Condet

Peter C. Gerszten, MD, MPH, FACS

• Associate Professor
• Department of Neurological Surgery and Radiation Oncology
• University of Pittsburgh Medical Center
• Pittsburgh, Pennsylvania

After 1939 medications beginning with z buy flutamide 250mg mastercard, the Third Reich had no option except to expend inordinate amounts of resources to secure and transport relatively small quantities of oil symptoms lead poisoning purchase flutamide 250mg without a prescription. Germany invested billions of Reichmarks medicine administration order flutamide 250mg fast delivery, millions of tons of coal and steel treatment keloid scars order flutamide 250 mg with mastercard, and the labor of tens of thousands of skilled and slave laborers to construct its synthetic fuel industry. The vast synthetic production facilities, which often produced a variety of synthetic products besides petroleum, including rubber or chemicals such as ammonia and methanol, were also vulnerable to bombing. Production could even be disrupted indirectly by attacks on the railway lines and distribution hubs that supplied these facilities with the coal and steel they needed to function, and which carried their output to consumers across Axis Europe. In the case of the former, we are speaking of the revolutionary application of tanks supported by mechanized infantry and close air-support that interwar theorists (in Germany and elsewhere) designed to overcome the stalemate of the First World War, and which supposedly brought France to its knees in six weeks. In the case of the latter definition, we are 17 For additional information concerning the extent of prewar capital, material, and labor investment in the German oil industry (both natural and synthetic), as well as detailed information concerning production, imports, and consumption, see: Chiefs of Staff Committee, Technical Sub-Committee on Axis Oil, Oil as a Factor in the German War Effort, 1933-1945, 08 March 1946, A. Karl-Heinz Frieser, the Blitzkrieg Legend: the 1940 Campaign in the West (Annapolis: Naval Institute Press, 2005), 4-11. Each military campaign from the invasion of Poland to Operation Barbarossa was designed to be selfsupporting and timed in such a way as to allow Germany to gather its economic resources before launching itself at its next opponent. The aforementioned analyst even surmised that Germany "came out ahead of the game," since he estimated that it managed to capture about 20,000,000 barrels in France and the Low Countries. Jensen, "The Importance of Energy in the First and Second World Wars," Historical Journal 11: 3 (1968): 545-554; and Lesser, Resources and Strategy, 70-72. The British Government estimated that the Germans captured 550,000 tons of oil in Norway, Denmark, Holland, and Belgium (3,850,000 barrels). The Germans, however, acquired only 800,000 529 Neither definition of Blitzkrieg is entirely accurate. The Germans rarely used the term, but analogous concepts such as Bewegungskrieg (war of movement) had a long pedigree in Prussia-Germany that dates back at least to Frederick the Great. By virtue of its exposed position in the center of Europe, small population prior to unification and industrialization, flat terrain, and lack of natural resources, Prussia, which did not even have contiguous borders until after the acquisitions from the Wars of Unification, had to a make a virtue out of necessity. The emergence of the oil-fueled triad of combined arms (tanks, mechanized infantry, and airplanes), like railroads and telegraphs before them, allowed practitioners of the German "way of war" to fight more effectively the kinds of short, sharp battles of encirclement and/or annihilation Prussia-Germany needed to win if it was to deny its enemies the time to make good on their numerical, economic, and materiel superiority. German officers served an institution that even before 1918 already valued the key tenets of Blitzkrieg/Bewegungskrieg: speed, surprise, tactical flexibility, mobility, and most importantly, aggression. The breakdown was: 363,000 tons of gasoline; 65,000 tons of diesel fuel; 222,000 tons of aviation fuel; and 150,000 tons of fuel oil. Before the war, it was an article of faith that France had pursued a conscientious policy of accumulating large war reserves, since it lacked either the extensive overseas oil concessions of Britain or sufficient coal to synthesize into petroleum like Germany. The Italians were astonished by the dearth of French reserves in the summer of 1940, having believed that the French Navy possessed "underground lakes" of petroleum in Tunisia and huge reserves in Toulon. In reality, France had been dependent upon shipments from Iraq, where the British and U. Gregory Nowell, Mercantile States and the World Oil Cartel, 1900-1939 (Ithaca: Cornell University Press, 1994), 252-262 and 275-276. Prospects for decisive victory, as opposed to bean-counting attrition, seemed to be reemerging. The political and social consequences of the failure of Bewegungskrieg were also troubling. MacGregor Knox, Common Destiny: Dictatorship, Foreign Policy, and War in Fascist Italy and Nazi Germany (Cambridge: Cambridge University Press, 2000), 186-226. Carole Fink, Isabel Hull, and Williamson Murray (Norman: University of Oklahoma Press, 1985), 71-79. Rather than weighing means and ends, the military stuck to its area of expertise, perhaps as a means of preserving its political independence, since military interference within traditionally civilian areas of policymaking would have risked reciprocal meddling in military affairs by politicians. In exchange for not commenting on matters of grand strategy in peacetime, German officers expected that political and economic considerations would be subordinated to "military necessity" in wartime. The ramifications would be sorted out by the civilian leadership after the military had achieved a decisive military victory. Although Hitler and the German Army thought Germany could wage such a campaign against the Soviet Union in 1941, there is no evidence that either intended to wage a "Blitzkrieg" against France in 1940. Only a combination of bad weather, opposition by the military (which wanted time to rest and refit while absorbing the lessons of the Polish campaign), and the compromising of the German war plan in January 1940 (after a plane carrying it accidentally landed in Holland) convinced Hitler to postpone the offensive.

