Despite the obvious comic element in the above quotation, Mr. Williams brings to light the growing influence of clinical specialty recognition (CSR) among health care providers and the patients they serve. Special Interest Group (SIG) 3, formerly Special Interest Division 3, has had many lively debates in the past on whether our profession should pursue formal recognition of voice as a clinical specialty. The topic has recurred regularly over the years, with similar impassioned and informed positions being expressed on either side of the debate. This article will provide a general overview of how this issue has been addressed by our SIG in the past and a starting point for future discussions. Because this article has been written from an historical perspective and before our name change to SIG3, the use of the word "Division" will be retained in the ensuing descriptions ...
TY - JOUR. T1 - Breast cancer screening. T2 - Effect of physician specialty, practice setting, year of medical school graduation, and sex. AU - Turner, B. J.. AU - Amsel, Z.. AU - Lustbader, E.. AU - Schwartz, J. S.. AU - Balshem, A.. AU - Grisso, J. A.. PY - 1992. Y1 - 1992. N2 - We surveyed physicians of different specialties in a large metropolitan area to determine how their characteristics affected their performance and beliefs about breast cancer screening. Of 664 general internists, obstetrician-gynecologists, and cardiologists surveyed, we received 298 responses (45%). We found significant differences in reported performance of breast cancer screening and physicians beliefs about mammography screening among practising obstetrician-gynecologists, internists, and cardiopulmonary specialists. Cardiopulmonary specialists performed the fewest breast examinations and screening mammograms and were most likely to believe annual mammography screening unnecessary even for women in their 50s. We ...
Medical Speciality courses in Vadodara. Medical Speciality in Vadodara, Find the right Medical Speciality in Vadodara course in the right location on Emagisters fast and effective search engine. Extensive range of course types available, from short courses to postgraduate. Medical Speciality.
Medical Specialties are for sites that pertain to information, practitioners, clinics and resources on the listed medical speciality. In turn, each sub-category of the Medical Speciality is broken down into areas related to that sub-category such as: Clinics and Hospitals, Journals, and Professional Organizations.
[124 Pages Report] Check for Discount on United States Medical Specialty Bags Market Report 2016 report by QYResearch Group. Notes: Sales, means the sales volume of Medical Specialty Bags...
The GW Medical Faculty Associates is the largest independent physician group in the DC area with more than 750 providers and 51 clinical specialties.
Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. 6.1 Work effectively in various health care delivery settings and systems relevant to ones clinical specialty ...
The GW Medical Faculty Associates is the largest independent physician group in the DC area with more than 750 providers and 51 clinical specialties.
Great Ormond Street Hospital has a dedicated and tireless workforce looking after the care requirements of our patients. If you would like to locate a member of staff or find out information about their clinical specialty please use our search below.. ...
Great Ormond Street Hospital has a dedicated and tireless workforce looking after the care requirements of our patients. If you would like to locate a member of staff or find out information about their clinical specialty please use our search below.. ...
Education. Master in Pharmacy, Hebrew University, Jerusalem, Israel. Clinical Specialty. Expert in developing Injectable products, which includes, pre-formulation, formulation, compounding and process development (parenteral and ophthalmic). Expert also in developing all topical, nasal, liquid and semi-solid dosage forms.. Professional Service. ...
Canon Medical Systems Europe is a leading supplier of high-quality medical imaging equipment for a wide range of clinical specialties. Serving the European market we provide industry-leading service, support and clinical education.
Canon Medical Systems Europe is a leading supplier of high-quality medical imaging equipment for a wide range of clinical specialties. Serving the European market we provide industry-leading service, support and clinical education.
Canon Medical Systems Europe is a leading supplier of high-quality medical imaging equipment for a wide range of clinical specialties. Serving the European market we provide industry-leading service, support and clinical education.
Access Siemens clinical specialties & diseases portal to learn more about Therapeutic Drug Monitoring - access additional resources
Easy to learn and use, the Quantum EMR (formally VIPER) software is highly responsive with single-tier navigation offering peace of mind that the process of EMR generation will not impact patient care or patient safety. It is ideally suited as a solution for clinical specialty areas not supported by larger enterprise systems or where flexible workflow / device integration is a key requirement for clinical use.. ...
