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Kries^^ and the common use of the concepts in the works which follow him or criticize him medicine 0829085 buy synthroid 50 mcg on-line. These works are primarily criminological but they are also produced by other legal writers pure keratin treatment buy 75mcg synthroid visa, particularly Merkel treatment viral meningitis discount synthroid 25 mcg without a prescription, Riimelen symptoms gallbladder problems order 50 mcg synthroid otc, Liepmann, and most recently, Radbruch. Heft 3 of Ahhandlungen des von Lisztschen Seminars in which references to the most important other literature are to be found. His analytical articulation of the concept of "adequate causatiori" can be taken into account only later, after the theory has been presented in the most simple possible formulation (for which reason, as we shall see, the formulation will be only provisional and not definitive). Tschuprow, whose article on Brockhaus-Ephron Encyclopoedic Dictionary, was unfortunately inaccessible to me. We will discuss later the point that the notion of efficacy need not and must not be encumbered with unnecessary and dubious meta(Cf. The historical material once formed, on the other hand, contains nothing of "possibility," at least, ideally. Subjectively for the mind of the historian himself the historical exposition only very seldom attains judgments of necessity but objectively the historical exposition undoubtedly is governed by the assumption that the "causes" to which the "cfTect" is imputed have to be regarded as unqualifiedly the sufficient conditions for its occurrence. For it a priori possible, actually frequent, and regularly the case today, the that meaning of the legal norms, explicitly stated or elicited by interpretation, inclines to the view that the existence of "guilt" in the sense of applicable law should depend primarily on certain. 0 It is only stages of the discussion that this difference in the aims of investigation are without significance. The inants is possibility of selection from among the infinity of the determ- conditioned, it is first, by the mode of our historical interest. When by this, as said that history seeks to understand the concrete reality its of an "event" in individuality causally, is what is obviously not meant we have seen, that it is to "reproduce" and explain causally its the concrete reality of an event in the totality of ties. Rather, history exclusively concerned with the causal explanation of those "elements" 3^ Modern law is directed against the agent, not against the action (cf. He is not interested in whether the fatal thrust leads to death with incidental phenomena which might be is quite interesting to the physiologist. He; not interested in whether the appearance of the dead person or the murderer could be a suitable object of artistic representation nor, for instance, in whether the death will help a non-participating "man behind i. Rather, does the attribution of effects to causes take place through a process of thought which includes a series of abstrac- the first and decisive one occurs when we conceive of one or a few of the actual causal components as modified in a certain direc- and then ask ourselves whether under the conditions which have been thus changed, the same effect (the same, i. No one has set forth the tion world historical "significance" of the Persian Wars for the develop- ment this of western culture as vividly and clearly as he has. This turn was the indispensible "precondition" of the development of the Attic fleet and thus of the further development of the war of independence of Hellenic culture, the liberation, the salvation of the positive stimulus of the beginnings of the specifically western histor- iography, the full development of the of the drama and all that unique life ards - mind which took place in this - by purely quantitative standbetween these two is miniature theater of world history. In every Hne of every piust, be, historical work, indeed in every selection of archival and source materials for knowledge. This process proceeds through the analysis and mental isolation of the com- ponents of the directly given data complex of possible causal relations - which are be taken a - and should culminate a synto as in thesis of the "real" causal complex. Even this first step thus transforms it the given "reality" into a "mental construct" in order to make into an historical fact. When station is the question whether a certain train has already passed a answered "it is possible," this assertion means that the per- son who answered its the question subjectively does not this belief, It know "jiot the facts, which would exclude to If, but that he is also not in a position argue for correctness. The "knowledge" on which such the Battle of hitherto, ical" Marathon rests is, we have said on the one hand, knowledge of certain "facts," ("ontolog- knowledge), "belonging" to the "historical situation" and ascer- tainable on the basis of certain sources, already seen - knowledge and on the other - as we have to of certain known empirical rules, particu- larly those relating to the ways in which human beings are prone react under given situations ("nomological knowledge"). In is any case, it is which into decisive for the "significance" of the Battle of Marathon, Eduard "situation" its Meyer must, if it is challenged, analyze that "components" down to this "ontological" to the point where our "imagination" can apply knowledge our "nomological" knowledge which has been derived from our own this experience and our knowledge of the conduct of others. The course historian will assert against this, correctly, that the actual of historical work and the actual content of historical writing follows a different path. Moreover, is further asserted, an objective judgment of what "would" have happened according to the general empirical rules, when a causal component is conceived as excluded or as modified, is often highly uncertain and possibility regarding often cannot be arrived at at tion of causes in history all. Arguments such as these confuse, basically, problems of distinct They confuse the psychological course of the origin of scientific knowledge and "artistic" form of presenting what is known, character. Ranke and even the advancement of knowlis edge by an historian of possess this "intuitive" lesser rank, poorly served if he does not abso- gift. Where this is so, he remains a kind of lower rung-bureaucrat in the historical enterprise.

