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One study suggests that arteria appendicularis buy lasix 100mg amex, given the same circumstances prehypertension epidemiology consequences and treatment purchase lasix 100mg overnight delivery, more dispositionally grateful people feel more grateful than less dispositionally grateful people hypertension diet purchase 40mg lasix with visa. In other words blood pressure 8040 purchase 100mg lasix fast delivery, a person with a more grateful personality may be more prone to feel grateful in a particular scenario than would a person with a less grateful personality (Wood, Maltby, Stewart, Linley, & Joseph, 2008) [255]. Still, it remains a matter of debate whether gratitude actually is a personality trait to begin with. In particular, studies have found that how participants see the intention of the benefactor, the cost to the benefactor, and the value of the benefit are all independently and significantly associated with the level of gratitude reported by these participants (Tesser, Gatewood, & Driver, 1968) [311] (Lane & Anderson, 1976) [65] (Tsang, 2007) [122]. More specifically, there is evidence that people feel more grateful when they believe that a helper has more autonomous motivation for their actions, such as when that person helps someone who is lost out of a sense of care for the lost person rather than because the person was taught to be helpful to lost people (Weinstein, DeHaan, & Ryan, 2010) [43]. Individual Factors Linked to Gratitude Together these results suggest that people feel most grateful when they perceive that a benefactor acted with free will and autonomous motivation. In other words, people had to believe they were responsible for their own success in order to feel gratitude for the help that they received (Chow & Lowery, 2010) [15]. Other studies have identified additional factors that can shape how we perceive acts of generosity and, thus, how much gratitude we feel and express as a result. For example, one study found that the amount of gratitude that a person felt following a particular hypothetical favor or gift depended on how that favor or gift compared to previous hypothetical help given by other friends (Wood, Brown, & Maltby, 2011) [49], and another study found that people felt (and expressed) more gratitude when someone was unexpectedly generous (Smith, Pedersen, Forster, McCullough, & Lieberman, 2017) [0]. In other words, we evaluate the gifts from a benefactor relative to how we expect that benefactor to behave toward us. That said, while some studies have found that people feel less gratitude when benefits feel expected or obligatory-as they often do coming from a sibling or other close relative (Bar-Tal et al. Gender Several studies have investigated whether there are gender differences in gratitude. In studies of children and adolescences, girls report being more grateful than boys (Froh, Yurkewicz, & Kashdan, 2009) [331] (Reckart et al. One study, though, suggests that boys may derive more social benefits from gratitude since they showed a stronger association between gratitude and emotional support from family. Adult women also report more trait gratitude than adult men (Sun & Kong, 2013) [23] (Kong, Ding, & Zhao, 2015) [41] (Morgan et al. A study of college students and older adults found that "men were less likely to feel and express gratitude, made more critical evaluations of gratitude, and derived fewer benefits" (Kashdan, Mishra, Breen, & Froh, 2009) [246]. And other studies have found that women were more likely to report feeling grateful to God than were men (Krause, 2006) [144] (Krause, Emmons, Ironson, & Hill, 2017) [0]. It is important to note that some men may associate gratitude with weakness, perhaps due Individual Factors Linked to Gratitude to its relationship to indebtedness, and thus may report lower levels of gratitude (Kashdan et al. Further research is needed to determine whether men actually do experience less gratitude, as well as which mechanisms could explain this difference. A study comparing the experience of emotions in men and women of different ages from the United States and Germany found that German men reported experiencing gratitude significantly more often than the American men did (Sommers & Kosmitzki, 1988) [54]. They also "tended more than the American men to evaluate gratitude positively, characterizing it as one of the most constructive emotions. Envy, materialism, narcissism, cynicism Michael McCullough and colleagues found that dispositional gratitude was negatively associated with both materialism and envy (McCullough et al. Because envy and materialism involve dwelling on what we do not have, they may be antithetical to gratitude, making it difficult for people to be grateful and envious at the same time. Indeed, when one study took a closer look at the negative relationship between materialism and life satisfaction, it found that the lower life satisfaction among materialistic people could be explained by the fact that they reported lower levels of gratitude (Tsang, Carpenter, Roberts, Frisch, & Carlisle, 2014) [52]. In one experimental study, participants who scored higher on the Narcissistic Personality Inventory reported feeling less gratitude towards their partners than did less narcissistic people (Farwell & Wohlwend-Lloyd, 1998) [288]. A recent study of undergraduate students found that self-reported levels of narcissism- along with cynicism and materialism/envy-at the beginning of the study were significantly negatively associated with state gratitude levels two months later (after controlling for initial gratitude levels) (Solom, Watkins, McCurrach, & Scheibe, 2017) [7]. One possibility: "Individuals high in narcissism may not even notice that a gift has occurred because they believe they are entitled to the benefit," write the researchers. Headwinds/tailwinds asymmetry Another phenomenon that may prevent people from feeling gratitude as often as they could is something called "headwind/tailwind asymmetry. While it makes sense that people would be more cognitively aware of challenges they have had to overcome, this also means that they may discount the benefits and resources that have allowed good things to happen in their lives, and thus make them less likely to feel grateful for these benefits. Religion As mentioned in the introduction, gratitude is an important component of many religious traditions, and a number of studies have investigated potential relationships between personal religiosity and gratitude, with varying results. In one study, more grateful people reported higher intrinsic religiosity (engaging with religion for its own sake) and lower extrinsic religiosity (engaging with religion for other gains, such as improved social status) (Watkins et al.
