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An individual medicine 6 clinic purchase thorazine with visa, who by virtue of the position held symptoms definition safe 100mg thorazine, is designated by law or executive order to treatment hepatitis b order 100mg thorazine with mastercard succeed to the position of and act as a particular statutory official in the event of the death, disability, or absence of that official. Such succession to office is on a temporary or interim basis and does not vacate the statutory position currently held by the incumbent. V-2) Sulfur Mustard (Mustard Gas): "Sulfur mustard is a type of chemical warfare agent. These kinds of agents are called vesicants or blistering agents, because they cause blistering of the skin and mucous membranes on contact. Sulfur mustard sometimes smells like garlic, onions, or mustard and sometimes has no odor. It can be a vapor (the gaseous form of a liquid), an oily-textured liquid, or a solid. Sulfur mustard can be clear to yellow or brown when it is in liquid or solid form. Supply Chain Management focuses on integrating the end-to-end supply chain processes, beginning with planning of customer-driven requirements for materiel and services, delivery to disaster victims as requested by the State or tribe, and ending with replenishment of agency inventories. Support Annexes describe essential supporting aspects of the Federal response that are common to all incidents, such as financial management, volunteer and donations management and private sector coordination. These include voice and data communications system, information systems, and display systems. These also include specialized technologies that facilitate incident operations and incident management activities in situations that call for unique technology-based capabilities. If the leaders responsible for managing emergencies and the capabilities needed for them to do so are not ready and survivable when the situations occur, the consequences can be catastrophic. That is why Survivable Crisis Management should be a high priority for the Federal Government and for every State and Territory in the United States. Survival planning can be done on a single city basis, or statewide, or for a whole cluster of critical target areas involving more than one State. Even in the development of proposals for Phase I Survival Plan studies, a large number of political subdivisions have had to face up to the fact that they can neither plan nor operate separately. Included in the two publications is a discussion of survey areas that should be covered in each study. These include (1) the location and anyalysis of population, including special assistance groups, institutional requirements, and a portion of the industrial jurisdiction coordination, the continuity of government, communications requirements, capabilities, service coordination, and alerting capabilities; (3) movement, including analysis of movement capabilities and capacities, transportation availability, and trafic control; (4) shelter availability and requirements; (5) reception and care, including assembly and reception area analysis, industrial population reception, institutional requirements and reception area, and a study of the return and/or resettlement analysis; (6) resources, which includes logtistical support and the utilization of Government resources with primary emphasis on the location of manpower, material, and facilities; (7) information and training, which includes romotional analysis and internal alerting capabilities. In determining the susceptibility of an attack or "vulnerability to attack" it is assumed that the asset has been targeted, that the terrorists have the required weapon(s) and equipment, and that the attack will take place. The susceptibility then measures the probability that the attack would achieve its desired result given the constraints that are in place at the target, including physical constraints, operational constraints, and security measures. These range from simple ratings of security capabilities to complex, simulation-based evaluations of detailed attack scenarios. The most appropriate method will depend on the type of asset and the goals of the risk assessment. In general, however, an appropriate assessment of susceptibility would include an evaluation of physical features, security capabilities, and response capabilities that serve to prevent an attack from being successful. Maintain effective support at critical or alternate locations in spite of natural or man-made disasters. They emphasize open space planning where appropriate by promoting greenways, parks, and landscaping. The effective use of open space can prevent development from encroaching upon floodplains, active fault zones, and other hazard areas. Sustainable communities also take advantage of underutilized urban areas and encourage infill and "brownfield" development. Emphasis is placed on public transit and creating mixed-use environments that are less dependent on automobiles. An essential characteristic of a sustainable community is its resilience to natural disasters. In the context of emergency management, this meaning remains and it is linked to creating places that are less vulnerable to natural and technological hazards and that are resilient to those events. Sustainable hazard management has five components: environmental quality; quality of life; disaster resilience; economic vitality; and inter- and intra-generational equity.

