Because of the constitutional directive that clemency rest with the executive treatment for glaucoma dogs order noroxin 400 mg with amex, independence from the president is not a relevant goal antibiotic resistance presentation cheap noroxin 400mg mastercard. In the federal system infection names order 400mg noroxin with visa, it would be possible to replicate such a system by appointing one commissioner from each Court of Appeals circuit infection zombie movie order noroxin 400 mg overnight delivery, but that would do little to encourage racial and ideological diversity antibiotics for acne how long should i take it purchase noroxin 400 mg mastercard. Similarly treatment for distemper dogs purchase noroxin 400mg otc, the diversity of the Ford Board was achieved through the intentional actions of the executive, and President Ford lived at a time when bipartisan cooperation was common. Previously, Rachel Barkow and I suggested a clemency board where slots are filled by people of certain expertise; for example, we might require a commission to include a former federal prosecutor, a former federal defender, a former federal judge, a former federal probation officer, and a former police officer, among others. Our inclusion of "former" in those descriptions was intentional; a board with the charge of running federal clemency would benefit from being staffed with full-time rather than part-time commissioners. As in the states, a greater degree of transparency could be achieved, as the system would be less complex and less hindered by the rules of multiple agencies. The Framers did not insert the pardon power into the Constitution by accident; they intended it to be used for the purposes favored by the president. The problem is clear, and so is the solution: Our inefficient vertical hierarchy of decision-making must be replaced with a modern horizontal process that can provide us with efficiency in the service of wisdom. A horizontal system, where members of a board deliberate with one another, seems to function more consistently and productively than one where officials review cases sequentially in a hierarchy. A flatter, horizontal system allows for consistency through consensus in a way that is not possible in a hierarchical process. Those evaluating clemency-either in making recommendations to an executive or determining outcomes-should be diverse in background and ideology. It is our privilege today to have before us the acting administrator of the National Aeronautics and Space Administration, Robert Lightfoot. I personally want to thank you on behalf of the American people for your extraordinary service to the country, to the space program. You have done a magnificent job and it has just been a real privilege to work with you. We have worked arm in arm to make sure that you got the resources you need to finally begin to do everything that you have got on your plate and we have got you headed in the right direction, and we are looking forward to your testimony today. I was saddened to learn of your impending departure from the Agency and just wanted to take a moment to thank you for your dedication and service to our nation. Chairman, I hope that we can work together in a bipartisan manner to preserve these programs that so greatly benefit the American people, just as we did for fiscal year 2018 just a few weeks ago. In addition, I am concerned by the intent to eliminate the Wide Field Infrared Survey Telescope. This project received 150 million in 2018 and was ranked as the highest scientific priority space astrophysics mission by the 2010 decadal survey. By the way, if you are short of people to send up, the Chairman and I could give you a list of a couple of people. To grow in communications, descent, and landing capabilities, and ways to protect astronaut health during long, deep space missions, among other things, all of these improvements will require massive amounts of money over a long period. Chairman, as you very well know, I am also a strong supporter of the Arecibo Observatory and believe that we must maintain strong support for its mission. Thank you once again, Acting Administrator Lightfoot, for joining us today, and I look forward to discussing these important issues with you. We were committed to get you north of 20 and we did so, with the help of Chairman Shelby. But we have your back, Administrator Lightfoot, and we are glad to have you here today and look forward to your testimony. To go off a little bit here, but as you leave, I hope you spread the word around that this Member of Congress, and I know the Chairman agrees with me, I have been in public office for 44 years, State Assembly and in Congress, and there is nothing more exciting to bring to a school than an astronaut. And your testimony in its entirety, if there is no objection, will be entered into the record. Chairman and members of the subcommittee for the opportunity to testify this morning. But before I begin, I do want to thank you, all of you, for the outstanding support with the 2018 budget recently enacted. Chairman, and I think that for us that lets us move forward pretty aggressively across our entire portfolio. I think through the mission, we are going to produce knowledge and discoveries as you have talked about to strengthen our economy and security, deepen our partnerships internationally, and as just stated, really inspire the next generation. As private companies continue their successful cargo missions to low earth orbit, we will once again launch astronauts from American soil beginning with test flights this year. We believe it is a perfect platform for us to understand the full potential of what we need to do while we still have it. Their momentum continues this year toward the first integrated launch of the system in fiscal year 2020, with a mission with crew in 2023. In 2019 in particular we will have an important test for us, the Orion Launch Abort System will test. We will also begin to build the in space infrastructure for longterm exploration and development of the moon by delivering to lunar orbit a power and propulsion element. This Gateway will expand what humans can do in the lunar environment and provide opportunities to support those commercial and international missions to the surface, but also in the area around the moon with the technologies we need for further exploration. Our plan is going to draw on the interesting capabilities of industry and international partners and we are going to develop progressively more complex robotic missions to the surface of the moon with scientific and exploration objectives in advance of human return. As you both stated, both human and robotic missions help us solve the problems in space and on earth. We have some technologies we need to work on and we need to make sure we have those before we press further into space. Those technology investments will be focused on that, as you said, the longer term application and what we want to do in deep space. Our incredible science portfolio will continue to increase the understanding of our planet and our place in the universe. We will pursue civilization level discoveries, such as whether or not there is life elsewhere in the universe. Chairman, and we will scout for the knowledge to inform us where we want to take future human-do future human advancement. Our scientific platform activity includes a Mars rover, lander, and sample return missions, the Europa Clipper mission, which will further the search of life beyond earth, diverse