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Concluding with Microaffordances into Future Imaginaries Disabled people care about place. This is work that goes on just to figure out what is around you, how it may or may not limit you or extend you, and how much you can manipulate it. Too often, it is assumed that there are not enough of us for economic viability of design products without medical reimbursement. The voice recognition software once developed for people who could not type used to be trainable to nonstandard voices. I have been called an infrastructure activist within anthropology and disability studies as I perform disability for different purposes. We understand the dominant discourse in disability studies, the Americans with Disabilities Act, and "reasonable accommodation," but as a discipline we are missing a deeper understanding and have not yet operationalized our knowledge to make a more accessible profession. We are still better off remaining individual disability experts; our collective efforts are still an "embarrassment to power. The American Anthropological Association has hired an access coordinator as of June 2019. In Politics of occupation-centered practice: reflections on occupational engagement across cultures. Rehabilitation Research and Training Center on Independent Living and Disability Policy. In memoriam: Mike Oliver: the British sociologist revolutionized the field of disability studies. In Occupying disability: critical approaches to community, justice and decolonizing disability. Access intimacy, interdependence and disability justice: my remarks from the 2017 Paul K. Longmore Lecture on Disability Studies at San Francisco State University delivered on April 11, 2017. Defusing the adverse context of disability and desirability as a practice of the self for men with cerebral palsy. Pamela Block and Russell Shuttleworth have been my long-term collaborators and Neil Marcus and Matthew Wangeman my muses. My teachers Jim Blaut, Bill Lockwood, Skip Rappaport, Art Vander, and Joan Ablon are always with me. Towards engagement: exploring the prospects for an integrated anthropology of disability. Activism, anthropology, and disability studies in times of austerity: in collaboration with Sini Diallo. Occupying disability: critical approaches to community, justice and decolonizing disability. Bioarchaeology of impairment and disability: theoretical, ethnohistorical, and methodological perspectives. The social model of disability and the disappearing body: towards a sociology of impairment. Disability Expertise Claiming Disability Anthropology Cassandra Hartblay this paper stakes out a space for a critical global disability anthropology that considers disability not as a medicalized classification of impairment but as a relational category. Disability expertise, I argue, is the particular knowledge that disabled people develop and enact about unorthodox configurations of agency, cultural norms, and relationships between selves, bodies, and the designed world. Disability expertise is a descriptive domain, that is, a container into which ethnographers might enumerate observations about how disabled people enact personhood and moral agency in diverse cultural settings. I elaborate one particular domain of disability expertise: managing perceptions of disability, especially the tendency of nondisabled people to view disability through the tropes of suffering and pity. I call for anthropologists to claim disability anthropology as a space for critical, interdisciplinary knowledge production. Disability, typically defined as a chronic impairment that significantly impacts the daily life of a given individual, is a complex category with culturally contingent political and social meanings. This paper calls for ethnographic reflection on a domain of human practice that I call "disability expertise" and offers my vision for a robust "disability anthropology" that both engages the existing canon and proposes new questions. Throughout, I focus on examples drawn from interviews with one research participant whom I call Anya.

