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Occurrence in Man: It was estimated in 1947 that nearly 39 million people in the world were infected by T diabetes symptoms ketones cheap glipizide 10 mg amex. Taeniases are not notifiable diseases blood sugar 53 buy glipizide overnight delivery, and the available information is based on isolated studies of specific sectors of the population, such as schoolchildren, recruits, and others. Also, since many studies of prevalence are based on the finding of eggs in feces, and the eggs of T. A local report in Poland analyzed 736 cases of cestodiasis diagnosed in 1997: 634 were caused by T. On a college campus in Chile, the 11 cases of taeniasis diagnosed at the species level between 1985 and 1994 were caused by T. In contrast, in Bali, Indonesia, one of every three cases of taeniasis was caused by T. Based on these findings, any prevalence exceeding 1% in the general population should probably be considered very high. Hinz (1991) estimated that there were 900,000 infections in Germany, for a prevalence of 1. The endemic areas are the Caucasus region, the former Soviet republics in south and central Asia, and certain countries on the Mediterranean, such as Lebanon, Syria, and the former Yugoslavia. Up to 65% of the children were found to be infected in parts of the former Yugoslavia. Fan (1997) reported a prevalence of 11% in the mountainous zones of Taiwan, 6% on Cheju Island in the Republic of Korea, and 21% on Samosir Island in Indonesia. But the natives of these areas engage in food and hygiene practices that greatly encourage the spread of parasites between man and swine (Depary and Kossman, 1991). Occurrence in Animals: Animals are resistant to infection with the adult parasites. In clinical cases, the most common symptomatology consists of abdominal pain, nausea, debility, weight loss, flatulence, and diarrhea or constipation. While a patient may have one or several of these symptoms, experience in Chile showed that only about a third of patients have any of these symptoms before becoming aware of the infection. In rare cases, there may be intestinal obstruction and even perforation of the colon (Demiriz et al. Individual reactions to the infection differ and may be influenced by psychogenic factors, since patients often notice symptoms only after they see the proglottids (Pawlowski, 1983). In addition, complications such as appendicitis and cholangitis have not been recorded. The most common signs were movement of proglottids (95% of patients), going on for years in some of them; anal pruritus in 77%; nausea in 46%; abdominal pain in 45%; dizziness in 42%; increased appetite in 42%; and headache in 26%. Source of Infection and Mode of Transmission: In contrast to their role in other zoonotic infections, humans constitute an essential link in the epidemiology of taeniasis. Humans are the exclusive definitive host of the three species of Taenia; their feces contaminate cow pastures and areas where home-bred swine may eat. Taeniae can live for many years in the human small intestine, and can eliminate hundreds of thousands of eggs in a single day in the gravid proglottids. Survival of the eggs in pastures depends on the ambient temperature and humidity; in summer, T. In developing countries, where peasants on poor farms or large ranches often defecate in open fields, both swine and cattle have access to taenia eggs. The use of sewer water for irrigation or of contaminated water from rivers or other sources for watering animals contributes to the spread of cysticercosis. Taenia eggs can be carried several kilometers by river water, and they may be transported over long distances by gulls and other birds. An important role in the dissemination of taeniae eggs is also attributed to coprophagous insects. The distribution and prevalence rates of the human taeniases vary considerably in different geographic areas of the world. The infection has almost disappeared from the more industrialized countries, where modern intensive swineraising practices do not permit access to human feces. Moreover, since this population group often does not have the benefit of drinking water and sewer systems, the swine have a much higher risk of infection by human feces. Finally, a high percentage of these swine are slaughtered at home for household or local consumption and, therefore, the animals are not subject to veterinary inspection.