The LOGIQ S7 ultrasound performs with amazing versatility across multiple clinical specialties, challenging patients and applications. From GE Healthcare. Learn More!
The European Academy of Allergy and Clinical Immunology, EAACI, is an association including 47 European National Societies, more than 8,000 academicians, research investigators and clinicians.
Journal Entry 1. This journal entry pertains to the following quote: "There are few educators who would disagree with the principle that lifelong learning is a good thing but the important questions are about the types of learning that the concept promotes, the life that it encourages us to lead, who benefits from this and the nature of the society that it upholds." (Merriam & Bierema, 2014, p. 20/21). Objective. This quote caught my attention because it defined my own learning principle in life: "never stop learning". I learned from an early stage of my schooling that nobody truly knew everything. Even physicians had their specialties in neurology, cardiology, psychiatry, oncology, and so on, so that they could become experts in that one particular area of medicine. Similar to nursing, we had different specialties such as critical care, surgical, medicine, psychiatric, pediatric, maternity, etc. I realized that when we all worked together as a team, we could help each other better understand ...
Developing new skills, meeting new people, networking with like-minded colleagues, carrying out a sense of purpose... The benefits often outweigh the time given, which may be why more than 1,100 of you volunteer for the College. Whether its representing your region or specialty on a committee, work ...
Dr Frank Veith presents an impassioned argument for making vascular surgery a specialty rather than a subspecialty in order to gain access to more resources for patients and surgeons.
As medicine becomes more specialized, doctors working in general medicine and general practice can quickly lose touch with advances occurring in other fields. Never having heard of an investigation, or carrying dated misconceptions as to a prognosis can be frustrating at best, and dangerous at worst.
The aim is for the list to be diverse enough to capture the wide range of possible specialties, while being small enough to allow logical and rapid classification of content - this should mean that the content you see on epgonline.org is as relevant to you, and as up-to-date as possible. Content related to the specialty/specialties you have selected will be presented to you when you are logged in to epgonline.org.. In tandem with the specialty list, we have implemented a disease list, which allows us to further classify the content on epgonline.org. To ensure that you are provided with the most relevant content, please update your profile to let us know which specialties and diseases are of most interest to you.. ...
And I dont think you "old docs" destroyed medicine, in fact, medicine today is what its is because of you, good and bad yes, but one should remember that we also have the best healthcare in the world. But I truly do hope the days of working for what amounts to a couple dollars an hour are gone for good. It was completely unfair to your generation that you were compensated in such a way for what is one of the most demanding jobs ever. In just one year of med school I have realized many sacrifices that I have had to make in my life to get here, and I realize that there are going to be a lot more. And while yes, it is also one the noblest professions, I dont think its right to ask of us to sacrifice the best years of our lives, our families, even our health, and saddle us with hundreds of thousands of dollars debt just for the privilege of saving lives or so we can go on to not have a good family life ...
Pathology is the term used for disease processes, the scientific study of them, and/or their detection using various tests and equipment.
Humanitas Group Humanitas is a highly specialized Hospital, Research and Teaching Center. Built around centers for the prevention and treatment of cancer, cardiovascular, neurological and orthopedic disease - together with an Ophthalmic Center and a Fertility Center - Humanitas also operates a highly specialised Emergency Department.. ...
KARYO LTD was founded in 2008. Since then we provide services of high quality in the fields of genetic material analysis to the health providers. Our strong commitment remains the reliability and validity of our results, along with fast response and low end user price.. ...
Moulana Hospital Commenced its services in 1990 with its sights at setting up a Super Specialty Referral Hospital, Equipped with the most advanced diagnostic and Medical Care Facilities. Since then, we have grown manifold and gained confidence of the people far and wide, especially the needy in the Malabar Region.
Whether youre looking for answers, would like to solve a problem, or just need to get in touch, you can contact us right here. To Contact Form ...
OBAT ANESTESI 1. Safol 1 cc = 10 mg Dosage: Induction of general anesth Adult Titrate 40 mg every 10 sec until onset of anesth.Adult |55 yr 1....
The many specialists who support the Spine Center team include neurologists, physical therapists, and other specialists as needed. Learn more.
General medicine at Spire Little Aston Hospital - Find experienced specialists at our state of the art facilities. Expert care for everyone.
