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Name of Acute Disease: Common names of the illness caused by these viruses are acute nonbacterial infectious gastroenteritis and viral gastroenteritis early warning signs diabetes type 2 buy generic acarbose 25 mg on-line. Nature of Disease: Viral gastroenteritis is usually a mild illness characterized by nausea diabetes medications images best 50mg acarbose, vomiting diabetes prevention supplements generic acarbose 50mg without a prescription, diarrhea blood sugar units of measure order acarbose 50 mg with mastercard, malaise, abdominal pain, headache, and fever. Specific diagnosis of the disease can be made by some laboratories possessing appropriate reagents. Identification of the virus present in early acute stool samples is made by immune electron microscopy and various enzyme immunoassays. Confirmation often requires demonstration of seroconversion to the agent by serological tests on acute and convalescent serum pairs. Viral gastroenteritis is transmitted by the fecal-oral route via person-toperson contact or ingestion of contaminated foods and water. Most American and British children over 10 years of age have antibodies to the virus. Parvo-like viruses have been implicated in a number of shellfish-associated outbreaks, but the frequency of disease is unknown. Usual Course of Disease and Some Complications: A mild, self limiting illness usually develops 10 to 70 hours after contaminated food or water is consumed and lasts for 2 to 9 days. The clinical features are milder but otherwise indistinguishable from rotavirus gastroenteritis. Co-infections with other enteric agents may result in more severe illness lasting a longer period of time. The target populations for astro and caliciviruses are young children and the elderly. Parvoviruses infect all age groups and probably do not ilicit a permanent immunity. Only a parvovirus-like agent (cockle) has been isolated from seafood associated with an outbreak. Although foods are not routinely analyzed for these viruses, it may be possible to apply current immunological procedures to detect viruses in clinical specimens. Selected Outbreaks: Outbreaks of astrovirus and calicivirus occur mainly in child care settings and nursing homes. In the past decade, 7 outbreaks of calicivirus and 4 of astrovirus have been reported from England and Japan. In California, an outbreak caused by an astrovirus, the Marin County agent, occurred among elderly patients in a convalescent hospital. However, if Norwalk and Norwalk-like viruses prove to be caliciviruses, they would account for most food and waterborne outbreaks of gastroenteritis in this country. Outbreaks of adenovirus have been reported in England and Japan, all involving children in hospitals or day care centers. The small featureless, parvo-like viruses caused outbreaks of gastroenteritis in primary and secondary schools in England (Ditchling and Wollan) and Australia (Paramatta). The cockle agent caused a large community-wide outbreak in England (1977) associated with consumption of contaminated seafood. Parvo-like viruses were also implicated in several outbreaks which occurred in the States of New York and Louisiana in 1982-1983. Name of Disease: Ciguatera Fish Poisoning Ciguatera is a fonn ofhuman poisoning caused by the consumption of subtropical and tropical marine finfish which have accumulated naturally occurring toxins through their diet. Manifestations of ciguatera in humans usually involves a combination of gastrointestinal, neurological, and cardiovascular disorders. Symptoms defined within these general categories vary with the geographic origin of toxic fish. Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensory reversal and acute sensitivity to temperature extremes, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure. Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset.

Context - sensitive biasing diabetes insipidus mnemonic buy 25 mg acarbose with visa, we concluded earlier diabetes medications nclex questions cheap acarbose 50mg free shipping, estab - lishes conditional probabilities among previously independent process es diabetic diet recipes menus purchase acarbose 50mg fast delivery. Through such context - dependent constraints and interacting with working memory and attention diabete and pregnancy buy acarbose 25 mg visa, these somatic states can select and order from the various possibilities available to the cognitive system (Oamasio 1994, 198). The resulting act - token is the constrained trajectory through this meaningful, self - organized region of neural space. Forming a Prior Intention Self-organized dynamical structures are globally stable despite disorder at the lower levels. However, as illustrated in the example of autocatalysis, complex adaptive systems can be driven far from equilibrium to an instability threshold by the interplay of external conditions and their own internal processes. The disequilibrium 180 Chapter12 and instability that precipitate the restructuring can occur at the cognitive and emotional levels, not just the chemical or biological one. I propose that settling on a prior intention embodies just such a phase change or bifurcation. If dynamical models are an appropriate theory -constitutive metaphor for people and their actions, the cognitive phase change that takes place when someone formulates a prior intention must dissipate the disequilibrium that had driven the system to an instability threshold. If the disequilibrium that prompted intentional action was cognitive and emotional, so, too, is the reestablished equilibrium. What sort of equilibrium could be restored when someone quits her job as an accountant to become a skydiver? Choices that appear mad on a two -dimensional scale might not be in a multidimensional manifold. The semantic space self-organized by (in) a prior intention automatically reduces the number of logically or physically possible behaviors to a more manageable set of now -meaningful options. Given the overall context established by the prior intention, the prior probability of each of the possible behavioral alternatives has suddenly changed. By formulating a prior intention, agents avoid having to consider and evaluate explicitly every logical or physical possibility (not only a wasteful utilization of resources but, as we saw, a situation that would effectively paralyze them). Formulating a new prior intention is the self-organizing process that narrows