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The committee concluded in February 1942 that biowarfare was feasible and the United States should reduce its vulnerability spasms jaw urispas 200 mg with visa. President Franklin D Roosevelt established the War Reserve Service (with George W Merck as director) to muscle relaxant migraine 200 mg urispas with amex develop defensive measures against biological weapons muscle relaxant starts with c purchase urispas 200 mg on-line. The Army selected a small National Guard airfield at Camp Detrick in Frederick spasms piriformis 200mg urispas visa, Maryland, for the new facilities in April 1943. By summer of 1944 the Army had testing facilities in Horn Island, Mississippi (later moved to Dugway, Utah), and a production facility in Terre Haute, Indiana. No agents were produced at the Terre Haute plant because of safety concerns; simulant tests disclosed contamination after trial runs. The War Reserve Service was disbanded after the war and the Terre Haute plant was leased for commercial pharmaceutical production. In an action that has become controversial, Ishii and his fellow scientists were given amnesty for providing information derived from years of biological warfare research. The plant featured advanced laboratory safety and engineering measures enabling large-scale fermentation, concentration, storage, and weaponization of microorganisms. The United States weaponized seven antipersonnel agents and stockpiled three anticrop agents (Table 1-1) over 26 years. At least 239 open-air tests were conducted at several locations including the Dugway Proving Ground, Utah; remote Pacific Ocean sites; and populated areas including Minneapolis, St. The Special Operations Division at Camp Detrick conducted most of the field tests to study possible methods of covert attack and to examine aerosolization methods, the behavior of aerosols over large geographic areas, and the infectivity and rates of decay of aerosolized microbes subjected to solar irradiation and climatic conditions. Most tests used simulants thought to be nonpathogenic, including Bacillus globigii, Serratia marcescens, and particulates of zinc cadmium sulfide. These studies included the 1951 exposure of uninformed workers at Norfolk Supply Center in Norfolk, Virginia, to crates contaminated with Aspergillus spores. Light bulbs filled with Bacillus subtilis var niger were dropped from subway platforms onto the tracks to study the distribution of the simulant through the subway system. The first large-scale aerosol vulnerability test conducted in San Francisco Bay in September 1950 using B globigii and S marcescens demonstrated the public health issues of such testing. A panel of civilian and academic public health experts secretly convened by the Army in 1952 failed to reach a conclusion regarding the possible link between the Stanford outbreak and the testing program, but recommended that other microbes be used as simulants. In all likelihood, the 1950 Stanford S marcescens epidemic represents an early example of a nosocomial outbreak caused by opportunistic pathogens of low virulence complicating the use of medical devices and surgical procedures in the setting of antibiotic selection pressure. Researchers began using human volunteers in 1956 as part of a congressionally approved program called "Operation Whitecoat. Active duty soldiers with conscientious objector status served as research subjects, and participation was voluntary with informed consent. Polish medical personnel were sent to China to support the communist war effort, accompanied by eastern European correspondents, who made numerous accusations based on anecdotal accounts of patients. Some stories, such as the use of insect vectors to spread cholera, had dubious scientific plausibility. The credibility of the United States may have been undermined by the knowledge of its biological weapons program and its failure to ratify the 1925 Geneva Protocol until 1975. Although unsubstantiated, these accusations resulted in a loss of international goodwill toward the United States and demonstrated the propaganda Historical Overview: from Poisoned Darts to Pan-Hazard Preparedness value of biological warfare allegations, regardless of veracity. The remote locations of the alleged attacks made intelligence investigations difficult. Western intelligence operatives never witnessed these alleged attacks, and no samples of the aerosols were recovered. By the late 1950s assessments of the potential utility of biological weapons were mixed. Still, questions remained about the potential to successfully use biological weapons in a controlled and reliable manner.
