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Her primary academic research interests are focused on the cultural ethno-history of the Canadian Arctic. Emily moved to the Eastern Arctic in the 1980s, where she became integrated into community life. Returning for community-based research projects from 2003-2011, her previous community relationships enabled the completion of a landmark study examining the human geography and cultural impact of tuberculosis from 1930-1972. From 2008-2015, her work in cultural resource management took her to the Canadian High Arctic archipelago to create a museum dedicated to the Defense Research Science Era at Parks Canada, Quttinirpaaq National Park on Ellesmere Island. When she is not jumping into Twin Otter aircraft for remote field camps, she is exploring cultural aspects of environmental health and religious pilgrimage throughout Mexico. Primitive Culture: Researches into the Development of Mythology, Philosophy, Religion, Language, Art, and Customs. Tylor, Primitive Culture: Researches into the Development of Mythology, Philosophy, Religion, Language, Art, and Customs (London: Cambridge University Press, 1871), preface. Lewis Henry Morgan was one anthropologist who proposed an evolutionary framework based on these terms in his book Ancient Society (New York: Henry Holt, 1877). For more on this topic see Adam Kuper, Anthropology and Anthropologists: the Modern British School (New York: Routledge, 1983) and Alfred Radcliffe-Brown, Structure and Function in Primitive Society (London: Cohen and West, 1952). His private diary and letters record the evolution of his thinking about what it means to be "civilized. We have no right to blame them for their forms and superstitions which may seem ridiculous to us. Clifford Geertz, the Interpretation of Culture (New York: Basic Books, Geertz 1973), 89. For more information about the controversy, see Thomas Gregor and Daniel Gross, "Guilt by Association: the Culture of Accusation and the American Anthropological Associations Investigation of Darkness in El Dorado. Napoleon Chagnon has written his rebuttal in Noble Savages: My Life Among Two Dangerous Tribes-The Yanomamo and the Anthropologists (New York: Simon and Schuster, 2013). Explain how traditional approaches to ethnographic fieldwork contrast with contemporary approaches. Identify some of the contemporary ethnographic fieldwork techniques and perspectives. Summarize how anthropologists transform their fieldwork data into a story that communicates meaning. I had planned to conduct an independent research project on land tenure among members of the indigenous tribe and had gotten permission to spend several months with the community. My Brazilian host family arranged for a relative to drive me to the rural community on the back of his motorcycle. After several hours navigating a series of bumpy roads in blazing equatorial heat, I was relieved to arrive at the edge of the reservation. Upon hearing us arrive, first children and then adults slowly and shyly began to approach us. As a group of children ran to fetch the cacique (the chief/political leader), I began to explain my research agenda to several of the men who had gathered. I mentioned that I was interested in learning about how the tribe Children Playing Outside a Home on the Jenipapo-Kanindй Reservation, 2001 negotiated land use rights without any private land ownership. I took a step back, surprised by the intensity of my first interaction in the community. The debate subsided once the cacique arrived, but it left a strong impression in my mind. Eventually, I discarded my original research plan to focus instead on this disagreement within the community about who they were and were not. I soon learned that many among the Jenipapo-Kanindй did not embrace the Indian identity label. The tribe members were all monolingual Portuguese-speakers who long ago had lost their original language and many of their traditions.
