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What are the historic preservation-related plans that will highlight the late Rep weight loss supplements for men discount shuddha guggulu 60caps with amex. These include historic places from the Harlem Renaissance to the more recent past weight loss questions purchase shuddha guggulu 60caps overnight delivery. Unfortunately, there are no known extant historic places associated with Primus and Brown. Like the injustices they have suffered, their tactics of resilience and resistance and their spaces and places are similar to but unique from other marginalized groups. Gay and lesbian spaces are a longtime part of the American landscape, but queer places are more recent. Doan, "Queers in the American City: Transgendered Perceptions of Urban Space," Gender, Place & Culture: A Journal of Feminist Geography 14 no. Nash, "Trans Experiences in Lesbian and Queer Space," the Canadian Geographer 55 no. Since the late nineteenth and throughout the twentieth century, most gay, bisexual, and queer men were largely unable to occupy private spaces alone together with the result that their "privacy could only be had in public. Bell, "One-handed Geographies: An Archaeology of Public Sex," in Queers in Space: Communities, Public Places, Sites of Resistance, eds. Gordon Brent Ingram, Anne-Marie Bouthillette, and Yolanda Retter (Seattle: Bay Press, 1997), 81-87; and Shaka McGlotten, "A Brief and Improper Geography of Queerspaces and Sexpublics in Austin, Texas," Gender, Place & Culture 21, no. The extra policing and more extreme regulation of people of color make clear that not all public spaces are made equally. Each city, town, suburb, or rural environment relates to the context of its state and region; however, rarely is research conducted at the level of the state, region, or nation state. Haraway, Simians, Cyborgs, and Women: the Reinvention of Nature (New York: Routledge, 1990). Studying San Francisco in the early 1990s, anthropologist Kath Weston wrote that "The result is a sexual geography in which the city represents a beacon of tolerance and gay community. Freedman, Intimate Matters: A History of Sexuality in America (Chicago: University of Chicago Press, 1998); and Karen Brodkin, "How Did the Jews Become White Folks Other numbers of the same group were unable to move out of cities or rural areas as they were most limited in their ability to choose where they could live. For example, the first gay rights organization, the Society for Human Rights, was founded by Henry Gerber in his Chicago home in 1924, and the more well-known homophile or gay rights organization, the Mattachine Society, was founded by Harry Hay and others in his Los Angeles home in 1950. Amy Gluckman and Betsy Reed (New York: Routledge, 1997), 45-64; and Sarah Schulman, the Gentrification of the Mind: Witness to a Lost Imagination (Berkeley: University of California Press, 2012). Wilson, Bulldaggers, Pansies, and Chocolate Babies: Performance, Race, and Sexuality in the Harlem Renaissance (Ann Arbor: University of Michigan Press, 2011); A. Christa Schwarz, Gay Voices of the Harlem Renaissance (Bloomington: Indiana University Press, 2003); Hanhardt, Safe Space; Philadelphia: Marc Stein, City Of Sisterly And Brotherly Loves: Lesbian and Gay Philadelphia, 1945-1972 (Philadelphia: Temple University Press, 2004); Elizabeth Kennedy and Madeline Davis, Boots of Leather, Slippers of Gold: the History of a Lesbian Community (New York: Penguin, 1994); Los Angeles: Moira Rachel Kenney, Mapping Gay L. Bailey, Butch Queens Up in Pumps: Gender, Performance and Ballroom Culture in Detroit (Ann Arbor: University of Michigan Press, 2013); Kansas City: David W. Along with the often steep increases in property values and mortgage loads, there is much debate over whether these gay villages have assimilated, or are being "de-gayed" through processes of gentrification. After decades of media and popular culture painting the rural as backwards or hateful, understandings of rural queer life have begun to shift in the public eye. Gill Valentine, "Negotiating and Managing Multiple Sexual Identities: Lesbian Time-Space Strategies," Transactions of the Institute of British Geographers, New Series, 18 no. Doan, "The Tyranny of Gendered Spaces - Reflections from Beyond the Gender Dichotomy," Gender, Place & Culture: A Journal of Feminist Geography 17, no. Johnson, Just Queer Folks: Gender and Sexuality in Rural America (Philadelphia: Temple University Press, 2001).

