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Indeed, a meta-analysis294 (Laws, 1999) suggests that really what is being picked up is only part of a general intellectual dysfunction. The Mill Hill Vocabulary Scale, an 276 277 278 Gale ea (2007) suggest that bright children often turn out to be adult vegetarians! Therefore, what appears to be due to change due to age may actually stem from inherent ability. Useful sources of information on this subject are Mittler(1973) and Lishman(1978). Zung Self-Rating Depression Scale: devised by W Zung, 1960s; patient asked to quantitate 20 sentences; poorly correlated with observer ratings; insensitive to change with treatment; fallen into disfavour. The dreaming component may entail brain tissue restoration, non-specific casting off of excess neuronal load, or intrusion of events from the previous day (day residue) to influence dream content. Thalamo-cortical arousal branch ­ contains cholinergic neurones from laterodorsal tegmental pedunculopontine tegmental nuclei thalamus cortex 2. Basal forebrain cholinergic magnocellular neurones project througout the cortex and appear to play an important part in the maintenance of cortical arousal. Sleep and chronobiology300 There are two main theories of sleep 301 energy conservation and energy restoration. Animals seldom attacked, such as horses, sleep much longer than those in constant danger, like bats. When much growth is required 302 slow wave sleep and the overall amount of sleep are increased. When less sleep is needed, as in hypothyroidism, the amount of slow wave sleep is diminished. Deficiency of melatonin303, which is produced from serotonin by the pineal gland at night and has a role in sleep-wake cycle regulation, or disruption of its rhythms has been suggested as explaining the increased prevalence of sleep disorders with advancing age. During winter, melatonin indirectly affects the gonads to reduce reproduction potential, a fact that is of particular relevance in season-breeding reptiles, amphibians, and birds. According to Famuyiwa and Adewuya (2008) the effectiveness of melatonin in getting children with neurodevelopmental disorders to sleep is questionable and it has a potential for causing adverse effects; sleep hygiene measures should take precedence in such cases. Anonymous (2009) states that the evidence for the use of melatonin for primary insomnia is limited. The homeostatic model emphasises need for sleep (stronger with time wake ­ adenosine, an inhibitory neurotransmitter, plays a role here) while the circadian model states that sleep propensity has a circadian (24 hour) pattern for sleepiness and attention. Depending on clock time, circadian issues can attenuate or promote homeostatic drive. Drugs capable of changing the circadian clock, such as in rodents, are known as chronobiotics. Daily injections of melatonin can entrain the activity cycle of rodents kept in perpetual darkness. Fruit flies were important in discovering how circadian clocks (transcriptional regulatory loop wherein each calculates its 24-hour period via an oscillating cycle of transcription and translation), with a similar mechanism throughout much of biology, work. Drosophila containing long- and short-day and arrhythmic mutants was to lead to similar discoveries in other living creatures. Hypernyctohemeral (or non-24-hour-day or free-running) syndrome resembles normals in time-free environment (non-24 hour circadian rhythm that is not entrained to astronomical time) and occurs in blind people or socially isolated (a similar problem is reported in schizophrenia); sleep-wake cycle delayed by 45 minutes later each day; 304 84 melatonin excretion patterns. Melatonin levels and rhythms have been reported to be normal in both unipolar depression305 and seasonal affective disorder. Excess nocturnal melatonin secretion, possibly related to nocturnal hypoglycaemia, has been reported in untreated females with anorexia nervosa. Therefore, between B and C, there may be a lower brain stem sleeppromoting area, and, between A and B, there may also be a rostral arousal area. More recently, it has been determined that a small group of neurones in the posterolateral hypothalamus secrete the neuroexcitatory peptides hypocretin 1 and hypocretin 2 (orexins A and B). The arousal produced by hypocretin 1 may occur via activation of histamine-1 receptors. Lesion studies in the rat suggests that cholinergic input from the nucleus basalis in the forebrain is important for suppressing slow wave activity during wakefulness. Sleep is inhibited by interleukins 4, 10 and 13, prostaglandin E2 and a number of other substances. Rats deprived of sleep for two weeks or more die, probably of infection, although short-term sleep loss may sometimes enhance host defences. Almost all biological functions have some rhythm and the length of the rhythm varies.

