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First gastritis diet to heal order zantac now, we need to acknowledge that gastritis diet 23 cheap zantac online amex, although plenty of published books recount the experiences of travelling in Europe between 1660 and 1840 gastritis daily diet cheap 300mg zantac mastercard, much of the relevant literature gastritis symptoms nausea discount zantac 150 mg with mastercard, especially on the Grand Tour gastritis diet öèòàòû purchase zantac 300mg on line, exists in private manuscript correspondence (some of it published posthu mously) chronic gastritis h pylori purchase zantac 300mg online, or in the form of arguments about the value of travelling, rather than that of travelogue. This essay will emphasise the framework of expectations and assumptions within which travel writing about Europe was produced between 1660 and 1840. In telling this story, one guiding question must be: what happened to the ideals and purposes associated with travel in Europe when they became (as it seemed) scandalously accessible to wider and wider swathes of the British population. How could the ideology of the Grand Tour survive in, or be altered to suit, the age of Thomas Cook and Son. Its lead ing purpose was to round out the education of young men of the ruling classes by exposing them to the treasured artifacts and ennobling society of the Continent. Usually occurring just after completion of studies at Oxford or Cambridge University and running anywhere from one to ve years in length, the Tour was a social ritual intended to prepare these young men to assume the leadership positions preordained for them at home. After crossing the Channel, the Tourist, having acquired a coach in Calais, would often pro ceed to the Loire Valley, where the purest French accent was supposed to have its home, and where the young Briton could spend some time prepar ing his tongue and his manner for the rigours of Paris society. A lengthy stay in the French capital might be followed by a visit to Geneva (and even, if one had the right connections, to Voltaire at his villa in the outskirts). One would then cross the Alps, as expeditiously as possible, proceeding via Turin or Milan down to Florence, to stay probably for some months. The return journey northward might include stays in Austria, the German university towns, Berlin, and Amsterdam. Several corollaries of the intended educative or preparatory function of the Grand Tour may be distinguished. The rst has to do with this classical tradition, by which eighteenth century British travellers meant Rome, not Greece. Personal experience of the places made famous by the Latin texts which the traveller had read in school would seal the bond between ancient and modern empires. Touring might also prepare the young Englishman for his future role by of fering him the opportunity not only to cultivate his historical consciousness and artistic tastes but actually to acquire works of art and antiquities that, displayed at home, would testify to the quality of his taste and surround him with objective con rmations of his self-worth. The tour of Europe, its proponents held, could usher the unformed, insular young Englishman into that domain of good manners and educated tastes which transcended single nations. Depending on the size of his purse, he might be accom panied by a considerable number of servants, attendants, instructors, artists (to copy landscapes or ruins), and assorted hangers-on. Such luminaries of post Renaissance culture as Thomas Hobbes, Ben Jonson, Joseph Addison, and Adam Smith served as tutors early in their careers. Perhaps because Grand Tour ideology like that stated by Richard Lassels or Thomas Nugent set impossibly high standards; perhaps because tutors failed to keep their charges in line; or perhaps because drinking, gaming, and whoring always held more attraction for the young traveller than did the other, more exalted objectives of the tour: for some combination of these reasons, the behaviour of Grand Tourists soon attracted suf cient criticism to call into question the aims of the entire enterprise. This gradual and very partial opening up of European travelling was disrupted by the French Revolution and by the twenty-odd years of nearly ceaseless con ict between France and Britain that followed it (c. A new vogue of domestic travel arose to ll this gap, impelled by several cultural currents that had been decades in the making. In 1760, James Macpherson published Fragments of Ancient Poetry, Collected in the Highlands of Scotland. Horace Walpole is usually credited with beginning the vogue of the Gothic with the Castle of Otranto (1764), but it was not until the 1790s that the mode really ourished. By that time, Celticism and the Gothic had become almost inextricably bound up with a third strand of cultural and aesthetic attitudes that, like these, opposed Grand-Tour neo classicism and became underpinnings of the Romantic Movement. This was the picturesque, which needs to be explained in terms of its relationship to two other aesthetic ideas, those of the beautiful and the sublime. The picturesque arose in the last third of the eigh teenth century as a kind of mediator between these opposed ideas, capable of running the gamut from relatively mild English landscapes to the breathtak ing cataracts and chasms of the Alps in stormy weather. The picturesque was introduced into English cultural debate by the Reverend William Gilpin, who in Observations on the River Wye, and Several Parts of South Wales, etc. Not accidentally, the object in ques tion is a Palladian, neoclassically regular and orderly, piece of architecture. Wordsworth him self, in many poems as well as in his Guide to the Lakes (1810; reprinted and revised several times up to 1842), confronted picturesque conventions of sightseeing, attempting to replace them with a morally engaged, more compassionate stance. It is hardly too much to say that hyperbolic reactions like this one invented the idea of mass tourism before the phenomenon really existed. The technological and institutional developments that brought it into ex istence began in the nal years of the period covered by this essay. Steam vessels began crossing the English Channel in 1821: estimates suggest that as many as 100,000 people a year were availing themselves of the service by 1840. The spread of railways across Europe was a highly uneven process, liable, even where quickest (as in Britain), to the chaos of a competitive free-for-all. Anything 47 james buzard like a seamless trans-Continental rail system remained the haziest of utopian dreams for much of the nineteenth century; yet here again, observers at the very start of this long evolution seemed ready to treat it as a revolution al ready well underway. Late in his life, Wordsworth submitted several letters to the Morning Post protesting against the construction of a railway line reaching into the heart of the Lake District. Such develop ments included the authoritative portable railway timetable, rst compiled by George Bradshaw, as well as improvements in the instruments of nance that enabled travellers to change currency with comparative ease abroad. This new, highly individualistic purpose for travel and travel writing arrived just when these activities were widely felt to need one. Hazlitt and Rogers, among others, wrote post-Grand Tour defences of travel that characterised it as answer ing a universal hunger for change and freedom from social responsibilities.