General Medicine at Spire Elland Hospital - Find experienced specialists at our state of the art facilities. Expert care for everyone.
To help you make the transition back to your precancer lifestyle, ask your healthcare provider and other specialists to design a rehabilitation program for you. Its goal should be to strengthen you both physically and mentally.
Billet Specialties V-Trac pulley systems work with any type of cylinder head or manifold configuration. Best of all, the V-Trac features Billet Specialties quality & delivery you can count on.
...   In medicine, surgery (from the Greek χειρουργική, or chirurgical, and latin chirurgiae meaning hand work) is a medical specialty that uses
There are so many different medical specialties that its easy to feel confused. Heres a guide to some of the experts who care for you in the hospital.
Health via Liposomal Vitamin C and other high-dose nutrients, Lecithin DMSO Humic-Fulvic and other specialty formulas, DIY and N=1 self-research. .
Health via Liposomal Vitamin C and other high-dose nutrients, Lecithin DMSO Humic-Fulvic and other specialty formulas, DIY and N=1 self-research. .
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Do you need help choosing your nursing specialty? Or studying for your degree? Our reviews and sample questions can help get you started, including the CCRN
Verkoop & inkoop banen bij AkzoNobel Speciality Chemicals. De interessantste banen vind je op StepStone. Bekijk onze vacatures en geef je carrière een boost!
While there is no cure for this rapidly progressive disease, we will use the latest research and medicines to develop a personalized plan for preserving your mobility and slowing your symptoms.. Learn More ...
as hard and as fast as you can until your lungs feel absolutely empty. You will be asked to repeat the test several more times until there are two to three good ...
Context: Because of the extent of the HIV pandemic, but also due to some specific historical conditions, HIV medicine has evolved as a field of its own in South African medicine. With the massive scale of the roll-out of antiretroviral drugs (ARVs) in South Africa, the need to devolve ARV roll-out into primary health care (PHC) services is currently being discussed. Family medicine was recognised in South Africa as a specialist qualification in August 2007 and is still undergoing an exciting process of defining its content and future role in the community of medical specialities. The South African approach to family medicine focuses strongly on the role of the family physician in the PHC setting at district hospitals and in PHC facilities within the South African district health framework. Objectives: The objectives of this article are to discuss the relation between family medicine and the field of HIV medicine. Key message: Family medicine in the South African context is the clinical discipline most
Section 1: Background. 1 Pathophysiology and epidemiologic burden of chronic cardiac disease.. 2Key therapeutic targets in chronic cardiac care.. Section 2: Effective Models of Chronic Cardiac Care.. 3 Slowing the progression of cardiovascular disease: innovative approaches to cardiac rehabilitation and secondary prevention.. 4 Chronic CHF management programs: an exemplar for chronic cardiac care.. Section 3: Managing Care: From the Organization to the Individual.. 5 Organizational aspects of chronic cardiac care.. 6 Individual aspects of chronic cardiac care.. Section 4: Optimizing Chronic Cardiac Care.. 7 Establishing a nurse-led program of chronic cardiac care.. Index. ...
Prenatal and Postnatal Care: A Woman-Centered Approach is a comprehensive resource for the care of the pregnant woman before and after birth. Ideal as a graduate text for newly-qualified adult nurses, family and womens health practitioners, and midwives, the book can also be used as an in-depth reference for antenatal and postpartum care for those already in practice.. Beginning by outlining the physiological foundations of prenatal and postnatal care, and then presenting these at an advanced practice level, the book moves on to discuss preconception and prenatal care, the management of common health problems during pregnancy, and postnatal care. Each chapter includes quick-reference definitions of relevant terminology and statistics on current trends in prenatal and postnatal care, together with cultural considerations to offer comprehensive management of individual patient needs.. Written by experts in the field, Prenatal and Postnatal Care: AWoman-Centered Approach, deftly combines the ...
Small Animal Emergency and Critical Care Service at the Veterinary Medical Center at Ohio State provides care for dogs and cats with many types of emergent or serious conditions. Our Intensive Care Unit provides 24/7 support for those patients needing close monitoring and extensive care. The ICU is fully staffed with dedicated registered technicians, some of which are certified in emergency and critical care, as well as state-of-the-art monitoring equipment, such as remote heart monitoring, direct blood pressure monitoring, and full blood work capability.. ...