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If the Office determines that the service cannot be provided, it will notify the requesting party in writing or by telephone and will explain the reasons for its decision. If the Office declines to provide a requested service because the requesting party is not authorized to view, inspect, or obtain copies of the requested record, the party may submit an appeal to the Office of the General Counsel of the U. For information concerning this procedure, the requesting party should contact the Office of the General Counsel. Since this is a publication sponsored and paid for by the State, the emphasis is on State government. However, the lists of county officers and those of Baltimore City, and the other local material are compiled with great care and ought to prove equally useful. Sketches of individual governmental agencies contain, at the very least, the legal justification of the agency, the date of its origin, its major function, the names of its responsible administrators, the members of its governing board or commission if any, the size of its staff, and its appropriation for fiscal years 1959 and 1960. This volume required more changes than usual because the last General Assembly radically redistributed many governmental functions, a new Annotated Code required alteration of almost every reference, and the completion of two new State Office Buildings caused the relocation of a large number of agencies. A book of this kind could never be compiled without the cooperation of a great many agencies and individuals. Everstine for the text of the Constitution, the Index and the Amendments thereto, as well as for the essay on the General Assembly of 1959. Lee helped with the Executive appointments, especially the difficult temporary commissions and committees. For the painstaking task of compiling the roster of Baltimore City officers we are grateful to James Benson. We are grateful to all the county officers, especially the clerks to the Boards of County Commissioners who gave us material available nowhere else but in the counties. Finally, the compiler wishes to acknowledge the help of the other members of the Hall of Records Staff who contributed time, energy and thought to this exacting task: Lois Green Clark, whose special assignment it is, Frank F. Millard Tawes, the fifty-ninth elected Governor of Maryland, was born April 8, 1894, in Crisfield, Somerset County, Maryland, a son of James B. He holds honorary doctor of laws degrees from Washington College and the University of Maryland. He began his career in business with lumbering and canning firms founded and owned by his father. He was secretary and treasurer of the Crisfield Shipbuilding Company, was vice-president and treasurer of the Tawes Baking Company, was associated in the management of the Tawes-Gibson Lumber Company and the Tawes-Gibson Packing Company, and is a director of the Bank of Crisfield. The Governor is a Methodist and has been active in church work from his early youth. He was a delegate to the 1952 General Conference of the Methodist Church held in San Francisco and formerly was treasurer of the Wilmington Conference Education Society, Incorporated. His active career in politics spreads over three decades, beginning in 1930 when he was elected Clerk of the Circuit Court for Somerset County. After two terms in this office (1930-38), he was elected Comptroller of the Treasury in his first State-wide election campaign in 1938. In 1942 he ran again without opposition in the primary and won a second four-year term in the general election. These eight years were the first part of an interrupted career of seventeen years in the office of State Comptroller. During that period, due to the growth in population and the broad expansion of State activities, the office personnel increased from one hundred to five hundred employees. In May 1947, Governor Lane appointed him State Bank Commissioner, a position he held until he was appointed State Comptroller on July 5, 1950 to fill the unexpired term of the late James J Lacy He was re-elected Comptroller, without primary or Republican opposition, in 1950 and again in 1954. He was elected Governor of Maryland in 1958 by the greatest majority ever given a candidate