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T h e balances o f military and e c o n o m i c power and o f political influence shifted (and will be explored in greater detail in a later chapter) diabetes in dogs natural diet cheapest generic glipizide uk. T h e West continued to have significant impacts on other societies diabetes in dogs diarrhea buy online glipizide, but increasingly the relations between the West and other civilizations were dominated by the reactions o f the West to developments in those civilizations. Far from being simply the objects o f Western-made history, non-Western societies were increas ingly b e c o m i n g the movers and shapers o f their own history and o f Western history. S e c o n d, as a result o f these developments, the international system expanded beyond the West and b e c a m e multicivilizational. Simultaneously, conflict among Western states - which had dominated that system for centuries - faded away. By the late twentieth century, the West has moved out o f its "warring state" phase o f development as a civilization and toward its "universal state" phase. At the end o f the century, this phase is still i n c o m p l e t e as the nation states o f the West c o h e r e into two semiuniversal states in E u r o p e and North America. T h e s e two entities and their constituent units are, however, b o u n d together by an extraordinarily c o m p l e x network o f formal and informal institu tional ties. S i n c e democracy, however, is the political form o f Western civilization, the emerging universal state o f Western civilization is not an empire but rather a c o m p o u n d of federations, confederations, and international regimes and organizations. T h e great political ideologies o f the twentieth century include liberalism, socialism, anarchism, corporatism, Marxism, c o m m u n i s m, social democracy, conservatism, nationalism, fascism, and Christian democracy. T h e y all share one thing in c o m m o n: they are products o f Western civilization. N o other 54 the Clash of Civilizations and the Remaking of World Order civilization has generated a significant political ideology. T h e great religions o f the world are all products o f non-Western civilizations and, in most cases, antedate Western civilization. As the world moves out o f its Western phase, the ideologies which typified late Western civilization d e c l i n e, and their place is taken by religions and other culturally based forms o f identity and c o m m i t m e n t. T h e Westphalian separation o f religion and international politics, an idiosyncratic product o f Western civilization, is c o m i n g to an end, and religion, as Edward M o r t i m e r suggests, is "increasingly likely to intrude into international affairs. G l o b a l political geography thus moved from the o n e world o f 1 9 2 0 to the three worlds o f the 1960s to the m o r e than half-dozen worlds o f the 1990s. C o n c o m i t a n t l y, the Western global empires o f 1 9 2 0 shrank to the m u c h more limited "Free World" o f the 1960s (which included many non-Western states opposed to c o m m u n i s m) and then to the still more restricted "West" o f the 1990s. T h i s shift was reflected semantically between 1 9 8 8 and 1993 in the d e c l i n e in the use o f the ideological term "Free World" and the increase in use of the civilizational term "the West" (see T a b l e 2. It is also seen in increased references to Islam as a cultural-political p h e n o m e n o n, "Greater C h i n a, " Rus sia and its "near abroad," and the E u r o p e a n Union, all terms with a civiliza tional content. Intercivilizational relations in this third phase are far more frequent and intense than they were in the first phase and far more equal and reciprocal than they were in the second phase. Also, unlike the C o l d War, no single cleavage dominates, and multiple cleavages exist between the West and other civilizations and a m o n g the many non-Wests. During the nineteenth and twentieth centuries the E u r o p e a n international system expanded to encompass virtually all societies in other civilizations. S o m e European institutions and practices were also exported to these countries. Yet these societies still lack the c o m m o n culture that underlay E u r o p e a n international society. In terms o f British inter national relations theory, the world is thus a well-developed international sys tem but at best only a very primitive international society. Reference numbers are numbers of stories about or containing the terms "free world" or "the West. T h i s has b e e n perhaps even m o r e true of the West than o f other cultures. S u c h monocivilizational viewpoints, how ever, have decreasing relevance and usefulness in a multicivilizational world. In 1 9 1 8 Spengler denounced the myopic view o f history prevailing in the West with its neat division into ancient, medieval, and modern phases relevant only to the West. It is necessary, h e said, to replace this " P t o l e m a i c approach to history" with a Copernican o n e and to substitute for the "empty figment o f o n e linear the drama o f a number o f mighty c u l t u r e s.