Once the seizures have stopped weight loss pills of the stars order 60 caps shuddha guggulu with amex, give intravenous phenytoin 15 mg/kg at 50 mg/ minute or fosphenytoin at the same dosage of phenytoin equivalents weight loss pills gallatin tn order shuddha guggulu 60caps mastercard, but at 100 to 150 mg/ minute. Intravenous valproic acid may also be used at 40 to 60 mg/kg at a rate of 20 mg/minute to maintain seizure control. However, at these rates, it takes at least 20 minutes to administer 1,000 mg of phenytoin and more than an hour to give doses of valproate above 1,200 mg. Hence, it is not unusual for seizures to recur during the administration of the antiepileptic drug, and this may require additional lorazepam. At times, generalized seizures cannot be stopped with the above agents and anesthesia with propofol, midazolam, or pentobarbital is necessary. Because these drugs further suppress respiration, the patient should be intubated at this point as well if this has not been done already. Approach to Management of the Unconscious Patient 315 Alternatively, some physicians prefer intravenous boluses of phenobarbital 65 mg every 3 to 5 minutes (which has a longer half-life) until seizures cease. Typically, the patient must remain in a deeply drug-induced coma for at least 24 hours, followed by attempts to wean the patient off the anesthetic doses of medication. Focal continuous epilepsy, by contrast, frequently occurs with metabolic brain disease, but is less threatening to the brain, and does not require the use of anesthetic doses of anticonvulsant drugs. Restore Acid-Base Balance With severe metabolic acidosis or alkalosis, the pH should be returned to a normal level by treating the cause, as metabolic acidosis can lead to cardiovascular abnormalities and metabolic alkalosis can depress respiration. Respiratory acidosis presages respiratory failure and warns the physician that ventilatory assistance may soon be needed. Respiratory alkalosis can cause cardiac arrhythmias and hinders weaning from ventilatory support. Treat Infection Many different infections cause delirium or coma, and infection may exacerbate coma from other causes. Draw blood cultures on all febrile patients and those who are hypothermic without obvious cause. As indicated in Chapter 3, if there is a strong suspicion of bacterial meningitis, empiric antibiotic therapy should begin immediately after blood cultures are drawn. In one large series of patients with sepsis treated in intensive care units, cultures were positive in only 60% of patients. A third-generation cephalosporin (cefotaxime, 2 g every 6 hours or ceftriaxone 2 g every 12 hours) should be started. In elderly or obviously immunosuppressed patients, ampicillin should be added to cover Listeria monocytogenes. Current evidence suggests that dexamethasone added to the regimen decreases long-term complications of the infection. In immunosuppressed patients, fungal and parasitic infections must also be considered, but because they tend to be less acute, they can await evaluation by imaging and spinal fluid examination. Other infections causing coma (Chapter 5) must Adjust Body Temperature Several metabolic and structural abnormalities lead to either hyperthermia or hypothermia, and these states may exacerbate abnormalities of cerebral metabolism. Significant hypothermia (below 348C) can lead to pneumonia, cardiac arrhythmias, electrolyte disorders, hypovolemia, metabolic acidosis, impaired coagulation, and thrombocytopenia and leukopenia. Administer Specific Antidotes Many patients entering an emergency room in coma are suffering from drug overdose. Empiric addition of amoxicillin is indicated for meningitis caused by Listeria monocytogenes. Continuation or change of antibiotics is guided by the results of cerebrospinal fluid analysis, blood culture, bacterial sensitivity to antibiotics, and clinical status of the patient. Steroid treatment in meningitis is unlikely to be of benefit if the diagnosis is delayed, if antibiotics have not been given, or if meningitis is Gram-negative bacillar or requires aminoglycoside antibiotics. Unless pneumococcal meningitis is proven or strongly suspected, dexamethasone use is not recommended in immunosuppressed or malnourished patients and in patients with other system infections. Most drug overdoses are best treated by the supportive measures considered in a subsequent section. Because these patients have ingested multiple agents, specific antagonists are often not useful. This drug must be used with great care, because in a patient physically dependent on opioids, the drug may cause acute withdrawal symptoms requiring opioid therapy. One should use the minimum amount necessary to establish the diagnosis by pupillary dilation and reverse the comatose state. Thus, patients who have taken an overdose of opioids, and whose toxic reactions are reversed by naloxone, may lapse back into coma after a few hours and require further treatment.

