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Of course asthma treatment breathing machines purchase albuterol american express, not every poor family with a preschooler wants to enroll their child in Head Start asthma symptoms voice buy albuterol mastercard. Some offer only half-day services asthma symptoms juvenile buy cheap albuterol 100 mcg line, while most others are open six hours asthma treatment xolair order discount albuterol on line, and some are only open four days per week. Unless wrap-around care is available for additional days and hours parents may choose other services. Many Head Start eligible families are also eligible for state and local pre-K programs, the majority of which also operate for six or fewer hours per day. Nevertheless, in 2005 about half of 3-year-olds and over one-third of 4-year-olds from families in the bottom fifth of the income distribution (poor families) were not enrolled in any center-based program and most of these were at home with their parents. In sum, there is a substantial population of children in poverty who could be served by Head Start or some other program, but are not. None of the child care tax credits is estimated to benefit families in poverty, while over 70 percent is estimated to be received by families in the top 40 percent of the income distribution. We also comment briefly on the paper outlining ways these programs might be better coordinated. The program provides educational, health, nutritional, social, and other services to low-income families and children, primarily those ages 3 to 5 in the two years prior to kindergarten. Annually, Head Start may serve around 900,000 children at a cost exceeding $7 billion. Less than half of the children enrolled received a full school day, five days a week during the school year in 2009. State and locally funded pre-K programs serve a substantial portion of the population at age 4. Most target lower-income families, but they are much less targeted by design than Head Start, and in practice participation rates in state and local pre-K are similar for lower-, middle-, and higher-income families. In 2005, preschool special education and "other public" programs facilities served 19 percent of 4-yearolds. Special education and other public programs are primarily administered and funded by state and local education agencies. In addition, the study estimated the effects of only one year of Head Start at a time and not the combined effects of two years. Even taking all of the mitigating considerations into account, we conclude that these two reports show that Head Start is not fulfilling its promise. The resulting study-the Head Start Impact Study-subsequently conducted in response to the congressional requirement provides longitudinal data on about 5,000 3- and 4-year-old children who applied for Head Start in the fall of 2002 and were randomly assigned to treatment and control groups for one year (3-year-olds in the control group could attend a year later at age 4). Participating children represented 383 centers in eighty-four agencies around the country, making this the biggest study of a representative sample of Head Start children and control children ever conducted. The study collected information from in-person and telephone interviews, child assessments, direct observations of program quality, and teacher ratings of individual children. Even taking all of the mitigating considerations into account, we conclude that these reports show that Head Start is not fulfilling its promise. There is evidence of long-term impacts of Head Start from other nonexperimental studies, as discussed in the chapter by Ludwig and Phillips. There is no plausible mechanism by which substantial long-term impacts could be produced without even stronger short-term results. A major characteristic of the program is that the mother develops a close relationship with the nurse-a respected authority figure-whose major goal is to help the mother make good decisions in her personal life and for her baby. In two carefully controlled randomized trials Olds replicated his Elmira program, with some planned variations, in Memphis and Denver. Meanwhile, his program developed a substantial national following and Olds, eschewing rapid expansion of his model program, tried to control expansion in order to maintain quality. Even so, by 2009 the Nurse-Family Partnership program was serving mothers and children in twenty-eight states, and the program had gained international notice and was being implemented in England, Australia, and other countries. During the 2008 presidential campaign, Barack Obama stated on several occasions that, if elected, he would fund a national network of homevisitation programs based on the Olds model. Although child advocates supported the approaches to learning, but not for other parent-reported measures of social and emotional development. Although it has been reported that some effects are larger for some types of programs or for some subgroups of children, these findings are not the same at age 3 and age 5, suggesting to us that they result from capitalizing on chance rather than real differences in programs or subgroups.

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The paramount importance of the food system in a long-duration human Exploration mission should not be underestimated asthma quality of life questionnaire order albuterol discount. Vehicle resources must be balanced with safety asthma steroids order albuterol on line, nutrition asthma symptoms versus copd buy albuterol master card, and acceptability to provide an adequate food system asthmatic bronchitis pictures generic albuterol 100 mcg with visa. The food system will provide not only the nutrients that will be needed for the survival of the astronauts, but also will enhance the psychological well-being of the crew by serving as a familiar element in an unfamiliar and hostile environment. This document presents the evidence that supports the risk factor of an inadequate food system as well as the knowledge gaps that still remain and that need to be filled. Risk Factor of Inadequate Food System 297 Chapter 12 Human Health and Performance Risks of Space Exploration Missions the authors of space program food system literature have documented the evolution of the space food system. With the exception of Skylab, there has not been a refrigerator or freezer on board a spaccraft that was dedicated to food storage. This requires inactivation of the microorganisms in the food during ground processing before flight. While processing the packaged foods to commercial sterility provides a safe food system, this level of processing can reduce the quality of the food, including nutritional content and acceptability. Thermostabilized ­ this process, which is also known as the retort process, heats food to a temperature that renders it free of pathogens, spoilage microorganisms, and enzyme activity. Food items are placed in cans or pouches and are heat-processed with steam- or water-overpressure to remove excess air/oxygen for specified times and temperatures to render the food commercially sterile. Irradiation involves the use of gamma rays, x rays, or electrons, and uses energy levels that assure the negative induction of radioactivity in the irradiated product. It controls naturally occurring processes such as ripening or senescence of raw fruits and vegetables, and is effective for inactivation of spoilage and pathogenic microorganisms. Rehydratable ­ A number of technologies are available that allow for the drying of foods. Examples of these technologies are drying with heat, osmotic drying, and freeze drying. These