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The global economy is changing, making the recruitment and employment of relevant candidates an increasingly demanding task. These emerging economic conditions include global competition, rapidly changing business climate, unemployment and the fight for the best candidates. Seeking candidates in this recruitment environment requires being up to date with new recruitment technologies, developing relationships with job applicants and asking the right questions. In addition, they must engage in committed activities to attract, hire and then retain the best employees to build an effective and profitable business. Other factors prompting companies to outsource are access to better techniques and quality or tweaking the faulty service structure. The goal may also be obtaining support in reimbursing qualified employees based on the belief that people are the cornerstone of every business success. Specialized outsourcing companies offer a combination of knowledge and experience while their process is not limited to only recruitment and pre-selection but it also encompasses image marketing for the employer. All this is to help enterprises gain an edge when competing for the best job candidates. Outsourcing companies dealing with recruitment processes can serve as strategic partners with specialized knowledge of market needs, talents, new recruitment technologies and methods of using data to improve decision-making processes. The research worked with a relatively small sample, therefore it should be treated merely as a pilot study, a precedence or supplement to quantitative research. The questions were: · Question 1: Determining company size Over 41% of respondents were small enterprises, from 10 to 49 employees, followed by medium-sized enterprises, from 50 to 249 employees (25%). Three enterprises (27%) assessed the cooperation as very good while one rated it as sufficient. They pointed primarily to leakage of confidential information (28%), as well as loss of control over the separated process and recruiting unsuitable candidates. Question 9: Ways of searching for job candidates Employers who do not outsource recruitment seem to most often post vacancies on online job websites as the basic way of informing candidates about recruitment. This was followed by posting advertisements at the local job office or on own website. In order to become a market leader, an organization should implement innovative and diverse strategies, an example being the outsourcing of recruitment processes. Most interestingly, lack of trust in the external recruiter was cited as the main reason for preferring to keep this process within the organization. When analyzing the responses, it turned out that outsourcing of recruitment is not used at all by micro enterprises. In general, it is the company owner who deals with staff matters in such companies. On the other hand, among the threats cited by companies who have yet to outsource recruitment, the possibility of leakage of confidential information was indicated. This article can be used as a pilot for conducting comprehensive marketing research or as a springboard for further deliberations. Act of 20 April 2004 on employment promotion and labor market institutions, Journal of Laws 2004 No. The paper will study and investigate how small family-run hotels can designate and create a tourist destination. The aim and purpose of this paper is to show how to create a quality brand of a small family hotel in the best possible way and to present it as high quality as possible in the market. By providing quality service, individual access to the guest, excellent advertising and cooperation with all bodies in the tourist destination, a small or family hotel can become, over a period of time, a brand that will be recognized in that tourist destination, for which guests will always return to that tourist destination. The following scientific research methods will be used in this paper: inductive and deductive methods, analysis and synthesis methods, descriptive methods and classification methods. The first point of the paper deals generally with small family-run hotels, their basic features and characteristics. Furthermore, it discusses the development of small family hotel offerings and characteristics of services in small family hotels, the national association of small family hotels, as well as topics and activities related to the offer of small family hotels. The second part deals with the management of small family hotels, the functions of the management of small family hotels. It also discusses some specifics related to the management of family hotels and the factors that affect the performance of small family hotels and the innovative management of small family hotels. The third part of the paper deals with the branding of small family hotels in a tourist destination, on how and in what way small family hotels can become a trademark of a tourist destination. The authors initially write what the brand is and what are the fundamental characteristics of the brand.

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The pathophysiology of cold intolerance seems to find its origin in disordered small nerve fiber endings, where disordered thermoregulation can accompany the complaints. Beukers scored more than the cut off value of 30 points and is diagnosed with cold intolerance. In addition, the rewarming pattern, quantitative sensory testing measurement and the conditioned pain modulation effect were examined. With the use of an infrared temperature measurement after a cold stress test, an abnormal rewarming pattern was seen in the stump. Unfortunately, at this moment, the hand surgeon could only conclude that the most effective way to prevent cold intolerance would be to avoid exposure to cold. Through the measurement of an abnormal rewarming pattern, to protect the stump of cooling, gloves were advised. Limitations and shortcomings of this thesis There are a number of limitations throughout the studies that are important to mention. In this section, we will not repeat what has been stated in the discussion section of each chapter. The outcome of the questionnaire is useful to test the "subjective" complaints of the patient and measures, in general, the disability in the daily life activities. We believe that the questionnaire can assess the complaints of cold intolerance in a patient population. However a measurement setup such as quantitative sensory testing should be used to more specifically assess the severity of cold intolerance in an individual. A questionnaire that does not focus solely on the disability in daily life but that also takes the range of pain sub-modalities in account should be developed. This additional information will be useful in a clinical surrounding and in a research setting, where the cold intolerant patient will be described in a more specific manner. Throughout this thesis we have struggled with the fact that in each subgroup 1) patients with cold intolerance after a fracture to the hand, 2) peripheral nerve injury and 3) an amputation of one or more digits, not a single patient has sustained the same type of trauma. The impact and the mechanism of the trauma are of influence on the type and severity of collateral damage. However, on the other hand, in the animal study designs (where there is a homogeneous trauma mechanism) it is difficult to objectify the severity of the cold intolerance complaints that the rat experiences. Unfortunately these issues are inherent on working in a posttraumatic clinical or animal setting on the complaints of a painful temperature. We used an algorithm to determine the start and ending of the active rewarming and, in the cases where the algorithm failed, we manually selected start and stop of the active rewarming. Especially in situations of abnormal rewarming, difficulties in defining these events can be predicted. We suggest that a commonly accepted algorithm should be created for future studies, where standard start and stop moments can be calculated based on the acceleration and deceleration of the rewarming. By means of a commonly accepted algorithm, comparisons within previous and future studies can be made. To fully investigate our two hypotheses of a vascular and neural origin of cold intolerance, a solely vascular injury model should be designed. We did not measure cold intolerance in a patient with solely a vascular injury without any type of nerve injury. However a suitable study design would be an animal vascular injury model without additional nerve injury. It could be that a rat has sustained an injury to a major artery in a paw, in which measurements are performed such as described in chapter 4 and 5. The outcome of such a study could possibly elucidate the neural hypothesis stated in this thesis. Despite the fact that the cold plate test can detect cold intolerance in an animal model, the test has it shortcomings and cold intolerance could be tested in a more sensitive manner. An objective measurement tool of noxious cold where animals are in their natural habitat could earn the attention of a researcher on cold intolerance that has knowledge of research on animal behaviour. This will make long-term measurements of the behaviour of an animal in its natural habitat more accurate.

