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From the laboratory perspective birth control vs contraception generic levlen 0.15 mg free shipping, these categories are: critical—instruments or devices that are exposed to normally sterile areas of the body require sterilization; semi-critical—instruments or devices that touch mucous membranes may be either sterilized or disinfected; non-critical—instruments or devices that touch skin or come into contact with persons only indirectly can be either cleaned and then disinfected with an intermediate-level disinfectant, sanitized with a low-level disinfectant, or simply cleaned with soap and water. Such disinfectants are capable of sterilization when the contact time is relatively long. As high-level disinfectants, they are used for relatively short periods of time. They are formulated for use on medical devices, but not on environmental surfaces such as laboratory benches or foors. In this arena, decontamination may entail disinfection of work surfaces, decontamination of equipment so it is safe to handle, or may require sterilization. Regardless of the method, the purpose of decontamination is to protect the laboratory worker, the environment, and anyone who enters the laboratory or handles laboratory products away from the laboratory. Decontamination and Cleaning Decontamination renders an area, device, item, or material safe to handle. The primary objective is to reduce the level of microbial contamination so that infection transmission is eliminated. The decontamination process may be ordinary soap and water cleaning of an instrument, device, or area. In laboratory settings, decontamination of items, spent laboratory materials, and regulated laboratory wastes is often accomplished by a sterilization procedure such as steam autoclaving, perhaps the most cost-effective way of decontaminating a device or an item. The presence of any organic matter necessitates longer contact time with a decontamination method if the item or area is not pre-cleaned. For example, a steam cycle used to sterilize pre-cleaned items is 20 minutes at 121°C. When steam sterilization is used to decontaminate items that have a high bio-burden and there is no pre-cleaning. Decontamination in laboratory settings often requires longer exposure times because pathogenic microorganisms may be protected from contact with the decontaminating agents. Descending Order of Resistance to Germicidal Chemicals Bacterial Spores Bacillus subtilis, Clostridium sporogenes ▼ Mycobacteria Mycobacterium tuberculosis var. Pseudomonas spp are sensitive to high-level disinfectants, but if they grow in water and form bioflms on surfaces, the protected cells can approach the resistance of bacterial spores to the same disinfectant. The same is true for the resistance to glutaraldehyde by some nontuberculous mycobacteria, some fungal ascospores of Microascus cinereus and Cheatomium globosum, and the pink pigmented Methylobacteria. Prions are also resistant to most liquid chemical germicides and are discussed in the last part of this section. Chemical germicides used for decontamination range in activity from high level disinfectants. Resistance of selected organisms to decontamination is presented in descending order in Table 1. Penetrations in these surfaces should be sealed or capable of being sealed for decontamination purposes. Care should be taken that penetrations in the walls, foors and ceilings are kept to a minimum and are “sight sealed. These seals must be tested and verifed to ensure containment in order to permit both liquid disinfection and fumigation. Procedures for decontamination of large spaces such as incubators or rooms are varied and infuenced signifcantly by the type of etiologic agent involved, the characteristics of the structure containing the space, and the materials present in the space. The humidity must be controlled and the system works optimally at 80% relative humidity. This method is effective in killing microorganisms but toxicity issues are present. Hydrogen Peroxide Vapor Hydrogen peroxide can be vaporized and used for the decontamination of glove boxes as well as small room areas. Vapor phase hydrogen peroxide has been shown to be an effective sporicide at concentrations ranging from 0. This system can be used to decontaminate glove boxes, walk in incubators and small rooms. The concentration of gas at the Appendix B: Decontamination and Disinfection 331 site of decontamination should be approximately 10 mg/L with contact time of one to two hours. Chlorine dioxide possesses the bactericidal, virucidal and sporicidal properties of chlorine, but unlike chlorine, does not lead to the formation of trihalomethanes or combine with ammonia to form chlorinated organic products (chloramines). The gas cannot be compressed and stored in high-pressure cylinders, but is generated upon demand using a column-based solid phase generation system. Within reasonable limits, a chlorine dioxide gas generation system is unaffected by the size or location of the ultimate destination for the gas. Although most often used in closed sterilizers, the destination enclosure for the chlorine dioxide gas does not, in fact, need to be such a chamber. Decontamination of Surfaces Liquid chemical germicides formulated as disinfectants may be used for decontamination of large areas. The usual procedure is to food the area with a disinfectant for periods up to several hours. This approach is messy and with some of the disinfectants used represents a toxic hazard to laboratory staff. For example, most of the “high-level” disinfectants on the United States market are formulated to use on instruments and medical devices and not on environmental surfaces. Intermediate and low-level disinfectants are formulated to use on fomites and environmental surfaces but lack the potency of a high-level disinfectant. For the most part intermediate and low level disinfectants can be safely used and, as with all disinfectants, the manufacturer’s instructions should be closely followed. Concentrations and exposure times vary depending on the formulation and the manufacturer’s instructions for use. This plan should include the rationale for selection of the disinfecting agent, the approach to its application, contact time and other parameters. Activity Levels of Selected Liquid Germicidesa Procedure / Product Aqueous Concentration Activity Level Sterilization glutaraldehyde variable hydrogen peroxide 6 – 30% formaldehyde 6 – 8% chlorine dioxide variable peracetic acid Disinfection glutaraldehyde variable high to intermediate ortho-phthalaldehyde 0. A large number of commercial products based on these generic components can be considered for use. Common household bleach is an excellent and inexpensive source of sodium hypochlorite. Concentrations between 500 and 1000 mg/L chlorine are appropriate for the vast majority of uses requiring an intermediate level of germicidal activity; higher concentrations are extremely corrosive as well as irritating to personnel, and their use should be limited to situations where there is an excessive amount of organic material or unusually high concentrations of microorganisms. Appendix B: Decontamination and Disinfection 333 d the effectiveness of alcohols as intermediate level germicides is limited because they evaporate rapidly, resulting in short contact times, and also lack the ability to penetrate residual organic material. They are rapidly tuberculocidal, bactericidal and fungicidal, but may vary in spectrum of virucidal activity (see text). Items to be disinfected with alcohols should be carefully pre-cleaned then totally submerged for an appropriate exposure time. Antiseptic iodophors are not suitable to disinfect devices, environmental surfaces, or medical instruments. Studies show that prions are resistant to conventional uses of heat and/or chemical germicides for the sterilization of instruments and devices. Disinfection, sterilization and antisepsis: principles and practices in healthcare facilities. Guidelines for Environmental Infection Control in Health-Care Facilities, 2003; [about 2 screens] Available from: Biological safety cabinets, decontamination or sterilization with paraformaldehyde. Biodecontamination of animal rooms and heat-sensitive equipment with vaporized hydrogen peroxide. Occupational risks associated with the use of selected disinfectants and sterilants. Appendix B: Decontamination and Disinfection 335 Appendix C—Transportation of Infectious Substances An infectious substance is a material known to contain or reasonably expected to contain a pathogen. A pathogen is a microorganism (including bacteria, viruses, rickettsiae, parasites, fungi) or other agent, such as a proteinaceous infectious particle (prion), that can cause disease in humans or animals.

