Emeralds, like all colored gemstones, are graded using four basic parameters – the four Cs of Gemstones: Color, Cut, Clarity and Crystal. The last C, crystal is a synonym that begins with C for transparency or what gemologists call diaphaneity. Before the 20th century, jewelers used the term water as in a gem of the finest water to express the combination of two qualities, color and crystal. Normally, in the grading of colored gemstones, color is by far the most important criterion. However, in the grading of emerald, crystal considered a close second. Both are necessary conditions. A fine emerald must possess not only a pure verdant green hue as described below, but also a high degree of transparency considered a top gem. In the 1960s, the American jewelry industry changed the definition of emerald to include the green vanadium-bearing beryl as emerald. As a result, vanadium emeralds purchased as emeralds in the United States recognized as such in the UK and Europe. In America, the distinction between traditional emeralds and the new vanadium kind reflected in the use of terms such as Colombian Emerald. Scientifically speaking, color divided into three components: hue, saturation and tone. Yellow and blue, the hues found adjacent to green on the spectral color wheel, are the normal secondary hues found in emerald. Emeralds occur in hues ranging from yellow-green to blue-green. The primary hue must be green. Only gems that are medium to dark in tone considered emerald. Light-toned gems known by the species name, green beryl. In addition, the hue must be bright (vivid). Gray is the normal saturation modifier or mask found in emerald. A grayish green hue is a dull green. Emerald tends to have numerous inclusions and surface breaking fissures. Emerald graded by eye. Thus, if an emerald has no visible inclusions to the eye it considered flawless. Stones that lack surface breaking fissures are extremely rare and therefore almost all emeralds are treated, oiled, to enhance the apparent clarity. Eye-clean stones of a vivid primary green hue with no more than 15% of any secondary hue or combination of a medium-dark tone command the highest prices.6 This relative crystal non-uniformity makes emeralds more likely than other gemstones to be cut into cabochons, rather than faceted shapes.

Buprenorphine

Buprenorphine is a partial agonist of opioid receptors that carries a low risk of overdose. Buprenorphine reduces or eliminates withdrawal symptoms associated with opioid dependence but does not produce the euphoria and sedation caused by heroin or other opioids. In 2000, Congress passed the Drug Addiction Treatment Act, allowing qualified physicians to prescribe Schedule III, IV and V medications for the treatment of opioid addiction. This bill created a major paradigm shift that allowed access to opioid treatment in general medical settings, such as primary care offices, rather than limiting it to specialized treatment clinics. Buprenorphine was the first medication approved under the Drug Addiction Treatment Act and is available in two formulations: Subutex®, which is a pure form of buprenorphine and the more commonly prescribed Suboxone®, which is a combination of buprenorphine and the opioid antagonist naloxone. Suboxone is a unique formulation with naloxone that causes severe withdrawal symptoms when addicted individuals inject it to get high. Physicians who provide buprenorphine treatment for detoxification and or maintenance treatment in office must have special accreditation. The government requires these physicians to have the capacity to provide counseling to patients when indicated or to refer patients to those who do. Treatment of opioid addiction in an office can be cost-effective approach that increases the reach of treatment and the options available to patients. Many patients have life circumstances that make treatment in the office of a physician a better option for than specialty clinics. For example, a recovering addict may live far away from a treatment center or have working hours incompatible with the clinic hours. Addiction treatment is available in the office of a primary care physician, psychiatrist and other specialists, such as internists and pediatricians. Patients stabilized on adequate, sustained dosages of methadone or buprenorphine can function normally. Recovering addicts can hold jobs, avoid the crime and violence of the street culture and reduce exposure to HIV by stopping or decreasing injection drug use and other risky sexual behavior. Patients stabilized on medications can also engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation.

Physical Medicine

Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipment and assistive device, orthotics, prosthesis, and experiential training approaches. Physical Medicine & Rehabilitation physicians may use electro-diagnostics, which are to provide nervous system functional information for diagnosis and prognosis for various neuromuscular disorders. The common electro diagnostic tests performed by physiatrists are nerve conduction studies and needle electromyographies. The nerve conduction study involves electrical stimulation to peripheral nerves, and the nerves' responses including such things as onset latency, amplitude, and conduction velocity. Needle electromyography requires needle electrode insertion into the muscles to detect the electrical potential generated from muscle fibers. Abnormal electrical potentials, such as fibrillation potential or positive sharp waves, detected by needles indicate the presence of muscle fibers that have abnormal nerve supplies. Common conditions that are by physiciaans include amputation, spinal cord injury, sports injury, and stroke, musculoskeletal pain syndromes such as low back pain, fibromyalgia, and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is through a multidisciplinary approach involving psychologists, physical therapists, occupational therapists, chiropractors, and interventional procedures when indicated. In addition to the previous methodology, stroke treatment is often with the help of a speech therapist and recreational therapist when possible.