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According to medicine grinder buy synthroid 100mcg overnight delivery large-scale national surveys conducted between 1972 and 1978 symptoms 5 days before your missed period buy synthroid 50mcg on-line, only 3 percent of American workers said they were very dissatisfied with their jobs medicine 3202 cheap synthroid 100mcg amex, while 52 percent said they were very satisfied-one of the highest rates in industrialized nations treatment yeast infection male discount synthroid 50 mcg. In our studies we find that American workers tend to mention three main reasons for their dissatisfaction with their jobs, all of which are related to the quality of experience typically available to them at work-even though, as we have just seen, Mihaly Csikszentmihalyi / 161 their experience at work tends to be better than it is at home. This can be a problem for everyone, but especially for those in lower-level occupations in which routine plays a major role. The second has to do with conflicts with other people on the job, especially bosses. The third reason involves burnout: too much pressure, too much stress, too little time to think for oneself, too little time to spend with the family. This is a factor that particularly troubles the higher echelons-executives and managers. Variety and challenge, for instance, are in one sense inherent characteristics of jobs, but they also depend on how one perceives opportunities. Ting, Serafina, and Joe saw challenges in tasks that most people would find dull and meaningless. Getting along with co-workers and supervisors might be difficult, but generally can be managed if one makes the attempt. To prove himself he sets certain goals for how others should treat him, and then expects rigidly that others will fulfill those expectations. This rarely happens as planned, however, because others also have an agenda for their own rigid goals to be achieved. Finally, stresses and pressures are clearly the most subjective aspects of a job, and therefore the ones that should be most amenable to the control of consciousness. Stress exists only if we experience it; it takes the most extreme objective conditions to cause it directly. The same amount of pressure will wilt one person and be a welcome challenge to another. There are hundreds of ways to relieve stress, some based on better organization, delegation of responsibility, better communication with co-workers and supervisors; others are based on factors external to the job, such as improved home life, leisure patterns, or inner disciplines like transcendental meditation. To do so involves mobilizing psychic energy and keeping it focused on personally forged goals, despite inevitable distractions. Various ways of coping with external stress will be discussed later, in chapter 9. Now it may be useful to consider how the use of leisure time contributes-or fails to contribute-to the overall quality of life. Free time, on the other hand, is unstructured, and requires much greater effort to be shaped into something that can be enjoyed. Hobbies that demand skill, habits that set goals and limits, personal interests, and especially inner discipline help to make leisure what it is supposed to be-a chance for recreation. But on the whole people miss the opportunity to enjoy leisure even more thoroughly than they do with working time. Over sixty years ago, the great American sociologist Robert Park already noted: "It is in the improvident use of our leisure, I suspect, that the greatest wastes of American life occur. Nevertheless, instead of using our physical and mental resources to experience flow, most of us spend many hours each week watching celebrated athletes playing in enormous stadiums. Instead of making music, we listen to platinum records cut by millionaire musicians. Instead of making art, we go to admire paintings that brought in the highest bids at the latest auction. We do not run risks acting on our beliefs, but occupy hours each day watching actors who pretend to have adventures, engaged in mockmeaningful action. This vicarious participation is able to mask, at least temporarily, the underlying emptiness of wasted time. The flow experience that results from the use of skills leads to growth; passive entertainment leads nowhere. Collectively we are wasting each year the equivalent of millions Mihaly Csikszentmihalyi / 163 of years of human consciousness. The energy that could be used to focus on complex goals, to provide for enjoyable growth, is squandered on patterns of stimulation that only mimic reality.

