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C. Rathgar, M.A., M.D., Ph.D.

Program Director, Duke University School of Medicine

At least one commenter stated that the Department failed to mention or justify the removal of the requirement to train recruiters on its non-discrimination policy, which the commenter argued is an important requirement to ensure that such a policy is not diluted in the field. The commenter stated that the Department previously issued guidance on notices of non-discrimination in 2010 and recommended that if the proposed rules are adopted, the Department should clarify any parts of the sample notice provided in the 2010 guidance that have changed as a result. The Department believes this list of types of publications is broad enough to achieve the purpose of ensuring that relevant individuals and organizations. The commenter further asserted that the proposed rules did not clarify how to identify appropriate professional organizations, nor whether the organization has a right of action or standing that warrants the need to provide it with separate notice. Whether an organization describes itself as a "union" or uses a different label, the term "or professional organizations holding collective bargaining agreements or professional agreements" encompasses the reality that many elementary and secondary schools have employees who are unionized or otherwise collectively bargain or hold professional agreements with the recipient. Most recipients have already complied with the regulatory requirement to send an "initial" notice within 90 days of the effective date of the 1975 regulations. Commenters argued that most elementary and secondary school students are minors and rely on their parents in making decisions related to school. Commenters asserted that since the parents of elementary and secondary school students would no longer be required to receive notice of the non-discrimination policy, children would have the task of providing notice to these individuals and would have to understand that what they have experienced is sexual harassment and feel comfortable sharing the experience with a stranger. Whether a publication "states" different treatment on the basis of sex, including based on a theory of sex stereotyping, is an inquiry distinct from whether the publication might be viewed as "suggesting" or implying different treatment on the basis of sex, including based on a theory of sex stereotyping. One commenter argued that the Department provided no statistical or other evidence to show that the rationale for the provision has changed, or that sex stereotyping no longer needs to be remedied. The commenter contended that published policies and materials of a school can be susceptible to suggestions of sex stereotyping even where the publications do not "state" discriminatory practices. The commenter argued that both male and female students continue to be subjected to sex stereotyping in the forms of visual images, statements, and conduct that limits or denies their access to career and technical education paths based on sex. One commenter asserted that it is rare for an entity to directly state that it discriminates and that there are many other ways a discriminatory message can come across; for example, a brochure used to recruit applicants to a nursing school should not contain 40 photos of female students and no photos of male students. Another commenter expressed concern that there are numerous symbols that get a point across as well as, if not better than, actually stating something. One commenter asserted that overt racism and sexism are less common in the modern era and that statements hinting at a policy of sex discrimination are used in lieu of explicit statements. The commenter suggested that the 1623 Department use an objective standard that also prohibits non-textual indications of sex discrimination. The Department disagrees with the commenter who argued that a recipient should not be allowed to use a picture on a nursing school brochure depicting a group of women, without additional context about the brochure asserting that men were treated differently in such a nursing program. Thus, the enforcement action described by the commenter may not reach a different result under the final regulations. The commenter also recommended that the Department reiterate Federal standards regarding translation of materials into languages other than English. The commenter asserted that requiring this information would promote consumer choice and is consistent with all other information that Federal law requires a school to disclose, particularly in higher education, and would enable a student to make a knowing and voluntary choice about 1626 whether to attend the school. One commenter expressed concern that the proposed rules did not address "totalitarian" reporting methods such as third-party reporting, bystander intervention, and posting fliers all over campus that encourage students to make reporting a habit. As discussed elsewhere in this preamble, the final regulations neither require nor 1629 prohibit a recipient from disseminating information about bystander intervention designed to prevent sexual harassment. Similarly, nothing in the final regulations requires or prohibits a recipient from posting flyers on campus encouraging students and others to report sexual harassment; recipients should retain flexibility to communicate with their educational community regarding the importance of reporting sexual harassment.