the list of available options by organizing them into meaningful groupings. Contrast Space Alan Garfinkel (1981) has argued that questions of the form " Why did X A? Once I form the intention to greet you, that cognitive reorganization circumscribes future behavior to winking rather than waving, saying " Hi! It does not even consider those behavioral alternatives excluded from the contrast space. As soon as I form the prior intention to greet you, turning away drops out as a possible act-type: the neural attractor for it flattens out. For Sutton, the possibility " not rob at all" is excluded altogether from his self-organized frame of mind. Conceptualizing self-organization topo logically, we saw, gives us a natural way of understanding this " closeness ": as relative location in semantic neurological space. The scope of the operator " by mistake" is determined by contrastive stress, whose function is to identify one alternative from a set of possibilities, while at the same time excluding other members of this set (Dascal and Gruengard 1981, 108). The intonation with which the sentences are spoken cues the listener to the range of alternatives that the speaker included in the contrast set. Applying this idea to the problem of action and using Oedi pus as a test case yields the following: 4. But since Oedipus did not include in his contrast set "Oedipus married the only Rh negative woman in Thebes indeed Oedipus could not ", have even considered it it does not identify an unintentional act. Because Oedipus is ignorant of the concept "Rh negative blood," his behavior could not have originated in that semanticspace nor could it, have been constrainedby it. The first point to be made here then, is that the particular act-token an, agent performs depends on the coordinates of his or her contrast space (B, C. As I noted in my comments on Rawis (1955) and Peters (1958), act -tokens such as signing a check cannot even be intended much less performed if, the corresponding social practice has not been established the Martian.

Needham diabetes prevention 9 easy buy acarbose 25mg,a British biologist diabetes type 1 gluten free diet order acarbose 50 mg with mastercard, esti- As a hand surgeon blood sugar levels after eating order 25 mg acarbose with visa,I was called upon to treat a steady proces- experience wounds much morefrequently diabetes diet high fiber cheap 25mg acarbose with visa, and, because they keep on using the affected hand, severe damage often results. At least 90 percentofthe insensitive hands I examine show scars and signs of deformity or injury. We urged them to take responsibility for parts of their bodies they could not feel, relying on other senses for their clues. Theincidence of direct injuries at Carville began to decrease, especially as we relied on tools like the thermograph to monitor the early problems undertheskin. If, however, the patient keeps walking on - the injured foot, infection may set in and spread through the foot, destroying bones and joints and making amputation inevitable. Constant Stress occasionsthey fall under theevil spell of shoe designers whofavor narrow, pointed shoes and high heels. But a constant, unrelieved pressure as low as one pound per square inch can do damage. Press a glass slide against your finger- Humanskin is tough: normally, it takes morethan five hundred Other damage was much harder for us to track down. Subsequent thermogramsclearly showedthatthis very slight pressure caused inflammation in and under the skin. The pressure spot turned red, and hair perma- him still, and apply very slight pressure to designated spots on his back. A cylindrical piston kept the pressure at a low but constant because pig skin has properties similar to those of human skin. People with a as horrible as any surface wound you mightfind in a battlefield hospital. If these quiet messages are ignored, the distressed region sends out a loudercry of real pain that forces the person to shift a buttock or turn over on onesideto relieve the pressure. They are consciously attending to what I am saying, and thus squelching or ignoring the subtle messages of discomfort. As soon as mylecture gets boring, though, their mental concen- tration wanders andinstinctively they tunein to the faint messages of distress from cells that have been sat on for too long. The problem, we discovered, was his toes because of the quiet tedium of constantstress. The risk of constant stress from poorly designed shoes is every bit as dangerousas therisk of direct injury from going barefoot. If my own shoesfeel too tight, I loosen the laces or take them off and put onsoft slippers. The leprosy patient, who feels no pain, leaves a tight shoe on even after pressure has shutoff the blood supply. Repetitive Stress In retrospect, the most valuable product of two decades of pain research was new insight into how ordinary, "harmless" stresses can cause severe damage to skin if they are repeated thou- question, Carville engineers rigged up a repetitivestress machine that reproducedthestresses of walking or running. The results proved conclusively that a "harmless" force, repeated often enough, does indeed cause tissue breakdown. The first day I put my finger under the hammer,I felt no pain up to Weused laboratory rats for these experiments, putting them wondered, that a healthy person can walk ten miles without injury while a leprosy patient often cannot? Forseveral decades I had puzzled over why the simple act of walking represented such a threat to a leprosy patient. We first became aware of this syndromein India while testing different kinds of footwear, but the research labs at Carville gave us the tools to discern exactly how repetitive stress like a vibro-massage. The second day it took far fewer strokes of the tiny hammer for me to sense tenderness. I now knew thattiny pressures, if repeated often enough, could damagetissue, so that undercertain circumstances the commonact of walking might indeed prove dangerous. YetI still had not answered the underlying question: What madethefeet oflep- about one thousand strokes. I had heard about a new wayof applying herbicides to cultivated fields by using water-soluble microcapsules: the same rain that stimulated weed growth also dissolved the capsules, releasing a herbicide to kill the weeds. This clever invention gave me the idea of hiring a chemical research company to develop a tiny microcapsule that would break down as a result of pressure, not water.

