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Eventually this approach may get us to a point at which, claims Elsa Barkley Brown, "all people can learn to center in another experience, validate it, and judge it by its own standards without need of comparison or need to adopt that framework as their own" (1989, 922). Viewing Black feminist epistemology in this way challenges additive analyses of oppression claiming that Black women have a more accurate view of oppression than do other groups. Such approaches suggest that oppression can be quantified and compared and that adding layers of oppression produces a potentially clearer standpoint (Spelman 1988). One implication of some uses of standpoint theory is that the more subordinated the group, the purer the vision available to them. This is an outcome of the origins of standpoint approaches in Marxist social theory, itself reflecting the binary thinking of its Western origins. Ironically, by quantifying and ranking human oppressions, standpoint theorists invoke criteria for methodological adequacy that resemble those of positivism. Although it is tempting to claim that Black women are more oppressed than everyone else and therefore have the best standpoint from which to understand the mechanisms, processes, and effects of oppression, this is not the case. Instead, those ideas that are validated as true by African-American women, African-American men, Latina lesbians, Asian-American women, Puerto Rican men, and other groups with distinctive standpoints, with each group using the epistemological approaches growing from its unique standpoint, become the most "objective" truths. Each group speaks from its own standpoint and shares its own partial, situated knowledge. But because each group perceives its own truth as partial, its knowledge is unfinished. Partiality, and not universality, is the condition of being heard; individuals and groups forwarding knowledge claims without owning their position are deemed less credible than those who do. Alternative knowledge claims in and of themselves are rarely threatening to conventional knowledge. Such claims are routinely ignored, discredited, or simply absorbed and marginalized in existing paradigms. If the epistemology used to validate knowledge comes into question, then all prior knowledge claims validated under the dominant model become suspect. Alternative epistemologies challenge all certified knowledge and open up the question of whether what has been taken to be true can stand the test of alternative ways of validating truth. Black feminism participates in this larger social justice project of Black diasporic feminisms, it too must "never stop questioning" social injustices. By stressing how African-American women must become self-defined and self-determining within intersecting oppressions, Black feminist thought emphasizes the importance of knowledge for empowerment. Empowerment also requires transforming unjust social institutions that African-Americans encounter from one generation to the next. As Chapters 10 and 11 suggest, Black feminist thought offers two important contributions concerning the significance of knowledge for a politics of empowerment. First, Black feminist thought fosters a fundamental paradigmatic shift in how we think about unjust power relations. Second, Black feminist thought addresses ongoing epistemological debates concerning the power dynamics that underlie what counts as knowledge. But activating epistemologies that criticize prevailing knowledge and that enable us to define our own realities on our own terms has far greater implications. Despite their significance, these contributions can serve only as guidelines because what works in one setting may not work in others. But how does one develop a politics of empowerment without understanding how power is organized and operates One way of approaching power concerns the dialectical relationship linking oppression and activism, where groups with greater power oppress those with lesser amounts. Rather than seeing social change or lack of it as preordained and outside the realm of human action, the notion of a dialectical relationship suggests that change results from human agency. Because African-American women remain relegated to the bottom of the social hierarchy from one generation to the next, U. This is not an intellectual issue for most African-American women-it is a lived reality. Moreover, dialectical analyses of power point out that when it comes to social injustice, groups have competing interests that often generate conflict. Even when groups understand the need for the type of transversal politics discussed in Chapter 10, they often find themselves on opposite sides of social issues.

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• Vomiting may occur after every feeding or only after some feedings
• Psittacosis
• Ultrasound of the abdomen
• Blood clots in the legs that may travel to the lungs
• No improvement after 3 days of home treatment
• Seizures
• Coconut, palm, and palm kernel oils, because they are very high in saturated fat.
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One additional change in the criteria was made for the sake of clarity and simplicity. This change brings the definition and staging criteria to greater parity and simplifies the criteria. Recommended diagnostic tests Volume status and urinary diagnostic indices Urine sediment examination, serologic testing and hematologic testing Kidney ultrasound some patients with specific kidney diseases. Research Recommendations K is discussed in greater detail, along with specific examples in Chapter 2. The use of urine output criteria for diagnosis and staging has been less well validated and in individual patients the need for clinical judgment regarding the effects of drugs. However, these recommendations serve as the starting point for further evaluation, possibly involving subspecialists, for a group of patients recognized to be at increased risk. It is recognized that it is frequently not possible to determine the cause, and often the exact cause does not dictate a specific therapy. Influence of fluid balance, percent volume overload, diuretic use, and differing weights (actual, ideal body weight, lean body mass) should be considered. For this reason, any acute change in kidney function often indicates severe systemic derangement and predicts a poor prognosis. Factors that determine susceptibility of the kidneys to injury include dehydration, certain demographic characteristics and genetic predispositions, acute and chronic comorbidities, and treatments. Most patients are seen only after having suffered an exposure (trauma, infection, poisonous plant, or animal). It may also be helpful to identify such patients in order to avoid additional injury. This is attributed to a number of susceptibility factors which vary widely from individual to individual. Our understanding of susceptibility factors (Table 6) is based on many observational studies that address different settings with regards to the type, severity, duration, and multiplicity of insults. While this heterogeneity provides insight into some susceptibility factors that are common across various populations, the generalizability of results from one particular setting to the next is uncertain. This will necessitate urinary bladder catheterization in many cases, and the risks of infection should also be considered in the monitoring plan. Drug history should include overthe-counter formulations and herbal remedies or recreational drugs. Physical examination should include evaluation of fluid status, signs for acute and chronic heart failure, infection, and sepsis. Individualize frequency and duration of monitoring based on patient risk, exposure and clinical course. Stage is a predictor of the risk for mortality and decreased kidney function (see Chapter 2. Dependent on the stage, the intensity of future preventive measures and therapy should be performed. This is because response to therapy is an important part of the diagnostic approach. For example, when alternative therapies or diagnostic approaches are available they should be considered. In order to ensure adequate circulating blood volume, it is sometimes necessary to obtain hemodynamic variables. Static variables like central venous pressure are not nearly as useful as dynamic variables, such as pulse-pressure variation, inferior vena cava filling by ultrasound and echocardiographic appearance of the heart (see also Appendix D). Note that while the actions listed in Figure 4 provide an overall starting point for stage-based evaluation and management, they are neither complete not mandatory for an individual patient. For example, the measurement of urine output does not imply that the urinary bladder catheterization is mandatory for all patients, and clinicians should balance the risks of any procedures with the benefits. Furthermore, clinicians must individualize care decisions based on the totality of the clinical situation. Such trials should also address the risks and benefits of commonly used fluidmanagement strategies, including intravenous. However, in real time, clinicians do not always have a complete dataset to work with and individual patients present with unique histories. Therefore, clinicians may be faced with patients in whom kidney function is already decreased and, during the hospitalization, improves rather than worsens.

