How Does a Grand Jury Work? #arrest, #booking #and #bail, #criminal #procedure


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How Does a Grand Jury Work?

The grand jury plays an important role in the criminal process, but not one that involves a finding of guilt or punishment of a party. Instead, a prosecutor will work with a grand jury to decide whether to bring criminal charges or an indictment against a potential defendant — usually reserved for serious felonies. Grand jury members may be called for jury duty for months at a time, but need only appear in court for a few days out of every month. Regular court trial juries are usually 6 or 12 people, but in the federal system, a grand jury can be 16 to 23 people.

The grand jury is one of the first procedures in a criminal trial, if used at all. See FindLaw’s Criminal Procedure section for more articles, including Criminal Procedure FAQ and How are Criminal Charges Brought Against Someone?

How Does a Grand Jury Differ from a Preliminary Hearing?

While all states have provisions in their laws that allow for grand juries, roughly half of the states don’t use them. Courts often use preliminary hearings prior to criminal trials, instead of grand juries, which are adversarial in nature. As with grand juries, preliminary hearings are meant to determine whether there is enough evidence, or probable cause. to indict a criminal suspect.

Unlike a grand jury, a preliminary hearing is usually open to the public and involves lawyers and a judge (not so with grand juries, other than the prosecutor). Sometimes, a preliminary hearing proceeds a grand jury. One of the biggest differences between the two is the requirement that a defendant request a preliminary hearing, although the court may decline a request.

Grand Jury Proceedings

Grand jury proceedings are much more relaxed than normal court room proceedings. There is no judge present and frequently there are no lawyers except for the prosecutor. The prosecutor will explain the law to the jury and work with them to gather evidence and hear testimony. Under normal courtroom rules of evidence. exhibits and other testimony must adhere to strict rules before admission. However, a grand jury has broad power to see and hear almost anything they would like.

However, unlike the vast majority of trials, grand jury proceedings are kept in strict confidence. This serves two purposes:

  1. It encourages witnesses to speak freely and without fear of retaliation.
  2. It protects the potential defendant’s reputation in case the jury does not decide to indict.

The Grand Jury’s Decision and a Prosecutor’s Discretion

Grand juries do not need a unanimous decision from all members to indict, but it does need a supermajority of 2/3 or 3/4 agreement for an indictment (depending on the jurisdiction). Even though a grand jury may not choose to indict, a prosecutor may still bring the defendant to trial if she thinks she has a strong enough case. However, the grand jury proceedings are often a valuable test run for prosecutors in making the decision to bring the case.

If the grand jury chooses to indict, the trial will most likely begin faster. Without a grand jury indictment, the prosecutor has to demonstrate to the trial judge that she has enough evidence to continue with the case. However, with a grand jury indictment, the prosecutor can skip that step and proceed directly to trial.

If you have more questions about how a grand jury works, or need help with a criminal case, consider speaking with a criminal defense lawyer in your area.


August 2002 Questions and Answers #recrystallization #procedure


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Question and Answer Section

Q Can I have dissolution results higher than 100.0% of the label claim?

A Yes, you can have results higher than 100.0% for several reasons. First, in most cases the acceptance criteria for the Assay of the drug is a range that has an upper limit higher than 100.0%. For instance, the range for the Assay test in the USP-NF monograph for Dextroamphetamine Sulfate Tablets is not less than 93.0 percent and not more than 107.0 percent of the labeled amount of dextroamphetamine sulfate. Second, the acceptance criteria for dosage uniformity (see USP-NF general chapter 905 Uniformity of Dosage Units) is the range from 85.0% to 115.0% of the label claim for tablets. Dissolution results higher than 100.0% should be less frequent because they depend on the probability of testing a tablet with a dose higher than 100% of the label claim.
If you frequently have dissolution results higher than 100.0%, this may be an indication of interference in your dissolution system. You need to verify that substances are not leaching from the filter and interfering with the measurements. Other sources of interference could be carryover in automatic sampling systems and inappropriate cleaning procedures.

Q Should I make a correction to the dissolution results based on the results obtained with the Assay?
A No. The dissolution results always refer to the label claim and not to the Assay values.