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Bjork A gastritis zungenbrennen discount zantac american express, Skieller V Normal and abnormal growth of the noticeable changes continuing throughout adult life gastritis diet åëìàç discount zantac 300mg on-line. Ver mandible: a synthesis of longitudinal cephalometric implant tical growth gastritis yellow stool discount zantac 300 mg otc, which had previously been observed to con studies over a period of 25 years gastritis que tomar order zantac mastercard, Eur J Orthod 5:1-46 gastritis vs pud cheap zantac 300mg free shipping, 1983 prepyloric gastritis definition generic zantac 150 mg without a prescription. Bjork A, Skieller V Postnatal growth and development of tinues at a moderate level throughout adult life. Richardson M, Mills K: Late lower arch crowding: the effect opment of sexual attraction, Current Directions Psychologi of second molar extraction, Am J Orthod Dentofacial Or cal Science 5:178-183, 1996. This is related to a decreased vol ume of amniotic fluid, which can occur for any of several rea sons. The result is an extremely small mandible at birth, usu ally accompanied by a cleft palate because the restriction on displacement of the mandible forces the tongue upward and prevents normal closure of the palatal shelves. In the malocclusion group, a small growth problem would not be present after birth, one would minority have problems attributable in a specific known cause; the predict normal growth thereafter and perhaps eventually a remainder are the result of a complex and poorly-understood com complete recovery. Some children with Pierre Robin syn bination of hereditary and environmental influences. For that reason, early aggressive treatment to lengthen the mandible should be avoided. It has been estimated that about one-third of the Pierre Robin patients have a defect in cartilage formation and can be said to have Stickler syndrome. Catch-up growth is most likely when the original problem was mechanical growth restric tion that no longer existed after birth. Many deformity pat terns now known to result from other causes once were blamed on injuries during birth. In some difficult births, however, the use of forceps to the head to assist in delivery might damage either or both the temporomandibular joints. At least in theory, heavy pressure in the area of the temporomandibular joints could cause internal hemorrhage, loss of tissue, and a subsequent underdevelopment of the mandible. If the car tilage of the mandibular condyle were an important Skeletal Growth Disturbances growth center, of course, the risk from damage to a pre Fetal Molding and Birth Injuries. In light of at birth fall into two major categories: (1) intrauterine the contemporary understanding that the condylar carti molding and (2) trauma to the mandible during the birth lage is not critical for proper growth of the mandible, it is process, particularly from the use of forceps in delivery. On rare occasions an arm is pressed across the mandibular deficiency has not decreased. Despite considerable postnatal growth of the mandible, mandibular deficiency has persisted. Fortunately, the condylar process tends to deformities involving the mandible are much more likely to regenerate well after early fractures. The falls and im the mandibular condylar process have normal mandibular pacts of childhood can fracture jaws just like other parts of growth, and therefore do not develop malocclusions that the body. For this patient, growth was normal until mandibular growth began to be restricted at age 6; then facial asymmetry developed rapidly. An old fracture is the most likely cause of asymmetric mandi bular deficiency in a child, but other destructive processes also can produce this problem. Interestingly, the prognosis is better the earlier the area to restrict the normal growth movements, so that the condylar fracture occurs, perhaps because the growth the maxilla or, more frequently, the mandible cannot be potential is greater early in life. If dren with later growth problems whose original fracture there is more scarring and restriction on one side, subse was not diagnosed, it appears that many early fractures of quent growth will be asymmetric. It seems to this concept is highly relevant to the management of be relatively common for a child to crash the bicycle, chip condylar fractures in children. It suggests, and clinical ex a tooth and fracture a condyle, cry a bit, and then continue perience confirms, that there would be little if any advan to develop normally, complete with total regeneration of tage from surgical open reduction of a condylar fracture in the condyle. The additional scarring produced by surgery could When a problem does arise following condylar frac make things worse. The best therapy therefore is conserv ture, it usually is asymmetric growth, with the previously ative management at the time of injury and early mobiliza injured side lagging behind (Figure 5-4). Muscle Dysfunction It is important to understand the mechanism by the facial muscles can affect jaw growth in two ways. First, which trauma can produce a distortion in subsequent the formation of bone at the point of muscle attachments growth. The maxilla normally grows downward and for depends on the activity of the muscle; second, the muscu ward because of a combination of push from behind by lature is an important part of the total soft tissue matrix the lengthening cranial base (which is largely complete at whose growth normally carries the jaws downward and for an early age) and pull from in front by anteriorly posi ward. Loss of part of the musculature can occur from un tioned tissue elements (probably including but not lim known causes in utero or as a result of a birth injury, but is ited to the