Rather medications blood donation discount flutamide 250mg with mastercard, "in contrast to the Treaty of Versailles treatment diffusion generic flutamide 250mg amex," Germany should engineer "[the] sale of English and French interests in third countries treatment strep throat generic 250mg flutamide, which are of particular interest to us treatment hypercalcemia order 250 mg flutamide free shipping," making specific reference to Anglo- and French-owned oil companies in Romania. Within the section pertaining to "Claims for Damages," Bohle made specific reference to the "oil trusts, mining companies of all kinds, [and] the Suez Canal Co. Both Ritter and Clodius were most concerned with the issue of postwar trade, since, as Ritter observed, the population of a German-dominated Europe "have for the most part a consumption and production capacity above average. Before the war, Continental Europe had consumed 26,800,000 tons of petroleum products against a local production of 7,950,000 tons of oil (not including German synthetic production). The major player in Europe was the Soviet Union, whose reserves could be as large as 1,000,000,000 tons. Although rising Soviet consumption had limited the exportable surplus to only 1,000,000 tons to 1,500,000 tons by the end of the 1930s, the RfB nevertheless felt confident "that Russian production will rise further during the next few years. The estimated reserves of the latter (960,000,000 tons) dwarfed those of the former (500,000,000 tons). Concerning the former, although oil had been discovered in Algeria and Morocco, the level of discoveries "was in spite of all efforts only limited. Even within Egypt, where production had reached over 1,000,000 tons by 1939/40, more than half of output was consumed locally, leaving little available for the Afrikakorps if they succeeded in conquering the country, none of which could be refined locally into high-octane aviation fuel. As for the rest of Africa, although there was some hope that more extensive exploration efforts might yield major discoveries in the future, the prognosis in the short to medium term was grim. Ironically, the Axis Powers were already in possession of territories containing quantities of oil beyond their wildest imagination in Libya. Whereas in the report of April 1940, British interests in the Near East "outweighed" all others, the situation had completely changed by May 1944: "The crude oil industry of the Near Orient stands today as a symbol of the advancing influence of the United States, which believes that, in the Near Orient, it sees the crude 445 Many of these points were elaborated upon in a follow-up report produced by the RfB in 1942 that dealt exclusively with the Middle East. The bulk of this increase would take place in just five nations: Iran, Iraq, Bahrain, Saudi Arabia, and Kuwait. But the RfB also warned that raising Middle Eastern production was more complicated than just raising output from existing fields. For one thing, "[a] boosting of Near Eastern oil production is dependent upon the possibilities for transportation. On 24 July 1940, Bentz completed a study considering "The Safeguarding of oil territory of the future, [and] whose development with great energy stimulates the protection of its own [oil] deposits [. Finally, although the discovery of oil in Iran was strictly a British measure in a commercial sense, Germans had participated in both the initial exploration and production efforts. The language within the reports is inoffensive, while the conclusions were based on publicly available data, especially trade publications. Unfortunately, this rate of production was unsustainable, and Bentz concluded that "one should not count upon Germany being able to deliver a yearly figure of more than 1 million tons of crude oil. He was confident that Soviet production would rise in spite of the existing material and labor handicaps, thanks in large part to the development of the "second Baku" west of the Urals. Bentz made special mention of Iraq, where the output of the Kirkuk field (4,200,000 tons) per annum was considerably below its "natural capacity" of between 15,000,000 to 20,000,000 tons. Within the Middle East, reserves fluctuated from a low of 10,000,000 tons in Egypt, to a high of 350,000,000 tons in Iraq just within the Kirkuk field (and a further 200,000,000 tons elsewhere in the country). Excluding England, Ireland, the Soviet Union, and Turkey, Bentz estimated that demand in Europe exceeded the supply by 19,000,000 tons. The situation was only slightly better if European supply and demand was combined with that of the Middle East: a demand of 30,600,000 tons against a total crude oil production of 24,800,000 tons. Bentz believed that there were two ways to resolve this shortfall: the first was through an expansion of synthetic fuel production.

