable subscription-based cost model
Simplifies IT environment by eliminating deployment and maintenance of in-house archive servers and applications
Allows IT staff to focus on other projects
24 x 7 technical support

mail defense

The dramatic increase in unsolicited junk email (spam), proliferation of computer viruses and worms, and the potential liability from the distribution of inappropriate content has rendered email a double-edge sword. In exchange for ease of communication, companies are now sacrificing network security and employee productivity, and risking corporate liability.

MX Logic’s Email Defense Service safeguards enterprises, service providers and government organizations from spam, viruses, worms, malicious content and attachments, and other email threats.

With our reliable and innovative Email Defense Service, you'll benefit from:

Comprehensive spam filtering—Instant blocking over 98% of spam, with industry leading low false positive rates (legitimate email marked as spam)
Eliminate over 90% of spam costs—Free up IT resources, increase employee productivity, and decrease network and storage costs
Reduce corporate liability and risk—Block the distribution of inappropriate content and attachments
Maximum virus protection—Leverage multiple leading anti-virus engines from McAfee and Sophos updated every five minutes
Around-the-clock messaging infrastructure attack protection—Real-time monitoring and analysis of traffic patterns by email security experts dedicated to safeguarding your network 24 hours a day, 365 days a year
Rapid service activation—No integration, migration or upfront capital investment required
Simple configuration and implementation of corporate email policies
Flexible, email-based end-user and administrator quarantine mail management

Built from the ground up for high-volume messaging environments, MX Logic’s cost-effective service provides around-the-clock email protection, automatically intercepting, analyzing and blocking malicious and unsolicited messages at the network perimeter—before they can enter or leave your internal network. By neither storing nor acknowledging receipt of an email message, MX Logic presents zero risk of message loss and virtually undetectable latency.

MX Logic’s Email Defense Service includes a SecureMX feature that shields and conceals your messaging infrastructure from attack—including the location of your mail servers—from the public Internet, removing the threat of network probes and providing robust protection from vulnerability and attack.

vancomycin treatment

Guidelines Issued for Monitoring of Vancomycin Treatment of S aureus Infection

Laurie Barclay, MD

Authors and Disclosures

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July 23, 2009 — The Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists have issued therapeutic guidelines for monitoring of vancomycin treatment for Staphylococcus aureus infection. The summary of consensus recommendations is published in the August 1 issue of Clinical Infectious Disease.
"Adjustment and targeting of specific serum concentrations of vancomycin in patients have been the subject of debate for many years," write Michael J. Rybak, PharmD, from the College of Pharmacy and Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, and colleagues.
"The primary premise for monitoring and adjustment of serum vancomycin concentrations is based on the perceived need to achieve serum concentrations at some multiple above the minimum inhibitory concentration (MIC) for the offending organisms and the avoidance of potential adverse effects, such as ototoxicity or nephrotoxicity. The lack of well-designed randomized clinical evaluations or data to support a clear relationship between specific serum concentrations and patient outcome has been the overriding contributor to this controversy."
A panel of experts from the authoring societies reviewed practice guidelines for therapeutic monitoring of vancomycin treatment for S aureus infection in adults and performed a literature search of existing evidence concerning vancomycin dosing and monitoring of serum concentrations and their relationship to patient outcomes. This review, as well as expert consensus opinion regarding the pharmacokinetic, pharmacodynamic, and safety record for vancomycin, led to new recommendations for targeting and adjustment of treatment.
Recommendations for Treatment
Specific clinical recommendations, and their accompanying level of evidence rating, are as follows:

