do hulled strawberries need to be refrigerated?

Store the berries refrigerator, but allow them to warm to room temperature beforedipping. After dipping, let chocolate set in refrigerator, but do not store the strawberries there. Eat within 48 hours. Since strawberries grow on the ground, they should be washed before they are eaten or dipped.

"Choc Dipped Strawberries-Refrigerate Or Not? Decorating By sweetchef Updated 4 Jan 2007 , 4:57pm by sweetchefsweetchef Posted 30 Dec 2006 , 6:20pm post #1 of 17When you refrigerate chocolate-dipped strawberries, they tend to sweat and get all slimy (I need to store them for days in my retail store...already thinking about Valentine's). Is it OK to leave them at room temp for several days?16 replieslkfarley Posted 30 Dec 2006 , 6:29pm post #2 of 17If I recall correctly we made and sold them last year and they kept fine in our pastry case for a day or two. I don't know that I would keep them much longer than that. That is the only problem with strawberries, they are very delicate and go bad so quick. Good luck & Happy New Year!sweetchef Posted 30 Dec 2006 , 6:43pm post #3 of 17Yes, they're so easy to make but so complicated to store. I assume I'll have a lot of customers want to buy Valentine gifts 2 or 3 days before. They always ask me if they should refrigerate they're gift box of strawberries or not, and I never know what to tell them. Since it's tied with ribbon, they don't see the berries until they open it...so I'd hate for them to refrigerate it and only see the sweaty, messed up berries days later. My pastry case is a little warmer than my walk-in with less humidity...maybe I should do a tester batch.mendhigurl Posted 30 Dec 2006 , 9:17pm post #4 of 17Don't refrigerate...they will sweat and not look pretty. If you're selling for Valentine's take pre-orders and have pickup that day. That's easiest way to make sure they are fresh.patton78 Posted 30 Dec 2006 , 9:22pm post #5 of 17I agree, do not refrigerate because of sweating. I think that chocolate strawberries are just not something you can make in advance and store, they must be fresh to be good. Fresh, ripe strawberries only last a few days at best. Monica_ Posted 31 Dec 2006 , 6:17am post #6 of 17Hrm, I've never had a problem refrigerating them before. I usually dip them in white chocolate a day ahead of time, and keep them in the fridge overnight, wrapped in plastic wrap on the tray they will be served on, and take them out at room temperature for the party or whatever. No clue why it would sweat for some and not for others. The only thing that comes to mind is the possibility that the strawberries are still damp when you dip them? I always roll my strawberries around gently in a kitchen towel, then leave them out to dry for a couple of hours after rinsing so there's absolutely no moisture still left when I dip them.playingwithsugar Posted 31 Dec 2006 , 6:37am post #7 of 17Do they have the stems on them? They will last longer with the stems on, and if you cut the end off the stem and wrap it in wet paper towel, it should last at least another day. My experience has been that locally, strawberries will mold after two days, especially around the calyx area. I do not store them for more than 1 day, and they are always refrigerated. Theresasweetchef Posted 3 Jan 2007 , 1:02am post #8 of 17So if I only leave them out for 1-2 days at room temp, should I tell the customers to refrigerate them after purchase? Should I tell them that they must be eaten same day (you know, for liability reasons)? Valentine's Day is on a Wed this year! Yuck! Everyone's going to try to celebrate the weekend before..or not...since it's my first year with a store, I never know what to expect. I want to make a TON of strawberries but I'm just not sure what day will be best. Arrgh... I hate planning!emmiepeterson Posted 3 Jan 2007 , 1:08am post #9 of 17I agree with the ones that say take preorders and make the day of. I love chocolate dipped strawberries,but a mushy one is sooo gross! Maybe you could do preorders and just make some extra's? Good luck! Emily Zmama Posted 3 Jan 2007 , 3:56am post #10 of 17There will be celebrations the weekend before, the day of, and the weekend after. So, you should have 5 days of pickups for these (Fri, Sat, Wed, Fri, Sat). Preorders for those days are a great idea, or a ""first come, first served"" for a limited amount above what is ordered.margery Posted 3 Jan 2007 , 4:18am post #11 of 17I had a friend send some she ordered and they came mailed to me with paper towel layer and gel/ice pack-- here is some info for what is it worth....good luck Chocolate Covered Strawberries.... Strawberries must be dry when dipping. The California Strawberry Commission recommends buying berries no more than a day ahead of when you want to dip them.

Leave the green caps on and wash the berries gently with cool water flowing from the tap so as not to bruise the fruit. If you are going to dip berries in chocolate or vanilla, they need to be completely dry. Just a tiny drop of water in the melted chocolate can cause the whole batch to seize (curdle) and it will be impossible to melt the chocolate and use it again. After washing the berries, pat them dry with a paper towel and place them on a dry paper towel until needed. margerybobwonderbuns Posted 3 Jan 2007 , 2:18pm post #12 of 17When I make my chocolate strawberry basket, I get the cake all done and basketweaved and the morning I'm to deliver I dip the dry strawberries 2/3 of the way up and let them dry for a few minutes on wax paper. I tried doing this the night before and putting them on the cake and putting the cake in the frig, but it sweated and by the next afternoon there was strawberry juice dripping down the sides of the cake. Remember that the sugar in the chocolate will react with the sugar in the strawberries to start making them juicy, so the last thing you want to do is the strawberries.gma1956 Posted 3 Jan 2007 , 2:31pm post #13 of 17Absolutely do not refrigerate. The condensation from the warming to room temperature, will break down chocolate. Chocolate bark also sweats and the juices of the strawberry will run. Strawberries should be done hours before serving for the best results. Those that put them in the refrigerator, whether you see them sweat or not they do, you may not see this take place if you have them covered. Working with bark and real chocolate are completely different. I have done both. If you are using real chocolate DO NOT refrigerate. And they will not keep after dipping at room temperature for 2 or three days. They need to be consumed the day they are dipped, at least within a 12 hour time frame. When strawberries are dipped in hot chocolate, the juices begin to flow and the fruit itself starts a breakdown process that will also breakdown the chocolate after more than 12 hours or so.mendhigurl Posted 3 Jan 2007 , 4:28pm post #14 of 17Quote: Originally Posted by sweetchef So if I only leave them out for 1-2 days at room temp, should I tell the customers to refrigerate them after purchase? Should I tell them that they must be eaten same day (you know, for liability reasons)? Valentine's Day is on a Wed this year! Yuck! Everyone's going to try to celebrate the weekend before..or not...since it's my first year with a store, I never know what to expect. I want to make a TON of strawberries but I'm just not sure what day will be best. Arrgh... I hate planning!I know you've heard this over and over, but I wouldn't make them 2 days ahead. Maybe the night before, but not before then. Tell the client to not refrigerate the strawberries. Sure you can tell them to eat the strawberries the same day, but chances are, they won't eat them all, so there's nothing you can do about that. That doesn't mean that when they eat them in 2 days (when the strawberries are 5 days old) that they aren't going to come back to you, and tell you that you gave them bad strawberries. Past experience with valentine's falling during the week, people celebrate that day. I think a small percentage will celebrate during the weekend. Also, don't wash your strawberries. Take a damp paper towel or towel and clean your strawberries. This will remove the dirt and most seeds but not saturate the berry with water. This will allow the berry to keep a little longer. Hope that helps. Cakes By Sandy Posted 3 Jan 2007 , 4:38pm post #15 of 17I agree with Mendhigirl, make them the night before. I made some for Christmas, dipped them that morning to use for garnishment on top of a cake. After the second day at room temp, they had kind of lost their crunch so to speak. Good lucknefgaby Posted 3 Jan 2007 , 5:09pm post #16 of 17I agree on the ""take orders and have them ready for pick-up on the same day"". I never store them on the refrigerator.sweetchef Posted 4 Jan 2007 , 4:57pm post #17 of 17That's what I did last year--dipped them the morning of Valentine's. I was wondering if there was a better way, but I guess I'm stuck with that. I'll probably make some for the weekend and some on Wed. Thanks for all the comments! "


why do we push others away

From a psychological standpoint, pushing away the people you love the most is a very basic and common, defense mechanism. As the relationship develops, people become inundated with their own fears and insecurities that they will not be accepted and therefore hurt by their loved one.

Why do some people push others away, even though they dearly love them?

"Quora User, Love isn't something I find. Love is something that finds me. <3Answered Jun 21, 2016 · Author has 291 answers and 471.5k answer views One of the most inherent desires of humanity is to be ""accepted"" and ""loved"" and ""wanted"". And yet quite often our behavior towards loved ones is contrary to just that. Pushing away the ones you love, for many people – begins in the early stages of a relationship. In the very beginning, there wasn’t a single thing that I would have tried to changed about my ex partner. Then, as the two of us got closer and we began to be aware of our idiosyncrasies, we became less accepting. Suddenly, his actions towards me demand changed. He began impressing upon someone else his personal expectations and experiences in life – and forget that the two of us are individuals lovers first. As the demands for change, and the denial to be accepting of things the way we became more pressing, I often end up subconsciously pushing the people I love the most away from me.

