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Flexor pollicis longus Flexor pollicis brevis Adductor pollicis Abductor pollicis longus Abductor pollicis brevis 572 Anatomy medicine to stop contractions order line chloroquine, Histology medicine dictionary pill identification cheap chloroquine 250mg otc, and Cell Biology 474 treatment quadriceps tendonitis discount chloroquine 250mg mastercard. On exploration of the wound symptoms of depression purchase chloroquine pills in toronto, a vessel and nerve are found to have been severed, but no muscle tendons were damaged. From the indicated location of the laceration and loss of sensation, the involved nerve is which of the following? Median nerve Recurrent branch of the median nerve Superficial branch of the radial nerve Ulnar nerve 475. A 71-year-old grandmother fell half way down the basement stairs while carrying a laundry basket after dinner. Her husband, who had heard the noise and came to check on her, helped her stand up. It was then that she felt a slight pain in her left hip when she placed weight on it. The next morning her husband brought her into your family practice office where you could clearly see that she walked with her pelvis tilted as if her left leg was slightly shorter. You order a plain film of the left femur from hip to knee expecting to find which of the following? Femoral neck fracture with compression Femoral neck fracture with complete displacement A spiral fracture of the femoral shaft A transverse supracondylar fracture An intercondylar fracture Extremities and Spine 573 476. The boy is supporting his left arm at the elbow by using his right hand because he thinks he has "broken his arm. Upon physical examination you note a slight drooping of the left shoulder when unsupported, and tenderness over the midclavicular region but no palpable fracture or displacement. The shoulder has normal movement, but the boy is unwilling to lift his hand above his head because it hurts. A 16-year-old girl is brought into your orthopedic office because she fell off her bicycle while riding down a steep hill. You examine her left arm and can palpate a displaced midshaft break of her humerus. You note that she can not extend her wrist, but you do not feel any distal broken bones. Her left forearm and hand feel slightly colder than her right arm and you note she seems to have lost some sensation on the posterior lateral portion of her left hand, though she says she can feel with all her fingertips. Axillary nerve Axillary nerve and posterior humeral circumflex artery Radial nerve Radial nerve and deep artery of the arm Median nerve and brachial artery 574 Anatomy, Histology, and Cell Biology 478. As a result broken femurs often lead to complete hip replacement with artificial parts. What type of femoral fracture in adults is most likely to result in avascular necrosis of the femoral head? Acetabular Cervical Intertrochanteric (between the trochanters) Subtrochanteric Midfemoral shaft 479. Paresthesia, hyperesthesia, or even painful sensation in the anterolateral region of the thigh may occur in obese persons. It results from an abdominal panniculus adiposus that bulges over the inguinal ligament and compresses which of the following underlying nerves? Femoral branch of the genitfemoral nerve Femoral nerve Iliohypogastric nerve Ilioinguinal nerve Lateral femoral cutaneous nerve Extremities and Spine 575 480. Your patient just took up jogging in the evening for exercise and complains that after a mile or so his left leg begins to hurt. You question him on regions of the body or movements that do or do not evoke pain and find that it is widespread throughout his left lower limb. Gluteal region Flexion of the thigh Extension of the leg Posterior thigh Plantar flexion of the foot 576 Anatomy, Histology, and Cell Biology 481. Excess ability to displace a flexed leg posteriorly Excess ability to displace a flexed leg anteriorly Excess ability to displace the ankle medially Excess ability to displace the ankle laterally Extremities and Spine 577 482.