Medical Speciality courses in Lucknow. Medical Speciality in Lucknow, Find the right Medical Speciality in Lucknow course in the right location on Emagisters fast and effective search engine. Extensive range of course types available, from short courses to postgraduate. Medical Speciality.
If its good to feel wanted, then advanced visualization technology developers must feel like pop stars with the top positions on the song charts. Seemingly every clinician from every medical specialty that uses diagnostic images wants to have the capability to display and perform image reconstruction. A group of researchers from Massachusetts General Hospital in Boston looked at the deployment of thin-client advanced visualization technology in the healthcare enterprise and found that it provides for greater collaboration among other clinical specialties and radiology. Their work, presented at this weeks 2009 Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, also holds that there is still a place for workstation-based, thick-client systems in diagnostic imaging workflow.
Atherosclerosis continues to be the most significant pathology giving rise to cardiovascular disease worldwide. Vascular biology forms the basic armamentarium to address the underlying mechanisms. The ESC Textbook of Vascular Biology discusses these new developments and recent breakthroughs in the field, while also covering the major changes in the diagnosis, prevention, and treatment of atherosclerosis that have occurred in recent years. This book offers a compendium of topics written by the best scientists in Europe. The dissemination of the authors vast knowledge and expertise in a single volume makes The ESC Textbook of Vascular Biology a useful companion for undergraduates in medicine and biology, but also for young scientists and early career staff. It also provides a comprehensive reference work for cardiologists and other clinical specialties dealing with vascular diseases and vascular imaging. The importance of vascular biology is crucial for the understanding of both physiological and
The GEMS is implementing a research strategy organised around the themes of metabolic mediators of chronic disorder, lifestage-specific conditions including aspects of ageing, and the provision of prophylactic guidance & therapeutic care in the community and acute facilities. The University has adopted a positive stance for the immediate provision of the essential research infrastructure required to implement the research strategy, including the development of core sophisticated medical research facilities both on the University campus and at the Universitys lead teaching hospital, the recruitment of experienced professorial leaders across the clinical specialities who are actively engaged in relevant top-tier health-oriented research.. ...
Search results for qualified General Medicine in Kanyakumari with their contact details, addresses and location map of 3 General Medicine Doctors / Internal Medicine Doctors in Kanyakumari
Free Online Library: INTEGRATED HEALTH SERVICES OPENS 123 NEW MEDICAL SPECIALTY BEDS; COMPANY ALSO ACQUIRES LEASEHOLD INTEREST IN ALABAMA FACILITY by PR Newswire; Business News, opinion and commentary Nursing home management Nursing homes Management
The Post BDI Resourcing are seeking several friendly, motivated and hardworking international doctors for Speciality Doctor posts located within a South East NHS Trust. For entry into the Specialty Doctor grade, applicants must have at least 4 years of experience in General/Acute Medical specialities after gaining MRCP. They must be able to demonstrate ...
Important information for patients of Alaska Medical Specialties can be found here. Want to learn more about our Anchorage Medical Center? Call us today!
Join for FREE to read real reviews and see ratings for Centre, AL Medical Specialists near you to help pick the right pro Medical Specialist.
Having covered the whole medical sector of disease diagnosis, ultrasound technology now provides 8 versatile specialization areas for interested applicants. If you were only interested in making the most money that you can, then you might consider going for todays most lucrative ultrasound profession, which is the Cardiac Sonographer career path.. However, if your list of requirements for job satisfaction goes a little wider than just the salary, you have a few different specialty options to choose from! Here is the breakdown of major ultrasound specialization areas ...
FierceHealthIT has named American Nursing Informatics Association (ANIA) President Patricia Sengstack, DNP, RN-BC, CPHIMS, one of the 10 Influential Women in Health IT in 2014 for her outspoken advocacy in the use of health technology among nurses.. Sengstack was chosen by the publications readers and joins other women who serve in a wide variety of health IT roles, from government to research. According to an article describing the influencers, "Women continue to play a major role in the evolution of health IT both in the U.S. and around the world.. A respected leader and widely known nursing informatics expert, Sengstack is also the Chief Nursing Informatics Officer (CNIO) for the Bon Secours Health System based in Marriottsville, MD. With her role as ANIA president, she has helped put the specialty on the industry map during her term.. Pattys intelligence, commitment, humor and positive outlook have led ANIA to another level this year, ANIA Vice-President Charles Boicey, MS, RN-BC, ...