for that office. The Governor holds membership in the following clubs and fraternal organizations: Crisfield Rotary Club (charter member). Elks, Knights of Pythias, Advertising Club of Baltimore, Hibernian Society of Baltimore, Maryland Society of Pennsylvania, Crisfield Fire Department (past president), Chesapeake Bay Fishing Fair Association (past president), Masons, Shrine, Order of the Eastern Star, Eastern Shore Shrine Club, Tall Cedars of Lebanon, Scimeter Club, and the Eastern Shore Society of Baltimore. He is a former member of the Board of Visitors and Governors of Washington College, and is a member of the Board of Trustees of Wesley Junior College, Dover, Delaware, the Board of Directors of the McCready Memorial Hospital in Crisfield, and the Board of Trustees of Dickinson College, Carlisle, Pennsylvania. He is past president of the National Association of State Auditors, Comptrollers, and Treasurers.
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Wilson Rush, Karol Rusk, Harry W Russell, Carl P Russell, Don J Russell, Harry S Russell, May Russell, Nina Russum, George Mitchell Ruth, Elbert B Rutherford, Mrs. Allen Rutherford, Allan D Rutherford, John 0 Rutledge, Irvine H Ryan, Edward J Ryan, Hubert F Ryan, James E Rybcznski, Edward B Rymland, Murray J Ryon, Louis Rysanek, Mrs. J 306 Sanders, William 307 Sandison, Fort 333 Sandrock, Virginia T 217 Sands, Douglas 80 Sandy, Charles E 103 Sanford, Mrs. Richard H 346 Saunders, Richard L 319 Savage, Leslie E 188, 208, 369 Saylor, Charles W 315 Scarborough, Irving 343 Schaefer, Louis 586 Schaefer, William D 351 Schafer, Elwood E 95 Schaffer, John A 68 Scharf, Mrs. John G 332 Scheeler, George F 330 Scheibel, John A 115 335 Scheiber, Walter I57 Schell, Carl A 324 Scherr, Stanley 120 Schiadaressi, Angelo 81 Schield, Joseph L 309 Schifter, Richard A 51 Schilling, Hans C 370 Schillinger, John 132 Schilpp, John G 56 Schirm, Charles 601 Schley, Winfield Scott 28 Schlosser, Donald 308 Schlosser, Henry W 103 Schmick, John T 408 Schmidt, Oscar, Jr 338 Schmidt, William S 335 Schmitz, F. Albert 370 671 Page Schoenhaar, William H 48 Schreiber, Robert F 313 Schroeder, Mrs. Lyman 350 Schuerholz, Leroy V 153, 353 Schuerholz, Louis R 40 Schukraft, Richard C 345 Schuster, Murray L 123, 124, 154 Schwagel, Rome F 616 Schwartz, Grace E 69 Schwarz, Harry W 310 Schweinhaut, Margaret C. Robert 614 Scott, Charles M 155, 327 Scott, George 576 Scott, Gustavus 576, 592 Scott, Otho 580 Scott, William H 348 Scott, Winfield 26 Scrivner, DeLancey B. Andrew 316 Sewall, Charles S 599 Sewall, Nicholas 572 Seward, Paul H 104, 326 Sewell, Chester L 103 Sewell, Claude F 342 Sewell, Nicholas L 590 Sewell, Pinkney 408 Sewell, Webster 71 Seymour, Charles A. Vannort, Jr 329 Simpkins, Lloyd L 35, 149, 367 Simpkins, Roger W 131 Simpkins, Thomas S 157 Simpkins, William T 340 Simpson, Robert S 318 Simpson, Vivian V 581 48 Singer, Sidney Singewald, Joseph T. T 342 Slaughter, Harry D 343 Slaughter, Regina 71 Slavin, Frances H 319 44 Slicher, James P Slider, Ernest R 305 Sloan, D. Lindley 152, 587, 588 Sloan, Melvin 305 4 Sloan, Melvin S 07 Slonaker, Freda 407 Slowik, John A 311 Small, Frank, Jr 603 Small, Solomon J 411 Smallwood, William 24, 576, 583 Smelser, Charles H 181, 188, 209, 369 Smith, Barnard 1 339 Smith, Benjamin W 339 Smith, Blair H Ill, 336 Smith, Carroll C 369 Smith, David 576 Smith, Dudley 132, 158 Smith, Eleanor J 144 Smith, Eleanor L 312 Smith, Elizabeth G 73 Smith, Evelyn M 305 Page 579 Shaaf, Arthur Shackelford, William T. S 614 Shank, Earl 318 Shank, Henry 23 Sharpe, Horatio, 574 Sharpless, Leslie B 323 Shaughnessy, LeRoy C 349 Shaw, Frank T 600, 601 Shaw, Harry B 55, 158 Shaw, James 579, 590 Shaw, James W 613 56 Shaw, John Shawn, Gordon L 337 15 Shealy, Walter H 109 Sheble, Earl, Jr 3 Sheckells, J. Widerman 308 Shepherd, Peter 575 Shepperd, Douglass 67 Sheredine, Upton 576, 595 Sheridan, Charles N 342 Sheridan, John J 311 Sheridan, Richard B. Miller 158 Sherwood, John R 352 Sherwood, Marion B 616 Shields, George B 101 Shields, John E 370 Shifflet, Kenneth E 323 Shillinger, Jacob E 370 Shipley, A. Clyde 406 Shoemaker, Henry R 323 Shook, Frank C 322 Short, Reese 404 Shower, Jacobs 600 Shreve, Arthur L 352 Shriner, George D 139 Shriver, David 576 Shriver, John S 47 Shriver, Woodrow A 410 