By Q. Thorald. Southeastern Oklahoma State University.

White Americans have long used the criminal justice system to advance their interests over those of blacks buy 35mg residronate overnight delivery; the difference today is that they may no longer be doing so consciously 35 mg residronate overnight delivery. Over a decade ago order residronate 35 mg line, observers of drug criminalization in the United States began labeling its impact on black Americans as the “new Jim Crow purchase 35 mg residronate with visa,” recognizing that drug law enforcement has the effect of maintaining racial hierarchies that benefit whites and disadvantage blacks. In her best-selling book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, Alexander (2010) contends that criminal justice policies and the collateral consequences to a criminal conviction today are—like slavery and Jim Crow in earlier times—a system of legalized discrimination that maintains a racial caste system in America: “today it is perfectly legal to discriminate against criminals in nearly all the ways that it was once legal to discriminate against African Americans…. As a criminal, you have scarcely more rights and arguably less respect, than a black man living in Alabama at the height of Jim Crow. She argues convincingly that drug policies have been and remain inextricably connected to white efforts to maintain their dominant position in the country’s social hierarchy. As Tonry says, “the argument is not that a self-perpetuating cabal of racist whites consciously acts to favor white interests, but that deeper social forces collude, almost as if directed by an invisible hand, to formulate laws, politics, and social practices that serve the interests of white Americans” (Tonry 2011, p. What will it take to change a quarter of a century of drug policies and practices that disproportionately and unjustifiably harm blacks? What will it take for Americans to condemn racial disparities in the war on drugs with the same fervor and moral outrage that they came to condemn the “old” Jim Crow? One part of the answer has to be public recognition that racial discrimination can exist absent from “racist” actors. The norm of racial equality has become descriptive and injunctive, endorsed by nearly every American. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs loathe to recognize or acknowledge structural racism because that would raise questions about their commitment to racial equality—and their willingness to give up the privileges of being white. White discomfort with even the very notion of structural inequality no doubt also is strengthened by conservative American political and moral cultures that stress individual responsibility. Implicit racial bias, racial self- interest, and conservative values combine to make it easy for whites to believe that black incarceration is a reflection of choices blacks have made and penal consequences they have merited. Whites rationalize or avoid seeing the inequities inherent in the war on drugs, assuming or persuading themselves “that the problem is not in the policies they and people like them set and enforce, but in social forces over which they have no control or in the irresponsibility of individual offenders” (Tonry 2011, p. The “myth of a colorblind criminal justice system” is widely influential in the United States because the language of police, judges, prosecutors, and public officials has been wiped clean of explicit racial bias (Roberts 1997, p. United States courts, unfortunately, have made it easier for white Americans to ignore racial disparities in twenty-first century America. Under current constitutional jurisprudence, facially race-neutral governmental policies do not violate the constitutional guarantee of equal protection unless there is both discriminatory impact and discriminatory intent. Supreme Court has decided that every lawsuit involving claims of racial discrimination directed at facially race-neutral rules would be conducted as a search for a “bigoted decision-maker”…. If such actors cannot be found—and the standards for finding them are tough indeed—then there has been no violation of the equal protection clause. In contrast, international human rights law prohibits racial discrimination unaccompanied by racist intent (Fellner 2009). Obviously, laws that make explicit distinctions on the basis of race (other than affirmative action policies) constitute prohibited discrimination. But so do race-neutral laws or law enforcement6 practices that create unwarranted racial disparities, even if they were not enacted or implemented by culpable actors who intentionally sought to harm members of a particular race (United Nations Committee on the Elimination of Racial Discrimination 2005; Zerrougui 2005). It has recommended that the United States “take all necessary steps to guarantee the right of everyone to equal treatment before tribunals and all other organs administering justice, including further studies to determine the nature and scope of the problem, and the implementation of national strategies or plans of action aimed at the elimination of structural racial discrimination” (United Nations Committee on Elimination of Racial Discrimination 2008, paragraph 20). Laws or practices that harm particular racial groups must be eliminated unless they “are objectively justified by a legitimate aim and the means of achieving that aim are appropriate and necessary” (United Nations Committee on the Elimination of Racial Discrimination 2008, paragraph 10). The operational and political convenience of making arrests in low-income minority neighborhoods rather than white middle-class ones may be an explanation but certainly not a justification. Even assuming the legitimacy of the goal of protecting minority neighborhoods from addiction and drug gang violence, the means chosen to achieve that goal—massive arrests of low-level offenders and high rates of incarceration—are hardly a proportionate or necessary response. No independent and objective observer believes the United States can arrest and incarcerate its way out of its “drug problem. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Criminology 44:105–37. National Corrections Reporting Program: Most Serious Offense of State Prisoners, by Offense, Admission Type, Age, Sex, Race, and Hispanic Origin, 2009. Imprisoning Communities: How Mass Incarceration Makes Disadvantaged Neighborhoods Worse. The Rest of their Lives: Life Without Parole for Child Offenders in the United States. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Husak, Douglas N. Marijuana Arrest Crusade: Racial Bias and Police Policy in New York City 1997-2007. Racial Disparity in Criminal Court Processing in the United States: Submitted to the United Nations Committee on the Elimination of Racial Discrimination. Black Arrests for Drug Abuse Violations, 1980 to 2009, generated using the Arrest Data Analysis Tool. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Spohn, Cassia, and Jeffrey Spears.