So the cunning, and self-deprecating thing to do is to hurt them before they hurt you. Rather than allow them to see your faults, or for you to feel exposed – you begin ‘ exposing ’ theirs. Unfortunately, as you do this you slowly but surely begin to throw roadblocks into the relationship and open the door for feelings of resentment and unhappiness. From my personal experience, the people we love the most, are often the ones we do not appreciate very much. This is true not just in romantic relationships or marriages but in all facets of our personal interactions. We have that one friend who has been with us through thick and thin, or our parents or siblings or grandparents (or children) who we become so accustomed to not appreciating that we end up treating them poorly. You have likely heard of the analogy about the man who opened doors for every woman he met but allowed the door to hit his own wife in the face upon entering restaurant. It was not that he was intentionally trying to disregard her feelings, but more that he had forgotten how to appreciate her. As relationships settle into routines, human beings often make this exact mistake and end up inadvertently pushing away the people that love them the most. Whether it is fear or insecurities, lack of respect or just the fact that your loved one take you for granted that causes you to push people away, it is an important aspect of humanity to be aware of. Sure, in relationships with other people there will always be the opportunity for you to get hurt at some point. I have experienced it! However, not taking the risk also voids you of enjoying some of the benefits of intimacy and love. This leads back to the infamous quote, “Don’t let the fear of striking out keep you from playing the game!” Risks are everywhere. One of the most beneficial and rewarding risks in life is to allow people to love and accept and want you – and to love, accept and want in return – with no strings attached. For many people, looking back on the difficulties that caused and end to a relationship, it is easy to see how insignificant things really were. Unfortunately, and far too often the end of a relationship comes with so many events and feelings that cannot be undone after the fact. So rather than push people away because of fear of complacency, it is best to live in your relationships with others every moment of every day! This way, you won't look back with regrets or remorse, but instead will know that you loved (and perhaps lost) passionately. Thanks for the A2A Janna!44.2k Views · View Upvoters · Answer requested by Janna Fars "


when is the latest time to book a flight

d. “For any given flight, the actual best time to buy might vary, depending on the market, the time of year, the day of week and other factors.”Rather unsurprisingly, the worst time to buy a ticket is the day before. Two days before is a close second, and then three days and so on until you get to 11 days out. After that, the next worst day to purchase a flight is between 208 and 210 days in advance.

When Is The Best Time To Book A Flight?

When Is The Best Time To Book A Flight? By Mark Johanson @Mark Johanson IBT On 01/21/13 AT 11:14 AMThe answer to this question has eluded even the most seasoned of travelers for years: When is the best time to book a flight and get the lowest airfare? The self-proclaimed “airfare geeks” at Cheap Air.com claim to “sort of have an answer.” Sifting through more than 560 million fare searches, they believe it’s 49 days (7 weeks) before departure. Looked at on a graph, domestic airfares generally start out high and steadily decrease as you get closer to a flight date until the magic 7-week mark, at which point they begin to increase ever so slightly. The fares stay relatively steady until about one month out, when they spike dramatically.“Of course, a million caveats apply, and this is all based on averages from a year’s worth of dates in over 11,000 purely domestic markets,” Cheap Air.com CEO Jeff Klee sai

“The simple fact is that the way to get the worst airfare last year was, in most cases, to buy your ticket really late or really early,” Klee noted. The results, however, differ when you look at international flights. While it’s still a good rule of thumb not to book too early or too late, Cheap Air.com found that the sweet spot is between 11 and 12 weeks prior to departure, or about 81 days. The magic number for busy holidays like Thanksgiving or Christmas is also slightly different, at about 14 weeks (96 days) in advance for domestic flights. Many travel experts claim that booking on Tuesday or Wednesday will get you the lowest airfares, but Klee said that’s an urban legend.“While it’s true that airlines frequently publish system-wide sales on those days, it’s also true that there are large numbers of smaller-scale, unpublished sales on other days. Add it all up, and we find that no one day was significantly better than any other.”That’s not to say that flying on certain days isn’t cheaper. No matter when you purchase your flight, Tuesdays, Wednesdays and Saturdays will typically have lower fares. But again, as Klee noted, “it’s best to take this information as a guideline and not a rule.”


what nationality is male name ish

sh Name: Ish Gender: Male Usage: Ish is a popular first name. It is more often used as a boy (male) name. People having the name Ish are in general originating from United States of America.

Ish

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Name Meaning of Ish We apologize, but we don't have a meaning for this name. Please feel free to read what others say about this name and to share your comments if you have more information. Name Compatibility Test To test the compatibility of this name with another, enter a name and click Calculate Numerology Interpretation The Growth number corresponding to this first name is 9. Interpretation: Qualities: Compassionate, Idealistic Ruling planet: Mars Colors: Red Gemstones: Bloodstone Learn more with our free Numerology Tool Popularity of the Name The name Ish is ranked on the 8,261st position of the most used names. It means that this name is commonly used. We estimate that there are at least 32300 persons in the world having this name which is around 0.001% of the population. The name Ish has three characters. It means that it is relatively short-length, compared to the other names in our database. We do not have enough data to display the number of people who were given the name Ish for each year. Name Day Calendar We do not have a name day for Ish. For other names check our Name Day Calendar Comments We always try to deliver a high-quality service to our customers. If you consider the information on this page is incomplete or incorrect, please post a comment below. Thank you!


can lice be transmitted to pets

Both types of lice can be passed directly from one dog to another through direct contact or through contact with contaminated objects, such as grooming utensils or bedding. Lice are species-specific. They do not move from one species to another.

Lice in Dogs

Canine Pediculosis

Lice are parasites that live on the skin of an affected dog. They are actually a small insect that feeds by chewing on the skin of the dog or by sucking the blood, depending on the type of louse. Left unchecked, they can grow to be an infestation on the dog’s body.

Dog lice are not as common as dog fleas, and are most often seen in situations where sanitary practices are poor. Symptoms and Types of Dog Lice Symptoms seen in infested dogs include: Excessive itchiness and scratching A dry scruffy-looking coat Hair loss, most often around the ears, neck, shoulders, groin, and rectal area Anemia, particularly in puppies and small dogs and particularly with severe infestation Causes of Dog Lice There are two species of lice that infest dogs: Trichodectes canis, known as a chewing louse; that is, it chews the skin of the dog it is infesting Linognathus setosus, a sucking louse, one that sucks the blood of the dog instead of chewing the skin

That means that you cannot get lice from your dog nor can your dog get human specific lice from you. Diagnosis of Dog Lice Diagnosis is easily made by visually observing lice or their nits (eggs) in the hair. Adult lice are flat, six-legged insects with no wings. Nits can be seen attached to the individual hair shafts and appear as small white dots. Treatment for Dog Lice There are a wide variety of shampoos, as well as insecticidal sprays and powders that are effective in killing lice. In addition, products such as fipronil and selamectin can also be used. (They come in various brand names.) It may be necessary to treat your dog more than once to kill the developing nits as they hatch. Follow your veterinarian’s directions closely, as these products can be harsh on some dogs, especially puppies. In cases where your dog’s fur is badly matted, it may be necessary to shave the fur to be sure of getting to the deeper lice and their nits. To prevent reinfection, dispose of or wash all of your dog’s bedding, as well as thoroughly cleaning all of the places your dog spends time. Some items that cannot be laundered or washed down may be sealed tightly in plastic bags for a few weeks. Disinfect all grooming utensils and anything else your dog comes into contact with regularly, such as crates, and of course, all of the furniture, rugs, carpeting and hard flooring.


what does attorneys charge for malpractice cases

The law limits attorneys' fees in medical malpractice cases to: (a) 33 1/3 percent of the first $ 1,000,000 recovered, (b) 25 percent of the first $ 1,000,000 recovered if liability was stipulated within 180 days after the complaint was filed and no later than 60 days before the first day of trial, and (c) 20 percent of any amount that exceeds $ 1,000,000.

