Scott Hultman, M.B.A., M.D.
- Burn Center Director, Vice Chair of Strategic Planning
- Professor of Plastic and Reconstructive Surgery
https://www.hopkinsmedicine.org/profiles/results/directory/profile/10004220/charles-hultman
Dynamically menopause yellow discharge discount fluoxetine 10mg free shipping, that means that once I form the prior intention to greet you breast cancer grade 0 discount fluoxetine 20 mg with amex, not every logical or physically possible alternative remains open downstream breast cancer 9gag buy 20 mg fluoxetine amex, and those that do are contoured differently: the probability of waving or saying " Hi! Thinking of prior intentions as parsing a self-organized dynamics in this way also explains why settling on one prior intention (say women's health issues in texas buy fluoxetine 20 mg otc, the intention to rob) precludes settling on a logically conflicting one (not to rob). Once I decide to perform act-token A, non -A is no longer a viable alternative (Bratman 1987): it drops out downstream as one of the coordinates. That is what Hinton, Plaut, and Shall ice (1993, 79) mean when they speak of " motion through a multidimensional semantic space. Top -down contextual constraints ensure that the behavioral trajectory will remain within the semantic space carved out by the meaning of the proximate intention. This approach does away with the atomistic Intentional Action 189 and instantaneous character of volitions and intentions, in effect dissolving the problem of wayward causal chains. The Problem of Wayward Causal Chains Resolved From a dynamical point of view, therefore, consequential wayward causal chains are trajectories lesioned below the semantic cleanup units responsible for the basic action: noise and equivocation entered downstream from those units. In consequential chains, that is, the appropriate general basin in semantic space originates and constrains the output, but damage caused by the stroke, say, affects the particular motor trajectory. By preserving the intended meaning but erring in the choice of words, the actual utterance betrays the presence of noise and equivocation, brought on by the stroke. And we know where that is happening: contextual constraints downstream from the semantic cleanup units have malfunctioned. Antecedential wayward chains, on the other hand- those characteristic of surface dyslexia or the nervous nephew example - can beconceptual ized as trajectories lesioned above the semantic cleanup units. When this happens, the resulting behavior is pure noise, even if, as in the case of the nervous nephew, the event happens to satisfy semantically (and can be traced to) an efficient cause. Topologically, the nephew example looks like a directed graph that catastrophically drops off semantic space altogether onto a different, nonsemantic page just after the intention is formulated. As a result, semantics do not constrain the downstream portion of the trajectory at all. A dynamical view of action has the advantage that unlike the old causal version, it can handle these distinctions. Multidimensional, intertwined dynamics should even be able to explain Freudian slips in this way! Multiple Realizability and Equivocation: An Objection In the chapter on information theory, I said that neurological processes constitute the communications channel for intentions and basic actions. On the other hand, 190 Chapter 12 information is generated whenever an option is selected from a set of alternatives. In other words, because intentions and other mental states can be realized in more than one neurological pattern, once one of those alternatives is chosen, is the neurology really silent, as it must be to serve as the communications channel? In the chapter on information theory I also claimed that to constitute action the trajectory " intention to raise arm - t arm rises", must unequivocally identify the intention as the source of the behavior. That is, the conditional probability that the arm went up because someone else lifted it, or as the result of a muscle spasm- or because of anything other than the intention - must be zero. Appealing to the dynamics of self-organization can help circumvent this potential objection. As we saw in the case of Benard cells, it does not matter whether the cells are made of water or other viscous materials. At any given moment, the alternatives that matter to a complex dynamical system, so to speak, are the coordinates of the graph on which the system currently finds itself (blue or red, after the B-Z self-organization, for example). If evolutionary sequences are like a series of catastrophes, the alternatives from which information can be generated are those coordinates of the page the system happens to be on at the moment. Since that indifference is a defining feature of hierarchical systematization, dynamical selforganization is one way levels become partly sealed off from one another. The particular embodiment or structure the action takes will depend on its initial conditions. Only when events at the component level compete with the integrity of the systems level organization (as happens biologically in cancer and cognitively with strokes) do the former generate their own information, which can make the output equivocal.
