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Ironically, despite his angelic past, Damiel approaches heterosexual desire in ways that are too familiar. His desire for Marion is first expressed via the objectifying gaze; she is the object of his look. Watching him watch her, I was reminded of that often quoted statement of John Berger in Ways of Seeing: Men act and women appear. This determines not only most relations between men and women but also the relation of women to themselves. The audience first sees Marion working as a trapeze artist, every movement of her body watched by males. Since her movements on the trapeze are difficult exertions of physical skill, we are all the more mesmerized. Her attire and the men watching deflect attention away from physical effort and her body movements are sexualized. From earliest childhood she has been taught and persuaded to survey herself continually. His watching her (unidentified and unseen) in her private space can be seen as benevolent since he is an angel. Another is that the embedded message here is that the angelic cloak is a disguise marking the potential reality of his gaze, especially as we later witness that gaze turn into an intense lustful stare. Constructing a male angel who both protects and ultimately desires the innocent unsuspecting female is a gesture more fundamentally linked to patriarchal valuation of dissimulation than a radical rediinking of coercive masculinity. W e watch them knowing they are to be seen as figures of innocence though we simultaneously recognize their embodiment as men. Throughout the film, viewers are to believe tiiat angelic status diffuses their power so it is in no way harmful. How can this imagery be trusted when the male gaze which begins as benevolent ends as a self-interested stare, expressed as longing for sexual possession? When the potential lovers finally meet at the bar, Marion wants to talk and Damiel wants to consume her physically (he is all over her). His acquiescence to her demands is not a gesture that transforms the dominating positioning of his desire. Much of the film centers on his enthrallment with her, which is so intense he surrenders being an angel to make contact. Though scenes in Paris, Texas moved me deeply, from a feminist perspective it was a problematic film. The film was groundbreaking in that it portrayed a male character coming to understand the degrees to which clinging to male domination and coercive control damages his primary love relationship. Yet that understanding is undercut when expressed in the context of a scene which reinscribes structures of domination. He knows her identity; she cannot recognize him until he identifies himself (sound familiar? While naming coercive male control as destructive, he does not surrender control, only the coercive element. However touching this confession and her ultimate recognition, it is not a scene of female empowerment; just as the scene where Marion speaks to Damiel does not change the dominating power of his presence. Despite her earlier insistence on will, knowledge, and choice, nothing has changed their physical placement in the film. Are they so well informed about feminist thinking that they are able to determine whether Marion is portrayed as subject or object? It is as though the stage of acquiring the feminist standpoint that would be a basis for constructing different images of women and critically examining that construction, though unnamed, is presumed to have occurred; the same might be said of race. Current trends in avant-garde cultural production by white people, which presume to challenge the status quo regarding race and gender, are ethically and politically problematic. In Wings of Desire, the library as storehouse of knowledge is the meeting place of angelic visionaries. That means they must consider the role whiteness plays in the construction of their identity and aesthetic visions, as well as the way it determines reception of their work. If the current fascination with otherness is an authentic expression of our desire to see the world anew, then we must be willing to explore the cultural blindness of the many people who saw Wings of Desire and who did not see whiteness represented there as sign and symbol. There, at the forefront of commercial youth culture, in the midst of all the dating games involving cross-dressing, suddenly, whoomp! The mostly white college jock audience in Daytona that spring responded with seriously muted applause - a reaction that was probably part embarrassment, part homophobia, and part jaw-dropped amazement at just how damned good he was. This was the same crowd that had bayed with co-sexual appreciation for the other black men on the bill - Shabba Ranks, the sexed-up Jamaican toaster, and Naughty by Nature, featuring Treach, with masculinity to spare in his minimalist moves. Either way - whether in the ghetto street or in the nightclub version - being fierce is a theatrical response to the phenomenal social pressure exerted upon black males in the waning years of the twentieth century. The dialogue between these two figures is not supposed be acknowledged publicly, and their relation to each other has been entirely ignored in the recent flap about gangsta rap, attended by so much moralizing. With the mercurial rise of the cross-dressing Dennis Rodman at the very core of sports celebrity culture, all bets are off. The profile of the reality rapper, scaled down to the ultimate, low metabolism vibe of Dr Dre (who had pursued an earlier glam-with-eyeliner singing career) and Snoop Doggy Dogg, evokes an affectless masculinity, conceived under siege and resonating with the long history of presenting a neutral face as a mask of inscrutability to the white gaze. White culture has always compelled black males to perform, usually as entertainers or as athletes. Performance has typically been the obverse of black invisibility in a society of white privilege. Today, however, the underlying trend points beyond invisibility, and towards disappearance. Efforts to evacuate young black men from the public sphere have proceeded on every front. It is from this context - the absent existential status of an entire social cohort - that the brouhaha about gangster rap took its political significance. Those who reduced rap to a discussion of its most disturbing misogynistic or anti-social lyrics ignore how both this context, and the way in which the culture that springs from it, merely exacerbates, rather than creates, forms of social prejudice long rife in white, patriarchal America. Those politicians and black preachers who took the high ground against gangsta rap have profited, as their professional status dictates, from media grandstanding. The broad left (black and white) has no excuse for indulging in this lazy moralizing, least of all when it chooses rap as a vehicle to bash the cause of cultural politics in general. In these apocalyptic years, before the first batch of the crack-baby generation came of age, hardcore rap was just about the only medium in which ghetto life attained something approaching authentic recognition. In rap, genre justice, earned at the microphone, determines how respect is distributed. The rap debate in the public media entirely missed such evolved and highly competitive aspects of the genre and instead revolved simply around whether gangsta lyrics represent reality or shape reality - in other words, induce criminal behavior. In the long run, both debates may be pretty inconsequential but they do demonstrate (a) the level of desperation among poor black youth; and (b) the sad lack of understanding among the larger public about the political nature of cultural events. At the very least, we ought to temper the moral panic about drugs with the knowledge that marijuana is now overwhelmingly the hiphop drug of choice, and that its advocacy among rappers not only challenged the chokehold of the crack economy but also reinforced the arguments for legalizing hemp as a versatile industrial crop - arguments hitherto only associated with white, countercultural voices. Second, we ought to connect the moral panic about guns with demands to demilitarize police divisions up and down the country. If the recent East-West Coast wars between the Death Row and Bad Boy companies (allegedly linked to the Tupac and Biggie Small killings) proved anything, it was not about how lyrical violence inevitably overflows into real homicides, but rather about the aggressive outcome of cut-throat commercial competition. The gangs I grew up around in the industrial Scottish lowlands were, by comparison, low tech in their cult of the flick knife. The gang in my own hometown was called Young Bowery, a parochial imitation of the notorious Glasgow gangs, and, 1 suppose, the result of some long-lost tribute to the first Irish gangs of Lower Manhattan. As an outlawed collectivity, the gang had its place then as a minor vehicle for the virility-testing Scottish proletarianism that was losing its muscle, even in my youth. Its more warlike sensibility fed the romance of precapitalist, clannish resistance to the English while, at the same time, providing fresh fuel to the London media for racist stereotypes of the barbarous Scottish male. Their pathologies did not belong to them, however, but were the cultural frames that denned how, where, and when they were permitted to announce their anger. Whereas in North America social divisions are most sharply determined by race, in the West of Scotland they were almost entirely the result of Protestant/Catholic antagonisms, as hate-bound as in Northern Ireland and much more meaningful than the weak socio-economic segmentation that existed within a broadly working-class culture. The point here is that while socially denied people do not express rage just as they please, or under circumstances of their choosing, they do tend to opt for vehicles that are the least likely to be culturally influenced by the powerful.