ATTORNEYS; MEDICAL MALPRACTICE;ATTORNEYS; MALPRACTICE;September 25, 20032003-R-0664MEDICAL MALPRACTICE—ATTORNEYS’ FEESBy: George Coppolo, Chief Attorney You asked whether other states limit the amount of fees attorneys may collect in medical malpractice cases. SUMMARYSixteen states, including Connecticut, have a statute or court rule that establishes a specific limit or sliding scale on contingency fees attorneys may charge clients who file a medical malpractice claim. (California, Connecticut, Delaware, Florida, Illinois, Indiana, Maine, Massachusetts, Michigan, New Jersey, New York, Oklahoma, Tennessee, Utah, Wisconsin, and Wyoming). Many of these statutes and rules, including Connecticut’s, apply to a much broader category of cases than just medical malpractice. We did not find any state that sets a numerical or percentage limit on the fees that health care providers or their insurers may pay for legal representation. But we did find several states that allow or require the court to determine the reasonableness of the attorney’ fees doctors, or their insurers, and plaintiffs pay. Most, like Connecticut’s, establish a sliding scale that places an upper limit based on the amount of the settlement or judgment. Connecticut allows 33 and 1/3% of the first $ 300,000, 25% of the next $ 300,000, 20% of the next $ 300,000, 15% of the next $ 300,000 and 10% of amounts exceeding $ 1,250,000. (This sliding scale applies to any lawsuit to recover damages resulting from personal injury, wrongful death, or property damage involving contingency fees, not just to medical malpractice cases. ) A few states such as Tennessee and Utah set the limit at one third regardless of the recovery. One state, Florida, establishes different limits depending on the stage the case gets to. For example, it allows a higher limit if the case goes to trial and even more if the case is appealed. Four of these states explicitly allow a court to authorize a larger fee (Illinois, Maine, New York, and Wisconsin), and Wyoming explicitly allows the client and attorney to contract for a larger fee. Connecticut does not explicitly allow a client to waive the statutory fee limits. But one Superior Court case held that the client could waive the limits because (1) the law did not explicitly prohibit a waiver, and (2) the legislative history supported the position that the legislature intended to allow clients to waive it. Because the court decided the case on statutory construction grounds it did not address the constitutional challenges the plaintiff raised against the law if it were interpreted as prohibiting waivers. Connecticut appears to be the only state thus far whose courts have allowed clients to waive the protection of a law that establishes a cap on attorneys’ fees. California courts faced the same issue but decided the law could not be waived. A state law without a waiver right would likely be challenged on constitutional grounds including equal protection, due process, separation of powers, and access to court. A New Hampshire court invalidated the New Hampshire attorney fee cap law on constitutional grounds. But courts in Indiana, Maryland, and Tennessee upheld their laws against constitutional challenge. It would appear that a constitutional challenge would have less of a chance to succeed if the law allowed a court to approve fees beyond the cap especially for (1) cases that are economically impractical for attorneys to undertake because they involve extraordinary costs, time, and risk, and (2) situations where the cap on fees might prevent the inured person from being able to retain an experienced counsel or being able to retain any attorney at all. Instead of a specific limit or a sliding scale, six states require or authorize court approval of the reasonableness of attorney fees under various circumstances (Hawaii, Iowa, Maryland, Nebraska, New Hampshire, and Washington). In all of these states, other than Iowa, it appears that the court may determine the reasonableness of both the plaintiff’s and defendant’s attorney’s fees. COMPARISON IN TABLE FORM OF STATE LIMITATIONS ON ATTORNEY’S FEESFollowing in Table 1 is a comparison of laws that establish specific percentage limits for plaintiff’s attorney’s fees in medical malpractice cases. Table 1: Percentage Limitations on Medical Malpractice Attorney’s Fees State Attorneys' Fees California Sliding scale fees may not exceed 40% of the $ 50,000, 1/3 of the next $ 50,000, 25% of the next $ 500,000, and 15% of damages exceeding $ 600,000. (Bus. & Prof. §6146)Connecticut Sliding scale fees may not exceed: one third of first $ 300,00; 25% of next $ 300,000; 20% of next $ 300,000; 15% of next $ 300,000; and 10% of damages exceeding $ 1. 2 million. (CGS §52. 251c)Delaware Sliding scale fees may not exceed: 35% of first $ 100,000; 25% of next $ 100,000; and 10% of damages exceeding $ 200,000. (Del. Code Ann Tit . 18 §. 6865)Florida Separate sliding scales for cases settling before filing an answer or appointing an arbitrator, cases settling before or after going to trial, and cases in which liability is admitted and only damages contested; 5% extra for cases appealed (See note below. ) * (Atty. Conduct Reg. 4-1. 5 (f) (40 (b))Illinois Sliding scale fees may not exceed one third of first $ 150,000; 25% of next $ 850,000, and 20% of damages exceeding $ 1 million. (Ill. Comp. Stat. Ann. §110. 2. 1114) Attorney may apply to the court for additional compensation under certain circumstances. (§735. 5/2. 111 4)Indiana Plaintiff's attorney fees may not exceed 15% of any award that is made from Patient’s Compensation Fund (covers portion of an award that exceeds $ 100,000). (Ind Code Ann. §16. 9 (5). 51)Maine Sliding scale fees may not exceed: one third of first $ 100,000; 25% of next $ 100,000, and 20% of damages that exceed $ 200,000; for purpose of rule, future damages are to be reduced to lump-sum value. (Me. Rev. Stat. Ann. §24. 2961)Massachusetts Sliding scale fees may not exceed: 40% of first $ 150,000, 33. 33% of next $ 150,000, 30% of next $ 200,000 and 25% of damages that exceed $ 500,000; further limits if claimants recovery insufficient to pay medical expenses. (Mass. Ann. Laws Chap. 231. § 601)Michigan Maximum contingency fee for a personal injury action is one third of the amount recovered. (Mich. Court Rules 8. 121 (b))New Jersey Sliding scale fees may not exceed one third of first $ 500,000, 30% of second $ 500,000, 25% of third $ 500,000 and 20% of fourth $ 500,000; and amounts the court approves for damages that exceed $ 2,000,000; 25% cap for a minor or an incompetent plaintiff for a pretrial settlement. (Court Rules §1: 2107)New York Sliding scale fees may not exceed 30% of first $ 250,000, 25% of second $ 250,000, 20% of next $ 500,000, 15% of next $ 250,000 and 10% over $ 1. 25 million. (N. Y. Jud. §474a) The court may allow higher fees upon application of the claimant or his attorney. Oklahoma Fee may not exceed 50% of net judgment. (§5. 7)Tennessee Fee may not exceed one third of recovery (Tenn. Code Ann. § 29-26-120)Utah Contingency fee may not exceed third of award. (§78. 14. 7 (5))Wisconsin Sliding scale may not exceed: third of first $ 1 million or 25% or first $ 1 million recovered if liability is stipulated within 180 days, and not later than 60 days before the first day of trial, and 20% of any amount exceeding $ 1 million. But court may approve higher limit in exceptional circumstances. (§655. 013)Wyoming Where recover is $ 1 million or less: third if claim settled within 60 days after filing, or 40% if settled after 60 days or judgment is entered; 30% over $ 1 million. But parties may agree to pay more. (Ct. Rules, Contingent Fee R. 5)* Note on Attorneys’ Fees Florida: The Supreme Court of Florida has declared that attorneys' fees in excess of the following amounts are presumed unreasonable:1. In cases that settle before filing an answer or appointing an arbitrator, 33 1/3 percent of any recovery up to $ 1,000,000, 30 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 20 percent of any excess over $ 2,000,000.2. In cases that settle subsequently or go to trial, 40 percent of any recovery up to $ 1,000,000, 30 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 20 percent of any excess over $ 2,000,000.3. In cases in which liability is admitted and only damages are contested, 33 1/3 percent of any recovery up to $ 1,000,000, 20 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 15 percent of any excess over $ 2,000,000. The Court allow an extra 5 percent over what is otherwise allowed In cases that are appealed (Fl. Atty. Conduct Reg. 4-1. 5 (f) (4) (B) (West Supp. 1998)). Following in Table 2 is a comparison of state laws or court rules that either allow or require a court to approve attorney fees in malpractice cases. Each of these statutes or rules, other than Iowa’s, applies to defendants as well as to plaintiffs. Table 2: States with Court Review and Approval State Attorneys' Fees Arizona Court may determine reasonableness of either party’s fees upon request (Ariz. Stat. 12-568)Hawaii Court must approve attorney fees. (§607. 15. 5)Iowa Court may review plaintiff’s attorney’s fees in any personal injury or wrongful death action against specified health care providers or hospitals. (§147. 138)Maryland Court or pretrial arbitration panel will review disputed fees in medical injury actions. (Cts. & Jud. Proc. §3. 2A. 07)Nebraska Court review for reasonableness of attorney fees in cases against health care providers for the party that requests it. (§44. 976)New Hampshire Fees for actions resulting in settlement or judgment of $ 200,000 or more shall be subject to court approval. (§508: 4. e)Washington In any medical injury the court may determine the reasonableness of each party's attorney fees if requested by the party. (§7. 70. 070)Following is a more detailed summary of the laws and rules summarized in Table 1 and 2. We have divided these laws into two categories. The first are those states that establish a limit or a sliding scale on fees. These are the states included in Table 1. These all apply to the fees the person filing the lawsuit may pay his attorney. The second category, are those states that allow the court or some other entity determine whether the fees are reasonable. These are the states included in Table 2. Most of these laws apply to both the person filing the lawsuit (the plaintiff) and the defendant. STATES WITH LIMITS OR SLIDING SCALES ON ATTORNEY’S FEESCaliforn

ia California limits the contingency fees attorneys may collect in a medical malpractice case to 40 percent of the first $ 50,000, 33 1/3 percent of the next $ 50,000, 25 percent of the next $ 500,000, and 15 percent of any amount that exceeds $ 600,000 (Cal. Bus. & Prof. Code § 6146).