earth science missions, and spacecraft to study the sun and how it influences the very nature of space. Powerful observatories, including the James Webb Space Telescope will study other solar systems and their planets and peer back to the dawn of time through other galaxies. As you know, we just announced the low boom flight demonstrator contract award last week. It is going to help us lead the world in the global aviation economy, with increasing benefits worldwide. We believe commercial supersonic flight, unmanned aviation systems and the next generation of aircraft are some of the critical focuses of this important program for our nation. They need to be sitting in this chair one day, the kids that are out there today and we need to inspire them as we go forward. On a personal note in closing, I want to thank the committee for supporting me during this time of being acting administrator. It has been an interesting time, I will say, but it has been great to have such proponents of what we are doing who work with us on a daily basis. We are, each one of us, keenly interested in making sure that the human space flight program stays on time, on track. That is a real source of concern that that critical piece is in the hands of somebody else that we are relying on. We moved the targeted date to December of 2019 and we said we would have four to six months of risk associated with that when we first changed that. The European Service Module and the core stage are our two items that really pace each other on the critical path, depending on really what week you are at. Most of the challenges we are having are because this is the first time we are building these pieces of hardware. Well, just what I would call for European Service Module, for instance, valves that are provided by a company in the U. The testing so far, the hardware that we have taken forward for structural testing has worked out fine. I think it is fairly important that everybody remembers we are not just building one launch vehicle, we are building a program that we can launch once a year to bring these elements that we need to deep space. They get a lot more meetings with other people, but I meet with them quarterly and those two battle back and forth. I had heard that one of the problems of the core stage is difficulties with the solid rocket engines, the exhaust. Is there any problem with the heat or the exhaust produced by the solid rocket motors causing any damage or problem to the rocket nozzles on the liquid fuel center stage To kind of summarize where that one is, we think we are going to get past that issue. When the engines start, you get heating, and then when the boosters start you get heating. The question is will the heating affect the main engines differently than what we saw under the shuttle program. Like I said, the welds, getting the welds done on the tanks to make sure they have got the right strength that we are- Mr. We have gotten those through now, but it is one of the reasons that we had a delay. We have done our proof test on some of the tanks and we are comfortable with that. Now, I heard you mention you think you have already had a few months slip, so you are already looking at early 2020 I have heard estimates ranging from 500 million to a billion for each launch and that is certainly not sustainable and something I know that the subcommittee, all of us, would like to get-see you do a better cadence. Once we get through the first builds, we will have a better feel for what it is going to take from a sustaining perspective. I am confident a private sector commercial company is going to help also drive down that cost. I also support the Chairman going up in space, but only on-with the condition that he allows me to be the one who wakes him up with one of my opening statements. Lightfoot, as you have noted in your testimony, the administration is proposing significant funding over many years for a Lunar Orbital Platform-Gateway to enable missions on and around the moon. In an era of challenging federal budgets and competing priorities, what are the best arguments for 9 how this is worthy of significant public investment Is there a case to be made that this is a new endeavor that pushes the envelope of space exploration or is this mostly a repeat of the activities of the Apollo program We are going on a sustainable approach, and we are also not just going to the moon. We are building systems that allow us to use those systems to even go onto Mars eventually. The biggest thing I think you are going to get out of this is a whole new leadership and inspiration piece that we bring to the next generation. If you go back to Apollo-that is one thing I would say is going to be like Apollo-if you go back to Apollo and you look at engineering schools before we tried to do what we did, the ripple effect of doing Apollo through our culture and what it did from an educational perspective, we expect the same thing. I think that is what great nations do is they take these challenges and it brings other people along with them. Our objective, our thought is that we will use landers, whether they are scientific or human, and they can go to and from the moon to the platform. The other advantage to the platform with the propulsion system we are building is you can move it around. We had a conference in Denver about a month ago and we had 74 or 75 strong proposals of things you could do that-yes, lunar science, but also other kinds of sciences you can do from- Mr. Well, I think if we go for the long duration here, we are going to talk about learning what we can do with the-the goal would be with these landers is the first ones will go almost as our scouts to start to tell us where to go look for volatiles in the 10 regolith surface of the moon. Can we pull that ice out and can we then-do something with it because it could become propellent, for us to use in the future or a source of oxygen if we need it in the future. Ultimately that would lead to human landings, and we would go there in a more sustainable way. All of those things we are doing are things we are going to need to do if we ever go to Mars. It is different at the moon, because there is no atmosphere, but there are still life support systems and things we will have to work on. The platform itself is going to have the ability to put instruments on it just like we do on the space station to look out from an astrophysics perspective or look at the sun from a heliophysics perspective when you are not blocked by the earth. We had proposed a cancellation of the education program then, and in the 2018 approps it was put back in. Our focus is going to be more on what can we do through the missions, what can we do through International Space Station down links and things like that-astronauts in schools. That is going to be how we are going to try to inspire the next generation as we go forward. We think we have got mission-I would call it mission excitement that gets people inspired again to go. We think we still have a good footprint to be able to inspire and bring in the next generation. We still recruit heavily and I think we have got a CubeSat coming from one of the universities in Puerto Rico- Mr. Strong support for that education program, whether it be New York, Pennsylvania, Washington State, Alabama, Mississippi, all over the country. My first question is can you please describe how the fixed price programs have encouraged innovation while controlling cost Yes, what we have seen is that through the fixed price processes we have relinquished a little bit of what I would call our control, but we have also learned from those programs. Those folks have come in with new ideas and new ways to approach what they are doing for us from a delivery of hardware. I think that is what has been the most positive thing about it to me is we are learning from some of the, what I would call different suppliers than we have had in the past.