Shrop, T. R 319, 328 Shryock, Henry 591 Shryock, Thomas J 582 Shuger, Albert A 122 Shuger, J. T 345 Smith, Lathrop E 334 Smith, Leon P 57 Smith, Lewis C 585 Smith, Marion deKalb 582 Smith, Mary H 406 Smith, Marvin H 408 Smith, Michael Paul 387, 397 Smith, Odell M 35 Smith, Paul M 614 Smith, Philip F 319 Smith, R. Paul 129 Smith, Robert 603 Smith, Ross V 322 Smith, Russell L 614 Smith, Russell P 157 Smith, Russell P. Dale 326 Snook, Harry C 344 Snouffer, Elroy J 310 Snyder, Forrest B 331 Snyder, G. Merlin 343 Snyder, George E 160, 186, 194, 367 Snyder, Henry 584 Snyder, Hubert 1 310 Snyder, Hubert L 158 Sobeloff, Simon E 588 Sodaro, Anselm 219, 349, 366, 382 Sellers, Augustus R 599, 600 Somerset, Mary 609 Sondberg, Chris 336 Sondheim, Walter 353 Sondheim, Walter, Jr 89 673 Page Soper, Hiram J 615 Sothoron, L. Harold 396, 405, 584 Sothoron, Richard H 335 Soypher, Maurice J 351 Sparks, David 160 Sparks, E. Clyde 405 Spaulding, Daniel W 368 Speelman, Lawrence E 331 Speicher, Charles M 41 Speidel, Richard Henry 380 Spence, Ara 586 Spence, John S 593, 593n, 599 Spence, Thomas A 600 Spencer, Annie jq Spencer, Richard 599 Spencer, William 533 Spencer, William A 589 Spicci, Morris Y Ill, 336 Spicer, Arthur K 102 Spoerlein, Frederick 324 Spoerlein, Randall 316, 613 Sponseller, Donald C 315 Sprague, Matilda R 404 Sprague, Thomas B 352 Sprecher, O. Daniel, Jr 344 Sprigg, Michael C 599 Sprigg, Osborn 576 Sprigg, Osborne 591 Sprigg, Richard 586 Sprigg, Richard, Jr 595, 598, 598n Sprigg, Samuel 576 Sprigg, Thomas 591, 595 Squires, Henry 403 Stack, Charles 308 Stack, Leon 333 Stack, Leon H 406 Stafford, Clifford L 404 Stafford, Edward S 68 Staley, Donald K 333 Staley, Donald M 345 Stamp, Adele H 57 Stankowski, Stanislaus 403 Stanley, Charles H 532 Stansbury, B. K Stevens, John Stevens, John H Stevens, Robert A Stevens, Samuel, Jr Stevens, William Stevenson, Adlai E Stevenson, Hugh. Charles Stewart, Arthur B Stewart, David Stewart, James A Stewart, James Augustus Stewart, John Stewart, Niven E Stewart, William A Stichel, Henry W. F 153 Strong, Woodrow F 153 Stuart, Philip 598, 599 Stuart, William R 583 Stubbs, J. Norman 613 Stull, Johanna M 324 Stull, John 576, 591 Stump, Herman 601 Stump, Herman, Jr 584 Sturtevant, Alderic 370 Styles, Albert W 308 Sulivane, Daniel 590 Sullivan, Abbie M 38 Sullivan, Francis J 69 Sullivan, John L 318 Sullivan, Lawrence A. Ferdinand 328 Sydnor, Giles 310 Syester, Andrew K 589 Sylvester, Emmett 337 Symington, Fife 363 Symons, T. B 5jt 109 T Tabler, Dan Taggart, Charles A Tailler, Thomas Talbot, George Talbot, Grace Talbott, J. Millard, 4, 35, 37, 134, 149, 151, 152, 360, 377, 577, 582 Tawney, Lewis S 147 Tayback, Matthew L 80 Taylor, Hugh E. Herbert 38 Taylor, Zachary 26 Tayman, Samuel 334 Templeton, Furman L 80 Tench, Thomas 573 Terrell, William 326 Testerman, Henry K 409 Teves, John F 140 Tevis, Stanley H.
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Fish, Georgia Rae Fish, Georgia Rae Fish, Marjorie May "rhodes" Fish, Terri Lynn Fish, Terry L. Fisher, Kenneth Jacob Fisher, Leo Andrew Fisher, Leo Andrew Fisher, Margaret "peggy" L. Fisher, Regina Lou Fisher, Robert Fisher, Robert Lester "bob" Fisher, Ronda Jean Fisher, William "wild Bill" Fisk, David Paul Fisk, Jim Fisk, Kevin Christopher lexicon. Fitch, John Michael Fitch, Leonard William Fitch, Roger Christian Fite, Helen Willey Fitka, Arthur Raymond Fitka, Arthur Raymond Fitka, Kevin Fitts, Joshua Fitts, Joshua Lamar Fitts, Joshua Lamar Fitzgerald, Aileen Marie Palmer Fitzgerald, Alexander Kennedy Fitzgerald, Barry W. Fitzgerald, Bruce Edward Fitzgerald, Bruce Edward Fitzgerald, Dolores Fitzgerald, Dolores Mary Fitzgerald, Dorothy J. Fitzgerald, Edward Francis Fitzgerald, James Norman Fitzgerald, James Norman Fitzgerald, John "jack" W. Fitzgerald, Mary Anne Fitzgerald, Mary Anne Fitzgerald, Mary Anne Fitzgerald, Sarah Ann Fitzhugh, John Evan Fitzjarrald, L. Fitzpatrick, Blythe Irene Fitzpatrick, Charles Fitzpatrick, Jack Russell Fitzpatrick, Mike Fitzpatrick, Mike "pat" Fitzsimonds, Jerry Fitzsimonds, Jerry Fitzsimons, Jr. Flanigan, Bryan William Flanigan, Cynthia Kay Flanigan, Floyd William Flanigan, John Clayton Flanigan, John Howard Flannigan, Bryan William Flara, Felix V. Flaskaf, Ipsipill Flattery-roessner, Alice Flattery-roessner, Alice