Key illnesses in the elderly buy residronate 35mg low price, focusing on their often atypical presentation discount residronate 35 mg overnight delivery, including: • Cardiovascular and cerebrovascular disease discount 35 mg residronate amex. Basic treatment plans for illness in the elderly purchase 35mg residronate, with an awareness of the pharmacokinetic and pharmacodynamic changes seen as we age. Principles of screening in the elderly, including immunizations, cardiovascular risk, cancer, substance abuse, mental illness, osteoporosis, and functional assessment. Principles of Medicare (including who and what services are covered) and prescription drug coverage (who and what drugs are covered). Taking a complete and focused history from a geriatric patient with attention to current symptoms, chronic illnesses, and physical and mental functioning. Always obtaining historical information from collateral source, whenever possible. Performing a mental status examination to evaluate confusion and/or memory loss in an elderly patient. Developing a diagnostic and management plan for patients with the with symptoms/conditions common in the geriatric population. Communicating the diagnosis, treatment plan, and subsequent follow-up to the patient and their family. Eliciting input and questions from the patient and their family about the diagnostic and management plan. With guidance and direct supervision, participating in discussing basic issues regarding advance directives with patients and their families. With guidance and direct supervision participating in discussing basic end-of- life issues with patients and their families. Participating in an interdisciplinary approach to management and rehabilitation of elderly patients. Accessing and using appropriate information systems and resources to help delineate issues related to the common geriatric syndromes. Respect the increased risk for iatrogenic complications among elderly patients by always taking into account risks and monitoring closely for complications. Demonstrate respect to older patients, particularly those with disabilities, by making efforts to preserve their dignity and modesty. Always treat cognitively impaired patients and patients at the end of their lives with utmost respect and dignity. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for the common geriatric syndromes. Recognize the importance of patient needs and preferences when selecting among diagnostic and therapeutic options for the common geriatric syndromes. Demonstrate ongoing commitment to self-directed learning regarding care of the geriatric patient. Appreciate the impact the common geriatric syndromes have on a patient’s quality of life, well-being, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other health care professionals in the diagnosis and treatment of geriatric patients. Key indications, contraindications, risks to patients and health care providers, benefits, and techniques for each of the following basic procedures: • Venipuncture. Obtaining informed consent, when necessary, for basic procedures, including the explanation of the purpose, possible complications, alternative approaches, and conditions necessary to make the procedure as comfortable, safe, and interpretable as possible. Demonstrating step-by-step performance of basic procedures with technical proficiency. Appropriately documenting, when required, how the procedure was done, any complications, and results. Appreciate the fear and anxiety many patients have regarding even simple procedures. Regularly seek feedback regarding procedural skills and respond appropriately and productively. Internists, by virtue of their dedication to providing comprehensive care to their patients, must assess nutritional factors on a routine basis. Medical students should be prepared to provide patients with basic advice regarding ways to optimize their nutritional status. Students also need to have at least a basic working knowledge of the principles of nutritional assessment and intervention. Contributions of nutrition to medical problems such as obesity, hyperlipidemia, diabetes, and hypertension. How to perform a nutritional assessment and assist the patient in setting goals for dietary improvement. Daily caloric, fat, carbohydrate, protein, mineral, and vitamin requirements; adequacy of diets in providing such requirements; evidence of need for and potential risks of supplements (e. Common dietary supplements and their known adverse and beneficial effects on health. The consequences of poor nutrition on a critically ill patient, such as poor wound healing, increased risk of infection, and increased mortality.