Jorgensen did not imagine that media coverage of her genital conversion surgeries in Copenhagen would make headlines around the world infection nursing diagnosis discount 400mg noroxin free shipping, but it did bacteria eating flesh order noroxin 400mg amex. Through her the idea of medical "sex-change" became part of common knowledge for anyone old enough to read a newspaper in the 1950s infection 3 months after miscarriage noroxin 400mg line. Jorgensen can antibiotics cure acne for good proven 400 mg noroxin, who had aspired to be a photographer and filmmaker before becoming a celebrity antibiotics ointment order 400mg noroxin free shipping, capitalized on her newfound fame by developing a successful night club act and traveling the globe antibiotic resistance microbiome buy noroxin 400 mg overnight delivery, staying in the media spotlight for more than a decade and earning a comfortable living. She bought a retirement home for her parents, with whom she continued to live until their deaths, in Massapequa, Long Island, New York; she later lived at various locations in Southern California, including the Chateau Marmont Hotel in Los Angeles, the home of friends in Riverside, and various apartments in Hollywood; for many years she owned a home in Laguna Niguel. The Chateau Marmont Hotel is located at 8221 Sunset Boulevard, Los Angeles, California. A collection of photographs from the resort have been published, Michael Hurst and Robert Swope, eds. A play by Harvey Fierstein based on the history of the resort, Casa Valentina, premiered on Broadway in 2014. Roger Segelken, "Examining Black Transness Through Contemporary Media," Cornell Chronicle, June 8, 2015. A native of Dyersburg, Tennessee, she returned home to care for her aging and infirm mother in the mid-1960s, and remained to run a convalescent home until her own retirement. As the child of a prominent local family, a headstone bearing her given name, Charles, had been erected in the family plot in Fairview Cemetery, at the time of her birth. McLeod took great satisfaction, after all her older relatives had died, in purchasing a plot in the same cemetery under her chosen name, and leaving the grave set aside for "Charles" permanently empty. Bourbon claimed (probably spuriously) to have had genital conversion surgery, and humorously recounted these supposed experiences on comedy albums such as Let Me Tell You About My Operation. In 1959, patrons at Cooper Do-Nut, a late-night hangout in downtown Los Angeles popular with street queens, gays, and hustlers, resisted arrest en masse when police made a "street sweep" to round up people accused of loitering, vagrancy, or public lewdness. They smashed windows, demolished a police car, set the corner newsstand on fire, and fought with police up and down the surrounding streets. Glide Memorial Methodist Church, a neighborhood institution, hosted the first 68 Marc Stein, City of Sisterly and Brotherly Loves: Lesbian and Gay Philadelphia, 1945-1972 (Chicago: University of Chicago Press, 2000), 245-246. See Raymond Broshears, "History of Christopher Street West-San Francisco," Gay Pride Quarterly 1 (San Francisco, 1972), n. Bullough and Bonnie Bullough, Cross Dressing, Sex, and Gender (Philadelphia: University of Pennsylvania Press, 1993), 259; Meyerowitz, How Sex Changed. By the end of the 1970s however, many of the advances of recent years had been undone. Setbacks included federal cutbacks to social service funding as well as new ideas in gay and feminist communities that began to characterize Figure 9: Sylvia Rivera Way, New York City, New York. The 1980s were an especially difficult decade for transgender people, who were largely excluded from other social justice activism, even as they faced new levels of pathologization. That same year a new organization was formed for medical and psychotherapeutic service providers who worked with transgender populations, the Harry Benjamin International Gender Dysphoria Association (later renamed the World Professional Association for Transgender Health). Perversely, this official pathologization did not make medical treatment more accessible for transgender people who needed it. Health insurance providers classified sex-reassignment procedures as "experimental" or "cosmetic" Fantasia Fair is held in multiple locations in Provincetown, Massachusetts, usually during the third week in October. One of the most significant developments of the 1980s was the formation of a national network of female-to-male transsexuals, primarily through the efforts of Louis G. Born and raised in the Milwaukee suburb of Wauwatosa, Wisconsin, Sullivan had transgender feelings from a very early age, which confused him because he was also attracted to men. Sullivan eventually realized that he was a gay transsexual man-that is, attracted to men as a man, in spite of starting life with a female anatomy. Transgender women of color who shared needles for hormones and engaged in survival sex-work were among the most vulnerable to , and at risk for, infection. In New York, transgender activist Riki Wilchins was an active member of Lesbian Avengers; in San Francisco, the first activist organization to use the term "transgender" in its name, Transgender Nation, began as a specialinterest focus group of Queer Nation in 1992. It adopted a harm-reduction rather than trans-pathologization model of health care provision, providing services that transgender people needed to live selfdirected lives rather than diagnosing them with Gender Identity Disorder and medically managing their transitions. The Tom Waddell Health Center, opened in 1993, was at 50 Lech Walesa (Ivy) Street, San Francisco, California. On the clinic, see Transgender Tuesdays: A Clinic in the Tenderloin, directed by Mark Freeman and Nathaniel Walters-Koh (San Francisco: Healing Tales Productions, 2012). Transexual Menace organized vigils outside the Richardson County Courthouse in nearby Falls City, Nebraska, 1700 Stone Street, during the murder trial. For an account of this activism, see Riki Wilchins, Read My Lips: Sexual Subversion and the End of Gender (New York: Riverdale, 2013). Heightened levels of security and surveillance, tightened border controls, and fears of terrorism deepened existing difficulties for transgender people who could have difficulty proving to others that they really were who they said they were. For more information, see Phyllis Randolph Frye, "History of the International Conference on Transgender Law and Employment Policy, Inc. Transgender populations in the United State experience incarceration rates more than twice that of the cisgender population. That was the last time, as of this writing, that transgender issues were sacrificed to a larger gay and lesbian liberal agenda. Under the Obama administration, the transgender movement is becoming thoroughly mainstreamed, and has made advances unthinkable only a few short years ago. Particularly since the Supreme Court ruled conclusively on the constitutionality of same-sex marriage in 2015, transgender issues have come to be considered a cutting edge of the