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Abstract thinking: Somewhat concrete; similarities: apple/orange-"both fruits"; poem/statue -"both have form"; fly/tree-"both are nature blood pressure high in morning buy calan 240 mg with amex, both are iridescent green, flies fly around crap, which is brown, the same color as tree bark" Insight: Poor. The patient does not recognize the presence of any illness or that his behavior is dangerous, stating, "Maybe I have a very mild case of mania, but if I need to be here, then 90 percent of everyone in the world needs to be locked up. He says that the next time he is angry with his boyfriend, he will "work it out, " and not try to kill himself. Relaxed and trustful patients are more likely to provide useful information than those who are nervous or on guard. Time and Setting the initial psychiatric assessment usually lasts between 45 and 90 minutes, with the length of time agreed upon in advance. Sometimes additional time is necessary to complete the evaluation, in which case it is better to schedule an additional session. Extending the length of the first session unilaterally is a discourtesy to the patient whose time may be scheduled with other demands, and it risks fatigue for both parties. In addition seeing the patient at different times helps to determine more accurately which presenting features are purely situational and how they have changed with time. While there is no reason to make the room impersonal, dramatic paintings, panoramic views, or expensive antiques may be distracting to a patient during a first visit. The psychiatrist should budget the full amount of time allotted for the interview and attempt to ensure that there are no interruptions during the session. Routine phone calls and messages should be intercepted by an answering machine or secretary. Interview the psychiatrist should have in mind the categories of information needed and their structural organization in the summary evaluation. However, it is seldom useful to proceed with a prescribed check-list of questions. However, the psychiatrist must keep in mind the information needed to formulate a diagnosis and treatment plan and be prepared to structure the interview more tightly if the patient appears to be vague and rambling. If a patient talks on with no pauses or natural endings, it may be necessary to interrupt and redirect. Closed-ended questions on the other hand ask for factual answers to specific questions. It is often useful to begin the interview with broad open-ended questions and to become more closed-ended and directive as the interview progresses. In addition, many patients prefer to tell their stories with their own words and emphases without interruption. Other patients, such as those who are psychotic, depressed, or paranoid, may need more structured questions. Closed-ended questions are particularly useful in clarifying information, in gathering factual data efficiently, and in describing the absence of key symptoms. Supportive and Obstructive Interventions Psychiatrists do much more during an interview than ask questions. They provide feedback and information, offer reassurances, and respond emotionally to what the patient is saying. Interventions may be classified as supportive or obstructive depending on the extent to which they increase the flow of information and enhance or diminish rapport. Body posture and facial expression that convey interest, concern, and attentiveness. My supervisor watches me like a hawk and criticizes the tiniest little mistake I make. Psychiatric interviewing is a complex, multifaceted task that is shaped by the personalities and circumstances of the interview. The concept of supportive and obstructive interventions has broad, general use but cannot be applied rigidly. There are circumstances in which an intervention that would be obstructive with other patients may be helpful or even necessary. In addition, at times the psychiatrist may appropriately ask patients how their misdeeds are perceived by others (a judgmental question) to test empathy.

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Given the ethic of confidentiality in anthropology heart attack ekg buy calan 80mg amex, I omit details about the country, organization, and ethnic group as much as possible, which allows me to focus on the processes involved. Although an education in anthropology stresses the importance of confidentiality and the potentially dire consequences of drawing attention to individuals and communities, it probably does not truly sink in until you conduct your first fieldwork and "subjects" turn into human beings with names, families, and feelings. One of the greatest ethical challenges anthropologists face in writing about individuals and communities is the additional attention drawn to them when the intention of the anthropologist is to highlight a concern that extends beyond specific individuals and communities and can thus have negative consequences. Take, for example, an assessment I conducted of a national safety net program that took place in a limited number of communities. Instead, the anonymity of the individuals and communities was protected, and the concerns and challenges were identified in a way that protected those who graciously and generously contributed their time and ideas to the research process. Complete anonymity is not always desirable, needed, or possible but is always an important consideration for anthropologists. Throughout the last ten years, I have worked for non-governmental organizations-about five years in Eastern Africa and shorter periods in Asia and the Middle East-as a volunteer, employee, and consultant with community-based groups and national and international organizations. In this chapter, I explore one of those experiences to convey a sense of what "seeing like an anthropologist" means by analyzing an effort to eliminate food taboos by a nongovernmental international development organization. This chapter was inspired by the work of political scientist and anthropologist James C. In listening, learning about, and seeing the world from the perspectives of others, anthropologists draw on the idea of cultural relativism. Cultural relativism posits that cultural practices and ideas must be understood within their contexts. In the past, some anthropologists participated in the "development" activities of colonial governments, and individual anthropologists and the discipline as a whole were rightly criticized for their roles in the injustices that resulted. While working in Afghanistan in 2013, I encountered anthropologists who were engaged in activities in the name of "development" that could be defined as neo-colonial in that they supported militaries by analyzing cultural communities with the goal of finding ways to weaken them and foster unequal and unfair relationships (cultural imperialism). As a result, anthropologists are encouraged to engage in self-reflection-to examine their roles, engagements, practices, and objectives critically, known as reflexivity. Some have called on international development practitioners to significantly reform their activities to make them more effective, while others have expressed more radical criticisms, including the view that provision of aid causes greater impoverishment and should end. Anthropological tools and ways of seeing are important means by which to answer these questions. I interacted with management staff based in the international head office as well as the national head office, who provided me with background information about the region and clarified expectations before visiting the project area. The project itself was not primarily geared toward ending "harmful traditional practices, " but included a component related to addressing gender inequality and practices that negatively impact women. Reflecting back on those discussions, it appears that staff and donors who were located furthest from the area of the project had the greatest interest in these "harmful traditional practices. For example, those who were more distanced from the people the project sought to support were particularly interested in "female genital mutilation, " exchange marriages, and seemingly irrational and bizarre food taboos. On the other hand, within almost every community in the project area, both men and women were primarily concerned about the lack of clean drinking water and healthcare options. The reason for this is rarely explicitly stated, however informal discussions with development agency personnel cite high costs and sustainability as concerns. A national committee in Ethiopia, for example, listed 162 "harmful traditional practices. Each practice, its context, laws, and discourse requires contextualization beyond the scope of this chapter. However, useful examples of deconstructions of one frequently discussed practice, female genital mutilation, have been made by Russell-Robinson (1997), James (1998), Obermeyer (1999), Ahmadu and Shweder (2009) and Londono (2009). The project staff identified a number of "harmful traditional practices" they believed ought to be 447 stopped, however, I will only explore one of them: a collection of food taboos that were believed to negatively affect the nutrition of women. In particular, there was a focus on one specific food taboo: the restriction of women from eating eggs, which was the only food taboo mentioned in every report provided by the organization. I learned from the project proposal that there were "cultural taboos" forbidding women from eating eggs and milk. An initial assessment report stated that this taboo was not only about prohibiting the consumption of eggs, but also poultry.