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Mixed manic or depressed episode in preventing new episodes were not analysed separately birth control for emergency contraception discount levlen 0.15mg overnight delivery, but carbamaze mixed episodes pine had more pronounced preventive efficacy than A recent Swedish national registers study identified lithium or valproate for depressive episodes and manic 35,182 individuals diagnosed with bipolar disorder. With each patient serving as but more than half of the participants were classified his own control, there was no advantage of taking as mixed. Tolerability issues may be less problematic with extended-release Cariprazine formulations as used in the more recent studies. Efficacy in acute manic mixed episodes Carbamazepine is teratogenic with an estimated risk of neural tube defects of 0. The use of carbamazepine can be licenced for the treatment of patients with schizophre complicated due to interaction with other psycho nia. Three double-blind, placebo-controlled studies tropic medication, including several antipsychotics, investigated the efficacy of cariprazine monotherapy in antidepressants and anticonvulsants (Spina et al. However, a more No maintenance data for cariprazine in bipolar dis recent pooled analysis of the three studies examined order has been published so far. With the exception of akathisia and baseline scores or whether there was a substantial extrapyramidal disorder, the differences in incidence subgroup with depressive mixed states included into versus placebo for these events were generally small. Prolongation, prolactin elevation and metabolic abnor No information on depressive mixed patients is malities (Citrome 2013). Efficacy in maintenance treatment after an acute mixed episode in preventing episodes of any polar ity or a new manic, depressive or mixed episode Clozapine No maintenance data following a mixed index episode See ‘Other atypical antipsychotics used in bipolar has been published so far. The results suggest that the clinical bene appear too substantial to regard its findings as reliable fits of lamotrigine in acute bipolar depression are pri evidence for lamotrigine in mixed mania. The incidence of a serious rash, how ity or a new manic, depressive or mixed episode ever, appears low with the recommended slow titration scheme. Major congenital defects have been described Two randomised, placebo and comparator (lithium) with lamotrigine in 1. None Efficacy in maintenance treatment after an acute Lithium manic or depressed episode in preventing new mixed episodes Efficacy in acute manic mixed episodes In the study by Bowden et al. However, the pres established effective prophylactic treatment for mixed ence of a mixed state may be a predictor of poor states (which imipramine is not), the efficacy of lithium response to lithium (Secunda et al. The Danish nationwide cohort study (Kessing, Hellmund, authors concluded that the presence of pre-treatment Geddes, et al. Based on a post hoc analysis of depressive symptoms is a predictor of non-response to the maintenance study by Bowden et al. However, as this was a post hoc analysis in a ate was considered more effective than lithium as a small number of patients, we would rather consider prophylactic agent after a mixed index episode the evidence insufficient than negative. Efficacy in maintenance treatment after an acute Efficacy in maintenance treatment after an acute manic or depressed episode in preventing new mixed episode in preventing episodes of any polar mixed episodes ity or a new manic, depressive or mixed episode We identified one controlled study reporting the A retrospective study found that the presence of three prophylactic efficacy of lithium specifically against new symptoms of the opposite polarity was a predictor of mixed episodes. In a head-to-head comparison, olanza poor long-term outcome in lithium-treated mixed pine (n ¼ 217) was compared to lithium (n ¼ 214, tar patients (Backlund et al. Subanalysis of a was testing non-inferiority of olanzapine against lith randomised maintenance study comparing lithium, ium for time to relapse/recurrence in the total popula imipramine and the combination of the two revealed tion. Secondary results showed that compared with a higher rate of recurrences in mixed than pure manic lithium, olanzapine had a significantly lower risk of patients (82% versus 6%) (Prien et al. However, symptomatic mixed episode relapse/recurrence (Tohen as we have no comparison against placebo or an et al. Up to 75% of reduced rate of admissions due to a mixed episode patients on lithium experience some side effects, but (Joas et al. Compared to other cohort studies, most are minor (transient metallic taste in mouth, selection bias will be lower as each patient served as polyuria, polydipsia, weight gain, mild oedema, con his own control comparing time periods on and off a centration difficulties, sedation) and can be reduced or specific medication; however, the order in which eliminated by dose adjustment or dosage schedule. This suggests that patients who impairment and/or reduced intensity of perceptions switched from lithium to a second drug were more and emotions) may be most crucial (Licht 2011). Another point which should be considered in clin Lurasidone ical decision making is the high rate of suicidality and suicide attempts in mixed patients (Strakowski et al. Efficacy in acute depressive mixed episodes Improvement in depressive symptoms was maintained in most patients treated with lurasidone, with rela One placebo-controlled monotherapy (Loebel, tively low rates of relapse, and with minimal effects on Cucchiaro, Silva, Kroger, Hsu, et al. Unfortunately, again cebo-controlled combination treatment study (Loebel, no separate analysis for patients with a depressive Cucchiaro, Silva, Kroger, Sarma, et al. Whereas the two combination treatment studies do Efficacy in maintenance treatment after an acute not report on depressive mixed patients as a separate manic or depressed episode in preventing new subgroup, the monotherapy study was subject to a mixed episodes post hoc analysis looking at patients with mixed manic features at study entry (McIntyre, Cucchiaro, et al. At baseline, mixed features were present in 56% (2017) does also not differentiate between manic and of patients (lurasidone, n ¼ 182/323; placebo, n ¼ 90/ mixed relapses in the total population. The authors observed, in addition to other secondary efficacy end report on 29% less relapses in the lurasidone þ lithium points (Suppes, Silva, et al. In the long-term study, there were no ive for treating co-existing manic and depressive clinically meaningful, treatment-emergent differences symptoms, especially when depressive symptoms are between lurasidone and placebo in metabolic parame moderate to severe. There is also reasonable evidence for olanzapine as the efficacy of olanzapine as monotherapy was dem an add-on treatment in mixed states. The results confirmed the advantage of olanzapine versus placebo showed that, among mixed patients, olanzapine was on manic symptoms and response rate in both manic superior when adjunctive to valproate (P < 0. A second was superior to placebo in improving both manic and ary post hoc analysis (Baker et al. The median times to mentation therapy) is ‘A’ for manic and depressive relapse of any kind was three times longer in the olan symptoms. Olanzapine-treated patients also experienced longer time to depressive symptomatic relapse (85 versus 22 Efficacy in acute depressive mixed episodes days, P ¼ 0. This study, together with a second study in results for mixed patients or for relapses into mixed Japanese patients with bipolar depression (Tohen episodes are reported as the total number of patients et al. The author con Efficacy in maintenance treatment after an acute cluded that olanzapine monotherapy was effective in manic or depressed episode in preventing new mixed episodes the treatment of bipolar depression irrespective of the presence of concurrent manic symptoms. We could not identify a placebo-controlled mainten In summary, we have two post hoc analyses show ance study analysing specifically prevention of mixed ing efficacy for olanzapine in depressive mixed states. However, we found information potentially However, the patient sample overlapped between supportive for the use of olanzapine versus lithium. Olanzapine monotherapy versus has been described in great detail in previous publica placebo has also been studied in the acute treatment tions (Grunze et al. Whereas short-term tolerability is reason of manic/mixed episodes in a population of adoles able, there are profound concerns about weight gain cents. There were no significant differences for and long-term metabolic effects of olanzapine. For improvement of manic symptoms versus placebo in detailed information we refer the reader to the either manic or mixed subgroups (Tohen, respective publications (Nasrallah and Newcomer Kryzhanovskaya, et al. Paliperidone mixed index episode and separate reporting of out comes for mixed patients. The maintenance study by Efficacy in acute manic mixed episodes Berwaerts, Melkote, et al. However, mixed episodes the article does not supply information of whether We could not identify any studies examining paliperi quetiapine was superior to placebo in the mixed sub done in maintenance treatment reporting a separate group on its own. Short and long-term We could not identify any studies examining paliperi safety and tolerability of paliperidone have also been done in bipolar depressive mixed states. Both studies found that, for the replacement of olanzapine by quetiapine improved in subgroup of mixed patients, the quetiapine combin terms of manic and psychotic symptoms (Catapano ation increased the time to recurrence to a mood Friedman 2001). The Swedish patients with a depressive mixed episode, only an registry study by Joas et al. The the best quality evidence for risperidone monother decrease in depressive symptoms was markedly signifi apy stems from a 3-week, randomised and double cant in the quetiapine group versus venlafaxine mono blind head-to-head comparison of risperidone versus therapy, being significant at week 1, and increased olanzapine, which can be considered as an efficacious until week 6 (P ¼ 0. The study was not powered to prove term treatment non-inferiority of risperidone compared to olanzapine. For more detailed information we refer the different from improvement observed with placebo þ reader to the previous papers of this series (Grunze lithium or valproate et al. In brief, examining adjunctive risperidone (plus mood stabil extrapyramidal symptoms (especially with higher dos iser) in manic and mixed patients (n ¼ 44) reported sig ages), akathisia and insomnia in short-term and weight nificant improvement of both manic and depressive gain and prolactin elevation in long-term treatment symptoms in both subgroups over 24 weeks (Woo may constitute problems. A controlled 12-week head-to head comparison of olanzapine and haloperidol (Tohen, Goldberg, et al. Secondary Different from the outcome in the controlled study analysis revealed that, for patients who entered the (Sachs et al. The risk of major congenital malformations in preg Efficacy in maintenance treatment after an acute nancy might differ between agents. Haloperidol is gen mixed episode in preventing episodes of any polar erally considered as a relatively safe option (Diav-Citrin ity or a new manic, depressive or mixed episode et al. Efficacy in maintenance treatment after an acute Valproate (including divalproate, divalproex, manic or depressed episode in preventing new valpromide) mixed episodes Efficacy in acute manic mixed episodes We could not identify any study with typical antipsy In contrast to several evidence-based recommenda chotics examining mixed relapses or recurrences. The safety and tol presence of even a modest level of pre-treatment erability profile varies.