Identification of empirically supported counseling psychology interventions: Commentary medicine zetia flutamide 250mg mastercard. Generalized social phobia and avoidant personality disorder: Meaningful distinction or useless duplication Morbidity risk of psychiatric disorders among the first degree relatives of schizophrenia patients in Taiwan symptoms 9dp5dt purchase 250mg flutamide free shipping. A twin study of generalized anxiety disorder symptoms medicine zofran generic flutamide 250 mg otc, panic disorder symptoms and post-traumatic stress disorder in men symptoms narcolepsy discount flutamide 250 mg without prescription. Poster presented at the Research Forum Educational Program, American College of Emergency Physicians, Seattle, Washington. In Treatments that work with children: Empirically supported strategies for managing childhood problems (pp. Tolerance to and physiological dependence on alcohol: Behavioral and neurobiological mechanisms. Meta-review on short-term effectiveness and safety of antidepressants for depression: An evidencebased approach to inform clinical practice. Self-help groups for families of persons with mental illness: Perceived benefits of helpfulness. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization. Evaluating three treatments for borderline personality disorder: A multiwave study. Contrasting perspectives on personality problems: Descriptions from the self and others. Implicit and explicit memory for catastrophic associations to bodily sensation words in panic disorder. A systematic method for clinical description and classification of personality variants: A proposal. Overlap among clinical, counseling, and school psychology: Implications for the profession and combined-integrated training. Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: A double-blind, placebo-controlled study. Alcohol expectancies as potential mediators of parent alcoholism effects on the development of adolescent heavy drinking. Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. Self-perceived family functioning in 40 French families of anorexic adolescents: Implications for therapy. The heritability of gender identity disorder in a child and adolescent twin sample. Identification of patient attitudes and preferences regarding treatment of depression. Plasma cortisol concentrations preceding lactate-induced panic: Psychological, biochemical, and physiological correlates. Serotonin and sensitivity to trauma-related exposure in selective serotonin reuptake inhibitors-recovered posttraumatic stress disorder. Childhood attentional dysfunctions predict social deficits in unaffected adults at risk for schizophrenia.