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No significant difference was found between children above and children below 104 Factors contributing to high mortality due to pneumonia among under-fives in Kalabo District, Zambia the third percentile in weight and height for age curves, although a clear difference in case fatality rate was found (Table 4. The mothers, who mentioned treatment with injections in 83% of cases, confirmed the finding among health workers that 88% use benzylpenicillin injection as the treatment of choice. The answers about the frequency of treatment, although, showed remarkable differences with information provided by health workers, 63% of whom said they give benzylpenicillin injections four times daily, 6% three times daily, 6% two times daily and 25% once a day. However, only 35% of the mothers mentioned to have received treatment for their children four times a day, 23 % three times daily, 24% two times daily and 17% one time daily. In focus group discussions mothers mentioned that health workers sometimes just leave the station, so that injectables are not given. Only 23% were very familiar with the cardinal signs and symptoms of pneumonia (mentioning of at least 4 signs and symptoms); 58% had scanty information (mentioning of two or three) and 19% of respondents had no knowledge (mentioning of less than 2 signs and symptoms). Hence less than a quarter of caretakers can take a correct and timely decision about attending a clinic. In focus group discussions, mothers, including the group with good knowledge of signs and symptoms of pneumonia, mentioned that pneumonia and severe malaria are difficult to distinguish. No money to pay the user fees was mentioned as an obstacle by 36% of the caretakers and lack of transport possibilities by 4% of respondents. It was mentioned that some health workers, especially in the health centres, do charge a fee, even for small children. Most mothers did not know that they did not need to pay for treatment of their under-fives. Patient satisfaction was high, with 94% of respondents appreciating the treatment. All data analyses, frequencies, cross-tabulations and chi-squares, were carried by hand and confounding was not examined. For some of the tables chi-squares were not valid because of low cell frequencies. Nevertheless, the use of both quantitative and qualitative methods, complementing each other, in this simple health system research, allows the reader to draw some conclusions concerning factors contributing to high mortality due to pneumonia among under-fives in Kalabo District. This is an example of demand-driven research conducted by locally trained health managers, which was conducted with a very low budget and led to results and recommendations which could immediately be implemented at the same local level. As such, it shows progress in the Zambian health system, where local health workers at the district level were trained to use health system research as a tool for policy and planning purposes. Structured interviews with 16 health workers showed that they considered pneumonia to be one of the major causes of death and disease in the district. Focus group discussions with mothers revealed that they recognised pneumonia as a serious disease and perceived it to be an important cause of death of children in the community. Case management of pneumonia was inconsistent and not standardised, which shows that former training programmes, pre-service and in-service, have been ineffective, although turnover of staff should be considered, as far as efficacy of in-service training is concerned. Half of the respondents answered that they do not usually admit under-fives with pneumonia, which probably means that many patients die in the community. This indicates that institutional data can never give a full picture of the situation. It was also discovered that some health workers do things differently from what they say: 87% recommended the use of benzylpenicillin as first-choice treatment, but one wonders how this treatment regime (four times daily) can be followed in outpatients. Only 35% of the mothers confirmed that their children had received the injections six-hourly. Half of the rural health centres visited are operated by personnel who are not adequately trained to run curative health services. An alarming finding is that there is hardly any difference between knowledge about the case definition of pneumonia between health workers and mothers. This means that making an informed, timely and correct decision about seeking care or referring a patient is not possible in many cases. A majority of Pakistani mothers were found to recognise the most important risk factors for pneumonia, but were not able to see the seriousness of the signs (Mull et al. It means that efforts to encourage mothers to visit the clinics should be continued and intensified, especially if education about the prevention of pneumonia and the recognition of early signs can be integrated in the education sessions.