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In choosing your treatment plan, you and your cancer care team will also take your age, general state of health, and personal preferences into account. The main treatments for stomach cancer are surgery, chemotherapy, and radiation therapy. If a cure is not possible, treatment is aimed at relieving symptoms, such as trouble eating, pain, or bleeding. It is important that you understand the goal of your treatment - whether it is to cure your cancer or to relieve symptoms - before starting treatment. If the goal of your treatment is a cure, you will also receive treatment to relieve symptoms and side effects. Even if the cancer is too widespread to be removed completely by surgery, most patients are helped by it because it may help prevent bleeding from the tumor or prevent the stomach from being blocked by tumor growth. This type of surgery is called palliative surgery, meaning that it relieves or prevents symptoms but it is not expected to cure the cancer. The type of operation usually depends on what part of the stomach is involved and how much cancer is in the surrounding tissue. There are 3 kinds of surgery that may be used to try to cure stomach cancer: Endoscopic Mucosal Resection In this procedure, the cancer is removed through an endoscope - a long, flexible tube passed down the throat and into the stomach. This can only be done for very early stage cancers, where the chance of spread to the lymph nodes is very low. Subtotal Gastrectomy this operation is recommended if the cancer is only in the lower part of the stomach. It is also sometimes used for cancers that are only in the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine (the duodenum). With only part of the stomach removed, eating is much easier than with removal of the entire stomach. Total Gastrectomy this operation is used if the cancer is spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus. It involves the total removal of the stomach and nearby lymph nodes, and may include the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs. If you have a total gastrectomy, the surgeon will make a new "stomach" out of intestinal tissue. Usually the end of the esophagus is attached to part of the small intestine, and some extra intestine is also attached. This can make room for food to be stored before moving down the intestinal tract, and will allow you to eat some food before getting filled up. But people who have a total gastrectomy can only eat a small amount of food at a time. In either a subtotal or total gastrectomy, the nearby lymph nodes and some of the omentum are usually removed. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes. Stomach cancer may also spread to lymph nodes that are farther away in the abdomen. But this is still unclear, and many surgeons are wary about doing such an extensive operation because it causes more complications. Surgeons in Japan have had very high success rates by removing all the lymph nodes near the cancer. Surgeons in Europe and the United States have not been able to equal the results of the Japanese surgeons. It is not clear if this is because Japanese surgeons are more experienced (stomach cancer is much more common in their country), because Japanese patients have earlier stage disease and are healthier, or if there are other factors that play a role. In any event, it takes a skilled surgeon who is experienced in stomach cancer surgery to remove all the lymph nodes successfully. It is important that you ask your surgeon about his or her experience in operating on stomach cancer. Studies have shown that the results are better when both the surgeon and the hospital have had extensive experience in treating patients with stomach cancer. These can include bleeding from the surgery, blood clots, and damage to nearby organs during the operation. Rarely, the new connections made between the ends of the stomach or esophagus and small intestine may leak. With improvements in surgical techniques in recent years, only about 1% to 2% of people die from surgery for stomach cancer. This number is higher when the operation is more extensive, such as when all the lymph nodes are removed. As many as 5% to 15% of their patients may die from the surgery when surgeons try to remove all the lymph nodes. These can include frequent heartburn, abdominal pain (particularly after eating), and vitamin deficiencies. If certain parts of the stomach are removed, doctors routinely prescribe vitamin supplements, some of which can be taken only by injection. Because of these problems, it is important that you discuss with your surgeon how big an operation he or she intends to do. Some surgeons try to leave behind as much of the stomach as they can to allow patients to be able to eat more normally afterward. The extent of the surgery should be discussed between patient and doctor before it is done. He or she should be experienced in treating stomach cancer and able to perform the most up-to-date operations to reduce your risk of complications. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond the stomach. Chemotherapy may be given as the primary (main) treatment for stomach cancer that has spread to distant organs. It may help relieve symptoms for some patients, especially those with spread (metastases) to other areas of the body. Chemotherapy is also used as an adjuvant treatment (given after surgery) along with radiation therapy for some stages of stomach cancer. It may delay cancer recurrence and extend the life span of people with less advanced stomach cancer, especially if their cancer could not be removed completely by surgery. The use of chemotherapy as a neoadjuvant treatment (given before surgery) in some situations is still being studied. Other drugs that may be helpful are docetaxel, irinotecan, capecitabine, and oxaliplatin. It is not yet clear which drugs or combinations of drugs work best against stomach cancer. Chemotherapy drugs kill cancer cells but also damage some normal cells, which can lead to side effects. The type of side effects depends on the type of drugs, the amount taken, and the length of treatment. Short-term side effects might include nausea and vomiting, loss of appetite, hair loss, diarrhea, and mouth sores. Because chemotherapy can damage the bone marrow, where new blood cells are made, your blood cell counts might become low. Targeted Therapies (21 of 39) Newer drugs, which target specific parts of cancer cells, are now being tested against stomach cancer. External-beam radiation therapy is the type of radiation therapy often used to treat stomach cancer. This treatment involves focusing the radiation on the cancer from a machine outside the body. Having this type of radiation therapy is like having an x-ray, except that each treatment lasts longer, and the patient usually receives 5 treatments per week over a period of weeks or months.


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With a last glance at them, it leapt toward the bushes, its tail sailing, and disappeared. Lina let out her breath and turned to look at Doon, whose mouth was open in astonishment. His voice shaky, he said, "That was the most wonderful thing I have ever seen, ever in my whole life. The creature was utterly strange, not like anything they had ever known, and yet when it looked at them, some kind of recognition passed between them. When they had eaten five or six apiece, they licked their sticky fingers clean and started to explore again. They went higher up the slope they were on, wading through flowers as high as their waists, and near the top they came upon a kind of dent in the ground, as if a bit of the earth had caved in. They walked down into it, and at the end of the dent they found a crack about as tall as a person but not nearly as wide as a door. By candlelight, they crept along until they came to a place where the tunnel ended abruptly. But it ended not with a wall but with a sudden huge nothingness that made them gasp and step back. They looked out into a cave so enormous that it seemed almost as big as the world outside. They could see the tiny bright streets crossing each other, and the squares, little chips of light, and the dark tops of buildings. From her pocket, Lina took the message that Doon had written, the one that was supposed to have gone to Clary, explaining everything. In small writing, they squeezed in this note at the top: Dear People of Ember, We came down the river from the Pipeworks and found the way to another place. With all her strength, she cast the message into the darkness, and they watched as it plunged down and down. Murdo, walking even more briskly than usual to keep her spirits up, was crossing Harken Square when something fell to the pavement just in front of her with a terrific thump. My gratitude to my agent, Nancy Gallt, who brought the City of Ember into the light, and my editor, Jim Thomas, who made it the best book it could be. She lives in Menlo Park, California, where she keeps a big garden and a small dog. A portion of the questions require interpretation of graphic or pictorial materials. This is the traditional, most frequently used multiplechoice question format on the examination. Strategies for Answering Single One-Best-Answer Test Questions the following are strategies for answering one-best-answer items: Read each patient vignette and question carefully. Alternatively, read each response option carefully, eliminating those that are clearly incorrect. If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. Although the sample questions exemplify content on the Step 1 examination overall, they may not reflect the content coverage on individual examinations. In the actual examination, questions will be presented in random order; they will not be grouped according to specific content. To take the following sample test questions as they would be timed in the actual examination, you should allow a maximum of 1 hour for each 40-item block, and a maximum of 58 minutes, 30 seconds, for the 39-item block, for a total of 2 hours, 58 minutes, 30 seconds. Please be aware that most examinees perceive the time pressure to be greater during an actual examination. All examinees are strongly encouraged to practice with the downloadable version to become familiar with all item formats and exam timing. Cardiac examination shows a grade 3/6 systolic murmur that is best heard over the second right intercostal space. A 12-year-old girl is brought to the physician because of a 2-month history of intermittent yellowing of the eyes and skin. Her serum total bilirubin concentration is 3 mg/dL, with a direct component of 1 mg/dL. During an experiment, drug X is added to a muscle bath containing a strip of guinea pig intestinal smooth muscle. Agonists are added to the bath, and the resultant effects on muscle tension are shown in the table. Blood Pressure (mm Hg) 85/60 85/60 85/60 120/80 120/80 120/80 Jugular Venous Pressure increased increased normal increased normal normal Pulsus Paradoxus increased normal normal increased increased normal (A) (B) (C) (D) (E) (F) Pulse (/min) 120 120 120 80 80 80 6. A 52-year-old woman begins pharmacotherapy after being diagnosed with type 2 diabetes mellitus. Ten days later, she develops fever, lymphadenopathy, arthralgias, and erythema on her hands and feet. She says that she needs the morphine to treat her pain, but she is worried that she is becoming addicted. A 22-year-old