The Cold War concentrated the minds of American strategic planners on narrowly defined military threats symptoms 7dpiui purchase 250mg chloroquine with amex, notably the Warsaw Pact and assorted client nationalist proxy groups (for example symptoms 5 days post embryo transfer cheap chloroquine 250mg mastercard, in Angola or Mozambique) medicine hat tigers order chloroquine from india. In the twenty-first century medicine ball abs cheapest generic chloroquine uk, however, the American public and thus American strategic planners have expanded the definition of a security threat to incorporate a variety of illicit flows: of people, of drugs, of nuclear and fissile materials and parts, and even of viruses. It now includes a vast expanse of scattered ungovernable zones we now call "failed and fragile states," whereas it used to be primarily focused on Europe. The focus of the Cold War remained squarely on interstate forms of conflict such as conventional and nuclear war. American forces now face varying configurations of all three, depending on local conditions in a theater of conflict. They contend with pirates off the Somali coast and criminal gangs seeking to smuggle drugs into the United States, who both use asymmetric means and are motivated by little more than theft. They combat jihadists in the Middle East who are engaged in an ideological struggle and use asymmetric and hybrid means. Furthermore, many strategists believe that a new era of great power conflict has already begun with China or Russia. By focusing on continuity, we are not suggesting that operational changes in strategy never occur. In practice, as we demonstrate, these factors can and do change in theaters of conflict. Nonetheless, although operational circumstances may evolve over time, presidents generally inherit the same or similar ones of their predecessors. President Trump-despite his forthright approach-is as much of a captive to these constraints as were his predecessors, George W. Domestic Bureaucratic and Leadership Constraints on Military Operations Furthermore, presidents inherit both the domestic political, bureaucratic, and historical capabilities and constraints of the American political system and national security state. It includes, below the level of political appointees, many of the same personnel and, of course, standard operating processes, budgetary claims made by powerful congressional constituencies, legal constraints, administrative traditions, and institutional cultures. The size and structure of the national security apparatus by default reinforces a propensity for continuity and can therefore often undermine the grand promises of politicians. As many journalists and scholars have documented, especially in the wake of 9/11, the national security state has inexorably grown, with a base budget increase of more than 50 percent between 2001 and 2016. That bureaucracy, broadly defined, now includes the Department of Homeland Security and the various intelligence agencies, those responsible for managing the massive growth of government contractors and private security services, and departments specifically created to address new forms of conflict across the entire electromagnetic spectrum (including cyber and space). Pointedly, national security professionals, regardless of their personal views and even any political differences, cannot simply be ignored; they are necessary for policy and strategy implementation. Indeed, they are more valuable than ever in the absence of more than half the number of key appointees. Furthermore, entirely consistent with the classic scholarship on bureaucratic and organizational behavior, their familiarity with ongoing operations and standard operating procedures generally reinforces the strategic status quo rather than radical change, often for fear of the unknown consequences of any major shift. The incoming leaders of national security departments often arrive intent on instituting dramatic strategic changes. McMaster as his second National Security Advisor, Gen James Mattis as secretary of Defense, and Gen John F. Their extensive Strategic Studies Quarterly Summer 2018 61 Peter Dombrowski and Simon Reich and distinguished military careers socialized them to view strategic challenges from a pragmatic, operational perspective rather than a dogmatic one. But if reports are to be believed, President Trump regards Mattis and Kelly as credible and authoritative to the point where he routinely delegates strategy to them. Time will tell if Bolton will be willing and able to impose new deployment patterns on both his more cautious colleagues and a possibly recalcitrant bureaucratic apparatus. High-profile debates aside, operations are calibrated to deal with local conditions and continuity is reinforced by domestic constraints. Senior military leaders like calibrated approaches because they often correspond to what combatant commanders tell them needs to be done. Bureaucrats in Washington like calibrated approaches because they generally conform to the standard operating procedures used in the Pentagon when the military encounters specific challenges-and are thus the default position when faced with the jostling and infighting common to Washington. And despite their best efforts, political leaders often abandon their commitment to their chosen electoral promises and succumb to the need to address a problem this way because of the exigencies of responding to a vocal media and an anguished public about an imminent threat. What we describe links both to military operations: what the military, diplomats, and senior policy makers do rather than what politicians say or what official documents, spokespeople, or even public statements claim. Our view is that, given the often-contradictory statements of President Trump and his closest staff members, it is important to ignore the tweets and focus on how operational imperatives constrain the strategic choices of the president and other senior policy makers.