cartilaginous nasal septum). The mandible most likely to result from damage to the motor nerve (the seems to be almost entirely pulled forward by the soft tis muscle atrophies when its motor nerve supply is lost). After an injury, result would be underdevelopment of that part of the face growth problems arise when there is enough scarring in (Figure 5-5). The muscle is an important part of the total soft tissue matrix; in its absence growth of the mandible in the affected area also is deficient. Although the excessive growth stops when the tumor is removed or irradiated, the skeletal deformity persists and orthognathic surgery to reposition the mandible is likely to be necessary (see Chapter 22). Occasionally, unilateral excessive growth of the mandible occurs in individuals who seem metabolically normal. It is most likely in girls between the ages of 15 and 20, but may oc cur as early as age 10 or as late as the early 30s in either sex. The condition formerly was called condylar hyperplasia, and proliferation of the condylar cartilage is a prominent as pect; however, because the body of the mandible also is af fected (Figure 5-9), hemimandibular hypertrophy now is considered a more accurate descriptive term. Excessive muscle contraction can restrict growth in a way Disturbances of dental development may accompany major analogous to scarring after an injury. Despite surgical release of congenital defects but are most significant as contributors the contracted neck muscles at age 1, moderate facial asymmetry to isolated Class I malocclusion. Significant disturbances developed in this case, and a second surgical release of the mus include: cles was performed at age 7. Excessive muscle contraction can restrict growth in the term oligodontia refers to congenital absence of many much the same way as scarring after an injury. This effect but not all teeth, whereas the rarely used term hypodontia is seen most clearly in torticollis, a twisting of the head implies the absence of only a few teeth. Since the primary caused by excessive tonic contraction of the neck muscles teeth give rise to the permanent tooth buds, there will be on one side (primarily the sternocleidomastoid) (Figure no permanent tooth if its primary predecessor was miss 5-6). It is possible, however, for the primary teeth to be restriction on the affected side, which can be quite severe present and for some or all the permanent teeth to be unless the contracted neck muscles are surgically detached absent. The result is increased anterior face hair and an absence of sweat glands in addition to their height, distortion of facial proportions and mandibular characteristically missing teeth (Figure 5-10). Occasion form, excessive eruption of the posterior teeth, narrowing ally, oligodontia occurs in a patient with no apparent sys of the maxillary arch and anterior open bite (Figure 5-7). In these children, it appears as if there is a random pattern to the missing Acromegaly and Hemimandibular teeth. Hypertrophy Anodontia and oligodontia are rare, but hypodontia is In acromegaly, which is caused by an anterior pituitary a relatively common finding. As a general rule, if only one tumor that secretes excessive amounts of growth hormone, or a few teeth are missing, the absent tooth will be the excessive growth of the mandible may occur, creating a most distal tooth of any given type. C and D, Anterior open bite, as in this patient, usually (but not always) accompanies excessive face height. After irradiation of the anterior pituitary area, elevated growth hormone levels dropped and mandibular growth ceased. Note the enlargement of sella turcica and loss of definition of its bony outline in the cephalometric radiograph (arrow), reflecting the secretory tumor in that loca tion. B, the dental occlusion shows open bite on the affected right side, reflecting the vertical component of the excessive growth. Why this type of excessive but histologically normal growth occurs, and why it is seen predominantly in fe males, is unknown. Abnormal Supernumerary or extra teeth also result from distur ities in tooth size and shape result from disturbances during bances during the initiation and proliferation stages of den the morphodifferentiation stage of development, perhaps tal development. The most common supernumerary tooth with some carryover from the histodifferentiation stage. The presence of an extra tooth obviously has "tooth size discrepancy" because of disproportionate sizes of great potential to disrupt normal occlusal development the upper and lower teeth. Unless the teeth are matched for (Figure 5-13), and early intervention to remove it is usually size, normal occlusion is impossible. As might be expected, required to obtain reasonable alignment and occlusal rela tb e most variable teeth, the maxillary lateral incisors, are the tionships. The diagnosis of tooth size discrepancy, dis seen in the congenital syndrome of cleidocranial dysplasia cussed in Chapter 6, is based on comparison of the widths of teeth to published tables of expected tooth sizes. Occasionally, tooth buds may fuse or geminate (par tially split) during their development. Fusion results in teeth with separate pulp chambers joined at the dentin, whereas gemination results in teeth with a common pulp chamber (Figure 5-12). The differentiation between gemination and fusion can be difficult and is usually confirmed by counting the number of teeth in an area. If the other central and both lateral incisors are present, a bifurcated central incisor is the result of either gemination or, less probably, fusion with a supernumerary incisor. On the other hand, if the lateral in cisor on the affected side is missing, the problem probably is fusion of the central and lateral incisor buds. Normal occlusion, of