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K. Rathgar, M.A., M.D., M.P.H.
Clinical Director, Lake Erie College of Osteopathic Medicine
After their lightning court ship and a first day of repeated and intense copulation treatment ingrown hair generic antabuse 250mg visa, the male and female remain inseparable till death does them part medications similar to lyrica order antabuse 500mg visa. The male actually acquires a sour disposition toward any creature other than his beloved and is usually quite helpful around the nest treatment lice buy 250mg antabuse overnight delivery. Such bonding is not only a charming adaptation but a most advantageous one treatment hepatitis b antabuse 250 mg for sale, in many species, since it keeps together those who must rear the offspring, and it also helps with other aspects of social organization. To the neurobiology of sex, about which a lot is currently known, we can now add the beginnings of the neurobiology of attachment, and, armed with both, throw a bit more light on that complex set of mental states and behaviors we call love. What is at play here, in the massively recurrent circuit arrangements I have outlined, is a collection of feedforward and feedback loops in which some of the loops are purely chemical. The hypothalamus, the brain stem, and the limbic system intervene in body regulation and in all neural processes on which mind phenomena are based, for example, per ception, learning, recall, emotion and feeling, and-as I shall pro pose later-reasoning and creativity. Curiously, it happens most strongly not far from the pineal gland, inside which Descartes once sought to imprison the nonphysical soul. Among animals, from insects to mammals, there are unequivocal examples of successful coping with particular forms of environment on the basis of innate strategies, and no doubt those strategies often include complex aspects of social cognition and behavior. I never cease to marvel at the intricate social organization of our distant monkey cousins, or at the elaborate social observances of so many birds. When we consider our own species, however, and the far more varied and largely unpredictable environments in which we have thrived, it is apparent that we must rely on highly evolved genetically based biological mechanisms, as well as on suprainstinctual survival strategies that have developed in society, are transmitted by culture, and require, for their application, consciousness, reasoned deliberation, and willpower. Western and Eastern thinkers, religious and not, have been aware of this for millennia; closer to us, the topic preoccupied both Des cartes and Freud, to name but two. I am not attempting to reduce social phenomena to biological phenomena, but rather to discuss the powerful connection between them. It should be clear that although culture and civilization arise from the behavior of biolog ical individuals, the behavior was generated in collectives of individ uals interacting in specific environments. Culture and civilization could not have arisen from single individuals and thus cannot be reduced to biological mechanisms and, even less, can they be re duced to a subset of genetic specifications. Their comprehension demands not just general biology and neurobiology but the meth odologies of the social sciences as well. In human societies there are social conventions and ethical rules over and above those that biology already provides. Those additional layers of control shape instinctual behavior so that it can be adapted flexibly to a complex and rapidly changing environment and ensure survival for the individual and for others (especially if they belong to the same species) in circumstances in which a preset response from the natural repertoire would be immediately or eventually counter productive. Although such conventions and rules need be transmitted only through education and socializa tion, from generation to generation, I suspect that the neural repre sentations of the wisdom they embody, and of the means to implement that wisdom, are inextricably linked to the neural repre sentation of innate regulatory biological processes. I see a "trail" connecting the brain that represents one, to the brain that repre sents the other. For most ethical rules and social conventions, regardless of how elevated their goal, I believe one can envision a meaningful link to simpler goals and to drives and instincts. Because the consequences of achieving or not achieving a rarefied social goal contribute (or are perceived as contributing), albeit indi rectly, to survival and to the quality of that survival. Does this mean that love, generosity, kindness, compassion, hon esty, and other commendable human characteristics are nothing but the result of conscious but selfish, survival-oriented neurobiological regulation? Does this mean that there is no true love, no sincere friendship, no genuine compassion? Love is true, friendship sincere, and compassion genuine, if I do not lie about how I feel, if I really feel loving, friendly, and compassionate. Perhaps I would be more eligible for praise if I arrived at such sentiments by means of pure intellectual effort and willpower, but what if I have not, what if my current nature helps me get there faster, and be nice and honest without even trying? The truth of the feeling (which concerns how what I do and say matches what I have in mind), the magnitude of the feeling, and the beauty of the feeling, are not endangered by realizing that survival, brain, and proper education have a lot to do with the reasons why we experience such feelings. In any case, the partial explanation of complexity by something less complex does not signify debasement. The picture I am drawing for humans is that of an organism that comes to life designed with automatic survival mechanisms, and to which education and acculturation add a set of socially permissible and desirable decision-making strategies that, in turn, enhance sur vival, remarkably improve the quality of that survival, and serve as the basis for constructing a person. At birth, the human brain comes to development endowed with drives and instincts that include not just a physiological kit to regulate metabolism but, in addition, basic devices to cope with social cognition and behavior. The neurophysiological base of those added strategies is interwoven with that of the instinctual repertoire, and not only modifies its use but extends its reach.