woman comes to the office because of a 4-day history of an itchy, red rash on her right arm. Six healthy subjects participate in a study of muscle metabolism during which hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects during the resting state show significantly increased concentrations of malonyl-CoA. The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects? Treatment efficacy is determined based on the results of complete blood counts and bone marrow assessments conducted regularly throughout the study. A 63-year-old man is brought to the emergency department because of a 4-day history of increasingly severe left leg pain and swelling of his left calf. During this time, he has had a 9-kg (20-lb) weight loss despite no change in appetite. A 40-year-old woman comes to the physician because of a 6-month history of increased facial hair growth. A 35-year-old man comes to the physician because of pain and swelling of his right arm where he scraped it on a tree branch 2 days ago. Examination of the right forearm shows edema around a fluctuant erythematous lesion at the site of trauma. A 12-year-old boy is brought to the physician because of a 2-month history of headaches and a 6-day history of nausea and vomiting. This patient most likely has impairment of which of the following oculomotor functions? A 52-year-old man comes to the emergency department because of a 1-day history of nausea, vomiting, and rightsided abdominal pain that radiates to his back. He has a history of type 2 diabetes mellitus, hyperlipidemia, hypertension, and atrial fibrillation. A 24-year-old man comes to the office because of a 2-day history of a red, itchy rash on his buttocks and legs. The infectious agent causing these findings most likely began to proliferate in which of the following locations? The pain tends to be more severe at night and occurs 1 to 3 hours after meals during the day. A photomicrograph of Steiner silver-stained tissue (400x) from a biopsy of the gastric mucosa adjacent to the ulcer is shown. A 14-year-old boy is brought to the emergency department after being hit with a baseball bat on the lateral side of his leg immediately below the knee. Fluid from this rupture will most likely be found in which of the following locations? The use of various conventional nonsteroidal anti-inflammatory drugs has been ineffective. A 55-year-old man comes to the physician because of a 2-week history of recurrent, widespread blister formation. These blisters are most likely the result of adhesion failure involving which of the following?

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The construction of an identity for the veterans has become the most conspicuous and persistent narrative of the memorial. Unlike the Second World War veterans, Vietnam veterans did not arrive home en masse for a celebration. They were expected to put their war experiences behind them and to assimilate quickly back into society. That many were unable to do so further exacerbated their marginalization - thev were labeled social misfits and stereotyped as potentially dangerous men liable to erupt violently at any moment. The scapegoating of the veteran as a psychopath absolved the American public of complicity and allowed the narrative of American military power to stand. It is estimated that 11,500 women, half of whom were civilians and many of whom were nurses, served in Vietnam and that 265,000 women served in the military during the time period of the Vietnam War. The experience of the women who served in Vietnam was equally affected by the difference of the war: an unusually large proportion of them, three-quarters, were exposed to hostile fire. Upon their return, they were not only subject to posttraumatic stress like the male veterans but they were also excluded from the veteran community. Many have since revealed how they kept their war experience a secret, not telling even their husbands about their time in Vietnam. These women veterans were thus doubly displaced, unable to speak as veterans or as women. The statue, which was designed by Glenna Goodacre, depicts three uniformed women with a wounded soldier. One could argue that the widespread discourse of healing around the original memorial led women veterans to speak of their memorial as the beginning rather than the culmination of a healing process. Yet the radical message of commemorating women in war is undercut by the conventionality of the statue itself. A contemporary version of the Pieta, the statue presents one woman nurse heroically holding the body of a wounded soldier, one searching the sky for help, and one looking forlornly at the ground. The Vietnam W a r is depicted as an event in which American masculinity was irretrievably damaged, and the rehabilitation of the Vietnam veteran is thus also a reinscription of American masculinity. As a form of re-enactment, this conflation of the memorial and the war is a ritual of healing, although one that appears to be stuck in its ongoing replay, with a resistance to moving beyond narratives of the war. In relighting that war every day, they are also reinscribing narratives of heroism and sacrifice. The one story for which the memorial appears to offer resolution is that of the shame felt by veterans for having fought in an unpopular war, a story that is their primary battle with history. The memorial as a shrine the Vietnam Veterans Memorial has been the subject of an extraordinary outpouring of emotion since it was built. Over 150,000 people attended its dedication ceremony and some days as many as 20,000 people walk by its walls. It is presently the most visited site on the Washington Mall with an estimated 22 to 30 million visitors. People bring personal artifacts to leave at the wall as offerings, and coffee-table photography books document the experiences of visitors as a collective recovery from the war. The rush to embrace the memorial as a cultural symbol reveals not only the relief of voicing a history that has been taboo but also a desire to reinscribe that history. The black granite walls of the memorial act as a screen for myriad cultural projections; it is easily appropriated for a variety of interpretations of the war and of the experience of those who died in it. To the veterans, the wall makes amends for their treatment since the war; to the families and friends of those who died, it officially recognizes their sorrow and validates a grief that was not previously sanctioned; to others, it is either a profound antiwar statement or an opportunity to recast the narrative of the war in terms of honor and sacrifice. This sentiment is not confined to those who wish to return to the intensity of wartime; it is also felt by the news media, who long to recapture their moment of moral power - the Vietnam War was very good television. And with a triumphant flourish it offered us the spectacle of its most successful creation, the veterans who will fight the next war. The Vietnam Veterans Memorial is the subject of no fewer than twelve books, many of them photography collections that focus on the interaction of visitors with the names. The memorial has tapped into a reservoir of need to express in public the pain of this war, a desire to transfer the private memories of this war into a collective experience. Many personal artifacts have been left at the memorial: photographs, letters, poems, teddy bears, dog tags, combat boots and helmets, M I A / P O W bracelets, clothes, medals of honor, headbands, beer cans, plaques, crosses, playing cards. At this site, the objects are transposed from personal to cultural artifacts, as items bearing witness to pain suffered. Thus, a very rich and vibrant dialogue of deliberate, if sometimes very private, remembrance takes place at the memorial. Of the approximately 40,000 objects that have been left at the wall, the vast majority have been left anonymously. Relinquished before the wall, the letters tell many stories: Dear Michael: Your name is here but you are not. I made a rubbing of it, thinking that if I rubbed hard enough I would rub your name off the wall and you would come back to me. I was only eighteen years old that day that we faced one another on that trail in Chu Lai, Vietnam. Hence, the memorial is perceived by visitors as a site where they can speak to the dead (where, by implication, the dead are present). Many of these letters are addressed not to visitors but to the dead, though intended to be shared as cultural memory. For those who left these objects, the memorial represents their final destination and a relinquishing of memory. The National Park Service, which is now in charge of maintaining the memorial, operates an archive of the materials that have been left at the memorial. Later, Park Service officials realized the artifacts had been left intentionally, and they began to save them. With each object we are in the presence of a work of art of individual contemplation. The thing itself does not overwhelm our attention since these are objects that are common and expendable. This attempt to tie these objects and letters to their creators reveals again the shifting realms of personal and cultural memory. Assigned authorship and placed in an historical archive, the objects are pulled from cultural memory, a realm in which they are presented to be shared and to participate in the memories of others. One of the most compelling features of the Vietnam Veterans Memorial collection is its anonymity, mystery, and ambiguity. It appears that many of the stories behind a substantial number of artifacts may never be known, and that the telling of these stories to history was never the purpose of their being placed at the memorial. Though couched within an official history and held by a government institution, these letters and offerings to the dead will continue to assert individual narratives, strands of cultural memory that disrupt historical narratives. They resist history precisely through their obscurity, their refusal to yield specific meanings. The construction of a history the politics of memory and history of the Vietnam Veterans Memorial shift continuously in a tension of ownership and narrative complexity. Has the Vietnam Veterans Memorial facilitated the emergence of the voices of veterans and the families and friends of veterans in opposition to the voice of the media and the government? The process of healing can be an individual process or a national or cultural process; the politics of each is quite difference. The period between the end of the war and the positioning of the memorial as a national wailing wall has been long enough for memories and culpability to fade. Ironically, the memorial allows for an erasure of many of the specifics of history. It is rarely noted that the discussion surrounding the memorial never mentions the Vietnamese people. This is not a memorial to their loss; they cannot even be mentioned in the context of the Mall. Nor does the memorial itself allow for their mention; though it allows for an outpouring of grief, it does not speak to the intricate reasons why the lives represented by the inscribed names were lost in vain. Why must a national memorial re-enact conflict by showing only one side of the conflict? Its presence indicates both the limitations and the complexity of that nationalist discourse. Lauren Berlant writes: When Americans make the pilgrimage to Washington they are trying to grasp the nation in its totality.