The therapist may succumb wittingly or otherwise, and the therapy will be sabotaged. If the therapist finds himself unable to resist the latter outcome, the patient must be referred to someone else. Few therapists can deal with all types of patients, particularly without psychotherapy themselves to remove as many of their blindspots as possible. Note-taking during sessions may be appropriate if used sparingly for the initial evaluation, but in therapy it is to avoided. Thoughts about what is going on, or a major shift in diagnosis can be briefly put down under "Assessment. This method will keep the therapist from straying, wandering, and wasting precious time, a thing all too easy to do in such a potentially nebulous undertaking as psychotherapy. Marital Therapy - A Brief Summary Marital therapy is not individual therapy with two people; there are unique, complex dynamics involved in the marital relationship that extend beyond the boundaries of the marital partners. However complex this relationship, it is still possible to unravel and understand enough of it to effect a change in a disturbed marriage. The responsibility for change rests with the husband and wife, whether it be to make the change within the marriage or to change by separation. There even may be the decision not to change but to keep the status quo as the least painful of the three choices. Any one of the three decisions - stay married and change, divorce, or make no change - is legitimate, but it should be made on the basis of information derived from the marital therapy process. The marital therapy process is based on two concepts germane to any interpersonal relationship - needs and communication. If needs complementary to the marriage, conscious or unconscious, are met, then the relationship remains stable. If these needs are not met, then communication is necessary to establish an awareness and a means whereby they will be met. It is helpful to have the couple enumerate their needs both as individuals and as partners in a marriage. Thii serves two purposes: one, to bring into mutual awareness the expectations each holds for himself and the 6-29 U. Communication is not limited to mere verbal exchange, but it includes connotation and nonverbal cues as well. The flight surgeon will probably not have time to do long-term marital therapy; what he can offer will be short-term, supportive counseling. Referral sources such as Family Services, chaplains, local ministers, other medical and psychological specialists, and even books on the subject are invaluable in extending his limitations for comprehensive treatment. If long-term therapy is indicated, the flight surgeon should have available a list of appropriate referral sources that includes payment modality and personal knowledge of qualifications. Because of the frequent absence of the spouse due to deployments and unaccompanied-tour duty stations, the effectiveness of marital therapy may be compromised. Supportive therapy and use of referral sources become essential in treating only one partner. For the husband, the flight surgeon may be limited to treating the symptoms, depression, anxiety, etc. For the wife, the flight surgeon will be limited to his list of referral sources and making appropriate recommendations. If divorce is the result of therapy, the goal should then be to return each partner to a functional status. All behavior therapies rest on the assumption that most human behavior, normal and abnormal, is learned. As such, behavior treatment involves the application of learning principles to modify or eliminate maladaptive behavior and to acquire behaviors considered to be adaptive. If a neutral stimulus becomes temporarily associated with another stimulus which naturally evokes an unlearned response (reflex), and the two are paired repeatedly, the neutral stimulus alone will then evoke the unlearned response (reflex). The formerly neutral stimulus has now become a conditioned stimulus and the reflex a conditioned response. This principle is applied in a wide variety of behavioral treatment techniques such as aversive conditioning and systematic desen- 6-30 Aviation Psychiatry sitization.

Solvents are composed predominantly of hydrocarbons, thus their importance in aviation. Solvents are substances capable of dissolving another substance (solute) to form a uniformly dispersed mixture (solution). Exposure to solvents occurs primarily through inhalation of vapors or through skin contact. The very short chain gases; methane (Cl), ethane (C2), propane (C3), and butane (C4), are biologically inert and nontoxic. The most common acute effect of hydrocarbons in the workplace is not a loss of consciousness, but instead, a prenarcotic syndrome of mild uncoordination and general malaise shading gradually into more severe symptoms. Many organic solvents have the potential upon acute high level vapor exposure to cause narcosis and death. Disorientation, euphoria, giddiness, confusion, progressing to unconsciousness, paralysis, convulsion, and death from respiratory or cardiovascular arrest are typically observed. One must also remember fire and explosion are common hazards associated with use of solvents. All are mixtures defined by certain physical parameters such as specific gravity, boiling point, or viscosity. As a general rule, the more volatile, the more toxic as well as the more hazardous. Vinyl chloride may cause hemangiosarcoma of the liver although polyvinyl chloride is harmless. Aromatic nitro and amino compounds cause production of methemoglobin, which interferes with normal oxygen transport. Solvents are used in dry-cleaning agents, drying compounds, degreasers, and liquid extractions. Their method of absorption is primarily by inhalation, although superficial cutaneous absorption is also common. In high concentrations, they may cause headache, nausea, confusion, drowsiness, convulsions, coma, and finally death. In summary, hydrocarbon mixtures are frequently found in the Navy with the typical hydrocarbon toxicity. In cases of fatal poisonings, symptoms include those of typical alcohol intoxication followed by coma, pulmonary edema, and death within 72 hours. In nonfatal cases, acute tubular necrosis with anuria occurs within 24 hours; 100 cc may be fatal. Liver alcohol dehydrogenase metabolizes ethylene glycol to oxalic acid, which is the likely cause of the metabolic acidosis and subsequent nephrotoxicity. Ethyl alcohol is a better substrate for alcohol dehydrogenase, which accounts for its use as therapy in massive ingestion. Hourly oral maintenance doses of 109 mg of 20 percent ethanol per kg body weight should be administered, along with rapid initiation of hemodialysis. Ethylene glycol is found in antifreeze, hydraulic fluids, condensers, and heat exchangers. Benzene is rapidly absorbed via inhalation of vapor and distributed throughout the body, tending to concentrate in tissues with high fat content. Measurement of total urinary phenols gives the most specific indication of exposure. Contact with broken skin may result in erythema, blistering, or dry, scaly dermatitis. Benzene is best known for its chronic effects; aplastic anemia, preleukemia, and acute myelocytic and monocytic leukemia. Abuse (sniffing) produces hyperchloremic acidosis, renal tubular acidosis, weakness, hypokalemia, and hypophosphatemia. Carbon Tetrachloride Carbon tetrachloride is an absolutely superb solvent and degreaser of metal. It proved to be a good fire extinguisher because heat and carbon tetrachloride form compounds which use up available oxygen; however, they form, among other things, phosgene.