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Managers across the globe from this study discussed sustainability innovations in terms of product innovation (products treatment definition statistics order synthroid 200mcg on-line, services treatment 30th october cheap 200mcg synthroid visa, product-service bundles) symptoms 5dp5dt buy synthroid 75mcg on line, process innovation medicine research synthroid 50 mcg with visa, and organizational innovation. However, forces act to constrain sustainability innovations in some agricultural industries including the wine industry. This article reports findings on forces constraining sustainability innovation from an ongoing six-year investigation into global contemporary wine marketing and sustainability. This inductive study, with theory-building grounded theory and phenomenological data collection, has been conducted relying upon a large number of in-depth interviews and using traditional interpretive trustworthiness criteria to ensure valid data were collected and the best interpretations developed. Executive perspectives from wineries of seven countries yielded insights to the notion of constraints to sustainability innovations and why, in some cases, making progress is difficult. The wine industry offers a unique set of challenges when it comes to pursuing sustainability objectives, however, some research suggests that these efforts pay off in terms of improved product quality and market perceptions (Pullman et al. While it is true that sustainability innovations are pursued by wineries around the world, sometimes out of firm strategy and sometimes due to industry or regulatory pressures, many find significant barriers to their innovation efforts, some of which are coming directly from the marketplace. These barriers in combination with forces driving them toward innovation challenge wineries to carefully select which forms of innovations to pursue and in some cases fight against pressures to pursue sustainability innovation projects. Yet firms are typically constrained by resources and capabilities in their abilities to innovate (Wernerfelt, 1984). For example, a firm may lack access to materials, lack employees with the capacity to innovate, lack an organizational culture enabling innovation to prosper, or lack formal processes enabling routine innovations to emerge. These constraints act as barriers to innovation and will apply to sustainability-focused process and product innovations. Despite normative advice on how to pursue sustainability projects, there are still calls for research into conditions under which sustainability projects emerge within the wine industry. Additionally, first hand perspectives on how winery leaders are attempting to pursue sustainability innovations around the globe are still lacking. As such, this paper is focused on this intersection of three concepts: sustainability, innovation, and barriers. By exploring meaning and processes, we discovered that leaders often felt significantly constrained in their pursuit of sustainability innovations regardless of pressures from within and outside of the firm. Thus, we found a tension that managers were experiencing that has yet to be described in the literature and that may partially explain the variance in the pace of sustainability innovations within this and other industries. Business sustainability is broader than the environment however, and is well represented in hundreds of contemporary articles and books as involving a balance between environmental, societal and economic longevity. Within agricultural-based consumer products, environmental sustainability has become very important. Sustainability has even been discussed in the wine industry as a potential source of competitive advantage (Flint and Golicic, 2009; Forbes et al. Over the years, a debate has existed on the extent to which economic sustainability may be hindered when an organization invests in environmental and or societal sustainability initiatives, resulting in detailed discussions of the viability of a true "triple bottom line" (Norman and McDonald, 2004). Small to medium sized wineries have been found to be responsive to internal stakeholder pressures to become more environmentally sustainable and seem to have more success in implementing environmental management practices when they voluntarily pursue changes, meaning that they buy into the sustainability attitudes and norms expressed by others (Cordano et al. The corollary is that coercing winery leaders to implement environmental management practices will likely result in less successful practices as well as innovations. As such, it seems important to understand at a deeper level what leaders are actually thinking regarding sustainability projects; do they buy into sustainability attitudes and norms or do they feel coerced (through regulation for example)? They found that institutional support coupled with a strong collective motivation to change, i. In some countries such as New Zealand sustainability and sustainability innovations are not only encouraged but are part of the culture, celebrated, rewarded and in some cases mandated by regulatory bodies. This variance will likely influence the intensity of sustainability innovations and the nature of the projects pursued. We noted here the need for buy-in or a positive attitude toward adopting sustainability practices. Additionally, organizations must often share information to improve practices within a region. Szolnoki (2013) emphasized how the lack of information sharing between relevant organizations may well be the most difficult barrier to sustainability improvements. For example, innovations in packaging such as using lighter glass or alternative materials (Svanes et al. We still lack an understanding of how leaders themselves see their organizations and the sustainability discussion as they attempt to address sustainability innovation pressures.