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Discovery of structurally diverse small-molecule compounds with broad antiviral activity against enteroviruses. Chronic enteroviral meningo-encephalitis in X-linked agammaglobulinaemia: favourable response to anti-enteroviral treatment. Successful treatment of chronic parvovirus B19 infection by high-dose immunoglobulin. Intrauterine anemia due to parvovirus B19: successful treatment with intravenous immunoglobulins. Successful intravenous immunoglobulin therapy in 3 cases of parvovirus B19-associated chronic fatigue syndrome. Intravenous immunoglobulin in acute rheumatic fever: a randomized controlled trial. Randoe mised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barre syndrome. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barre syndrome: randomised trial. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barre syndrome. Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Outcome of severe Guillain-Barre syndrome in children: comparison between untreated cases versus gamma-globulin therapy. High-dose immunoglobulin therapy for Guillain-Barre syndrome in Japanese children. Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: a two-year study. A plasma exchange versus immune globulin infusion trial in chronic inflammatory demyelinating polyradiculoneuropathy. Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy. High-dose intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy: a double-blind, placebo-controlled, crossover study. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review. 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A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy. Immunotherapy for IgM anti-myelin-associated glycoprotein paraprotein-associated peripheral neuropathies. Immunotherapy for IgM anti-myelin-associated glycoprotein paraprotein-associated peripheral neuropathies [update]. Intravenous immunoglobulin in the preparation of thymectomy for myasthenia gravis. A comparative study of intravenous immunoglobulin and plasmapheresis preoperatively in myasthenia. Current therapy for Lambert-Eaton myasthenic syndrome: development of 3,4-diaminopyridine phosphate salt as first-line symptomatic treatment. Autoimmune channelopathies: well-established and emerging immunotherapy-responsive diseases of the peripheral and central nervous systems. Long-term follow-up of Lambert-Eaton syndrome treated with intravenous immunoglobulin. Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis. A double-blind, cross-over trial of intravenous immunoglobulin G in multiple sclerosis: preliminary results. Intravenous immunoglobulin treatment following the first demyelinating event suggestive of multiple sclerosis: a randomized, double-blind, placebo-controlled trial. Intravenous immunoglobulins as therapeutic option in the treatment of multiple sclerosis. Effect of intravenous immunoglobulin treatment on pregnancy and postpartum-related relapses in multiple sclerosis. Intravenous immunoglobulin G for the treatment of relapsing-remitting multiple sclerosis: a meta-analysis. Chronic inflammatory demyelinating polyradiculoneuropathy associated with multiple sclerosis. Intravenous immunoglobulin in primary and secondary chronic progressive multiple sclerosis: a randomized placebo controlled multicentre study. Treatment of multiple sclerosis with intravenous immunoglobulin: review of clinical trials. Intravenous immunoglobulin in relapsing-remitting multiple sclerosis: a dose-finding trial. Intravenous immunoglobulins are a therapeutic option in the treatment of multiple sclerosis relapse. Atypical benign partial epilepsy of childhood (pseudo-Lennox syndrome): report of two brothers. High-dose intravenous immunoglobulin treatment in cryptogenic West and Lennox-Gastaut syndrome; an add-on study. Intravenous immunoglobulin: a single-blind trial in children with Lennox-Gastaut syndrome. Demyelinative brainstem encephalitis responsive to intravenous immunoglobulin therapy. Evidence-based guidelines on the use of intravenous immune globulin for hematologic and neurologic conditions. Neurologic improvement after high-dose intravenous immunoglobulin therapy in patients with paraneoplastic cerebellar degeneration associated with anti-Purkinje cell antibody. Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up. Successful management of cataplexy with intravenous immunoglobulins at narcolepsy onset. Intravenous high-dose immunoglobulin treatment in recent onset childhood narcolepsy with cataplexy. No persistent effect of intravenous immunoglobulins in patients with narcolepsy with cataplexy. A randomised clinical trial comparing interferon-alpha and intravenous immunoglobulin in polyneuropathy associated with monoclonal IgM.