Background: Intrarenal infiltration of immune cells is an established pathogenic mechanism in various inflammatory kidney diseases. Methods: A total of 10 cynomolgus monkeys with various renal function were included. Mccole,2 Marie Mcgarvey,2 Ciaran Richardson,2 Peter Fitzgerald,3 John Lamont,3 Amar Sethi. Methods: Randox Biochip Array technology was used to develop a multiplex immunoassay panel for the below biomarkers. Functional sensitivity, cross reactivity, and interference were assessed, along with a sample correlation in 30 subjects. There was no significant cross reactivity (<1% cross reactivity or <10% interference) for any of the analytes when spiked with x10 concentration of the highest standard of the other panel antigens. However, the latter association was attenuated and no longer significant when using only research measurements (Table1). Methods: We have included 14 septic shock patients (onset < 12 h) requiring high doses of noradrenaline (> 0. Clinical and chemical data were obtained longitudinally besides the evaluation of 28-day mortality. A vast majority of cases were diagnosed in early childhood and late onset cases were thought to present with mild clinical symptoms. Methods: A 30-year-old African American female presented with fatigue, nausea, vomitings and abdominal pain. Hospital course was complicated by severe hypoglycemia, acute cardiopulmonary failure requiring mechanical ventilation, acute liver failure with biopsy findings of diffuse micro steatosis, rhabdomyolyis and acute renal failure requiring continuous renal replacement therapy. This mutation has never been reported as pathogenic or benign variant in population database. The primary outcome was the development of de novo infections, analyzed with a time-dependent multivariate Cox regression model. Pneumonia, intra-abdominal infections, and lower urinary tract infections were most common. Logistic regression models were performed to determine predictors of progression and mortality at 3 months. At 3 months post hospitalization, 241 were accounted for and 199 had creatinine measured. Glynn-Atkins,2 Denise Darby,1 Brandon Bennett,3 Sheila Mccorkindale,2 Smeeta Sinha,1 Dimitrios J. A 2x2 factorial design exposed each group to different combinations of the 2 interventions. Time to response and mortality pre and post the intervention period was analyzed using Mann U Whitney and Chi Square respectively. Methods: Analyses included 521 protocol biopsies taken at 6 weeks, 3 and 6 months after transplantation and 141 biopsies for cause from 204 patients. Results: Inter-observer reproducibility was good for pyknosis, flattening, brush border loss, fair for lucency and poor for nuclei loss and luminal debris. Only in patients with tubular Ki-67 expression long-term allograft function improved. Examination of Ki-67 expression can help determine the potential for recovery from this damage. Among the evaluated risk factors after transplantation were the complications: acute and chronic graft versus host disease, sepsis, cytomegalovirus reactivation, sinusoidal occlusive disease, immunosuppressive therapy, nephrotoxic medications and contrast medium. Age, duration of the therapy with CsA and the count of acute kidney injuries were risk factors for chronic kidney disease in the multivariate analysis. Sepsis was a universal risk factor in the multivariate analysis which was associated not only with kidney injury but also with excess mortality. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all inpatients who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. Results: Among 5,253,185 adults, mean age was 48 years, 53% were women and 45% were minorities. Methods: 250 consecutive adult patients admitted to the Medical wards were screened. Background: Assessing the severity of renal disease often requires extended periods of observation and data collection. Anatomical scans were obtained using a respiratory-gate multi-slice fast spin-echo pulse sequence.