The underlying cause may be an unresolved social conflict (familial, professional, financial) or some other mental disorder (depression, anxiety, obsessive-compulsive disorder, personality disorder). Conversion disorders (previously termed "conversion hysteria") often present with a single (pseudoneurological) symptom, such as psychogenic amnesia, stupor, mutism, seizures, paralysis, blindness, or sensory loss. It has been theorized that such symptoms serve to resolve unconscious inner conflicts. The diagnosis may be particularly difficult to make in patients who simultaneously suffer from organic neurological or psychiatric disease. In somatization disorder, the patient asks for treatment of multiple, recurrent, and frequently changing symptoms, which often affect multiple organ systems. In hypochondriacal disorder (previously termed "hypochondriasis"), the patient is less concerned about the symptoms themselves, and more preoccupied with the supposed presence of a serious disease. The fears persist despite repeated, thorough examination, normal test results, and medical reassurance. The physical impairment that the patient attributes to pain may actually be due to a lack of fulfillment in familial, professional, or social relationships. Patients with Ganser syndrome give approximate or fatuous answers to simple questions, possibly creating the impression of dementia. It regulates hormonal and immunological processes as well as the functioning of major organ systems (cardiovascular, respiratory, gastrointestinal, urinary, and reproductive systems). The latter are small clusters of specialized neurons, lying on the surface of the ventricular system, that sense changes in the chemical composition of the blood and the cerebrospinal fluid. Projections from the hypothalamus and brain stem, particularly from the brain stem reticular formation, travel to the lateral horn of the thoracolumbar spinal cord, where they form synapses onto the sympathetic neurons of the spinal cord. The parasympathetic neurons receive input from higher centers in similar fashion and project in turn to parasympathetic ganglia that are generally located near the end organs they serve. The hypothalamus regulates hormonal function through its regulator hormones as well as efferent neural impulses. The sympathetic and parasympathetic components are both structurally and functionally segregated. The intestine has its own autonomic ganglia, which are located in the myenteric and submucous plexuses (p. The projecting fibers of the spinal autonomic neurons (preganglionic fibers) exit the spinal cord in the ventral roots and travel to the paravertebral and prevertebral ganglia, where they synapse onto the next neuron of the pathway. The sympathetic preganglionic fibers (unmyelinated; white ramus communicans) travel a short distance to the paravertebral sympathetic chain, and the postganglionic fibers (unmyelinated; gray ramus communicans) travel a relatively long distance to the effector organs. An exception to this rule is the adrenal medulla: playing, as it were, the role of a sympathetic chain ganglion, it receives long preganglionic fibers and then, instead of giving off postganglionic fibers, secretes epinephrine into the bloodstream. The parasympathetic preganglionic fibers are long; they project to ganglia near the effector organs, which, in turn, give off short postganglionic processes. Acetylcholine is the neurotransmitter in the sympathetic and parasympathetic ganglia. The neurotransmitters of the postganglionic fibers are norepineprhrine (sympathetic) and acetylcholine (parasympathetic). Among its anatomical components are the preoptic area, infundibulum, tuber cinereum, and mamillary bodies. It is responsible for the control and integration of endocrine function, thermoregulation (p. The ensuing effects are sensed by the hypothalamus, thus closing the regulatory loop. Various regulatory hormones (releasing and inhibiting hormones) are secreted by hypothalamic neurons into a local vascular network, through which they reach the adenohypophysis to regulate the secretion of pituitary hormones into the systemic circulation. Finally, the plasma concentration of the corresponding effector hormones and aglandotropic pituitary hormones affects the hypothalamic secretion of regulatory hormones in a negative feedback circuit (closed regulatory loop).

Using the method of least squares, we must minimize 1y1 - 322 + 1y2 - 522 + 1y3 - 722, y1 = m112 + b = m + b, y2 = m142 + b = 4m + b, y3 = m162 + b = 6m + b. Setting the partial derivatives equal to 0 and solving the system, we get m = 40 15, b =. The process of determining maximum and minimum values of f subject to the constraint g is called constrained optimization. We write the constraint as x + 2y - 1 = 0 and form the Lagrange function: F1x, y, l2 = xy - l1x + 2y - 12. Differentiating F with respect to its three input variables, we have Fx = y - l, Fy = x - 2l, and Fl = - x - 2y + 1. Substituting for y in Fl and setting the 2 expression equal to 0 gives - x - 2A1 xB + 1 = 0 2 Solving for x, we have x = 1. A suggested method of solution is to isolate l in the equations Fx = 0 and Fy = 0, substitute to cancel out l, and simplify the resulting equation in terms of x and y. We integrate with respect to y, treating x as a constant: 3 1 L or a c L L x2y dy = x2 C 1 y2 D 1 = x2 A 9 2 2 3 1 2 B = 4x2. If the region is not rectangular, then the bounds of integration may contain variables. Iterated integrals are evaluated by first