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Strategic foresight succeeds when leaders and organisations challenge the "official future" ­ the implicit organisational view of the future treatment algorithm buy 10mg zyprexa with mastercard, which is usually a continuation of the status quo medications kidney infection buy zyprexa 5mg lowest price. How can countries so rapidly achieve the necessary scale and ambition of change, while leaving no one behind? A common, strong and collaborative vision of an aspirational future can contribute. The 2030 Agenda is a starting point for that vision ­ and strategic foresight processes can help bring communities, businesses and civil society together with government to clarify the details, the roadmaps and the joint aspirational vision at national and local levels to generate momentum, new commitments and resources, and radical new ideas (Box 12. Strategic foresight is not a silver bullet, but a potential complementary approach for development co-operation. The mindset of those engaged in strategic foresight is one that seeks to embrace, rather than control, uncertainty. One way they do this is by seeking out "pockets of the future", which frequently lie on the periphery, in communities which are outside of the "centre" (Sharpe, 2013[17]) and may, indeed, be left behind. When all members of a community are able to collaboratively discuss their futures, the results can be deeply empowering for those on the margins, who are in a position to establish "stories for the storyless". The way strategic foresight works While there are many strategic foresight tools and their use is context- and resource-dependent, strategic planning processes usually have five key components. Analyse trends and drivers of possible futures contexts and their interdependencies ­ whether demographics, emerging technologies such as Artificial Intelligence, digitisation, domestic and international migration, economic fragility, geopolitical transitions, or attitudes to gender equality and participation in the workforce. Monitor shocks, risks, opportunities and assumptions and identify alternative outcomes in an adaptive way. It allows citizens, communities, businesses and non-traditional actors to participate in shaping and delivering the 2030 Agenda, and includes vulnerable and very poor citizens. A diversity of perspectives helps to understand and separate the "signal from the noise", and to develop common knowledge and ownership. Dialogues and relationships should form the basis of future scanning and re-adjustment of policies. Challenge received wisdom (for example, that trends will continue), examine dynamics, consider multiple time horizons. Use scenarios and assumptions not just to guide strategic planning, but most importantly to inform decision-making in the moment. Review what genuine strategic alternatives look like and understand what assets, capabilities and policies can help build resilience in alternative futures, as well as how to achieve your desired outcome. Take an adaptive and innovative approach to reviews, monitoring and implementation. Build the institutional capacity to learn and adapt (data collection, monitoring and finance, and a risk-friendly approach to evaluation). Conduct reviews and monitoring in real time, as far as possible, including through assessment of data to monitor assumptions, risks and success. Things often go wrong during the implementation phase so it is important to be as flexible as possible. The growing discipline of foresight: Examples Although strategic foresight has been established as a discipline for some 70 years, it has been on the periphery of governance, policy making and public administration practice until recently. It is perhaps unsurprising that there has been a rush of interest in strategic foresight across the private, public and not-for-profit sectors in a time of financial crises, new disruptive technologies like blockchain (Box 12. At the same time, increased interest within international development and related fields results, in part, from the 2030 Agenda itself. It is an agenda that requires long-term thinking, and it proposes that to achieve the future we want for the world, and to ensure no one is left behind, means to plan for the future strategically and collaboratively. Many governments around the world are using strategic foresight with different purposes, informing agendas and identifying new solutions, enhancing the relevance and effectiveness of consultations, and creating multidisciplinary connections between policy silos. In countries like Canada, Finland and Slovenia, these systemic approaches to the future are taking place at a whole-of-government level; in others such as the Netherlands and the United kingdom, they are being conducted within ministries; while in Australia, research organisations are supporting the government in the effort. In Germany, the 2013 coalition agreement established a more systematic within-ministerial activity including the German Corporation for International Co-operation, as well as a cross-ministerial network led by the Federal Academy for Security Policy. Technological innovations are being harnessed for inclusive development Technological innovation can be hard to predict, and its applications even harder to conceive. In 1994, as the Internet was emerging, it would have been hard to imagine the impact of companies such as Uber or Google, the emergence of the sharing economy, or technologies such as blockchain.