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What we are talking about here is resting injured joints over long periods of time Figure 14-1: Anterior view of the shoulder joint what causes diabetes type 2 yahoo buy glipizide 10mg fast delivery. A without any other regenerative vast majority of athletic injuries involve the muscles diabetes symptoms 4 days purchase generic glipizide from india, treatment being done. The longer an athlete restricts movement after an injury, the longer it will take to heal. In our office, it may be used early in the treatment course for more severe cases of instability. Immobilization is generally discouraged for most cases because it can cause the following changes: · proliferation of fatty connective tissue within the joint · cartilage damage and necrosis · scar tissue formation and articular cartilage tears · increased randomness of the collagen fibers within the ligaments and connective tissues · ligament weakening with a decreased resistance to stretch. Ice decreases circulation to the area of injury, thereby allowing fewer immune cells to clean up the injured site and lay down new collagen tissue needed to repair ligaments, tendons, and muscles. It has been shown that as little as five minutes of icing a knee can decrease both blood flow to the soft tissues and skeletal metabolism. Regular use of ice increases the chance of incomplete healing by decreasing blood flow to the injured ligaments and tendons. By retarding the healing process, anti-inflammatory medications make re-injury much more likely in the future. Anti-inflammatory medications mask the pain and do nothing to Figure 14-3: Nature does not use R. Corticosteroids inactivate vitamin D, limiting calcium absorption by the gastrointestinal tract and increasing urinary excretion of calcium. Bone also shows a decrease in calcium uptake, ultimately leading to weakness at the fibro-osseous junction. Corticosteroids also inhibit the release of Growth Hormone which further decreases soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease in bone, ligament, and tendon strength. The net catabolic effect (weakening) of corticosteroids is inhibition of fibroblast production of collagen, ground substance, and angiogenesis (new blood vessel formation). Cortisone, even one shot, may cause irreversible damage to the joint and cartilage. A patient who came to our Florida office was a former basketball player who had been drafted to an international team. By the time he was in his late 20s, the pain was so bad that he was referred for surgery. Had the patient originally received medical care from a Prolotherapist who prioritized the long-term strength of the joint, he could have avoided surgery and saved his career. Instead, so many players are subjected to treatments that help them play the game today, but leave them with irreparable damage that can prematurely end their careers. As discussed in greater detail in Chapter 2, cortisone permanently weakens tissue, including cartilage. Taking a scalpel and slicing open muscles and fascia, and removing disc, cartilage, and ligament tissue weakens the injured joints. How many big-time athletes do you see come back and compete at the same level after the surgeon has touched them? Any athlete who consents to exploratory surgery without receiving an evaluation for Prolotherapy is playing Russian roulette with his/her career. Arthroscopy, and the cutting, burning, or shaving that goes with it, leaves the athlete in a weakened state. Prolotherapy, if fully utilized, would stop about 80% of the orthopedic surgeries in this country for chronic pain. By strengthening the tendons, ligaments, and other supporting structures of the joints, Prolotherapy strengthens the injured areas. Figure 14-4: Many roads lead to pain management, but only one road leads to pain cure.