Detailed discussions of all these techniques can be found in radiology textbooks and the radiology literature spasms 1983 imdb order urispas 200mg with visa. From the many strategies muscle relaxant medication order urispas 200 mg with visa, these authors only retain parenteral volume expansion spasms left upper quadrant buy urispas 200 mg with mastercard, minimizing contrast-media volume spasms below left breast urispas 200 mg low price, use of lowosmolar and iso-osmolar contrast media, and administration of non-iodinated contrast media as strategies with definitive value. The Work Group feels that such expression can be misleading, since commercially available contrast-media concentrations range from 140 to 400 milligrams of iodine per milliliter, a difference with almost a factor of 3. The Work Group recommends, therefore, that the dose of contrast medium should be better expressed in relation to both volume and concentration. Given the logistic challenges in the outpatient setting, the use of specific prophylactic measures prior to administration of i. K Dosing per kilogram body weight to reduce the amount of contrast media is needed in thin patients. K Avoid test injections; the same amount may be enough for a diagnostic digital-subtraction angiography run. K Scrutinize each series before performing the next; avoid unnecessary projections. K Decrease kilovoltage in a thin patient; a lower iodine concentration may be used. K Assess the physiologic significance of a stenosis by measurement of translesional pressure gradient and fractional flow reserve, a technique well accepted and validated for the coronary circulation. For different arterial beds, perform manometry of a questionable stenosis instead of multiple projections. K Avoid ventriculography: echocardiography (and ``echo contrast') is always a reasonable alternative. K When renal artery stenosis is suspected, map the origin of major renal arteries with noninvasive procedures. K Reduce aortic flow and amount of contrast medium by temporal occlusion of femoral arteries with tourniquets when performing aortography. In addition, high-osmolar contrast media have virtually been abandoned in modern radiological units. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low osmolar contrast media: meta-analysis of randomized controlled trials. There is only moderate quality of evidence and overall, no benefit-or, at least, no consistent benefit-was found of nonionic isoosmolar (iodixanol) contrast media compared to lowosmolar ionic or nonionic contrast media. The volume of contrast medium, volume of saline administered, frequency of coronary interventional procedures, and severity of baseline kidney disease and of diabetes mellitus were similar between treatments. Finally, a recent meta-analysis457 (Figure 14) analyzed studies comparing iodixanol with low-osmolar contrast media. In the studies that included only patients with decreased kidney function after i. The clinical heterogeneity between all these studies, as far as basal kidney function and prevalence of diabetes mellitus are concerned, hampers the ability to compare the results across studies, but can widen the applicability of consistent findings across different risk groups provided the mechanisms of contrast-induced nephrotoxicity are the same. Finally, different types and amounts of volume expansion and different pharmacological preventive strategies have been used throughout the studies, making conclusive comparisons virtually impossible. Although overall the number of patients is substantial, there is heterogeneity among the comparators with which iodixanol has been compared. In addition, the cost of iodixanol is probably higher than the cost of most of the low-osmolar contrast agents.
All of these issues are just as germane in conceptual and operational definitions of variables manipulated in experimental design back spasms 22 weeks pregnant buy urispas 200mg free shipping. These issues cannot be underemphasized for experimental designs that involve creating muscle relaxant back pain over counter buy discount urispas 200mg, or generating levels of a variable rather than measuring levels spasms on right side of head buy cheap urispas 200 mg on line. For instance muscle relaxant baclofen cheap 200mg urispas with amex, the underlying dimensionality of the construct needs to be explicated before it can be operationalized through manipulation. In addition, levels at which a construct will be operationalized need to be discussed as well. Whereas very abstract constructs are difficult to manipulate, concrete constructs may not be sufficient for the purpose of theoretical generalization. An important step in measure development is domain delineation (Churchill, 1979; DeVellis, 1991), which involves explicating what the construct is and is not. This step involves understanding what is being measured by elaborating on the concept, before the measure is designed and items in the measure are generated. Issues considered here include using past literature and relating the construct to other constructs, placing the construct in the context of existing knowledge, and describing the construct in different ways, in terms of what is included and what is not included by the domain. A clear understanding of the domain of a construct versus related constructs is also essential in experimental designs in moving from the conceptual to the operational domain and manipulating a construct in experimental design. Often, researchers are not sure what confounding checks to employ to assess a manipulation. A full understanding of the domain of the construct would be useful in subsequent assessment of the operationalization through manipulation and confounding checks. Delineation is also useful in developing a measure or using an existing measure as a manipulation check. A key point worth reemphasizing in the context of experimental design is the need to explicate the construct and its domain before developing and assessing manipulations. The operationalization to construct link needs to be made carefully when developing manipulations just as it is when developing measures. The sizable effort that is invested in developing measures in a measure development effort is noteworthy. Often, the step from construct to manipulation is made without sufficient understanding of the domain and the variety of ways of manipulating a construct. Essentially, whereas measurement involves rules for assigning numbers based on responses on some continuum, manipulation involves creating levels of a construct on a continuum. In measure development, there are no direct empirical measures of content validity, and assessment is based on whether (1) a representative set of items was developed, and (2) acceptable procedures were employed in developing items (Nunnally, 1978). Similarly, appropriate procedures are necessary to design manipulations in experiments to enable content validity, including pretesting of a range of stimuli. Measure design and item generation follows domain delineation in measure development. Before specific items can be generated, the design of the measure needs to be determined and can range from observational data to behavioral inventories. Measure design is followed by item generation, a stage where redundancy is a virtue and the actual effects of minor wording differences are put to empirical test. Such procedures include asking experts to generate items, and asking experts or respondents to evaluate items in the degree to which they capture defined constructs (Haynes, Richard, & Kubany, 1995). In place of measure design and item generation, designing manipulations involves developing the experimental task. Manipulations can range from artificial scenarios to lab studies involving confederates and role-playing to actual interventions in field research. For example, in a study on consumer disclosure in marketing relationships (White, 2004), scenarios about a fictitious service were used to manipulate deep versus shallow relationships; for instance, the deep relationship was manipulated by asking respondents to imagine that they had an ongoing relationship and by describing some characteristics of the service provider. In contrast, a field experiment can be designed where prespecified scenarios are enacted by service providers. Procedures for assessing content validity of measures can be applied for assessing manipulations during their development, including evaluation by experts. A variety of approaches to manipulating a construct need to be considered before deciding on a subset.