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Uremia may cause mania blood pressure chart kidney disease discount 120mg calan with visa, delirium or seizures, and hypertensive encephalopathy is characterized by delirium and seizures. Steroid treatment may also cause neuropsychiatric side-effects, including depression, mania, and psychosis. Finally, treatment with either steroids or immunosuppressants opens the way to opportunistic central nervous system infections (Futrell et al. On a final differential diagnostic note, care must be taken to distinguish naturally occurring lupus from drug-induced lupus. This syndrome is most commonly seen secondary to use of procainamide, hydralazine, or, less frequently, alphamethyl dopa; it has also been rarely noted secondary to use of other medications, including chlorpromazine, carbamazepine, phenytoin, and primidone. Importantly, unlike naturally occurring lupus, drug-induced lupus rarely causes cerebral symptoms. When there is doubt as to whether any given case of lupus is drug-induced or not, antibody levels may be helpful. Obtaining an antihistone antibody level may also be helpful: whereas patients with drug-induced lupus typically have this, it is unusual in patients with naturally occurring lupus. Treatment Treatment of the various features of cerebral lupus is dictated by the presumed underlying etiology, as discussed above. If this is the case, treatment is directed at the cause of the underlying infarction, as discussed in Section 7. In cases of infarction occurring in the context of the anti-phospholipid syndrome, preventive treatment with warfarin is probably in order. In the remaining cases, which are presumably due to a cerebritis, consideration may be given to treatment with steroids or cyclophosphamide, either individually or in combination. Initial treatment with steroids generally involves a 3- to 7-day course of methylprednisolone, 250 mg intravenously four times daily, followed by prednisone in a dose of 1 mg/kg/day, with the dose of prednisone gradually p 17. With regard to cyclophosphamide, some clinicians will utilize this as single-agent therapy from the start, whereas others will add it to the course of steroids, generally several days into treatment with methylprednisolone. Repeat courses of steroids or monthly infusions of cyclophosphamide are generally required to maintain remission. Remarkably, at the time of this writing there has been only one double-blind study comparing steroids alone with the combination of steroids and cyclophosphamide (Barile-Fabris et al. This study found that the addition of cyclophosphamide to an initial course of steroids, followed by monthly cyclophosphamide, was greatly superior to initial treatment with steroids alone, followed by repeat courses of methylprednisolone. However, this study primarily included patients with seizures and excluded patients with depression, mania, psychosis, delirium, or dementia, and hence it is not clear whether the results would apply to these syndromes. Symptomatic treatment of depression, mania, psychosis, delirium, dementia, and seizures may or may not be required, and is discussed in Sections 6. In patients with meningitis, contrast enhancement is seen in the meninges, as expected. Once thought to be rare, it is now known to occur in up to 2 percent of those over 60 years. Lymphocytic infiltration is seen in exocrine glands and, in those with central nervous system disease, similar infiltrates may be found in a perivascular location, both in the parenchyma and the meninges (Caselli et al. Differential diagnosis Clinical features the onset is very gradual and typically occurs in middle or later adult years. Although the sicca syndrome is present in all cases it may be relatively mild, and direct questioning is often required to elicit these symptoms. The proportion of patients who develop central nervous system involvement is not known with certainty, but it probably represents a very small minority (Anaya et al. Peripheral nervous system involvement may also occur and is far more common than central nervous system involvement (Goransson et al. The sicca syndrome may be seen in other connective tissue diseases, such as systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and polymyositis. Multiple sclerosis enters into the differential, especially in patients with optic neuritis and/or myelopathy. Here the differential rests on finding the typical serologic abnormalities mentioned above; in doubtful cases, a lip biopsy may be required. The sicca syndrome, of course, may also be caused by multiple different medications. Treatment Central nervous system involvement generally requires treatment with steroids or immunosuppressants, such as cyclophosphamide. This is a rare disorder, more common in woman than men, with an onset in early to middle adult years.