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Turks c o m i n g back from West G e r m a n y "reacted to hostility there by falling b a c k on what was familiar diabetes definition and types order glipizide american express. In the 1980s and 1990s the supposedly secular Turkish government maintained an Office o f Religious Affairs with a budget larger than those o f some ministries diabetes mellitus acidosis buy glipizide with visa, the construction o f mosques, required financed religious instruction in all public schools, and provided funding to Islamic schools, which quintupled in n u m b e r during the 1980s, enrolling about 15 percent o f secondary school children, and which preached Islamist doctrines and produced thousands o f graduates, many of whom entered government service. In symbolic but dramatic contrast to France, the government in practice allowed schoolgirls to wear the traditional Muslim headscarf, seventy years after Ataturk b a n n e d the f e z. S e c o n d, the resurgence o f Islam c h a n g e d the character o f Turkish politics. Political leaders, most notably Turgut Фzal, quite explicitly identified them selves with M u s l i m symbols and policies. In Turkey, as elsewhere, democracy reinforced indigenization and the return to religion. W h i l e elite and bureaucratic groups, particularly the military, were secularly oriented, Islamist sentiments manifested themselves within the armed forces, and several hundred cadets were purged from military academies in 1987 because o f suspected Islamist sentiments. T h e major political parties increas ingly felt the need to seek electoral support from revived M u s l i m tarikas, select societies, which Ataturk had b a n n e d. In the D e c e m b e r 1995 elections the Welfare Party won m o r e votes and seats in parliament than any other party and six months later took over the government in coalition with one o f the secular parties. T h i s c o n s e q u e n c e did not, however, materialize, and N A T O hesi tation over what response it would make if Turkey had b e e n attacked by Iraq during that war did not reassure the Turks as to how N A T O would respond to a non-Russian threat to their country. M o r e significantly, during the 1980s Turkey expanded its relations with Arab and other M u s l i m countries and in the 1990s actively promoted Islamic interests by providing significant support to the Bosnian Muslims as well as to Azerbaijan. W i t h respect to the Balkans, Central Asia, or the Middle East, Turkish foreign policy was b e c o m i n g increasingly Islamicized. For many years Turkey m e t two o f the three m i n i m u m requirements for a torn country to shift its civilizational identity. T h e elites o f the recipient, the Cultural Reconfiguration of Global Politics Western civilization, however, were not receptive. W h i l e the issue h u n g in the balance, the resurgence o f Islam within Turkey activated anti-Western senti ments among the public and began to u n d e r m i n e the secularist, pro-Western orientation o f Turkish elites. Reflecting these conflicting pulls, Turkish leaders regularly described their country as a "bridge" between cultures. Turkey, P r i m e Minister Tansu C i l l e r argued in 1 9 9 3, is both a "Western democracy" and "part o f the M i d d l e East" and "bridges two civilizations, physically and philosophically. E v e n in the twentieth century, as Octavio Paz put it, "the core o f M e x i c o is Indian. In the second and third decades o f the twenti eth century, M e x i c o, like Turkey, went through a revolution which established a new basis o f national identity and a new one-party political system. In Turkey, however, the revolution involved both a rejection o f traditional Islamic and Ottoman culture and an effort to import Western culture and to join the West. In M e x i c o, as in Russia, the revolution involved incorporation and adaptation of elements o f Western culture, which generated a new nationalism opposed to the capitalism and democracy o f the West. T h u s for sixty years Turkey tried to define itself as European, while M e x i c o tried to define itself in opposition to the United States. President M i g u e l de la Madrid began and his successor President Carlos Salinas de Gortari carried forward a full-scale re definition o f M e x i c a n purposes, practices, and identity, the most sweeping effort at change since the Revolution o f 1 9 1 0. Ataturk promoted secularism and nationalism, dom inant themes in the West o f his time; Salinas promoted e c o n o m i c liberalism, one o f two dominant themes in the West o f his time (the other, political democracy, he did not e m b r a c e). As with Ataturk, these views were broadly J 50 the Clash of Civilizations and the Remaking of World Order shared by political and e c o n o m i c elites, many o f whom, like Salinas and de la Madrid, had b e e n educated in the United States. Salinas dramatically reduced inflation, privatized large numbers o f public enterprises, promoted foreign investment, reduced tariffs and subsidies, restructured the foreign debt, chal lenged the power o f labor unions, increased productivity, and brought M e x i c o into the North A m e r i c a n F r e e Trade Agreement with the United States and C a n a d a. T h i r d World nationalist and protectionist path that their predecessors had followed for most o f the century. Alternatively, as s o m e M e x i c a n s urged, they could have attempted to develop with Spain, Portugal, and South A m e r i c a n countries an Iberian association o f nations. T h e overwhelming bulk o f the political, e c o n o m i c, and intellectual elites favor that course. T h e crucial intercivilizational issue o f immigration high lights this difference. T h e fear o f massive Turkish immigration generated resistance from both E u r o p e a n elites and publics to bringing Turkey into E u r o p.