This limit applies whether the recovery is by settlement, arbitration, or judgment. If the fee is based on an award of periodic payments, the court must place a total value on the payments based upon the claimant’s projected life expectancy of the claimant, and then calculate the contingent fee percentages. California courts have held that the fees may not exceed the caps; thus, clients may not waive the law’s protection and pay more than the cap allows ( Schultz v. Harney 33 Cal. Rept. 2d 276, (1994); Fineberg v. Harney and Moore 255 Cal. Rept. 299 (1989). Connecticut Connecticut law limits lawyers' contingency fees in personal injury, wrongful death, and property damages cases to a certain percent of the damage award or settlement agreement (CGS § 52-251c). Connecticut law has a sliding scale that places an upper limit on contingency fees based on the amount of the settlement or judgment. It allows 33 and 1/3% of the first $ 300,000, 25% of the next $ 300,000, 20% 0f the next $ 300,000, 15% 0f the next $ 300,000 and 10% of amounts exceeding $ 1,250,000. In addition, (1) the fee must be based on damage awards and settlements actually received; (2) costs, other than ordinary overhead and expenses, can be charged in addition to the contingency fee; and (3) any contingency fee contract involving personal injury, property damages, or wrongful death must comply with all applicable Superior Court rules governing attorneys. One Superior Court judge held that tort victims could waive this protection ( In re Estate of Salerno, 42 Conn. Supp. 526 (1993)). Some attorneys have asked their clients to waive this protection in certain medical malpractice cases. Delaware Delaware limits the contingency fee attorneys may collect in medical malpractice claims to 35 percent of the first $ 100,000 in damages, 25 percent of the next $ 100,000, and 10 percent of any remaining award (Del. Code Ann. tit. 18, § 6865). A party may also elect to pay his attorney on a per diem basis if a written contract providing for such compensation is drafted at the time he is retained. Florida The Supreme Court of Florida has determined that attorneys' fees in excess of the following amounts are presumed unreasonable:• In cases that settle before filing an answer or appointing an arbitrator, 33 1/3 percent of any recovery up to $ 1,000,000, 30 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 20 percent of any excess over $ 2,000,000.• In cases that settle subsequently or go to trial, 40 percent of any recovery up to $ 1,000,000, 30 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 20 percent of any excess over $ 2,000,000.• In cases in which liability is admitted and only damages are contested, 33 1/3 percent of any recovery up to $ 1,000,000, 20 percent of any recovery between $ 1,000,000 and $ 2,000,000, and 15 percent of any excess over $ 2,000,000. The court allowed an extra 5 percent over what is otherwise allowed in cases that are appealed (Fl. Atty. Conduct Reg. 4-1. 5 (f) (4) (B)). Illinois An attorney's contingent fee in a medical malpractice case is limited to (a) 33 1/3 percent of the first $ 150,000 recovered, (b) 25 percent of the next $ 850,000 recovered, and (c) 20 percent of any amount over $ 1,000,000. But, if the claimant's attorney performs extraordinary services involving more unusual time and effort, the attorney may ask the court for additional compensation (735 Ill. Comp. Stat. Ann. § 5/2-1114). Indiana An attorney’s fee may not exceed fifteen percent of any award from the state’s Patient Compensation Fund (Ind. Code Ann. § 34-18-18-1 (West Supp). There is no cap on attorneys' fees in cases not brought against health care providers who are covered by the fund. Maine An attorney may not collect contingent fees in excess of 33 1/3 percent of the first $ 100,000 recovered, 25 percent of the next $ 100,000 recovered, and 20 percent of any amount above $ 200,000 in any lawsuit alleging professional negligence (Me. Rev. Stat. Ann. tit. 24, § 2961). Future damages must be reduced to a lump-sum value. But the court may review the reasonableness of the attorneys' fees in a particular case and authorize a larger percentage. Massachusetts An attorney may not collect a fee in a medical malpractice case which, after being deducted from his client’s recovery, will leave an amount for the claimant's compensation that is less than the total amount of the claimant's unpaid past and future medical expenses, unless the attorney's fee is either 20 percent or less of the claimant's recovery, reduced to 20 percent or less of the claimant's recovery, or reduced to a level that permits the claimant to be paid his unpaid past and future medical expenses (Mass. Ann. Laws ch. 231, § 60I). Also, they may not exceed the following limits: (a) 40 percent of the first $ 150,000 recovered, (b) 33 1/3 percent of the next $ 150,000 recovered, (c) 30 percent of the next $ 200,000 recovered, and (d) 25 percent of any amount by which the recovery exceeds $ 500,000. Michigan An attorney’s fee is left to the express or implied agreement of the parties, subject to court rule (Mich. Comp. Laws Ann. § 600. 919). Court rules limit contingency fees in any personal injury and wrongful death case to one third of the amount recovered (Mich. Ct. R. 8. 121). New Jersey Attorney’s fees may not exceed: (a) 33 1/3 percent of the first $ 500,000, (b) 30 percent of the second $ 500,000, (c) 25 percent of the third $ 500,000, (d) 20 percent of the fourth $ 500,000, and (e) a reasonable amount approved by the court for the excess over $ 2 million (N. J. Ct. R. § 1: 21-7). If the claimant is a minor or incompetent, no fee may exceed 25 percent of any pre-trial settlement. New York

An attorneys' contingent fee in a medical malpractice case may not exceed: (a) 30 percent of the first $ 250,000, (b) 25 percent of the next $ 250,000, (c) 20 percent of the next $ 500,000, (d) 15 percent of the next $ 250,000, and (e) 10 percent of any amount over $ 1,250,000 (N. Y. Jud.

Law § 474-a). The court may allow higher fees if either the claimant or his attorney asks the court to determine this issue. If the court allows a higher fee it must make a written order stating the reasons for granting the greater compensation (N. Y. Jud Law 474-a). Oklahoma Attorneys may lawfully contract for a percentage of the recovery, but it may not exceed 50 percent (Okla. Stat. Ann. tit. 5, § 7). Tennessee An attorney's contingency fee in a medical malpractice case may not exceed 33 1/3 percent of all damages awarded to the claimant (Tenn. Code Ann. § 29-26- 120). The cap was held to be constitutional in Newton v. Cox, 878 S. W. 2d 105 (Tenn. ), cert. denied, 513 U. S. 869 (1994). Utah In a medical malpractice lawsuit, an attorney may not collect a contingency fee that exceeds one third of the amount recovered (Utah Code Ann. § 78-14-7. 5). Wisconsin