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Foreknowledge cannot be obtained through spirits or the supernatural; It cannot be deduced by analogy; Nor verified through measurements birth control for menstrual cramps buy levlen 0.15mg low price. What enables the wise government and the good commander to strike and conquer, to achieve things beyond the reach of ordinary men, is foreknowledge. This foreknowledge cannot be elicited from spirits, cannot be obtained inductively from experience, nor by any deductive calculation. Knowledge of the enemy’s dispositions can only be obtained from people who know their condition. Arthur Wellesley, First Duke of Wellington Foreknowledge or prescience is the basis for the success of an excellent commander, since such knowledge makes it comparatively easy to formulate winning strategies that would defeat the adversary whose strategic plans and operational concepts are already known through intelligence. In the military context, knowledge is the foundation for vision, an understanding of what the future might hold, which is based on a clear appreciation of the plans of the adversary. Sun Tzu very clearly denounces the concept of using non scientifc methods to predict the future and also reliance on analysis that is based on conjunctures and less than factual data. In Sun Tzu’s time, accurate foreknowledge was only obtainable from people who physically knew the adversary’s dispositions. However, in contemporary terms, information can also be gathered from a number of other sources, both overt and covert, with growing emphasis on the use of technology. The common factor here is the role of people, whether physically gathering information as humint or analysing information obtained from other sources to confrm its veracity and usefulness. In all cases, it is this knowledge that will provide the necessary and vital input to commanders to achieve decision superiority that will lead to success in confict. Only foreknowledge of the adversary and their plans can provide complete assurance of success to one’s own strategy, provided it has been designed with the built-in capability to cater for the dynamic confict environment. This is true of all commanders, irrespective of the environment in which they operate. In contemporary confict, air power is the primary provider of foreknowledge, created through the skilled employment of airborne and space-based assets that gather information on a continuous basis. However, these assets are extremely expensive to acquire and operate and also require specialised technological training for the personnel. This contributes to a situation wherein the demand for intelligence can never be met to the complete satisfaction of all commanders. If we consider the actual basis of this information, how unreliable and transient it is, we soon realize that war is a fimsy structure that can easily collapse and bury us in ruins. The textbooks agree, of course, that we should only believe reliable intelligence, and should never cease to be suspicious, but what is the use of such feeble maxims? They belong to that wisdom which for want of anything better scribblers of systems and compendia resort to when they run out of ideas. However, the nature of alliances and international relationships is such that it creates the drawback of available intelligence not necessarily being complete because of a number of factors like, interoperability, doctrinal diferences, rules of engagement etc. Sun Tzu’s injunction that foreknowledge is vital to success in confict is a clear pointer to the necessity for a nation to apply all possible efort to ‘nurture’ these relationships. However, these are the realities of contemporary confict and strategic commanders and civilian leadership alike should be aware of them and would have to cater for these exigencies when committing a nation to war. Foreknowledge of adversary plans can make one’s own strategy successful The demand for information can never be fully met, increasing the strategic air commander’s responsibilities Alliances will have to be relied on to complete the information picture 430 The Use of Intelligence The Divine Web There are five sorts of Intelligence: Local, Inside, Counterintelligence, Deadly and Secure. When the five Intelligence all occur together And none know of the method, this is called the Divine Web. Local Intelligence comes from natives showing the way; Inside Intelligence from the enemy’s officials; Counterintelligence from the opponent’s Intelligence. Deadly Intelligence is deliberately created false information, Knowingly passed to the enemy. Tere are fve sorts of secret agents or spies—local, inside, counter, deadly and secure. When all of them are working simultaneously and no-one knows their methods of operation, it is achieved through organisational genius and they are treasures of a government. Local spies are hired from among the people of a locality, inside spies from among enemy ofcials and counter spies from among enemy spies. Deadly spies are own spies who are deliberately given fabricated information and used to spread it, and secure spies are those who return with accurate information. Sun Tzu’s words have been translated most commonly to mean diferent kinds of ‘spies’; however, the Chinese words that are used in the original could also be translated to mean channels of information. This stanza therefore, could be taken literally as discussing the diferent kinds of ‘spies’, their application and the explanation of the fve types of intelligence that they provide. Information is multidimensional and, therefore, it is necessary to analyse and correlate all the fve types of information available to create a complete strategic picture. When a nation has the organisational structure in place to have all fve channels of information gathering operating simultaneously and the facility to combine and convert the inputs from all the fve sources, and the entire process conducted with security that cannot be breached, the operation is almost foolproof. Intelligence Intelligence is the information produced by a country’s intelligence and security organisations on the activities and capabilities of the nation’s enemies. The information must be the product of close analysis and evaluation of all available data and be set in context so that it gives useful insight into the enemy’s future actions. After the Yom Kippur War of 1973 several senior Israeli intelligence ofcers were removed from their posts. The complaint against them was that they knew everything about the Arab capabilities but had little concept of how the Arab nations would employ those capabilities to attack Israel. Thus the Israelis were caught unawares by the Arab attack—particularly the Egyptian thrust across the Suez Canal. However, the recent conficts in Afghanistan and Iraq have reinforced the need for humint and processes have been initiated to remedy the situation. Sun Tzu emphasised the importance of people contact and the criticality of such contacts to ensure the veracity of one’s own information channels. Piecing together the complete picture from disparate and scanty information is one of the major leadership skills that the treatise mentions in a number of places. In terms of humint, the fve channels can be thought of as that gathered through local sources, those obtained from ofcials of the adversary on one’s own payroll, information from double agents or counterintelligence, misinformation spread to the adversary through one’s own agents and the information brought out by an agent personally. The role of air power in establishing and securely maintaining the information channels will vary with circumstances. In terms of humint it would normally be restricted to the insertion and extraction of assets and the dissemination of analysed data. In extreme cases the protection of human assets in adversary territory could also become a necessity and 432 The Use of Intelligence air power, even though not ideally suited for such operations, is perhaps the best option available under these time and option-constrained circumstances. In contemporary confict, the nature of humint has undergone a change in that the use of ‘spies’—and the sinister meaning that it conveys—is fairly restricted. The fve diferent categories of ‘spies’ that Sun Tzu listed and the dissimilar types of information that they provide can be diferentiated in terms of the requirements to formulate an efective strategy to achieve victory. The frst channel should provide information regarding the local terrain, which is best obtained from within the area of operations through the expertise of local people. Air power can also provide vital information regarding the terrain through aerial mapping and surveillance. However, in some cases confrmation of adversary deployment may require local knowledge. The second is to obtain information regarding the adversary’s plans and intentions, obtained by gathering inside information from the contacts that one has within the adversary camp. Air power can utilise its signifcant signals intelligence capability to string together the adversary intention through analysis of communication and electronic emissions collected from deep inside adversary territory. Tird is the need to have double agents who provide the information regarding the adversary’s methodology to collect intelligence and their organisation and functional concepts. While this is predominantly a humint activity, signals intelligence and countermeasures that can be cleverly deployed will also provide a great deal of information that can be used to create foreknowledge of the adversary intentions, uncover weaknesses in their intelligence and thereby neutralise their advantage. The fourth channel is one of misinformation that is fed to the adversary to confuse their planning and force deployment so that one’s own forces can then exploit the weaknesses thus created. The use of media, even without their direct knowledge of being used, to spread false information could be considered as a viable proposition. Air power assets can also be used to indicate force deployment in one area of the theatre while the actual plan would be to attack another area. Air power’s reach and speed allows it to be repositioned very rapidly after the confict has actually commenced.