In short blood glucose 69 buy cheap acarbose 25 mg on-line, as was the case in autocatalytic webs diabetes mellitus entgleist definition order acarbose 25mg visa, here diabetes diet needs discount 25 mg acarbose amex, too diabetes mellitus type 2 hereditary buy 50 mg acarbose mastercard, feedback takes the network far from equilibrium. Once trained, artificial neural networks with recurrent feedback display an interesting feature: vector completion. Cleanup units therefore allow upstream layers (in this case the, level at which the network processes the visual form of the word) to be EmbodiedMeaning 167 imprecise. Vector completion due to feedback is a valuable property because it makes neural networks robust to noise: the context -dependence the feedback provides allows them to detect a signal even amid noise. As a result, artificial networks, like people, can make out a faded, blurry text. This robustness seems to characterize all complex systems with homolo gous dynamics. Hinton, Plaut, and Shallice claim that postulating the existence of semantic at tractors explains deep-dyslexia -type errors. Artificial networks without feedback do not make deep-dyslexic type mistakes, but those with cleanup units do. When the network reads the word correctly, the output represents the endpoint of a trajectory through the attractors of this high -dimensional, semantically organized space. The actual path is an unequivocal trajectory on a directed graph, starting at a node (the source) within that semantic space, continuing along a specific trajectory, and terminating at another node (the sink). And it is precisely in virtue of their high -level properties (that is, of the 168 Chapter11 meaning embodied in the relations among their components that the selforganized) dynamics produce the output: the dynamics are causalas mean ingful. This is the primary advantage of a dynamic account over an information-theoretic one: the former, unlike the latter, can account for both the emergence of meaning and its causal efficacy. Separately Jeffrey Elman (1995) and JeanPetitot (1995) have also constructed, connectionist models of linguistic performancewhose results support the claim that artificial neural networks construct semanticattractors. The closeness the various regions lvithin of that state space embodiesboth semanticsimilarity and hierarchicalselforganizatio. According to (Bechtel 126), connectionist systems identify, "the objects or situations with which they are presentedas exemplarsof semantic categories On the account presented here regions of selforganized. That closeness carves out a broad region or subvolume that in effect capturesthe semantictype or exemplar "mouse Coarsecoding makesthis generalizationpossible. This particular valley might embody or represent"Herman -in- EmbodiedMeaning 169 I 2. I Hierarchicalclustering diagram of hidden unit activations in the simulation with simple sentences. After training, sentences passedthrough the network, and the hidden unit activation are pattern for each word is recorded the clustering diagram indicates the similarity. Relative position in semantic space distinguish es one universal from another, even if more fuzzlly and idiosyncratically than previously thought. If, as appears plausible, people self-organize neurological semantic attractors in similar fashion, eliminativist materialists (Church land, P. But because an indefinitely large number of self-organized spaces can coexist and each run of a complex system is unique, it is also likely that each person will show evidence of idiosyncratic psychological overlaps. For example, although the dictionary shows no conceptual relationship between " goose" and " dangerous," my particular psychological dynamics might - if I was attacked by a goose the first time I saw one. While the Newtonian framework ruled, discussions about reductionism were usually framed as a strong disjunction: either intentions were reducible to neurophysiology or, if not, they were therefore sui generis. The assumption that neurophysiological structures and their causal relations would be completely describable without reference to semantics has been a central dogma of the philosophy of mind. EmbodiedMeaning Studies 1995 of the way that be infants we are learn on for (Thelen in wells basins " perceptual, where of the attraction the the to kick a mobile track, that of 1994 " may acts that of of (reported homologous cognition)the also be ability depicted and more unsurprising in in 171 Thelen) suggested can also. Learning across right dynamics human to generalize as a acting general in postulated categories emergence and Smith beings variations potential wider stimuli local landscape come classes light of to of of form perceiving represent are solutions the similarity, on (95). Radically organized of white of and different cognitive than complex trajectories do environments the produce many to more differently shades landscapes Floridians systems, even. Eskimos any recognize case, the progressively of sensitivity initial conditions dynamics.