Activists such as Debra Harry (Northern Paiute) and Brenda LaFrance (Akwesasne Mohawk) stated that nothing at the conference had convinced them that these "new" directions in genetics research womens health medicaid discount fluoxetine 10 mg with amex, repackaged in the vocabulary of "environmental justice women's health issues in the workplace buy fluoxetine 10mg amex," were anything more that the latest form of biocolonialism breast cancer nails design discount fluoxetine 10mg online. Examining the specificity of the growing collective response by Indigenous activists from around the world to the triumphalist discourse of the "gene age" reveals particular kinds of languages and practices of resistance menopause medicine generic 20mg fluoxetine free shipping, as the Native American voices at the New York Conference on Human Genetics and Environmental Justice illustrated. A significant difference in the language and practices of environmental justice and human rights activism in Indigenous communities living within states is the assertion of their right of self-determination: the recognition of their status as distinct societies with rights of selfgovernance and control of land and resources that derive, in turn, from their status as original peoples. The central aim of the global movement of Indigenous activists fighting against the onslaught of genetic researchers into their communities is to resist the neocolonial state apparati (in this case represented by government-funded genetic studies) from gaining further access to and exploitation of their bodies, their territories, 260 Giovanna Di Chiro and their traditional knowledge. The corporate hunt for genetic resources within our territories raises new difficulties for those maintaining permanent sovereignty over natural resources that have long been sought after by colonial governments. Intellectual property rights are being used to turn nature and life processes into private property. This, in the eyes of many Indigenous peoples, is an attempt to legalize thievery, a thievery that we recognize as "biocolonialism"-the extension of colonization to the biological resources and knowledge of Indigenous peoples. Certainly, African American and Latino environmental justice activists express well-founded misgivings about biomedical research that highlights racialized bodies or that is preoccupied with the concept of genetic variation. This wariness (sometimes characterized by the medical community as "science-phobia") is situated in the context of two notorious historical episodes: the late nineteenth- and early twentiethcentury eugenics movement, which, in the name of scientific objectivity and social improvement, aimed to breed out racially and biologically "inferior" segments of the population through sterilization programs and antimiscegenation laws, and the now-infamous Tuskegee syphilis experiment conducted between 1932 and 1972 by the U. Public Health Service on unsuspecting, poor, African American men suffering the agonizing symptoms of late-stage syphilis. Used as the quintessential human "guinea pigs," the men were not informed of the experiment by government scientists or given medical attention, all in the interest of tracing the etiology of the disease in the human body to develop better treatments and cures. Citing the Principles of Environmental Justice, many environmental justice organizations insist that the government agree to "strict enforcement of the principles of informed consent" and invite historically marginalized communities "to participate as equal partners at every level of decision-making" (Sze and Prakash 2004, p. For most Native American communities, the condition of "participating as equal partners" in the research process cannot be met until the U. In contrast, citing different histories of dispossession and environmental racism, environmental justice activists see themselves as rightful, though marginalized, citizens making demands on the democratic state to fulfill its duty to protect all citizens equally by regulating industrial pollution, mandating corporate accountability, and, most important, assuring that low-income communities of color partake of the benefits that may spring from the latest scientific advances. Although Indigenous communities also call for equality of access within national states to entitlements such as education, health care, and economic opportunities, the overriding goal to protect their right of selfdetermination dictates a different relationship to the state, the scientific enterprise, and claims for environmental justice. If we go back to the first colonization of this country, it was about the tearing down of our forests and the rape of the land to introduce the technology of sheep farming. Then it was the polluting or damming of the rivers to introduce the technology of hydropower. The only substantive difference now is that whereas the other instances were largely driven by the colonizing government, genetic modification is driven by multi-national corporations. For Harry and many other Indigenous activists, therefore, the definition of "environmental justice" must take into account the history of Western property rights, the idea of individual Indigenous Peoples and Biocolonialism 263 land ownership, and the concept of the alienability and commodification of land, resources, and genetic materials. Patent Office transforms life forms into commodities, making them alienable, and thus available for incorporation into the market (Harry and Kanche 2005). Expressing the central tenet of human-environment interdependence underlying the view of environmental justice held by most Indigenous peoples, Harry asks, "Is the human body a commodity? To construct a postcolonial "science of environmental justice," the knowledges and practices developed by many Indigenous communities must be taken seriously and not dismissed as relics of the primitive past or caricatured as stemming from an inherent, intuitive ecological consciousness. The New "Biowarriors": Protecting "Our Life, Lineage, and Sustenance" Recognizing that she would not have walked a life path absorbed in the science and policy of genetics and biotechnology had the path not "chosen her," Harry laments the lost opportunities for cultural growth and development that more than 500 years of colonialism has wrought: Our early ancestors made significant contributions to