The virus symptoms viral meningitis cheap chloroquine 250mg with visa, transmitted by infected mosquitoes medicine x ed chloroquine 250mg discount, was discovered in a surveillance pool in a densely wooded area between Route 35 and the northeast edge of Sebago Lake medicine to calm nerves order chloroquine cheap online, said Standish Town Manager Gordon Billington symptoms 6 days after iui order genuine chloroquine. He was informed of the finding Thursday by the state Center for Disease Control and Prevention, which posted a notification on its website. The exact location of the infected mosquito sample was not disclosed by state officials, who continue to monitor for the virus throughout Maine. He said he expects more infected mosquitoes will be detected in the Sebago Lake region. There has been considerable debate among school officials, parents, activists and pesticide applicators about the use and efficacy of pesticide poisons to control West Nile virus, which has not spread to humans in Maine. West Nile virus was found earlier in August at a mosquito-surveillance site in Lebanon, on the New Hampshire border in York County. School officials in the town of about 4,000 residents ordered preventive spraying of a botanical pesticide on the edges of two elementary school properties. The disease has been detected and spread to humans in Massachusetts and New Hampshire, and pesticides have been more widely used in communities in those states. The total number of cases of West Nile virus has exceeded 40 nationwide, most in Texas and other Southern states. Symptoms of the virus include headache, high fever, altered mental state, tremors, convulsions and, rarely, paralysis. It can also cause meningitis, an inflammation of the protective membranes covering the brain and spinal cord, or encephalitis, which involves irritation and swelling of the brain. There is no specific treatment for West Nile virus, so state and town health officials have urged residents to do all they can to avoid exposure to mosquitoes. If so, please fill out our accuracy form Send Question/Comment to the Publisher Recommend 29 people recommend this. With six monitors and 26 stations statewide, the program tracks insect populations to determine whether and where West Nile virus or eastern equine encephalitis has surfaced. Juris and other trained site monitors practice a form of science that seems mostly low-tech and very laborintensive for the critical job of informing the public about the spread of infectious diseases. These traps and bait stations are relatively inexpensive essentials that do a reliable job in a crucial task -monitoring mosquitoes for a range of infectious diseases. The traps operate for one day and one night, in most cases at least 15 to 24 hours, attracting and snaring mosquitoes and other insects. The next morning, Juris returns, collects the mosquitoes and returns to a modest lab in a small cottage in Arundel. She uses a microscope, tweezers and intense concentration to count and identify every single mosquito and separate the whole take into specific genus and species. The various traps for mosquito-monitoring harvest live mosquitoes, which are kept in chilled coolers and then transferred to Petri dishes on dry ice. The state is interested now in testing only six species of mosquitoes, those in which diseases have been found. Juris, who works for Atlantic Pest Solutions in Arundel, a state contractor in the program, records the number, genus and species of the mosquitoes she captures. Maine Medical Center is a kind of "bug hub" in the surveillance work: Mosquitoes from all over the state are delivered to the lab there, arriving in test tubes, called pools, containing from one to 50 mosquitoes. The samples come from the 26 stations - some with several traps - around York, Cumberland, Waldo, Kennebec and Aroostook counties, said Chuck Lubelczyk, a field biologist who supervises the Maine Medical Center portion of the work. Describing a small vacuum that sucks mosquitoes into a trap, he said it "involved a lot of tinkering (and) was a long time in the making. Only when it is re-confirmed is it deemed a clearly positive result and reported to local authorities. Once local authorities have been contacted, a public announcement can be issued - the end of an intricate, if unromantic, chain of detective work. If so, please fill out our accuracy form Send Question/Comment to the Publisher Recommend 3 people recommend this. Centers for Disease Control said that the West Nile outbreak is one of the largest in U. Vermont, Hawaii, and Alaska were the only three to not have instances of the disease. Victor Cardenas with the University of Texas School of Public Health, according to the Fort Worth Star-Telegram. Marilnn Marchione / the Associated Press West Nile virus cases are up 40 percent since last week and may rival the record years of 2002 and 2003, federal health officials said Wednesday.