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One possible option may be to quarantine the refugees for a period of time before any contact with your group residronate 35mg otc. There is no perfect quarantine time frame – but 14 days should cover the vast majority of infectious diseases order 35 mg residronate fast delivery. The doctor-patient relationship: Another important area is that of confidentiality and trust generic 35mg residronate mastercard. Obviously this has to be weighed against the "common good" of the group but unless it would place the group in danger there should be an absolute rule and practice of confidentiality cheap residronate 35mg online. Fortunately it is possible to manage 90% of medical problems with only a moderate amount of basic equipment and drugs. Obviously the treatment may not be as high quality as that provided by a proper hospital but it may be life saving and reduce long term problems. For example; a general anaesthetic, an operation for an internal tibial nail, followed by pain management, and physiotherapy usually manages a broken tibia in a hospital setting. In a remote austere situation it can be managed by manipulation with analgesia, and immobilization with an external splint for 6-8 weeks, and as a result the patient may be in pain for a few weeks, and have a limp for life but still have a functioning leg. Also appendicitis has been treated with high-dose antibiotics when surgery has been unavailable such as on a submarine or in the Antarctic. Removal of an appendix has been done successfully many times under local anaesthesia. Although in each case management maybe sub-optimal and may have some risk in a survival situation it can be done and may be successful with limited medication and equipment. Below are some suggestions for legally obtaining medicines for use in a survival medicine situation. Demonstrate an understanding of what each drug is for and that you know how to safely use it. This approach depends on your relationship with your doctor, and how comfortably you are discussing these issues. Then return the meds when they have expired, this will confirm that you are not using them inappropriately. This includes antibiotics, strong narcotic analgesias, and a variety of other meds. Prescription medicines are available over the counter in many third world countries. While purchasing them certainly isn’t illegal, importation into your own country may well be. While it is unlikely that a single course of antibiotics would be a problem, extreme care should be exercised with more uncommon drugs or large amounts. Should you purchase drugs in the third (or second) world you need to be absolutely sure you are getting what you believe you are, the best way is to ensure that the medications are still sealed in the original manufactures packaging. We cannot recommend this method, but obviously for some it is the only viable option. Generally speaking most veterinary drugs come from the same batches and factories as the human version, the only difference being in the labelling. If you are going to purchase veterinary medications I strongly suggest only purchasing antibiotics or topical preparations and with the following cautions: (1) Make sure you know exactly what drug you are buying, (2) avoid preparations which contain combinations of drugs and also obscure drugs for which you can find no identical human preparation and (3) avoid drug preparations for specific animal conditions for which there is no human equivalent. A recent discussion with a number of doctors suggests that options ii and iii would be acceptable to the majority of those spoken too. In fact many were surprisingly broad in what they would be prepared to supply in those situations. However, be warned the majority of the same group considered the preparedness/survivalism philosophy to be unhealthy! Try looking in the yellow pages for medical, or emergency medical supply houses, or veterinary supplies. A number of commercial survival outfitters offer first aid and medical supplies, however, I would shop around before purchasing from these companies as their prices, in my experience, are higher than standard medical suppliers. The above approaches for obtaining medicines can also be used for obtaining medical equipment if you do have problems. The most important point is to be able to demonstrate an understanding of how to use what you are requesting. Pre-packaged Kits: Generally speaking it is considerably cheaper to purchase your own supplies and put together your own kit. The commercial kits cost 2-3 times more than the same kit would cost to put together yourself and frequently contain items which are of limited value. Storage and Rotation of Medications Medications can be one of the more expensive items in your storage inventory, and there can be a reluctance to rotate them due to this cost issue, and also due to difficulties in obtaining new stock. It is our experience that these are usually very easy to follow, without the confusing codes sometimes found on food products, e.