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One uncontrolled report indicated that 80% of women receiving long-term val proate treatment for epilepsy before the age of 20 had polycystic ovaries or hyperandrogenism (247) birth control for women knitted purchase levlen 0.15mg mastercard. Other cross-sectional studies have demonstrated higher rates of polycystic ovaries and Treatment of Patients With Bipolar Disorder 35 Copyright 2010, American Psychiatric Association. However, none of the studies examined whether the polycystic ovarian syndrome began before or after the development of ep ilepsy or the initiation of valproate therapy (246). Furthermore, women with bipolar disorder may differ from women with epilepsy in their rates of polycystic ovarian syndrome independent of treatment. An accurate assessment of risk will require a longitudinal study of women with bi polar disorder before and after initiation of valproate treatment (246). Consequently, although the risks are unclear, psychiatrists should be aware that polycystic ovarian syndrome may be pos sible with valproate treatment, and thus patients should be monitored accordingly (244). Rare, idiosyncratic, but potentially fatal adverse events with valproate include irreversible hepatic failure, hemorrhagic pancreatitis, and agranulocytosis. Thus, patients taking valproate need to be instructed to contact their psychiatrist or primary care physician immediately if they develop symptoms of these conditions. Results of liver function tests and hematologic measures should be obtained at baseline to evaluate general medical health. Data from a number of open trials (230, 251–253) and one randomized controlled trial (254) indicate that divalproex can be administered at a therapeutic initial starting dose of 20–30 mg/ kg per day in inpatients. This strategy appears to be well tolerated and may be more rapidly efficacious than more gradual titration from a lower starting dose (254). After a serum valproate level is obtained, the dose is then adjusted downward to achieve a target level between 50 and 125 mcg/ml. Among outpatients, elderly patients, or patients who are hypomanic or euthymic, valproate may be initiated in low, divided doses to minimize gastrointestinal and neurological toxicity. Depending upon clinical response and side effects, the dose is then titrated upward by 250–500 mg/day every few days, generally to a serum concentration of 50– 125 mcg/ml, with a maximum adult daily dose of 60 mg/kg per day (250). Once the patient is stable, valproate regimens can be simplified to enhance convenience and compliance, since many patients do well with once or twice-a-day dosing. Extended-release divalproex, a new formulation that allows for once-a-day dosing, has be come available. Bioavailability is approximately 15% lower than the immediate-release formu lation (hence usually requiring slightly higher doses), and side effect profiles appear to be better than that of the immediate-release formulation (255). Demonstration of efficacy in patients with bipolar disorder is limited to open studies (255–257). Asymptomatic hepatic enzyme elevations, leukopenia, and thrombocytopenia do not reli ably predict life-threatening hepatic or bone marrow failure. In conjunction with careful mon itoring of clinical status, educating patients about the signs and symptoms of hepatic and hematologic dysfunction and instructing them to report these symptoms if they occur are es sential. Some investigators believe that in otherwise healthy patients with epilepsy receiving long-term valproate treatment, routine monitoring of hematologic and hepatic function is not necessary (258). Nevertheless, most psychiatrists perform clinical assessments, including tests of hematologic and hepatic function, at a minimum of every 6 months for stable patients who are taking valproate (252, 259, 260). Patients who cannot reliably report signs or symptoms of toxicity need to be monitored more frequently. Psychiatrists should be alert to the potential for interactions between valproate and other medications (261). For example, valproate displaces highly protein-bound drugs from their protein binding sites. In addition, valproate inhibits lamotrigine metabolism and more than doubles its elimination half-life by competing for glucuronidation enzyme sites in the liver (262, 263). Consequently, in patients treated with valproate, lamotrigine must be initiated at a dose that is less than half that used in patients who are not receiving concomitant valproate. Carbamazepine Many controlled trials of carbamazepine have been conducted in the treatment of acute bipolar mania, but interpretation of the results of a number of these studies is difficult because of the confounding effects of other medications administered as part of study protocols (264). Carbamazepine was less effective and associated with more need for adjunctive “rescue medication” than val proate in a randomized, blind, parallel-group trial of 30 hospitalized manic patients (266). Car bamazepine was comparable to lithium in two randomized comparison trials (181, 182) and comparable to chlorpromazine in two other randomized trials (267, 268). The most common dose-related side effects of carbamazepine include neurological symp toms, such as diplopia, blurred vision, fatigue, nausea, and ataxia. Less frequent side effects include skin rashes (271), mild leukopenia, mild thrombocytopenia, hyponatremia, and (less commonly) hypo-osmolality. Mild asymptomatic leukopenia is not related to seri ous idiopathic blood dyscrasias and usually resolves spontaneously with continuation of car bamazepine treatment or with dose reduction. In the event of asymptomatic leukopenia, thrombocytopenia, or elevated liver enzymes, the carbamazepine dose can be reduced or, in the case of severe changes, discontinued. Hyponatremia may be related to water retention caused by carbamazepine’s antidiuretic effect (272). Hyponatremia occurs in 6%–31% of patients, is rare in children but probably more common in the elderly, occasionally develops many months after the initiation of carbamazepine treatment, and sometimes necessitates carbamazepine dis continuation. In addition, carbamazepine may decrease total and free thyroxine levels and in crease free cortisol levels, but these effects are rarely clinically significant. Rare, idiosyncratic, but serious and potentially fatal side effects of carbamazepine include agranulocytosis, aplastic anemia, thrombocytopenia, hepatic failure, exfoliative dermatitis. Although these side effects usually occur within 3–6 months of carbamazepine initiation, they have also occurred after more extended periods of treatment. Routine blood monitoring does not reliably predict blood dyscrasias, hepatic failure, or exfoliative dermatitis. Thus, in addition to careful moni toring of clinical status, it is essential to educate patients about the signs and symptoms of he patic, hematologic, or dermatologic reactions and instruct them to report symptoms if they occur. Other rare side effects include systemic hypersensitivity reactions, cardiac conduction disturbances, psychiatric symptoms (including sporadic cases of psychosis), and, very rarely, re nal effects (including renal failure, oliguria, hematuria, and proteinuria). Signs of impending carbamazepine toxicity include dizziness, ataxia, sedation, and Treatment of Patients With Bipolar Disorder 37 Copyright 2010, American Psychiatric Association. The most common symptoms of carbamazepine overdose are nystagmus, ophthalmoplegia, cerebellar and extra pyramidal signs, impaired consciousness, convulsions, and respiratory dysfunction. Cardiac symptoms may include tachycardia, arrhythmia, conduction disturbances, and hypotension. Management of carbamazepine intoxication includes symptomatic treatment, gastric lavage, and hemoperfusion. Serum electrolyte levels may also be ob tained, especially in the elderly, who may be at higher risk for hyponatremia. Although doses can range from 200 to 1800 mg/day, the relationships among dose, serum concentration, response, and side effects are variable. Therefore, the dose should be titrated up ward according to response and side effects. In patients over the age of 12, carbamazepine is usually begun at a total daily dose of 200–600 mg, given in three to four divided doses. In hos pitalized patients with acute mania, the dose may be increased in increments of 200 mg/day up to 800–1000 mg/day (unless side effects develop), with slower increases thereafter as indicated. In less acutely ill outpatients, dose adjustments should be slower, since rapid increases may cause patients to develop nausea and vomiting or mild neurological symptoms such as drows iness, dizziness, ataxia, clumsiness, or diplopia. Should such side effects occur, the dose can be decreased temporarily and then increased again more slowly once these side effects have passed. While therapeutic serum levels of carbamazepine have not been established for patients with bipolar disorder, serum concentrations established for treatment of seizure disorders (4–12 mcg/ml) are generally applied. Trough levels are most meaningful for establishing an effective level for a given patient and are conveniently drawn before the first morning dose. Serum levels should be determined 5 days after a dose change or sooner if toxicity or noncompliance is sus pected. Maintenance doses average about 1000 mg/day but may range from 200–1600 mg/day in routine clinical practice (204). Thereafter, if results of laboratory tests remain normal and no symptoms of bone marrow suppression or hepatitis appear, blood counts and liver function tests should be performed at least every 3 months (204).