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Precious years have been wasted that increase both the urgency and difficulty of responding and the damage that is already under way blood pressure lab buy generic lasix 100mg on line. Six committees subsequently investigated the allegations blood pressure medication yellow teeth buy discount lasix 40 mg online, finding no evidence of fraud or scientific misconduct heart attack history order lasix 100 mg, but by then the damage was done heart attack 30s lasix 40mg fast delivery, and a cloud of doubt had fallen over the science surrounding climate change. While the scientific consensus on both its causes and consequences has continued to strengthen, public concern, especially in the North, has weakened. On the other side of the debate, environmental and, increasingly, development organisations have been joined by some unusual allies from the private sector. Some business sectors with 30-year investment horizons, such as pension funds or oil companies, naturally think along a longer timescale than the four-year electoral cycles of many politicians. The banking, insurance, and reinsurance industries meanwhile have become alarmed at the spiralling costs of environmental disasters, or interested in the potential returns from climate-friendly energy sources, technologies, and production systems. Progress has also been hampered by the intellectual gulf between the natural scientists who have so far dominated the climate change debate and the social scientists who lead discussions on development. The two academic tribes speak different languages, and so have struggled to build a common front. Technology is bound to play a central role in the transition to a low-carbon economy that drastically reduces reliance on fossil fuels for transport, agriculture, and energy production. Nothing of that kind appears imminent, however (scientists have been trying 346 5 the international sYsteM to tame fusion for some 50 years, with little success) and even were such a technology to be discovered, it would take decades to commercialise and disseminate. With the global economy growing, and carbon emissions rising, the world cannot afford to wait any longer for such a painless technological fix to the problem. Existing technology could in theory buy us some time, but only if the most advanced, cleanest techniques were to rapidly spread to all countries. That, together with existing technological trends (global carbon efficiency has improved by about 1. It also ignores issues such as the rapidly rising use of air travel, which is becoming increasingly significant as a source of greenhouse gases, without any low-carbon alternative in sight. It may well be that patterns of consumption have to change as much as patterns of production. These are huge challenges, but the alternatives are equally unpalatable: cross your fingers and hope for some technological magic bullet to emerge, or accept lower global rates of growth in the market economy. In practice, avoiding catastrophic climate change is likely to require a mix of solutions, including accelerated technology transfer, innovation, and reduced emissions in the big polluter countries. It remains an open question whether this will include lower growth rates in some or all countries, or whether a combination of human ingenuity and political leadership will be enough. For the poorest countries, the transition to a low-carbon economy may not be so urgent after all, with the exception of the giant and rapidly growing economies of China and India, their carbon footprint remains very small. Eventually, however, they will have to find a path to development that does not rely on massive fossil fuel consumption, either because prices are simply too high or because (in a manner analogous to the nuclear proliferation treaty) those countries that have already used huge reserves of carbon to industrialise their own economies will deny that option to others. What if there is no technological fix, and a planned and publicly agreed rebalancing of growth fails to occur? Then, economic adjustments can only occur chaotically in a scramble for carbon based on brute force rather than reason. While rising prices would help push the world towards cutting carbon emissions (indeed that is part of the reason behind carbon trading and carbon taxes), they are likely to be a disaster for equality. These are apocalyptic thoughts, and environmentalists have been accused of crying wolf in the past, only to be proved wrong by new technologies and further discoveries of natural resource deposits. Complicating matters further, developing country governments are themselves divided on climate change. Low-lying countries such as Bangladesh and a number of small island states face national disaster if sea levels continue to rise, and are vociferous in their demands for action. Others are in the middle of huge economic growth spurts, heavily dependent on rising fossil fuel use, and are rapidly becoming some of the largest greenhouse gas emitters in the world. On that reckoning, emissions from the industrialised nations still dwarf those from emerging powers. They have a point, but global warming is a reality, and even as they resist imposed disciplines on their emissions, large developing countries are actively experimenting with different varieties of self-discipline. Brazil, China, India, Mexico, and South Africa have all introduced voluntary measures to moderate their emissions growth. However, the terms of disciplines assumed in the context of an international agreement, in particular the justice or injustice with which the pain is distributed between countries and between groups within them, continue to be hotly disputed.
