Daniel Len Edmonston, MD
- Medical Instructor in the Department of Medicine
- Member in the Duke Clinical Research Institute
https://medicine.duke.edu/faculty/daniel-len-edmonston-md
The effect should be kept in mind in analyses of accidents during the war (Writer birth control pills libido 3.03 mg drospirenone with mastercard, DeFraites birth control xulane 3.03mg drospirenone otc, and Brundage birth control helps acne purchase drospirenone 3.03 mg line, 1996) and in accidents of returned veterans (Kang and Bullman birth control 4 placebo pills buy drospirenone 3.03mg free shipping, 1996). Of course, many other factors are involved in increased accidents during periods of high operational activity and on return from overseas. In 1998, a new Russian (Soviet-developed) nerve agent, Novichok-said to be a binary agent and highly toxic-was mentioned in the press (Englund, 1992a, 1992b; Adams, 1996; Tucker, 1996; Uhal 1997; "Russia Dodges. There are no peer-reviewed or scientific journal references to this agent, although there are some press reports. Mirzaynov said he was certain that the Soviets and Russia had not sent Novichok to Iraq. The existence Novichok is scientifically undocumented, and its use has not been mentioned in any of the postwar revelations about Iraqi chemicals. The matter is mentioned here for completeness but does not appear relevant to a scientific review of chemical agents associated with the Gulf War. Epidemiology reviews of medical experience in the theater should keep in mind the reports of increased outpatient visits for eye, headache, and respiratory complaints noted in a farm clinic on days when organophosphate pesticides were sprayed nearby. Whether it is practical or desirable to do so is a matter for discussion with the institute and relevant specialists. In the ongoing discussions with Japanese clinicians about their follow-up studies, it would be valuable to develop a clearer picture of the long-term outcomes of the many mild cases who did not require treatment. There would be interest in long-term follow-up of such workers, most of whom would be rather elderly now. Such a study would be difficult and expensive, especially in providing suitable controls and obtaining credible data about other occupational exposures. It was not within the scope of this report to survey such activity or to report on work in progress or in unreviewed drafts. It would be helpful to use animal models of repeated subclinical exposure to replicate the effects Husain reported and to determine the threshold level of exposure that produces the effect. If the effects are consistently observed, it would be important to attempt their replication in some other species such as nonhuman primates, to better judge the hazard to humans from the effects of repeated subclinical exposures. It is not certain that important combined effects of nerve agents and organophosphate chemicals could not occur. Those working in the field might be asked about experimental designs to look at combined effects that might relate to pesticides to which troops were exposed during the war, if any. The role of receptor downregulation from sustained subclinical exposures is worth additional research. Further documentation of effects from subclinical exposures to military agents and interactions with anticholinesterase pesticides and pretreatments appears to be important. There is also evidence in animals that nerve agents at lower doses may permit the entry of viruses normally excluded by the barrier (Grauer et al. Regional activity within the brain increases cerebral blood flow to the active region. This in turn may alter the regional distribution to the brain of lipophylic agents and toxins such as nerve agents. The state of cerebral activity at the time of exposure may influence the response to nerve agents and other toxins. This variable might be examined in modeling the effects of agents at lower levels of exposure. Longerterm observations, performance effects, and biochemical studies are indicated for these analog exposures, to simulate possible exposures of the Gulf War. The possibility of a convergent mechanism with a common pathway for several exposures might be kept in mind in epidemiology studies that might develop an aggregate index of exposures of different kinds with which to compare later health effects. It may well be that nerve agents had nothing to do with illnesses of veterans of the Gulf War, but enough is known-and unknown-about their effects (especially in combination with other factors) not to ignore them. They define a minimum baseline of quality and workmanship for installing electrical products and systems. Existence of a standard shall not preclude any member or non-member of either organization from specifying or using alternate construction methods permitted by applicable regulations.