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In lowlanders exposed to 7 medications that cause incontinence purchase thorazine 100mg otc medications versed generic thorazine 100 mg on-line moderate altitude (> 2 treatment urticaria order thorazine overnight,500 m), hypoxia will rapidly initiate diuresis that continues for several days (Anand and Chandrashekhar, 1996; Hoyt and Honig, 1996). This diuresis and the factors discussed above decrease total body water and plasma volume in proportion to the elevation of ascent (Sawka et al. Mechanisms responsible for the resultant hemoconcentration include diuresis, natriuresis, and dehydration, as well as loss of circulating plasma protein (Anand and Chandrashekhar, 1996; Hoyt and Honig, 1996; Sawka et al. This hemoconcentration is isoosmotic (unless sweat-induced dehydration contributes) and exceeds the reduction in total body water because it is largely oncotically mediated (Sawka et al. Body water reduction and hemoconcentration are believed to provide several physiological benefits by contributing to the increased oxygen content (Sawka et al. The effects of dehydration on mountain sickness and performance decrements at altitude have not been studied. Body fluid losses in cold climates can be as high as losses in hot climates due to high rates of energy expenditure and use of heavy clothing (Freund and Young, 1996). The reduction in body water with contracting vascular volume is probably of no concern as long as the body remains cool. However, if the dehydrated person were to subsequently exercise and produce body heat while wearing highly insulating clothing, then heat stress will be encountered. It is estimated that 20 to 30 percent of Americans consume more than 600 mg of caffeine daily (Neuhauser-Berthold et al. The other two methylxanthines, theobromine (found in chocolate) and theophylline (found in tea), demonstrate some, but not all, of the pharmacological effects of caffeine (Dorfman and Jarvick, 1970). It has long been thought that consumption of caffeinated beverages, because of the diuretic effect of caffeine on reabsorption of water in the kidney, can lead to a total body water deficit. As early as 1928 it was reported that caffeine-containing beverages did not significantly increase 24-hour urinary output (Eddy and Downs, 1928). Caffeine-containing beverages did not increase 24-hour urine volume in healthy, free-living men when compared with other types of beverages. Given that the study design did not evaluate habitual intake, it is difficult to determine the extent to which this large amount of caffeine would impact total water needs on a chronic basis. In an earlier study, the effect of caffeine intake on urinary output was evaluated in eight men who were asked to consume four cups of coffee or six cups of tea/day (providing approximately 240 mg of caffeine/day) for 5 days prior to data collection and then to abstain from caffeine 24 hours prior to data collection (Passmore et al. The subjects were then given various doses of caffeine (45, 90, 180, or 360 mg) on the study day. Cumulative urine volume 3 hours after consuming the test dose was increased significantly only at the 360-mg dose of caffeine. In aggregate, available data suggest that higher doses of caffeine (above 180 mg/day) have been shown to increase urinary output, perhaps transiently, and that this diuretic effect occurs within a short time period (Passmore et al. Hence, unless additional evidence becomes available indicating cumulative total water deficits in individuals with habitual intakes of significant amounts of caffeine, caffeinated beverages appear to contribute to the daily total water intake similar to that contributed by noncaffeinated beverages. Alcohol Similar to caffeine, the diuretic effect of alcohol is mediated by the suppression of arginine vasopressin (Stookey, 1999). Increased diuresis was reported during the initial 3 hours of consuming a beverage in which alcohol (ethanol) was present (consumed at level of 1. Nonetheless, 6 hours after ingestion, there was an antidiuretic phase, which lasted up to 12 hours post-alcohol ingestion (Taivainen et al. This could have been a result of a high serum osmolality that stimulated arginine vasopressin, resulting in water reabsorption (Taivainen et al. The effects of ethanol appear to change during the course of the day and may depend on the amount of water consumed at prior meals (Stookey, 1999). Thus, based on these limited data, it appears that the effect of ethanol ingestion on increasing excretion of water appears to be transient and would not result in appreciable fluid losses over a 24-hour period. Macronutrients Urea, a major end product of metabolism of dietary proteins and amino acids, requires water for excretion by the kidneys. Thus, if a person consumes 63 g of protein in a diet that contains 2,100 kcal, the volume of water required increases by 0.

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Those empirical links should also be used in the standard-setting process so providers develop cut scores that truly differentiate masters from nonmasters symptoms 32 weeks pregnant purchase generic thorazine. If the student is allowed to treatment whooping cough purchase thorazine with visa medicine wheel colors cheap 100 mg thorazine fast delivery demonstrate mastery in the competency at any time, without regard to time or place of learning, we have competency-based education. In addition, the criteria for mastery would include facility with an array of related skills, an understanding of overarching concepts, and the ability to perform over time. The Road to Personalized Learning the road to the modern-day version of personalized learning can be traced by examining the evolution of competency-based education, the efforts to address student diversity through differentiation, and the advent of learning technologies. As jobs became more specialized, identifying competencies and their component skills enabled efficiencies in training workers for the jobs, doing the work, and evaluating performance. Mulder, Weigel, and Collins (2006) describe the behaviorist approach to competency in the business sphere, based on the research of psychologist D. McClelland (1973), 9 Handbook on Personalized Learning known for his achievement motivation theory. This approach was applied by the Hay Group in behavioral-event interviews to appraise levels of competence in selecting and training corporate and governmental leaders. The behaviorist approach cleaved competency from intelligence and asserted that competency could be developed through training, can be observed and assessed in behavior, and accounts for a significant portion of the differences in the job performance of individuals. Thus, measurable objectives entered the mainstream of education, paving the way for the standards movement of the 1990s that spawned curriculum content standards in every state. It recognizes achievement with badges and certificates which employers and schools may choose to also recognize. Antecedents of personalized learning can be seen in the progressive education philosophy of John Dewey, William Kilpatrick, and others in the early decades of the 20th century. A great leap forward, however, came later, as educators sought methods to address student As the first decades of the twentydiversity. Carol Ann Tomlinson