astronomy, arts, architecture, agriculture, mathematics, ecology, social science, political science, and genetics. How far we would have gone in these areas is unknown because our recent ancestors put them aside as they were forced to contend with colonization. Frank Dukepoo, the respected Hopi geneticist, Indigenous Peoples and Biocolonialism 265 who was one of the early Native American scientific voices questioning the potential dangers to Indigenous peoples of some of the new directions in genetics research. As one of only two American Indian research geneticists at the time, Dukepoo made the decision in the early 1990s, after a thirty-year academic career studying the genetic basis of albinism in the Hopi people, to "put a moratorium on his own research. Harry maintains a demanding schedule of presentations, lectures, and expert testimonials and sits on the board of several transnational Indigenous organizations, such as the Call of the Earth and Je Atawha ote Ao: Independent Maori Institute for Environment and Health, and numerous genetics watchdog organizations, including the Council for Responsible Genetics. One protective measure encourages tribes to enact legal codes that regulate research within tribal jurisdictions. She continues, the unmet need for tribes who want to interface with genetics research is for enforceable, legal frameworks that regulate this research. They say that we are created by the four sacred elements earth, air, fire and water. They must do whatever is necessary to protect their resources and knowledge at the local level.
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The enormous capacity of the new large machines means closure of older plant and concentration of production onto fewer plants - and fewer jobs breast cancer z11 discount fluoxetine 20mg visa. It is difficult for the unions to organise in these units not only because of their small size but also because the relatively low level of skill required enables employers to side-step the traditional system of supply of skilled labour by the unions womens health zeitschrift buy generic fluoxetine 10mg. Thus an increasing proportion of print in London is being carried out in small units outside the union structures of the industry womens health of blairsville order 20 mg fluoxetine otc, especially in instant printshops women's health center vanderbilt cheap 10mg fluoxetine, and in in-house printing units within major offices. Meanwhile, medium-size printers are being competitively squeezed between the two extremes. On the business printing side, London is not only the national centre of business and governme nt but also a major international financial and commercial centre. On the consumer print side, London is the national centre of cultural production, including publishin g of all kinds from the popular to the esoteric. The London industry has benefitted directly from the massive expansion of demand for both business and consumer print during the 20th century. This has occurred both by firms shifting their productio n out of London, and by a shift in contracts placed to out-of-London firms because of their lower prices. Recently, decentralisation has moved beyond the national boundarie s and has reached the Third World, motivated by very much lower wage costs and weaker union organisation. Changes in the method of productio n have been necessary to enable firms to free themselve s from their previous ties to London. Neverthel ess, capital has sought to free itself from this constraint by using new productio n technologies to lessen or to change the skills needed. This was so with the successful struggle around the turn of the century for the employment of existing manual typesetters on the new mechanised Linotypes and Monotypes. Together with the agreements over recruitment and training secured by the unions, this has inhibited the shift of the industry from London. However, the new technology available to firms now gives them greater means by which to deskill and to decentralise than ever before (see below). The buyers of print the market ties that initiate and end the printing process operate in different ways for consumer and business print. For business print, the material is originated by the client and is also, in the great majority of cases, returned to the client for any subsequent distribution, as for company accounts, for example. In this case, then, there is a tie to the client for the transport both of the copy and of the final product. In the case of consumer print, as in newspapers and magazines, the tie to the client only operates for the input of the copy, since the product is generally distributed directly to the consumers. Thus the tie to the client has operated to keep printing production in London only for work which requires a very fast turnaround time. In contrast, most consumer print has a slow turnaround time, apart from newspapers and, to a lesser extent, magazines and some types of advertising material. This has been one factor enabling the decentralisatio n of much consumer print from London since the mid-19th century. The publishing operations commissioning this work, however, generally depend strongly on face-to-face contacts within the cultural industries of London and have therefore been much more resistant to decentralisation. The relation to the customer is now being revolutionised, in both business and consumer print, by the new communicatio ns technologies (see below). The transport system has therefore tended to enable the less timely work for London clients to be decentralised. Book printing was moved to other parts of Britain during the 19th century, and since the war an increasing part has been moved abroad. The volume printing of brochures and advertising material has tended to move out of London and increasingly out of Britain since the war. Since the 1960s much of the less urgent business work has also been decentralised, mostly to other parts of south east England. However, the majority of the printing of local (borough) newspape rs is done outside London. City printers specialising in overnight and fast turnaroun d work for business and governme nt. These are medium sized firms, though many are now subsidiaries of large companies. They are also geographically extremely concentra ted, around the eastern and southern fringe s of the City and West End. These are small or medium enterprise s (though many of the medium sized firms operate from more than one site).