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The approach encompasses seven important components: direct targeting of non-stimulable sounds, making targets the joint focus of attention, associating speech sounds with hand and body movements, associating speech sounds with alliterative characters, encouraging vocal practice, ensuring early success through inclusion of stimulable sounds, and ensuring successful communicative attempts. The stimulability approach was designed for use with very young children aged between 2 and 4 years who have very small phonetic inventories and are not stimulable for production of many or all of the absent sounds. The focus is on improved production but there is some evidence that perceptual skills may also improve as a result of production training (Wolfe et al. In common with complexity theory, proponents of the stimulability approach argue that acquisition of non-stimulable sounds results in greater system wide change in which improvement is seen in both treated and non-treated sounds. Delivery Intervention is typically short with studies reporting approximately 12 sessions, twice a week for 45-50 minutes. Level of Evidence While a number of studies have included stimulability training as part of the intervention, relatively few Target group Speech Language Communication Complex needs Age range Preschool Primary Secondary Focus of intervention Universal Targeted Specialist Delivered by Specialist Teacher Assistant Other 131 have looked exclusively at stimulability therapy. To date, these have used case study designs and have not yet been tested at a group level (Miccio & Elbert, 1996; Miccio, 2009; Powell, 1996). The stimulability treatment approach has an indicative evidence level, with limited evidence available for this approach used exclusively. Current evidence suggests as part of other approaches, it is a useful approach to consider, especially when services determine where and when it is most effective for the children they work with. First things first: Stimulability therapy for children with small phonetic repertoires. Stimulability considerations in the phonological treatment of a child with a persistent disorder of speech-sound production. Format Manual Approach Technique Evidence rating Strong Moderate Indicative 132 Title: 48. It includes Comprehension monitoring: designed to help children to work out what is needed to help them understand and to know how to seek help and clarification when they did not understand. Vocabulary development: understanding, learning and using words relating to ideas relevant in schools, and teaching children strategies to help them to remember new words they have learned. The approach includes encouraging the child to think about how the word sounds and what the word means and encourages them to use specific memory and rehearsal techniques. Vocabulary from the maths and literacy curriculum, school topic vocabulary and words relating to concepts, questions and directions were used to focus word learning, but the emphasis was on children reflecting on how they learn and remember words and developing independent strategies for learning words. A list of grammar markers was collated, to be taught in key contexts following the work of Fey and Proctor­Williams. Narrative therapy: this involves teaching understanding and use of narrative, based on the work of Shanks and Rippon using materials from their activities pack. Delivery the intervention is presented in a manual and specifically designed for use by therapy/teaching assistants under guidance from a speech and language therapist. A comparison was also made between the intervention being delivered by speech and Language therapists and appropriately trained teaching assistants, which found no real difference between the two. The model in the intervention has been further developed for use with primary school teachers. Within the evidence are examples of significantly positive outcomes for children with speech and language difficulties. The construction of a therapy manual for use with language impaired children in mainstream primary schools. Evidence rating Strong Moderate Indicative Manual Approach Technique 134 Boyle, J. Cost analysis of direct versus indirect and individual versus group modes of manual based speech and language therapy for primary school-age children with primary language impairment. The mainstream primary school as a language-learning environment for children with language impairment ­ implications of recent research. Themed invitation issue: `Social and Environmental Influences on Childhood Speech, Language and Communication Difficulties. Direct versus indirect and individual versus group modes of language therapy for children with primary language impairment: principal outcomes from a randomised controlled trial and economic evaluation. Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention. The programme, devised from speech and language therapy practice, runs for 10 weeks with 30 sessions of activities.