Flaugh, Harold Flavel, Andrew Ross Flavel, Andrew Ross Flavin, Kenin Joseph Fleckenstein, Dan S. Fleek, Dale Alfred Fleek, Donald Fleek, Donald Fleek, Sandy Fleet, Alfred Fleetwood, Louise Fleischer, Christine E. Fleming, Kyeisha Charife Fleming, Mark Roy Fleming, Mary Fleming, Mary Imelda Fleming, Robert Henry Fleming, Roy Leroy Fleming, Sr. Flemming, Roy Fletcher, Charles Dennis Fletcher, Dean Fletcher, Edwin Fletcher, Edwin E. Flood, Christopher Flood, Christopher John Flood, Christopher John Flood, Helen K. Flores, Joe Flores, Larenzo Flores, Omega Floresta, Esperidon Floresta, Esperidon Roberts Floresta, Esperidon Roberts Flothe, Milo Ellsworth Flotre, Bert Allen Floura, Warren E. Flowers, Leonard "len" Donald Floyd, Alice Floyd, Alice Floyd, Bennett Eugene Floyd, Chad Anthony Floyd, Kathleen M. Floyd, Taylor Paige Floyd, Taylor Paige Flygare, Clark Leroy Flygare, Narlene Jean Grant Flynn, Billye Ruth Flynn, Donald E. Flynn, Helen Pauline Flynn, Hilda Lee (miner) Flynn, Maria Agatha Flynn, Mary Bonnie Flynn, Mary Bonnie Flynn, Rosemarie C. Foley, Ida Foley, Jacob Foley, Jacob Harrison Foley, John Michael Foley, Michael Lloyd Foley, Sr. Ford, Clifton Ford, David Ford, Echols Garland Ford, Herbert Ford, Irene Ford, Jane L. Ford, Verna "pinkie" Ford, Verna "pinkie" Fordham, Lawrence Rocko Foreman, Annie Smith Foreman, Dustin T. Forest, Dorothy Margaret Forest, Dorothy Margaret Forester, Edmund Beall "tiny" Forlenza, Gerard Forlenza, Gerard Formento, Matthew Forrest, Janet Ann Forrest, Sr. Forslund, Clara Forslund, Clara Forster, Terry John Forsting, John Anthony Forstrom, Ethel I. Forte, Teresa Ann "terry" Fortes, Pablo Fortier, Jeanne Marie Fortier, Margaret Theodora Fortier, Margaret Theodora Fortner, Robert D. Foster, Cory Allen Foster, Deborah Ann Foster, Dixie Lee Foster, Dyane Jeni Foster, Elmer "john " M. Fountaine, Adelyn Fountaine, Adelyn "lynn" Anderson Fountaine, John Craig Fournelle, Harold J. Fowler, Kenneth Albert Fowler, Kenneth Albert Fowler, Kenneth Albert Fowler, Larry Fowler, Larry C. Fowler, Ralph Fowler, Richard Everett Fowler, Victoria Fowler, Wilma Marie Fox, Benjamin "ben" Ray Fox, Devin Fox, Ethel Margaret Westdahl Fox, Irene C.
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Gradual onsets may occur with mass lesions, such as tumors, in the same locations; more commonly, however, gradual onsets are seen in certain neurodegenerative Differential diagnosis Sensory aphasia, given the overall difficulty with comprehension, may make it very difficult to test for ideomotor, ideational, or constructional apraxia. Visual agnosia may complicate testing for ideational apraxia, in that patients may simply not recognize the tool that you are asking them to use. Consequently, if patients do display apparent ideational apraxia, it is necessary to ask them to name the offered tool and if they have difficulty with that one should go on to ask them to describe what the tool is used for in order to rule out mere anomia. Anomic patients may not be able to say the name of the tool, but can describe its use; agnosic patients, by contrast, will neither be able to name it nor describe its use. In neglect, however, the deficient drawing is present only on the left side of the figure, whereas the right side of the figure is drawn more or less normally; in contrast, in constructional apraxia both the left and right halves of the figure are poorly drawn. Left neglect may also simulate dressing apraxia, as patients may leave the left side of their dressing unattended to, with the left shirt sleeve dangling or the left shoe untied. Here, however, as with the differential with constructional apraxia, the clue to the diagnosis of neglect is the presence of adequate dressing on the right side of the body. Treatment Speech and occupational therapy should be considered in addition to treatment, if possible, of the underlying cause. There are a number of different kinds of agnosia and these may be grouped as described below. Thus, in visual agnosia, there is a failure to recognize an object by sight, in tactile agnosia, by touch, and in auditory agnosia by the sound made by the object. Other agnosias are characterized by a specific kind of feature that cannot be recognized: in prosopognosia there is difficulty in recognizing