popularized and provided research substantiation for instructional differentiation, beginning with her 1995 book, How to Differentiate Instruction in the Mixed Ability Classroom. Technology, especially learning management software and the burgeoning resources of the Internet, catalyzed this weaving of elements and burst of enthusiasm for personalization. The technology industry, with ideas and resources from the Bill and Melinda Gates Foundation and endorsement from the U. Department of Education, signaled that the age of personalized learning had arrived. The Gates Foundation (2010) itemized several of the threads, as follows: 10 Competencies and Personalized Learning Learning models that support personalized learning pathways require some basic building blocks. These include effective assessment tools that align with college preparation standards and clear postsecondary learning objectives, engaging digital content, algorithms that match student needs with content and delivery methods, technology-enabled professional development tools, and learning management platforms that integrate and deliver these diverse components. The teacher knows her subjects and the possible paths a student might take in studying them. The student is at once an individual scholar and a constituent of a group of learners, and his or her relationship with the group constitutes some of what it means for a young person to become socialized. Personhood, in fact, is acquired through social interaction, as the self is defined and understood in relationship to other people. The Internet and software that coordinates the work of colearners across time and place provides a middle ground between isolated, individualized learning and a face-to-face classroom experience. The ideal may be a blending of group learning in the traditional classroom with individualized learning and with personalized learning that includes virtual learning cohorts. Strategies to Personalize Learning Use of Technological Tools Learning technology makes personalization practical, at once reducing the time required for a teacher to differentiate instruction, opening access to unlimited content, structuring content and activity into manageable pathways, assessing progress and scaffolding tasks, and facilitating individual and group work across time and place. Blended learning, a method of personalization, mixes traditional classroom instruction with online delivery of instruction and content, including learning activities outside the school, granting the student a degree of control over time, place, pace, and/or path (Bonk & Graham, 2006). In a blended learning approach, technology is not seen as a replacement for the 11 Handbook on Personalized Learning traditional classroom, but rather as a powerful tool to enhance what is already proven to be effective pedagogy. Competency-Based Education Strategies to implement competency-based education in personalizing learning include: Flexible credit schemes break the ties among class time, learning time, and assessment. Flexible credit schemes include (a) dual enrollment and early college high schools, (b) credit recovery, and (c) multiple paths to graduation. Service learning, a dimension of many character and social/emotional learning programs, is easily accommodated in a personalized learning environment. Community-based learning directed at competencies (personal, academic, and career/ occupational) extends the time and opportunity for learning beyond the school day and provides rich experiences beyond the classroom.

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When I was on the McGuire course medicine gabapentin order 100 mg thorazine with amex, I would have enormous difficulty with Chinese and Indian people medicine xanax buy generic thorazine 50 mg line. The environmental cues of being back home are sometimes too much and my speech quickly goes out of control treatment associates purchase genuine thorazine on-line. When you first began to overcome stuttering, did you just talk regardless of the fact that you might stutter, or did you control the stutter first Regards a Andrew, >> How are things, have you attended the McGuire program (full duration) yet I seldom backed out of the situation, because if worse came to worse, I could fall back on one of those tricks. Whatever fears I had about looking bad were dealt with big time in those trainings. I have completed a 10,000-word dissertation about stuttering, and a 10,000-word project about adolescent substance abuse. However I do believe that it has been by far the best treatment I have participated in. When I accept and truly regard myself as someone who will occasionally stutter, I tend to experience the moment and react accordingly. Regards Andrew, Hi Andrew, >> Are you still very much involved with the McGuire method When I accept and truly regard myself as someone who will occasionally stutter I tend to experience the moment and react accordingly. Future progress will depend on getting out there and doing a lot of speaking, or perhaps, taking a McGuire refresher. I have been trying to consciously change the many schemas I hold within my psyche. I have approached people in my past with whom I felt I had let myself down (many years ago). I have found that many of my schemas erode within minutes as opposed to trying to change through years of intellectualizing about a situation etc. I never knew life could be fun, I never knew a life outside the mentality of stammering. From my own perspective you were always the lighthouse guiding the ships through the fog! He just fills in the blanks, usually with a patronizing statement for the person who is filling the room with energy. I got so frustrated with this that I no longer see him anymore, and what a relief it is. And sometimes, even as you begin to reprogram your mind, the learned behavior will kick in as a conditioned response to various stimuli. Otherwise, your subconscious mind keeps learning that it is something to fear, to dread, to hate, to loathe. And it places too much importance on stuttering (which ultimately causes more stuttering). Ask yourself if you would let anyone else treat you/talk to you about your stuttering the way you talk to yourself. November 9, 2005 Subj: my story so far Hi John, I read your new correspondence and it was right on the mark if I can be so bold. I appeared to let life wash all over me and get other interests like meeting with friends, relationships with the opposite sex. I consider myself 10 years behind those who had no problem with their speech, so my mindset is gradually beginning to change to that of a normal speaker. I remember last week I was walking up a hill not thinking about stammering but thinking about the Thomas Harris novel, "Silence of the Lambs". In the past I received a lot of sympathy (because of the stuttering), but now I have to deal with people naturally and absorb their moods (maybe they have had a bad day, etc. This is all I can offer for now, but I will set my mind in observation role and try to correspond with more perceptual insights. The challenge is to live through your difficulties as they present themselves and build up emotional muscle. On the other hand, when you run your life by your intentions, you end up having a totally different response to things not working out.

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