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However hypertension bench discount 120mg calan otc, since chiefdoms have more-elaborate status hierarchies than tribes, marriages tend to reinforce ranks. A particular kind of marriage known as matrilateral cross-cousin demonstrates this effect and is illustrated by the diagram in Figure 4. The figure shows three patrilineages (family lineage groups based on descent from a common male ancestor) that are labeled A, B, and C. Viewed from the top of a flow diagram, the three lineages marry in a circle and at least three lineages are needed for this arrangement to work. The Purum of India, for example, practiced matrilateral crosscousin marriage among seven lineages. If A2 married b2, he would be marrying his patrilateral cross-cousin who is linked to him through A1, his sister a1, and her daughter b2. Therefore, b2 must marry C2 and lineage B can never repay lineage A for the loss of their daughters-trace their links to find out why. Paradoxically, lineage A (which gives its daughters to B) owes lineage C because it obtains its brides from lineage C. In that system, the wife-giving lineage is known as mayu and the wife-receiving lineage as dama to the lineage that gave it a wife. Thus, in addition to other mechanisms of dominance, higher-ranked lineages maintain their superiority by giving daughters to lower-ranked lineages and reinforce the relations between social classes through the mayu-dama relationship. The Natchez peoples, a matrilineal society of the Mississippi region of North America, were divided into four classes: Great Sun chiefs, noble lineages, honored lineages, and inferior "stinkards" (commoners). Thus, if a Great Sun woman married a stinkard (commoner), the child would become a Great Sun. If a stinkard man were to marry a Great Sun woman, the child would be the same rank as the mother. The same relationship obtained between women of noble lineage and honored lineage and men of lower status. Only two stinkard partners would maintain that stratum, which was continuously replenished with people in warfare. Brother-sister marriages, for example, were common in the royal lineages of the Inca, the Ancient Egyptians, and the Hawaiians, which sought to keep their lineages "pure. This marriage system, which operated among many Middle Eastern nomadic societies, including the Rwala Bedouin chiefdoms, consolidated their herds, an important consideration for lineages wishing to maintain their wealth. Elsewhere, they are legal and membership is universally mandatory under local laws. According to Beryl Bellman, who is a member of a poro association, the standard among the Kpelle of Liberia is an ability to keep secrets. Members of the community are entrusted with the political and religious responsibilities associated with the society only after they learn to keep secrets. The sacred structure (the zo) is composed of a hierarchy of "priests" of the poro and the sande in the neighborhood, and among the Kpelle the poro and sande zo take turns dealing with intown fighting, rapes, homicides, incest, and land disputes. Some authors have suggested that sacred structure strengthens the secular political authority because chiefs and landowners occupy the most powerful positions in the zo. Strategic resources include water for states that depend on irrigation agriculture, land in agricultural societies, and oil in industrial societies. Capital and products and resources used for further production are modes of production that rely on oil and other fossil fuels such as natural gas in industrial societies. An extreme example is the caste system of traditional Indian society, which draws its legitimacy from Hinduism. In caste systems, membership is determined by birth and remains fixed for life, and social mobility-moving from one social class to another-is not an option. Although efforts have been made to abolish castes since India achieved independence in 1947, they still predominate in rural areas. It is composed of priests, governmental officials and bureaucrats at all levels, and other professionals. The next highest is the Kshatriya, the warrior caste, which includes soldiers and other military personnel and the police and their equivalents. Next are the Vaishyas, who are craftsmen and merchants, followed by the Sudras (pronounced "shudra"), who are peasants and menial workers. Metaphorically, they represent the parts of Manu, who is said to have given rise to the human race through dismemberment. The head corresponds to Brahmin, the arms to Kshatriya, the thighs to Vaishya, and the feet to the Sudra.

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And provided further that nothing in this section shall be 1 Written thus in Chapter 327 heart attack statistics cheap calan 240mg without prescription, Acts of 1924. No debt shall be hereafter contracted by the General Assembly unless such debt shall be authorized by a law providing for the collection of an annual tax or taxes sufficient to pay the interest on such debt as it falls due, and also to discharge the principal thereof within fifteen years from the time of contracting the same; and the taxes laid for this purpose shall not be repealed or applied to any other object until the said debt and interest thereon shall be fully discharged. And they shall not use or appropriate the proceeds of the internal improvement companies, or of the State tax, now levied, or which may hereafter be levied, to pay off the public debt (or) to any other purpose until the interest and debt are fully paid or the sinking fund shall be equal to the amount of the outstanding debt; but the General Assembly may authorize the Board of Public Works to direct the State Treasurer to borrow in the name of the State, in anticipation of the collection of taxes, such sum or sums as may be necessary to meet temporary deficiencies in the treasury, to preserve the best interest of the State in the conduct of the various State institutions, departments, bureaus, and agencies during each fiscal year. Subject to the approval of the Board of Public Works and as provided by law, the State Treasurer is authorized to make and sell short-term notes for temporary emergencies, but 1 Thus amended by Chapter 327, Acts of 1924, ratified Nov. No extra compensation shall be granted or allowed by the General Assembly to any public Officer, Agent, Servant or Contractor, after the service shall have been rendered, or the contract entered into; nor shall the salary or compensation of any public officer be increased or diminished during his term of office. Provided, however, from and after January 1, 1956, for services rendered after that date, that the salary or compensation of any appointed public officer of the Mayor and City Council of Baltimore may be increased or diminished at any time during his term of office; except that as to officers in the Classified City Service, when the salary of any appointed public officer of the Mayor and City Council of Baltimore shall be so increased or decreased, it shall not again be increased or decreased as the case may be, during the term of such public officer. Nothing in this Constitution shall exempt the salary or compensation of any judge or other public officer