Condet

Alex Han Cho, MD

• Assistant Professor of Medicine
• Affiliate, Duke Global Health Institute

https://medicine.duke.edu/faculty/alex-han-cho-md

The fetus is at risk for intrauterine growth retardation medications safe during pregnancy buy liv 52 120ml free shipping, prematurity medicine used to induce labor order 60 ml liv 52 visa, and intrauterine death symptoms intestinal blockage order 100 ml liv 52 amex. Hypertension is the most common medical problem in pregnancy symptoms 2016 flu discount 200 ml liv 52 visa, complicating up to 15% of pregnancies and accounting for about a quarter of all antenatal admissions. Pre-eclampsia is a pregnancy-specific syndrome that occurs after mid-gestation, defined by the de novo appearance of hypertension, accompanied by new-onset of significant proteinuria. Oedema is no longer considered part of the diagnostic criteria, as it occurs in up to 60% of normal pregnancies. Overall, pre-eclampsia complicates 5­7% of pregnancies,213 but increases to 25% in women with pre-existing hypertension. Pre-eclampsia occurs more frequently during the first pregnancy, in multiple fetuses, hydatidiform mole, or diabetes. It is associated with placental insufficiency, often resulting in fetal growth restriction. Additionally, pre-eclampsia is one of the most common causes of prematurity, accounting for 25% of all infants with very low birth weight (,1500 g). Management of pre-eclampsia focuses essentially on recognition of the condition and, ultimately, delivery of the placenta, which is curative. As proteinuria may be a late manifestation of pre-eclampsia, it should be suspected when de novo hypertension is accompanied by headache, visual disturbances, abdominal pain, or abnormal laboratory tests, specifically low platelet count and abnormal liver enzymes; it is recommended to treat such patients as having pre-eclampsia. Ultrasound investigation of the adrenals and urine metanephrine and normetanephrine assays may be considered in pregnant women with hypertension to exclude pheochromocytoma which may be asymptomatic and, if not diagnosed before labour, fatal. This may mask the pre-existing hypertension and, when hypertension is recorded later in pregnancy, it may be interpreted as gestational. Women with essential hypertension and normal renal function have good maternal and neonatal outcomes and are candidates for non-drug therapy because there is no evidence that pharmacological treatment results in improved neonatal outcome. However, close monitoring and, if necessary, resumption of treatment is necessary. The only trial of treatment of hypertension in pregnancy with adequate infant follow-up (7. A short-term hospital stay may be required for confirming the diagnosis of and ruling out severe gestational hypertension (pre-eclampsia), in which the only effective treatment is delivery. A normal diet without salt restriction is advised, particularly close to delivery, as salt restriction may induce low intravascular volume. Calcium supplementation of at least 1 g daily during pregnancy almost halved the risk of pre-eclampsia without causing any harm. Fish oil supplementation218 as well as vitamin and nutrient supplements have no role in the prevention of hypertensive disorders. Low dose acetylsalicylic acid (75 ­100 mg/day) is used prophylactically in women with a history of early-onset (,28 weeks) pre-eclampsia. Weight reduction is not recommended during pregnancy in obese women, because it can lead to reduced neonatal weight and slower subsequent growth in infants of dieting obese mothers. However, as maternal obesity can result in negative outcomes for both women and fetuses, guidelines for healthy ranges of weight gain in pregnancy have been established. If taken inadvertently during the first trimester, switching to another medication and close monitoring including fetal ultrasound are advisable and usually are sufficient. Potential synergism with magnesium sulfate may induce maternal hypotension and fetal hypoxia. Diuretics should be avoided for treatment of hypertension because they may decrease blood flow in the placenta. The selection of the antihypertensive drug and its route of administration depend on the expected time of delivery. Prolonged treatment with sodium nitroprusside is associated with an increased risk of fetal cyanide poisoning as nitroprusside is 9. Delivery Induction of delivery is indicated in gestational hypertension with proteinuria with adverse conditions such as visual disturbances, coagulation abnormalities, or fetal distress.