civil rights agenda, and seem unlikely to retreat in the foreseeable future. These gains remain unevenly distributed, with transgender women of color still facing extreme levels of violence, poverty, and incarceration not usually experienced by their white counterparts. In the second decade of the twenty-first century, transgender people and topics have become ubiquitous in the mass media as well as on social media. The critically acclaimed show Orange Is the New Black features positive representation of transgender people, while Transparent employs numerous transgender people as writers, directors, producers, crew members, and on-camera talent. Perhaps even more significant than transgender representation in commercial media is the explosion of transgender content in usergenerated social media, much of it produced and circulated by transgender youth such as Leelah Alcorn, a transgender teen who committed suicide in 2014 after posting her suicide note on Tumblr. Such 10-35 Susan Stryker nonprofessional media production can play an important role in providing emotional support and creative outlets, as well as "how to" information for individuals seeking gender transition. Although the most conservative estimates of transgender adults in the United States place their numbers around one and a half million people, those same techniques now place the number of transgender-identified youth somewhere between four and ten million. Public toilets, locker rooms, and other sex-segregated built environments, particularly when they are located in public schools that receive federal funds, have become the latest architectural sites of importance in the transgender history of the United States. That this history is unfolding all across the country, in the most banal and intimate structures imaginable, attests to the truly fundamental level of change our society is undergoing. In this report, the authors cite other scholars who, based on a review of multiple local probability samples and national convenience samples, found that between 1. When Chinese and Polish American Christopher Lee who identified as a transgender man killed himself in 2012, the coroner listed him as female on his death certificate. Three years later, Japanese American Kris Hayashi stood at the helm of the Transgender Law Center as its executive Amy Sueyoshi director when the organization celebrated the passage of the bill. The Transgender Law Center is located at 1629 Telegraph Avenue, Oakland, California. Masen Davis had in fact been the previous executive director whom Hayashi succeeded. Engel, "Development Perspectives on Lesbian and Gay Politics: Fragmented Citizenship in a Fragmented State," Perspectives on Politics 13, no. It was issued on December 21, 1993 and was in effect from February 28, 1994 through September 20, 2011. Foundational writings in Asian American studies explicitly derided samesex sexuality in the 1970s establishing a less than queer friendly beginning to the movement and the field. And, since the 1980s queer Asian Pacific Americans have become increasingly "out and proud," engaging in activism at the intersection of race, gender, himself to the White House fence on April 20, 2010. I include in a more abbreviated form Koreans, Filipinos, Indonesians, Vietnamese, Native Hawaiian, Okinawan, Samoan, and Indian activism mostly after 1965. Historians though have rendered their stories invisible through a heteronormative recounting of history. Chinese men languished painfully in "bachelor societies" in cities such as San Francisco and New York. The miniscule number of women immigrants existed only as prostitutes to serve these men deprived of "normal" heterosexual contact. Yet, same-affairs did exist among Asians and Pacific Islanders in America or in territories later to be become part of the United States even as those engaged in these intimacies may not have had a gay, lesbian, or bisexual identity. White missionaries and imperial zealots wrote often of the prevalence of same-sex intimacies in the Pacific, as they sought refuge from the stigma of their own same-sex proclivities at home. In the 1890s, authorities in San Francisco arrested a number of Chinese men impersonating women to attract fellow countrymen for sex work. See also Gregory Tomso, "The Queer History of Leprosy and Same-Sex Love," American Literary History 14, no. For more on Stoddard, see Roger Austen, Genteel Pagan: the Double Life of Charles Warren Stoddard, ed. Sex workers divided their earnings equally with cannery foremen who occasionally "pimped" for them. Chinese immigrants accustomed to homosocial spaces in their homeland may have actively enjoyed all-male spaces and forged meaningful same-sex relationships as they gathered for mahjong or benevolent association events as "bachelors" in America. Without the imposition of a western lens that assumes heterosociality as the ideal, men from China, steeped in a tradition of same-sex social interaction, may not have been as deprived as more insistently heteronormative histories have declared. Miscellaneous photographs collection, Archives of American Art, Smithsonian Institution. Hsu, "Unwrapping Orientalist Constraints: Restoring Homosocial Normativity to Chinese American History," Amerasia Journal 29, no. The influx of white women in the 1860s and its accompanying valorization of "civilized" families-code for white heterosexuality-would later fuel the formation of rigid racial hierarchies. See Brian Niiya, "Shin Sekai (newspaper)," Densho Encyclopedia, accessed October 4, 2015, encyclopedia. Japanese American History Archive, Japanese American Cultural and Community Center of Northern California, San Francisco, California. He carved his name in Japanese into the wall of the Carmel Mission during his tramp to Los Angeles. The Carmel Mission, also known as Mission San Carlos Borromeo de Carmelo, is located at 3080 Rio Road, Carmel-by-the-Sea, California. Miller, also an active member of the San Francisco Bohemian Club, frequently declared his love of men, even as he remained married to a woman. The Bohemian Club Clubhouse was located at the northeast corner of Post Street and Grant Avenue. Bohemian Club, Certificate of Incorporation, Constitution, By-Laws and Rules, Officers, Committees, and Members (San Francisco: H. His home is located within Joaquin Miller Park at 3590 Sanborn Drive, Oakland, California. By the 1920s, Chung would become a successful physician, the first American surgeon of Chinese descent (Figure 3). She also raised funds for the war and Judy Tzu-Chun Wu, Doctor Mom Chung of the Fair-Haired Bastards: the Life of a Wartime Celebrity (Berkeley and Los Angeles: University of California Press, 2005). The 1929 San Francisco city directory lists Chung as living at 340 Stockton Place (now demolished). Government officials claimed that Japanese living along the West Coast posed a threat to national security as the nation embarked on a war with Japan. And, while Japanese Americans could only bring what they could carry into the incarceration camps, Onuma made it a point to pack the patriotic 1942 "Victory Issue" of male physique magazine Strength and Health and a medal of completion awarded by Earle Liederman, a professional muscle man who ran a popular twelve-week mail-order bodybuilding school Wu, Doctor Mom Chung of the Fair-Haired Bastards. The Topaz War Relocation Center, also known as the Central Utah Relocation Center (Topaz), was built in 1942 in Millard County, Utah. As they sought out same-sex intimacies, they