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Still blood sugar 61 discount dapagliflozin 10mg on-line, questions remained about the potential to blood sugar monitor reviews buy generic dapagliflozin 5 mg on-line successfully use biological weapons in a controlled and reliable manner. The follow-on testing authorized by President John F Kennedy under the umbrella program of Project 112 was designed to fill in these knowledge gaps. The codenamed "Marshall Plan" called for releasing incapacitating agents to attack defenders on the beach. At Dugway Proving Ground, an incident involving chemical weapons testing caused the death of 3,000 sheep. Debates about chemical and biological weapons, both for and against the development of offensive capabilities, ensued between Congress, the administration, industry, and even private citizens. In explaining his decision, President Nixon stated, "Biological weapons have massive, unpredictable, and potentially uncontrollable consequences. By May 1972 all antipersonnel agents had been destroyed, and the production facility at Pine Bluff, Arkansas, was converted into a research facility. Biological weapons were unnecessary for national security because of a formidable arsenal of conventional, chemical, and nuclear weapons. Although open-air simulant studies suggested that biological weapons would be effective, the potential effects of aerosols of virulent agents on targeted populations were still conjectural and could not be empirically validated for ethical and public health reasons. Most importantly, the United States and allied countries had a strategic interest in outlawing biological weapons programs to prevent the proliferation of relatively low-cost weapons of mass destruction. Outlawing biological weapons made the arms race for weapons of mass destruction prohibitively expensive, given the cost of nuclear programs. Work was initially done with typhus, reportedly with experimentation on political prisoners at Slovetsky Island in the Baltic Sea and nearby concentration camps. The program subsequently expanded to include work with the agents of Q fever, glanders, and melioidosis, and possibly tularemia and plague. Stalin was forced to move his biological warfare operations out of the path of advancing German forces. Laboratories were moved to Kirov in eastern 8 European Russia, and testing facilities were eventually established on Vozrozhdeniya Island on the Aral Sea between the Soviet Republics of Kazakhstan and Uzbekistan. At the conclusion of the war, Soviet troops invading Manchuria captured many Unit 731 Japanese scientists and learned of their extensive human experimentation through captured documents and prisoner interrogations. After Stalin died in 1953, Beria was executed, and Nikita Khrushchev, the new Kremlin leader, transferred the biological warfare program to the Fifteenth Directorate of the Red Army. Colonel General Yefim Smirnov, a strong advocate of biological weapons who had been the chief of army medical services during the war, became the director. Biopreparat conducted clandestine activities at 52 sites and employed more than 50,000 people. Soviet physicians participating in the program sent specimens to Soviet research facilities. For the Soviets, the program presented an opportunity not only to rid the world of naturally occurring smallpox, but also- reportedly-to obtain virulent strains of smallpox virus that could be used to develop biological weapons. It was this vulnerability that would inspire the former Soviet Union to develop smallpox as part of a strategic weapons system, with production of the virus on a massive scale and plans for delivery using intercontinental missiles. An assassination using a biological weapon was executed in September 1978 when a Bulgarian secret service member attacked Georgi Markov, a Bulgarian exile living in London. A device concealed in an umbrella discharged a tiny pellet into the subcutaneous tissue of his leg. The pellet, which had been drilled to hold a toxic material, was found at autopsy. No toxin was identified, but ricin was postulated as the only toxin with the potency to kill with such a small dose. He experienced fever and pain and bleeding at the wound site, yet had no further complications. Kostov then tested positive for anti-ricin antibodies, supporting the probable use of ricin in these attacks. The military reportedly took control of hospitals in Sverdlovsk to care for thousands of patients with a highly fatal form of anthrax.