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Furthermore, in many regions and ecosystems, this potential is also not static because of ongoing regional and global changes such as climate change and atmospheric nitrogen deposition. Examples include the Park Grass Experiment that started in 1856 (Silvertown et al. However, few of these records are coordinated, and start dates, repetitions and types of measurements generally differ, which makes comparisons difficult. Care must be taken to avoid a false impression of more or less degradation based on different starting dates (Pauly, 1995). This seems an obvious baseline from which to assess any trends in degradation and recovery, since it was before any human modification (Kotiaho et al. Practically, it is rare to find objective data from so far into the past (Spikins, 2000). The only data of this type are fossil deposits, pollen and also fossil parts of plants, insects and diatoms and evidence of human-induced soil erosion that can provide some indications (Hoffmann et al. Of course, a pre-human baseline has no use when the climate or other physical environmental conditions changed in the time between the baseline and the present time, as occurred, for example, in the Little Ice Age just 400 years ago (Matthews & Briffa, 2005). The start of the Anthropocene (approximately 1950) (Ludwig & Steffen, 2017; Morselli et al. While anthropogenic degradation occurred in many places before the beginning of the Anthropocene, it was often negligible compared with the post-1950 period and is therefore a useful starting point to assess anthropogenic degradation. A more objective method is the "space for time" substitution (Johnson & Miyanishi, 2008; Pickett, 1989), which compares similar sites in different locations and treats spatial and temporal variation as equivalent. Although this assumption has been challenged, space-for-time substitution is often used due to necessity or convenience (Pickett, 1989). A more objective method for inferring a former state from the current condition is by mathematical process modelling (McGrath et al. Furthermore, there are many potential errors in modelling; for example, the mathematical representation of natural processes may not apply to the entire period between the current state and the original natural state. Data processing Examples Davis & Shaw (2001); Graumlich (1993) Pre-modern (10,000 yr. Adequate data to match with key characteristics of; "Current", "Ecological Integrity" or "Target" definitions Long time-series of records allow more accurate specification of trends Measurement techniques used must be known and repeated in all subsequent data collections Repeatable measurement techniques. Speculation of future trends are often based on hypothetical, but realistic scenarios of future human activities (see Chapter 7) including future land cover, changes in carbon sequestration and pollution. In order to have consistency in forecasts, scenarios that provide some descriptions of how the future might unfold have been developed. Notwithstanding this long history, modern day attempts to quantify the extent and scale of land degradation have proven difficult, especially at the global scale. More recent studies have been based on loss of net primary production, often using satellite data (Jackson & Prince, 2016; Noojipady et al. Note: (i) light degradation was excluded from the estimates here; and (ii) North America includes Mexico and Central America, unless otherwise noted. Table annotations: a - does not include Caribbean; b - includes some Caribbean countries; c - total based on country areas listed in Bai et al. Nevertheless, the effects of soil erosion can be positive as well as negative (Figure 4. Erosion is a natural process, but is strongly accelerated by agriculture (Montgomery, 2007b) and mismanagement (Diamond, 2011). Sub-Saharan Africa has variable trends, whereas Asia, Latin America and the Caribbean, the Near East and North Africa have particularly negative trends. Three climatic zones where erosion rates can be particularly high are Mediterranean, monsoonal and semiarid areas (Walling & Kleo, 1979). Water or hydric erosion is caused by running water and includes the detachment of particles by splash, transport (concentrated runoff) and deposition. Wind erosion (deflation or aeolian) occurs in areas having <250mm annual rainfall (Shao, 2008). Extreme rain events can render areas vulnerable to floods, landslides, gully incisions and soil erosion by water, depending on geology, relative relief and climate (Figure 4.

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Depression is more common than mania, which in turn is more common than mixed affective states. Over 90% of patients with steroid-induced psychiatric disorder are recovered within 6 weeks of onset. There is a case for baseline psychiatric evaluation before starting high dose steroid therapy. Some patients develop psychological dependence on corticosteroids and they may strongly resist their discontinuance. They cause increased body weight (increased appetite, fluid retention, and redistribution of fatty tissues). Reversal of these changes, together with corticosteroid-induced skin atrophy, may make the patient look old and wrinkled. Anabolic steroid abuse (see Rashid ea, 2007; Sjцqvist ea, 2008) is, however, not confined to athletes. A narcissistic body image is common among users of anabolic steroids, as is personality disorder (antisocial, paranoid, histrionic, and borderline). Withdrawal symptoms include reduced sex drive, fatigue, depression, dissatisfaction with body image, headaches, physical violence, angry and hostile feelings, manic or psychotic episodes, and a desire for more steroids. Glucocorticoid levels normalise with abstinence, although a blunted stress response and increased glucocorticoid feedback may persist for long periods. Acute cocaine intake increases glucocorticoid secretion, this effect decreasing with chronic exposure. Abrupt cessation of heavy cocaine intake also increases glucocorticoid secretion, but this promptly normalises with abstinence. Suppressed cortisol response to stress occurs in abstinent cocaine addicts unless when craving for cocaine is induced. Glucocorticoid secretion is increased by intense cigarette smoking, tolerance to this effect often appearing with chronic nicotine intake; cortisol levels rise when a heavy smoker ceases his habit; abstinence leads normalisation (and even an eventual drop in) of cortisol levels. Coffee and tea, though not caffeine itself, substantially reduce phenothiazine absorption. Caffeine- (or halothane-) induced contraction of muscle tissue in vivo is employed in the standardised test for malignant hyperthermia. An intake of two or more servings of caffeinated beverages per day may place one at risk for withdrawal symptoms. It is the most widely used psychoactive drug worldwide and in excess is unhealthy. If a patient is drinking lots of coffee to counter sedation from medications such as anticonvulsants it may be possible to replace caffeine with modafinil. There is a risk of cardiac dysrhythmia, mainly in the elderly and those with preexisting