Syndromes
It will provide critical leadership for preparedness and response by combining key federal personnel and assets treatment quotes images buy antabuse 500 mg overnight delivery, as well as federal partnerships with state and local officials and the private sector to prepare for and respond to terror attacks or natural disasters symptoms 9 weeks pregnant discount 250mg antabuse fast delivery. It would also place a hardship on states that would have to coordinate their preparedness and response efforts through two separate federal agencies symptoms heart attack discount antabuse 500mg with mastercard. Katrina has made it clear that we need more integration in federal preparedness and response symptoms your having a boy discount antabuse 250mg fast delivery, not less, and that we need to effectively integrate, not bifurcate, prevention, preparedness, protection and response initiatives with state, local, and non-governmental and private-sector partners. It is important to distinguish between preventing a terrorist attack and preventing damage from a terrorist attack or natural disaster. The Director would also serve as the Advisor to the President for national emergency management, in a manner akin to the Chairman of the Joint Chiefs of Staff. The Director would have a direct line of communication to the President during catastrophes. The Director and each of the three Deputy Directors should have significant experience in crisis management, in addition to substantial management and leadership experience, whether in the public, private, or nonprofit sector. For example, appropriate experience could include a military career with broad leadership experience; emergency-management experience and a proven track record of leading complex preparedness and response efforts; or private-sector experience successfully leading a company or organization through a crisis. Core Recommendation #2 From the Federal Level Down, Take a Comprehensive All-Hazards Plus Approach to Emergency Management. The new organization should bring together the full range of responsibilities that are core to preparing for and responding to disasters. These include the four central functions of comprehensive emergency management preparedness, response, recovery and mitigation which need to be integrated. The Director, moreover, must be responsible for administering and distributing preparedness grants to state and local governments and for national preparedness training, as these are key tools for ensuring a consistent and coordinated national response system. At the same time, it must not neglect to build those unique capabilities like mass decontamination in the case of a radiological attack, or water search and rescue in the case of flooding that will be needed for particular types of incidents. Core Recommendation #3 Establish Regional Strike Teams and Enhance Regional Operations to Provide Better Coordination Between Federal Agencies and the States. Most of the essential work of emergency management does not happen in Washington, D. Regional offices can facilitate planning tailored to the specific risks and needs of a particular geographic area: for example, the risks faced, and the types of preparedness necessary, in Gulf Coast states may differ markedly from that of cities along the Northeast Corridor that were attacked on 9/11, or of those areas that lie along the New Madrid seismic fault in the central Mississippi Valley. These regional Strike Teams should coordinate their training and exercises with the state and local officials and the private-sector entities they will support when disasters occur. Currently, a multiplicity of interagency coordinating structures with overlapping missions attempt to facilitate an integrated federal response. Although the federal government should play a more proactive role in responding to catastrophic events when state and local officials may be overwhelmed, states and localities will continue to provide the backbone of response the first response for all disasters, catastrophic or not. The importance of providing for the safety of American citizens in the event of a natural disaster or terrorist attack can hardly be overstated. Resources are needed for additional planning, more frequent and ambitious training and exercises, enhancement of regional offices, staffing and preparation of regional Strike Teams, better development of a trained cadre of reservists, and development of new logistics capabilities. To be full partners in the national preparedness effort, states and localities will need additional resources as well. The pattern over the last three years of steadily declining funds for state and local preparedness needs to be reversed. Every homeland security dollar, whether provided by the federal government or through state and local resources, must be spent only on those things that truly support the homeland-security mission. The federal government must provide protection no less robustly for all domestic hazards than it does for the defense from threats abroad. Any attempt to develop a full-fledged national system of preparedness and response must fully integrate state and local officials into the system. The advisory council should play an integral role in ensuring that the full range of activities of the new organization including developing response plans, conducting training and exercises, formulating preparedness goals, and effectively managing grants and other resources are done in full consultation and coordination with, and take into account the needs and priorities of, states and localities. After Katrina struck, private companies and their employees provided important and even life-saving, relief to citizens across the Gulf Coast region; many other companies sought to offer assistance. Yet there was no system in place to effectively incorporate many privatesector resources into the response effort. Nor was there a system to efficiently incorporate 613 Recommendations important contributions from faith-based and other charitable and community organizations that sought to offer assistance. Where appropriate, private-sector representatives should also be included in planning, training, and exercises. In all cases, advance planning for how to most effectively utilize these nongovernmental resources is essential.