Men 51 through 70 years of age had the highest intakes at the 99th percentile of 2 buy generic residronate 35mg. L-Cysteine is mutagenic in bacteria (Glatt residronate 35mg visa, 1989) generic residronate 35 mg free shipping, but not in mammalian cells (Glatt residronate 35mg overnight delivery, 1990). Administration to perinatal mice or rats that have an immature blood–brain barrier produces neuro- toxicity. Swiss Webster albino mice, 10 to 12 days old, were given a single oral dose of 3 g/kg of body weight of L-cysteine (Olney and Ho, 1970). At 5 hours after treatment, necrosis of hypothalamic neurons was found, as well as retinal lesions. At 1 hour, exposure produced elevated brain levels of malondialdehyde in the substantia nigra. In addition to the report of Olney and Ho (1970) on retinal lesions in mice, subcutaneous injection of 9- to 10-day-old Wistar rats with L-cysteine at 1. Single oral doses of 5 and 10 g of L-cysteine have produced nausea and light-headedness in normal humans (Carlson et al. Glutamic Acid, Including Its Sodium Salt Dietary glutamate is almost totally extracted by the gut and is metabo- lized rapidly by transamination to α-ketoglutarate, and hence to other intermediary metabolites, notably alanine. Glutamate is also synthe- sized endogenously as a product of transamination of other amino acids during the catabolism of arginine, proline, and histidine, and by the action of glutaminase on glutamine. Its importance in metabolism is that it is a dispensable amino acid that plays a role in the shuttle of nitrogen from amino acid catabolism to urea synthesis through its transamination reamination reactions, and behaves as a neurotransmitter in the brain. Men 31 through 50 years of age had the highest intakes at the 99th per- centile of 33. Hazard Identification Most of the body’s free glutamate pool is concentrated in the tissues, especially brain (homogenate, 10 mmol/L; synaptic vesicles, 100 mmol/L) (Meldrum, 2000). By contrast, the concentration of glutamate in the blood is low, typically about 50 µmol/L in the fasting state (Stegink et al. During absorption of a high-protein meal (1g protein/kg/d), there is about a twofold rise in the concentration of glutamic acid in the systemic plasma (Stegink et al. However, a larger dose of glutamate, 150 mg/kg/d, which increased the total intake by 69 percent, resulted in a larger increase in glutamate level than the meal alone (by about 50 percent) (Stegink et al. Both the peak level achieved and the time course of rise in glutamate level have been shown to be highly dependent on the way in which the glutamate is ingested. A single drink of glutamate (150 mg/kg) in water resulted in a large and rapid rise in the plasma level, peaking at about 12 times the basal level at 45 minutes, and falling quickly thereafter (Stegink et al. By contrast, a meal consisting of a liquid formula substantially inhibited the rise in glutamate level (Stegink et al. Subchronic studies in mice showed an increase in body fat and female sterility in animals that had been subcutaneously injected with glutamate (2. Mice given subcutaneous injections of glutamate (3 g/kg) at 2 days of age were also found to have higher body weights (Olney, 1969). Other studies showed no effects of glutamate on learning or recovery from electroconvulsive shock (Porter and Griffin, 1950; Stellar and McElroy, 1948). Longer-term investigations of the effects of glutamate in animals have revealed few adverse effects. Similar negative results were reported from chronic studies (2 year) in rats given diets containing 0, 0. In humans there is a direct relationship between serum glutamate level and nausea and vomiting with concentra- tions above 1 mmol/L resulting in vomiting in 50 percent of the individuals (Levey et al. For example, arginine glutamate has been given to treat ammonia intoxication, at a dose of 50 g every 8 hours, but no more than 25 g over 1 to 2 hours in order to avoid vomiting (Martindale, 1967). Despite the generally low level of toxicity of glutamic acid demon- strated in the studies on animals and humans, there has remained concern over its continued use as a flavor-enhancing agent. This has been fueled by the discovery that high doses of glutamate can under certain circumstances be neurotoxic (Olney, 1969), and by the reported occurrence of distressing symptoms after the consumption of Asian foods, generally known as Chinese restaurant syndrome. As glutamate is an excitatory neurotransmitter, its potential for neurotoxicity has been studied extensively. In 1957 it was shown that injection of glutamate into suckling mice resulted in degenera- tion of the inner neural layers of the retina (Lucas and Newhouse, 1957). Later work showed that neuronal destruction also occurred in several regions of the brain in mice after glutamate was parenterally administered (Olney, 1969). Neurons are destroyed by excessive activation by glutamate of excitatory receptors located on the dendrosomal surfaces of neurons (Olney, 1989). The most sensitive areas of the brain are those that are relatively unprotected by the blood–brain barrier, notably the arcuate nucleus of the hypothalamus. However, lesions have never been observed in animals taking glutamate with food, although lesions were noted when the glutamate was given as a large dose by gavage. The neonatal mouse is the most sensitive, the sensitivity declining in weanlings through adults. More- over, the sensitivity is lower in rats, hamsters, guinea pigs, and rabbits, and effects have rarely been detected in nonhuman primates. There are also reports of reproductive abnormalities in animals given glutamate as neonates (Lamperti and Blaha, 1976, 1980; Matsuzawa et al.

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