Q Can I carry out only the dissolution test and not the assay and estimate the assay results from the dissolution results?
A The dissolution test and the Assay measure different attributes. In the Assay the amount of active ingredient in the dosage form is measured. In general, the sample is a composite of several units of the dosage form being tested, and an extraction procedure generally is be used to extract the active ingredient from the dosage form as completely as possible and in a much shorter time than given for the dissolution test. The dissolution test is a performance test that measures the rate of active ingredient released from each unit of the dosage form. Although the dissolution test procedure often can be used to completely extract the contents of a dosage form, that is not its primary function.

Q I am analyzing a tablet that has a label claim of 250 mg. The tolerance in the dissolution test for this particular tablet is not less than 80% (Q) of the labeled amount dissolved in 30 minutes. What amount, 200 or 212.5 mg, represents the acceptance criterion given by the dissolution test for this product?
A – The tolerances in the monograph define the value of Q. In this case it will be 80% of the label claim of 250 mg or 200 mg. However, the acceptance criterion is defined by the acceptance table (see USP-NF general chapter 711 Dissolution and 724 Drug Release), unless a different acceptance table is presented in the specific monograph. The acceptance table under 711 states that for the S1 stage the acceptance criterion is each unit is not less than Q + 5%. For your product it means 200 mg (Q) + 5% of 250 mg, equal to 212.5 mg.

Q When opened, our bottle of Salicylic Acid Tablets had a large amount of powder inside. Can I expect the dissolution to be affected?
A Salicylic acid has a high vapor pressure and will sublime completely at about 70 C. Typically some powder will be found inside the bottles due to recrystallization. Brush off any powder from the tablets before use. Studies have found that the dissolution performance of the salicylic acid tablets is not affected.

Q Why would the specification for an oral extended-release product list multiple tests under 724 Drug Release? Which test should I use?
A Extended release formulations use various physical mechanisms to control the rate of drug delivery in vivo; these formulations may or may not have different in vitro drug release profiles. In most cases, when a new monograph for an oral extended-release product is introduced in the USP-NF, this monograph is written based on documentation from the innovator and, therefore, there will be only one Drug Release test. In order to market generic versions of extended release oral dosage forms in the US, bioequivalence to the reference listed drug must be demonstrated to the Food and Drug Administration. This is in addition to the submission of the chemistry, manufacturing, and controls information. An in vitro drug release test must be included for quality control purposes. When the FDA receives multiple product applications, the agency indicates their therapeutic equivalence status in the Approved Drug Products with Therapeutic Equivalence Evaluations ( Orange Book ). As a result of differences in drug release properties, bioequivalent products may not perform identically in vitro but can be approved by FDA with different drug release tests. The USP monograph reflects this by including multiple tests under 724 Drug Release. FDA must have previously approved the use of each of these tests The product label must indicate which of these tests was used to demonstrate compliance with the monograph.


Tubal Ligation Reversal: Procedure, Success Rates, Cost and Insurance #tubal #ligation #reversal, #tubal #ligation #reversal


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What Is Tubal Ligation Reversal?

When you had your tubes tied, you were probably 100% sure you never wanted to get pregnant. But what if you change your mind? There’s still a way to make it happen.

Your doctor may suggest an operation called “tubal ligation reversal.” A surgeon will reopen, untie, or reconnect your fallopian tubes so you can have a baby again.

Can I Have Tubal Reversal Surgery?

Your doctor will consider several things before you both decide that the operation is right for you:

  • Your age
  • The type of surgery you had to get your tubes tied
  • Your overall health and the health of your ovaries, uterus, and remaining fallopian tubes, especially their length

Your doctor will also ask you questions like:

  • When did you have your tubes tied and what type of surgery did you have?
  • Were you ever pregnant and was it a healthy pregnancy?
  • Had you had surgery for endometriosis. fibroids. pelvic inflammatory disease (PID), or other gynecological disorders? Surgery can cause scar tissue, which may affect the success of the tubal reversal.

In general, tubal reversal could be right for you if you had only small parts of your fallopian tubes removed, or if your tubes were closed with rings or clips.