too contributed to the changing face and social dynamic of America. The pocket might be more fitting for the countless others with more precarious relationships to individual property and identity: colonized peoples who have had their property taken from them; people who have been treated as property; aliens ineligible for citizenship; migrant workers. Political scientist Cathy Cohen has detailed how, in the late twentieth century, gay African Americans have also been out in less public ways to not risk losing their ethnic communities in racist America. Ironically, even when obviously queer Asians such as Yone Noguchi and Margaret Chung initiated significant action alongside history-making whites, their activities still remain barely visible in history. Bamberger invited a group of six women including Martin and Lyon to join her and her partner Rosemary Sliepen for drinks and dinner at their home in San Francisco on Friday, September 21, 1955. During the 1950s she had a different job nearly every year as a machine operator, brush maker, or factory worker and additionally changed residences at least five times. Without job security and little residential stability, the consequences of coming out for Bamberger would have likely been unfathomable to bear. On campus Mangaoang joined the Filipino Club, became an officer on the student council, and worked with other student groups of color to establish an ethnic studies Gallo, Different Daughters, 8. He and other student activists negotiated with the administration to ensure that courses in Filipino history and Tagalog be included in the curricula. In the 1960s, Crystal Jang and her women friends began a petition at the City College of San Francisco calling for women students on campus to be allowed to wear pants and successfully changed the dress code. On their way to and from City College and their homes in Chinatown, they also defiantly rode cable cars hanging off the side when the law still mandated women to sit safely inside. In 1960 at the North Beach branch, Jang, still an eighth grader, read about the Kinsey Scale just seven years after sexologist Alfred Kinsey published Sexual Behavior in the Human Female.
Currently available data allow for many analyses within countries and comparisons across countries antibiotics zoloft discount noroxin 400 mg free shipping. A valuable addition to this dialogue would be research to model the impact of the present risk behaviors antibiotic herbs infections cheap 400 mg noroxin free shipping, the apparent trends antibiotic resistance usa cheap noroxin 400 mg overnight delivery, and the impact of changes in those anticipated trends virus with headache proven 400 mg noroxin. This modeling could then be used to estimate the likely burden of either not taking any action or the benefits of different interventions to lower risks virus 00000004 purchase noroxin 400 mg with visa. Since the cost of treating resulting diseases may vary country-bycountry infection blood pressure discount noroxin 400mg fast delivery, it would be valuable to have this research conducted at the national level. National level estimates would likely be more useful to policymakers and those who are developing interventions. Research on obesity pursues the ties to specific diseases and assesses the impact of broad social initiatives in influencing behavior. An innovative announcement specifically sought to improve the understanding of policy changes by facilitating research on the natural experiments that emerge through policy or program changes. There is a wealth of research on tobacco use and growing interest in how the built environment influences activity levels. The landmark Add Health Study57 has shown the power of a large, representative sample of youth surveyed over time, as it has added to our understanding of how adolescent behaviors influence later health. Youth in developing countries are often facing rapid urbanization that may be disruptive to family and social supports. Urban areas may make an active lifestyle and healthy eating more difficult, but the density Burden of Non-Communicable Diseases 82 found there may present opportunities for interventions. Urban living may simply be a current example of how researchers could take context into account in studying these health behaviors. Modeling the impact of changes in risk behavior in relation to later expected disease burden could advance our understanding of the likely impact of interventions or the cost of neglect. One intervention that has spread is the increase in the cost of tobacco products through taxation. The large and growing portfolio of interventions could allow the developing world to move more quickly on addressing youth smoking than was the case in higher income countries. Interventions to address youth alcohol consumption can include taxation, since increasing the price of alcohol tends to lower youth consumption and also provides a funding stream for other health interventions. Laws to prohibit the provision of alcohol to youth can help address underage drinking. Developing parental, family, and community understanding of the risks of underage and excessive drinking may be a way to support enforcement. There are growing examples of campaigns to address problematic drinking, such as those focused on drinking and driving, that provide concrete tools. A great deal of attention has been given to the rise in overweight and obesity, and there have been a plethora of approaches to deal with it after the fact. This is not the place to review the myriad tools to help people lose weight; instead we need to ask how we can support youth to establish healthy eating patterns and maintain them into adulthood. Some social interventions, such as taxes on sodas or required labeling of foods and restaurant meals, have been tried with mixed results in terms of support for them and evidence of their effectiveness. A cross-national study59 found a significant relationship between soft drink consumption and overweight and obesity, as well as a relationship to the prevalence of diabetes. Further research could sharpen our understanding of how soft drinks come to replace healthier options in different settings. Such research would have to confront the role of commercial interests in the transition in food choices in developing countries. Schools offer one setting to provide both nutritious food and education about the importance of healthy eating. Low income urban areas, typically slums or informal settlements, may become food deserts where there is limited access to a wide range of nutritious, fresh foods. Policies that limit unhealthy fats, salt, and sugar in prepared foods or in restaurant foods are gaining traction and can be tested in a variety of settings with different forms of implementation. Population Health: Behavioral and Social Science Insights Section I: Demographic and Social Epidemiological Perspectives on Population Health 83 It is unusual to see small children who are not physically active, but levels of activity seem to decline during adolescence. As young people begin to live lives filled with education, work, and family responsibilities, physical activity may suffer. Recent research has shed light on the linkage of physical activity and diet and shown that when physical activity is labeled as being "exercise" it is less effective than physical activity that just appears to be enjoyable, even when it is the same activity. Findings such as these could provide guidance in the ways interventions