July birth control pills ortho novum buy drospirenone 3.03mg with mastercard, the North Vietnamese were reacting aggressively to these raids birth control pills 852 order drospirenone 3.03mg free shipping, pursuing and attacking the seaborne commando units birth control pills side effects buy drospirenone 3.03 mg low price. It was uncertain to the Americans what the Vietnamese oreciselv knew of the Craia or its mission birth control for women after menopause buy drospirenone 3.03mg free shipping. Hettick (left), the on-site tcisk force commqndet, qnd Commqndet Herbert Ogier, commqnding officer of the M4ddox commandos, along with the proximity of the Maddox, that would set off the confrontation. But the planners felt that these attacks could be attributable to the South Vietnamese. The plan did suggest that the communists would choose to continue to support the southern front, and it left open the possibility of further operations to offset the anticipated Chinese aid. The American involvement, though extensive in the planning, training, and logistics portions, was minimized to achieve the usual "nonattribution" status in case the raids were publicized by the North. It began with harassment attacks and operations, whose cumulative effect, though labeled "unspectacular," was to make Hanoi aware of them to the extent it would allocate forces to counter them. Until a better plan, such as 37-64, could be implemented, then doing "something," even as ineffective as the raids, was the course Washington chose to follow. Communications about small boat actions, commando landings, and high-speed chases out at sea were intercepted and reported back to Washington. What the reports showed was a North Vietnamese navy emboldened to more aggressive reactions to incursions by the commandos from the south. Whether or not the Vietnamese believed that the Americans were preparing for a larger war was not important. Codenamed Kit Kat, the effort required that the then current ceiling of 660 cryptologic personnel in South Vietnam had to be raised. It would be the intercept and reporting by the Marine unit at Phu Bai and the navy site in the Philippines which would prove critical to the events in the Gulf of Tonkin. A few of these would be cited in the various after-action analyses and postmortems that attended the Gulf of Tonkin. However, many more field translations and reports based on the intercept during the period of the incidents would be issued as late as two to four days after the crisis. Rather than try to retell the story all at once and incorporate the new evidence into the narrative, which could be overwhelming, especially to those readers not intimately familiar with the events of 2 to 4 August, a different tack will be used. First, we vill review the details of the known engagement of the afternoon of 2 August. While there is no controversy surrounding this fight - at least there is no question that it occurred - there is an important point to draw from it: that is, the North Vietnamese communications profile during a naval combat engagement was revealed. For ease of reference, we shall refer to this communications profile as the "command and control communications and intelligence" system or C3I. This is a functional description used widely in the intelligence and defense communities to describe the process whereby the individual elements of intelligence (information/intelligence), command and control (interaction by command authorities), and communications (communications links among all operating elements and units) are combined in military operations. In this section, the entire scenario of what was reported and, more importantly, what was not reported, will be considered. In this approach we vvill consider how the product was developed and the serious problems in translation, composition, and reporting of the information. For purposes of clarity, all time references will be marked either Zulu time ("Z," or Greem0ch Mean Time) or Golf ("G," or Zulu +7), which is the time zone for the Gulf of Tonkin. The use of Zulu time allows for a consistent and universal benchmark for analysts and recipients of the intelligence. Navy used Hotel time (Zulu +8) in all of its messages, which is carried over into its history of the Vietnam War. For example, if something happened at 1500 hours Zulu, it is reflected as 2200 hours Golf, 2300 hours Hotel and 1100 hours Romeo of the same day. However, a two-hour advance in Zulu time, that is, 1700 hours on 4 August, means 0000 hours Golf and 0100 hours Hotel time on 5 August, while Washington will be 1100 hours on 4 August. For ease of reference, the reader can observe that there is a eleven-hour difference between Washington and the Gulf of Tonkin.
In all cases birth control pills grapefruit juice buy 3.03 mg drospirenone, using the rescaled squared predicted values from the base model accomplishes the same task birth control and breastfeeding buy drospirenone 3.03mg mastercard. There are several further models of interaction that can be useful birth control for 35 and older buy 3.03mg drospirenone overnight delivery, particularly for designs with only one data value per treatment birth control pills ovarian cancer generic drospirenone 3.03mg fast delivery. These models have the restrictions that j = j i i = 0, so they represent b - 1, a - 1, and a + b - 2 degrees of freedom respectively in the (a - 1)(b - 1) degree of freedom interaction. It is not difficult to verify that the row- and column-models of interaction are orthogonal to the main effects and each other (though not to the Tukey model, which they include, or the slopes-model, which includes both of them). Johnson and Graybill (1972) proposed a model of interaction that does not depend on the main effects: ij = vi uj, 2 with the restrictions that i vi = j uj = 0, and i vi = j u2 = 1. This j more general structure can model several forms of nonadditivity, including one cell interactions and breakdown of the table into separate additive parts. The components, vi, and uj are computed from the singular value decomposition of the residuals from the additive model. In this experiment there are two types of flour (Patent or First Clear); the flour treatment factor (extraction) has eleven levels, and the flour has been stored for one of six periods (0, 3, 6, 9, 15, or 21 weeks). Of particular interest are the effect of storage time and how that might depend on the other factors. Here we are trying to understand the effect of freezing on the potency of chicken semen. Four semen mixtures are prepared, consisting of equal parts of either fresh or frozen Rhode Island Red semen, and either fresh or frozen White Leghorn semen. Sixteen batches of Rhode Island Red hens are assigned at random, four to each of the four treatments. Each batch of hens is inseminated with the appropriate mixture, and the response measured is the fraction of the hatching eggs that have white feathers and thus White Leghorn fathers (data from Tajima 1987). Explore the interaction in the tropical grass production data introduced in Problem 8. One measure of the effectiveness of cancer drugs is their ability to reduce the number of viable cancer cells in laboratory settings. In this experiment, the A549 line of malignant cells is plated onto petri dishes with various concentrations of the drug cisplatin. After 7 days of incubation, half the petri 224 A Closer Look at Factorial Data dishes at each dose are treated with a dye, and the number of viable cell colonies per 500 mm2 is determined as a response for all petri dishes (after Figure 1 of Alley, Uhl, and Lieber 1982). The dye is supposed to make the counting machinery more specific to the cancer cells. There are four starch sources (adzuki bean, corn, wheat, and potato), two starch percentages (5% and 7%), and two temperatures (22o C and 4o C). Determine the condition for orthogonality of two main-effects contrasts for the same factor when the data are unbalanced. The analysis of unbalanced data is more complicated, in part because there are no simple formulae for the quantities of interest. Thus we will need to rely on statistical software for all of our computation, and we will need to know just exactly what the software is computing, because there are several variations on the basic computations. The root cause of these complications has to do with orthogonality, or rather the lack of it. When the data are balanced, a contrast for one main effect or interaction is orthogonal to a contrast for any other main effect or interaction. One consequence of this orthogonality is that we can estimate effects and compute sums of squares one term at a time, and the results for that term do not depend on what other terms are in the model. When the data are unbalanced, the results we get for one term depend on what other terms are in the model, so we must to some extent do all the computations simultaneously.