How that bounce back occurs can generally be described in four ways: attaining and resuming the previous course (an engineering view); rebounding to a newly established "normal" (an ecological view); rebounding to a certain degree but continuing with an unstable pattern of ups and downs; or not able to recover medicine for vertigo cheap 120 ml liv 52 overnight delivery. Ecological resilience is interpreted as "how much disturbance [a system] can take and remain within critical thresholds" (Davoudi 2012 medications during breastfeeding buy liv 52 60ml on line, p medications in mothers milk buy 200 ml liv 52 free shipping. Community resilience is a new and emerging branch in resilience theory symptoms kidney problems order 100ml liv 52 with visa, and literature focusing at the local level is even less developed (Berkes and Ross 2013). The research I present here contributes to neighborhood-level community resilience literature and more specifically, resilience in the suburban and urban-infill neighborhood context. Ecologists equate resilience inversely with vulnerability while planners and 9 engineers view it as a "core capacity of disaster recovery" (Foster 2012, p. Davoudi (2012) looks to a third "socio-ecological resilience" as a parallel to planning, a concept referred to as evolutionary resilience. This branch of resilience theory advocates that an external disturbance is not necessarily the stressor event, but it may come from within or without the system. It also promotes an interconnectedness of socio-spatial systems that are unpredictable with complex feedback processes. Evolutionary resilience posits that, "past behaviour of the system is no longer a reliable predictor of future behaviour even when circumstances are similar (Duit et al. Foster (2012) discusses outcome and capacity as a "primary conceptual divide" in how resilience is demonstrated. As an outcome, resilience is the degree to which a person or place recovers from a stress; as capacity, resilience is the degree to which a person or place "has the conditions and attributes to potentially recover from a stress" (p. Leichenko (2011) uses a simple definition of resilience as "the ability of a system to withstand a major shock and maintain or quickly return to normal function" (p. Leichenko further states that: "(1) cities must become resilient to a wider range of shocks and stresses in order to be prepared for climate change; and (2) efforts to foster climate change resilience must be bundled with efforts to promote urban development and sustainability" (p. Thus, positioning communities for climate change must include securing their economic 10 and social viability. I extend this interpretation of the resilient city as a step beyond that of the sustainable city. In broad terms, a sustainable system is one that can meet present needs without compromising its ability to meet future needs. Both resiliency and sustainability are thus concerned with the ability to persist. The breadth and depth of the discussion on sustainability has afforded its understanding to all levels of society, from the White House to the elementary school. It is common knowledge that if natural resources are depleted or not properly conserved, future generations are in peril. This is also a question of resiliency ­ will communities be able to bounce back to some equilibrium? Although sustainability has at its core a clear three-part focus, its common interpretation and implementation has been hijacked in the practical, and nearly singularly equated with environmental stewardship. Sustainability also tends to track with the concept of some supply "running out," whereas resilience encompasses both a chronic condition and a sudden shock. In easily relatable terms of physical health, resilience can address a long battle with cancer in and out of remission (capacity), or a heart attack (sudden shock). Resilience also emphasizes the building-in of capacity and adaptability to amass pre-stressor resources. In their book, Resilience: Why Things Bounce Back, Zolli and Healy (2012) 11 identify two key aspects to resilience as continuity, and recovery following change. The key aspects of continuity and adaptability, as discussed by Zolli and Healy, are common themes throughout resilience literature. They argue that the resilience of a system hinges on its preserving of adaptive capacity, the quality that allows a system to adapt to change without losing the ability to fulfill its core purpose. Like other systems in nature or commerce, "social resilience often rests on the adaptive capacity of a community, or its ability to sense, interdict, and intervene" (Zolli and Healy, 2012 p. Other scholars point to a key factor in resilience as the need for an adaptive system that self-corrects in response to change (Swanstrom, 2012; Reckhow and Weir, 2012). The networks present provide a reference system from which needed resources are drawn in times of stress.

