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Medical Instructor, Morehouse School of Medicine

But because of my political interest, I also became interested in other questions. In order to get a scholarship you have to be over eighteen and I was rather younger, so I took the final A-level exam twice, I had three years in the sixth form. Eliot, James Joyce, Freud, Marx, Lenin and some of the surrounding literature and modern poetry. I got a wider reading than the usual, narrowly academic British-oriented education. First of all, they gave me a strong sense of selfconfidence, of academic achievement. Second, they themselves being teachers, were identified with these emerging nationalist tendencies. Although they were strongly academic and English-oriented, they were also attentive to the rising Caribbean nationalist movement. For instance, a Barbadian who studied at Codrington College taught me Latin and ancient history. A Scottish, exCorinthian footballer made me do the modern current affairs paper in my final history exam. I learned for the first time about the Cold War, I learned about the Russian revolution, about American politics. Much of that time, I read on my own, trying to make sense of them, and dreaming of one day becoming a creative writer. I used to play games about the war and learned a lot about where these places were, about them. It was important for me more in the context of colonialism, than about western capitalism. The questions of class were clearly present in the political conversation about colonialism going on in Jamaica, the question of poverty, the problem of economic development, etc. A lot of my young friends, who went to university at the same time I did, studied economics. Economics was supposed to be the answer to the poverty which countries like Jamaica experienced, as a consequence of imperialism and colonialism. She began a relationship with a young student doctor who had come to Jamaica from Barbados. There was a tremendous family row and she, in effect, retreated from the situation into a breakdown. I was suddenly aware of the contradiction of a colonial culture, of how one lives out the colour-classcolonial dependency experience and of how it could destroy you, subjectively. I am telling this story because it was very important for my personal development. It broke down forever, for me, the distinction between the public and the private self. I learned about culture, first, as something which is deeply subjective and personal, and at the same moment, as a structure you live. I could see that all these strange aspirations and identifications which my parents had projected onto us, their children, destroyed my sister. She was the victim, the bearer of the contradictory ambitions of my parents in this colonial situation. From then on, I could never understand why people thought these structural questions were not connected with the psychic-with emotions and identifications and feelings because, for me, those structures are things you live. It was a very traumatic experience, because there was little or no psychiatric help available in Jamaica, at that time. When I look at the snapshots of myself in childhood and early adolescence, I see a picture of a depressed person. Gradually, I came to recognize I was a black West Indian, just like everybody else, I could relate to that, I could write from and out of that position. It has taken a very long time, really, to be able to write in that way, personally. You can see that this formation-learning the whole destructive, colonized experience-prepared me for England. She gave me to the astonished college scout and said, `There is my son, his trunks, his belongings. It was compounded by the fact that my brother, who was the eldest, had very bad sight, and eventually went blind.

However, there are no data obtained from randomized trials on which to base this recommendation (259, 260). In the event that ongoing central venous access is necessary for the acute management of the patient, a new site should be obtained. In hospitals or practice areas where the incidence of non-albicans Candida blood isolates exceeds 10%, an initial empiric regimen other than fluconazole, such as either a polyene or an echinocandinbased regimen, should be considered due to the higher incidence of fluconazole resistance in these species. Our committee supports this recommendation, largely on the basis of the increasing resistance to fluconazole of non-albicans Candida spp, specifically, C. If the Candida isolate is determined to be susceptible to fluconazole, then a switch to fluconazole should be made. For patients who are clinically unstable and for whom identification of the Candida species in the blood is unknown, there is no definitive recommendation. The choice of options should consider the local epidemiology of Candida isolate, as noted above. For patients whose Candida species is known, the efficacy of specific agents can be predicted. Ocular findings may be the only sign for disseminated candidiasis and can result in blindness. The examination should preferably occur when candidemia is controlled and new spread to the eye is unlikely. In neutropenic patients, this exam should be performed once the neutrophil count has recovered, as earlier exams can be misleading in neutropenic patients. Additional specific therapeutic strategies may be required when the vitreous is involved, including intraocular therapy and consultation with an ophthalmologist for consideration of vitrectomy. With eye involvement, parenteral therapy should also be prolonged, at least until endophthalmitis is arrested. Furthermore, ophthalmic infection may represent a sign of failure of the current selected regimen. In cases of endophthalmitis, expert consultation with infectious disease specialists should be obtained. The topic of prophylaxis for critical-care patients at risk for candidemia remains controversial at the time of this document. A retrospective study identified factors associated with invasive candidiasis in patients hospitalized for at least 4 days (264). The factors included any systemic antibiotic or the presence of a central venous catheter and