Some species should be housed in separate rooms even though they are from the same geographic region blood pressure zetia buy 40mg lasix. For example blood pressure chart record format purchase lasix 40mg free shipping, squirrel monkeys (Saimiri sciureus) and tamarins (Saguinus oedipus) may be latently infected with herpesviruses (herpesirus saimiri and h hypertension at 60 lasix 100 mg fast delivery. Intraspecies separation may be essential when animals obtained from multiple sites or sources blood pressure vertigo generic lasix 100 mg with mastercard, either commercial or institutional, differ in pathogen status-for example, with respect to rat theilovirus in rats, mouse hepatitis virus in mice, bacterial gill disease in rainbow trout, Pasteurella multocida in rabbits, Macacine herpesirus 1 (B virus) in macaque species, and Mycoplasma hyopneumoniae in swine. Surveillance, Diagnosis, Treatment, and Control of Disease All animals should be observed for signs of illness, injury, or abnormal behavior by a person trained to recognize such signs. As a rule, such observation should occur at least daily, but more frequent observations may be required, such as during postoperative recovery, when animals are ill or have a physical deficit, or when animals are approaching a study endpoint. Professional judgment should be used to ensure that the frequency and character of observations minimize risks to individual animals and do not compromise the research for which the animals are used. Unexpected deaths and signs of illness, distress, or other deviations from normal in animals should be reported promptly and investigated, as necessary, to ensure appropriate and timely delivery of veterinary medical care. Animals that show signs of a contagious disease should be isolated from healthy animals. If an entire room or enclosure of animals is known or believed to be exposed to an infectious agent. Procedures for disease prevention, diagnosis, and therapy should be those currently accepted in veterinary and laboratory animal practice. Health monitoring programs also include veterinary herd/flock health programs for livestock and colony health monitoring programs for aquatic and rodent species. If a disease or infectious agent is identified in a facility or colony, the choice of therapy should be made by the veterinarian in consultation with the investigator. If the animal is to remain in the study, the selected treatment plan should be therapeutically sound and, when possible, interfere minimally with the research process. Subclinical microbial infections (see Appendix A, Pathology, Clinical Pathology, and Parasitology) occur frequently in conventionally maintained rodents but can also occur in facilities designed and maintained for production and use of pathogen-free rodents if the microbial barrier is breached. Examples of infectious agents that can be subclinical but that may induce immunologic changes or alter physiologic, pharmacologic, or toxicologic responses are noroviruses, parvoviruses, mouse hepatitis virus, lymphocytic choriomeningitis virus, and helicobacter spp. Scientific objectives of a particular protocol, the consequences of infection in a specific strain of rodent, the potential for zoonotic disease, and the adverse effects that infectious agents may have on other animals or protocols in a facility should determine the characteristics of rodent health surveillance programs and strategies for keeping rodents free of specific pathogens. The principal methods for detecting microbial infections in animal populations are serologic tests. Transplantable tumors, hybridomas, cell lines, blood products, and other biologic materials can be sources of both murine and human viruses that can contaminate rodents or pose risks to laboratory personnel (Nicklas et al. Because health monitoring programs are dependent on the size and complexity of the Program, the species involved, and the institutional research focus, it is beyond the scope of the Guide to go into details about health monitoring programs for all species; additional references are in Appendix A (under Disease Surveillance, Diagnosis, and Treatment; Pathology, Clinical Pathology, and Parasitology; and Species-Specific References). To be effective in providing clinical care, the veterinarian should be familiar with the species and various uses of animals in the institutional research, teaching, testing, or production programs and have access to medical and experimental treatment records. The responsibility for communicating these concerns rests with all those involved with animal care and use. Well-planned experiments with clearly delineated scientific and humane endpoints will help to ensure that a contingency plan is in place for problems that may arise during the study (see Chapter 2, Experimental and Humane Endpoints). Emergency Care Procedures must be in place to provide for emergency veterinary care both during and outside of regularly scheduled hours. Such procedures must enable animal care and research staff to make timely reports of animal injury, illness, or death. A veterinarian should be involved in establishing, reviewing, and overseeing medical and animal use records (Field et al. All those involved in animal care and use must comply with federal laws and regulations regarding human and veterinary drugs and treatments. Drug records and storage procedures should be reviewed during facility inspections. The individual impact of those factors will vary according to the complexity of procedures involved and the species of animal used.