from the imposition by the General Assembly of a nondiscriminatory tax upon income. The General Assembly shall pass no Law providing for payment by this State, for Slaves emancipated from servitude in this State; but they shall adopt such measures, as they may deem expedient, to obtain from the United States, compensation for such Slaves, and to receive, and distribute the same, equitably, to the persons entitled. The books, papers and accounts of all banks shall be open to inspection under such regulations as may be prescribed by law. The General Assembly shall enact no Law authorizing private property to be taken for public use without just compensation, as agreed upon between the parties, or awarded by a jury, being first paid, or tendered to the party, entitled to such compensation. The General Assembly shall enact no law authorizing private property, to be taken for public use, without just compensation, to be agreed upon between the parties, or awarded by a jury, being first paid or tendered to the party entitled to such compensation, but where such property is situated in Baltimore City and is desired by this State or by the Mayor and City Council of Baltimore, the General Assembly may provide for the appointment of appraisers by a Court of Record to value such property, and that, upon payment3 the amount of such valuation to the party entitled to compensation, or into Court and securing the payment of any further sum that may be awarded by a jury, such property may be taken. The General Assembly shall enact no law authorizing private property to be taken for public use without just Compensation, to be agreed upon between the parties, or awarded by a Jury, being first paid or tendered to the party entitled to such compensation, but where such property is situated in Baltimore City and is desired by this State or by the Mayor and City Council of Baltimore, the General Assembly may provide for the appointment of appraisers by a Court of Record to value such property, and that, upon payment of the amount of such valuation to the party entitled to compensation, or into Court and securing the payment of any further sum that may be awarded by a jury, such property may be taken; and where such property is situated in Baltimore County and is desired by Baltimore County, Maryland, the County Council of Baltimore County, Maryland, may provide for the appointment of an appraiser 1 Thus amended by Chapter 14, Acts of 1950, ratified Nov. The General Assembly shall enact no law authorizing private property to be taken for public use without just Compensation, to be agreed upon between the parties, or awarded by a Jury, being first paid or tendered to the party entitled to such compensation, but where such property is situated in Baltimore City and is desired by this State or by the Mayor and City Council of Baltimore, the General Assembly may provide for the appointment of appraisers by a Court of Record to value such property, and that, upon payment of the amount of such valuation to the party entitled to compensation, or into Court and securing the payment of any further sum that may be awarded by a jury, such property may be taken; and where such property is situated in Montgomery County and in the judgment of and upon a finding by the County Council of said County that there is immediate need therefor for right of way for County roads or streets, the County Council may provide that such property may be taken immediately upon payment therefor to the owner or owners thereof, or into court, such amount as an appraiser appointed by a Court of Record shall estimate to be the fair market value of such property, provided that the Council shall secure the payment of any further sum that may subsequently be awarded by a jury. This section shall not apply in Montgomery County if the property actually to be taken includes buildings or improvements. The General Assembly shall enact no law authorizing private property to be taken for public use without just compensation, to be agreed upon between the parties or awarded by a jury, being first paid or tendered to the party entitled to such compensation, except that where such property in the judgment of the State Roads Commission is needed by the State for highway purposes the General Assembly may provide that such property may be taken immediately upon payment therefor to the owner or owners thereof by said State Roads Commission or into Court, such amount as said State Roads Commission shall estimate to be of the fair value of said property, provided 1 this amendment was submitted by Chapter 224, Acts of 1959, to be voted upon by2 the voters in November, 1960. This amendment was submitted by Chapter 604, Acts of 1959, to be acted upon by the voters in November, 1960. Any citizen of this State, who shall after the adoption of this Constitution, either in, or out of this State, fight a duel with deadly weapons, or send, or accept a challenge so to do, or who shall act as a second, or knowingly aid or assist in any manner, those offending, shall, ever thereafter, be incapable of holding any office of profit or trust, under this State, unless relieved from the disability by an act of the Legislature. The General Assembly shall pass Laws necessary for the preservation of the purity of Elections. Laws shall be passed by the General Assembly, to protect from execution a reasonable amount of the property of the debtor, not exceeding in value, the sum of five hundred dollars. The General Assembly shall provide a simple and uniform system of charges in the offices of Clerks of Courts and Registers of Wills, in the Counties of this State and the City of Baltimore, and for the collection thereof; provided, the amount of compensation to any of the said officers in the various Counties and in the City of Baltimore shall be such as may be prescribed by law. The General Assembly shall have power to receive from the United States, any grant, or donation of land, money, or securities for any purpose designated by the United States, and shall administer, or distribute the same according to the conditions of the said grant. The General Assembly shall make provisions for all cases of contested elections of any of the officers, not herein provided for. Corporations may be formed under general laws, but shall not be created by Special Act, except for municipal purposes and except in cases where no general laws exist, providing for the creation of corporations of the same general character, as the corporation proposed to be created; and any act of incorporation passed in violation of this section shall be void. All charters granted, or adopted in pursuance of this section, and all charters heretofore 1 2 Added by Chapter 607, Acts of 1941, ratified Nov, 3, 1942. The General Assembly shall not alter or amend the charter of any corporation existing at the time of the adoption of this Article, or pass any other general or special law for the benefit of such corporation, except upon the condition that such corporation shall surrender all claim to exemption from taxation or from the repeal or modification of its charter, and that such corporation shall thereafter hold its charter subject to the provisions of this Constitution; and any corporation chartered