Includes psychoeducation medicine mountain scout ranch cheap zyprexa 2.5mg overnight delivery, safety planning medicine 6 year program purchase zyprexa 2.5mg with amex, risk identification, and harm reduction 46 Conclusion and Comment Research shows that when parents have experienced traumatic events during childhood, especially within their familial relationships, their children may experience secondary effects of these exposures through complex and overlapping relationship processes. Risk factors for increased likelihood of transmission of trauma effects include the "conspiracy of silence," witnessing violence in the family of origin, poor attachment with caregivers, functional impairments in parenting, certain personality characteristics and contextual factors. In urban poverty contexts, positive relationships with parents and high self-reliance are protective factors that limit transmission of violence. Although studies to date mainly inform understanding of intergenerational dynamics of family violence, the literature suggests that interventions geared to addressing trauma effects in families living in urban poverty should emphasize primary and extended family systems, build on an understanding of cultural variations in family roles and functions, and incorporate strategies that promote affect management. The legacy of combat trauma: Clinical implications of intergenerational transmission. Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping. Conflict resolution strategies and marital distress as mediating factors in the link between witnessing interparental violence and wife battering. Transgenerational transmission of effects of the Holocaust: the North American research perspective. Transgenerational trauma and resilience: improving mental health counseling for survivors of Hurricane Katrina. Maternal reflective functioning, mother­infant affective communication, and infant attachment: Exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Clinical epidemiology of urban violence: Responding to children exposed to violence in ten communities. The co-occurrence of husband-towife aggression, family-of-origin aggression and child abuse potential in a community sample. Understanding inner city child mental health needs and trauma exposure: Implications for preparing urban service providers. Brief report: Poverty, stress and support: Patterns of parenting behaviour among lower income black and lower income white mothers. Efficacy and social support as predictors of parenting stress among families in poverty. Consequences of socioeconomic disadvantage across three generations: Parenting behavior and child externalizing problems. Maternal mental representations of the childin an inner-city clinical sample: Violence-related posttraumatic stress and reflective functioning. Traumatized mothers can change their minds about their toddlers: Understanding how a novel use of videofeedback supports positive change of maternal attributions. Posttraumatic Stress Disorder among African Americans in an inner city mental health clinic. Effects of family violence and parental psychopathology on the psychological outcome of urban adolescents exposed to community violence. Dissertation Abstracts International: Section B: the Sciences and Engineering, 65(7-B), 3724. Emotional understanding: A comparison of physically maltreating and nonmaltreating mother-child dyads. Emotion management skills in sexually maltreated and nonmaltreated girls: A developmental psychopathology perspective. Traumatic stress: the effects of overwhelming experience on mind, body, and society. Growing up in a dangerous developmental milieu: the effects of parenting process on adjustment in inner city African American adolescents. Witnessing the effects of political violence in families: Mechanisms of intergenerational transmission and clinical interventions. Caregiver unresolved loss and abuse and child behavior problems: Intergenerational effects in a high-risk sample. Generally speaking, research indicates that the quality of the parent-child relationship is negatively impacted when a parent (mother) has experienced a traumatic event or events and when the child being parented experiences an event or events.

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Association of Bacillus anthracis capsule with lethal toxin during experimental infection medications kidney failure purchase zyprexa 20mg fast delivery. Anamnestic protective immunity to Bacillus anthracis is antibody mediated but independent of complement and Fc receptors medications you cant donate blood discount 20mg zyprexa amex. Capsule synthesis by Bacillus anthracis is required for dissemination in murine inhalation anthrax. Poly(gamma-D-glutamic acid) protein conjugates induce IgG antibodies in mice to the capsule of Bacillus anthracis: a potential addition to the anthrax vaccine. A dually active anthrax vaccine that confers protection against both bacilli and toxins. Observations on experimental anthrax: demonstration of a specific lethal factor produced in vivo by Bacillus anthracis. Cloning and characterization of a gene whose product is a trans-activator of anthrax toxin synthesis. The three Bacillus anthracis toxin genes are coordinately regulated by bicarbonate and temperature. Identification and characterization of a trans-activator involved in the regulation of encapsulation by Bacillus anthracis. Global effects of virulence gene regulators in a Bacillus anthracis strain with both virulence plasmids. A plasmid-encoded regulator couples the synthesis of toxins and surface structures in Bacillus anthracis. Construction and characterization of a protective antigen-deficient Bacillus anthracis strain. Rapid lethal effects in rats of a third component found upon fractionating the toxin of Bacillus anthracis. Lipopolysaccharide releases a priming substance from platelets that augments the oxidative response of polymorphonuclear neutrophils to chemotactic peptide. Anthrax edema toxin cooperates with lethal toxin to impair cytokine secretion during infection of dendritic cells. Anthrax toxin lethal factor contains a zinc metalloprotease consensus sequence which is required for lethal toxin activity. Macrophages are sensitive to anthrax lethal toxin through an acid-dependent process. Macrophage-derived cell lines do not express proinflammatory cytokines after exposure to Bacillus anthracis lethal toxin. The carboxyl-terminal end of protective antigen is required for receptor binding and anthrax toxin activity. Location of receptor-binding region of protective antigen from Bacillus anthracis. Transcriptional stimulation of anthrax toxin receptors by anthrax edema toxin and Bacillus anthracis Sterne spore. Calcium is required for the expression of anthrax lethal toxin activity in the macrophagelike cell line J774A. Anthrax toxin protective antigen is activated by a cell surface protease with sequence specificity and catalytic properties of furin. Anthrax toxin triggers endocytosis of its receptor via a lipid raft-mediated clathrin-dependent process. Membrane insertion of anthrax protective antigen and cytoplasmic delivery of lethal factor occur at different stages of the endocytic pathway. Role of the protective antigen octamer in the molecular mechanism of anthrax lethal toxin stabilization in plasma. Purified Bacillus anthracis lethal toxin complex formed in vitro and during infection exhibits functional and biological activity. Fatal pneumonia among metalworkers due to inhalation exposure to Bacillus cereus containing Bacillus anthracis toxin genes. Fatal Bacillus cereus endocarditis masquerading as an anthrax-like infection in a patient with acute lymphoblastic leukemia: case report. Rapidly progressive, fatal, inhalation anthrax-like infection in a human: case report, pathogen genome sequencing, pathology, and coordinated response. Bacillus cereus G9241 S-layer assembly contributes to the pathogenesis of anthrax-like disease in mice. Analysis of a novel spore antigen in Bacillus anthracis that contributes to spore opsonization.