Interestingly diabetes type 1 weight loss cheap dapagliflozin 10mg with mastercard, his lab tests were highly correlated with the actual sales figures related to diabetes treatment journal articles generic dapagliflozin 5 mg amex each ad. As his studies progressed, he considered individual differences such as gender and socioeconomic differences. Hollingworth even constructed a panel of New York City residents, the first systematic effort to track consumption behavior (Kuna, 1976). In 1913, Advertising and Selling: Principles of Appeal and Responses was published. Building on his earlier work but appearing to move away from behaviorism, his next book on the topic, Advertising: Its Principles and Practice (1915) captured four principle functions of advertising: securing attention, holding attention, establishing associations, and influencing conduct by making associations dynamic. Cattell had earlier challenged the claim that introspection was the most valid methodology for the study of psychology. As an example, his version of the order-of-merit method was strictly objective, requiring subjects to order stimuli on some criterion (Kuna, 1976; 1979). Strong and Hollingworth took a more "molar" view of behaviorism, with a focus on complex stimuli as opposed to discrete stimuli. They employed the order-of-merit method as well as a refined recognition test that Strong (1914) developed in a reaction to the traditional mentalist recall measures. Strong believed that recognition was the best surrogate for actual purchase behavior and tested the influence of several presentation variables to include size and frequency, and repetition intervals. It is important to reflect on the contribution to consumer psychology of John Broadus Watson. His treatise on behaviorism in 1913 earned him great acclaim as a psychologist, as he informed the world that efforts based on psychology principles should lead to greater control and prediction of behavior. He became the chair of the psychology department at Johns Hopkins University, editor of the Psychological Review, and served as a president of the American Psychological Association in 1915. However, a scandal led to his termination and exit from academic life, and a transition into a career in advertising. Stanley Resor, the "dean of American advertising," hired Watson to work for him at J. The business world embraced him and his leadership and philosophy resulted in numerous successful advertising campaigns. Resor showcased Watson in such a way that it legitimized the role of psychologists working in advertising. Although Gale, Scott, and Starch all brought forth such notions of the unconscious as instincts, emotions, and interests, they continued to offer explanations consistent with a mentalistic outlook. Thorndike (1911) explained instinct and motivation as an inherited response tendency, adhering to a behavioral explanation where the catalyst for the response was a stimulus, not a condition of the being. It was McDougall who took direct aim in differentiating his purposive psychology from Watsonian behavioral psychology as reflected in the following passage: the two principal alternative routes are (1) that of mechanistic science, which interprets all its processes as mechanical sequences of cause and effect, and (2) that of the sciences of mind, for which purposive striving is a fundamental category, which regard the process of purposive striving as radically different form mechanical sequence. Woodworth is credited with putting the organism in the stimulus-organism-response (S-O-R) model and thus finding a home for the contribution of motivation and instinct to human behavior. In his book Dynamic Psychology (1918), he attempted to bring together (and even expand) the work of Freud and McDougall with mainstream psychology. Dynamic psychology was focused upon the influence of basic motivational drives on behavior. McDougall spoke of "drives" as strong and persistent stimulation, as initiating goal-directed actions through selective excitation of response mechanisms related to particular goals. Hollingworth and Strong, as colleagues of Woodworth, were naturally exposed to his thinking and his ideas regarding drives and organism responses, even his early ideas on psychoanalysis. Strong too experienced this transference and by 1925 his thinking culminated in his book, the Psychology of Selling and Advertising. While Strong provided leadership in the adoption of the dynamic approach to applied psychology, his eventual fame came from a different applied focus. Although he continued to conduct research in advertising, he also served on the committee on Classification of Personnel during World War I.

Both rely on the ability of antibody to diabetes symptoms pathophysiology generic dapagliflozin 5 mg amex prevent the binding of ricin to diabetes mellitus type 2 biochemistry order dapagliflozin 10mg visa cell receptors. To ensure maximum protection, the vaccine must be given before exposure, and sufficient antibody must be produced. Additionally, ricin is not completely inactivated by formalin and may retain some of its enzymatic activ ity (albeit approximately 1,000-fold lower than native ricin). Thus, other approaches to vaccine development have been investigated to develop a safe and efficacious candidate. Results of these studies showed that RiVax appeared to be immunogenic and well tolerated in humans. An end of clinical use stability testing to include the 54-month time point was initiated in October 2013 for both the final drug product and the diluent. In mice, pretreatment of nebulized antiricin IgG protected against aerosol exposure to ricin. In a recent study, four chimeric toxin-neutralizing monoclonal antibodies were produced and evaluated for their ability to passively protect mice from a lethal-dose ricin challenge. Introduction of a disulfide bond leads to stabilization and crystallization of a ricin immunogen. Supportive and Specific Therapy the route of exposure for any agent is an important consideration in determining prophylaxis and therapy. For oral intoxication, supportive therapy includes intravenous fluid and electrolyte replacement and monitoring of liver and renal functions. Because of the necrotizing action of ricin, gastric lavage or induced emesis should be used cautiously. An aerosol-exposed patient may require the use of positive-pressure ventilator therapy, fluid and electrolyte replacement, antiinflammatory agents, and analgesics. Development of Ricin Small Molecule Inhibitors Reaching intracellular space with a ricin inhibitor provides an ideal pre- and postexposure therapeutic. At a minimum, small molecule inhibitors must pos- sess sufficient safety and efficacy to enable a pathway to