at least two of the following: total parenteral nutrition, any dialysis, any major surgery, pancreatitis, any use of steroids, or use of other immunosuppressive agents (264). These results have been used to support the initiation of empiric fluconazole for such patients at risk of candidemia. In these critically ill adults with risk factors for invasive candidiasis, empirical fluconazole did not clearly improve a composite outcome when compared with placebo after 4 weeks of follow-up. In fact, the isolation of candidal species from respiratory secretions is most often not clinically significant. That said, two forms of Candida pneumonia have been rarely reported (266, 267): primary pneumonia, which follows aspiration of Candida-laden oropharyngeal secretions (268), and pneumonia secondary to hematogenously disseminated candidiasis, especially in immunocompromised hosts (269, 270). Most reported cases have received amphotericin B therapy, but with the availability of newer agents, several treatment options exist, as described under candidemia. Recommendation for use of an agent other than fluconazole, such as either a polyene- or an echinocandin-based regimen, would also apply to hospitals where primary resistance of C. This recommendation is largely based on the increasing resistance to fluconazole of non-albicans Candida spp, specifically, C. This recommendation specifically deals with the initial empiric treatment regimen. In patients with candidemia who are clinically unstable and for whom identification of the Candida species in the blood is unknown, we recommend either amphotericin B deoxycholate (0. Additional treatment options include high-dose fluconazole (800 mg/kg/d or z 12 mg/kg/d) or voriconazole (6 mg/kg/12 h 3 2, then 3 mg/kg/12 h), or a combination regimen with high-dose fluconazole (800 mg/d) and amphotericin B (0.

Of total oil exports, coconut oil is by far the leader in quantity and value, followed by soya bean oil. Soya bean oil was by far the largest oil export in both quantity and value all three years. Soya beans were by far the largest bean or seed export in both quantity and value all three years. As a food it is the principal ingredient of soy sauce, bean curd, and steamed beans. The bean cake, containing a high percentage of nitrogen, is a valuable fertilizer and is used extensively in Japan, and recently bean oil temporarily replaced petroleum for lighting in China when lack of shipping facilities kept that product off the market. The center of soya-bean production is Manchuria, and Japan is the chief crusher and producer of oil and cake, though the manufacture of bean oil and cake is also a very important industry of Dairen, Kwantung Leased Territory. Mukden is the center of the bean trade and the beans are there bought for cash from the farmers. As a rule, however, the other varieties of beans are not planted for oil or curd, but are eaten steamed when the bean is young and tender. This milk is cooked in a large kettle and the film removed from the surface after a quarter of an hour and dried. This film or skin is known as Tou Fu Yi [doufu pi, usually called "bean curd skin" in English; yuba in Japanese] and 20 or 30 films can be obtained from a kettle without thinning the milk too much. After boiling half an hour the remaining milk is poured into a jar and a gypsum or salt solution added to curdle it. This product is molded in wooden frames by a heavy block of wood for 15 minutes and is then cut into small pieces with a dull brass knife. This curd forms the basis for numerous Chinese articles of food and is prepared in various ways. Perhaps the most usual form of serving is to press the curd, wrapped in cloth, for six hours in a box 1 foot square and 8 inches high and then cook in oil. Seventy-five per cent of this crush is made in the Kobe district and is handled by 25 oil mills, modernly equipped. He concludes that "American importers of Far Eastern products may well investigate the domestic market for Far Eastern oilseeds with a view to supplying oil mills in the U. Paillieux, Sagot, Raoul, and Jumelle, and the various soyfoods from China and Japan that they describe (Miso, shoyu , tofu , dried frozen tofu , yuba ), and the potential threat of soya to 82 the French cheese industry. The most important varieties mentioned are: Mammoth, Hollybrook, Ito San, Guelph, Haberlandt, Medium Yellow, Wilson, Peking, Tokio, Manchu, Black Eyebrow, Barchet. Illustrations (line drawings, both non-original) show: (1) Soja hispida plant, with closeup of a cluster of pods. Address: Director, Ferme Expйrimentale de Nйoculture du Sud-Est, at Villardonnel (Aude), France. Summary of tariff information, 1920; prepared for the use of the Committee on Ways and Means, House of Representatives. Even if not bean cake it is dutiable as a product similar to bean cake, bean stick, and miso. Oil cake produced from the soya bean is free of duty as oil cake provided for in paragraph 560. Soya-bean cake, or meal, a by-product of oil manufacture, is a valuable cattle feed and enters extensively into international trade. Except by resident Asiatics there is only a limited use of soya beans for food purposes. Imports of soya beans, too small to be listed separately prior to 1914, rose from about 2,000,000 pounds in 1914 to about 32,000,000 pounds in 1918; during the same period imports of soya bean oil rose from 16,000,000 to nearly 337,000,000 pounds. A black bean known to the Japanese as Kuromame, was held not to be free of duty under this paragraph, the evidence being insufficient to prove that the merchandise was soya beans. A brief description is given of how Bean Curd or "Tou Fu" is made in Peking from Yellow Soy Beans. The residue, on top of the sieve, is washed once with hot water then "sold as food for animals or for very poor people. A film or skim [yuba] forms on top, which is carefully removed with a stick, and put aside to dry. Consider the following very interesting statement concerning yuba and tofu: "From fifteen to twenty such films may be removed without affecting the value of the `Tou Fu. The small pieces of curd are wrapped in coarse cloth and pressed between two boards for half a day.