But the court may approve attorneys' fees beyond these limits in exceptional circumstances (Wis. Stat. Ann. § 655. 013). Wyoming The law specifies that the following contingent fees are presumed reasonable and not excessive in casualty or wrongful death cases where the total recovery is $ 1,000,000 or less: (a) 33 1/3 percent, if the claim is settled prior to or within 60 days after suit is filed, or (b) 40 percent, if the claim is either settled more than 60 days after filing suit or judgment is entered upon a verdict (Wyo. Ct. Rules Ann. , Contingent Fee R. 5). In casualty and wrongful death cases involving a recovery of more than $ 1,000,000, 30 percent of the excess over $ 1,000,000 is a reasonable contingent fee. But, the law specifies that contingent fee rules are not intended to abridge the freedom of the attorney and client to contract for different percentages. STATES WITH GENERAL LIMITS AND REVIEW PROVISIONSHawaii Hawaii does not limit attorneys' fees in medical malpractice actions. But, in all personal injury or wrongful lawsuits that result in a judgment attorneys' fees for both the plaintiff and the defendant are limited to a reasonable amount as approved by the court. In lawsuits in which a settlement is reached, the plaintiff or the defendant may request that the amount of their respective attorneys' fees be subject to the court’s approval (Haw. Rev. Stat. § 607-15. 5). Iowa Iowa does not place a limit on the fees an attorney may recover in a medical malpractice action. But, Iowa courts must determine the reasonableness of fee arrangements between medical malpractice claimants and their counsel (Iowa Code Ann. § 147. 138). Maryland When attorneys' fees are in dispute, an arbitration panel or court must approve it (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-07). Until recently, all claims for medical malpractice had to be reviewed by an arbitration panel under the Health Claims Arbitration Office (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-02). The law formerly allowed a waiver of arbitration if all the parties agreed, (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-06A), but since 1995 either party may waive arbitration (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-06B). If the arbitration panel determines that a health care provider is liable to the claimant or claimants, it then itemizes and apportions damages (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-05). Any party may reject the panel's findings. But those findings are admissible and presumed correct in any subsequent court proceedings, unless the court vacates them (Md. Code Ann. , Cts. & Jud. Proc. § 3-2A-06). If a subsequent verdict is not more favorable to the rejecting party, the rejecting party must pay the other party’s costs. Nebraska Nebraska does not place a limit on the fees a medical malpractice claimant's attorney may recover for services rendered. But, in all cases against a health care provider for professional negligence, the court, upon motion of either party, must review the attorneys' fees incurred by that party and allow such compensation as the court finds reasonable (Neb. Rev. Stat. § 44-2834 (1993). In addition, if the court finds the loosing party did not have a reasonable chance to recover or to defend a malpractice claim, it may order the loosing party to pay the prevailing party’s 1) reasonable costs of preparation and trial, including reasonable attorney’s fees, and 2) reasonable loss of earnings the trial caused. A patient has the right to agree with his attorney to pay for the attorney's services on a mutually satisfactory per diem basis. Such election must be exercised in writing at the time he retains the attorney or by written agreement he enters into thereafter with his attorney. A court has held that a court review of arrangement for attorney's fees is constitutional ( Prendergast v. Nelson, 199 Neb. 97, 256 N. W. 2d 657 (1977)). New Hampshire All fees for actions resulting in a settlement or judgment of $ 200,000 or more are subject to court approval ( N. H. Rev. Stat. Ann. § 508: 4-e). Specific limits applicable to medical malpractice cases, (N. H. Rev. Stat. Ann § 507-C: 8), have been held to be unconstitutional. Carson v. Maurer, 120 N. H. 925, 424 A. 2d 825 (1980). Washington While there is no defined cap for attorneys' fees in Washington, either party charged with the payment of attorneys' fees in a tort action may petition the court within 45 days of receipt of the final billing for a determination of the reasonableness of that party's attorneys' fees (Wash. Rev. Code Ann. § 4. 24. 005). The court must consider the following when making its decision:1. The time and labor required, the novelty and difficulty of the questions involved, and the skill requisite to perform the legal service properly;2. The likelihood, if apparent to the client, that the acceptance of the particular employment will preclude other employment by the lawyer;3. The fee customarily charged in the locality for similar legal services;4. The amount involved and the results obtained;5. The time limitations imposed by the client or by the circumstances;6. The nature and length of the professional relationship with the client;7. The experience, reputation, and ability of the lawyer or lawyers performing the services;8. Whether the fee is fixed or contingent;9. Whether the fixed or contingent fee agreement was in writing and whether the client was aware of his or her right to petition the court under this section; and10. The terms of the fee agreement. CONNECTICUT LAW-WAIVEROur statute is silent as to whether a client can waive the contingency fee limits that the statute imposes. One case addressed this issue. Judge Vertefeuille held that tort victims could waive their right to the protections afforded by the contingency fee law. She also decided the plaintiff's waiver was valid, and the fee arrangement the plaintiff entered into with her attorney was reasonable ( In re Estate of Salerno, 42 Conn. Supp. 526 (1993)). Testimony at the trial indicated that several experienced plaintiff’s attorneys wanted to represent her or at least investigate her case but refused to do so because the cap made representation economically infeasible. Her case involved harm caused by exposure to toxic chemicals, and according to the testimony, would have likely involved a lengthy and expensive trial to resolve. Facts On January 4, 1991, Rita Salerno was appointed conservatrix of the estate and person of her husband, Pasquale Salerno, a 37-year old who was totally and permanently disabled. He contracted toxic hepatitis and suffered from severe organic brain syndrome. He was unable to care for himself and required round-the-clock personal care, which was provided by his wife. Mrs. Salerno contended that her husband's condition was caused by exposure to certain toxic chemicals where he worked. From 1979 to 1989, he was employed as a vapor degreaser and exposed to various chemicals. His medical reports confirmed that his condition was related to toxic chemical exposure. In November 1990, Mrs. Salerno contacted Attorney Richard Bieder about suing the chemical manufacturer. Bieder advised her that he was willing to represent her but that he would need to investigate the claim first and the cost of investigation could be substantial. Salerno could not pay for the investigation or for legal representation on an hourly basis since she only received $ 978 a month in Social Security benefits. Section 52-257c establishes a fee cap for contingency cases. It provides in relevant part: (a) in any claim or civil action to recover damagesresulting from personal injury, wrongful death or damageto property occurring on or after October 1, 1987, theattorney and the claimant may provide by contract, whichcontract shall comply with all applicable provisions ofthe rules of professional conduct governing attorneysadopted by the judges of the superior court, that the feefor the attorney shall be paid contingent upon, and as apercentage of: (1) damages awarded and received by theclaimant, or (2) settlement amount pursuant to a settle-ment agreement. (b) in any such contingency fee arrange-ment such fee shall be the exclusive method for paymentof the attorney by the claimant and shall not exceed anamount equal to a percentage of the damages awarded andreceived by the claimant or of the settlement amountreceived by the claimant as follows: (1) thirty-threeand one-third per cent of the first three hundredthousand dollars; (2) twenty-five per cent of the nextthree hundred thousand dollars; (3) twenty per cent ofthe next three hundred thousand dollars; (4) fifteen percent of the next three hundred thousand dollars; and (5)ten percent of any amount which exceeds one million twohundred thousand dollars. Bieder advised her that he could not represent her for the amount specified by this statute because it was not economically feasible. Bieder told her that his firm would have to advance the investigation cost which was likely to be $ 20,000 to $ 25,000. He also told her that the litigation would probably be contested, that a trial was likely, and that his time to represent her would probably be worth $ 200,000 to $ 400,000. Under the fee cap, payments of such a fee would probably not be possible. Bieder offered to represent her for 30%, subject to approval by the probate court. Before finalizing the agreement, Bieder advised her to contact other experienced attorneys to see if any would represent her in compliance with the cap. She and Bieder contacted seven or eight attorneys. All were experienced in complex tort cases. Each expressed an interest in taking the case or investigating it, but each declined to do so because the statutory cap made it economically unfeasible. Procedural History Mrs. Salerno, as conservatrix, applied to probate court for permission to enter into the 30% fee agreement. The court denied the application because, as a court of limited jurisdiction, it did not have the authority to declare the statute invalid. She then filed a pro se complaint as conservatrix of the estate and on her own behalf seeking damages from the chemical makers. The defendants, represented by Day, Berry and Howard, Howd and Ludorf, and Cummings and Lockwood, removed the case to federal court. District Judge Nevas approved the fee agreement after a hearing and after Mrs. Salerno waived her rights under the fee cap statute. He expressed serious reservations about the statute’s constitutionality and stated a preference for state court to first decide this issue. Mrs. Salerno appealed the probate court decision not to approve the fee agreement to the Superior Court. She contended that the fee cap is unconstitutional in each of the following respects:1. it denies the plaintiff equal protection of the laws under Article First, § 20 of the State Constitution;2. it violates Article First, § 1 by creating an exclusive public emolument or privilege for the insurance industry and defense bar;3. it denies tort victims due process of law; and4. it improperly interferes with judicial rule-making authority and violates separation of powers. The plaintiff further contended that the fee cap statute should be construed to permit tort victims to waive their rights under the statute and enter into other fee arrangements. Trial Testimony Most of the attorneys contacted by Mrs. Salerno testified at the Superior Court trial. They explained why the cap made it economically unfeasible to handle such a case. They indicated that most complex toxic tort cases are not settled but rather proceed to what normally are lengthy trials. The value of time spent by a firm, according to these attorneys,can be anywhere from $ 200,000 to $ 400,000 or more, calculated on an hourly basis. Yet if the verdict amount is $ 1,200,000, the maximum attorney's fee is $ 280,000 under the statutory cap. They also testified that complex tort cases often require the attorneys to advance funds for investigation and for hiring experts and that in such cases, out-of-pocket costs can be $ 200,000 or more. Judge’s Decision Judge Vertefeuille resolved the case on nonconstitutional grounds. She first noted that rights granted by statute can be waived unless the statute is meant to protect the general rights of the public rather than private rights. She then cited instances where statutes relating to litigation have been construed as conferring a private right that can be waived (e. g. , statute of limitations for tort actions, right to trial by jury, defense of statute of fraud). She concluded that the fee cap statute clearly confers a private right and does not protect the general rights of the public. She also cited the legislative history where proponents of the law indicated that it could be waived (29 H. R. Proc. pp. 5830-33 (1986)). She concluded that the benefits of CGS § 52-251c could be waived, Salerno's waiver of the fee cap was valid, and the fee agreement reasonable. POLICY OPTIONSIf the legislature determines the current situation allowing clients to waive the attorney fee cap is problematic, it has at least three options. One option is to pass an amendment to specify that clients cannot waive the law’s protection. As noted before, California courts have interpreted its law as not allowing waivers. This option would almost certainly result in a challenge to the law’s constitutionality. In the Salerno case Judge Vertefeuille stated that the plaintiff “ presented to the court a compelling case for declaring the statute unconstitutional”. It is not possible to know for sure whether such a challenge would be successful. At least two states have upheld their attorney fee cap law against constitutional challenges (Indiana and Tennessee) while at least one state (New Hampshire) has invalidated its attorney fee cap law. Another option might have a greater chance to withstand constitutional challenge. At least four states explicitly allow a court to authorize fees in a greater amount than the fee cap allows in unusual or extraordinary circumstances (Illinois, Maine, New York, and Wisconsin). Such an approach might tend to eliminate the possibility that a person with a meritorious claim would be unable to retain an experienced attorney because of the amount of expenses required for expert witnesses and the amount of time and risk involved. A third option is to eliminate the fee schedule but allow a court to approve the reasonableness of the attorney’s fees. At least six states have adopted this approach (Hawaii, Iowa, Maryland, Nebraska, New Hampshire, and Washington). In each of these states other than Iowa, the court may or must approve the fees of both the plaintiff and the defendant. Please let me know if you want additional information about constitutional issues involved in a law that does not allow for greater fees under unusual circumstances. GC: ro


what is an ankle dislocation

Key points about ankle dislocation An ankle dislocation is a severe injury in which there is an abnormal separation between one or more of the bones of your ankle joint. These bones are the tibia, the fibula, and the talus. It most often happens with a fracture of your ankle joint.

What is ankle dislocation?