Significant efforts have focused on speeding up vaccine development and scaling up production blood pressure levels usa generic 40mg lasix amex. Vaccination strategies targeting younger populations may be especially beneficial blood pressure medication heart palpitations lasix 100 mg, in part because influenza transmissibility is higher among younger populations during pandemics (Miller and others 2008) arrhythmia risk factors 40mg lasix fast delivery. Additionally arrhythmia recognition poster discount lasix 40mg with mastercard, pandemics may be caused by a pathogen without an available vaccine or efficacious biomedical therapy. Care and Treatment to Reduce the Severity of Pandemic Illness During a pandemic, health authorities work to reduce the severity of illness through patient care and treatment, which can help decrease the likelihood of severe outcomes such as hospitalizations and deaths. During the prepandemic period, plans to implement these measures should be developed and tested through simulation exercises. Maintaining supportive care during an epidemic or pandemic can improve mortality rates by alleviating the symptoms of disease. During the 2014 West Africa Ebola epidemic, for example, evidence suggests that earlier case identification, supportive care, and rehydration therapy modestly reduced mortality (Walker and Whitty 2015). Indeed, despite the unavailability of antivirals or vaccines, efforts to engage communities with added medical supplies and trained clinicians decreased the case-fatality ratio moderately as more patients trusted, sought, and received clinical care (Aylward and others 2014). For example, despite biomedical advances, most influenza vaccines are produced through vaccine platforms that rely on the availability of embryonated chicken eggs and can take several months to produce (Reperant, Rimmelzwaan, and Osterhaus 2014). Vaccines that are in development may take decades to become available for human use. For example, Ebola vaccines were in development for more than a decade, with the first vaccine approved for clinical use only in 2015 (Henao-Restrepo and others 2016; Richardson and others 2010). Several areas of active research seek to hasten and strengthen vaccine development. Food and Drug Administration approved an influenza vaccine produced in insect cell lines (Miliбn and Kamen 2015). Medical interventions for pandemic influenza include antiviral drugs and antibiotics to treat bacterial coinfections. Antivirals especially may reduce mortality when given within 48 hours of symptom onset (DomнnguezCherit and others 2009; Jain and others 2009). However, because of delays in case identification and antiviral deployment (as discussed in box 17. Potential for Scaling Up the term scaling up refers to the expansion of health intervention coverage (Mangham and Hanson 2010). In the context of pandemic preparedness, successfully scaling up requires health systems to expand services to accommodate rapid increases in the number of suspected cases. Scaling up is facilitated by surge capacity (the ability to draw on additional clinical personnel, logisticians, and financial and other resources) as well as preexisting operational relationships and plans linking government, nongovernmental organizations, and the private sector. Ultimately, scaling up consists of having both local surge capacity and the absorptive capacity to accept outside assistance. Local capacity building is vital, and some capacities may have particularly important positive externalities during outbreaks. During the 2014 Ebola importation into Nigeria, surge capacity that existed because of polio eradication efforts contributed to a more successful outbreak response (Yehualashet and others 2016). Stockpiling of vaccines, medicines (including antibiotics and antivirals), and equipment (such as masks, gowns, and ventilators) also can be useful for building local surge capacity (Dimitrov and others 2011; Jennings and others 2008; Morens, Taubenberger, and Fauci 2008; Radonovich and others 2009). During a pandemic, health systems can tap into stockpiles more quickly than they can procure supplies from external sources or boost production. Boosting local production capacity for necessary supplies may be a viable strategy for pandemic preparedness and may circumvent some of the challenges associated with amassing stockpiles. The 2009 influenza pandemic demonstrated how scaling up can affect the success rate of a mass vaccination campaign (table 17. The biggest challenges include infrastructural gaps (such as weak road, transportation, and communications networks) and shortfalls in human resources (such as logisticians, epidemiologists, and clinical staff). Pandemics: Risks, Impacts, and Mitigation 331 During the 2014 West Africa Ebola epidemic, a surge of foreign clinicians, mobile medical units, and epidemiologists and other public health personnel was required to bolster limited local resources. Even so, local absorptive capacity (that is, the ability to channel and use foreign assistance effectively) has its limits. Constraints in bureaucratic capacity, financial controls, logistics, and infrastructure all are likely to be most severe in the countries that most need foreign assistance to manage infectious disease crises.