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For example birth control japan order levlen 0.15mg visa, you can warn participants that a survey includes questions about their fear of crime and remind them that they are free to withdraw if they think this might upset them. Prescreening can also involve collecting data to identify and eliminate participants. For example, Burger used an extensive prescreening procedure involving multiple questionnaires and an interview with a clinical psychologist to identify and eliminate participants with physical or psychological problems that put them at high risk. You should keep signed consent forms separately from any data that you collect and in such a way that no individual’s name can be linked to his or her data. In addition, beyond people’s sex and age, you should only collect personal information that you actually need to answer your research question. If people’s sexual orientation or ethnicity is not clearly relevant to your research question, for example, then do not ask them about it. Be aware also that certain data collection procedures can lead to unintentional violations of confdentiality. When participants respond to an oral survey in a shopping mall or complete a questionnaire in a classroom setting, it is possible that their responses will be overheard or seen by others. If the responses are personal, it is better to administer the survey or questionnaire individually in private 15. Remember that deception can take a variety of forms, not all of which involve actively misleading participants. Therefore, if your research design includes any form of active deception, you should consider whether it is truly necessary. Imagine, for example, that you want to know whether the age of college professors afects students’ expectations about their teaching ability. You could do this by telling participants that you will show them photos of college professors and ask them to rate each one’s teaching ability. But if the photos are not really of college professors but of your own family members and friends, then this would be deception. This deception could easily be eliminated, however, by telling participants instead to imaginethat the photos are of college professors and to rate them as if they were. In general, it is considered acceptable to wait until debriefng before you reveal your research question as long as you describe the procedure, risks, and benefts during the informed consent process. For example, you would not have to tell participants that you wanted to know whether the age of college professors afects people’s expectations about them until the study was over. Not only is this information unlikely to afect people’s decision about whether or not to participate in the study, but it has the potential to invalidate the results. Participants who know that age is the independent variable might rate the older and younger “professors” diferently because they think you want them to . Alternatively, they might be careful to rate them the same so that they do not appear prejudiced. But even this extremely mild form of deception can be minimized by informing participants—orally, in writing, or both—that although you have accurately described the procedure, risks, and benefts, you will wait to reveal the research question until afterward. In essence, participants give their consent to be deceived or to have information withheld from them until later. Once the risks of the research have been identifed and minimized, you need to weigh them against the benefts. Remember to Chapter 3 61 consider benefts to the research participants, to science, and to society. If you are a student researcher, remember that one of the benefts is the knowledge you will gain about how to conduct scientifc research in psychology—knowledge you can then use to complete your studies and succeed in graduate school or in your career. If the research poses minimal risk—no more than in people’s daily lives or routine physical or psychological examinations—then even a small beneft to participants, science, or society is generally considered enough to justify it. If the research has the potential to upset some participants, for example, then it becomes more important that the study be well designed and answer a scientifcally interesting research question or have clear practical implications. It would be unethical to subject people to pain, fear, or embarrassment for no better reason than to satisfy one’s personal curiosity. In general, psychological research that has the potential to cause harm that is more than minor or lasts for more than a short time is rarely considered justifed by its benefts. Consider, for example, that Milgram’s study—as interesting and important as the results were—would be considered unethical by today’s standards. Once you have settled on a research design, you need to create your informed consent and debriefng procedures. First, when you recruit participants—whether it is through word of mouth, posted advertisements, or a participant pool—provide them with as much information about the study as you can. Second, prepare a script or set of “talking points” to help you explain the study to your participants in simple everyday language. This should include a description of the procedure, the risks and benefts, and their right to withdraw at any time. Your university, department, or course instructor may have a sample consent form that you can adapt for your own study. Remember that if appropriate, both the oral and written parts of the informed consent process should include the fact that you are keeping some information about the design or purpose of the study from them but that you will reveal it during debriefng. Debriefng is similar to informed consent in that you cannot necessarily expect participants to read and understand written debriefng forms. So again it is best to write a script or set of talking points with the goal of being able to explain the study in simple everyday language. During debriefng, you should reveal the research question and full design of the study. For example, if participants are tested under only one condition, then you should explain what happened in the other conditions. If you deceived your participants, you should reveal this as soon as possible, apologize for the deception, explain why it was necessary, and correct any misconceptions that 62 participants might have as a result. Debriefng is also a good time to provide additional benefts to research participants by giving them relevant practical information or referrals to other sources of help. For example, in a study of attitudes toward domestic abuse, you could provide pamphlets about domestic abuse and referral information to the university counseling center for those who might want it. Remember to schedule plenty of time for the informed consent and debriefng processes. The next step is to get institutional approval for your research based on the specifc policies and procedures at your institution or for your course. This will generally require writing a protocol that describes the purpose of the study, the research design and procedure, the risks and benefts, the steps taken to minimize risks, and the informed consent and debriefng procedures. Do not think of the institutional approval process as merely an obstacle to overcome but as an opportunity to think through the ethics of your research and to consult with others who are likely to have more experience or diferent perspectives than you. This might even mean making further modifcations to your research design and procedure before resubmitting your protocol. Your concern with ethics should not end when your study receives institutional approval. It now becomes important to stick to the protocol you submitted or to seek additional approval for anything other than a minor change. During the research, you should monitor your participants for unanticipated reactions and seek feedback from them during debriefng. One criticism of Milgram’s study is that although he did not know ahead of time that his participants would have such severe negative reactions, he certainly knew after he had tested the frst several participants and should have 16 made adjustments at that point (Baumrind, 1985). Keep the consent forms and the data safe and separate from each other and make sure that no one, intentionally or unintentionally, has access to any participant’s personal information. Finally, you must maintain your integrity through the publication process and beyond. Address publication credit—who will be authors on the research and the order of authors—with your collaborators early and avoid plagiarism in your writing. Remember that your scientifc goal is to learn about the way the world actually is and that your scientifc duty is to report on your results honestly and accurately. Besides, unexpected results are often as interesting, or more so, than expected ones. These include making changes to your research design, prescreening to identify and eliminate high-risk participants, and providing participants with as much information as possible during informed consent and debriefing. You need to monitor participants’ reactions, be alert for potential violations of confidentiality, and maintain scholarly integrity through the publication process.