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T h e y sought the secret o f this success in Western values and institutions blood sugar quick fix glipizide 10 mg generic, and when they identified what they thought might be the key they attempted to apply it in their own societies managing diabetes holistically 10mg glipizide overnight delivery. East Asians attribute their dramatic e c o n o m i c development not to their import o f Western culture but rather to their a d h e r e n c e to their own culture. Similarly, when non-Western societies felt weak in relation to the West, they invoked Western values o f selfdetermination, liberalism, democracy, and i n d e p e n d e n c e to justify their oppo sition to Western domination. Now that they are no longer weak but increasingly powerful, they do not hesitate to attack those same values which they previously used to promote their interests. T h e revolt against the West was originally legitimated by asserting the universality o f Western values; it is now legitimated by asserting the superiority o f non-Western values. T h e rise o f these attitudes is a manifestation o f what Ronald D o r e has termed the "second-generation indigenization p h e n o m e n o n. Partly because they first go abroad as impressionable teenagers, their absorption o f Western values and life-styles may well be profound. T h e s e universities "provide a m u c h m o r e diluted c o n t a c t with metropolitan world culture" and "knowledge is indigenized by means o f transla tions - usually o f limited range and o f poor quality. T h e y have to find the means o f success within their own society, and h e n c e they have to a c c o m m o d a t e to the values and culture o f that society. T h r e e notable cases are M o h a m m a d Ali J i n n a h, Harry L e e, and S o l o m o n Bandaranaike. L e e was, in the words of one British cabinet minister, "the best bloody E n g l i s h m a n east o f Suez. T h e y reverted to their ancestral cultures, and in the process at times changed identities, names, dress, and beliefs. T h e 94 the Clash of Civilizations and the Remaking of World Order English lawyer M. T h e secularist J i n n a h b e c a m e the fervent apostle o f Islam as the basis for the Pakistani state. T h e Anglofied L e e learned Mandarin and b e c a m e an articulate promoter o f Confucianism. T h e Christian Bandaranaike converted to B u d d h i s m and appealed to Sinhalese nationalism. Indigenization has b e e n the order o f the day throughout the non-Western world in the 1980s and 1990s. T h e resurgence o f Islam and "re-Islamization" are the central the m e s in M u s l i m societies. In India the prevailing trend is the rejection o f Western forms and values and the "Hinduization" o f politics and society. In East Asia, governments are promoting Confucianism, and political and intellectual leaders speak o f the "Asianization" o f their countries. In the mid-1980s Japan b e c a m e obsessed with "Nihonjinron or the theory o f Japan and the Japanese. For a decade, however, the trend was from the former to the latter, as the Westernized G o r b a c h e v gave way to Yeltsin, Russian in style, Western in articulated beliefs, who, in turn, was threatened by nationalists epitomizing Russian Orthodox indigenization. Indigenization is furthered by the d e m o c r a c y paradox: adoption by nonWestern societies o f Western democratic institutions encourages and gives ac cess to power to nativist and anti-Western political movements. In the 1960s and 1970s Westernized and pro-Western governments in developing countries were threatened by coups and revolutions; in the 1980s and 1990s they are increasingly in danger o f being ousted by elections. Democratization conflicts with Westernization, and d e m o c r a c y is inherently a parochializing not a cosmopolitanizing process. Politicians in non-Western societies do not win elections by demonstrating how Western they are. Electoral competition instead stimu lates the m to fashion what they believe will b e the most popular appeals, and those are usually ethnic, nationalist, and religious in character. T h e result is popular mobilization against Western-educated and Westernoriented elites. Islamic fundamentalist groups have done well in the few elec tions that have occurred in M u s l i m countries and would have c o m e to national power in Algeria i f the military had not c a n c e l e d the 1992 election.

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