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The devilish doctors now laugh and grin and chuckle in their ghoulish glee: "Oh, we are the only, only ones, now, who can touch the sick for a fee. With Chiropractic established in 1885, 1900 and 1909 it ought to be quite well and securely established. They do not use salve or other preparations to soothe or mollify abnormal functionating in living organisms, or when correcting an unreliable timekeeper. He has risen to a proud station among the members of the British Union for the Abolition of Vivisection. Shaw made up his mind to join a society of fools, naturally nothing would satisfy him short of being the biggest fool of the lot. The ignorance and prejudice which he exhibited in a widely-published address to the union, not long ago, show that his eminence has been worthily won. An anti-vivisection speech, which did not contain at least a score of falsehoods, would be rather flat. If it treated physicians and men of science with anything like common fairness, the speaker would be hooted. Anti-vivisection thrives on a diet composed half of deliberate lying and half of mawkish conceit. In the speech to which we have referred, Bernard Shaw says over and over again that vivisection has accomplished nothing for the good of mankind or the increase of knowledge. Statements of this sort display absence of conscience, which would be incredible in anybody tent an animal worshipper, but it is notable that men and women who have devoted themselves to the religious cult of dogs, cats and monkeys lose every vestige of feeling for the woes of their own kind. No women are so utterly insensible to human suffering as those who have become the slaves of a pet dog. To see some of them grovel before their ugly little idols is enough to make a person ashamed of his species. The dog worshiper in general not only becomes dehumanized to an astonishing degree, but he even boasts of his mania as if it were something to take pride in. Did you ever hear one of these infatuated monsters proclaim his love for his fellow man? She consecrates every waking hour to its service, dreams of tit by night and when she dies it is bounteously remembered in her will. There are instances of besotted females who have left fortunes of $10,000 for the support of a pet cat! To a beloved and adored dog now and then $30,000 or $40,000 have been left by some dying idiot for luxurious maintenance. It finally died from a surfeit brought on by dining on a whole chicken, followed by a pound of candy. Meanwhile there were thousands of children in the same city who had not had a decent dinner in their lives. Such is the dire influence of dog and cat worship on the human intelligence and conscience, and yet the anti-vivisectionists boast of their addiction to the vice. A good specimen of the dense ignorance he displays is to be found in this sentence: "I wish myself that the vivisectors could be induced to perform some really scientific experiments upon themselves. Shaw would go on repeating his dull falsehood, even if somebody would tell him of the medical officers who inoculated themselves with the yellow fever at Havana; of the scientists who permitted poisonous insects to bite them on the Roman Campagna, and of the young experimenter who tried upon his own body the effect of cancer virus. Whatever may be said for or against the physicians and other men of science, they have never hesitated to put their theories to the supreme test of a trial on their own persons. Their own courage in this particular far surpasses what is required of a soldier on the battlefield. Bernard Shaw and the coterie of shrews and imbeciles who train with him to rail at physicians and assert that their experiments on living animals are a systematic cultivation of cruelty, but one may predict safely enough that in all the multiple of the anti-vivisectionists there is not a single individual who ever willingly made the smallest sacrifice of his own bodily comfort for the good of the human race. They are all of them completely satisfied when they have secured the comfort of their pet dogs and cats. Where will you find anybody else who is willing to doom thousands of human beings to death for the sake of gratifying his own vanity? The problems which now confront physicians cannot be solved without making experiments on living animals. We are compelled, therefore, to choose between inflicting some transitory pain on a few cats and monkeys and permitting such diseases as cancer to ravage mankind without a remedy. They have won so much support in Great Britain that they have substantially stopped the progress of medical research there. British physicians who wish to do scientific work have to go to the continent for an opportunity. If the animal worshipers can accomplish their purpose they will do the same thing in America. They openly avow their intention to close the Rockefeller and Buffalo research hospitals. They will put an end to medical experiment in every laboratory in the country if they can once get control of legislation. They ought to be roundly denounced as enemies of the human race and every person who cares for the welfare of his own species should do his part to help thwart their wicked schemes. The Oregonian, instead of citing the reader to some knowledge gained by torturing helpless, dumb animals, uses;slanderous epithets, such as fools, monsters idiots, shrews, imbeciles, animal worshipers and besotted females. It says that the lovers of household pets were silly, wicked, fetish worshipers; that the eminent George Bernard Shaw, who has risen to the proud station among the members of the British Union for the Abolition of Vivisection is the biggest fool; that he exhibits dense ignorance prejudice, mawkish conceit and states falsehoods and deliberate lies in his speeches. Vivisection is supposed to be performed in the interest of pathologic physiology, with a hope of discovering the cause of abnormal metabolism, so that the surgeon may learn something regarding biology-the science of life. Thousands and thousands of helpless victims, unable to call down the vengeance of heaven upon their cruel tormentors, have been slowly tortured in the interests of science until a lingering death put an end to their misery. These deluded vivisectors imagine that, by observing, under the microscope, the behavior of the pathological conditions and processes induced by their cruel and unnecessary experiments, they will be able to discover the cause and nature of disease. But, with all of their efforts, these ardent enthusiasts have not disclosed the reason for functional derangement, or the cause of any disease. Is there any science in the practice of medicine and has vivisection advanced it along the lines of scientific investigation? In a frank and honest manner McFarland states that the nature of assimilation of digested foods is still undetermined. What becomes of the sugar (in diabetes) under normal conditions, is a problem of great importance concerning which we are still somewhat in the dark. The importance of bile salts, or rather, of the acid of which they are formed, is not known. In the physiology of dwarfs there is probably some hidden error of nutrition or metabolism. In truth, we are no nearer the correct solution of the etiology of tumors, so far as any accurate knowledge is concerned, than we were ten years ago. The above extracts are gleaned from a pathological textbook which is intended to give physicians and students who "look to vivisection as our only salvation from numerous ills," more and better knowledge of pathological physiology. Why not get wise and accept the truism of an illustrious medical grandfather of 1776, Baron von Swieten, counsellor and first physician to their Majesties, the Emperor and Empress of Germany; perpetual president of the College of Physicians in Vienna; member of the Royal Academy of Sciences and Surgery at Paris; H. How many more thousands of helpless creatures will be made to suffer before we can be edified on biology, or told the origin and nature of any one disease? Pray tell us how much longer will you continue to callous your feelings before you will give up the bloody delusion of vivisection? How many more generations will come and go before you will be able to lesson the number of your self-limited diseases-those which run a definite course, notwithstanding your coveted ignorance gained by centuries of misdirected cruelty? McFarland says: "A knowledge of these specific actions of poisonous substances that form the foundation of therapeutics, and it is only a thorough knowledge of their pharmacology that gives medicine a firm scientific station. Vivisection and pharmacology have not and never will enlighten the world concerning pathological physiology. If your windows fail to move freely and your doors to open easily, because your building has sagged, would you slash, cut and destroy others in order to learn the reason of their nonperformance of the acts which they were designed to do? Would you not rather make an effort to discover what part of the structure had become displaced, permitting the building to settle and thereby deranging some part of its architecture which in turn had been drawn out of alignment sufficiently to cause the difficulty with the doors and windows? You would not permit a would-be workman to butcher your doors and windows, but would employ a master-mechanic who would adjust displaced portions. It supports the softer structures which are grouped around it, and affords protection to many delicate organs which are lodged within its cavities. By the articulation of its several parts, its segments are converted into levers which constitute the passive portions of the locomotory system. The various bones and cartilages are united by means of ligaments so arranged as to give the body definite shape and afford attachment to the muscles by which the various movements are accomplished.

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Yes, chickenpox is reportable by New Hampshire law to the Division of Public Health Services, Bureau of Infectious Disease Control at (603) 2714496 Who should be excluded? Children should be excluded from daycare after the rash eruption first appears and until the vesicles become dry and crusted over. In certain situations exposed unvaccinated children without symptoms do need to stay at home. Generally exposed children, who have been vaccinated, do not need to stay at home. Usually the viral illness causes some combination of stuffy nose, runny nose, sore throat, cough, runny eyes, ear fluid and fever. Occasionally, the common cold or influenza can be complicated by a bacterial infection such as an ear infection, sinus infections, or pneumonia. These complications can be treated with appropriate antibiotics after evaluation by their health care provider. While there is medication available, most health care providers suggest rest and plenty of fluids. To see if there is bacterial infection in addition to the viral infection, a healthcare provider should evaluate a child who has a high fever, persistent cough, or earache. Influenza vaccine is the primary method of preventing influenza and its severe complications. Two doses should be given the first year the child receives the influenza vaccine. As the number of persons in contact with a child increases, so does the likelihood of exposure to the common viruses that cause the cold and flu. The viruses can be transmitted from one person to another in respiratory secretions (i. Infected droplets may be scattered through sneezing or coughing or they may land on surfaces touched by other persons, who then touch their eyes, nose or mouth. The symptoms of influenza appear in 1-4 days after exposure, and typically last 2-3 days. Keep tissues available Toys that children put in their mouths and frequently used surfaces. Children should be excluded if they have a fever or are unable to participate in general activities. Influenza is not