Another way of making this point is that masculinity and femininity express what it means to be a heterosexual male or female in a court of law weight loss pills without working out buy discount shuddha guggulu 60caps line, in hospitals weight loss drops purchase shuddha guggulu 60caps line, schools, or in churches, that is, in institutions that sanctify those privileges. The more obvious Latino expression of heterosexual masculinity is located in the term macho, which is defined as a strong, often exaggerated sense of masculine pride. Most gay men, in traditional Latino/a thinking, would be considered less masculine and not sufficiently macho (Figure 5). Marianismo derives from the worship or following of the Virgin Mary (Maria) and her central role in active Catholicism. When he discovered that Samuel was embezzling money from him, Novarro opted not to press charges, but took over ownership of the house in Hollywood Hills. Unlike other gay actors at the time, however, Novarro refused to marry a woman to hide his sexuality. He was murdered in his Studio City home in 1968 by two brothers who were hustlers and physique photo models. Marianismo serves as the female companion to "machismo," or hyper-masculinity, and originated as its counterpoint during the time of the Spanish conquest. Hern ndez direct response to the overused machismo and was intended to explain a female phenomenon in Latin America in which women were either depicted as saints or as whores. Female superiority was at the heart of Marianismo but its opposite also accounts for how easily, in this dichotomous construction, women could also be seen as overly and overtly sexual, that is, as super-sexed. Beginning in 1973, scholars have located the concept across many Latino/a cultures, meaning that it is a gender construction shared across national borders. A mujerista theology was also a response to maleconstructed notions of how women should behave in social and religious contexts; in this case, the message was directed toward the traditional Catholic hierarchy. Less obvious is the mujer passiva (or, la mujer abnegada) who negates herself for the love of her husband and children and sacrifices her individualism for the benefit of the family. Gender and sexuality have their own unique expressions within Latina/o communities. In the most basic sense, gender refers to the biological identity assigned at birth, usually, boy or girl, and depending on the circumstances of birth because some newborns on rare occasions have genitalia that might be male and female at once. Vasquez, the Maria Paradox: How Latinas Can Merge Old World Traditions With New World Self-Esteem (New York: G. As a cultural facet of every Spanish-speaking nation across the Americas shaped by unique traditions, religious influences, and laws, most gender codes of conduct in the vast Latina/o experience emphasize femininity for women and masculinity for men. Ideally, these gender codes of masculinity and femininity have served as the basis of heterosexuality and with them, support the formation of the family social structure as a central basis for constructing gender and sexual identities. The virgin/whore complex refers to the way Latinas are situated between two completely opposite views: the virgin and the whore or the martyr and the witch are ideals embedded in cultural practices, religious or spiritual values, and in social life and they require women to behave and position themselves as either celibate (virginal) or as sacrificing themselves for the good of the family, the community, or the collective (martyr). Like the terms suggest, the virgin is the idealized woman in Latina/o culture, while the term witch refers to the maligned aspects of a woman who shows too much independence. While attitudes about sexuality have changed See Roscoe (this volume) for a discussion of multiple genders recognized by Native American societies. Hern ndez during the last five decades, some of these attitudes about Latina/o men and women remain despite efforts to move away from cultural prescriptions and established preconceptions. The belief that heterosexuality was the only option for sexual behavior no longer dominates Latina/o perspectives. Heteronormativity, the belief that heterosexuality is the only acceptable way of expressing and enjoying sexuality in the human experience, is further challenged by science, psychology, religious, and cultural mores. These but reinforce the idea that sex and sexuality are not simple concepts and to be understood simply as uniformly or divinely ordained. Muxe are generally accepted by the Zapotec Indian culture and are not viewed negatively as they might be in western industrialized cultures. Gender identity and sexual orientation are related, but distinct cultural identities. There are many people in the United States who do not identify with the gender they were identified as at birth. Some people find that they identify opposite to the gender they were identified as; others may feel that they exist somewhere on the continuum between the two binaries, or as some gender not represented by male or female, or as no gender at all (agender).