by this State which shall accept, use, enjoy, or in any wise avail itself of any rights, privileges, or advantages that may hereafter be granted or conferred by any general or special Act, shall be conclusively presumed to have thereby surrendered any exemption from taxation to which it may be entitled under its charter, and shall be thereafter subject to taxation as if no such exemption has been granted by its charter. The General Assembly shall have power to regulate by Law, not inconsistent with this Constitution, ail matters which relate to the Judges of election, time, place and manner of holding elections in this State, and of making returns thereof. It shall be the duty of the General Assembly, at its first session, held after the adoption of this Constitution, to provide by Law for the punishment, by fine, or imprisonment in the Penitentiary, or both, in the discretion of the Court, of any person, who shall bribe, or attempt to bribe, any Executive, or Judicial officer of the State of Maryland, or any member, or officer, of the General Assembly of the State of Maryland, or of any Municipal corporation in the State of Maryland, or any Executive officer of such corporation, in order to influence him in the performance of any of his official duties; and also, to provide by Law for the punishment, by fine, or imprisonment in the Penitentiary, or both, in the discretion of the Court, of any of said officers, or members, who shall demand, or receive any bribe, fee, reward, or testimonial, for the performance of his official duties, or for neglecting, or failing to perform the same; and also, to provide by Law for compelling any person, so bribing, or attempting to bribe, or so demanding, or receiving a bribe, fee, reward, or testimonial, to testify against any person, or persons, who may have committed 1 Thus amended by Chapter 195, Acts of 1890, ratified November 3, 1891. The personal property of residents of this State, shall be subject to taxation in the County or City where the resident bona fide resides for the greater part of the year for which the tax may or shall be levied, and not elsewhere, except goods and chattels permanently located, which shall be taxed in the City or County where they are so located, but the General Assembly may by law provide for the taxation of mortgages upon property in this State and the debts secured thereby, in the County or City where such property is situated. Each Budget shall contain a complete plan of proposed expenditures and estimated revenues for said fiscal year and shall show the estimated surplus or deficit of revenues at the end of the preceding fiscal year. Section 52 was amended by Chapter 497, Acts of 1947, ratified November 2, 1948; section 52 (3) was amended by Chapter 725, Acts of 1955, adopted by the voters November 6, 1956. Neither House shall consider other appropriations until the Budget Bill has been finally acted upon by both Houses, and no such other appropriation shall be valid except in accordance with the provisions following: (a) Every such appropriation shall be embodied in a separate bill limited to some single work, object or purpose therein stated and called herein a Supplementary Appropriation Bill; (b) Each Supplementary Appropriation Bill shall provide the revenue necessary to pay the appropriation thereby made1 a tax, direct or indirect, to be levied and collected as shall be directed in said bill; (c) No Supplementary Appropriation Bill shall become a law unless it be passed in each House by a vote of a majority of the whole number of the members elected, and the yeas and nays recorded on its final passage; (d) Each Supplementary Appropriation Bill shall be presented to the Governor of the State as provided in Section 17 of Article 2 of the Constitution and thereafter all the provisions of said section shall apply.

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In addition hypertension kidshealth generic 120 mg calan with amex, the Office will create a public record for the supplementary registration that identifies and describes the changes or revisions that have been made to the registration record. The Office will assign a separate registration number to the supplementary registration. In most cases, this number will begin with the same prefix that appears in the basic registration. Copyright Office will place a note in the public record for the supplementary registration that cross-references the registration number and the year of registration for the basic registration. In addition, the Office will place a note in the public record for the basic registration that cross-references the registration number and the effective date of registration for the supplementary registration. Copyright Office completed its review of the application for supplementary registration and approved the claim. This date appears on certificates issued on or after August 19, 2019, but it does not appear in the online public record for such claims. As a general rule, if the applicant makes a reasonable, good faith effort to identify the basic registration that needs to be corrected or amplified and completes the relevant fields/spaces in the application, the effective date of registration will be the date that the Office received the application, provided that the applicant paid the applicable filing fee as of that date. The Office cannot assign an effective date of registration if the changes proposed in the application are improper. If the Office issues a certificate of supplementary registration and if the payment for the filing fee is returned for insufficient funds, or if the Office subsequently determines that the registration should not have been issued, the supplementary registration will be cancelled. The effective date of registration for the basic registration and the effective date of registration for the supplementary registration will coexist with each other in the registration record. The Office maintains both records to allow courts to decide (i) whether the changes made by the supplementary registration are material, and (ii) whether those changes should or should not be deemed effective as of the date that the basic registration was made or the date that the supplementary registration was made. Copyright Office will issue only one basic registration to the same claimant for the same work, and a supplementary registration is the preferred method for correcting or amplifying the information in a basic registration. See Applications for Registration of Claim to Copyright under Revised Copyright Act, 42 Fed. In those cases, a new application for a new basic registration may be used to correct an error or omission in a basic registration, instead of filing an application for a supplementary registration. Publication issues: Basic registration for an unpublished work that is subsequently published. If the Office issued a basic registration for an unpublished work that was published sometime thereafter, the date of publication cannot be added with a supplementary registration. Instead, the applicant may provide the date of publication by submitting a new application for a new basic registration to register the first published edition of the work (even if the published version "is