reportable, but please notify the Division of Public Health Services, Bureau of Infectious Disease Control at (603) 271-4496 of influenza outbreaks. It is most often caused by a virus (like those which cause the common cold), but can also be caused by bacteria, allergies or chemicals. Signs and symptoms of purulent conjunctivitis are white or colored discharge from the eye, eye redness, eyelid swelling, eye pain, and sometime fever. Occasionally the doctor will examine the discharge under the microscope or culture it. Often an antibiotic eye medicine will be given because treatment of bacterial conjunctivitis shortens the length of symptoms and decreases infectiousness. There is not treatment for viral conjunctivitis; it will go away by itself but may last a week or more. Signs and symptoms of nonpurulent conjunctivitis are clear watery discharge from the eye, without eye redness or pain or fever. Preschoolers and school-age children have it most often and can spread it to people taking care of them or to each other. Both viral and bacterial conjunctivitis spread by contact with discharge from the eye. Dispose of tissues/towels in lined, covered container kept away from food and childcare materials. It is recommended that children and staff with purulent conjunctivitis be excluded from childcare until examined by a healthcare provider and approved for re-admission, with or without treatment. Children with nonpurulent conjunctivitis do not need to be excluded from childcare. Conjunctivitis is not reportable by New Hampshire state law to the Division of Public Health Services, Bureau of Infectious Disease Control. Some of the causes of infectious diarrhea, such as Campylobacteriosis, shiga-toxin producing E. Although these other diseasecausing organisms are not discussed in detail, the general principles outlined in this section are applicable to prevent the spread of any of these germs. The germs can be diagnosed by stool cultures or by looking at stool under a microscope for eggs or parasites. Specific methods for preventing the spread of infectious diarrhea are discussed in each fact sheet. Any person with diarrhea shall be excluded from food handling, from childcare agencies and from direct care of hospitalized or institutionalized patients until 48 hours after resolution of symptoms. For diarrhea caused by a specific agent, see the related fact sheet to learn if exclusion is necessary. It can spread especially quickly among babies and young children who are not toilet-trained or who may not wash their hands well after going to the bathroom. It can also easily spread to the adults taking care of them and helping them with diapering and toileting. Clusters of diarrhea illness in a facility should be reported to the Division of Public Health Services, Bureau of Infectious Disease and Control at (603) 2714496. The bacteria are spread by direct contact with discharge from the nose, throat, skin, eyes, or from sores of infected persons. Patients and carriers of diphtheria should receive appropriate treatment and not return to childcare until two (2) cultures from both the nose and throat (and from skin sores in cutaneous diptheria), are negative for the bacteria. These cultures should be taken at least 24 hours apart and no sooner than 24 hours after finishing antibiotic treatment. Where culture is impractical, isolation may be ended after 14 days of appropriate treatment. Children and staff should be excluded until bacteriological examination proves them not to be carriers. Diphtheria causes a sore throat and swollen tonsils, with a grayish covering and swollen glands in the neck. The bacteria also produce a toxin (a type of poisonous substance) that can cause severe and permanent damage to the nervous system and heart. Yes, Diphtheria is reportable by New Hampshire law to the Division of Public Health Services, Bureau of Infectious Disease Control at (603) 271-4496. Individuals who have been in contact with an infected person and are not adequately vaccinated should receive a booster. Usually symptoms disappear in a few days but the bacteria can remain in the intestinal tract for several weeks. Drinking unpasteurized milk and swimming in or drinking sewagecontaminated water can also cause infection. An infected person having diarrhea can pass the bacteria from one person to another if hand-washing habits are not adequate. Young children usually continue to shed the bacteria in their stool a week or two following their illness. Avoid drinking from unknown water sources, raw milk, and unpasteurized apple juice. Children who are infected with this bacterium will be excluded from childcare while they are symptomatic.

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Research costs were rising, and the time it took to take innovative science and convert it into therapeutic agents grew longer. Drug approval times increased, and existing drug products that had provided the fuel to drive investments in R&D gradually ran out of patents. Further, governments in the United States and elsewhere, which earlier had been very supportive of the pharmaceutical industry, began to withdraw their support as they confronted long-term entitlement and fiscal challenges. Pharmaceutical companies initially responded to these headwinds by A Chinese Pharmaceutical Startup Acquires an American Firm to "Go Global" 8 Paulson Papers on Investment Case Study Series Figure 1. Declining Productivity of Pharmaceutical R&D Spending Source: WuXi PharmaTech Investor Presentation. Innovative new methods such as computational design, combinatorial chemistry, high throughput screening, macromolecular x-ray crystallography, informatics, genomics, and others were developed for this purpose and became integral methods for drug discovery today. By the early 1990s, a number of leading pharmaceutical companies also faced patent cliffs as many patents approached expiration. To cut costs, affected companies offered early retirement incentives to senior scientists and laid off junior staff. Such actions marked a new era in the employer/employee relationship in the pharmaceutical industry. Some of those employees, armed with rich insider knowledge of the industry and the drug innovation process, had other ideas. Baldwin, an organic chemist at Merck & Co, was one such employee offered an early retirement package. A Chinese Pharmaceutical Startup Acquires an American Firm to "Go Global" 9 Paulson Papers on Investment As a senior scientist and manager of Merck Research Laboratories, Baldwin had a productive and distinguished 33-year career that included the development of several path breaking and profitable drugs. Instead of settling for retirement, however, Baldwin struck out to become an entrepreneur. Pepcid, of course, went on to generate billions in revenue for Merck and became a widely available over-the-counter drug. He and some of his peers became interested in research conducted at Columbia University and Cold Springs Laboratory by scientists Clark Still and Michael H. The researchers were developing techniques in the early-stage drug discovery process that would prove to have market potential. Case Study Series In the past, a major bottleneck in the drug discovery process involved the limited number and diversity of available chemical compounds. Using traditional manual chemical synthesis techniques, a chemist is usually able to synthesize 25 to 50 compounds per year. These compounds are screened in order to select potential leads for drug candidates. Over the years, however, several technologies were developed to accelerate the synthesis of chemical compounds, but most of the earlier methods produced high molecular weight compounds that are generally considered not useful for oral drugs. Pharmaceutical companies prefer low molecular weight compounds because they are more likely to be effective as drugs in tablet or capsule form, tend to have longer-lasting action, and are cheaper to manufacture. High molecular weight compounds are usually degraded by human digestive enzymes and must be administered by injection. These compounds can then be tested for potential drug candidates in a process called "high-throughput screening" (see Box). But the technique Box: Accelerating the Drug Discovery Process Existing approaches to combinatorial chemistry required inducing huge numbers of chemical reactions. For example, a robotics-based method developed and popularized in the 1980s called "parallel synthesis" needed approximately 111,110 individual chemical reactions to synthesize 100,000 compounds. A newer approach, called "pool and split," dramatically slashed that number to only 50 chemical reactions to synthesize the same 100,000 compounds. However, "pool and split" produced a serious complication: it created a mixture of diverse compounds whose structures all need to be determined to be useful for research. Beads are then washed with solvents to remove byproducts, and individual compounds can then be isolated from a mixture by removing a single bead and breaking the linkage to detach the compound from the bead. During each step of the solid phase synthesis process, specific tags are attached to each bead to indicate the chemical reagent and reaction conditions used in that step. By the end of the synthesis process, each bead has accumulated a set of tags that represent all of the building blocks used to create the compound on that build. Using the tags, researchers can then quickly identify the structure of an active compound using the "pool and split" technique. A Chinese Pharmaceutical Startup Acquires an American Firm to "Go Global" 11 Paulson Papers on Investment was so cutting edge and new that pharmaceutical companies had not yet adopted it when Baldwin started exploring these new methods. Baldwin and his colleagues believed that these advantages were exactly what pharmaceutical companies needed to be able to reshape early-stage drug discovery. The group entered into an exclusive license agreement with Columbia University and Cold Springs for their patent applications covering molecule encoding. Unlike traditional pharmaceutical firms, Pharmacopeia had no plans to develop, manufacture, and sell its own products. For example, in December 1994 Pharmacopeia signed its first collaborative agreement with ScheringPlough, in which Schering-Plough tasked Pharmacopeia with synthesizing and optimizing libraries of lead compounds that interact with molecular targets related to cancer and asthma. As for "licensing libraries," Pharmacopeia would continuously add to its own set of internal compound libraries, to which customers could pay for access. Pharmacopeia was unusual in that its services were (1) for early-stage drug discovery and (2) targeted to serve large pharmaceutical companies. This was a break from historical practices, where drug companies conducted early-stage discovery entirely within their own research departments. Factors such as the highly proprietary nature of the work, the central importance of the activities to their drug discovery and development efforts, and Case Study Series the desire to obtain maximum patent and other protection of their internal programs all argued for the more vertically integrated model. In fact, the company quickly signed up major customers, including Schering-Plough, Sandoz, Bayer, and the Japanese pharmaceutical company Daiichi. Such trials require complex permitting, breeding, sales, and upkeep of exotic lab animals and finding a sufficient number of humans with the desired characteristics for trials. They researchers certain products, testing, and services can had recognized are generally much smaller and may have be more efficiently provided by third parties. In 1947, Foster had thousands of rat cages that he had purchased from a defunct Virginia farm shipped up to a rental by the Charles River in Boston and began breeding rats. Over the years, the company expanded its services to include breeding and selling lab animals, toxicology testing, preclinical and clinical