In Charlotte, Mayor Anthony Foxx and the City Council were grappling with the impacts of starter-homes and the differences in the quality of construction and aesthetic appeal in differing neighborhoods. This was a source of discussion at a May 2008 meeting of the Charlotte-Mecklenburg Economic Development and Planning Committee: Council member Carter: "I think there is one more basic level that I encourage us and that is the grading of these lots. I saw significant erosion that is not controlled when we out to see the last neighborhood. Council member Lassiter: "What I would like you to do is broaden this just a little bit, if you want to . We all struggle with the starter home neighborhood and depending on where that is in town, it has a very different look. It puts all sorts of pressure on homebuilders, but people are still going to build homes and people will buy homes, and the degree to which we do things in our subdivision ordinance or do things within our zoning code that creates some decision point that we can make policy wise and they reflect the economics of the transaction, I think is a good discussion. Regions are made of people with a diversity of ethnicities, ages, interests, economic means, etc. In an increasingly metropolitan existence, cooperation at a regional scale is vital. Suburbs are aging and growing poorer, and older urban neighborhoods are challenged by either decay or gentrification. For the poor, the inability to break out of their isolated neighborhoods prevents them from entering the economic mainstream. For the wealthy, the insular nature of neighborhood life allows them to ignore the inequities that metropolitan sprawl creates. One of the issues at hand in terms of sprawl and starter-homes is that the starter-home model of a rapidly built neighborhood on inexpensive land (and sold just as quickly with easy move-ins and little or no money down) accelerates the speed with which land is consumed. A community may not fully realize the consequences of trying to provide services and infrastructure to its sprawling footprint until it has advanced to an alarming level. Adopting a regional perspective focused on cooperation between municipalities and citizens can provide many benefits, including more efficient functioning and cost saving in the provision of services like education, infrastructure, and economic development. A report published in 2003 by the Center for Urban Policy Research, Rutgers University, predicted that "In the next 25 years, the United States will convert 18. The report also says that approximately one-fourth of this land conversion, or 233 about 2. In addition, the reduced length of roads, water, sewer, and other utilities can significantly reduce costs needed for sprawling infrastructure. Urban containment is a powerful strategy that can be applied to a multitude of issues simultaneously, such as sprawl, inequities in housing and education, uneven taxation, uncoordinated land use policies, sluggish regional or central city economies, and environmental protection. It has also been shown that inclusionary zoning designed to encourage diverse housing types open to all income groups with affordable options reduces the risk of foreclosure (Nelson 2013). Studies in this area have been somewhat inconclusive, but more recently have found that market demand, and not land constraints, determine housing prices (Nelson et al. The trend in the literature tends to support a market-driven influence on property values (Grout et al. It is the evolution of the humane metropolis ­ one that can meet the hierarchical and fundamental needs of its residents. In order to realize ecological, economic, and social resilience, a shift is needed. Our consumption of natural resources must decrease, our economy must be stabilized, and our social fabric nourished to provide equity and dignity for all. Providing for open space has become more difficult due to the lack of available land in urban areas and the insatiable demand for housing in suburban ones. Public spaces, including streets and small parks or plazas, are a vital part of embracing nature in such settings. These neighborhood-scale insertions provide easy, nearby access to nature for a greater number of people, contribute to the overall quality of urban life (Olmsted, 1870; Trowbridge and Bassuk, 2004; Carter 2007), enhance physical and mental health and are an important part of the built environment (Ulrich, 1984; Sullivan & Kuo, 1996; Wells, 2000; Frumkin, 2001; Kuo, 2001; Kaplan and Kaplan, 2003; Frank et al. The lack of open spaces, gathering spots, playgrounds, parks, sidewalks, trails, and trees were frequently mentioned by residents and noted through neighborhood observation in starter-home neighborhoods. In suburban areas, the presence of parks, both large and small, can help neighborhoods be more self-sufficient, balanced 235 communities (not just bedroom communities) by providing recreational space for largely residential areas. It is easier for small parks and public spaces to be an influence on their surroundings in denser areas than more spread out, low-density ones.