substantially the same as the unpublished version"). If the deposit requirements are different, the applicant cannot correct this error with a supplementary registration. Instead, the applicant must submit a new application for a new basic registration, together with the proper filing fee and deposit copies for the published edition of the work. In such cases, the applicant should submit a new application for a basic registration together with the proper filing fee and deposit copy(ies) for the derivative work. Adverse claims: If the applicant contends that the basic registration is invalid because it was filed by or on behalf of a party who was not authorized to register the copyright or names the wrong author(s) and/or claimant(s), the applicant should assert an adverse claim. Specifically, the applicant should file a competing application providing the name(s) of the party(ies) who should have been named as the correct author(s) and/or copyright claimant(s). Specifically, the applicant should provide this information in the Previous Registration field (in the case of an online application) or on space 5 (in the case of a paper application). But if an applicant intends to assert an adverse claim, the applicant should not provide the registration number for the other registration in the Previous Registration field/space. Instead, the applicant should provide a brief statement in the Note to Copyright Office field or in a cover letter indicating that the exact same work has been registered by another party. The registration specialist may add a note to the certificate of registration and the online public record indicating the presence of correspondence in the file or may add a note clarifying that the applicant has asserted an adverse claim. Examples: Dennis Lockhart and Betty Patton co-wrote a ballad titled "Forever Apart. In the alternative, Betty may file a new application for a new basic registration naming herself as the copyright claimant for this work if the work is jointly owned. The date of publication cannot be added to the basic registration with a supplementary registration. Matt should provide the registration number and year of registration for the previous registration in the Previous Registration field.

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Flowells pulse pressure 29 cheap 80mg calan amex, includes the most recent historical sketch, an account written by Jerome Schneck and simply titled "United States of America" (Brunner/Mazel, 1975). The World History is also useful for its articles on other countries whose interaction with psychiatry in the United States is important to know. It is readable, dependable, and well-researched, the work of a scholarly man who was also one of the first modem "advocacy" journalists. We could use a new history, however, that would take advantage of all the latest research. By period histories, we mean those which are limited in the span of time they cover. This is the first work that describes only the first half of the twentieth century, but it must be regarded as an introduction and not a thorough study. His book, Every Other Bed (World, 1956) has frank discussions of the politics of psychiatry and mental health legislation in the 1950s, especially at the level of state government. A similar book is by Robert Felix, : Mental Illness; Progress and Prospects (Columbia, 1967). The report of the experience with mental illness in the First World War, covered in the Medical Department of the U. Brand, "The National Mental Health Act of 1946: A Retrospect, " Bulletin of the History of Medicine, 39:231-245, 1965. Another interesting publication by that organization is the Centennial Anniversary of the American Journal of Psychiatry, 1844-1944, (vol. Presidential Addresses usually appear in the July issue of the Journal, beginning in 1883. They are much more than straightforward narratives, and so they deserve a separate heading. Rothman contends that the creation of the insane asylum in the Jacksonian Era was an effort to impose stability on a society whose traditional way of life was changing rapidly. Psychiatrists who write history maintain that Rothman commits errors of fact and interpretation. Like Rosenberg, Grob studies the process more than the result, he studies the past on its own terms, and he does not agree with Rothman that ". Americans have traditionally penalized poor and dependent groups by imposing a welfare system whose basic objectives were to ensure social stability, and control the behavior of lower-class groups (Rothman p. The book is doubly valuable because Grob informs us of the context around mental hospitals, part of which consisted of an evolving private and public welfare policy. On the matter of welfare policy, the readiest sources are Robert Bremner, American Philanthropy (Chicago, 1960); Bremner, From the Depths: the Discovery of Poverty in the United States (New York University, 1956); Samuel Mencher, Poor Law to Poverty Program: Economic Security Policy in Britain and the United States (Pittsburgh, 1968); Barbara Rosenkrantz, Public Health and the State: Changing Views in Massachusetts, 1842-1936 (Harvard, 1972); David M. Schneider, the History of Public Welfare in New York State (Patterson Smith, 1969, vol. Schneider and Albert Deutsch, the History of Public Welfare in New York State (Patterson Smith, 1969, vol. Studies of historical American psychiatric theory and practice are beginning to be written. Dain discusses the interrelationships between somatic and moral treatments, especially the rise and decline of the latter. See also Edward Stainbrook, "The Use of Electricity in Psychiatric Treatment During the Nineteenth Century, " Bulletin of the History of Medicine, 22:156-177, 1948, and "A Short History of Orthopsychiatry" by David F. Musto, in Mental Health and Social Change; 50 Years of Orthopsychiatry, edited with an introduction by Milton F. There is a rich, specialized literature already on moral treatment and moral insanity. Sanbourne Bockoven, Moral Treatment in American Psychiatry (Springer, 1963), which is an extension of an earlier article by the same title in the Journal of Nervous and Mental Disease, 124:167194;292-321, 1956. Bockoven extends his analysis still further in a later version of that book, retitled Moral Treatment in Community Mental Health (Springer, 1972), which has six additional modem chapters on the results of new hospital treatments. One should also consult the several articles on moral treatment and moral insanity co-authored by Eric T. Carlson and Norman Dain, "The Psychotherapy That Was Moral Treatment, " American Journal of Psychiatry, 117:519-524, 1960 Carlson and Dain, "The Meaning of Moral Insanity, " Bulletin of the History of Medicine, 36:130-140, 1962; Dain and Carlson, "Moral Insanity in the United States, 1835-1866, " American Journal of Psychiatry, 116:795-801, 1962. On moral treatment and the origins of community psychiatry, see Ruth Caplan, Psychiatry and the Community in Nineteenth-Century America (Basic, 1969). Musto, the American Disease; Origins of Narcotic Control (Yale, 1973), Richard and Charles Whitehead, the Marihuana Conviction: A History of Marihuana Prohibition in the United States (Virginia, 1974), and John B.