cardiac disease. Ground coffee brewed by mixing it with hot or boiling water may increase the serum cholesterol level, an effect that is substantially reduced by filtering, but caffeine may not be the culprit. Caffeine increases gastric acidity and is best avoided in people with peptic ulcer disease. Wisborg ea, (2003) in a prospective Danish study, found that heavy coffee intake during pregnancy was associated with having a stillbirth (8 or more cups of coffee per day increases the risk to twice that where no coffee is consumed) but not with death of the baby during the first year of postnatal life. Earlier, Cnattingius ea (2000) had reported that caffeine use may increase the risk of spontaneous abortions in early pregnancy. Some causes of early morning wakening Depression Alcoholism Anorexia nervosa Caffeine Caffeine can worsen many psychiatric symptoms, especially panic. Caffeine given under double-blind conditions made psychotic symptoms worse in schizophrenia. The management of excessive coffee consumption is based on education, a stepwise reduction in intake over 1-2 weeks, and a final goal of a more acceptable intake. Cigarette smoking induces the metabolism of many drugs so that cessation or curtailment of smoking. This negative prognostication does not seem to be true since only 23% of men and 21% of women were smokers in 2006, with a decline in British smokers over 16 years of age from 24% in 2005 to 22% in 2006. Smoking is very common in psychiatric patients in all settings, but recording of smoking habits and intervention by medical personnel are uncommon. The High Court in England and Wales, when deciding on an appeal by patients at Rampton in 2008, decided that there is no absolute right to smoke in ones place of abode and that staff are not obliged to arrange for smoking areas2452.

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The problems facing us today were already flagged in the preliminary debates and reports for Stockholm Conference (Hardin, 1968; Meadows et al. The necessities of achieving development was a priority to reduce poverty and reach Western standards of living (Castro, 1972) with a twofold ideological basis: 1. Human beings stood above any environmental concern: "From the point of view of Man ­ and we have no other standpoint ­ Man [. By the time of the Rio Summit in 1992, developed countries had already accepted the idea of "common but differentiated responsibilities," according to which they should assume the financial burden of capacity building and technological transfer through the recently created Global Environment Facility (do Lago, 2009). Genetic diversity did not become the financial manna expected and the collective intellectual property of indigenous and local communities has not yet been clearly conceptualized (Gцrg & Brand, 2006) nor defined in law. The reluctance of corporations to invest in and pay for indigenous or local knowledge about biodiversity is partially due to the complexity of negotiating rights to access and to benefit-sharing (Rosendal, 2011). Other developing countries (G77) disagreed with this orientation (Visentini & da Silva, 2010). The focus on the human dimensions of sustainable development push us to think about different ways of conceptualizing socio-ecological relationship. As this chapter will further explore, we propose ecological solidarity (see Section 2. If fertility declines from what it is today, but remains half a child above the replacement level, human population will grow 120% and reach 16. More attention is now given to how much each person consumes and how the Earth is used to support each person, especially in the context of growing meat consumption (Alexandratos & Bruinsma, 2012; Bailey et al. If consumption per capita is important for degradation, then limiting consumption per person is also an appropriate goal (Ehrlich & Ehrlich, 2009; Ehrlich & Holdren, 2011). Both issues are equally complex as developing and emerging countries are striving to achieve Western standards of living and many developed countries are reluctant to change their way of life. Soon after, the population problem was principally deemed a social and/or educational problem, excluding it from environmental discussions. Its conclusion was that demography was a matter of education and empowerment of women, to be solved by international aid (Ashford, 2001; McIntosh & Finkle, 1995; Roseman & Reichenbach, 2010). Where appropriate, institutional changes must be implemented so that old-age security does not entirely depend on input from family members. Demographic issue is even more of a delicate matter in those countries where having many children is an element of social prestige for men, especially, but not only, in polygamist countries (Fargues, 1994; Goldstone, 2010). Even after the demographic transition, the population does not diminish, partly because immigration from overpopulated or conflict-ridden countries compensates for the birth deficit. Perhaps the key problem lies in the conception that birth limitation is invariably a violation of human rights. This perception is somewhat one-sided insofar as there is a distinction between controlling natality and not encouraging it. The Alliance for a Green Revolution in Africa programme, as discussed below (Box 2. This view was expressed in a programmatic paper signed by two members of the Rockefeller Foundation and by the President of the African Bank of Development (Toenniessen et al. While the objective of an African Green Revolution is to ensure cereal self-sufficiency by 2050 (van Ittersum et al. Most of the literature dealing with ex-post evaluation in several African countries (Ghana, Uganda, Tanzania and others) insist on the very context-specific successes or failures of this trend towards modernization and market-based policy (Dawson et al. One of the inhibiting factors is the strongly anchored traditional seed exchange system, reluctant to adopt hybrid varieties (Louwaars & de Boef, 2012). A comparison between Asian and African Green Revolution shows that in the case of the former, the countries (especially India and Indonesia) were strongly supported and oriented by States, whereas Green Revolution in Africa relies more on markets for internal and external demand (Fischer, 2016). On the other hand, the Alliance for a Green Revolution in Africa programme has been criticized by both scientists and international organizations. This assessment involved 400 researchers and dozens of national delegates (including those from Sub-Saharan Africa), who strongly recommended the adoption of agroecology as a sustainable practice. The Alliance for a Green Revolution in Africa was also criticized by the special rapporteur on the Right to Food, in a statement submitted in 2009 to the Human Rights Council of the Office of the United Nations High Commissioner for Human Rights (Schutter, 2009). The conclusions of the Report on the Right to Food (Schutter, 2010) were identical. Land investment by multinational corporations can make the lives of small-scale farmers precarious because they are marginalized in the wider agricultural economy (Martiniello, 2013; Matondi et al.