development services, and cell culturing, primarily serving the biotech industry. The company gained international notoriety in 1989 when primates in its Reston, Virginia testing facility were found to be infected by the deadly Ebola virus. Throughout the 1990s and 2000s, healthcare spending in Western European countries soared, in part because the government provided partial or total reimbursement for the cost of prescription medicines. At the same time, most governments also resorted to price controls to curtail runaway government spending on entitlement benefits that cover prescription drugs. Such policies had the cascade effect of hitting company revenues, which led to R&D funding cuts and increasing pressure to contain drug development costs. Many European pharmaceutical companies ended up shifting sales and R&D activities to the United States, where drug prices were still more market based. What had been deemed cutting-edge technology not so long ago very quickly became a common basic requirement within every drug discovery organization. By 2000, Pharmacopeia had grown to 746 employees, about 40 percent of which were chemists, biologists, and engineers with PhDs, and the discovery Case Study Series chemistry segment was pulling in $39 million in annual revenue. It is a complex chemical process performed repeatedly with different reagents to produce different compounds. This allows for the compound to be identified easily, as the coding molecules are removed, which tells the researcher what steps that bead has been exposed to. Those two regions had a labor pool that was considered skilled relative to the prevailing wage rates in those labor markets, creating what has been termed "talent arbitrage" opportunities. Studies showed that moving R&D to India could save multinationals anywhere between 30-50 percent in costs, depending on the service. For most of the 20th century, these advantages were stifled by differences in disease profiles between the Indian and Western populations. But, over the past two decades, increasingly common "lifestyle" diseases in the West such as obesity, diabetes, and lung cancer have become much more prevalent in India, which has diversified its patient pool into more areas of study. These advantages turned India into a hotbed for clinical trials, as companies flocked there. A prominent example is Biocon-one of the first of these A Chinese Pharmaceutical Startup Acquires an American Firm to "Go Global" 17 Paulson Papers on Investment firms-which dates back to 1978 when two scientists in Bangalore opened a makeshift "lab" in the garage of a rented house. They produced an enzyme used to prevent beer from appearing hazy and sold it to local brewers.

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Nerve-stretching may be useful also in cases in which irritation of a centripetal nerve gives rise to reflex or epileptic convulsions by diminishing the peripheral irritability (in addition to the action described). In the case also of diseases of the spinal cord that have not yet advanced to a state of gross degeneration nerve-stretching is not to be neglected as a therapeutic agent. This consists of a vibrating ivory hammer attached to an extension of the Neef hammer of the induction-apparatus, which by a rapid succession of blows upon the underlying nerve develops a condition of tetanus lasting up to two minutes. Bones of the body framework give to nerves a proper and normal tension, known as tone. Placing an exposed nerve against a vibrating tuning fork or a vibrating string of a musical instrument, will cause a similar vibration in the nerve, just as the contact of a telegraph wire will affect a telephone wire. McConnell, of Chicago, took dogs from the pound and wrenched their spines at certain points. The nerves near the strained vertebrae were examined with the naked eye and microscope; also the organs which those nerves supplied. In every instance the nerves and the organs innervated by them were found congested, inflamed and their functions disordered. Smith pounding tables used to make muscle; the Langworthy stretching machine; the throat punching; the no cranial nerves; the no sympathetic nerves and the no reflex action are not Chiropractic. The mission of the Adjuster will be to give Chiropractic up to date, throw down and out all rubbish that accumulated while I was "on a vacation. Why not say Ki-ro-prak-tik is the only scientific method known which removes the cause of 95 per cent of all diseases without Drugs, Medicine or Operation? That system of remedial treatment which seeks to cure diseases by producing a condition incompatible with the disease; opposed to homeopathy. That system of medical treatment which seeks to cure a disease by administering medicine which would produce this same disease in a healthy condition; opposed to Allopathy. Biology is the science of life; that branch of knowledge which treats of living matter as distinct from that which does not possess a living force. Morphology deals with the origin, form, structure and distribution of living things. Physiology treats of the functions which create and continue a living existence, and the manner in which its individual parts perform their functions. Anatomists study the structure of organs, their shape, size, the tissues of which they are composed and their relative position in the body. Pathology treats of the modification of functions changes in position and structure of parts. Pathological processes are but greater or less variations from those which are physiological. These deviations are regarded as morbid, since they pertain to abnormal functions or diseased structure. Disease is the result of the quickening or the retarding of impulses which excite, sway or modify the orderly transformation of energy. It is the amount of energy which transmits an impulse and gives it force; too much or not enough causes functions to be performed in too great or too little degree. It is the manifestation of perturbed functions or altered structure, or both; in fact, either cannot exist without the other. Pathology deals with the disturbances of functions and the alteration of structure in living beings which are induced by unusual agencies and conditions. The functional disturbances thus produced are embraced and known as symptoms of disease or pathological physiology. The phenomena of pathological physiology are in no way opposed to those of normal physiology; they are their inevitable correlatives, when the living body is placed under sufficiently abnormal conditions. Pathological morphology is concerned with the structural alterations of the organism which result from abnormal conditions. It deals with the gross and microscopic alterations of structure; it embraces pathological anatomy and pathological histology. Alterations in structure are always associated with disturbance of function; both are dependent upon the inciting factors of disease. An intelligent study of morphology, of necessity includes normal anatomy and normal physiology, also pathological anatomy and physiology. Physiology as defined by the medical profession includes the laws of chemistry and physics; that is, the same laws which regulate action of the mineral, organic world are believed to be operative in organic beings. That is, food contains chemical substances which are acted upon in a chemical way by the various digestive juices in order to render them of service in building up the organism. Digestion is that to be a form of fermentation; when it is excessive or deficient there results a condition known as disease. McFarland states, "Until our knowledge of biology in its normal and abnormal relations is perfected, medicine cannot become an exact science. In general it may be said that the extremes of life show an increased disposition to disease. Certain diseases as mumps, diphtheria, croup, measles, chicken pox and pertussis affect children principally and occur only occasionally in adults. Nerves become hardened and less sensitive as we advance in age; the glands, organs and cartilage become more fibrous and less elastic. Functions are modified by traumatic injuries and various substances which, when taken inwardly or applied externally, impair the normal or special action of a part. Displacements of the osseous frame-work impinge upon nerves which direct the communication of impulses, and give an undue force to functional activity. Poisons just as surely act upon and cause contraction of nerves and muscles, drawing bones out of alignment. Local inflammations and fevers are due to traumatic injuries, inoculated virus or to poisons taken internally. An overheated condition, whether local or general, disturbs the functions of the body. The body derives its nourishment from a circulating, nutritive fluid which is transuded thru the tissues by exosmosis and imbibition. When it is considered that the body contains in all its tissues about half its weight in water which is constantly being thrown off with the urine and feces, as well as, by the skin and lungs; that, in the process of digestion and absorption, most substances must be dissolved in water; that water is a constituent of fluid-food, and, likewise, that numerous waste-products, especially in the urine, must leave the body; in aqueous solution, the importance of a constant supply and continued renewal of water will be at once obvious. Provision is made for its removal from the tissues, after it has fulfilled its purpose, thru the lymphatic vessels which begin as mere clefts and gradually develop into larger vessels so as to provide a system of tissue drainage. I am now describing what is known by some Chiropractors as "the serous circulation" which, because it was a new thot to them, was considered a new discovery. All physiologists and anatomists know of, and have written extensively about, the "serous," the fluid transudation which pertains to all vegetable and animal life. There is a physiologic balance between the circulation and the amount of lymph, so that no more fluid exudes into a tissue than it needs. If the quantity of the fluid is increased the circulation is correspondingly accelerated. In diseased conditions this even balance is disturbed; either the transudate liquid is increased or the circulation is less active; the tissue becomes distended, saturated, macerated and tumefied, a condition known as edema or dropsy. The physiologic functions of fat are, to protect the organs, maintain temperature and in time of need to become liquidized for nutritive purposes. Fat is a common physiologic phenomenon; it becomes pathologic only when it occurs in unusual tissues or in excessive amount. A physiologic function becomes pathologic when either excessively or deficiently active. The science of Chiropractic has modified our views concerning life, death, health and disease. We no longer believe that disease is an entity, something foreign to the body, which may enter from without, and with which we have to grasp, struggle, fight and conquer, or submit and succumb to its ravages. Disease is an abnormal performance of certain functions; the abnormal activity has its causes, as much so, as the windows which are bound and cease to be movable, or the transoms and doors which we are unable to close, because of the settling of some portion of the building. The morphological alterations of the body superinduced by displaced structure can be located and as surely corrected as can the sagging of the building. These constitute the signs, symptoms and lesions of a departure from a state of health. The body in disease does not develop any new form of energy; what it already possesses is diminished or increased, perverted or abolished. In health there is a constant physiological, invincible molecular change-the manifestations of energy. In disease this manifestation of energy is modified and the quality of structure is altered. The transmission of physiological impulses in normal amount is health; in a less or greater degree, disease.