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Parkinsonian features of eight pathologically diagnosed cases of diffuse Lewy body disease arrhythmia technology institute calan 80mg visa. Modafinil reduces excessive somnolence and enhances mood in patients with myotonic dystrophy. The neuropathology of frontotemporal lobar degeneration caused by mutations in the progranulin gene. The clinical features of the Steele­Richardson­Olszewski syndrome (progressive supranuclear palsy). Hypersomnia in dystrophica myotonica: a neurophysiological and immunogenetic study. Idiopathic torsion dystonia (dystonia musculorum deformans): a review of forty-two patients. Selective thalamic degeneration ­ report of a case with memory and mental disturbances. Mapping of the gene for a novel spinocerebellar ataxia with pure cerebellar signs and epilepsy. An evaluation of the predictive validity and inter-rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type. Efficacy of rivastigmine in dementia with Lewy bodies: a randomized, double-blind, placebo-controlled international study. Cerebrotendinous xanthomatosis: molecular diagnosis enables presymptomatic detection of a treatable disease. Preliminary findings: behavioral worsening on donepezil in patients with frontotemporal dementia. Cerebrotendinous xanthomatosis: the storage of cholestanol within the nervous system. A syndrome of paralysis of downward gaze, dysarthria, pseudobulbar palsy, axial rigidity of neck and trunk and dementia. Characterization of the pattern of cognitive impairment in myotonic dystrophy type 1. Pathologic and biochemical studies of juvenile parkinsonism linked to chromosome 6q. Pathological, clinical and genetic heterogeneity in progressive supranuclear palsy. The gene responsible for adrenoleukodystrophy encodes a peroxisomal membrane protein. Late juvenile metachromatic leukodystrophy treated with bone marrow transplantation: a 4-year follow-up study. Autosomal dominant adult cerebral neuronal ceroid lipofuscinosis: parkinsonism due to both striatal and nigral dysfunction. Dopa-responsive dystonia: the spectrum of clinical manifestations in a large North American family. Neurogenic muscular atrophy and low density of large myelinated fibres of sural nerve in chorea­acanthocytosis. Diffuse intracytoplasmic ganglionic inclusions (Lewy type) associated with progressive dementia and quadriparesis in flexion. Gabapentin for essential tremor: a multiple-dose, double-blind, placebo-controlled trial. Neuronal loss in the medullary reticular formation in myotonic dystrophy: a clinicopathological study. Loss of serotonin-containing neurons in the raphe of patients with myotonic dystrophy: a quantitative immunohistochemical study and relation to hypersomnia. Olanzapine in severe Gilles de la Tourette syndrome: a 5-week double-blind crossover study vs. The spectrum of pathological involvement of the striatonigral and olivopontocerebellar system in multiple system atrophy: clinicopathological correlations. The distribution of oligodendroglial inclusions in multiple system atrophy and its relevance to clinical symptomatology. A controlled, randomized, delayed-start study of rasagaline in early Parkinson disease.

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This model of setting aside protected areas has been exported to blood pressure chart normal calan 240 mg free shipping the rest of the world and persists as the most common strategy for numerous environmental goals, including protection of watersheds, endangered plants and animals, and providing space for people to interact with nature. We often forget, for example, that the "natural" state of such parks is mostly a recent phenomenon. Many Native American groups were systematically removed from parks (and rarely compensated) to make the parks "natural, " and some parks, such as Mt. In other areas of the world, especially in developing countries, most protected areas are occupied by groups of people who have lived there for decades or centuries and have legitimate claims to the land. Some may not be aware that their land is being transformed into a park and, once informed, are shocked by all of the new regulations they Figure 4: Yosemite Valley, one of the first national parks in the are expected to obey. In worst-case scenarios, they are United States, established a precedent of setting aside natural areas for their scenic beauty, recreation, and conservation. From the perspective of such groups, the government seems to value elephants, tigers, or scenic vistas more than the people living on the land. And those negative views can thwart conservation efforts when locals resent preferential treatment of animals and choose to poach or simply ignore the new regulations. Conservation groups have begun to recognize that they must support economic development of local communities to get them on board with conservation efforts. When local residents benefit from jobs as park guards, tour guides, and research assistants, they recognize the positive economic benefits of conservation and support the initiatives. This approach aims to combine conservation and development, bringing together typically different objectives. Initially, this approach was a response to development policies associated with building infrastructure such as roads and dams that had huge environmental impacts and created negative press for the World Bank, the U. Now, most conservation projects incorporate development objectives, and the environmental impacts of development projects usually must 371 be assessed. Some aim to help local communities develop industries that depended on rainforests in nondestructive ways, such as non-timber forest products like rattan, rubber, medicines, and fruit. By assisting local communities in developing and marketing such products, the programs have provided them with economic alternatives that encourage people to preserve rainforests instead of chopping them down, a form of sustainable development. The conservation and development project with which I am most familiar is related to extractive reserves in the Brazilian Amazon. These rubber tappers live in the rainforest and tap natural rubber by scraping a long thin cut into the bark of the tree and returning later in the day to collect the sap that had dripped into a small container hung on the tree. Rubber trees do not grow together; they are spread out throughout the forest, requiring rubber tappers to walk several trails each day. Many also collect and sell Brazil nuts, which fall from ancient trees that live for centuries. Brazil nuts cannot be commercially grown so they must be collected from rainforests. And although rubber can be produced synthetically, natural rubber is stronger, longer lasting, more flexible, and more resistant to heat than synthetic alternatives, making it ideal for use in medical and aeronautic industries where high-quality material is essential. As cattle ranching expanded in the Amazon, rubber tappers were being evicted because they did not have formal title to the land on which they lived and worked. Led by local activist Chico Mendes, the rubber tappers organized and petitioned the government for the right to remain on the land. Mendes was eventually assassinated by owners of some of the cattle ranches who were unhappy about his activism, but ultimately, the movement was successful. Environmentalists who were worried about Amazonian deforestation joined forces with the rubber tappers, who were worried about their livelihoods, and together they created extractive reserves-protected areas owned by the federal government but managed by local communities of rubber tappers who could stay on the land indefinitely as long as they followed the environmental regulations they established. The model was successful and has since been expanded to include millions of hectares throughout the Amazon. As with many conservation and development projects, the economic benefits of the extractive reserves were slow to accrue. When rubber prices fell in response to international commodity markets, many families stopped tapping rubber and focused on subsistence agriculture.