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Personal protective equipment birth control pills for women over 40 buy levlen online pills, such as splash shields, face protection, gowns, and gloves should be used in accordance with a risk assessment. Shigella the genus Shigella is composed of nonmotile gram-negative bacteria in the family Enterobacteriaceae. There are four subgroups that have been historically treated as separate species, even though more recent genetic analysis indicates that they are members of the same species. Members of the genus Shigella have been recognized since the late 19th century as causative agents of bacillary dysentery, or shigellosis. Most transmission is by fecal-oral route; infection also is caused by ingestion of contaminated food or water. Complications of shigellosis include hemolytic uremic syndrome, which is associated with S. Laboratory Safety and Containment Recommendations the agent may be present in feces and, rarely, in the blood of infected humans or animals. Accidental ingestion and parenteral inoculation of the agent are the primary laboratory hazards. The 50% infectious dose (oral) of Shigella for humans is only a few hundred organisms. The importance of proper gloving techniques and frequent and thorough hand washing is emphasized. Care in manipulating faucet handles to prevent contamination of cleaned hands or the use of sinks equipped with remote water control devices, such as foot pedals, is highly recommended. Treponema pallidum Treponema pallidum is a species of extremely fastidious spirochetes that die readily upon desiccation or exposure to atmospheric levels of oxygen, and have not been cultured continuously in vitro. No cases of laboratory animal-associated infections are reported; however, rabbit-adapted T. Venereal syphilis is a sexually transmitted disease that occurs in many areas of the world, whereas Yaws occurs in tropical areas of Africa, South America, the Caribbean, and Indonesia. Accidental parenteral inoculation, contact with mucous membranes or broken skin with infectious clinical materials are the primary hazards to laboratory personnel. Gloves should be worn when there is a likelihood Agent Summary Statements: Bacterial Agents 157 of direct skin contact with infective materials. Periodic serological monitoring should be considered in personnel regularly working with these materials. Growth of Vibrio species is stimulated by sodium and the natural habitats of these organisms are primarily aquatic environments. Although 12 different Vibrio species have been isolated from clinical specimens, V. Natural Modes of Infection the most common natural mode of infection is the ingestion of contaminated food or water. Other clinical specimens from which vibrios may be isolated include blood, arm or leg wounds, 158 Biosafety in Microbiological and Biomedical Laboratories eye, ear, and gallbladder. Yersinia pestis Yersinia pestis, the causative agent of plague, is a gram-negative, microaerophilic coccobacillus frequently characterized by a “safety pin” appearance on stained preparations from specimens. The incubation period for bubonic plague ranges from two to six days while the incubation period for pneumonic plague is one to six days. Pneumonic plague is transmissible person-to-person;155 whereas bubonic plague is not. Prior to 1950, at least 10 laboratory acquired cases were reported in the United States, four of which were fatal. Natural Modes of Infection Infective feabites are the most common mode of transmission, but direct human contact with infected tissues or body fuids of animals and humans also may serve as sources of infection. Agent Summary Statements: Bacterial Agents 159 Primary pneumonic plague arises from the inhalation of infectious respiratory droplets or other airborne materials from infected animals or humans. This form of plague has a high case fatality rate if not treated and poses the risk of person to-person transmission. Primary hazards to laboratory personnel include direct contact with cultures and infectious materials from humans or animal hosts and inhalation of infectious aerosols or droplets generated during their manipulation. Laboratory and feld personnel should be counseled on methods to avoid feabites and accidental autoinoculation when handling potentially infected live or dead animals. Special care should be taken to avoid generating aerosols or airborne droplets while handling infectious materials or when performing necropsies on naturally or experimentally infected animals. Gloves should be worn when handling potentially infectious materials including feld or laboratory infected animals. Information on which to base assessments of risk from environments contaminated with anthrax spores. Investigation of bioterrorism related anthrax, United States, 2001: epidemiologic fndings. Containment of pertussis in the regional pediatric hospital during the greater Cincinnati epidemic of 1993. Use and safety of acellular pertussis vaccine among adult hospital staff during an outbreak of pertussis. Evidence for a high attack rate and effcacy of erythromycin prophylaxis in a pertussis outbreak in a facility for the developmentally disabled. Analysis of Bordetella pertussis isolates from an epidemic by pulsed-feld gel electrophoresis. Serological response to flamentous hemagglutinin and lymphocytosis-promoting toxin of Bordetella pertussis. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Fatal case of unsuspected pertussis diagnosed from a blood culture—Minnesota, 2003. A twenty-fve year review of laboratory acquired human infections at the National Animal Disease Center. An outbreak of Brucella melitensis infection by airborne transmission among laboratory workers. Outbreak of Brucella melitensis among microbiology laboratory workers in a community hospital. Resistance of normal or immunized guinea pigs against a subcutaneous challenge of Brucella abortus. Pathologic changes associated with brucellosis experimentally induced by aerosol exposure in rhesus macaques (Macaca mulatto). Ecology of Burkholderia pseudomallei and the interactions between environmental Burkholderia spp. Burkholderia pseudomallei infection in a Puerto Rican patient with chronic granulomatous disease: case report and review of occurrences in the Americas. Application of serotyping and chromosomal restriction endonuclease digest analysis in investigating a laboratory-acquired case of Campylobacter jejuni enteritis. Mediastinal and supraclavicular lymphadenitis and pneumonitis due to Chlamydia trachomatis serovars L1 and L2. Toxin production by clostridium botulinum type A under various fermentation conditions. Recommended childhood and adolescent immunization schedule—United States, January-June 2004. Immunization against tularemia: analysis of the effectiveness of live Francisella tularensis vaccine in prevention of laboratory-acquired tularemia. Unidentifed curved bacilli in the stomach of patients with gastritis and peptic ulceration. Trends in legionnaires’ disease, 1980-1998: declining mortality and new patterns of diagnosis. Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. Epidemiological and environmental investigations of Legionella pneumophila infection in cattle and case report of fatal pneumonia in a calf. Primary cutaneous listeriosis in adults: an occupational disease of veterinarians and farmers. Preparation of acid-fast microscopy smears for profciency testing and quality control. Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone. Introduction of salmonellae into a centralized laboratory animal facility by infected day-old chicks.