For example muscle relaxant liquid generic 200 mg urispas with mastercard, during the early 1980s kidney spasms after stent removal cheap urispas 200 mg with mastercard, market research for Philip Morris distinguished smoking trends among four U muscle relaxant at walgreens urispas 200 mg with visa. It is not clear whether such a distribution indicates a long-term strategy or whether these cities are meant to muscle relaxant for migraine cheap urispas 200mg with amex act as test markets. New cigarette products, including line extensions, are commonly test-marketed on a geographically limited basis. Advance is targeted at "health conscious" smokers with a campaign that includes the following advertising copy: "Great taste-less toxins," "Advance the way you smoke," and "Everyone knows quitting is the best thing. Although geographic segmentation plays a role in the development of advertising strategies and media buys, for the most part it is national brands that dominate the U. Regional variations in cigarette brand success do not seem nearly as pronounced in the United States relative to other markets such as Canada and Australia. A review of internal tobacco industry documents reveals that the Australian cigarette market is also decidedly regionalized. Escort is a popular brand in South Australia, while Winfield has been a brand leader in Western Australia, New South Wales, and Victoria. Key Principles of Promotion and Rationales for Regulation play a role in the development of product and related promotional strategies. Camel Exotic Blends includes flavors such as Kauai Kolada and Twista Lime, which are identified as "summer" blends. With respect to occasions of use as a segmentation variable, marketers assess whether consumers are likely to use a product primarily on special occasions or more regularly. Product consumption patterns often fluctuate from month to month (described in management and marketing as "the rhythm of the business"), and cigarettes are no exception. In the United States, cigarette sales peak during the summer months, June through August. The warmer weather during the summer months may also prompt smokers to more frequently go outside to smoke in locales where indoor smoking laws have been enacted. The situation in which products are used can be considered as a market segmentation variable. Smoking is frequently done in conjunction with the consumption of alcohol or coffee, and cigarette promotions may include pictorials that encourage the co-use of these products. The statement "Complements Your Cocktail" is found on the packaging of Camel Izmir Stinger, which is one of the Exotic Blends line extensions. Reflecting the synergy between smoking and drinking alcohol, as well as a similar target consumer, several examples of industry efforts co-promote cigarette brands with particular liquor and beer brands whose cultural identity Behavioral Segmentation Behavioral segmentation involves dividing consumers into groups according to occasions of use, usage situation, extent of use, user status, and benefits sought. As cultural anthropologist Grant McCracken explains, "The meaning of a good is best (and sometimes only) communicated when this good is surrounded by a complement of goods that carry the same significance. Within this complement, there is sufficient redundancy to allow the observer to identify the meaning of the good. Conversely, Winston cigarettes combined with a bottle of fine wine would seem inappropriate. When segmenting a market, marketers also account for user status, which may involve classifying groups of consumers into nonusers, ex-users, potential users, first-time users, sporadic users, and heavy users of a product. An appearance of healthfulness and reassurance is particularly likely to be seen in the advertising of cigarette brands such as Carlton and Merit Ultra Lights, which are promoted with messages about their low-tar yields. Meanwhile, cigarette brands such as Marlboro and Camel are both classified "Value" brand advertisement for Doral cigarettes 61 3. Key Principles of Promotion and Rationales for Regulation and promoted as "premium" brands. The "premium" moniker conveys that the product is of high quality and a market leader, suggesting status redemption for its user. Tobacco advertisements are also used to link smoking with a variety of other supposed benefits such as affording pleasure, improving social confidence, advancing relaxation, reducing stress, aiding concentration, and helping in weight reduction71 (chapter 5). Reynolds that detailed an assessment of various product designs, consumer benefits can include "prestige," "cost," "time management," "social interaction," "mood enhancement," "health," "implied health," and "taste burnout. Tobacco companies, and the market research firms that do contract work for them, extensively study the personality characteristics of smokers. Personality characteristics identified by Lorillard during the mid-1980s included the rugged man, pleasure seekers, unsettled dreamers, outdoor individualists, refined ladies, satisfied secures, and social strivers.
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