Some surgeons say the best candidates for tubal reversal are women younger than 40 who had their tubes tied right after childbirth. a procedure called postpartum tubal ligation.

Before the Procedure

Your doctor will likely suggest you and your partner get a complete physical exam. That way you can find out if there’s anything that might keep you from getting pregnant after a tubal reversal.

Your exam may include blood and imaging tests to make sure your ovaries are normal. You’ll also need a test called a hysterosalpingogram (HSG ), to check the length and function of your remaining fallopian tubes. An HSG can be done using dye and X-rays or saline and air along with ultrasound .

Your doctor may also suggest that your partner get tests such as a sperm count and semen analysis to rule out any fertility problems.

Continued

How Is Tubal Reversal Done?

You’ll need to go to a hospital or an “outpatient” center — a place where you don’t stay overnight after surgery. You’ll be given general anesthesia, which means you’ll be pain-free and won’t be awake during the operation.

Your surgeon places a small lighted scope, called a laparoscope, through your belly button and into the pelvis area. This lets him look at your fallopian tubes and decide if reversal surgery is possible.

If he decides it’s OK to do the reversal, your doctor then makes a small surgical cut, called a “bikini cut,” near your pubic hair line. Microscopic instruments attached to the end of the laparoscope let him remove any clips or rings that were used to block your tubes, and reconnect the ends of the tubes to the uterus, using very small stitches .

The surgery usually takes about 2 to 3 hours.

Recovery After a Tubal Reversal

Recovery time depends on the surgical method your doctor used. Tubal reversal is major abdominal surgery that is more difficult and takes longer to do than your original tube-tying operation.

Some women may need to stay in the hospital for 1 to 3 days. But today, tubal reversal surgery is most often done using “microsurgical” techniques. An overnight hospital stay may not be needed. Women who have the microsurgical method usually go home the same day, typically within 2to 4 hours after the surgery is complete.

Your doctor will prescribe painkillers to help you manage any discomfort. Most women go back to their normal activities within 2 weeks.

Pregnancy Success Rates After Reversal

If your remaining fallopian tubes are healthy, and you and your partner don’t have any other infertility issues, you have a good chance of getting pregnant after tubal reversal.

Keep in mind, though, that it doesn’t work for everyone. Age plays an important role in whether you get pregnant after tubal reversal. Older women are much less likely than younger woman to have success.

In general, pregnancy success rates range from 40% to 85%. When pregnancy does happen, it’s usually within the first year.

Continued

Besides your age, getting pregnant after tubal reversal depends on things such as:

  • Type of tubal ligation procedure you had
  • Length of your remaining fallopian tubes, and whether they still work properly
  • Amount of scar tissue in your pelvic area
  • Results of your partner’s sperm count and other fertility tests
  • Your surgeon’s skill

You’ll need another X-ray dye test (hysterosalpingogram) about 3 to 4 months after surgery to make sure your tubes are open and working right.

Complications and Risks

All surgery has some risk. It’s rare, but it’s possible you could have bleeding, infection, damage to nearby organs, or reactions to anesthesia. Tubal reversal also gives you a higher risk of ectopic pregnancy. a life-threatening condition in which a fertilized egg grows outside your womb.

And sometimes, the area where you had the tubal reversal forms scar tissue and blocks the fallopian tubes again.

How Much Does Tubal Reversal Surgery Cost?

Insurance doesn’t typically cover the procedure. Tubal reversal is expensive — several thousand dollars for the surgery, along with anesthesia and hospital fees and the cost of fertility tests that you need to get before the procedure.

Alternatives to Tubal Reversal Surgery

You may want to consider in vitro fertilization (IVF). In this procedure, your egg and a man’s sperm are fertilized outside the womb in a laboratory dish. The fertilized egg (embryo) is later placed into your womb.

IVF is also an option if you don’t get pregnant after tubal reversal surgery.

WebMD Medical Reference Reviewed by Kecia Gaither, MD, MPH on October 05, 2016

Sources

News release, Norgenix Pharmaceuticals, LLC.

InterNational Council on Infertility Information Dissemination web site.

American Congress of Obstetricians and Gynecologists web site: “Postpartum Sterilization Brochure.”