Even for obese patients, initial vancomycin dosages should be calculated based on actual body weight. To achieve targeted therapeutic concentrations, further dosage adjustments should be based on actual serum concentrations. Compared with intermittent dosing, continuous infusion is not likely to significantly improve patient outcome (level of evidence, 2; grade of recommendation, A).
The most accurate and practical way to monitor vancomycin effectiveness is by using trough serum vancomycin concentrations, which should be measured just before the fourth dose, at steady-state conditions (level of evidence, 2; grade of recommendation, B).
To avoid the development of resistance, trough serum vancomycin concentrations should always be maintained at greater than 10 mg/L, based on evidence suggesting that exposure of S aureus to trough serum concentrations of less than 10 mg/L can produce strains with vancomycin–intermediately susceptible S aureus–like characteristics (level of evidence, 3; grade of recommendation, B).
Trough serum vancomycin concentrations of 15 to 20 mg/L are recommended because of the potential of these concentrations to improve penetration, to increase the likelihood of optimal target serum concentrations, and to improve clinical outcomes of complicated infections caused by S aureus, such as bacteremia, endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia. If the MIC is less than 1 mg/L, trough serum vancomycin concentrations of 15 to 20 mg/L should achieve an area under the curve/MIC of 1400 for most patients (level of evidence, 3; grade of recommendation, B). For seriously ill patients, a loading dose of 25 to 30 mg/kg (based on actual body weight) can be considered to rapidly reach this target concentration (level of evidence, 3; grade of recommendation, B).
For patients with normal renal function, defined as creatinine clearance 70 to 100 mL/minute, a targeted area under the curve/MIC of more than 400 is not achievable with conventional dosing methods if the vancomycin MIC is 2 mg/L or higher, and alternative treatments should therefore be considered. To achieve the recommended trough serum concentrations when the MIC is less than 1 mg/L, most patients with normal renal function should receive vancomycin dosages of 15 to 20 mg/kg (based on actual body weight) given every 8 to 12 hours. The guidelines authors note that because currently available nomograms were not developed to achieve these targeted end points, individual pharmacokinetic adjustments and confirmation that target serum concentrations have been reached are recommended. The infusion period should be increased to 1.5 to 2 hours when individual doses greater than 1 g (eg, 1.5 and 2 g) are used (level of evidence, 3; grade of recommendation, B).
Evidence to date for a direct causal relationship between toxicity and specific serum vancomycin concentrations is limited, and data are inconclusive because of confounding nephrotoxic agents, inconsistent and highly variable definitions of toxicity, and difficulty in assessing the time sequence of events regarding changes in renal function secondary to vancomycin exposure. In the absence of an alternative explanation, a patient should be considered to have vancomycin-induced nephrotoxicity if there are multiple (at least 2 or 3 consecutive) high serum creatinine concentrations (increase of 0.5 mg/dL or 150% increase from baseline, whichever is greater) after several days of vancomycin therapy (level of evidence, 2; grade of recommendation, B).
Evidence to date does not suggest that monitoring of peak serum vancomycin concentrations will reduce the incidence of nephrotoxicity (level of evidence, 1; grade of recommendation, A). In patients receiving aggressive dose targeting to achieve sustained trough serum concentrations of 15 to 20 mg/L, or those at risk for toxicity (eg, because of concurrent treatment with nephrotoxins), monitoring of trough serum vancomycin concentrations to decrease nephrotoxicity is most appropriate (level of evidence, 3; grade of recommendation, B).
In addition, patients with unstable renal function and those being treated for more than 3 to 5 days should also undergo monitoring (level of evidence, 2; grade of recommendation, B). All patients treated with vancomycin for 5 days or more should have at least 1 steady-state trough serum concentration measured just before the fourth dose. Frequent monitoring with more than 1 measurement of trough concentration before the fourth dose is not recommended for treatment lasting less than 5 days or for lower-intensity dosing targeted to achieve trough serum vancomycin concentrations of less than 15 mg/L (level of evidence, 2; grade of recommendation, B).
Because evidence is limited to support the safety of sustained trough serum vancomycin concentrations of 15 to 20 mg/L, once-weekly measurements of trough concentrations are recommended for hemodynamically stable patients in whom this target range is desired. To prevent toxicity in hemodynamically unstable patients, frequent or even daily monitoring of trough concentrations is recommended, although clinical judgment should guide the exact frequency of monitoring (level of evidence, 3; grade of recommendation, B).
Because of conflicting evidence regarding comparative vancomycin toxicity for continuous vs intermittent administration, no recommendation can be made. The guidelines do not recommend monitoring serum vancomycin concentrations to prevent ototoxicity, because monotherapy seldom results in ototoxicity and there is no apparent correlation with serum vancomycin concentrations. However, monitoring may be more important during coadministration of aminoglycosides or other ototoxic agents (level of evidence, 3; grade of recommendation, B).