course, is all but impossible in the presence of geminated, fused, or otherwise malformed teeth. It is easier to build up small laterals than re location for a supernumerary tooth, which can be of almost any duce the size of large ones-the lateral incisors for the patient in shape. The supernumerary may block the eruption of one or both (A) already have been reduced as much as possible without going the central incisors, or may separate them widely and also displace through the enamel. A, Age 10, after surgical removal of primary and supernumerary incisors and uncovering of the permanent incisors. B, Age 14, after orthodontic treatment to bring the incisors into the mouth and surgical removal of primary canines and molars, as well as supernumerary teeth in that area. C, Age 16, to ward the completion of orthodontic treatment to bring the unerupted teeth into occlusion. The maxillary right second premolar became ankylosed, but other teeth responded satisfactorily to treatment. To accomplish this, it is necessary not cles (collar bones), many supernumerary and unerupted only to extract any supernumerary teeth that may be in the teeth, and failure of the succedaneous teeth to erupt (see way but also to remove the bone overlying the permanent further discussion following). Supernumerary teeth, sclerotic bone, malocclusion only when other teeth drift to improper po and heavy fibrous gingiva can obstruct eruption. The multiple supernumerary teeth contribute before it finally resorbs and exfoliates. More seriously, eruption of its permanent successor, there is usually no last children with this condition have a defect in bone resorp ing effect. This condition is called ectopic eruption and is most Ectopic eruption of other teeth is rare but can result likely to occur in the eruption of maxillary first molars. The mesial position of the perma ally is due to the eruption path being altered by a lack of nent molar means that the arch will be crowded unless the space. When a unit within the dental arch is lost, the arch tends to contract and the space to close. At one time, this space closure was attributed entirely to mesial drift of posterior teeth, which in turn was confidently ascribed to forces from occlusion. Although a 14 mesially-directed force can accompany occlusion, it prob ably is not a major factor in closure of spaces within the dental arches. The contemporary view is that mesial drift is a phe nomenon of the permanent molars only. Experimental data suggest that, rather than caus first molar apparently results from mesial position or inclination ing mesial drift, forces from occlusion actually retard it. This causes the eruptive path of the first molar In other words, a permanent molar is likely to drift mesially to contact the root of the primary second molar. Delay in erup tion of the first molar and root resorption of the second primary more rapidly in the absence of occlusal contacts than if they molar usually result, as shown here in an 8-year-old boy. Crowding of the permanent Mesial drift of the permanent first molar after a pri teeth is inevitable without treatment. Rarely, the premolars migrate distally beneath the permanent molars (C), and extreme migration into the mandibu lar ramus, even to the point that a premolar is found at the top of the coronoid process, is possible (D), as in this specimen from a sixteenth century burial site. The impact of fluoridation and other caries the posterior part of the dental arch. This has been a sig preventive treatment on the prevalence of malocclusion in nificant cause of crowding and malalignment of premolars dicates that it is not. For this reason, maintenance of the space after caries and early loss of primary teeth in typical U. Even without fluoridation, in other words, When a primary first molar or canine is lost prema most crowding problems are not caused by early loss of pri turely, there is also a tendency for the space to close. The pull from transseptal trauma can lead to the development of malocclusion in fibers probably is the more consistent contributor to this three ways: (1) damage to permanent tooth buds from an space closure tendency, whereas lip pressure adds a vari injury to primary teeth, (2) drift of permanent teeth after able component (see the following section on equilib premature loss of primary teeth, and (3) direct injury to rium). First, if the trauma occurs while the crown of the permanent From this description, it is apparent that early loss of tooth is forming, enamel formation will be disturbed and primary teeth can cause crowding and malalignment within there will be a defect in the crown of the permanent tooth. Is this a major cause of Class I crowding Second, if the trauma occurs after the crown is com plete, the crown may be displaced relative to the root. More frequently, root formation continues, but the re maining portion of the root then forms at an angle to the traumatically displaced crown (Figure 5-19). This distor tion of root form is called dilaceration, defined as a distorted root form. Dilaceration may result from mechanical inter ference with eruption (as from an ankylosed primary tooth that does not resorb), but its usual cause, particularly in permanent incisor teeth, is trauma to primary teeth that also displaced the permanent buds. For this reason, it may be necessary to what is seen in primitive populations: individuals in whom extract a severely dilacerated tooth. Traumatically dis tooth size-jaw size discrepancies are infrequent, and groups placed tooth buds in children should be repositioned as in which everyone tends to have the same jaw relationship. If inherited dispropor rapidly and easily, so early treatment is indicated (see Chap tions of the functional components of the face and jaws ter 14).