What is ankle dislocation? A joint dislocation is when there is an abnormal separation between the bones of a joint. When this happens in your ankle joint, it’s known as an ankle dislocation. It is a severe injury. Three bones make up the ankle joint. These are your tibia (shinbone), your fibula (the smaller bone in your leg), and your talus (a bone in your foot). This joint helps you make the up-and-down motion of your foot. Below this joint is another joint of the ankle called the subtalar joint. This joint is between the talus and another bone in your foot called the calcaneus. This joint allows side-to-side motion of your foot. Normally, a set of very strong ligaments hold all of these bones tightly in place. Severe trauma can pull or tear these ligaments out of place. This creates an abnormal space between one or more of the bones. The ligaments are very strong and don't pull away or tear easily. Ankle dislocations usually occur along with a break in one of the bones of your ankle. In some cases, an ankle dislocation can happen without a break in the bones of the ankle. In these cases, the ankle dislocation occurs along with a severe ankle sprain. A severe sprain is when the ligaments are torn. Most commonly, the injury pushes the talus bone behind the other ankle bones. It may also be pushed to either side, to the front, or upwards. Ankle dislocations can happen to people of all ages. They occur with ankle fractures much more often than with just sprains. What causes ankle dislocation? Ankle dislocation results from severe injury to the ankle. This tears one or more of the ankle ligaments. Without these ligaments to hold your bones in place, the bones of your ankle separate. This can happen in a motor vehicle accident. It may also happen while playing sports, especially ones that involve jumping. It is more likely to happen when you have your foot pointed down during impact. What are the risks for ankle dislocation? You may be at a greater risk for ankle dislocation if: You’re very involved in athletic activities You’ve had an ankle sprain, fracture, or dislocation in the past Your ankle has not been normal since birth You have a condition that makes your ligaments loose, such as Ehlers-Danlos syndrome You smoke cigarettes or are obese What are the symptoms of ankle dislocation? With your ankle injury, you may have symptoms such as: Immediate, severe pain Swelling and bruising Tenderness to the touch Inability to put weight on your foot Difficulty moving your ankle A deformed look to your ankle A bone that pokes through your skin How is ankle dislocation diagnosed? Your healthcare provider will talk to you about your symptoms and about your medical history. He or she will give you a physical exam and check you for other injuries. The healthcare provider may put pressure on parts of your lower leg and ankle to check for pain and swelling. Your doctor may also check that blood vessels in your leg aren’t stopping blood flow to your foot and ankle. Your healthcare provider will order X-rays of your leg, ankle, and foot to look for broken bones. You may also need a computed tomography (CT) scan or an MRI. These let your healthcare provider look at your injury with more detail. How is ankle dislocation treated? You will likely see an orthopedic doctor to treat your injury. Your treatment may vary depending on the type of your dislocation and any other injuries. Your treatment may include: Pain medicines A doctor moving your bones back into place without surgery (closed reduction)Elevation and use of cold packs on your ankle In some cases, emergency surgery A splint to hold your ankle in place at first A cast or boot to hold your ankle once your swelling goes down You might need surgery to treat your injury. During your surgery, your doctor will put your bones back in place to let them heal correctly. This is called internal fixation. Your doctor may use special plates and screws to keep the bones in place. This is called internal fixation. He or she may also repair tears to your ligament. After your leg has healed a bit, your doctor may give you a removable brace or splint. This is so you can start physical therapy. These exercises will help you restore and keep your range of motion and strength. You will likely need to use crutches or a cane for several months after your injury. Your doctor or physical therapist will let you know when you can go back to normal activities. Your doctor might also prescribe you a medicine to prevent blood clots in your leg while you recover. This is called a blood thinner. You might also need antibiotics if your injury caused a break in your skin. Your doctor may give you advice about your diet. This is because eating a diet that is rich in calcium, vitamin D, and protein can help you heal. Your doctor may ask you to not use certain over-the-counter medicines for pain. Some of these may delay normal bone healing. If you smoke, your doctor will advise you to stop smoking. Smoking can also delay bone healing. What are the complications of ankle dislocation? You might have complications from your ankle dislocation, such as: Stiffness in your joint (which physical therapy may help)Ankle arthritis causing chronic ankle pain Infection, which may need treatment with antibiotics or follow-up surgery A broken bone that fails to heal properly, which might need follow-up surgery Pain from the plates and screws used in your surgery (these may be removed at a later date)Problems with wound healing Blood vessel or nerve damage from your dislocation or fracture Blood clot Your risk of complications may vary according to your general health and how severe your injury is. Follow all of your doctor’s instructions carefully. This will help to reduce your risk of complications. When should I call the doctor? Call your doctor right away if your pain is getting worse instead of better. Let your doctor know if you have any numbness or swelling in your leg, or a high fever. Call 911 if you have any sudden, severe symptoms, such as sudden shortness of breath.

Severe trauma pulls away the strong ligaments that normally hold your ankle joint in place. With your injury, you might have severe pain right away, swelling, and a deformed look to the ankle. You will not be able to put weight on your foot. Your doctor can diagnose your condition by giving you a physical exam and taking X-rays. You might receive treatment with splints, casts, reduction of your joint, and pain medicines. Many people with ankle dislocation will also need surgery. Some people may have complications. These can include an infection or arthritis in the ankle. Follow your doctor’s instructions to help you reduce your chance of complications. Next steps Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen. Before your visit, write down questions you want answered. Bring someone with you to help you ask questions and remember what your provider tells you. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are. Ask if your condition can be treated in other ways. Know why a test or procedure is recommended and what the results could mean. Know what to expect if you do not take the medicine or have the test or procedure. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Know how you can contact your provider if you have questions.


is an american staffordshire a pitbull

One of the most noticeable differences between these two breeds is that pit bulls are taller and heavier than Staffordshire bull terriers. American Kennel Club breed standards state that Staffies should stand between 14 and 16 inches tall at the shoulder and weigh between 24 and 38 pounds.

Staffordshire Bull Terrier Vs. Pit Bull

Staffordshire bull terriers are smaller than American pit bull terriers. Staffordshire bull terriers and American pit bull terriers -- commonly known as pit bulls -- may look similar at first glance, but they're two distinct breeds. Although both types of dogs sometimes get a bad rap, they can make loyal and loving pets if properly trained and socialized. A Head for Heights

United Kennel Club breed standards for American pit bull terriers say the breed should be roughly between 17 and 21 inches tall -- although taller is OK, as long as they remain in proportion -- and weigh between 35 and 60 pounds. Color Conundrums Although both Staffordshire bull terriers and American pit bull terriers should have short, smooth coats, the latter can come in many more colors. According to the UKC, pit bulls can be any color other than merle and exhibit any coat pattern. On the other hand, the only colors allowed by the AKC for Staffordshire bull terriers are white, red, fawn, blue, black or brindle. White markings are allowed with any of these colors. Body Talk Staffies and pit bulls have fairly similar body types. Both should look strong and well muscled in proportion to their sizes, with deep chests and level top lines. While they should both have broad, straight muzzles, with just a slight taper to the end of the nose, UKC breed standards dictate that American pit bull terriers must have a short muzzle than the length of their head, with a rough 2:3 ratio. There's no such rule regarding Staffordshire bull terriers, who can have longer muzzles. Pet Personalities While temperament and personality varies from dog to dog, some expectations exist when it comes to these breeds. The AKC says that Staffordshire bull terriers should be courageous, tenacious, highly intelligent, trustworthy and affectionate to those they know. The UKC states American pit bull terriers should be strong, confident, eager to please and have a zest for life. They say that aggression toward humans is highly undesirable, but some level of dog aggression may be expected. Both breeds are noted as making exceptional family pets and being good with children. References American Kennel Club: Staffordshire Bull Terrier Breed Standard Dog Time: Staffordshire Bull Terrier United Kennel Club: American Pit Bull Terrier Breed Standard Dog Breed Information Center: American Pit Bull Terrier Photo Credits Jupiterimages/Polka Dot/Getty Images MORE MUST-CLICKS: How to Adopt a Stray Kitten The Best-Temperament Dog Breeds Types Of Akita How to Adopt a Retired Standard Poodle Does Homeowner's Insurance Cover Staffordshire Terriers? Where Did Pit Bulls Originate? How to Train My Pit Bull Puppy Not to Bite How to Train Pit Bull Terriers


what is methylphenidate generic for

Ritalin (methylphenidate) is a central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. Ritalin is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy.

Ritalin

Ritalin Generic Name: methylphenidate (oral) (METH il FEN i date) Brand Names: Aptensio XR, Concerta, Cotempla XR-ODT, Metadate CD, Metadate ER, Methylin, Quilli Chew ER, Quillivant XR, Ritalin Medically reviewed: September 5, 2017Overview Side Effects Dosage Professional Interactions Pregnancy Warnings More Breastfeeding Warnings User Reviews Drug Images Support Group Q & ACompare Alternatives Pricing & Coupons What is Ritalin?