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In time many symptoms 7 weeks pregnancy buy synthroid 50 mcg on-line, but not all medicine zolpidem discount 25mcg synthroid amex, members of countercultures eventually adopt the norms and values of the dominant culture medications used to treat fibromyalgia 125mcg synthroid sale. Assimilation and multiculturalism Many people see the United States as "a melting pot" comprised of a variety of different cultural medications gout generic synthroid 200mcg line, subcultural, and countercultural groups. However, people today increasingly recognize the value of coexisting cultural groups who do not lose their identities. This perspective of multiculturalism respects cultural variations rather than requiring that the dominant culture assimilate the various cultures. It holds that certain shared cultural tenets are important to society as a whole, but that some cultural differences are important, too. For example, children in schools today are being taught that the United States is not the only culture in the world, and that other viewpoints may have something to offer Americans. Norms within a culture frequently translate into what is considered "normal," so that people think their own way of doing things is "natural. Nationalism often includes the notion that a particular nation has a God-given or historical claim to superiority. Instead, they generally embrace cultural relativism, or the perspective that a culture should be sociologically evaluated according to its own standards, and not those of any other culture. And they are better able to understand the standards of other cultures because they do not assume their own is somehow better. Toward a Global Culture Some sociologists today predict that the world is moving closer to a global culture, void of cultural diversity. A fundamental means by which cultures come to resemble each other is via the phenomenon of cultural diffusion, or the spreading of standards across cultures. Cultures have always influenced each other through travel, trade, and even conquest. As populations today travel and settle around the globe, however, the rate of cultural diffusion is increasing dramatically. Examples of social forces that are creating a global culture include electronic communications (telephones, e-mail, fax machines), the mass media (television, radio, film), the news media, the Internet, international businesses and banks, and the United Nations-to name only a few. Even phrases like "global village" seem to imply that the world is growing "smaller" every day. Still, while many aspects of culture have been globalized, local societies and cultures remain stable and, in many instances, are being affirmed with enthusiasm. Although people may relocate on the other side of the planet, they tend to remain faithful to their culture of origin. Hunting and gathering societies the members of hunting and gathering societies primarily survive by hunting animals, fishing, and gathering plants. The vast majority of these societies existed in the past, with only a few (perhaps a million people total) living today on the verge of extinction. To survive, early human societies completely depended upon their immediate environment. When the animals left the area, the plants died, or the rivers dried up, the society had to relocate to an area where resources were plentiful. Consequently, hunting and gathering societies, which were typically small, were quite mobile. In some cases, where resources in a locale were extraordinarily plentiful, small villages might form. But most hunting and gathering societies were nomadic, moving constantly in search of food and water. Because of the mobile nature of the society, these societies stored little in the form of surplus goods. These societies probably also had at least some division of labor based on gender. Females hunted smaller animals, gathered plants, made clothing, protected and raised children, and helped the males to protect the community from rival groups. They also sacrificed their individuality for the sake of the larger tribal culture.