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It was provoked by political rumblings of discontent symptoms 6 year molars generic liv 52 120ml fast delivery, from male-dominated trade unions and local councils treatment kidney stones liv 52 60 ml low cost, and from evidence given to a parliamentary sub-committee medications kidney infection discount 200 ml liv 52 free shipping. And within academe treatment action group purchase 100 ml liv 52 fast delivery, a whole new line of inquiry started as to why these jobs were for women. Women were also more available than men for part-time work, an effect of the long-established domestic division of labour within the household. Both of these reasons were characteristic of male/ female relations, within the home and within the employment market, across the country. But some reasons were more specific, or at least more important, to these particular regions to which the jobs had been decentralized. Thus, the women in these regions had very low rates of organization into trade unions, a result of the very low levels of their previous incorporation into paid employment. The female economic activity rates there were indeed amongst the lowest in the country. Such a revised understanding led also to a revised evaluation of the effectivity of regional policy. And yet there was a further stage in the development of this argument: stage three. For the more that one thought about it, the more the story seemed more complicated than that. Why, for example, had the economic activity rate for women in these regions been historically so low? Many people, writing in both geography and sociology, commented upon the domestic labour burden of being a wife or mother to miners. They commented also on how the length and irregularity of shift-work made it problematical for the other partner in a couple also to seek paid employment outside the home. There was much detailed investigation of the construction of particular forms of masculinity around jobs such as mining. And all these investigations, and others besides, pointed to a deeper explanation of why, more than in most other regions of the country, there was in these areas a culture of the man being the breadwinner and of the women being the homemaker. Moreover this gave us, once again, both a different story of what had happened and a different evaluation of regional policy. Harold Wilson had come to power in 1964 on a programme of modernizing social democracy, part of which centred on the rationalization of old industries such as coal mining. Contradictorily for him, however, the loss of jobs which would be consequent upon that rationalization would occur precisely in the regions which were his main geographical power base-regions such as the north-east of England, south Wales, and the central area of Scotland. In order, therefore to proceed with this reconstruction of the old basic sectors of these regions, it was necessary to have as the other side of the deal a strong regional policy. However, it was the very fact that the men in the region were being made redundant which was important in creating the availability of female labour. They needed paid employment, most particularly now in the absence of work for men, and there was less of a domestic labour burden upon them restraining them from taking it. Moreover these women had been constructed over the years, precisely by the specificity of the local gender culture, into just the kind of workforce the decentralizing industries were looking for. It certainly remained true that regional policy had brought with it only low-paid jobs, but on the other hand there were some positive aspects to the jobs it did bring, which previously had been unrecognized. Most importantly, it did bring some independent income for women, and for the first time in decades. Moreover, as the very fact of the initial complaints indicated, precisely by bringing in those jobs it began to disrupt some of the old gender relations. In other words, on this score (though not on many others) regional policy can be seen to have had some quite positive effects-though in a wholly different way from that initially claimed in stage one of the development of the argument. There are a number of reflections which can be drawn from this story of a developing analysis. First, and most obviously, taking gender seriously produced a more nuanced evaluation of regional policy, a far better understanding of the organization and reorganization of our national economic space, and indeed-since these decentralizing industries were moving north to cut costs in the face of increasing international competition-it has shown us how British industry was actively using 131 Ј Doreen Massey ў regional differences in systems of gender relations in an early attempt to get out of what has become the crisis of the British economy. Second, this understanding was arrived at not just by looking at women-although that was a start-but by investigating geographical variations in the construction of masculinity and femininity and the relations between the two.