The difficulties in locating records or traces of the sexualities of people of color make clear that while exploring the links between gender and sexuality are critical weight loss unexpected shuddha guggulu 60 caps amex, attention to the relationships between sexuality weight loss uk discount 60caps shuddha guggulu otc, race, class, and ethnicity are equally if not more important. See also Hortense Spillers, "Interstices: A Small Drama of Words," in Pleasure and Danger: Exploring Female Sexuality, ed. In 2016, as we write this chapter, some activists and historians are pointing to the 1967 Supreme Court decision in Loving v. Virginia (which struck down state statutes banning interracial marriage) as a legal precedent to striking down bans on same-sex marriage. Somerville makes clear in her work that analogies like this erase identities that exist at the intersections of queer and nonwhite. For example, the musical performances carried out by female blues singers during the Harlem Renaissance of the 1910s and 1920s. The presumption that "community" is or should be the goal for sexual and gender minorities and the implicitly celebratory stance of many studies of sexual communities has been challenged by several scholars, including historian Karen Krahulik in her study of Provincetown, Massachusetts (Figure 6). In the early 1930s, she headlined at the Ubangi Club at 131st Street and Seventh Avenue, Harlem, New York (now demolished). The stories highlight that "community" is defined as much by who is excluded as it is by who is included. Krahulik suggests the need to move beyond a simple celebration of the creation of queer community and look to the consequences of such creation. In other words, the creation of a queer community-like the creation of any other community-is always also about constructing boundaries-boundaries that operate within communities as well as between emergent and existing communities. The Atlantic House at 4-6 Masonic Place, Provincetown, Massachusetts was built in 1798. It became truly gayfriendly in the early 1950s, and has continued as a gay bar ever since. See also, Scott Herring, Queering the Underworld: Slumming, Literature, and the Undoing of Lesbian and Gay History (Chicago: University of Chicago Press, 2007). Webster Hall and Annex, famous in the 1910s and 1920s as a site of masquerade and drag balls, is located at 119-125 East 11th Street, New York City, New York. Rockland Palace, 280 West 115th Street, New York City, New York (demolished in the 1960s) was another well-known location of drag balls. Visitors to the Rockland Palace balls of the 1920s and 1930s included Tallulah Bankhead and members of the Astor and Vanderbilt families). That said, the very term "community" also suggests the creation of new generalizations and exclusions. Instead, he proposes that scholars ask and research the importance of people of color forming and acting within their own "racial communities. Other scholars have challenged this idea, suggesting instead that residents of towns and other smaller communities developed their own understandings of sexuality and gender based on their unique histories, locations, and populations. These understandings may or may not mirror developments in urban America, but they are not blind copies of the changes happening in city centers. Howard shows us that queer sexuality in rural Mississippi was not based on "urban archetypes" but was regionally specific and rooted in local community folkways and institutions. For an example of differences in gender between urban and rural areas, see Emily Kazyak, "Midwest or Lesbian This provided multiple possibilities to explore their sexualities and gender identities. During the 1940s, exclusively gay bars appeared for the first time in cities as diverse as San Jose, Denver, Kansas City, Atlanta, and Cleveland. As significant, during the war the various military branches called on psychiatrists to evaluate the suitability of the male draftees and male and female volunteers for military service. The military collaboration with psychiatric professionals meant that male and female inductees were asked directly whether or not they had thought about or engaged in homosexual encounters. While intended to eliminate those soldiers, sailors, marines, and officers who might be homosexual or present stereotypical homosexual tendencies, this policy instead introduced the concept of same-sex sexuality to many of these enlistees and draftees for the first time and for some of them gave, finally, a definition that seemed consistent with how they understood themselves. In 1948 and again in 1953, zoologist, taxonomist, and sexologist Alfred Kinsey shocked Americans when he published his respective reports on male and female sexuality and reported that people had sex-lots of it, and in many different configurations. Because of his homosexuality, he was subject to beatings, blackmail, and other harassment including confinement in the guardhouse by other members of the military also stationed at Governors Island.