are developed and marketed for adolescents. Countries facing this looming shift in burden of disease could make an "adolescent health report card" to guide their actions. This could ask basic questions about the steps that were being taken to address each of the risk factors. For example, What steps are being taken to reduce youth smoking-taxation, health education, enforcement of laws about selling tobacco to minors Are there health education programs about the risks of early and extreme drinking Are parents provided tools to help them identify problems and manage alcohol and tobacco use among their children Are economic development tools used to advance healthy eating and physical activity While the specific approaches will vary with different settings, a policy approach can be one that is implemented at different levels. Action at the national level would be needed for taxation approaches, but the enforcement of laws typically happens at the community level. Where there is widespread understanding of the risks of underage drinking and smoking, enforcement may be more rigorous. Community, cultural, and religious institutions can sponsor activities that support physical activity, such as sports. That creates an opportunity to have more players who are challenged to contribute to primary prevention. The World Health Organization has articulated an essential package of "Best Buys" for population-based interventions. There is even an expressed interest in improving the measures used for diet and physical activity. Other initiatives call up the role of schools, social, and other media and highlight gender/ethnic issues, setting the stage for this work to focus on adolescents and include the considerations of these behaviors in developing countries. This existing background work and interest could be directed to include relevant studies that address adolescent risk behaviors in developing countries. Conclusion In sum, the developing world is facing an epidemiologic transition that makes non-communicable diseases the most prominent cause of death. Despite ongoing needs to address infectious disease and malnutrition, we also must pay attention now to the morbidity and mortality associated with heart disease, diabetes, cancer, and chronic respiratory disease. Two of the primary behavioral risk factors-use of tobacco and alcohol-begin during adolescence. To promote a healthy diet and active lifestyle in later years, adolescence is an important time to solidify positive health behaviors that will, among other things, lower the risk from overweight and obesity. Basic data are available about youth risk behaviors in the developing world, but vigilance is needed to enhance those data systems. Acknowledgments Special thanks go to Toshiko Kaneda of the Population Reference Bureau who has participated in the development of data on youth in Latin America and the Caribbean. The opinions presented herein are those of the author and do not necessarily represent the position of the Agency for Healthcare Research and Quality, the National Institutes of Health, or the U. Report by the Director-General to the special session of the Executive Board on Ebola. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis 1. Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban Asian Indian adolescents aged 14-17 years. Rapid increases in overweight and obesity among South African adolescents: comparison of data from the South African National Youth Risk Behaviour Survey in 2002 and 2008. Noncommunicable diseases in Latin America and the Caribbean: Youth are key to prevention. Tobacco product use among middle and high school students-United States, 2011 and 2012. Double burden of malnutrition: a silent driver of double burden of disease in low- and middle-income countries. Raising cigarette taxes reduces smoking, especially among kids (and the cigarette companies know it). Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012. Population Health: Behavioral and Social Science Insights Section I: Demographic and Social Epidemiological Perspectives on Population Health 87 48. Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. Cognitive-behavioural health-promotion intervention increases fruit and vegetable consumption and physical activity among South African adolescents: a cluster randomized controlled trial. Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. From burden to "best buys": reducing the economic impact of non-communicable diseases in low- and middle-income countries. Burden of Non-Communicable Diseases 88 Wendy Baldwin, PhD, is a social demographer with a background that spans government, academic, and privatesector organizations. As the Deputy Director for Extramural Research, she advanced policies to support the sharing of research data and streamlined peer review and the electronic submission and processing of grants. Baldwin focused on developing data about youth risks for non-communicable diseases in developing countries and communicating with policymakers. Population Health: Behavioral and Social Science Insights Section I: Demographic and Social Epidemiological Perspectives on Population Health 89 Identifying the Principal Factors Responsible for Improvements in the Health of Populations By Samuel H. Preston Abstract Improvements in health and length of life for the average person have been among the greatest of human achievements. Global life expectancy at birth has risen from about 31 years in 1900 to 70 years today. In this chapter, I describe some important contributions to understanding the principal factors driving improvements in health since the mid-1800s. While this chapter does not represent a comprehensive account of the relevant literature, it does provide some examples and discussion of useful analytic studies that examine the progress that has been made over the past 150-plus years toward improving health and life expectancy, both globally and here in the United States. Introduction In the United States, life expectancy has increased from about 48 years in 1900 to 79 years today. If the value of improvements in morbidity were factored into the assessment, the value of health gains would have exceeded the value of increased consumption of all other goods and services combined (see also Murphy and Topel4). Social scientists have been the key contributors to understanding the broad social forces that have driven these improvements in health. Their central role in these discussions is a product of their concern with accurate measurement, their attention to issues of research design, and their emphasis on understanding population-level phenomena. While medical sciences have focused on molecules, micro-organisms, genes, and physiology, social scientists have attempted to assess what advances in the broad realms of personal income, medicine, and public health have meant for levels of population health. The results have helped to calibrate public investments in health and in other social sectors. The main reason for using these measures is that they are often available from registries of death that usually span long periods of time and include nearly 100 percent population coverage. Furthermore, death is an unambiguous event whereas measures of self-assessed health and of disease incidence and prevalence are subject to many forms of error and bias. Costa5 demonstrates for the United States that secular improvements in longevity have been accompanied by huge reductions in the prevalence of major chronic conditions. Identifying