Action items from Book of Secrets symptoms thyroid order 250 mg chloroquine amex, however symptoms 1 week after conception purchase chloroquine with a visa, do not apply exclusively to the president pure keratin treatment purchase chloroquine once a day. Future War is a timely medicine with codeine buy discount chloroquine 250 mg on-line, authoritative, and wide-ranging look at the interplay of ethics and technology in warfare. While the title promises preparing for the "new global battlefield," this book does not delve into the question of how, where, or with what weapons future wars will be fought. Instead it limits itself to surveying the ethical and moral dilemmas of employing advanced, autonomous, or futuristic weapons such as artificially intelligent machines, gene editing, or long-range hypersonic vehicles. Robert Latiff explicitly states his purpose is to explore how new technology has changed warfare and to "highlight both the dramatic developments in technology and war and the speed with which they have occurred and to describe how these will challenge soldiers, decision makers, and the public," he is less than immediately clear that the challenges he is describing are ethical and moral in nature. Ultimately Future War is a cautionary tale warning that unless we begin to understand the ramifications of technology on war, as a nation and a military the United States will be ill-equipped to control technological development and the destructiveness it can cause. Future War begins by cataloging the myriad technologies that already have been integrated into military arsenals or potentially could be in the coming decades. Strategic Studies Quarterly Summer 2018 141 Book Reviews Within his catalog of future weapons, Latiff shows a remarkable understanding of numerous technological disciplines and a keen awareness for how these technologies-many of which are still highly experimental-might be employed during hostilities. The first chapter alone serves as a wonderful primer for anyone interested in the scope and scale of developing technologies broadly defined within national security circles as the "Third Offset Strategy. What is surprising to find in a book on future war is a rather deep and informed discussion of just war theory, the law of armed conflict, and the importance of military leadership. Central to his discussion, Latiff argues that although its adversaries may be unethical in the use and development of advanced technologies, the United States should not sacrifice its values by pragmatically following suit but instead should preserve the standards and values that make us human. By doing so the United States will be able to lead by example and thereby help persuade its adversaries that discrimination, proportionality, military necessity, and the reduction of suffering should be critical criteria used in limiting warfare, especially as technology deadens our senses to the horror of war and its consequences. Throughout the book, Latiff posits that in future wars killing will be impersonal. It is argued that technology will reduce the amount of human interaction required on the battlefield by continuing to replace humans with intelligent and autonomous systems with long-range capabilities. Latiff worries that without the fear of death to modulate and restrict their actions, soldiers of the future may be willing to be unethical in their actions and their political and military leadership more willing to engage in armed conflict. He even goes one step further in arguing that the conflicts of tomorrow will be increasingly defined by speed-of-light weapons and computer automation, making human perception and coordination a limitation. Wars of the future will become more a test of technology than a struggle between humans, and death by algorithm would be the ultimate indignity for the soldier. This brings Latiff to his final point, echoing ethicist Wendell Wallach that we are at an inflection point in our development of technology. We can either choose to deliberately and ethically develop our weapons, being fully aware of the implications of their use, or we can lose control of technology and potentially suffer the loss of our humanity. Latiff argues that as the primary conduit through which most of the public and our political leadership are informed about the military and war, the media has the burden of educating society on technology and ethical warfare. However, his argument suffers in the closing chapters of his book as he dwells on his observation that "there is a strong strain and long history of anti-intellectualism in American culture. In its current form, it dismisses science, the arts, and the humanities in favor of entertainment and self-satisfied ignorance. Despite this, Latiff returns to his primary thesis at the conclusion of the book, that the deliberate and ethical development of technology is possible if our leaders and the public make the concerted effort to create the generational changes necessary to educate themselves and take ownership of the issues. Overall, Future War is a quick read and a wonderful introduction to several topics relevant to military conflict. This book should be a welcome read for anyone serving in acquisitions, concerned with how the United States should use future weapons of war, or charged with commanding those who will use them. Coletta has written an interesting thought piece on the role of science in modern geopolitics-a combination of concepts not often associated with each other. In subsequent chapters, he makes the rather broad claim that in democracies "a national commitment to scientific achievement brings with it a salutary discipline, moderating popular opinion and refining political culture" (p. Since "Science" is a means for a nation to encourage both "engagement and trust," "mutually beneficial cooperation" in space and other scientific activities "would allow American hegemony to survive a second century" (p.

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