licensure. A strong safety profile is critical since no diagnostic capability exists to identify personnel who have received a clinically significant dose of ricin. Ideally, the inhibitor is also self-administered, which would greatly reduce the burden on the healthcare system and allow the provider to focus on patients who require more intensive care and medical resources. A variety of approaches have been used to identify suitable small molecule ricin therapeutics. Although the large, open, and polar nature of the active site makes it a difficult drug target,151,152 high-resolution X-ray structures of the active site can help in the design of inhibitors. Virtual screening uses computational methods to evaluate large numbers of compounds for possible activity against ricin but requires careful consideration of molecular parameters to ensure optimal results, access to libraries of appropriate chemicals,154,155 and structural data, such as high resolution crystal structures of the target molecule. For cellbased assays the tested compounds should be soluble in cell culture media or with an excipient compatible with cellular growth. The solubility requirement significantly reduces the number of compounds that can be tested in cell-based assays. Furthermore, poor solubility may mask an otherwise useful molecule because it cannot be delivered to the cells in a high enough concentration to have an observable effect. Similar approaches have been used to 390 identify small molecule inhibitors of shigatoxin, a prokaryotic enzyme with related enzymatic activity but limited structural homology to ricin, suggesting pharmacophore discovery is broadly applicable. This approach to inhibitor design was designated as the "door-stop" approach because it prevents Tyr80 from undergoing the necessary conformational change for enzymatic activity. Pang et al161 screened more than 200,000 molecules with molecular weights lower than 300 Da and 226 were predicted to block the movement of Tyr80. Furthermore, these results demonstrated that direct competition with the ricin active site, a difficult target, was not essential to achieve inhibition of the ricin catalytic activity.

With notification of any outbreak diabetes prevention management purchase 10mg dapagliflozin, whether natural or intentionally caused diabetes type 2 zwanger discount 10 mg dapagliflozin with amex, there are standard steps to follow in an outbreak investigation (Exhibit 2-2), although these steps may not always occur in order. Once an event is ongoing, the second step is to investigate, verify the diagnosis, and decide whether an outbreak exists. Therefore, existing surveillance information and heightened targeted surveillance efforts are used to determine whether reported items are cause for concern. The third step is to define the outbreak and seek a definitive diagnosis based on historical, clinical, epidemiological, and laboratory information. The fourth step is to establish a case definition that includes the clinical and laboratory features that the ill individuals have in common. Define the outbreak and seek a diagnosis (including specimen collection and testing). Test and evaluate the hypothesis with analytical studies and refine the hypothesis. The case definition enables the investigator to count cases and compare exposures between cases and noncases and compare these with other investigators and regions using the same case definition. To obtain symptom information, it may not be sufficient to look at healthcare facilities only, but also necessary to interview the ill persons and their family members, as well as coworkers, classmates, or others with whom they have social contact. It is important to maintain a roster of potential cases while obtaining this information. Commonly during an investigation, there is a risk of double or even triple counting cases because they may be reported more than once through different means. Key information needed from each ill person, besides identifying information to ensure accurate case counting and ability to contact the cases again if necessary, includes date of illness onset; signs and symptoms; recent travel; ill contacts at work, home, or school; animal exposures; and treatments received. With this information, an epidemic curve can be constructed (see Figure 2-2) that may provide information as to when a release may have occurred, especially if the disease is known, and an expected exposure date based on the typical incubation period, known ill contacts, or geographic risk factors. If there is a common vehicle for disease transmission (such as a food or water source) that remains contaminated, it might be possible to see a longer illness plateau (a continuous common source curve [Figure 2-3]) than is seen with a point source of infection. If the agent is spread person to person, successive waves of illness may be seen as one group of individuals infects a follow-on group, which in turn infects another, and so on (Figure 2-4). With time and additional cases, the successive waves of illness may overlap with each other. Once cases have been identified, exposures based on person, place, and time can be determined. Information can be obtained either informally or formally with a case control study. A case control study is a type of study where investigators identify individuals with and without disease and compare their potential exposures or risk factors for disease. With a known exposure, one can also identify exposed and nonexposed populations and determine illness rates with a retrospective cohort study to help determine whether that particular exposure is a risk factor for disease. The sixth step is to implement control measures as soon as feasible and continuously evaluate them. If necessary, control measures can be quickly implemented and then modified as additional case information becomes available. Based on the characteristics of the disease, the ill persons, and environmental factors, a hypothesis can usually be generated for how the disease occurred, how it is spreading, and the potential risk to the uninfected. The eighth step is to test and evaluate the hypothesis using analytical studies and refine the hypothesis. Typical propagated (secondary transmission) outbreak epidemic curve Epidemiology of Biowarfare and Bioterrorism Once developed, it is important to test the hypothesis to ensure it fits with the known facts. It is possible that some outliers may seem as if they should be ill but are not, or some who are ill but have no known exposure. With preliminary control measures implemented, the hypothesis can be tested formally with analytical studies. The ninth step is to formulate a conclusion about the nature of the disease and exposure route.