faces, in topographagnosia landmarks go unrecognized and patients get lost, and in color agnosia patients cannot recognize various colors. Two other agnosias are marked by an inability to recognize certain facts: in anosognosia, patients fail to recognize certain signs and symptoms, as for example hemiparesis; in asomatognosia patients fail to recognize that a body part, for example a hemiparetic arm, belongs to them. Finally, there is a form of agnosia, namely simultanagnosia, wherein patients fail to simultaneously recognize all the objects in their view, as if one or more of them had actually disappeared. Interestingly, however, if they are given the object and allowed to handle it, they are able to recognize it by touch. Visual agnosia may be broken down into two subtypes: apperceptive and associative. In apperceptive visual agnosia patients can neither make a drawing of the object nor can they pick it out of a group of objects. At a phenomenological level, it seems that when apperceptive subtype patients are shown an object they do not experience an image of it and, lacking such an image, have no subsequent recognition and, of course, no ability to make a drawing. Despite the presence of an image, however, there is an inability to make a connection between that image and the concept of that object, and thus a failure to recognize it, name it, or say what it is used for. Of note, visual agnosia is typically more severe for small objects, such as a pair of scissors, than it is for large objects, such as chairs or desks, which patients are generally able to recognize and name. Furthermore, the presence of a larger object may, by providing a context, allow a patient to recognize a smaller object, which, if seen in isolation, he or she would be unable to name. For example, if shown a pair of scissors on a desk-top, the patient might be able to name it, whereas if shown the scissors in isolation, perhaps by placing them on the bed sheet, the patient would be unable to do so. Thus, if shown a pair of scissors, they will be unable to Apperceptive visual agnosia has been noted with bilateral infarction of the occipital lobes, which spare the striate cortex but involve the secondary visual cortices; the adjacent temporal lobes are often also involved but only in their more posterior extent (Benson and Greenburg 1969; Ferreira et al. Associative visual agnosia may occur secondary to bilateral infarction of the medial occipitotemporal cortex and subcortical white matter, especially involving the lingual, fusiform, and parahippocampal gyri (Albert et al. Cases have also been reported secondary to a left unilateral occipitotemporal infarct coupled with infarction of the splenium of the corpus callosum (Feinberg et al. Theoretically, it appears reasonable to say that in the apperceptive subtype the destruction of the secondary p 02. In the associative subtype, sparing of the secondary visual cortices allows for the development of an image, but destruction of the more anterior occipitotemporal cortex renders impossible an association between the image and the concepts that the patient has regarding various objects. The anomic patient, upon handling the pair of scissors, will still remain unable to come up with the name, whereas the agnosic patient will recognize and name the object. Anomic aphasia may also appear similar to tactile agnosia in that anomic patients also are unable to name an object by touching it. In contrast with tactile agnosia, however, patients with anomic aphasia are unable to name the object although they can describe its use. Auditory agnosia Auditory agnosia, or, more explicitly, environmental auditory agnosia, is a very rare condition characterized by an inability to recognize such environmental sounds as the ringing of a telephone or the honking of a horn, despite normal hearing and a normal ability to understand the spoken word (Vignolo 1982). Tactile agnosia Tactile agnosia is characterized by an inability to recognize objects by touching and handling them, despite normal light touch, pin-prick, vibratory and two-point discriminatory sensation, and despite an ability to describe the shape of the object in question (Platz 1996). If the patient has any difficulty in doing so, ask for a description of the object.