It could preserve what it considered to be the important aspects of nature while promoting public enjoyment of the parks. For instance, the 1918 Lane Letter, the principal national park policy statement of the Mather era, embraced these two goals without any suggestion of contradiction. It 90 Perpetuating Tradition asserted that the parks were to remain ``absolutely unimpaired,' but also stated that they were the ``national playground system. By that time (the mid-1960s) increased postwar tourism and an improved understanding of ecology would reveal much more clearly the inherent tension between park development and preservation. Forest Service had been launched with the advantage of a forestry profession already developed in Europe in the late nineteenth century. In contrast, he believed that national parks were a ``distinctly American idea,' with European precedents limited to ``formal park design rather than large wild parks' such as those in the United States. Adams noted also that there had been ``no adequate recognition' that ``these wild parks call for a new profession, far removed indeed from that of the training needed for the formal city park or that of the conventional training of the forester. Indeed, during the Mather era the Service built on precedents it found in landscape design and in tourism and recreation management to make the parks enormously inviting. Although operating under a unique and farsighted mandate to keep the parks unimpaired, the newly established bureau relied on precedents of traditional forest, game, and fish management. The success of this effort inspired the Park Service to establish a ``wildlife division,' inaugurating a decade of substantial scientific activity within the Service. During this period, the wildlife biologists under Wright developed new perspectives on natural resources, opening new options for park management. They promoted an ecological awareness in the Service and questioned the utilitarian and recreational focus that dominated the bureau. Although the biologists remained responsible for national park wildlife programs, their administrative separation symbolized the diminishing influence of science in the Service by the late 1930s. The decade of the 1930s thus witnessed a rise-and then a decline- of ecological thinking in the National Park Service. It also saw a vast diversification of Park Service programs, which expanded responsibilities beyond management of mostly large natural areas and drew attention to matters other than nature preservation. Park Service Leadership and the Wildlife Biologists In addition to efforts to make tourism development harmonious with scenic park landscapes, the Service during the Mather era tended to measure 91 92 the Rise and Decline of Ecological Attitudes its success in leaving the parks unimpaired by the degree to which it restricted physical development. The undeveloped areas (the vast backcountry of the parks) were considered to be pristine, evidence that park wilderness had been preserved. For example, in the fall of 1928 Yellowstone superintendent Horace Albright (soon to succeed Mather as Park Service director) published a Saturday Evening Post article entitled ``The Everlasting Wilderness,' in which the absence of physical development was equated with pristine conditions. Responding to fears that the Service might ``checkerboard' the parks with roads, Albright noted the relatively small percentage of lands impacted by road and trail construction in the parks. Comparable statistics were given for Yosemite, Grand Canyon, Mount Rainier, and other parks. Albright notwithstanding, virtually the entire scientific effort within the National Park Service during the 1930s contradicted such thinking. Cammerer (who succeeded Albright as director in 1933) about setting aside supposedly pristine park areas solely for scientific study. Thompson bluntly declared that no ``first or second class nature sanctuaries are to be found in any of our national parks under their present condition. He declared that cougar, white-tailed deer, wolf, lynx, and perhaps wolverine and fisher, were most likely ``gone from the Yellowstone fauna. At Grand Canyon feral burros had ``decimated every available bit of range' in the canyon, and domestic livestock had taken a ``heavy toll from the narrow strip of South Rim range. Yosemite National Park had lost its bighorn and grizzly popula- the Rise and Decline of Ecological Attitudes 93 tions, and its cougars were ``almost gone. But the new cadre of wildlife biologists judged the same landscapes in ecological terms. Although roads and other development had not penetrated many areas of the national parks, other activities had, such as predator control, cattle grazing, and suppression of forest fires. As Thompson indicated, these interferences had greatly altered natural conditions, affecting backcountry well away from developed areas.

Diseases

• Bathophobia
• Sosby syndrome
• Gen?e-Wiedemann syndrome
• Gastrointestinal neoplasm
• Psoriatic rheumatism
• Bonnevie Ullrich Turner syndrome
• Intracranial aneurysms multiple congenital anomaly
• Epilepsy occipital calcifications
• Asphyxia neonatorum