integrating the inside integral, indicated by the innermost differential, and then integrating the outer integral. If f 1x, y2 is continuous over a region of feasibility that is closed and bounded, then the Extreme-Value Theorem guarantees the existence of an absolute maximum value and an absolute minimum value of f. We integrate the result with respect to x: 2 L 0 4x2 dx = C 4 x3 D 0 = 418 - 02 = 3 3 2 32 3. Find the absolute maximum and minimum values of f 1x, y2 = x 2 + y 2 - 2x - 2y, subject to the constraints 0. We find that f has an absolute maximum at both 10, 3, 32 and 12, 3, 32 and an absolute minimum at 11, 1, - 22. Consider the data in the following table regarding enrollment in colleges and universities during a recent 3-year period. Find the absolute maximum and minimum values of f 1x, y2 = x 2 - y 2 subject to the constraints - 1. The density of students living near a university is modeled by p1x, y2 = 9 - x 2 - y 2, where x and y are in miles and p is the number of students per square mile, in hundreds. Suppose that beverages could be packaged in either a cylindrical container or a rectangular container with a square top and bottom. If we assume a volume of 26 in3, which container would have the smaller surface area Suppose that Southwest can make a total investment in labor and capital of $600,000. How should it allocate the investment between labor and capital in order to maximize production Consider the data in the following table regarding the total sales of a company during the first three years of operation. For a multilevel building with a square base, one design concern is minimizing travel time between the most remote points. Suppose that you are standing at point P in the top northeast corner of the twelfth floor of this building. How long will it take to reach the most remote point at the southwest corner on the first floor-that is, point Q The vertical time is h, the height of point P from the ground, divided by a, the speed at which you can travel in a vertical direction (elevator speed). The horizontal time is the time it takes to go across one level, by way of the square grid of hallways (from R to Q in the figure). If each floor is a square with side of length k, then the distance from R to Q is 2k. Thus, the time it will take to go from P to Q is a function of two variables, h and k, given by t1h, k2 = vertical time + horizontal time h 2k = +, a b where a and b, the elevator speed and walking speed, are constants.

Increased plasma levels appear to be weakly associated with an increased risk of cardiac conduction abnormalities. Steady-state plasma levels of desipramine or of desipramine plus imipramine should therefore not exceed 300 ng/mL. Adverse effects-The most common adverse effects are nausea, nervousness, and sweating. Hypertension is likely with doses over 300 mg or over 225 mg of the extendedrelease version. Venlafaxine must be discontinued slowly to minimize withdrawal symptoms: severe headaches, dizziness, and significant flulike symptoms. Mirtazapine Mirtazapine is an 2-antagonist that enhances central noradrenergic and serotonergic activity. Contraindications-Mirtazapine should not be given in combination with monoamine oxidase inhibitors. Duloxetine Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor. Indications-It is approved for the treatment of major depression, generalized anxiety disorder, and diabetic peripheral neuropathic pain in adults. Contraindications-Duloxetine should not be given in combination with monoamine oxidase inhibitors. New research also finds that the atypical antipsychotic medications are also effective. Lamotrigine (Lamictal) was recently approved for the treatment of bipolar depression in adults. Other antiepileptic medications, such as gabapentin and topiramate, have also been used with varying efficacy. Medications that are effective as mood stabilizers may be helpful also in the treatment of severe aggressive symptoms. Other effects-Orthostatic hypotension and dizziness, lowered seizure threshold, increased appetite and weight gain, sedation, irritability and psychomotor agitation, rash (often associated with yellow dye No. Contraindications-Lithium is contraindicated in patients with known renal, thyroid, or cardiac disease; those at high risk for dehydration and electrolyte imbalance (eg, vomiting and purging); and those who may become pregnant (teratogenic effects). Dosage-For children the starting dose is usually 150 mg once or twice a day, with titration in 150- to 300-mg increments. Blood levels required for therapeutic effects are close to those associated with toxic symptoms. Moderate to severe symptoms of lithium toxicity are associated with blood levels above 2 mEq/L. A new form of carbamazepine-oxcarbazepine (Trileptal)-is also rarely being used for pediatric mood disorders; however, its efficacy has not been established. Reportedly, it does not have the worrisome side effects of bone marrow suppression and liver enzyme induction. Blood levels cannot be monitored, and the dose range is similar to that of carbamazepine. Leukopenia and thrombocytopenia are more common, and if present, should be monitored closely for evidence of bone marrow depression. These effects usually occur early and transiently and then spontaneously revert toward normal. Liver enzyme induction may significantly change the efficacy of medications given concurrently. Medical follow-up-Hematologic, hepatic, and renal parameters should be followed at least every 3 months for the first year.