By revaluing process treatment of chlamydia purchase 100 ml liv 52 free shipping, the people involved in building production are then as interesting and important to architectural history as those who finance or design buildings treatment 6th february discount 200 ml liv 52 with visa. Feminists have suggested that it is precisely in the area of design process that female difference might be expressed symptoms ptsd cheap liv 52 120ml amex. On the one hand medicine and manicures order liv 52 120 ml without prescription, as discussed with respect to Matrix, for some practitioners the intention has been to organise the design process in such a way that it benefits users and clients. But it is important in this case not to collapse the creative processes of specific groups of black African women with the design work of black women practising architecture in other cultures. The influences of cultural and economic differences regarding land ownership and social relations of production produce forms of architectural practice which differ significantly from those in developed capitalist western countries. Like sex and gender, differences of race and ethnicity are contingent on geographical locations and other forms of social relations. The focus in Chapters 34­38 is on the ways in which feminist and critical theory have influenced the writing of architectural history. It is worth therefore noting the academic context in which feminist architectural history is located and which it radically critiques. Architectural history can be broadly described as a practice which studies the history of buildings. They have analysed this architecture in terms of form, style, type and aesthetics. Critical approaches to architectural history have been made by those concerned with the politics of architecture, specifically with issues of class. Although vital in providing new material, this work does not seek to question conventional architectural historical models or raise methodological issues concerning, for example, the status of the architectural object, the role of the architect and kind of analysis relevant to the objects of study. The implications of feminist work on representation and gender in other fields-namely, psychoanalysis, philosophy, cultural studies, film theory and art history-have raised two main issues for the practice of architectural history: first, new objects of study-the actual material which historians choose to look at; and second, the intellectual criteria by which historians interpret those objects of study. Critics such as Beatriz Colomina in Chapter 34, Zeynep Зelik in Chapter 35 and Mabel Wilson have focused on developing sustained feminist critiques of the traditional male canon. Using feminist interpretative techniques, they place issues of gender, race and ethnicity at the heart of the architectural practice of such male masters as Adolf Loos and Le Corbusier. In order to develop an argument concerning secrecy and display with relation to homosexuality, Urbach focuses on an unusual object of study, the design of the closet. Feminist criticism has allowed a scrutiny of the aims and ambitions of architectural designers and the value given to the end product over process. More recent feminist work, however, suggests that radical practice should not only concentrate on solving problems in a practical way but also critique architecture as a form of representation consisting of images and writing. Such a shift, which involves thinking about architectural practice as text as well as building, may be characterised as postmodern and opens up possibilities for many different approaches to the feminist practice of architecture. Feminist criticism in shifting the location of theory from within architecture, as a description of architectural design and a way of prescribing practice, to outside architectural discourse, has changed definitions of the practice of architecture. Architecture is no longer considered only in relation to the mode of production, but rather in relation to its reproduction through cultural representations, through consumption, appropriation and occupation. As historians have shown, representations of architecture-drawings, plans, sections and photographs-are gendered, but the language used to describe architectural form is also gendered, such as the classical orders of architecture, where Doric is masculine and Ionic and Corinthian feminine, or the binary of masculine-structure/feminine-decoration. The language of architectural professional practice is also gendered, as Diane Agrest shows in Chapter 39. The procedures and methodologies of architecture, 233 Ј Jane Rendell ў laid out in treatises, to be adopted by those practising architecture, contain representations of male and female. Using examples from the drawing and writing of Renaissance architects who advocated the use of particular proportion systems for setting out the formal geometries of buildings, Agrest argues that it is the male which is used to represent the ideal set of proportions, whereas the female body is either rejected from the practice of architecture or suppressed within it. American architect and critic Jennifer Bloomer also raises a number of questions concerning the professional practice of architecture through her drawn and written projects, in Chapter 40. For Bloomer, different modes of writing express different ways of understanding architecture through the intimate and personal, the subjective rather than objective, through sensual rather purely visual stimulation. Instead she brings into operation the irrational and subversive elements in written texts-the feminine. Drawing parallels between the creation of a building, assumed to be a clean act of control and precision, and the mess of childbirth, Bloomer questions the gender of creativity. Through her dirty drawings and her incorporation of parts of the female anatomy-breasts, milk, fluids, blood, hatching, udders-into architecture, Bloomer generates a critique of the sterility of the architectural drawing process. But can the role of the feminine and female body as a container or empty signifier be used to represent patriarchal ideologies? A number of architectural design projects have followed a similar kind of approach, drawing on theoretical concerns to stimulate a different way of considering the process of design, from the choosing of site to the articulation of services.

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