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For example, a student who feels alienated by the conservative, "preppy, " students at her East Coast school can cultivate an alternative identity by growing dreadlocks, wearing Bob Marley T-shirts, and practicing djembe drumming, all of which are associated with the African diaspora outside the United States. Critics have argued that a consequence of globalization is the homogenization of culture. Along similar lines, some have worried that the rapid expansion of the leisure market would decrease the diversity of cultural products. The disappearance of small-scale shops and restaurants has certainly been an outcome of the rise of global conglomerates, but the homogenization of culture is not a foregone conclusion. At times these are at the expense of existing options, but it is also important to acknowledge that people make choices and can select the options or opportunities that most resonate with them. The concept of lifestyle thus highlights the degree of decision-making available to individual actors who can pick and choose from global commodities, ideas, and activities. At the same time as individual choices are involved, the decisions made and the assemblages selected are far from random. Participating in a lifestyle implies knowledge about consumption; knowing how to distinguish between goods is a form of symbolic capital that further enhances the standing of the individual. For example, children who have been raised in upper-class homes are able to more seamlessly integrate into elite boarding schools than classmates on scholarships who might find norms of dining, dress, and overall comportment to be unfamiliar. The fact that the students of this prestigious liberal arts college are in the position to critique the ethical implications of specific recipes suggests that their life experiences are far different from the roughly one in seven households (totaling 17. Once a commodity becomes part of these global flows, it is theoretically available to all people regardless of where they live. In actual practice, however, there are additional gatekeeping devices that ensure continued differentiation between social classes. Likewise, although Kobe steaks (which come from the Japanese wagyu cattle) are available in the U. Advantages of the Intensification of Globalization As optimists, we will start with the "glass-half-full" interpretation of globalization. Political Scientist Manfred Steger has argued that "humane forms of globalization" have the potential to help us deal with some of the most pressing issues of our time, like rectifying the staggering inequalities between rich and poor or promoting conservation. In his book on the global garment industry, Kelsey Timmerman highlights the efforts undertaken by activists in the U. Globalization has also facilitated the rise of solidarity movements that would not have been likely in an earlier era. To take a recent example, within hours of the 2015 terrorist attacks in Paris, individuals from different nations and walks of life had changed their Facebook profile pictures to include the image of the French flag. This movement was criticized because of its Eurocentrism; the victims of a bombing in Beirut just the day before received far less international support than did the French victims. Shortcomings aside, it still stands as a testament to how quickly solidarity movements can gain momentum thanks to technological innovations like social media. Micro-loan programs and crowd-source fundraising are yet more ways in which individuals from disparate circumstances are becoming linked in the global era. Kiva, for example, is a microfinance organization that enables anyone with an Internet connection to make a small ($25) donation to an individual or cooperative in various parts of the developing world. The projects for which individuals/ groups are seeking funding are described on the Kiva website and donors choose one or more specific projects to support. Crowd-source fundraising follows a similar principle, though without the requirement that money be paid back to the donors. One small-scale example involves funds gathered in this way for a faculty led applied visual research class in Dangriga, Belize in 2014. As a result, the team was able to over-deliver on what had been promised to the community. The Austin Rodriguez Drum Shop-a cultural resource center, and producer of traditional Garifuna drums-had wanted help updating their educational poster (see Figure 2a and 2b). For both groups the team was able to a) provide digital frames with all the research images (so that the local community partners had something "in hand" and could use as they wanted; b) use higher grade production materials, and c) start work on large-format, coffee-table style documents to be provided to each family and also copies to be donated to the local Gulisi Garifuna Museum.
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Whether the patient has been in treatment, has been taking any psychotropic medication, and has (or has not) been compliant are essential elements of the history of the present illness. If a patient has stopped taking a prescribed medication the reasons should be determined. Noncompliance is a symptom that needs to be investigated and not simply dismissed as poor judgment or character weakness. Noncompliance has many possible causes: unpleasant adverse effects, failure to understand the necessity for chronic medication despite symptomatic improvement, insufficiently treated symptoms such as the fear of being poisoned by medication, a reluctance to see oneself as psychiatrically impaired, or simply lacking the transportation and money to get a prescription refilled. Any current alcohol or other substance use should be described, including amounts, frequency, and last use. It is also useful to ask why the person came for treatment at this time, and what the patient believes to be causing the present symptoms. The patient is a 21-year-old male with a history of one prior suicide attempt who was brought to the hospital emergency room by ambulance, accompanied by his boyfriend and roommate, after having taken an overdose of atenolol (Tenormin) (twenty-five 25-mg tablets), zolpidem (Ambien) (twenty 10-mg tablets), and possibly fluoxetine (Prozac) pills (number unknown) in a suicide attempt. The patient went to a bar with another friend where he consumed four beers and a shot of vodka. The patient filled the empty pill bottles with water and left them in plain view on the sink. The patient then unlocked the door and went to bed, telling his boyfriend where to find syrup of ipecac. A usual amount of alcohol for him consists of two vodka tonics and eight or nine beers. He remembers always speaking and thinking very quickly, because he was always "so bright and talented and good looking and smart. The racing thoughts, pressured speech, and decreased need for sleep have become more pronounced since September, when he started feeling "very up. Past Psychiatric History the past psychiatric history describes all previous episodes and symptoms whether treated or not. The history should begin with the first onset of symptoms and progress chronologically to the current episode. It describes symptoms in detail and clearly delineates their longitudinal progress. Disorders that are chronic and relapsing are distinguished from isolated episodes of disturbance. It is particularly important to obtain the fullest possible information on prior treatments. If a person has taken psychiatric medication before, it is essential to determine not only which drug, but the dosage and length of treatment, to distinguish nonresponse from a subtherapeutic drug trial. Similarly, if a patient has received psychotherapy it is important to establish which modality of therapy, at what frequency, for what length of time, and with what benefit. Throughout his childhood, he got into fights with other children and would even attack family members and teachers. Once he attacked his older brother and kicked him in the head repeatedly until he lost consciousness and required medical attention. During his senior year in high school, the patient was forced to see the school therapist because of a heated argument with a teacher. The teacher claimed that the patient tried to hit him, and though the patient denied this, he was expelled. He met with the psychologist five or six times and stopped treatment when he graduated. There is a history of one previous suicide attempt 2 years ago, precipitated by the infidelity of his first boyfriend. Medical History the importance of a thorough, accurate medical history is difficult to overstate. In addition, many medical conditions and their treatments cause psychiatric symptoms that are clinically indistinguishable from primary psychiatric disorders. Hypoglycemia can cause panic and anxiety; hypercalcemia, depression and lethargy; and acute porphyria, psychotic symptoms. Moreover, the presence of underlying medical conditions will inform treatment decisions: tricyclic antidepressants will be avoided in patients with cardiac conduction abnormalities, and bipolar I disorder patients with a history of renal disease are more likely to be treated with an anticonvulsant than with lithium.