Other noncaustic items menstruation cup effective fluoxetine 10 mg, after the initial discomfort subsides menopause uterus pain purchase fluoxetine 10 mg amex, will often pass through on their own menstrual symptoms after hysterectomy cheap fluoxetine 10mg amex. For any questions or concerns menopause panic attacks order 20 mg fluoxetine fast delivery, always consult with your medical-care professional. Managing Shock Preventing and managing shock is a matter of life and death in emergencies. When the circulatory system stops working to deliver blood to the body, shock occurs. If the heart beats irregularly, if blood vessels become too dilated, or if a person is losing too much blood, shock may occur. If someone is in shock, elevate her legs, keep her warm, and turn her head to one side if neck injury is not suspected In emergency situations you must guard the person against shock. Call 911 for help immediately, because you cannot manage shock alone for long, and the person is likely to go into cardiac arrest. If the head, neck, back, hips, or legs are not injured, lay the person on the ground facing up and elevate the legs to keep critical blood flow to vital organs. Use a towel, a sanitary napkin, or a piece of clothing to apply pressure to open wounds to slow bleeding. Keep the person calm, comfortable, and warm, but never give the person water, even if they claim to be very thirsty. This chapter will help keep you and your family safer in the home, with an overview of prevention measures you should take. Take a look at your home, assess any safety issues and unsafe habits, and determine potential hazards. Think about what you can do to correct those danger areas, and take necessary safety and prevention measures. Many chemical products are particularly damaging to the eyes and require protective goggles (even if you wear glasses) during use. The word "nontoxic" only indicates that a substance may cause little to no adverse reactions if you eat it or inhale it. Reading labels and directions will help you determine if it is a product you really want in your home and will instruct you how to use it and what to do in case of emergency ingestion or contact with eyes. Try to avoid products labeled with the words "Caution," "Poison," "Danger," or "Warning. Take a break, go outside, or even stop working altogether if you become dizzy, nauseated, or develop a headache. For pests, baits and traps are the safest pesticides because they do not cause the entire area that you are treating to become toxic, and are designed so that the pest enters the container containing the pesticide and then takes it back to the colony or nest. For pet flea control, try alternatives such as enzyme shampoos and using a 50:50 mixture of white vinegar and water sprayed on the pet, weekly washing of pet bedding, and frequent vacuuming. After using rags with any flammable products, such as furniture stripper or paint remover, store them in a sealed and labeled, preferably metal, container away from heat or sparks that could ignite them. Fact If you are pregnant, try to avoid toxic chemical exposure, because many toxic products have either never been tested for potential harmful effects to an unborn fetus or have been manufactured, sold, and then later found to be toxic and taken off the market. Fire Administration recommends having working smoke detectors installed in all bedrooms, in rooms outside the bedroom areas, and at least one detector on each story of your house. They also recommend that you test your smoke detectors monthly, replace the batteries once a year, and replace the detectors after ten years of use. Because fires commonly travel along the stairway, you should have escape ladders to help you get out of the second story of a house and practice using them when you practice your escape plan. Never try to put an out-of-control fire out, just leave quickly and call for help. Also be sure to plan a location where the family will meet together outside after escaping. Chimneys and stovepipes should be professionally cleaned yearly for creosote, a substance that can ignite and cause a house fire.
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