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Sometimes gastritis food to eat purchase 150 mg zantac, decision-makers value control over their own choices gastritis symptoms in telugu zantac 150mg low price, even if the outcome would be better if they let someone else choose on their behalf gastritis kronis pdf discount generic zantac canada. When decision-making is deferred gastritis tea order zantac 150 mg with mastercard, outsourced to experts definition akute gastritis purchase zantac australia, or done by computer algorithms (see gastritis zucchini buy discount zantac 150mg online. This view contrasts with standard economics, in which rational agents revise their beliefs based on any new information they receive. Sometimes, people avoid information, even if acquiring this knowledge would be to their own benefit (Golman, Hagmann & Loewenstein, 2017). The more recent behavioral economics view of Golman and colleagues (2017) focuses on active information avoidance, which occurs when access to information is free and people are aware that it is available. There are different ways in which individuals avoid information; for example, they may physically avoid it by failing to return to a clinic to get medical test results, or they may simply not pay proper attention to it. Even forgetting can be the result of an active process when people do not rehearse (negative) information; for example, research has shown that car buyers avoid information that challenges the quality of their choice, and they are more likely to remember reading advertisements that promote their car than those that promote other models. If information comes with high levels of threat, such as knowing whether or not one carries a gene for an incurable disease, information avoidance is not uncommon. Nonetheless, it can also be strategic; for example, an athlete might avoid information about competitors, because she fears that this knowledge would make it difficult to keep up the motivation needed to train for an event. Similarly, a taxpayer who believes that he is entitled to a tax deduction may choose not to seek advice from an accountant, who may try to convince him otherwise. Assuming that people have an inherent drive for sense-making (Chater & Loewenstein, 2016), the choice between embracing and avoiding information depends on whether the pleasure of making sense. If information is very useful to the individual, its avoidance would be especially prevalent among those who heavily discount the future and put disproportionate weight on present benefits. However, it also has negative utility, especially in the longer term, because it deprives Behavioral Economics Guide 2017 5 people of potentially useful information for decision-making and feedback for future behavior. Furthermore, it can contribute to a polarization of political opinions and media bias. Information avoidance in the information age George Loewenstein argues that a better understanding of the hedonics of information would be beneficial to the discipline of economics in the information age (Edwards, 2016; Loewenstein, 2017). This is an important point and raises interesting questions about the effect of both information quality and quantity on avoidance. A study conducted a few years ago, for instance, seems to suggest that exposure to more information makes it more likely that people will seek information that is consistent with a prior decision (Fischer, Schulz-Hardt & Frey, 2008). Information avoidance on the internet has been investigated by Nachum Sicherman and collaborators (2016), who found evidence of an ostrich effect among investors. Data from investment accounts showed that people are less likely to check their portfolio online when the stock market is down rather than when it is up. The research also found that people with big portfolios are less likely to look at their portfolio under those conditions, even though having the information should be more important to them. One of the core behavioral insights in relation to behavior change is the importance of providing individuals with feedback about the consequences of their actions. Thus, information avoidance is also relevant in this domain, where the motivated avoidance of information about goal progress has been referred to as another ostrich problem (Webb, Chang & Benn, 2013). While new technologies, such as health and fitness monitoring devices, allow people to receive feedback about their behaviors and outcomes (Nunes & Goncalves, 2017), their effectiveness could undoubtedly be increased further by gaining a better understanding of information avoidance. There are growing efforts to connect theories and effects seen on this (micro) level with larger forces, such as those studied by macroeconomists (see references in previous editions of this Guide, for example). New articles in the Annual Review of Organizational Psychology and Organizational Behavior provide an overview of the organizational context of decision-making, increasingly prevalent evidence-based management approaches, and associated ideas on field experimentation in organizations. The author notes that behavioral insights from decision research have been applied in social settings by simply extending individual processes. In order to gain a better understanding of decision-making in organizations, however, more dynamic factors should be considered, such as the flow of information between people. Social life in organizations also involves intergroup dynamics and social preferences along with group memberships. Finally, from an organizational point of view, it is important to consider that decisions also occur in the context of social processes. Social influence is beneficial when it enhances creativity and boosts the knowledge with which individuals can work. Remedies to excessive convergence in thinking include having group members think for themselves independently before making decisions collaboratively, creating diverse teams from the point of view of both individual knowledge and external relationships, rotating individuals across teams, and even relying on the wisdom of crowds. According to Larrick, two factors affect the accuracy of decisions made by groups: the people who are involved (composition) and the processes of sharing and using information. In terms of composition, groups have inherently greater potential than individuals to be accurate, due to the basic principles of error reduction and knowledge aggregation. One estimate may be too high and the other one too low, and so error reduction occurs when guesses offset each other. Diverse views can lead to a fuller understanding of the facts, as evident in the decision-making of cross-functional teams. Decisions