With the rise of healthcare reform and coordination of patient care among different specialties, many physicians are joining multi-specialty groups. Still others are becoming employed by hospitals in an effort to manage patient care and costs in a more centralized manner. In these situations, it is often difficult to manage the many different aspects of billing for different and unfamiliar specialties.. Below is a list of the Multi-Specialty Billing Services we offer:. ...
Buy artisan bread baking equipment such as bread ovens, bannetons, baskets, cutters, starters, grignettes and peels for the artisan sourdough bread baker
... had been taped transcribed and examined by 18 doctors (six general professionals six gastroenterologists and six gastrointestinal cosmetic surgeons) who finished a questionnaire for every individual. The questionnaires had been scored as well as the relative responsibility for the failure was attributed to the patient primary care secondary care and interaction in the health services. Results Failing interaction in the health services was the most important reason behind treatment failing followed by failing in major care secondary treatment and the individual himself; the relative duties had been 35% 28 27 and 10% respectively. There is satisfactory contract about the complexities between doctors with different specialities but significant inter-individual distinctions between your doctors. The sources of the failures differed between your sufferers. Conclusions Treatment failing is a complicated problem. ...
Regular clinics taking months for an appointment? SEE A MEDICAL SPECIALIST WITHIN A WEEK! Specialists available 7 days a week with extended hours.
Aim: 1) To reduce redundant and unnecessary specimen collection from patients with a new order entry strategy. Background: As a tertiary referral center, we see many patients who require multi-disciplinary care. A majority of our patients receive care from multiple providers in different specialties, and as a result these patients often have redundant lab tests ordered. This often results in submission of multiple specimens for overlapping tests in short periods of time. The ease of ordering tests on our EMR has not improved our ability to streamline lab test ordering and specimen requirements for patients. We seek to leverage the power of the EMR to improve coordination of care for patients. Proposal:. 1) Modify the EMR to have the order entry window appear parallel to a modified Results Display screen. 2) Flag future labs that have been ordered by other providers and allow easy modification for additional tests that can be consolidated. 3) Separate lab order entry panels into acute (1 time or ...
Reduce your stress with a day filled with relaxing spa services from Loveland Massage Center in Loveland. Feel your troubles drift away as you enjoy the different specialty massages at this spa like deep tissue and Swedish.Get the relaxation of an entire vacation in one afternoon at Loveland Massage Center. Book your appointment today!
Targeted therapy drugs are a lot like Navy Seals behind enemy lines: stealth and clandestine operatives with different specialties. They create very strategic problems for their target: cancer. And theyre so good at it that they may be the next beachhead in the war on cancer.
Doctors and medical specialists for Muscular fibrosis, multifocal - obstructed vessels possibly involved in diagnosis or treatment.
Search for information about Dr. P. P. Sunil Kumar, General Medicine Doctor / Internal Medicine Doctor in Mallappuram, Kerala. Get directions from the interactive map. Medindia has information on more than 207,000 doctors.
Fishpond United States, Clinical Cases in General Medicine by Sanjaya SenanayakeBuy . Books online: Clinical Cases in General Medicine, 2010, Fishpond.com
Understanding which medical specialists are involved in managing the different needs of plasminogen deficient patients and how they help with care
A woman contacted me yesterday highly frustrated because she has been trying for seven months to get a diagnosis and so far - nuttin. She asked me about it because she had just visited a specialist, and his first question to her had been "why are you here?" Turns out, the referral was made by her Primary Care Physician - but no paperwork had ever been sent by the PCP to the specialist.. It was not the first time that had happened. Other specialists had asked her the same thing. She wanted to know how she could prevent that from happening again. Further, she was being sent for duplicate tests because the specialists didnt have any records to realize she had already had those same tests.. Is this not a PERFECT example of why we patients need to take responsibility for our own medical situations? How ironic that the inability to get a diagnosis may be the result of bad customer service, and not bad medicine! And what if whatever is wrong with her is beyond a cure now - only because of the lack of ...
Ask a Hiv Treatment Specialist Online - Ask a question to a Hiv Treatment Specialist and get instant answer. 29+ Hiv Treatment Specialists are online to answer. Ask Now.