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Of note, sildenafil, which may be prescribed for the erectile dysfunction seen in obstructive sleep apnea, may also worsen the apnea (Roizenblatt et al. Differential diagnosis As noted, most patients with the Pickwickian syndrome also have obstructive sleep apnea, and the somnolence that they experience is often attributed entirely to the sleep apnea. The differential between the combination of the Pickwickian syndrome plus sleep apnea and sleep apnea alone rests on measurement of daytime arterial blood gases: in the combination, one finds waking hypercapnia and hypoxemia, whereas in sleep apnea alone, waking blood gases are normal. As noted below, the extreme obesity in this syndrome leads to waking hypoventilation. Alcohol, sedativehypnotics, and any other medications that may reduce respiratory drive, such as antihistamines or opioids, should be avoided. Concurrent obstructive sleep apnea is treated as described in the preceding section. Supplemental oxygen is sometimes recommended but this must be administered with caution as it may precipitate respiratory failure. In some cases oral medroxyprogesterone may improve daytime ventilatory status (Sutton et al. The usefulness, if any, of modafinil or stimulants such as methylphenidate is unclear. Clinical features Patients are extremely obese and often have a ruddy complexion; they are typically somnolent and lethargic and have difficulty paying attention or concentrating on things (Burwell et al. Arterial blood gases drawn while patients are awake reveal significant hypercapnia and hypoxemia; erythrocytosis may occur as may pulmonary hypertension and cor pulmonale. Although, as might be expected, most patients also have obstructive sleep apnea, this is not inevitable, and some patients with the Pickwickian syndrome may have normal sleep (Kessler et al. Clinical features the clinical features of the KleineLevin syndrome have been described in a number of case series (Critchley 1962; Critchley and Hoffman 1942; Dauvilliers et al. As noted, this is an episodic disorder, and the first episode, although able to occur at almost any age, from early childhood to the ninth decade, appears in late adolescence in the vast majority. Although in the majority of cases the first episode is preceded by an infection, often viral, subsequent episodes generally occur without any precipitating factors. The episodes themselves generally last in the order of two weeks; however, the range is wide, from days up to 3 months. These extremely obese patients are prone to venous stasis and deep venous thrombosis, and any acute worsening of their clinical status should always prompt a search for pulmonary emboli. Etiology the burden of excess adipose tissue encircling the chest and also pushing up the diaphragm from the obese abdomen p 18. During the episode proper, all patients experience hypersomnia, often sleeping 18 or more hours per day. During waking hours, about three-quarters of patients will also experience hyperphagia. Mood changes are seen in over half of all patients and typically consist of depression. Hypersexuality occurs in a little less than half of patients and may manifest with exhibitionism, unwelcome sexual advances, and frequent, and at times public, masturbation. Delusions and hallucinations may appear in a small minority, as may unusual behaviors such as persistent humming and singing. As noted, hypersomnia and hyperphagia constitute the primary symptomatology seen during an episode. Levin (1936) noted that `the patient sleeps excessively day and night, in extreme instances waking only to eat and go to the toilet. When roused he is usually irritable and wants to be left alone so that he can go back to sleep. The hyperphagia seen during the episode is often indiscriminate, and patients may eat whatever is at hand (Critchley 1962), beg for food from other patients (Garland et al. Cognitive changes most frequently manifest with confusion; however, there may also be short-term memory loss and incoherence.