the Principal Factors Responsible for Improvements in the Health of Populations 90 the subject of this review is massive, and what follows should be considered a set of illustrations of useful analytic studies rather than a comprehensive account of the relevant literature. Selected Case Studies England and Wales the first serious effort to identify major factors responsible for improvements in longevity was made by a medical historian, Thomas McKeown. McKeown took advantage of the longest series of vital statistics on causes of death for a national population, that pertaining to England and Wales, which dates back to 1838. Tuberculosis, the single most important disease, had declined by some 80 percent before effective medical therapy was available. McKeown argued that, if improvements in medical treatment were not responsible for the declines in infectious and parasitic diseases, then improvements in standards of living must be responsible. In particular, he attributed the bulk of the mortality decline to improved nutrition. Especially important elaborations of the part played by public health initiatives in England have been provided by Szreter7 and Woods. McKeown did make one very important point that has for the most part stood the test of time: specific therapeutic medical treatments have played a minor role in reductions in infectious disease mortality in now-developed countries. The United States was already a very well-fed country by 1900, when life expectancy at birth was only 48 years; dietary reconstructions from direct inquiries suggest that the average daily caloric consumption per adult equivalent was about 3,700, higher than today. This theory was empirically validated in the 1880s and was beginning to displace the misguided miasma theories by the turn of the century. The development and diffusion of the theory and its practical technologies is a plausible explanation of why the frontier of national life expectancy increased faster between 1880 and 1950 than in any equivalent period, as shown by demographers Vallin and Mesle. While public health departments had been concerned about the need to improve water supply and sewage disposal processes before the germ theory, the criteria for success were sight and taste and odor, rather than bacteria counts. Enlightened public health officials were quick to recognize how the germ theory should guide their practice.
Do alternate methods of analysing motor evoked potentials give comparable results Magnetic and electrical stimulation of cervical motor roots: technique antibiotic resistance of staphylococcus aureus 400 mg noroxin for sale, site and mechanisms of excitation non penicillin antibiotics for sinus infection noroxin 400mg free shipping. Silent period evoked by transcranial stimulation of the human cortex and cervicomedullary junction 999 bacteria buy 400mg noroxin mastercard. Motor inhibition and excitation are independent effects of magnetic cortical stimulation infection 6 months after hysterectomy generic 400 mg noroxin overnight delivery. On the origin of the postexcitatory inhibition seen after transcranial magnetic brain stimulation in 23 viruswin32virutce purchase noroxin 400 mg with visa. Motor potentials evoked by magnetic stimulation of the motor cortex in normal subjects and patients with motor disorders virus wot buy 400mg noroxin overnight delivery. Transcranial magnetic stimulation of the motor cortex in cervical spondylosis and spinal canal stenosis. Silent period following transcranial magnetic sitmulation: a study of intra- and inter-examiner reliability. Ipsilateral cortical stimulation inhibited the long-latency response to stretch in the long finger flexors in humans. Demyelination and axonal degeneration in corpus callosum assessed by analysis of transcallosally mediated inhibition in multiple sclerosis. Inhibitory influence of the ipsilateral motor cortex on responses to stimulation of the human cortex and pyramidal tract. Age related changes of motor evoked potentials in healthy humans: Noninvasive evaluation of central and peripheral motor tracts excitability and conductivity. Standardization of facilitation of compound muscle action potentials evoked by magnetic stimulation of the cortex. Results in healthy volunteers and in patients with multiple 100 Central Motor Conduction and Its Clinical Application 35. Corticomotor threshold is reduced in early sporadic amyotrophic lateral sclerosis. Increased cortical excitability in generalised epilepsy demonstrated with transcranial magnetic stimulation. Cortical hyperexcitability in progressive myoclonus epilepsy: A study with transcranial magnetic stimulation. Duration, configuration and amplitude of the motor response evoked by magnetic brain stimulation in patients with multiple sclerosis. Characteristics and variability of lower limb motoneuron responses to transcranial magnetic stimulation. Clinical evaluation of conduction time measurements in central motor pathways using magnetic stimulation of human brain. Measurement of central motor conduction in multiple sclerosis by magnetic brain stimulation. New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Central motor conduction in multiple sclerosis: evaluation of abnormalities revealed by transcutaneous magnetic stimulation of the brain. The role of magnetic stimulation as a quantifier of motor disability in patients with multiple sclerosis. Motor evoked potentials and disability in secondary progressive multiple sclerosis. The diagnostic reliability of magnetically evoked motor potentials in multiple sclerosis. Responses of single spinal motoneurons to magnetic brain stimulation in healthy subjects and patients with multiple sclerosis. Corticospinal facilitation of hand muscles during voluntary movement in the conscious monkey. Correlation of phasic muscle strength and corticomotoneuron conduction time in multiple sclerosis. Improvement of amplitude variability of motor evoked potentials in multiple sclerosis patients and in healthy subjects. Frequency-dependent conduction delay of motor-evoked potentials in multiple sclerosis. Latency and duration of the muscle silent period following transcranial magnetic stimulation in multiple sclerosis, cerebral ischemia, and other upper motoneuron lesions. Central motor conduction studies in motor neurone disease using magnetic brain stimulation. Motor neuron disease: usefulness of transcranial magnetic stimulation in improving the diagnosis. Responses of masseter muscles to transcranial magnetic stimulation in patients with amyotrophic lateral sclerosis. Towards a neurophysiological marker of amyotrophic lateral sclerosis as revealed by changes in cortical excitability. Transcranial magnetic stimulation identifies upper motor neuron involvement in motor neuron disease. The natural history of central motor abnormalities in amyotrophic lateral sclerosis. Primary lateral sclerosis: clinical, neurophysiological, and magnetic resonance findings. Motor-evoked potentials from multiple target muscles in multiple sclerosis and cervical myelopathy. Maertens de Noordhout A, Myressiotis S, Delvaux V, et al Motor and somatosensory evoked potentials in cervical spondylotic myelopathy. Predictability of surgical results of herniated disc-induced cervical myelopathy based on spinal cord motor conduction study. The contribution of magnetic stimulation of the motor cortex to the diagnosis of cervical spondylotic myelopathy. Transcranial magnetic stimulation in patients with cervical spondylotic myelopathy: Clinical and radiological correlations. Motor evoked potentials elicited from erector spinae muscles in patients with thoracic myelopathy. Segmental recording of cortical motor evoked potentials from thoracic paravertebral myotomes in complete spinal cord injury. Central motor conduction in degenerative ataxic disorders: a magnetic stimulation study. Motor evoked potentials by magnetic stimulation in hereditary and sporadic ataxia. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Magnetic transcranial stimulation in non-haemorrhagic sylvian strokes: interest of facilitation for early functional prognosis. Magnetic evoked potentials in neurocritical care patients with acute brainstem lesions. Multimodal electrophysiological studies including motor evoked potentials in patients with locked-in syndrome: report of six patients. The relation between motor evoked potential and clinical motor status in stroke patients. Transcranial magnetic stimulation-evoked inhibition of voluntary muscle activity (silent period) is impaired in patients with ischemic hemispheric lesion. Cortical silent period evoked by transcranial magnetic stimulation in ischemic stroke. The silent period induced by transcranial magnetic stimulation in muscles supplied by cranial nerves: normal data and changes in patients. Motor responses evoked by magnetic brain stimulation in psychogenic limb weakness: diagnostic value and limitations. Effects of sex, height and age on motor evoked potentials with magnetic stimulation. However, if it is true that neuroradiologic examination represents the procedure of choice for the recognition of the causes of most of these disorders, it is also true that a correct interpretation of the data provided by neuroradiological studies can be achieved only if morphological findings are correlated with functional data. The first step in the diagnosis of spinal and radicular disorders should be, as for any other disorder, history taking and the clinical examination, and neuroradiological study should be considered as the final step that may demonstrate or exclude extrinsic or intrinsic lesions involving spinal cord or roots. The main role of neurophysiology is to define the locus of the disease within the nervous system, particularly when this is not possible on a clinical basis alone, to perform a targeted neuroradiological study when this is indicated. Consider the case of a patient with a pure spastic paraparesis without any other neurological symptom or sign. Many different disorders, such as spinal cord compression at any level, multiple sclerosis, motoneuron disease with predominant upper motoneuron involvement, or conditions such as hereditary spastic paraparesis, may manifest in this way. Examples are given for disorders such as cervical spondylotic myelopathy, motoneuron diseases, and hereditary spastic paraparesis. This is particularly relevant for the early phases of many myeloradicular disorders that are characterized by very mild symptoms or when only minor radiological changes are evident. For example, the common complaint of stiff and heavy legs and lower limb fatigability in an old patient with no clear neurological signs on examination may have many different causes involving different parts of the nervous system. Performing an extensive neuroradiological study to seek the cause of this symptom 105 106 Myelopathy, Radiculopathy, and Thoracic Nerve Evaluation may yield information that is difficult to interpret. It is well known that there is no direct correlation between the degree of spinal canal stenosis and the degree of spinal cord and root dysfunction, and severe stenosis of the spinal canal does not necessarily entail a significant myeloradicular dysfunction. Moreover, despite the presence of myeloradiculopathy and cerebrovascular disease, other diseases such as motoneuron disease or subacute combined degeneration may still be responsible for the symptoms. The neurophysiological study, providing a functional exploration of central and peripheral nervous system, may identify the site of the dysfunction. In the latter case, other well-established neurophysiological methods such as electromyography should be employed. A study including a large number of patients with myelopathies1 (>170 patients) confirmed the high sensitivity (about 0. Central motor conduction time is usually calculated by subtracting the latency of muscle responses evoked by magnetic paravertebral stimulation from the latency of responses evoked by brain stimulation. The calculated central motor conduction time includes the time of conduction along the most proximal part of the motor root because magnetic paravertebral stimulation activates the motor axons of peripheral nerves near their exit from the intervertebral neuroforamina. A delay of conduction along the motor roots therefore may determine a prolongation of central motor conduction time that is peripheral in origin rather than pyramidal. For this reason, when the central motor conduction time calculated using magnetic paravertebral stimulation is prolonged in patients with suspected motoneuron disease, radiculopathies, and in general in all patients with clinical or neurophysiologic. The total peripheral conduction time can be estimated from the latency of the F wave and of the distal motor response (M response) using the formula of Kimura,37 whereby the F-wave and M-response latencies are added; 1 ms, corresponding to the turn-around time at the anterior horn cells, is subtracted from the total; and the remainder is divided by two. The central motor conduction calculated using the F-wave method enables a selective exploration of fast-conducting corticospinal projections to all muscles in which an F wave is elicitable. The difference between the two differently calculated central conduction times represents the root motor conduction time. When the central motor conduction time calculated with respect to the latency of motor responses evoked by magnetic paravertebral stimulation is prolonged while the central motor conduction time calculated with respect to the latency of the F wave is normal, the delay may be attributed to proximal motor root damage with a normal central motor pathway function. This is particularly relevant for lower limb muscles because the roots supplying these muscles have a long intrathecal segment, and the radicular component of the central conduction evaluated using magnetic paravertebral stimulation therefore represents a significant percentage of the total central conduction time. A strict correspondence between the site of cervical cord compression documented by the neuroradiological study and the level of cord lesion documented by neurophysiological study is not clear-cut in all patients. Almost all patients with cervical spondylotic myelopathy present an abnormality of the central motor conduction time for distal upper limb muscles and for lower limb muscles. Central motor conduction time is normal for the biceps brachii, but it is prolonged for the abductor digiti minimi and tibialis anterior muscles. Myelopathy, Radiculopathy, and Thoracic Nerve Evaluation 10 9 upper limb muscles even when the narrowing of the spinal canal also involves the upper cervical segments. Segmental demyelination of central motor pathways due to mechanical cord compression is probably the most important factor in the patients for whom there is a strict correlation between neuroradiological and neurophysiological findings.
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