about a new product, for example, necessarily need to involve people with technical and marketing expertise, and more. The other factor is the process through which a group shares and uses information. According to Larrick, a good decision-making process broadens the information considered prior to a conclusion being reached. To this end, team members need to explore and share knowledge through equal participation. Cognitively, information with statistical dominance tends to gain the upper hand, which is reinforced by prevailing norms. Relationally, the dynamics of social influence and preferences mean that disagreement can be costly to individuals. Larrick posits that conflict can be one way to promote the sharing of diverse information, though this conflict should be built around tasks. This means that organizations should build norms about being critical while also building trust to reduce friction. Larrick concludes his article by outlining possible research directions and practical implications. While some aspects of social decision-making are readily apparent, such as diversity factors, the author suggests that other aspects may be more difficult to see, such as the need to encourage independent thinking, reducing shared blind spots, and the role of teams in individual creativity. According to the authors, evidence-based management grew against the backdrop of three other developments: the academic-practice gap, a lack of consensus in academic research, and evidence-based practice in other domains, ranging from medicine to education. An article in the Harvard Business Review, by the behavioral economist Iris Bohnet (2016; see also Dana, 2017, for related ideas), offers a constructive, evidence-based management view on hiring decisions. Managers may decide against testing, due to overconfidence in their own experience and expertise and a dislike of structured approaches that outsource human judgment. Bohnet recommends that managers use work-sample tests, which are related to the tasks the job candidate will have to perform. When evaluating answers, interviewers should score each answer immediately after it has been given, which would counteract a number of biases, including those around the vividness of examples (favoring candidates who are good storytellers) and their recency. Horizontal comparisons also reduce problems with stereotyping, such as gender bias rooted in expectations of typical male or female jobs. Finally, Bohnet encourages managers to abolish panel (group) interviews altogether, as there appears to be no evidence to support this practice. If that is not possible, interviewers need to keep their ratings of candidates as independent of each other as possible. Organizations are becoming increasingly popular settings for research conducted by behavioral scientists. A newer article, by Dov Eden (2017), offers an excellent field experiment how-to guide for researchers in organizations. Common topics researched experimentally in organizations, mentioned in the article, include communication, benefits utilization, training, engagement, and performance management. He also addresses common misconceptions and how to overcome deterrents to field experimentation (see Table 2). Explain randomization: Provide lay managers with a jargon-free explanation of what randomization does, how easy it is to do, and the problems associated with not randomizing. Examples of these opportunities include training, the introduction of new technology, reorganizations, and managerial transitions. Consider alignments between randomization and fairness: Remember that there are many contexts in which randomization is fair, because the study involves something desirable to be distributed. Invert the treatment: Certain experimental treatments, such as being subjected to stress, would be unethical. In stress abatement, for example, the harmful phenomenon of interest occurs in the (untreated) control condition and is exposed by averting it in the experimental treatment. Transform delicate data: Field experimentation may require the analysis of sensitive or proprietary data, such as absence rates or units produced. Researchers can overcome by asking the organization to make linear transformations of the data that are still statistically usable but useless to others, such as competitors. Table 2: Overcoming Deterrents to Field Experimentation (adapted from Eden, 2017) Behavioral Economics Guide 2017 10 A unique example of employee behavior change is provided by a recent field experiment conducted in the airline industry (Metcalfe, Gosnell & List, 2016). The experimental participants were informed that their flight and fuel behavior would be monitored for a period of eight months. A target group was given a performance target 25% above their past performance, in addition to the feedback. Finally, a prosocial incentives group was given feedback and a performance target and told also that a small donation would be made on their behalf for meeting the target. The researchers estimated that their practically costless intervention led to fuel cost savings of $5. Moreover, the study appeared to induce a longer-term change in habits, as the captains continued to demonstrate these fuel-efficient behaviors after the study ended (for at least six months). The Psychology of Financial Decision-Making Organizational aspects of behavioral science are also one of several dimensions in an excellent review of behavioral finance and related areas written by Frydman and Camerer (2016) in the journal Trends in Cognitive Sciences. In the article, the authors discuss financial decision-making in four different domains: Households, individual investors, markets, and managers. Households, individuals, markets, and managers In many countries, the responsibility for retirement savings is increasingly shifting away from government and employers to households. For example, many people still choose not to invest in a company pension plan that offers a matched contribution by the employer, fail to switch to lower-interest mortgages, or do not know how to spread risk properly between different mutual funds. One important area mentioned by Frydman and Camerer relates to the attention paid by individual investors to different information. They cite recent research that used data from online brokerage accounts, showing that people tend to pay more attention to their portfolio when markets are less volatile or are rising (see also my previous discussion on the ostrich effect). Other well-known tendencies are for people to invest in Behavioral Economics Guide 2017 11 local stocks (the home bias), making assumptions about future earnings based on past returns, and overtrading (trading too frequently).