People with catatonic schizophrenia typically cannot care for themselves and require constant attention symptoms kidney failure buy 250 mg flutamide with amex. Residual schizophrenia may also be diagnosed when prominent negative symptoms are absent but two or more mild positive symptoms in treatment online discount 250mg flutamide overnight delivery, such as odd beliefs that are not delusional treatment uterine fibroids buy flutamide 250mg low price, are present (American Psychiatric Association medicine 79 purchase 250mg flutamide with mastercard, 2000). The deficit subtype requires the presence of severe neurocognitive defi cits in attention, memory, and executive functioning, as well as the positive and negative symptoms that are manifestations of these deficits, such as disorganized speech and behavior and alogia. Such patients are generally more impaired than are other patients with schizophrenia, their symptoms are less likely to improve with currently available treatments, and they have a poorer prognosis. The nondeficit subtype requires the presence of primarily positive symptoms, such as hallucinations and delusions, in conjunction with relatively intact cognitive functioning. People with this subtype are generally less impaired, and they have a better prognosis (McGlashan & Fenton, 1993). Distinguishing Between Schizophrenia and Other Disorders Positive or negative symptoms may arise in schizophrenia or in the context of other disorders. Clinicians and researchers must determine whether the positive or negative symptoms refl ect schizophrenia, another disorder, or, in some cases, schizophrenia and another disorder. We will contrast schizophrenia with mood disorders, substance-related disorders, and a set of various psychotic disorders-including schizophreniform and brief psychotic disorders, schizoaffective disorder, delusional disorder, shared psychotic disorder, and schizotypal personality disorder. Psychotic Symptoms in Schizophrenia, Mood Disorders, and Substance-Related Disorders Undifferentiated schizophrenia the subtype of schizophrenia characterized by symptoms that do not completely match those specified for the paranoid, disorganized, or catatonic subtype. Other psychological disorders, most notably mood disorders and substance-related disorders, may involve symptoms such as hallucinations and delusions. For instance, people with mania may become psychotic, developing grandiose delusions about their abilities. Psychotic mania is distinguished from schizophrenia by the presence of other symptoms of mania-such as pressured speech or little need for sleep. Substance-related disorders can lead to delusions (see Chapter 9), such as the paranoid delusions that arise from chronic use of stimulants. Substances (and withdrawal from them) can also induce hallucinations, such as the tactile hallucinations that can arise with cocaine use. Some negative symptoms of schizophrenia can be difficult to distinguish from symptoms of other disorders, notably depression: People with schizophrenia or depression may show little interest in activities, hardly speak at all, give minimal replies to questions, and avoid social situations (American Psychiatric Association, 2000). With schizophrenia, these behavioral symptoms stem from the cognitive deficits associated with the disorder. In general, people with schizophrenia but not depression do not have other symptoms of depression, such as changes in weight or sleep or feelings of worthlessness and guilt (American Psychiatric Association, 2000). Of course, people with schizophrenia may develop comorbid disorders, such as depression or substance abuse. The presence of any comorbid disorder can make it more difficult to determine the correct diagnoses. In contrast, the criteria for the disorders collectively referred to as psychotic disorders specifically require the presence of psychotic symptoms. Psychotic disorders are considered to lie on a spectrum, related to each other in their symptoms and risk factors but differing in their specific constellations of symptoms, duration, and severity. In addition to schizophrenia, these disorders include schizophreniform disorder, brief psychotic disorder, schizoaffective disorder, delusional disorder, and shared psychotic disorder. Although it is not classified as a psychotic disorder, the personality disorder schizotypal personality disorder (discussed in Chapter 13) is thought to be part of the spectrum of schizophrenia-related disorders (Kendler, Neale, & Walsh, 1995). The individual clearly suffers from some psychotic symptoms and has significant difficulty in functioning as a result of his or her psychological problems. Two disorders fall into this class, depending on the specifics of the symptoms and their duration. In addition, daily functioning may or may not have declined over that period of time. In contrast, brief psychotic disorder refers to the sudden onset of psychotic symptoms (hallucinations and delusions), symptoms of disorganized speech or behavior, or catatonic behavior, that last between a day and a month and are followed by a full recovery (American Psychiatric Association, 2000).

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