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Bipolar I patients stabilised on quetiapine plus lithium or divalproex took longer to relapse than did those on placebo plus lithium or divalproex. If the patient is not on prophylactic treatment and the depression is mild, one may try lithium (or an anticonvulsant) or interpersonal or cognitive therapy; if it is severe, one may combine lithium with an antidepressant or increase the dose of lithium (Nemeroff ea, 2001). In general, mood stabilisers may be moderately effective for acute bipolar depression but the available research is somewhat compromised by brevity and high dropout rates. Studies of treatment in acute mania often excluded persons incapable of giving informed consent; exclusion criteria do not reflect clinical reality; high dropout rates are common; response is usually defined as at least 1426 Vieta ea (2008) suggest that the hopes associated with new anticonvulsants, apart from lamotrigine, have not been fulfilled in either bipolar disorder or epilepsy. The study was not able to pronounce of the difference in efficacy between lithium monotherapy and lithium plus valproate. Whilst the evidence is that combined second-generation antipsychotic agents and mood stabilisers represent the most efficacious treatment for acute mania,(Scherk ea, 2007) more research evidence is needed on when and if to taper drugs used in combination. Higher plasma levels of lithium are used for acute treatment than for prophylaxis. Low-grade hypomania in-patients who can be supervised outside hospital can sometimes be treated with lithium alone if follow up is frequent enough. Lithium has the advantage of been less likely than neuroleptics of causing a switch into depression, but the disadvantage of a delayed effect. Withdrawal of antidepressant drugs may abort a manic episode if done early enough. This was replaced in turn by haloperidol, which has been challenged in turn by atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, aripiprazole1433, and clozapine) with or without a benzodiazepine. Clozapine may bring mania under control when other approaches fail or are associated with excessive side effects. Olanzapine was superior to divalproex in one study of the treatment of mania,(Tohen ea, 2002) but with a different side effect profile: weight gain, dry mouth, increased appetite, and somnolence versus nausea respectively. Olanzapine was reported as being superior to divalproex in the treatment of acute mania but to be no better than divalproex in terms of rates of relapse of bipolar disorder. The combination of olanzapine and carbamazepine was not better than carbamazepine alone for mania in another study1435. Also, Calabrese ea (2005b) found that quetiapine monotherapy was effective in treating bipolar depression. Because of effectiveness and cost issues, Wassef ea (2005) recommend starting with generic valproic acid and only switching to delayed-release divalproex if intolerance occurs. The literature on oxcarbazepine suggests that it might be more efficacious for mild to moderate mania at best. These amino acids compete for brain entry with phenylalanine and 1433 Aripirazole may be added to other drugs, such as lithium or valproate, in the management of mania to improve response. In their study,(Scarnб ea, 2003) relative to placebo, administration of this mixture to manics lowered Beigel mania ratings acutely over the first six hours. Patients on anticonvulsants should have their serum levels checked; it is also prudent to check the white cell count and liver function from time to time. Alcohol and substance abuse, including cannabis,(Strakowski ea, 2007 1436) may contribute to the phenomenon of rapid cycling and need to be addressed. Rapid cycling should be managed by avoiding or stopping antidepressant drugs, by optimising mood stabiliser treatment (starting/adding ­ Calabrese ea [2005a] found no difference between lithium and divalproex sodium in the treatment of rapid cycling), or, when necessary, adding levothyroxine. Should there have been a partial response with the initial agent they would either switch to an alternative drug or attempt augmentation. Potentially, T3 may exacerbate anxiety, cause weight loss, and induce cardiac arrhythmias. T3 appears to be more effective than T4 as an augmenting agent in unipolar depression. Testosterone gel has been shown in a preliminary study to alleviate refractory depression in men with low testosterone levels when added to an existing antidepressant regimen. Modafinil (Provigil) may be efficacious as adjunctive therapy in bipolar depression.