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Each complete rotor mechanism might measure roughly 7 nm (wide) x 14 nm (tall) x 14 nm (deep) in size with a mass of about 2 x 10-21 kg if composed mostly of diamondoid structure gastritis diet vs exercise buy generic zantac 300 mg on line. The classic sorting rotor can turn at up to ~86 gastritis acid reflux diet zantac 150 mg overnight delivery,000 430 rev/sec which exposes 1 million binding sites per second to the source fluid gastritis diet example zantac 150 mg for sale, giving a conservative rim speed of 2 gastritis dieta en espanol zantac 300mg on line. Pumping against a more aggressive c /c = 106 concentration gradient costs G ~ 60 2 1 c zJ/molecule high fiber diet gastritis buy zantac pills in toronto. Besides the compression energy Gc gastritis diet ulcer generic zantac 300 mg with visa, there is also less disorder (lower entropy) in the world when two gases are separated than when they share a common volume, and the entropy of the world can only be decreased by the expenditure of energy. For a fluid environment having the approximate viscosity of water (~10-3 kg/m-sec at 20 oC) on both sides of the wall, the sorting rotor described and operated as above has an estimated continuous drag power loss of 10-16 W while transporting 106 molecules/sec,1942 or ~0. The strength of the binding of the target molecule to the artificial receptor site can be designed to be sufficient to achieve high occupancy of all pockets. The mechanical energy consumed to force the target molecule out of its binding site into the receiving chamber is delivered from the cam to the rods, but this energy is largely returned with minimal losses to the cam on the source side by the compression of the rods during the binding of the target molecule to the receptor, a process that regenerates mechanical energy. The artificial receptors are best designed for high affinity binding in the presence of a dominant background of quite different molecules. Analogies with antibodies suggest that a rotor with binding pockets of this type could deliver a product stream with impurity fractions on the order of 10-4 to 10-9. To design this binding site, we took a thin sheet of hydrogen-terminated diamond with the C(111) lattice on the top and bottom horizontal faces, cut out a hexagonal perimeter with the C(100) lattice on all six vertical sides, punched a small hole in the center, and hydrogenated the inner walls of the pore, making a 420-atom (C240H180) all-hydrocarbon binding site. Such a structure could readily be nanofabricated as a solid block using a specific sequence of positionally-controlled tip-based mechanosynthetic reactions. This is calculated as the difference between the total energy of the binding site with the molecule bound inside it and the sum of the total energies of the empty binding site and the isolated molecule. The fractional binding site occupancy of a molecular species, or exp(-E /k T) where k = 8. For experimental mechanosynthesis work, see: Sugimoto Y, Pou P, Custance O, Jelinek P, Abe M, Perez R, Morita S. Complex Patterning by Vertical Interchange Atom Manipulation Using Atomic Force Microscopy. A second generation force field for the simulation of proteins, nucleic acids, and organic molecules. Atmospheric Fractional Amber99 Binding Energy % Concentration Molecular Atmospheric of Molecular Component of Air Component Component Concentration in Simple Binding Site in Gas Filtrate (fair) (Eb) Nitrogen (N) 7. This manual is a practical guide, for use by laboratory workers in health centres and district hospitals, to the procedures to be followed in obtaining specimens, isolating and identifying bacteria, and assessing their resistance to antibiotics. Basic laboratory procedures in clinical bacteriology A Basic laboratory procedures in clinical bacteriology Second edition J. Verhaegen Department of Microbiology St Rafael Academic Hospital Leuven, Belgium K. Engbaek Department of Clinical Microbiology University of Copenhagen Herlev Hospital Herlev, Denmark P. Rohner Department of Clinical Microbiology Cantonal University Hospital Geneva, Switzerland P. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: bookorders@who. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The laboratories that are involved in this scheme are able to play a leading role in the implementation of national quality assessment schemes at all levels of the health care system. The information included is intended to lead to harmonization of microbio logical investigations and susceptibility testing, and to improve the quality of laboratories at both central and intermediate levels. According to the world health 1 report, acute diarrhoea is responsible for as many as 2. Acute respiratory infections (primarily pneumonia) are another impor tant cause of death, resulting in an estimated 4 million deaths each year. Analysis of data on lung aspirates appears to indicate that, in developing countries, bacteria such as Haemophilus in uenzae and Streptococcus pneumo niae, rather than viruses, are the predominant pathogens in childhood pneu monia. There are still threats of epidemics and pandemics of viral or bacterial origin, made more likely by inadequate epidemiological surveillance and de cient preventive measures. To prevent and control the main bacterial diseases, there is a need to develop simple tools for use in epidemiological surveillance and disease monitoring, as well as simpli ed and reliable diagnostic techniques. To meet the challenge that this situation represents, the health laboratory ser vices must be based on a network of laboratories carrying out microbiologi cal diagnostic work for health centres, hospital doctors, and epidemiologists. The complexity of the work will increase from the peripheral to the inter mediate and central laboratories. Only in this way will it be possible to gather, quickly enough, suf cient relevant information to improve surveillance, and permit the early recognition of epidemics or unusual infections and the devel opment, application, and evaluation of speci c intervention measures. A 1 Quality assurance in bacteriology Introduction Quality assurance programmes are an ef cient way of maintaining the standards of performance of diagnostic laboratories, and of upgrading those standards where necessary. In microbiology, quality goes beyond technical perfection to take into account the speed, cost, and usefulness or clinical relevance of the test. Laboratory tests in general are expensive and, with progress in medicine, they tend to use up an increasing proportion of the health budget. De nitions To