Ritalin may also be used for purposes not listed in this medication guide. Slideshow Insomnia and Sleep Deprivation: The Case For A Good Night's Sleep Important information You should not use Ritalin if you have glaucoma, tics or Tourette's syndrome, or severe anxiety, tension, or agitation. Methylphenidate may be habit-forming, and this medicine is a drug of abuse. Tell your doctor if you have had problems with drug or alcohol abuse. Stimulants have caused stroke, heart attack, and sudden death in people with high blood pressure, heart disease, or a heart defect. Do not use Ritalin if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. Methylphenidate may cause new or worsening psychosis (unusual thoughts or behavior), especially if you have a history of depression, mental illness, or bipolar disorder. You may have blood circulation problems that can cause numbness, pain, or discoloration in your fingers or toes. Call your doctor right away if you have: signs of heart problems - chest pain, feeling light-headed or short of breath; signs of psychosis - paranoia, aggression, new behavior problems, seeing or hearing things that are not real; signs of circulation problems - unexplained wounds on your fingers or toes. Before taking this medicine Do not use Ritalin if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. You should not use Ritalin if you are allergic to methylphenidate, or if you have:glaucoma;a personal or family history of tics (muscle twitches) or Tourette's syndrome; orsevere anxiety, tension, or agitation (stimulant medicine can make these symptoms worse). Stimulants have caused stroke, heart attack, and sudden death in certain people. Tell your doctor if you have:heart problems or a congenital heart defect;high blood pressure; ora family history of heart disease or sudden death. To make sure Ritalin is safe for you, tell your doctor if you or anyone in your family has ever had:depression, mental illness, bipolar disorder, psychosis, or suicidal thoughts or actions;motor tics (muscle twitches) or Tourette's syndrome;blood circulation problems in the hands or feet;seizures or epilepsy;problems with the esophagus, stomach, or intestines;an abnormal brain wave test (EEG); ora history of drug or alcohol addiction. It is not known whether Ritalin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether methylphenidate passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Ritalin is not approved for use by anyone younger than 6 years old. How should I take Ritalin? Take Ritalin exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take Ritalin in larger or smaller amounts or for longer than recommended. Ritalin may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Selling or giving away this medicine is against the law. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions. To prevent sleep problems, take this medicine in the morning. Ritalin tablets and Ritalin SR tablets should be taken at least 30 to 45 minutes before a meal. Extended-release Ritalin LA capsules can be taken with or without food. Follow the directions on your medicine label. Do not crush, chew, or break a sustained-release tablet. Swallow the tablet whole. Breaking the tablet may cause too much of the drug to be released at one time. To make swallowing easier, you may open the Ritalin LA capsule and sprinkle the medicine into a spoonful of pudding or applesauce. Swallow right away without chewing. Do not save the mixture for later use. While using Ritalin, your doctor will need to check your progress at regular visits. Tell any doctor who treats you that you are using this medicine. If you need surgery, tell the surgeon ahead of time that you are using Ritalin. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat. Keep track of your medicine. Methylphenidate is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription. Ritalin dosing information Usual Adult Dose of Ritalin for Attention Deficit Disorder: Immediate release Ritalin tablets: Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before breakfast and lunch, and a third dose between 2 and 4 PM, if necessary. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM. Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM. Sustained release Ritalin SR tablets: Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets. Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed. Extended release Ritalin LA capsules; Initial Dose: 20 mg orally once a day in the morning before breakfast. For patients already receiving methylphenidate: If switching from immediate release tablets 10 mg twice a day or sustained release tablets 20 mg/day: 20 mg once daily. If switching from immediate release tablets 15 mg twice a day: 30 mg once daily. If switching from immediate release tablets 20 mg twice a day or sustained release tablets 40 mg/day: 40 mg once daily. If switching from immediate release tablets 30 mg twice a day or sustained release tablets 60 mg/day: 60 mg once daily. Maintenance Dose: Doses may be increased weekly in increments of 10 mg up to a maximum of 60 mg once daily in the morning. For patients unable to swallow the capsule, the contents may be sprinkled on applesauce and administered. Usual Adult Dose of Ritalin for Narcolepsy: Immediate release Ritalin tablets: Initial Dose: 10 mg orally 2 or 3 times daily, preferably 30 to 45 minutes before meals. Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg per day. In some patients, 10 to 15 mg daily may suffice. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM. Sustained release Ritalin SR tablets: Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets. Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed. Usual Pediatric Dose for Attention Deficit Disorder:6 years or older: Immediate release Ritalin tablets: Initial Dose: 2.5 to 5 mg orally twice daily, taken 30 to 45 minutes before breakfast and lunch. Maintenance dose: Doses may be increased weekly in increments of 5 to 10 mg up to a maximum of 60 mg/day in 2 or 3 divided doses. For patients who have trouble sleeping at night while receiving methylphenidate, the last dose should be taken before 6 PM. Sustained release Ritalin SR tablets: Initial Dose: Methylphenidate is also available as a 10 mg and 20 mg sustained release tablets with a duration of action of approximately 8 hours. If dose of the sustained release tablet corresponds with the titrated dose of methylphenidate regular tablets (taken not more frequently than every 8 hours), then the sustained release tablets may be used instead of the regular tablets. Maintenance Dose: The dose may be increased in weekly increments of 10 mg, up to a maximum of 60 mg/day, with the first dose taken before breakfast. Tablets should not be crushed or chewed. See also: Dosage Information (in more detail)What happens if I miss a dose? Take the missed dose as soon as you remember. Skip the missed dose if it is later than 6:00 p.m. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methylphenidate could be fatal. What should I avoid while taking Ritalin? Methylphenidate may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Ritalin side effects Get emergency medical help if you have signs of an allergic reaction to Ritalin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have:signs of heart problems - chest pain, trouble breathing, feeling like you might pass out;signs of psychosis - hallucinations (seeing or hearing things that are not real), new behavior problems, aggression, hostility, paranoia;signs of circulation problems - numbness, pain, cold feeling, unexplained wounds, or skin color changes (pale, red, or blue appearance) in your fingers or toes;a seizure (convulsions);muscle twitches (tics);changes in your vision; orpenis erection that is painful or lasts 4 hours or longer (rare). Methylphenidate can affect growth in children. Tell your doctor if your child is not growing at a normal rate while using this medicine. Common Ritalin side effects may include:mood changes, feeling nervous or irritable, sleep problems (insomnia);fast heart rate, increased blood pressure;loss of appetite, weight loss;nausea, stomach pain; orheadache. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. See also: Side effects (in more detail)What other drugs will affect Ritalin? Ask your doctor before using a stomach acid medicine (including Alka-Seltzer or sodium bicarbonate). Some of these medicines can change the way your body absorbs methylphenidate, and may increase side effects. Many drugs can interact with methylphenidate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your current medicines and any medicine you start or stop using. Next → Side Effects Add to My Med List More about Ritalin (methylphenidate)Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Compare Alternatives Support Group Pricing & Coupons En Español113 Reviews – Add your own review/rating Generic Availability Drug class: CNS stimulants Consumer resources Ritalin Ritalin (Advanced Reading)Other brands: Concerta, Metadate CD, Quillivant XR, Methylin, ... +6 more Professional resources Ritalin (FDA)Methylphenidate Hydrochloride (AHFS Monograph)Other Formulations Ritalin LARitalin SRRelated treatment guides ADHDNarcolepsy Where can I get more information? Your pharmacist can provide more information about Ritalin. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Ritalin only for the indication prescribed. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Copyright 1996-2018 Cerner Multum, Inc. Version: 17.01.


zarxio what is this medication use

USGranix; Neupogen; Zarxio Brand Names: Canada Grastofil; Neupogen What is this drug used for? It is used to lower the chance of getting an infection in people with bone marrow problems caused by chemo. It is used to raise the number of white blood cells in certain patients. It is used in patients who have been exposed to certain doses of radiation. It may be given to your child for other reasons.

Filgrastim

For Adult Patients Cancer Care Patient & Caregiver Education Filgrastim Pediatric Medication Share Email Print Brand Names:

Talk with the doctor. What do I need to tell the doctor BEFORE my child takes this drug? If your child has an allergy to this drug or any part of this drug. If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. This drug may interact with other drugs or health problems. Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor. What are some things I need to know or do while my child takes this drug? All products: Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists. Do not give this drug to your child at the same time or within 24 hours before or after he/she gets chemo or radiation treatment. Talk with your child’s doctor. Have blood work checked as you have been told by the doctor. Talk with the doctor. This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug. This drug may cause a very bad and sometimes deadly problem called capillary leak syndrome (CLS). CLS may lead to low blood pressure and harm to the body. It may also lead to a heartbeat that is not normal, chest pain or pressure, heart attack, lung or breathing problems, bleeding or lower blood flow in the stomach or bowel, kidney problems, swelling, or feeling confused. Talk with the doctor. Some people with sickle cell disease have had times where the sickle cell disease has gotten worse when taking this drug. Sometimes, this has been deadly. Talk with the doctor. If your child is pregnant or breast-feeding a baby: Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks of using this drug. Neupogen, Zarxio, and Grastofil: If your child has a latex allergy, talk with the doctor. Some products have latex. What are some side effects that I need to call my child’s doctor about right away? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain. Dark urine. Dizziness or passing out. A fast heartbeat. Sweating a lot. Shortness of breath. Fast breathing. Fever. Coughing up blood. Feeling very tired or weak. Any unexplained bruising or bleeding. Purple spots or redness of the skin. Very bad headache. Swelling. Enlarged and ruptured spleens have happened with this drug. Sometimes, ruptured spleens have been deadly. Call the doctor right away if your child has left upper stomach pain or left shoulder pain. What are some other side effects of this drug? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away: Back pain. Bone pain. Joint pain. Cough. Headache. Upset stomach. Feeling tired or weak. These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects. You may report side effects to your national health agency. How is this drug best given? Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely. All products: It is given as a shot into the fatty part of the skin. To gain the most benefit, do not miss giving your child doses. Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well. If you will be giving your child the shot, your child’s doctor or nurse will teach you how to give the shot. Follow how to give this drug as you have been told by your child’s doctor or read the package insert. Before using this drug, take it out of the refrigerator and leave it at room temperature for 30 minutes. Do not use if the solution is cloudy, leaking, or has particles. Do not use if solution changes color. Do not shake the solution. Wash your hands before and after you give the shot. Do not give into skin that is irritated, bruised, red, infected, or scarred. Move the site where you give the shot with each shot. Throw away any part left over after the dose is given. Throw syringe away after use. Do not use the same syringe more than one time. Throw away needles in a needle/sharp disposal box. Do not reuse needles or other items. When the box is full, follow all local rules for getting rid of it. Talk with a doctor or pharmacist if you have any questions. Do not switch between different brands of this drug without first talking with the doctor. Neupogen: Do not switch between different forms of this drug without first talking with the doctor. Neupogen, Zarxio, and Grastofil: It may be given into a vein by a doctor or other healthcare provider. Granix®: If you get this drug on the skin, wash it off right away with soap and water. If you get this drug in the eyes, flush right away with cool water and get medical help. What do I do if my child misses a dose? Call your child’s doctor to find out what to do. How do I store and/or throw out this drug? All products: Store in a refrigerator. Do not freeze. Store in original container. Protect from light. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area. Neupogen, Zarxio, and Grastofil: If this drug freezes, let it thaw in the refrigerator before use. Do not use if this drug has been frozen more than once. If needed, this drug can be left out at room temperature for some time. Be sure you know how long you can leave this drug at room temperature before you need to throw it away. Do not put this drug back in the refrigerator after it has been stored at room temperature. Granix®: If needed, this drug can be left out at room temperature for up to 5 days. If not used within 5 days of being left out at room temperature, you can return this drug to the refrigerator. Do not do this more than 1 time. Throw away unopened drug if left at room temperature for more than 5 days. General drug facts If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor. Do not share your child’s drug with others and do not give anyone else’s drug to your child. Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor. Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins. Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. Consumer Information Use and Disclaimer This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Last Reviewed Date2018-03-02Copyright© 2018 Wolters Kluwer Clinical Drug Information, Inc. and its affiliates and/or licensors. All rights reserved. If you have any questions or concerns, contact a member of your healthcare team directly or call 212-639-2000 for help. Last Updated Tuesday, March 27, 2018