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As a result, when the preponderance of men/women is observed in certain professional roles, we naturally assume that men/women are better at those "masculine"/"feminine" careers. The implication is that women are insecure and less technically "savvy", traits which do not allow them to overcome barriers to better career paths. Men use computers and the Internet more than women, while reporting more experience and positive attitudes towards computer-related activities. Moreover, organizations are not gender neutral (Acker 2006; Ferguson 1984; Wajcman, 1998) and culture and climate have been identified as crucial to the recruitment and retention of women. In this sense, "chilly" is a term that has been used to describe unfriendly climates for academic women (Chilly Collective 1995). Cultures are inherently resistant to change and so effective interventions are needed in order to reshape the values and assumptions of their members and to facilitate a cultural transformation; however, as research has pointed out, adequate monitoring (Doherty and Manfredi 2006) and resistance (Vбzquez and Elston, 2006) are needed as well. Educational and professional choices An early concern of feminist research was the different subject and career paths that girls and boys take. A national curriculum which allows little subject choice tends to reduce the gender gap in subject choice and attainment (Arnot et al. The different choices of men and women are associated with typical male and female stereotyped characteristics (Suter, 2006). Moving beyond traditional organizational thought, theories of gendered organizational culture are concerned with deconstructing the ways in which organizations serve to maintain the gendered status quo (Kanter, 1977; Acker, 1990; Connell, 1995). From this perspective, researchers focus on the ways in which organizations help to influence and shape societal understandings of gender, masculinities/femininities and sex-role expectations. Gender is a socially constructed distinction between masculine and feminine (Goode, 1995). Acker (1990 and 1992) produced an analysis of gendered organizations in which she argued that men and women are active agents who "do" gender in the course of their everyday work lives. As gender is created and recreated in organizations, the term "gendered processes" has been used to refer to the ways in which "advantage and disadvantage, exploitation and control, action and emotion, meaning and identity, are patterned through and in terms of a distinction between male and female, masculine and feminine" (Acker, 1990:146). Box 13: Gendered organizations In spite of feminist recognition that hierarchical organizations are an important location of male dominance, most feminists writing about organizations assume that organizational structure is gender neutral. This article argues that organizational structure is not gender neutral; on the contrary, assumptions about gender underlie the documents and contracts used to construct organizations and to provide the commonsense ground for theorizing about them. Their gendered nature is partly masked through obscuring the embodied nature of work Abstract jobs and hierarchies, common concepts in organizational thinking assume a disembodied and universal worker. The positing of gender-neutral and disembodied organizational structures and work relations is part of the larger strategy of control in industrial capitalist societies, which, at least partly, are built upon a deeply embedded substructure of gender difference. Source: Acker, Joan (1990) "Hierarchies, Jobs, Bodies: A Theory of Gendered Organizations", in Gender and Society, Vol. Thus, within the workplace, masculinities and femininities are created and reinforced through the values and beliefs of both the individuals within the institution and the institution itself. In 64 Meta-analysis of gender and science research Topic report "Stereotypes and Identity" summary, far from gender-neutral entities, organizations are gendered sites which reflect larger society. For example, sex-role stereotyping within work organizations restricts their ability to become actively involved in the private sphere (LaRossa, 1988). The research literature focuses on the masculine atmosphere in science and its effects on the gender order. In the construction of gender and the reproduction of male power in science, the concept of traditional hegemonic masculinity is central (Connell, 1987). Hegemonic masculinity is "the configuration of gender practice which embodies the currently accepted answer to the problem of the legitimacy of patriarchy, which guarantees (or is taken to guarantee) the dominant position of men and the subordination of women" (Connell, 1995: 77). The image of hegemonic masculinity in science is transferred through polarized gender stereotypes which connect initiative, strength, rationality and autonomy with men, while women are constructed as inferior (Wajcman, 1991). Women and men who differ from the hegemonic form of masculinity are both devalued (Dцge, 2002). The culture of organizations is based on stereotypical gender roles and the image of the "ideal manager" or a "normal employee" tends to be male-biased (Bischoff, 2005). Thus, working styles, professional identities and the shared culture are gendered (Faulkner, 2000a and 2000b). Thus, elements of dominant masculinity such as male homosocial networks help to construct and reproduce male identity, power, and privilege through the accumulation of resources relevant to career success (Rastetter, 1998). The lower status of women in educational and professional organizations, together with their minority status, hinders their access to the unacknowledged and implicit patriarchal support system (Morley, 1999; Bagilhole and Goode, 2001; Husu, 2001).

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  • https://anesthesia.ucsf.edu/sites/anesthesia.ucsf.edu/files/wysiwyg/pdfs/Anesthesia-for-Liver-Transplantation_Anesthesiology-Clinics.pdf
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