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Abulia may be seen as part of the frontal lobe syndrome interleukin 6 arrhythmia cheap calan 240mg, wherein it may be accompanied by perseveration. Etiology the syndrome has been noted most commonly with bilateral or unilateral lesions of the inferior frontal lobe (De Renzi et al. Treatment Bromocriptine, anecdotally, has been effective (Barrett 1991); treatment may be commenced at a low dose of p 04. The difference lies in what the patient does with the grasped object: the patient with forced grasping simply holds on, whereas the patient with the environmental dependency syndrome will utilize the object and do something with it. Delirious patients may take hold of and use nearby objects but here one also finds confusion, a sign that is absent in the environmental dependency syndrome. The placidity of these patients is at times remarkable: they seem to have no fear, and pointing out the consequences of their behavior to them typically does nothing to disturb them. In one case, a 57-yearold professor suffered head trauma that led to a maceration of the inferior surface of both temporal lobes. After recovering from the trauma, the patient: failed to recognize objects placed in front of him or into his hand. He ate voraciously and, in fact, had a tendency to place almost everything that came into view in his mouth. He made inappropriate sexual advances, rather indiscriminately; both male and female attendants were cautious in his presence. If restrained, he became agitated, but when his attention was diverted, he immediately calmed down. In another case, a 46-year-old man had a complex partial seizure wherein: he was awake and alert, but almost mute and lacking facial expression. He was observed grabbing for objects on his bedside table, and he masturbated in front of the nursing staff. He also placed objects in his mouth, chewed on tissue paper, and attempted to drink from his own urine container. This Kluver­Bucy syndrome has subsequently been noted in humans, wherein its most prominent clinical manifestations are hyperorality and hypersexuality. Clinical features In the full form of the human Kluver­Bucy syndrome, one finds a heightened, but indiscriminate, interest in nearby objects coupled with hyperorality, hypersexuality, and a certain placidity marked by an absence of fear. Patients appear to take an almost equal interest in all nearby objects and may appear restless as they reach out for one object on the bedside table after another, or pace about the room, again, from one thing to another. Hypersexuality may be a voracious appetite and indiscriminate eating habits which included paper towels, plants, styrofoam cups, and even faeces. He tended to wander about the ward touching objects or people and made inappropriate comments of a sexual nature. On the day of his death, the patient had a respiratory arrest after stuffing his mouth with surgical gauze. He had wandered about the ward picking up whatever he could find and putting it into his mouth. The terminology they utilized is somewhat cumbersome but is still at times seen in the literature. Bilateral ablation or injury to the temporal lobes is most obvious after bilateral temporal lobectomy. Traumatic brain injury, with contusions of the inferior surfaces of both temporal lobes, may also cause the syndrome, as may a late-delayed radiation encephalopathy after irradiation, say, for a pituitary tumor or nasopharyngeal carcinoma. Herpes simplex viral encephalitis classically involves both temporal lobes, and the syndrome may appear as a sequela in those who survive. Finally, there are rare cases of infarction of both temporal lobes (as for example secondary to a vasculopathy of systemic lupus erythematosus) with a resulting Kluver­Bucy syndrome. Epileptic conditions may be characterized by the Kluver­Bucy syndrome, either ictally during a complex partial seizure or post-ictally after either a grand mal seizure or an episode of complex partial status epilepticus. Miscellaneous, and very rare, causes of the syndrome include adrenoleukodystrophy and heat stroke. Differential diagnosis When a patient presents with disinhibition, the frontal lobe syndrome may come to mind; in this syndrome, as in the Kluver­Bucy syndrome, one may see inappropriate sexual advances. The differential lies in finding features such as hyperorality and a heightened and indiscriminate interest in nearby objects, features which are not found in the frontal lobe syndrome. Treatment There are no controlled studies of the treatment of the Kluver­Bucy syndrome.

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