The federal government played no role in providing transportation for pre-landfall evacuation symptoms torn rotator cuff generic 250 mg antabuse overnight delivery. Both in the run-up to Katrina and subsequent interviews medications not to take after gastric bypass generic antabuse 250mg on-line, federal officials provided the same explanation: they were accustomed to the longstanding practice of generally deferring to the primary emergency response to state and local governments permatex rust treatment purchase antabuse 500 mg with amex. Mayor Nagin took the unprecedented step (albeit with some hesitation) of calling for a mandatory evacuation of New Orleans medications breastfeeding order antabuse 250mg without prescription. While the widespread support for mandatory evacuation is laudable, it is unfortunate that the federal government did not take a greater interest in the practicality of that evacuation in a city widely known to have made no arrangements for evacuation of the thousands of its citizens lacking personal transportation. Federal officials had participated actively in the Hurricane Pam exercise (See Chapter 8), which predicted that some 100,000 New Orleanians would lack means of evacuation. Nor did they ask whether it would be useful for the federal government to mobilize and deploy buses or drivers to Southeast Louisiana. During the Hurricane Pam exercise, and follow-up July 2005 workshop, federal officials had heard state and local officials openly discuss their shortage of buses and other resources to evacuate that population. With no plans to supplement state and local transportation resources, federal options were limited. Getting buses from distant sources to New Orleans, as it did after landfall, may not have been realistic, depending on when the effort was initiated over the weekend. On the 258 Pre-Storm Evacuations other hand, there were many transportation assets either in the area (such as municipal buses, riverboats and cruise ships) or accessible (such as trains and airplanes) that the federal government could have helped to make available. The post-landfall resourcefulness of many officials who arranged for transportation alternatives suggests what could have been easily attempted before landfall. There is other evidence that the federal government can mobilize transportation resources for evacuation when it chooses to do so. Federal officials were both aware of state and local shortfalls, and had both the capacity and opportunities to help. But in the absence of adequate plans and policies, federal officials were paralyzed to act. Secretary Chertoff was right when he said that evacuation was the primary mission before landfall. Federal law imposes no requirement for the federal government to aid pre-landfall evacuations. Such a requirement would be inconsistent with the principle that local and state authorities have primary responsibility for emergencies, receiving federal assistance only when their own resources are overwhelmed. However, federal law does not prohibit the federal government from extending assistance, even without a request from the state, when preparing for or responding to an imminent catastrophe such as Hurricane Katrina. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) gives the federal government the authority to assist the state and local governments with an evacuation. Congress made clear in the Stafford Act that its purpose was to "vest responsibility for emergency preparedness jointly in the Federal government and the states and their political subdivisions. Provisions for Household Pets Hurricane Katrina revealed that consideration of the needs of those with pets should be a factor in emergency planning for evacuations and sheltering. Most of these references relate to preventing outbreaks of disease through animals. In other words, in childless households, owners "were apparently willing to jeopardize their lives to stay with their pets. The American Red Cross implements this policy by encouraging local chapters to work with animal organizations to establish local agreements. Typically used for 4-H events and rodeos, it has almost 1,000 horse stalls and thus was able to serve both large and small animals. Terry Ebbert is the point of contact, "The city of New Orleans faces the reality that it is impossible to conduct a mandatory evacuation in advance of a Category 3, 4, or 5 hurricane, as well as respond to other disasters including terrorism. Terry Ebbert and former Office of Emergency Preparedness Director Terry Tullier expressed this sentiment in interviews. Ivan last year bored down on us until it got to the mouth of the Mississippi and it turned. Tullier said, "The first thing is a public official has to convince this cultural masses [sic] that have accumulated this cultural philosophical viewpoint over 40 years, has to convince them it is in their best interests [inaudible] to leave.