This step contributed to diabetes type 2 disease process cheap 5 mg dapagliflozin visa an understanding of the social and emotional domains and subdomains that frequently were assessed by measurement instruments diabetes symptoms ulcers generic dapagliflozin 10 mg line. We found that the most frequently represented domains are Values (93) and Interpersonal Processes (87). The Prosocial/Cooperative Behavior subdomain (57) within the Interpersonal Processes domain was the most frequently measured construct. Within the Values domain, the Performance Values subdomain (32) was the most frequently measured construct. American Institutes for Research Identifying, Defining, and Measuring Social and Emotional Competencies-68 We also found that the least frequently represented domains are Perspectives (33) and Cognitive Processes (54). Within the Perspectives domain, the Enthusiasm/Zest subdomain (3) was the least measured construct. Within the Cognitive Processes domain, Working Memory and Planning Skills (6) and Cognitive Flexibility (6) were the least measured constructs. Table 1 shows a summary of the number of measures by domain and subdomain, and Figure 1 shows the percentage of measures in each subdomain. Number of Measures by Domain and Subdomain Domain and Subdomain Frequency in Measurement Review Cognitive Processes Domain (54) Attention Control (9); Working Memory and Planning Skills (6); Inhibitory Control (21); Cognitive Flexibility (6) Critical Thinking (12) Emotional Processes Domain (63) Emotional Knowledge and Expression (18); Emotional and Behavioral Regulation (34); Empathy/Perspective Taking (11) Interpersonal Processes (87) Understanding Social Cues (21); Conflict Resolution/Social Problem-Solving (9); Prosocial/Cooperative Behavior (57) Values (93) Ethical Values (12); Performance Values (32); Civic Values (23); Intellectual Values (26) Perspectives (33) Optimism (13); Gratitude (8); Openness (9); Enthusiasm/Zest (3) Identity/Self-knowledge (71) Self-knowledge (16); Purpose (13); Self-efficacy/Growth Mindset (19); Self-esteem (23) American Institutes for Research Identifying, Defining, and Measuring Social and Emotional Competencies-69 Figure 1. All observationbased assessments were conducted in the classroom setting by teachers or staff. Most observation-based assessments were applicable to youth in early childhood, elementary, middle, and high school. The majority of the three performance tasks were designed for the classroom setting and appropriate for youth in middle and high school. We also included measures listed in articles identified during the framework scan and measures identified through a subsequent, targeted search. The team accessed articles to identify key characteristics of the measures, including age group, constructs measured, respondent group and format, and administration setting. Constructs were mapped to subdomains of the coding taxonomy, but these results should be interpreted with caution because we did not utilize the underlying skill codes to make determinations. Instead, the team relied on previous training and knowledge of the coding system to make judgments about where constructs could fit within the taxonomy. Rather, the table contains illustrative measures that (a) arose organically through the iterative literature review, or (b) were found in several searches and existing compendia of measures. American Institutes for Research Identifying, Defining, and Measuring Social and Emotional Competencies-70 Most of the scales we identified were self-reports, whereas teacher and staff reports were the second most frequent type of measure. Together, the Optimism, Gratitude, and Openness subdomains were matched with competencies fewer than a dozen times, and the Enthusiasm/Zest subdomain did not map to any competencies. This result suggests that these competencies may not be prioritized in measurement considerations. Several measures addressed perceptions of environmental factors, such as child perceptions of health, community stability, and family conditions. However, these "contextual" competencies do not map well to the taxonomy in its current form. These instruments have been developed for a variety of purposes, they come from a variety of disciplines, and they assess a breadth of social and emotional domains. Competencies associated with critical thinking, bias recognition, cultural competence, enthusiasm/zest, and cognitive flexibility have the greatest need for more representation. Another pressing concern is how the abundance of social and emotional assessments can support practitioners as they seek to understand the outcomes of their efforts. Many of the assessments were developed separately from social and emotional frameworks. Consequently, practitioners hoping to assess constructs as defined by frameworks will encounter challenges given that many measures have different definitions for the same construct. Thus, practitioners must search for measures that are psychometrically sound and usable in practice.

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References:

• https://www.wordfrequency.info/files/entries.pdf
• https://education.ucdavis.edu/sites/main/files/file-attachments/joint_attention_and_the_social_phenotype_of_asd_2015.pdf
• https://www.johnsoncontrols.com/-/media/jci/global-capabilities/be/files/be_york_industrial_commercial_hvac_2018.pdf