Reproductive Associates of Delaware web site: “Tubal Reversal.”

Cleveland Clinic OB/GYN Women’s Health Institute Clinic web site: “Tubal Reversal.”

Gabbe, S.G. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Elsevier Churchill Livingstone; 2007: chap 21.

Chicago Infertility Associates web site: “Tubal Reversal.”

Penn Medicine web site: “Tubal Ligation Reversal,” “Q A About Tubal Reversal and Vasectomy.”

© 2016 WebMD, LLC. All rights reserved.


Male Sling for Bladder Incontinence After Prostate Cancer #male #sling,sling #procedure,bladder #incontinence,prostate #cancer,bulbourethral #sling


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Male sling for bladder incontinence

An option for some men

A male sling available for men who have prolonged incontinence that is often caused by sphincter damage related to treatment for prostate cancer.

There are several different devices and they all require some kind of surgery.

The bulbourethral sling

The bulbourethral sling uses a technique that is similar to slings used to help women with incontinence. The device is:

  • Typically made of a synthetic mesh material
  • Surgically implanted through the abdomen (often using laparoscopic surgery) underneath the urethra inside the man’s body
  • Tied to the fibrous tissue of the rectum to keep it in place

The male sling supports the urethra, which is the tube that carries urine from the bladder through the penis where it is released when a man urinates. The sling also helps return the urethra to its normal position to help reduce the risk of urine leakage, particularly when a man coughs, sneezes, or engages in strenuous activities.

Tip: Ask the doctor for his or her definition of success or a complete cure for incontinence.

In one study (Schaeffer et al) of 64 men with severe incontinence following prostatectomy (50% of the men were totally incontinent):

  • 36 men were dry about a year and a half after getting a bulbourethral sling
  • Slings needed to be retightened in 17 men (which required another surgery)
  • A small number of men (6%) had urinary tract erosion
  • 3% of men had infection

In another study (Clemens et al):

  • Only one of 12 men who had adjuvant radiation (radiation in addition to another type of treatment, such as surgery), had success with the bulbourethral sling
  • 32 men reported persistent numbness or discomfort

Male sling attached to the bone

Another procedure attaches the male sling to the pubic bone on both sides of the urethra, usually with titanium screws. The male sling places pressure/constricts the urethra, which prevents it from releasing urine.

In one study (Comiter et al) of 48 men who used at least 3 pads a day for stress bladder incontinence after radical prostatectomy:

  • Average pad use decreased to about one pad a day, two to four years after receiving the bone-attached sling
  • 31 men needed no pads, 7 men needed 1 pad a day, and 3 men needed 2 pads a day
  • 7 men failed and needed more than 3 pads a day

Overall success rates for bone-attached slings have been reported to be between 40% to 88%. Side effects may include:

  • Acute urinary retention
  • Infection of the perineal incision
  • Erosion of the urethra
  • Pain
  • Urinary urgency
  • Loosening of the bone screws

Adjustable retropubic slings

The benefit of these systems is that they can be adjusted after surgery to make them tighter or looser. One system has a mechanical regulator that is implanted under the skin.

In a European study (Sousa-Escandon, et al) of 51 men who were followed on average after 32 months:

  • 33 men (64.7%) were considered to be cured and 25 of these men did not have to wear pads
  • The other men needed only small pads or sanitary napkins

Another system uses a silicone foam pad that is placed under the bulbar urethra. In a study (Hubner, et al) of 101 men with an average follow up after 2.1 years, 79.2% of men were considered to be dry.

But another study (Dalpiaz, et al) reported mid-term complications after a median follow-up of 35 months, including:

  • Acute urinary retention
  • Removal of the sling
  • Persistent pain

Like any outpatient surgical procedure, there may be some risks, including:

  • Complications from anesthesia
  • Heart attack
  • Stroke
  • Blood clots
  • Infection

Before you decide on an approach, it’s important to ask the doctor about all the benefits and associated risks.

Your loved one may need a catheter for a day or so. While recovery time is expected to be fairly quick, he may be advised to avoid heavy lifting or activities that could result in straining for several months.