The recognition and subsequent identification of the specific contaminants (dust treatment yellow jacket sting antabuse 500 mg visa, fume severe withdrawal symptoms buy antabuse 250 mg cheap, gas chi royal treatment discount 250mg antabuse fast delivery, vapor medicine for yeast infection 500mg antabuse visa, mist, 184 Occupational Health and Safety microorganisms, and sound pressure level etc) is the first stage in the sequence. A number of spot check devices are used such as detector stain tubes for gases, or in the case of noise, a sound pressure meter. Once the contaminants have been identified, it is necessary to measure the extent of the contamination. Measured level of contamination must be compared with existing hygiene standards (always assuming there is such a standard applicable to the material in question), such as exposure limits, control limits and recommended limits. In addition, the duration and frequency of exposure to the contaminants must be taken into account. Following a comprehensive evaluation, a decision must be made as to the actual degree of risk to workers involved. Evaluation of occupational hazards the basic principles to evaluate occupational health and safety hazards, and the philosophical basis for establishing safe levels of exposure to chemical, physical and biological agents is based on evaluation of occupational environment. Evaluation can be defined as the decision making process that results in an opinion as to the degree of risk arising from exposure to chemical, physical, biological, or other agents. It also involves making a judgment of the magnitude of these agents and 185 Occupational Health and Safety determines the levels of contaminants arising from a process or work operation and the effectiveness of any control measures used. Method of sampling Grab Sampling Vs integrated Sampling Air sampling can be conducted for long or short periods depending upon what type of information is needed. Instantaneous or grab Sampling is the collection of an air sample over a short period whereas longer period of sampling is called integrated sampling. Grab samples represent the environmental concentration at a particular point in time. It is ideal for following cyclic process and for determining air- borne concentration of brief duration but it is seldom used to estimate eight-hour average concentration. In integrated sampling, a known volume of air is passed through a collection media to remove the contaminant from the sampled air stream. Area or general room air samplings are taken at fixed locations in the work place. For this reason it is used mainly to pinpoint high exposure areas, indicate flammable or explosive concentrations, or determine if an area should be isolated or restricted to prevent employees from entering a highly contaminated area. Personal sampling the objective of personal sampling is to see the extent of exposure of the person working on a particular contaminant while he/she is working at a location or work place. For example, if the worker is working in a garage where cars are painted the area as a whole is sampled to see how much lead which is present in all car paints, is on the air but with personal sampling one can determine how much are inhaled by the person performing the work or those who are working near by. In short it is the preferred method of evaluating workers exposure to air contaminants. It indicates exactly what has been absorbed into the body rather than what is in the environment. Particulate matter measurement To measure dust exposure, it is necessary to determine the composition of dust that are suspended in the air where workers breathe. Operation that involves the crushing, grinding, or polishing of minerals or mineral mixtures frequently do not produce airborne dusts that have the same size composition. If a larger number of these particles appear in the dust sample, the effect of their presence may have to be evaluated separately. To evaluate either the relative hazard to health posed by dusts or effectiveness of dust control measures, one must have a method of determining the extent of the dust problem. Ideally the method employed should be as closely related to the health hazard as possible. Count Procedure the concern of industrial hygienists has been to measure the fraction of dust that can cause pneumoconiosis. Since it has been recognized that only dust particle smaller than approximately 10 micrometer are deposited and retained in the lung method were sought to measure the concentration of these tiny particles. The "total" mass, however, is determined to a considerable extent by the large dust particle, which can not penetrate to the pulmonary space and cause adverse health effect. Thus the total dust 189 Occupational Health and Safety concentration by weight is not a reliable index of "respirable" dust concentration. This is because in this method of measurement the proportion of dust that is small enough to penetrate into the pulmonary space (respirable dust 2.