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As a result birth control natural method buy 3.03mg drospirenone, it is not uncommon to be less disturbed by them birth control 10 years cheap 3.03mg drospirenone amex, or disturbed by them in a different birth control pill 5 days buy 3.03 mg drospirenone with visa, a wiser way birth control options for women purchase 3.03 mg drospirenone visa, even when they are acute. Awareness learns to let them be as they are and to hold them without triggering so much emotional reactivity and also so much inflamed thinking about them. We sometimes speak of awareness and discernment differentiating and perhaps naturally "uncoupling" the sensory dimension of the experience of pain from the emotional and cognitive dimensions of pain. It seems as if awareness itself, holding the sensations without judging them or reacting to them, is healing our view of the body and allowing it to come to terms, at least to some degree, with conditions as they are in the present moment in ways that no longer overwhelmingly erode our quality of life, even in the fact of pain or disease. The awareness of pain really is a different realm from being caught up in pain and struggling with it, and setting foot in that realm, we discover some succor and respite. This is itself is an experience of liberation, a profound freedom in that moment, at least from a narrower way of holding the experience of pain when it is not seen as bare sensation. It is not a cure by any means, but it is a learning and an opening, and an accepting, and a navigating the ups and downs of what previously was impenetrable and unworkable. The body scan is not for everybody, and it is not always the meditation of choice even for those who love it. But it is extremely useful and good to know about and practice from time to time, whatever your circumstances or condition. If you think of your body as a musical instrument, the body scan is a way of tuning it. If you think of your body as Page 9 the Body Scan Meditation a house, the body scan is a way to throw open all the windows and doors and let the fresh air of awareness sweep it clean. You can also scan your body much more quickly, depending on your time constraints and the situation you find yourself in. You can do a one in-breath or one out-breath body scan, or a one-, two-, five-, ten-, or twentyminute body scan. The level of precision and detail will of course vary depending on how quickly you move through the body, but each speed has its virtues, and ultimately, it is about being in touch with the whole of your being and your body in any and every way you can, outside of time altogether. You can practice body scans, long or short, lying in bed at night or in the morning. There are countless creative ways to bring the body scan or any other lying down meditation into your life. If you make use of any of them, it is highly likely that you will find that they will bring new life to you, and bring you to a new appreciation for your body and how much it can serve as a vehicle for embodying here and now what is deepest and best in yourself, including your dignity, your beauty, your vitality, and your mind when it is open and undisturbed. D Page 10 Sitting Meditation We call the heart of the formal meditation practice "sitting meditation" or simply "sitting. But mindful sitting is different from ordinary sitting in the same way that mindful breathing is different from ordinary breathing. We consciously adopt an alert and relaxed body posture so that we can feel relatively comfortable without moving, and then we reside with calm acceptance in the present without trying to fill it with anything. You have already tried this in the various exercises in which you have watched your breathing. It helps a lot to adopt an erect and dignified posture, with your head, neck, and back aligned vertically. It is also the physical counterpart of the inner attitudes of self-reliance, self-acceptance, and alert attention that we are cultivating. If you choose a chair, the ideal is to use one that has a straight back and that allows your feet to be flat on the floor. We often recommend that, if possible, you sit away from the back of the chair so that your spine is self-supporting (see Figure A). If you choose to sit on the floor, do so on a firm, thick cushion which raises your buttocks off the floor three to six inches (a pillow folded over once or twice does nicely; or you can purchase a meditation cushion, or zafu, specifically for sitting). There are a number of cross-legged sitting postures and kneeling postures that some people use when they sit on the floor.
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