Always consult a medical professional.

Atiemo HO, Moy L, Vasavada S, Rackley R. Evaluating and managing urinary incontinence after prostatectomy: beyond pads and diapers. Cleveland Clinical Journal of Medicine. 2007;74 (1):57-63.

Clemens JQ, Bushman W, Schaeffer AJ. Questionnaire based results of the bulbourethral sling procedure. J Urol. 1999;162:1972-1976.

Comiter CV. The male perineal sling: intermediate-term results. Neurourol Urodyn. 2005;24:648-653.

Kim JC, Cho KJ. Current trends in the management of post-prostatectomy incontinence. Korean J Urol. 2012;53(8):511-518.

Schaeffer AJ, Clemens JQ, Ferrari M, Stamey TA. The male bulbourethral sling procedure for post-radical prostatectomy incontinence. J Urol. 1998;159(5):1510-1515.


mortgage broker license


#DORA Division of Securities – Mortgage Broker Licensing Procedure

NOTE: Most mortgage brokers must register with the Colorado Division of Real Estate while very few must register with the Colorado Division of Securities.

Information regarding mortgage broker registration is available from the Colorado Division of Real Estate at:

Those mortgage brokers who raise money from individual investors to fund mortgage loans would need to be licensed under the state securities laws with the Colorado Division of Securities. Please review the following information before you apply for a Colorado Securities Division Mortgage Broker-Dealer license.

General information Regarding Mortgage Broker-Dealers

(e) A mortgage broker-dealer whose business is limited exclusively to effecting transactions with financial institutions [as defined in section 11-51-201(6), C.R.S.] is exempt from the licensing requirements of section 11-51-401(1), C.R.S.

11-51-201(6),(C.R.S.) Financial or institutional investor means any of the following whether acting for itself or others in a fiduciary capacity:

(a) A depository institution;

(b) An insurance company;

(c) A separate account of an insurance company;

(d) An investment company registered under the federal Investment Company Act of 1940 ;

(e) A business development company as defined in the federal Investment Company Act of 1940 ;

(f) Any private business development company as defined in the federal Investment Advisers Act of 1940 ;

(g) An employee pension, profit-sharing, or benefit plan if the plan has total assets in excess of five million dollars or its investment decisions are made by a named fiduciary, as defined in the federal Employee Retirement Income Security Act of 1974, that is a broker-dealer registered under the federal Securities Exchange Act of 1934 , an investment adviser registered or exempt from registration under the federal Investment Advisers Act of 1940 , a depository institution, or an insurance company;

(h) An entity, but not an individual, a substantial part of whose business activities consist of investing, purchasing, selling, or trading in securities of more than one issuer and not of its own issue and that has total assets in excess of five million dollars as of the end of its latest fiscal year;

(i) A small business investment company licensed by the federal small business administration under the federal Small Business Investment Act of 1958 ; and

(j) Any other Institutional Buyer.

A mortgage broker-dealer whose business is not limited exclusively to placing mortgage loans with institutional investors is subject to the mortgage broker-dealer licensing requirements under the state securities laws. Therefore, a mortgage broker-dealer who raises money from individual investors to fund mortgage loans would need to be licensed under the state securities laws.

When applying for a Mortgage Broker-Dealer and/or Sales Representative license(s), file the following at the Colorado Division of Securities, 1560 Broadway, Suite 900, Denver, CO 80202.

Filing fees are required for a mortgage broker-dealer license and for each sales representative license. Make your check payable to the Colorado State Treasurer. Refer to the Fee Schedule for appropriate fee requirements.

Form BD.

Undertaking – Mortgage Brokers.

Agent application Form U-4 for each person who will represent the firm in Colorado as sales representative and proof that applicant has passed the Uniform Securities Agent State Law Examination (Series 63).Individuals who are licensed as a real estate broker or salesman are excused from this examination requirement.When filing, provide proof of real estate licensure.Request a Uniform Qualifications

A mortgage broker-dealer who maintains possession or control of investor funds or securities must meet certain financial responsibility requirements. The options for requirements are listed in Rule 4.6B. At the time of application for license, provide proof of compliance with such requirements, if applicable.