General Considerations Pediatric undernutrition is usually multifactorial in origin, and successful treatment depends on accurate identification and management of those factors. Emond A et al: Postnatal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children. Clinical Findings Failure to thrive is a term used to describe infants and young children whose weight curve has fallen by two major percentile channels from a previously established rate of growth. The reduction in height for age, as is seen with more chronic malnutrition, is termed stunting. The typical pattern for mild pediatric undernutrition is decreased weight, with normal height and head circumference. In more chronic malnutrition, height and eventually head circumference growth slow relative to the standard for age. Significant protein deprivation in the face of adequate energy intake, possibly with additional insults such as infection, may produce edematous malnutrition called kwashiorkor. A discussion of the multiple medical conditions that can cause pediatric undernutrition is beyond the scope of this chapter. In young but otherwise healthy breast-fed or bottle-fed infants, a weak suck is often the causative factor. Diets restricted because of suspected food allergies or intolerances may result in inadequate intake of calories, protein, or specific micronutrients. Iron and zinc are micronutrients that are often marginal in many young children with undernutrition. Cases of severe malnutrition and kwashiorkor have occurred in infants of well-intentioned parents who substitute "health food" milk alternatives (eg, rice milk or unfortified soy milk) for infant formula. General Considerations the prevalence of childhood and adolescent obesity has increased rapidly in the United States and many other parts of the world. Currently in the United States, approximately 17% of 6- to 19-year-olds are obese, with even higher rates among subpopulations of minority and economically disadvantaged children. The increasing incidence of childhood obesity is related to a complex combination of genetic, environmental, psychosocial, biologic, and socioeconomic factors. Overweight status in the pediatric population is associated with significant comorbidities which, if untreated, are likely to persist into adulthood. The probability of obesity persisting into adulthood has been estimated to increase from 20% at 4 years to 80% by adolescence. Obesity is associated with cardiovascular and endocrine abnormalities (eg, dyslipidemia, insulin resistance, and type 2 diabetes), orthopedic problems, pulmonary complications (eg, obstructive sleep apnea), and mental health problems. Families should be counseled regarding choices of foods that are appropriate for the age and developmental level of the child. Children should have structured meal times (eg, three meals and two to three snacks during the day), ideally at the same time other family members eat. Children whose households are chaotic and children who are abused, neglected, or exposed to poorly controlled mental illness may be described as poor eaters, and may fail to gain. Careful assessment of the social environment of such children is critical, and disposition options may include support services, close medical follow-up visits, family counseling, and even foster placement while a parent receives therapy. For children younger than 2 years, weight for length greater than the 95th percentile indicates overweight and warrants further assessment, especially of energy intake and feeding behaviors. Diet Portion sizes: adult portions for young children Frequency of meals away from home (restaurants or take out) Frequency/amounts of sugar-sweetened beverages (soda, juice drinks) Meal and snack pattern: structured vs grazing, skipping meals Frequency of eating fruits and vegetables Frequency of family meals Activity Time spent in sedentary activity: television, video games Time spent in vigorous activity: organized sports, physical education, free play Activities of daily living: walking to school, chores, yard work B. Risk Factors There are multiple risk factors for developing obesity, reflecting the complex relationships between genetic and environmental factors. If one parent is obese, the odds ratio is approximately 3 for obesity in adulthood, but if both parents are obese, the odds ratio increases to greater than 10. Excessive consumption of sugar-sweetened beverages, large portion sizes, frequent consumption of foods prepared outside the home, excessive television viewing, and sedentary lifestyle are all associated with a greater risk of excessive weight gain. Treatment Therapy should be based on risk factors, including age, severity of obesity, and comorbidities, as well as family history and support. For all children with uncomplicated obesity, the primary goal is to achieve healthy eating and activity patterns, not necessarily to achieve ideal body weight.