Will someone please clarify. Our office has always used 1997 guidelines, but I believe for some of our physicians/specialities it may be more benefici
Our well trained lung specialists are located in Kenner and Uptown.Patients may make their own appointments for consultation, or be referred...
We treat cancer. We care for people. Cancer is the second leading cause of death in both men and women. Screenings can lead to early detection. When cancer is discovered in its earliest stages, treatment can be most effective. Our team of specialists are highly skilled and dedicated to providing quality care with state-of-the-art equipment. Types of Cancer treated:
Specialists are coming around for rounds this afternoon (now Derm is involved) so am going back this afternoon to be with him and get more updates and will be back here later as well ...
Need Help Finding a Product?. Our reagent specialists are to help you find the best product for your application. Please Call or Email us and we will be happy to help you find the right product for the job. ...
Find the best General-Physician in Faridabad. Browse through our list of General Medicine Doctors in Faridabad to seek medical advice. Book an Appointment on Ask Apollo today!
Monthly changes of other specialist lenders sterling secured gross lending for other advances to individuals (in sterling millions) not seasonally adjusted ...
Reading, PA (PRWEB) November 30, 2015 -- Brenntag Specialties, Inc. (BSI) has been appointed by Ashland Specialty Ingredients (ASI) as their exclusive channel
Priapus Shot®️ (P-Shot®️) - The Priapus Shot® (otherwise known as a P-Shot®) is a 20 minute non-surgical procedure that uses our bodys capability to heal itself and it may help
The opthal specialty is one of 30 specialties which bring together communities of clinical practice and research expertise. We make sure the studies on our national portfolio of research receive the right support so they can be successfully delivered in the NHS.
... is a medical specialty that manages medical conditions affecting babies, children and young people. Paediatricians are doctors who look at...
Statistics for MedicineNet estradiol Specialty, MedicineNet estradiol Specialty, By: Feedage Forager, ID: 331374, Grade: 91, Type: RSS20
Title: MedicineNet Face Lift Specialty, Description: MedicineNet Face Lift Specialty, By: Feedage Forager, ID: 331389, Grade: 89, Type: RSS20
Vantage Specialty Ingredients is a leading supplier of specialty ingredients to the global personal care and cosmetics industries
Search 720,000 doctors by last name with Lifescript Doctor Finder. Search by medical specialty, condition, location, and insurance. Read reviews.
Search 720,000 doctors by last name with Lifescript Doctor Finder. Search by medical specialty, condition, location, and insurance. Read reviews.
Aarogya.com is Leading comprehensive health portal. This site has covered almost all the medical specialties and give useful information on various diseases.
... is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all
Many believe modern science is pure and uncontaminated. I wish it to be true , But reality mirror tells a different story ! The following spheres of knowledge collectively form the cardiology literature . How much ? each sphere , contribute is any bodys guess ! The same rule might apply in all medical specialties.…
Aarogya.com is Leading comprehensive health portal. This site has covered almost all the medical specialties and give useful information on various diseases.
Diagnosis. Based in Lehigh Acres, FL, Lehigh Regional Medical Center serves a five-county area, boasting a broad range of medical specialties.
Monomer-Polymer and Dajac Laboratories is a manufacturer and supplier of custom synthesis products and other speciality chemicals.
Meet best and top Medical Specialists, Nurses, Scientists, Researchers from USA, Europe, Asia at MedTech & Expo Conferences, Nursing Events, Medicine Meetings during 2020
Many doctors specialise in a specific field in order to provide better health care to their patients. Each speciality has a different average salary that usually depends in some part on a combination of hours worked per week and length of education.
I am an ADN student and will be graduating this may. I was wondering if I should start out on a Med/surg floor, or if it would be okay to start in a specialty field like Labor and Delivery?
According to Stratistics MRC, the Specialty Fibers Market is estimated at $12.4 billion in 2015 and is expected to reach $28.7 billion by 2022 growing at a...
According to Stratistics MRC, the Global Specialty Chemicals market is accounted for $346.49 billion in 2015 and is expected to reach $530.9 billion by 2022...
CENTAURI Technologies, LP is a leader in the quality production of specialty chemicals manufactured to customer specifications under contractual and spot