be of good quality, a diagnostic test must be clinically relevant, i. Inadequate working space, lighting, or ventilation, extreme temperatures, excessive noise levels, or unsafe working conditions may affect results. The method and time of sampling and the source of the speci men are often outside the direct control of the laboratory, but have a direct bearing on the ability of the laboratory to achieve reliable results. Other factors that the laboratory can control and that affect quality are the trans port, identi cation, storage, and preparation (processing) of specimens. The laboratory therefore has a role in educating those taking and trans porting specimens. Written instructions should be made available and regularly reviewed with the clinical and nursing staff. The quality of reagents, chemicals, glassware, stains, culture media, and laboratory animals all in uence the reliability of test results. Lack of equipment or the use of substandard or poorly main tained instruments will give unreliable results. Hurried reading of results, or failure to examine a suf cient number of microscope elds, can cause errors. At each stage in the examination of a specimen, the results should be interpreted in order to select the optimum test, in terms of speed and reliability, for the next stage of the examination. Quality assurance in the microbiology laboratory Quality assurance is the sum of all those activities in which the laboratory is engaged to ensure that test results are of good quality. Types of quality assurance There are two types of quality assurance: internal and external. Laboratories have an ethical responsibility to the patient to produce accurate, meaningful results. In some countries, participation is mandatory (regulated by the government) and required for licensure. Quality criteria in microbiology Clinical relevance An important criterion of quality for a microbiological test is how much it contributes to the prevention or cure of infectious diseases; this is called its clinical relevance. Clinical relevance can only be ensured when there is good communication between the clinician and the laboratory. If a few colonies of Gram-negative rods are isolated from the sputum or throat swab of a hospitalized patient, further identi cation and an anti biogram are of no clinical relevance, since neither procedure will have any effect on treatment of the patient. If Streptococcus pyogenes is isolated, a full antibiogram has no clinical rele vance, since benzylpenicillin is the drug of choice, and this is always active in vitro. If Escherichia coli is isolated from a sporadic case of non-bloody diarrhoea, identi cation of the serotype is of no clinical relevance, since there is no clearly established correlation between serotype and pathogenicity. It would be costly in time and materials, and would not affect treatment of the patient. If a yeast is isolated from a respiratory tract specimen, an identi cation test for Cryptococcus should be done. Further identi cation tests have no clin ical relevance, since they would have no effect on patient management. It is not necessary to isolate and identify all the different types of organism in the sample. Reliability For tests that give quantitative results, reliability is measured by how close the results are to the true value. For tests that give qualitative results, reliability is measured by whether the result is correct. Reproducibility the reproducibility or precision of a microbiological test is reduced by two things: 1. As time passes, the microorganisms in a specimen multi ply or die at different rates. To improve precision, therefore, specimens should be tested as soon as possible after collection. Ef ciency the ef ciency of a microbiological test is its ability to give the correct diag nosis of a pathogen or a pathological condition. Diagnostic sensitivity total number of positive results Sensitivity = total number of infected patients the greater the sensitivity of a test, the fewer the number of false-negative results. This important enteric pathogen is often missed because of overgrowth by nonpathogenic intestinal bacteria. Diagnostic speci city total number of negative results Specificity = total number of unifected patients the greater the speci city of a test, the fewer the number of false-positive results. By lowering the level of discrimination, the sensitivity of a test can be increased at the cost of reduc ing its speci city, and vice versa. The diagnostic sensitivity and speci city of a test are also related to the prevalence of the given infection in the popula tion under investigation. Internal quality control Requirements An internal quality control programme should be practical, realistic, and economical. An internal quality control programme should not attempt to evaluate every procedure, reagent, and culture medium on every working day. It should eval uate each procedure, reagent, and culture medium according to a practical schedule, based on the importance of each item to the quality of the test as a whole. The operations manual should be carefully followed, and regularly revised and updated. Care of equipment It is particularly important to take good care of laboratory equipment. Good quality tests cannot be performed if the equipment used is either of poor quality or poorly maintained. Table 1 is a schedule for the routine care and maintenance of essential equip ment. Equipment operating temperatures may be recorded on a form such as the one shown in Fig. Culture media Culture media may be prepared in the laboratory from the basic ingredients or from commercially available dehydrated powders, or they may be pur chased ready for use. Commercial dehydrated powders are recommended because they are economical to transport and store, and their quality is likely to be higher than media prepared in the laboratory. Selection of media An ef cient laboratory stocks the smallest possible range of media consistent with the types of test performed. For example, a good agar base can be used as an all-purpose medium for preparing blood agar, chocolate agar, and several selective media. In a humid climate, seal the tops of containers of dehydrated media with paraf n wax (ll the space between the lid and container with molten wax, and let it harden). Prepare a quantity that will be used up before the shelf-life expires (see below). Media containing blood, other organic additives, or antibiotics should be stored in the refrigerator. The shelf-life of prepared media, when stored in a cool, dark place, will depend on the type of container used.

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