"On the basis of in vitro, animal, and limited human data, an [area under the curve]/MIC value of 400 has been established as the pharmacokinetic-pharmacodynamic target," the guidelines authors conclude. "To achieve this target, larger vancomycin doses and high trough serum concentrations are required. Although vancomycin administration is associated with some adverse effects, the committee felt that the potential benefit of increased drug dosage was worth the risk of mostly reversible adverse events."
Some of the guidelines authors have disclosed financial relationships with Astellas, Cubist, Forest, Pfizer, Ortho-McNeil, Targanta, Astra-Zeneca, Schering, Wyeth, Theravance, Optimer, Bayer, Eli Lilly, Johnson & Johnson, Bristol-Myers Squibb, and/or Sanofi-Pasteur.

greymail spam

running the Grey Mail Gauntlet

A while ago over at Security Insights, McAfee CTO Chris Bolin blogged about grey spam. As far as content-based analysis goes, it is a tricky area for anti-spam vendors.

Mass email can roughly be categorised into three groups:

Real spam: the dubious pills, the get-rich-quick scams, phishing, etc. Everyone hates that, but if you have a good anti-spam solution in place you should end up seeing a very small percentage of what was sent to you.
Mass-marketing mail: the kind of stuff your bank sends out to each one of its customers. Some of that is useful; some of it you might not care about. Usually if you ask, your bank will stop emailing you.
Grey-mail spam: This lies somewhere between the top two. This is the stuff that cannot really be classified as spam. They have valid email addresses and even valid telephone numbers. But it doesn’t matter to you; these emails are just irritating. You really don’t want any of them.

For vendors providing anti-spam solutions, grey mail is a difficult thing to tackle. Any attempt to add too many detection rules risks false positives for good sites like Amazon. It might even place the vendor at risk for legal action from some marketing companies. This makes this form of spam very attractive to many unscrupulous mass-mailing marketeers; they’re willing to run the grey-mail gauntlet.
Don’t get me wrong: I think email marketing has its place and that it can be a very powerful tool, but it should be done ethically. There are many mail-marketing firms that play by the rules, but they can get a bad name because of the bigger group that simply doesn’t care, as long as they can make a few bucks.
To a great extent, remediation for grey spam falls outside the scope of a content-analysis engine. Although the latter can help, it needs input from the customer. Only the cutomer can determine what is unwanted and what is allowed in this case: one person’s spam is another person’s ham. Chris has listed a number of things you can do to protect yourself, but if you are already receiving grey mail, here are two good techniques for combating this:

Blacklists
Bayesian

Blacklists: Because grey spam tends to have a defined structure, known sender email addresses, etc., you can use blacklists. These blacklists should be created and updated by the customer and not the vendor.
Bayesian: Spam filtering might be another solution, but the problem is that it needs to be trained correctly. The training itself might be too much work for the ordinary home user. Luckily some email clients do a good job of making it easier for a person to use.
Handling false positives: Normally content rules will receive rigorous testing to avoid false positives. When customers introduce blacklists or Bayesian techniques, they are creating custom content rules. As these rules will be ad-hoc, there is a higher chance for false positives. To help with this issue, some form of quarantine system needs to be introduced. The single person at home or in a small company with fewer than 10 employees might use the rules-and-folders functionality in a decent email client to handcraft a solution. However, for any company with a large number of employees, something more structured is required. McAfee offers the product Quarantine Manager to complement some of its other mail-product offerings.
Expect to read more postings on this topic from some of my colleagues at Avert Labs.