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Movement research is moreover grounded in a moment when the politics of and around the body is questioned and trans formed birth control tri sprintec order levlen, not least the understanding that the personal is political which also politicizes the body in new ways. Movement research more than so also comes out of desire to democratize the body, in respect of its internal hierarchies but more obviously to give prominence to all kinds of bodies concerning size, form, age, race, gen 13 der, class, social belonging etc. Movement research in other words is not a matter of making oneself and one’s body available for a choreographer or any other regulating power bit instead of creating awareness of one’s body and self in diferent dancerly as well as social environments. Movement research although a rather difuse and open phenomena or episode in western dance history was incredibly important for dance and choreography in general. It was perhaps a part of an organic development but never the less critical in respect of establishing what we might call contemporary dance. But as much as movement research was central to dance for a number of years it at some point in the mid 80s came to lose it relevance. One important reason defnately had to do with that movement research focused on the politics of the body in the sense of practice and awareness and was not primarily concerned with dance or movement as political representation something that become crucial especially in the second part of the 80s. As much as movement research was a child of its time there is however something that in a way makes it impossible already from the start. Interestingly, when philosophy and aesthetic theory, including visual art to 14 a large extent dethrones essence in favor of language, dance and in particular movement research is obsessing about authenticity and, in lack of a better wording, the possibility of an expression of a “true self”. A paradox appears to hide in the fold between a wish for authen ticity (not least through diferent practices bundled together under the notion authentic movement) and the personal is political. The moment when identity politics makes its entrance in the artistic domain in general and more or less quickly in dance it, needless to say, becomes somewhat difcult to argue for authenticity as Butler’s elaboration of the subject and the body as performative rests on the necessity that everything is practices and negotiated. The moment when identity becomes politics there is simply no place for either authenticity or autonomy, and that is both the up and down-side of Butler’s thinking. With identity politics the personal is political on the one hand gains a completely new understanding, namely that every choice made by a human being already is an iteration into the world and that provokes politics. More over an identity without foundation is the individual’s problem, the responsibility is all on the person, which also means that identity becomes subject to economy. Identity turns into a matter of afordance and investment and hence primarily a concern for the already privileged. It is indeed interesting to take into account how Judith 15 Butler, although involuntarily, opens for a kind of hyper individualism that plays out perfect in neoliberal capi talism and how she implicitly crosses out the possibil ity of being equal, which might be naïve but never the less the moment when identity is articulated through performativity – supported by Austin and Derrida – identity and the body becomes a matter of positioning oneself. It might be an exaggeration to argue that movement research relies on authenticity but it is not to con clude that it rests on an understanding that the body goes beyond language and, so to say, has its own real ity. Movement research insists on awareness but it is an awareness of something external to the self. Forms of awareness that one through practice can develop not least in favor of being in harmony with one self. Postmodernism in general and identity politics in particular dissolve the opportunity of forms of aware ness that is external to the self and turns awareness into something that always is an awareness in respect of what language enables, which is to say that one’s aware ness of the body is language awareness of a body that is accessible only through and as language. This is the moment when movement research defates and turns into something utterly uncool. One result of Judith Butler’s ideas is conceptual dance 16 that exactly like conceptual art in the early 70s trans forms art, or in our case dance, into a matter of signs and reason. Conceptual dance might present bodies but these bodies are, so to say, not of fesh and blood but only tokens and signs, and signs generate meaning not sensation. Consequently, dance becomes a matter of reading and interpretation not of experience and sensa tion, of being smart and able to decipher what a “dance” means and not of tactility, intimacy or transformation. Not at all it is still practiced but it never the less was pushed of center stage and the term lost signifcation. Over the last decade, give and take, it however seems like prac tices connected to movement research is making their reentry into dance. Under new names certainly and with new relations to the world, society, the body, dance and what it means to be human. This anthology is an at tempt to put focus on what those practices are and how they generate new forms of awareness or knowledge related to what kind of politics and political situations. What does it mean to practice yoga guided by a person on YouTube that pronounce Namaste as if was an anti-depressant? Or, what does it mean to practice yoga on a daily basis in a society that makes money on all our resilient bodies? What does it mean to obsess about Pilates or Kundalini when physical and spiritual well-being has become commodities, or when your subject, or identity, has become something one invests 17 in and has transformed into one of your most impor tant possessions? Or the other way around, does body practices of diferent kind today carry with them forms of resistance or even the potentiality for forms of insur rection? Can we identity forms of dance that generate forms of subjectivity that is posing a threat to our global capitalism? Can we consider movement research not just as body practice but as ways of practic ing being together diferently? We are not interested in one answer but instead in the multiplicity of possibilities and what can open up between perspectives. The contributors invited to this volume come from radically diferent places and they tackle or care for movement research in equally dif ferent ways. Some start from the body and the studio others take on activist perspectives or use movement research to venture into poetics or philosophy, imagi nation or political critique. As we said a somewhat far fetched entry point can not seldom generate surprising results. The texts in this anthology has (with a couple of ex ceptions) been published before, in the magazine Performance Journal, a magazine published by the organization Movement Research in New York, which I was asked to be the editor of for the Spring 2018 issue. And it seems that what came out of this somewhat ridiculous idea is that movement research, however in a very diferent costume is more active than in a long time and that both Performance Journal and Movement Research are important resourc es in dance. But why should these text remain in New York City which is where the magazine predominantly is circulat ed when it can reach so many more. Here the so many more is, and the book will also be distributed for free and will be available on the internet. The contributions in this volume were commissioned during the spring 2017 which is one of the reasons why recent political events in the world, art and dance, that would have been highly relevant to include, is only implicitly present. It was on the other hand, this time, important to curate a publication that concerned dance and didn’t use artistic practice as a vehicle for political engagement or activism, at least not directly but instead turn towards movement research and look for political relevance and potentiality in practices of the body and movement. The images in Movement Research is the result of a 19 commissioned to the American choreographer Jennifer Lacey, who herself has been and is an extraordinary force in respect of movement research. The commission was simply to send images of books that for her has been crucial to her concerning movement research. Movement Research is the frst unauthorized continua tion of the 2017 publication Post-Dance edited by Danjel Andersson, Mette Edvardsen and Mårten Spångberg. During the coming years further volumes using similar formats will show up, without any particular periodicity but they will show up. These books are created by and for us who make dance without publishing houses or ofcial distribution opportunities, not least in order to be able to pass them out for free. Because at the end of the day those books are meant to be instruments, instruments in the work we engage in together, namely to create a wild and amazing conditions for movement, dance and choreography. Entertain the possibility of material things, of real as well as imaginary things, of each part of every thing, of each occurrence of every thing throughout time, of contradictory things, of impossible things; Treat each possibility equally; Make free and equal possibilities the element of thought. V Never set one principle against another Avoid moral and external criticism of a thought; such criticism does no more than object to consequences; Do not confate an idea with its defenders; rather, show yourself capable of making it your own as well; Nothing that can be thought is foreign to anyone who can think: engage as thoroughly as possible in the ethical and internal criticism of any thought. Above all, do not seek a compromise between or hybrid of the two positions or otherwise negotiate an intermediary solution; Use the arguments of one side against the other. Do not claim that each side has its share of the truth but, rather, that the one and the other are completely correct, until one shows the other to be wrong. Work always with the most radical thoughts, the ones that put the most strenuous, opposing stretch on the feld of thought. To classical and reactionary minds, which condemn the indistinction of all things to which late modernity has led, reply the following: You are correct, we must draw distinctions; but your purpose in drawing them is to reintroduce hierarchies. To modern and postmodern minds, which condemn the introduction of hierarchies in all things, reply: you are correct, we must equal-ize; but you seek to equalize by making everything indistinct, by eliminating all categories (species, genres, classes); In all areas of thought, make do by observing at the same time both the need for distinction and the need for equality. X Resist the future domination efects of your own thought Behave in such a way as to change your ideas as little as possible when a dominated idea becomes dominant; Draw no legitimacy from a mere sense of being in the minority and misunderstood: always envisage the moment when what you think becomes the majority opinion, and acknowledge that our idea will become that of a school of thought; Neutralize in advance the authority efects of what you think, especially the paradoxical domination efects inherent to the most liberal and emancipatory ideas.