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The finished surface of wooden potty chairs is not durable and, therefore, may become difficult to wash and sanitize effectively. Hand washing sink and towels the best hand washing sink is one equipped with both hot and cold running water mixed through one faucet (with a minimum water temperature at least 60-degrees and not greater than 120-degrees). Ideally, water controls should be foot, knee or wrist operated to avoid contamination of or by hands. Diapers Use of disposable diapers is recommended to best reduce the risk of infections. Cloth diapers require more handling than disposable diapers (the more handling the greater chance of infection). When cloth diapers are used, no rising or dumping of contents of the diaper shall be performed at the childcare facility. Step 2: Carry the child to the changing table, keeping soiled clothing away from you and any surface you cannot easily clean and sanitize after the change. Put the soiled wipes into the soiled diaper or directly into a plastic-lined, hands-free covered can. Step 4: Remove the soiled diaper without contaminating any surface not already in contact with stool or urine. If pins are used, place your hand between the child and diaper when inserting the pin. If the recommended bleach dilution is sprayed as a sanitizer on the surface, leave it in contact with the surface for at least two (2) minutes. The surface can be left to air dry or can be wiped dry after two (2) minutes of contact with the bleach solution. Children and infants should not have contact with these animals or items that have been in contact with these animals or their environments. When bringing appropriate pets into a childcare facility, the following guidelines should be followed: 1. All animals should be in good physical condition and vaccinated against transmittable diseases. Animals should be kept clean and free of intestinal parasites, fleas, ticks, mites, and lice. All fecal material must be cleaned from the cage of any mammal or bird on an as needed basis, (at a minimum of one time per week), and appropriate sanitizer used. Reptiles, fish and insects must be cared for in a manner to minimize odor and maintain health. Cleaning should be preformed by individuals >5 years old, under the supervision of an adult. Wash hands with soap and warm water after contact with animals or their environment. Because wild animals can carry diseases that are dangerous to people, children should not have direct contact with wildlife. Teach children never to handle unfamiliar animals, wild or domestic, even if the animal appears to be friendly. For concerns about pets in a childcare facility please contact the Division of Public Health Services, Bureau of Infectious Disease and Control at (603) 271-4496. Persons who have signs or symptoms of illness, including vomiting, diarrhea or infectious skin lesions which can not be covered, or who are infected with foodborne pathogens. Whenever possible, staff who diaper children and have frequent exposure to feces should not prepare food for others. Careful handwashing needs to be practiced at all times, especially for caregivers who prepare food. Do not reuse lunch bags or bags from other items because of possible contamination. If defrosting outside the refrigerator, place food in a sealed plastic bag and immerse in cold water, changing the water frequently. Do not refreeze foods unless the package label states that it is safe to refreeze. Follow instructions for microwave defrost as given in operating manuals of microwave. Wash utensils, platters, counter tops and cutting boards with hot soapy water before and after contact with raw meat or poultry products. Staff who diaper children and have frequent exposure to feces should not prepare food for others. Wash meal service area before and after serving food with hot soapy water followed with a disinfectant solution. If interrupted while feeding an infant, wash hands again before continuing and before feeding another child. LikeDivision of Public Health Services Bureau of Infectious Disease Control What to Do If the Freezer Fails or the Power Goes Out 1. If your refrigerator-freezer will be shut off for more than two hours, make immediate arrangements for alternate storage of food elsewhere. If refrigerated foods are above 40 F for more than two hours, most perishable foods will be need to be discarded. Frozen foods can be refrozen if they are at or below 40 F or still contain ice crystals. Any formula or bottled breast milk not consumed by an infant may be used later in the day if dated and stored in the refrigerator. Otherwise, is should be discarded or returned to the parent at the end of the day. Allow adequate transport time to and from grocery shopping to prevent spoilage of fresh or defrosting of frozen products. Do not buy or use food from containers that are leaking, bulging or severely dented. Do not buy jars that are cracked or have bulging lids or cans that are bulging or leaking. Proper Hand Washing Technique Children and babies should have their hands washed: 1) upon arrival to the daycare facility, 2) before eating/preparing food, 3) after toileting/diapering changes, and 4) after touching body secretions 5) after playing outside, especially after playing sandboxes. Adults (including staff, volunteers, students and parent helpers) should wash their hands: 1) when they arrive at the daycare facility, before starting work, 2) before eating/preparing food, or feeding children, 4) after toileting/diapering a child or using the bathroom themselves, and 4) after handling body secretions. Check the gaskets regularly; they should be flexible to keep the cold air from leaking out. If refrigeration is not available, put a container filled with frozen water, a plastic bag with ice cubes or a cold or frozen beverage into the bag for storage. Wash your hands for at least 10 seconds while rubbing your hands vigorously as you wash them. In most cases, rashes that last for more than a day that are accompanied by fever and/or other symptoms of illness, or rashes that develop all over the body should be referred to a physician for diagnosis before a child returns to the childcare facility. Sensitive rashes that are caused from plant sensitivity such as poison ivy, poison oak and poison sumac often have unusually shaped blister-like sores. People react to direct contact from the plant or from indirect contact from clothing, or other objects contaminated from plant contact. Hives is a rash that may happen when a person is hypersensitive to such things as certain foods, drugs, and bee stings. Hives that are accompanied by difficulty breathing, unusual anxiety and hives occurring all over the body needs to be seen by a physician immediately. Generally, no treatment is required for the rash since it goes away in a few days and does not cause lasting effects. Make sure children wash their hands after handling pets or have contact with animal feces. Symptomatic staff with positive stool cultures for Campylobacter should be excluded from work. Always treat raw poultry, beef and pork as if they are contaminated and handle accordingly. Wrap fresh meats in plastic bags at the market to prevent blood from dripping onto other foods.