what is a unit step response

ly. Find the unit step response of the sytstems. Remember, the unit step response is a zero state solution, so no energy is stored in the system at t=0 - (i.e., the capacitor is discharged and the spring is uncompressed).

The Unit Step Response: Time domain

"The Unit Step Response: Time domain Contents Introduction Step Response of a First Order System Step Response of Second Order System Homogeneous Response Case 1: The overdamped case Case 2: The critically damped case Case 3: The underdamped case Particular Response Complete Response Introduction One of the most common test inputs used is the unit step function. The step models many types of inputs: a switch turning on a voltage at t=0; a step change in road surface (e.g., a curb); a sudden change in temperature... The response of a system (with all initial conditions equal to zero at t=0 -, i.e., a zero state response) to the unit step input is called the unit step response. This page serves as a review of the method of finding the step response of first and second order system. It is assumed that the reader has studied this topic previously and merely needs a quick overview. Step Response of a First Order System This section serves as a review of the calculation of the step response of first order systems by the method of homogeneous and particular (or natural and forced) response. Example 1: No discontinuity in step response Consider the systems shown below. In the circuit the input and output are e in and e out, respectively. In the mechanical system the input and output are x in and x out, respective

Solution: First we need to find the differential equation representing the systems. We do this by summing currents at a node (e out) or forces (at xout). Electrical Equations (sum of currents at e out)Mechanical Equations (sum of forces at xout)If we replace RC and k/b by τ, and set the input (e in (t) and x in (t)) to a unit step ( γ (t)), and call the output ""y"" the equations become identical We now proceed with the solution: Homogeneous Solution We assume a homogeneous solution of the formand put this into the differential equation (with the input set to 0) to getwhere the coefficient A is yet to be determined. Particular Solution We assume that the particular solution is a constant (since the input is constant for t>0). Complete Response The complete response is simply the sum of the homogeneous and particular responses. We find ""A"" from initial conditions at t=0 + . For the electrical circuit e out (0 + )=0 (voltage across a capacitor cannot change instantaneously), and x out (0 + )=0 (dashpot has finite force, hence finite velocity, hence continuous position: x out (0 - )=x out (0 + )). The response is shown below for a τ =2 sec. Example 2: Discontinuity in step response As a second example, consider the systems shown below in which we have swapped the components from the fires example. Find the unit step response of the systems. Remember, the unit step response is a zero state solution, so no energy is stored in the system at t=0 - (i.e., the capacitor is discharged and the spring is uncompressed). Solution: First we need to find the differential equation representing the systems. We do this by summing currents at a node (e out) or forces (at xout). Electrical Equations (sum of currents at e out)Mechanical Equations (sum of forces at xout)If we replace RC and k/b by τ, and set the input (e in (t) and x in (t)) to a unit step ( γ (t)), and call the output ""y"" the equations become identical We now proceed with the solution: Homogeneous Solution We assume a homogeneous solution of the formand put this into the differential equation (with the input set to 0) to getwhere the coefficient A is yet to be determined. Particular Solution We assume that the particular solution is a constant (since the input is constant for t>0). Complete Response The complete response is simply the sum of the homogeneous and particular responses. We find ""A"" from initial conditions at t=0 + . For the electrical circuit e out (0 + )=1 (voltage across a capacitor cannot change instantaneously, so e out (0 + )=e in (0 + )), and x out (0 + )=1 (dashpot has finite force, hence finite velocity, hence cannot compress instantaneously: x out (0 + )=x in (0 + )). The response is shown below for a τ =2 sec. Key Concept: Unit Step Response of a First Order Differential Equation A first order differential equationhas homogeneous, particular, and complete responses given by The unknown coefficient, ""A,"" in the complete response is found from initial conditions at t=0 +. Step Response of a second order system As you would expect, the response of a second order system is more complicated than that of a first order system. Whereas the step response of a first order system could be fully defined by a time constant and initial conditions, the step response of a second order system is, in general, much more complex. As a start, the generic form of a second differential equation that we might solve is iven by:where y (t) is the output and x (t) is the input. We will proceed by examining a particular system. To find the step response of a second order system like the one shown belowwe start by finding the differential equation (using Kirchoff's voltage law) relating e in and e out. (differentiate to get rid of integral)Homogeneous Response of Second Order System To find the homogeneous solution of a second order system, we proceed as before, i.e., we assume the form of the solution to be We set the input in the differential to zero, and substitute this expression and solve for ""s.""This last equation is called the ""characteristic equation"" of the system. Since we get a second order polynomial, we get two values for sand our homogeneous solution becomes We now have two unknown coefficients, A 1 and A 2 to be determined from initial conditions. However we have three distinct cases that we will consider based upon the characteristics of s 1 and s 2 . The simplest case occurs when s 1 and s 2 are real and negative and not equal to each other; we call this the overdamped case. If s 1 and s 2 are real and negative and equal to each other we call this the critically damped case. If s 1 and s 2 are complex conjugates (and have negative real parts), we say that the system is underdamped. Name Roots of s Characteristics of ""s""Overdamped s=σ 1, σ 2 Two real and negative roots Critically Damped s=σ A single negative real root Underdamped s=σ ± j ω d Complex conjugate with negative real part ( j = √-1)It is also possible to have positive (or zero) real part - we will no first three cases are most important, and the last two will be discussed only briefly in what follows. Case 1: The overdamped case (ζ>1)In the overdamped case we have two negative real roots at s 1 =σ 1 and s 2 =σ 2.and Case 2: The critically damped case In the critically damped case, there is only a single negative root (i.e., the term under the square root sign is zero). For this particular case, we have to adjust the form of the solution Case 3: T: The underdamped case The last case we consider is the underdamped case (where we have two complex conjugate roots with negative real parts)We can write the solution as Since e out,h (t) is real A 1 and A 2 must be complex conjugates: While this form of the homoegeneous response is correct, it can be shown that there are two forms that are equivalent We will use the last expression. Particular Response of Second Order System If the input to a system is a step that is constant for t≥0, the particular response of the system is a constant. Complete Response of Second Order System The complete response is simply the sum of the homogeneous and particular solutions. The unknown coefficients of the complete solution are found from initial conditions at t=0 + (because there are two unknown coefficients, two initial conditions are necessary). Example: Unit Step Response of a Second Order System Find the unit step response of the circuit shown (R=2, L=1, and C=1/5)Solution: We start by finding the differential equation that defines the system: We then find the homogeneous response. Homogeneous Response The characteristic equation is given by:with roots at This is the underdamped case with σ=-1 and ω d =2 so Particular Response The particular response is just a constant, which we find by substituting into the equation (with t>0)All derivatives are zero (because input and output are constant for t>0)so Complete Response The complete response is the sum of the homogenous and particular solutions The unknown coefficients are determined from initial conditions. We know the current through the inductor doesn't change instantaneously, so the current through the circuit (and in particular, the resistor) is zero at t=0 +. We also know that the voltage across the capacitor doesn't change instantaneously, so all of the input voltage is across the inductor and We use these two inital conditions to determine C and φ. First we apply the initial condition on the output voltage.so φ is an odd multiple of π/2 radians (or 90°);. We will choose φ=pi/2. So Next we apply the initial condition on the derivative of the output voltage (we employ the chain rule on the derivative of the right side of the equation)and This is shown in the graph below Key Concept: Unit Step Response of a Second Order Differential Equation A second order differential equation Has characteristic equationwith roots at The characteristics of the roots determine the form of the homogeneous response Name Roots of s Characteristics of ""s"" Form of Homogeneous Response Overdamped s=σ 1, σ 2 Two real and negative roots Critically Damped s=σ A single negative real root Underdamped s=σ ± j ω d Complex conjugate with negative real part ( j = √-1)The particular response is given byand the complete response is given by The complete response is simply the sum of the homogeneous and particular solutions. The unknown coefficients of the complete solution are found from initial conditions at t=0 + (because there are two unknown coefficients, two initial conditions are necessary). References© Copyright 2005 to 2015 Erik Cheever This page may be freely used for educational purposes. Comments? Questions? Suggestions? Corrections? Erik Cheever Department of Engineering Swarthmore College "