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Those metabolic encephalopathies that are most likely to produce either irreversible brain damage or a quick demise but are potentially treatable include drug overdose weight loss boot camp best shuddha guggulu 60 caps, hypoglycemia weight loss workouts for men purchase shuddha guggulu 60caps with visa, metabolic or respiratory acidosis (from several causes), hyperosmolar states, hypoxia, bacterial meningitis or sepsis, and severe electrolyte imbalance. It is important to secure an arterial sample for blood gas analysis, although emergency management may have to begin even before laboratory results are returned. Both acidosis and alkalosis can cause cardiac arrhythmias, but acute metabolic acidosis is more likely to be lethal; however, pH is not an independent predictor of mortality in critically ill patients with metabolic acidosis. Instead, urgent treatment of the underlying cause of the acidosis is probably the best approach. Relieve hypoxia immediately by ensuring an adequate airway and delivering sufficient oxygen to keep the blood fully oxygenated. Such patients should be given 100% oxygen and hyperventilated to increase blood oxygenation. Hyperbaric oxygenation may improve the situation, and if a hyperbaric chamber is available, it should probably be utilized for patients with life-threatening exposure. Severe anemia (hematocrit less than 25) in a comatose patient should be treated with transfusion of whole blood or packed red cells. The absence of cells in the spinal fluid does not rule out acute bacterial meningitis; if there is a high index of suspicion, the lumbar puncture can be repeated in 6 to 12 hours. The centrifuged sediment should also be examined by Gram stain, as occasionally organisms may be seen even before there is pleocytosis. It usually is advisable to adjust both electrolyte and acid-base imbalances slowly, since too rapid correction often leads to overshoot or intracellular-extracellular imbalances and worsens the clinical situation. Therefore, no stuporous or comatose patient suspected of having ingested sedative drugs should ever be left alone. This is particularly true in the minutes immediately following the initial examination; the stimulation delivered by the examining physician may arouse the patient to a state in which he or she appears relatively alert or his or her respiratory function appears normal, only to lapse into coma with depressed breathing when external stimulation ceases. The management of specific drug poisonings is beyond the scope of this chapter,88,94 but certain general principles apply to all patients suspected of having ingested sedative drugs. Both respiratory and cardiovascular failure may occur with massive sedative drug overdose. Anticipation and early treatment of these complications often smooth the clinical course. Insert an endotracheal tube in any stuporous or comatose patient suspected of drug overdose and be certain that an apparatus for respiratory support is available in case of acute respiratory failure. The placement of a central venous line allows one to maintain an adequate blood volume without overloading the patient. Give generous amounts of fluid to maintain blood volume and blood pressure, but avoid overhydrating oliguric patients. Place a pulse oximeter on the finger, but also measure arterial blood gases; a difference between the two (oxygen saturation gap) may indicate poisoning. Carbon monoxide, methemoglobin, cyanide, and hydrogen sulfide cause an increased oxygen saturation gap. Once the vital signs have been stabilized, one should attempt to remove, neutralize, or reverse the effects of the drug. Attempts to remove poi- son from the gastrointestinal tract and thus prevent absorption have included inducing vomiting with syrup of ipecac,95 gastric lavage,96 cathartics,97 activated charcoal ingestion,98 and whole bowel irrigation. Multiple doses of charcoal administered at an initial dose of 50 to 100 g, and then at a rate of not less than 12. In addition to eliminating drugs from the small bowel, the agents may interrupt the enteroenteric and, in some cases, the enterohepatic circulation of drugs.

References:

• https://www.sgna.org/Portals/0/Issues/PDF/Infection-Prevention/6_HLDGuideline_2013.pdf
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• https://www.isinj.com/mt-usamo/Applied%20Combinatorics%20(6th%20Edition)%20by%20Alan%20Tucker%20Wiley%20(2012).pdf