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Nutritional deficiencies in resource-poor areas are common acne natural treatment cheap 100mcg synthroid fast delivery, particularly iron deficiency medicine youtube 200 mcg synthroid amex, which is frequently exacerbated by infectious diseases shinee symptoms synthroid 50mcg without prescription. Implications for Clinical Practice and Public Policy the recommended thresholds for diagnosis and evaluation of anemia should not be interpreted as being thresholds for treatment of anemia but simply for the identification of this complication medicine wheel colors cheap synthroid 200mcg on-line. Practice preferences with respect to treatment strategies should be directed according to local resources. The latter will also be influenced by whether or not anemia is being treated and what type of treatment is undertaken. The statements specifically address the need to measure Hb concentrations at a minimum and are not intended to deter the clinician from more frequent measurements as required for individual circumstances. The major health consequences include poor pregnancy outcome, impaired physical and cognitive development, increased risk of morbidity in children, and reduced work productivity in adults. Once baseline values have been obtained, the subsequent frequency of testing will be determined on an individual basis by the actual value and any intervention that may be introduced. Immunohistochemical abnormalities in bone also occur early and generally precede changes in mineral homeostasis. Extraskeletal calcification may result from deranged mineral and bone metabolism and from the therapies used in an attempt to correct these abnormalities. Testing for these parameters would therefore be informed by the demographics of the population. In different countries and regions, the ability to measure these parameters may 83 chapter 3 vary, thus the authors of the guideline statements appreciate that implementation of regular measurements of all these parameters may not be possible in all jurisdictions. There are no data to suggest how effective or useful repeated monitoring of abnormal values is, nor what an acceptable interval of monitoring should be to inform care. Laboratory testing for phosphate and calcium is relatively inexpensive, but treatment and ongoing monitoring may be expensive. At the current time, recommendations for testing frequency may be problematic for clinical practice. The questions of whether vitamin D therapies are toxic in some or all patients and what values of phosphate are pathologic have yet to be resolved. Numerous issues arise, including age-related variation in normative values, comparisons across age, sex, size, and the need to account for pubertal changes etc. Such programs include medication review; prevention of postural hypotension; cardiac pacing, where appropriate; home hazard assessment and modifications; muscle strengthening and retraining; and treatment of vitamin D deficiency. In making recommendations for therapeutic targets for mineral metabolism abnormalities, we have been careful not to reach beyond the evidence. Similarly there is insufficient evidence that any specific phosphate binder significantly impacts patient-level outcomes. Sources of dietary phosphate are protein-rich foods, including dairy products, meat, and fish as well as legumes, nuts, chocolates and inorganic phosphate additives such as those found in carbonated drinks. In a non-vegetarian Western diet, over half the dietary intake of phosphate comes from animal protein. Although the phosphate content of plant-derived phosphate is higher than animal derived, its bioavailability in terms of gastrointestinal absorption is lower. In people on hemodialysis, a post hoc analysis suggested that more restrictive prescribed dietary phosphate was associated with poorer indices of nutritional status and a greater need for nutritional supplementation. Table 29 details the relative cost comparisons of phosphate binders currently in clinical use for which there is observational or study trial data demonstrating their efficacy. Data concerning comparative patient-level outcomes such as mortality are not available. There are a number of agents available for phosphate binding which are listed in the table ranked in order of relative cost, appreciating that both availability and specific costs are country- and era-specific. International Relevance Availability of different phosphate binders differs around the globe. Thus, recommendations as to specific agents are not possible within the context of these statements. Similarly, dietary phosphate intake may be different around the world, 85 chapter 3 Phosphorus All-cause mortality Adequate adjustment Partial adjustment All studies combined Cardiovascular mortality Adequate adjustment Partial adjustment All studies combined No. Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis.


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