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The pain of self-laceration obliterates birth control for 2 weeks discount 0.15 mg levlen visa, if only momentarily, the pain of a larger hurt deep in the psyche. One of Arlene’s medications controls this compulsive self-wounding, and she’s always afraid I’m reducing her dose. Close to us, in the shadow of the Portland Hotel, two cops have Jenkins in handcuffs. Jenkins, a lanky Native man with black, scraggly hair falling to below his shoulders, is quiet and compliant as one of the officers empties his pockets. After a minute or two Jenkins is set free and lopes silently into the hotel with his long stride. Meanwhile, within the span of a few minutes, the resident poet laureate of absurdity has reviewed European history from the Hundred Years’ War to Bosnia and has pronounced on religion from Moses to Mohammed. The Germans had this gun Big Bertha that spoke to the Allies but not in a language the French or the Brits liked. Guns get a bad rap, a bad reputation—a bad raputation, Doc— but they move history forward, if we can speak of history moving forward or moving at all. Maté is trying to get home,” he says in his characteristic tone: at once sarcastic and sweetly genuine. The chain of rings piercing his left ear glimmers in the bronzed gold of the late afternoon sun. We congregate, these Fellini figures and I—or I should say we, this cast of Fellini characters—outside the Portland Hotel, where they live and I work. My clinic is on the first floor of this cement-and-glass building designed by Canadian architect Arthur Erickson, a spacious, modern, utilitarian structure. It’s an impressive facility that serves its residents well, replacing the formerly luxurious turn-of-the-century establishment around the corner that was the first Portland Hotel. The old place, with its wooden balustrades, wide and winding staircases, musty landings and bay windows, had a character and history the new fortress lacks. Although I miss its Old World aura, the atmosphere of faded wealth and decay, the dark and blistered windowsills varnished with memories of elegance, I doubt the residents have any nostalgia for the cramped rooms, the corroded plumbing or the armies of cockroaches. A local newspaper ran a story and a photograph featuring a female resident and her cat. The nonprofit Portland Hotel Society, for whom I am the staff physician, turned the building into housing for the nonhousable. My patients are mostly addicts, although some, like Randall, have enough derangement of their brain chemicals to put them out of touch with reality even without the use of drugs. The new Portland faces the Army and Navy department store across the street, where my parents, as new immigrants in the late 1950s, bought most of our clothing. Back then, the Army and Navy was a popular shopping destination for working people—and for middle class kids looking for funky military coats or sailor jackets. On the sidewalks outside, university students seeking some slumming fun mixed with alcoholics, pickpockets, shoppers and Friday night Bible preachers. Now these streets and their back alleys serve as the centre of Canada’s drug capital. One block away stood the abandoned Woodward’s department store, its giant, lighted “W” sign on the roof a long-time Vancouver landmark. For a while squatters and antipoverty activists occupied the building, but it has recently been demolished; the site is to be converted into a mix of chic apartments and social housing. The Winter Olympics are coming to Vancouver in 2010 and with it the likelihood of gentrification in this neighbourhood. There’s a fear that the politicians, eager to impress the world, will try to displace the addict population. Eva intertwines her arms, stretches them behind her back and leans forward to examine her shadow on the sidewalk. In the rearview mirror the receding figure of Eva gesticulates, legs splayed, head tilted to the side. The Portland and the other buildings of the Portland Hotel Society represent a pioneering social model. These are people who are frequently viewed as liabilities, blamed for crime and social ills, and…seen as a waste of time and energy. A review done shortly after the Portland was established revealed that among the residents three-quarters had over five addresses in the year before they were housed, and 90 per cent had been charged or convicted of crimes, often many times over, usually for petty theft. The proportion of Native Canadians among Portland residents is five times their ratio in the general population. It took eight years of fundraising and four provincial government ministries and four private foundations to make the new Portland a reality. Now people finally have their own bathrooms, laundry facilities and a decent place to eat food. Our clients are not the “deserving poor” they are just poor—undeserving in their own eyes and in those of society. At the Portland Hotel there is no chimera of redemption nor any expectation of socially respectable outcomes, only an unsentimental recognition of the real needs of real human beings in the dingy present, based on a uniformly tragic past. We may (and do) hope that people can be liberated from the demons that haunt them and work to encourage them in that direction, but we don’t fantasize that such psychological exorcism can be forced on anyone. The uncomfortable truth is that most of our clients will remain addicts, on the wrong side of the law as it now stands. Kerstin Stuerzbecher, a former nurse with two liberal arts degrees, is another Portland Society director. Home support staff clean rooms and assist with personal hygiene for the most helpless. When possible, patients are accompanied to specialists’ appointments or for X-rays or other medical investigations. There is a writing and poetry group, an art group—a quilt based on residents’ drawings hangs on the wall of my office. There are visits from an acupuncturist, hairdressing, movie nights, and while we still had the funds people were taken away from the grimy confines of the Downtown Eastside for an annual camping outing. My son Daniel, a sometime employee at the Portland, has led a monthly music group. That this is the only home he’s ever had and how grateful he was for the community he was part of. And how proud he was to be part of it, and he wished his mom and dad could see him now. Often I face the refractory nature of people who value their health and well-being less than the immediate, drug driven needs of the moment. Much as I want to accept them, at least in principle, some days I find myself full of disapproval and judgment, rejecting them and wanting them to be other than who they are. It’s my problem —except that, given the obvious power imbalance between us, it’s all too easy for me to make it their problem. Where else do you find people in such poor health and yet so averse to taking care of themselves or even to allowing others to take care of them? Take Kai, who has an immobilizing infection of his hip that could leave him crippled, or Hobo, whose breastbone osteomyelitis could penetrate into his lungs. Both men are so focused on their next hit of cocaine or heroin or “jib”—crystal meth—that self-preservation pales into insignificance. Many also have an ingrained fear of authority figures and distrust institutions, for reasons no one could begrudge them. The Hell Realm of painful emotions frightens most of us; drug addicts fear they would be trapped there forever but for their substances. The cement hallways and the elevator at the Portland Hotel are washed clean frequently, sometimes several times a day. Blood also seeps from blows and cuts inflicted by their fellow addicts or from pits patients have scratched in their skin during fits of cocaine induced paranoia. Vermin populate many of my patients’ beds, clothes and bodies: bedbugs, lice, scabies. Cockroaches occasionally drop out from shaken skirts and pant legs in my office and scurry for cover under my desk.