However symptoms of pregnancy 10 mg zyprexa, treatment should be initiated to reduce the spread of the infection (see chapter Gonorrhea and Chlamydia) symptoms 6 week pregnancy generic zyprexa 5 mg without prescription. Gingivitis See chapter Necrotizing Ulcerative Periodontitis and Gingivitis for details. They appear as single or clustered vesicles and may extend onto adjacent skin of the lips and face to form a large herpetic lesion. Medication-Related Mouth or Throat Lesions · Candidiasis: antibiotics · Xerostomia: antihistamines, anticholinergics, tricyclics, antipsychotic · Gingival hyperplasia: phenytoin, calcium channel blockers Aphthous Ulcers Aphthous ulcers are eroded, well-defined lesions surrounded by erythema, ranging in size from <6 mm to several centimeters in diameter. The ulcers can appear anywhere in the oral cavity or pharynx and may be recurrent; they are extremely painful. See chapters Esophageal Problems, Candidiasis, Oral and Esophageal, and Cytomegalovirus Disease. Less commonly, esophageal cancer or another cause of stricture may produce symptoms. If untreated, esophageal problems may result in esophageal ulcers, scarring of the esophagus, dehydration, and weight loss. S: Subjective the patient may complain of difficulty swallowing, a feeling of something being "stuck in the throat," retrosternal pain when eating, "hiccups," indigestion ("heartburn"), retrosternal burning, acid reflux, nausea, vomiting, or abdominal pain. For patients with severe oral or esophageal pain, viscous lidocaine 1% 5-10 mL 2-4 times daily (with swallowing precautions) or Magic Mouthwash (viscous lidocaine 1%, tetracycline, diphenhydramine, and nystatin compounded 1:1:1:1) may be tried. Other treatments may depend on the underlying cause: · Esophageal candidiasis: Fluconazole is the drug of choice. See chapter Candidiasis, Oral and Esophageal for more treatment options and for dosing information. Reevaluate after 2-4 weeks; if symptoms are controlled, treat for 4-8 weeks, then reduce the dosage to the lowest effective amount. P: Plan Section 5: Common Complaints Diagnostic Evaluation Diagnosis often can be made on clinical grounds; in this case, empiric treatment may be initiated (see below). If the patient has dysphagia, odynophagia, Esophageal Problems Patients may require maintenance therapy for an indefinite period because of the high likelihood of recurrence. Nutritional supplements along with soft, bland, high-protein foods are recommended. For atazanavir, specific dosing strategies are required, and some combinations are contraindicated. Ascertain the following during the history: · Pain: clarify type and characteristics · Unilateral or bilateral problem · Visual defects (central or peripheral vision loss or distortion), scotomata (an area of lost or depressed vision surrounded by an area of less depressed or normal vision); occurs with reading, distance, or both? The differential diagnosis includes the following conditions: Blepharitis Blepharitis is inflammation of the eyelids, a common condition with dry eyes. Treatment includes cleaning of the eyelashes with warm water and mild shampoo, and applying antibiotic ointment if indicated. Infectious Keratitis the patient may complain of photophobia, eye pain, decreased vision, and irritation. Fungal infections are caused most frequently by Candida species, especially in intravenous drug users. Section 5: Common Complaints Eye Problems 281 Refraction Problems the patient may complain of blurring vision with near or distance vision. Retinal examination shows creamy to yellowish lesions, white granular areas with perivascular exudates, and hemorrhages ("cottage cheese and ketchup"). The abnormalities initially appear in the periphery, but progress if untreated to involve the macula and optic disc. Iridocyclitis/Anterior Uveitis the patient may complain of redness or watering of the eyes, constriction of the pupil, and blurred vision. Ocular bacterial infections, syphilis, toxoplasmosis, and tuberculosis can cause severe symptoms. If drug toxicity is suspected, the offending drug should be discontinued or reduced in dosage, if possible.

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• http://www.meddean.luc.edu/lumen/meded/obgyne/tools.pdf
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