processes reduce the water activity of foods, which results in the inability of microorganisms to thrive. Extended shelf-life bread products ­ Items such as scones, waffles, and dinner rolls can be formulated and packaged to give them a shelf-life of up to 18 months. Fresh food ­ Fresh fruit, vegetables, tortillas, and other foods that have a short shelf-life are provided on a limited basis, more for psychological support than as part of meeting dietary requirements. One of the goals of the Constellation Program (CxP) lunar long missions is to use the lunar surface as a test bed for future Mars missions. Although it is possible for CxP mission planners to continue using current food technologies, a change in missions will necessitate a change in the food system. The CxP missions will require longer shelf-life packaged foods with improved nutrition and acceptability. These missions will also require more attention to resource utilization such as mass, volume, power, crew time, and water use. The Mars missions, in particular, will require that technologies be developed so that the crew is more self-sufficient and less dependent on resupply missions. Fresh fruits and vegetables, such as spinach, lettuce, tomatoes, carrots, bell peppers, onions, potatoes, and strawberries, could be grown hydroponically in environmentally controlled chambers. In addition, baseline crops, such as soybeans, wheat, rice, peanuts, and dried beans, could be grown on the surface or launched in bulk from Earth. These edible ingredients, the freshly grown fruits and vegetables, and packaged food items would be used to prepare meals in the galley. Dependence on the processing and preparation of bioregenerative and bulk commodity foods presents unique risks for these missions. Currently, prepackaged foods have a stated shelf-life of 18 months but will need a 5-year shelf-life for the Mars missions. Any of these criteria can be the limiting factor in determining the shelf-life of food. Safety Food safety is the protection of food from physical, chemical, and microbiological contamination. The food system must be designed to ensure that the initial provisions are safe from contamination and are packaged to remain safe from contamination for up to 5 years of storage in multi-environments. Microbiological contamination of food can negatively affect crew health and possibly compromise crew survival. Nutrition Adequate nutrition has two components: necessary nutrients and energy in the form of calories.

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While sex reassignment surgery can function as a vehicle of trans agency asthma symptoms in toddlers buy 100mcg albuterol, it can also be deployed to police nonnormative trans bodies that transgress and challenge gender and sexual normativity asthma treatment meds buy albuterol online now. This is most evident in social policies requiring sex reassignment surgery for a legal change of sex on identification documents definition of asthma gina discount albuterol 100mcg free shipping, for example asthma for kids albuterol 100 mcg generic, or bureaucratic rules making sterilization mandatory for gender transitioning. A biopolitical analysis emphasizes how these mandates are part of a larger administrative apparatus of managing bodies and their productive and reproductive capacities for state interests. Pregnant men, men with breasts, and females with penises all unhinge the sex/gender binary and heterosexuality as socially engineered contrivances, while bureaucracies are erected to reel these transgressive bodies back in for biopolitical management. Despite the attempt at containing trans bodies, many people still find ways (depending on their economic and political situation) to circumvent the system and exercise some modicum of control of their transition trajectory. Cotten is an associate professor of gender studies at California State University, Stanislaus. His areas of research are in transgender surgery and medicine and transgender identities in Africa and the Diaspora. His latest book is Hung Jury: Testimonies of Genital Surgery by Transsexual Men (2012). Following these guidelines, medical professionals approved surgery or hormones for clients fitting the standardized criteria and expected these clients to eventually eliminate all references to their former gendered lives and fully assimilate into a normatively gendered world (see Stone 1991; Califia 2003). Thus two major forms of surveillance operate through medical and psychiatric institutions: first, the monitoring of individuals in terms of their ability to conform to a particular medicalized understanding of transgender identity; and second, the expectation that medical transition should enable those individuals to withstand any scrutiny that would reveal their transgender status. These forms of surveillance also reach beyond medical contexts to influence law, policy, and social relations. For instance, legal changes of gender on identification documents typically rely on medical evidence as proof of gender identity, and the data collected as part of these legal processes (along with any form requiring one to identify as a specific gender) form a paper trail through which state agencies may track, assess, and manage transgender people. Similarly, the policing of gendered spaces ranging from public bathrooms to homeless shelters disproportionately affects gender-nonconforming people (Spade 2011). And representations of transgender people in popular media such as police dramas and daytime talk shows often encourage viewers to uncover gendered truths by scrutinizing certain bodies and identities. All of these practices reinforce the discursive and material links between the category transgender and various forms of surveillance, from the systemic to the quotidian. But transgender people, particularly trans people of color, poor trans people, trans youth, and trans immigrants, are especially targeted by such scrutiny because they are more likely to have inconsistent identification documents. Related security measures, including increased restrictions on immigration and asylum, new forms of state scrutiny of those perceived to be undocumented immigrants, and the implementation of x-ray scanning technologies in airports and prisons typically do not cite explicit concerns with transgender populations. But because these policing practices are often concerned with individuals who appear to be fraudulent or deceptive, gender-nonconforming people-culturally constructed as concealing something-disproportionately feel their effects. Even while surveillance mechanisms discipline transgender people, the very efforts made to police and manage gender nonconformity reveal productive contradictions and fissures in surveillance practices. By seemingly displacing gender regulation onto only transgender people, nontransgender bodies and identities appear both naturally gender normative and free from scrutiny. Yet the difficulty these systems encounter in trying to classify gender-nonconforming people demonstrates how regulatory norms of gender affect all bodies and identities by enforcing categories that are made to seem natural. Standards of Care: the Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons. Symbolic violence refers to the almost unconscious, internalized modes of cultural of social domination (Bourdieu 1991). Heteronormativity refers to a system in which sexual conduct and kinship relations are organized in such a way that a specific form of heterosexuality becomes the culturally accepted ``natural' order. Thus biological sex, sexuality, gender identity and expression and normative gender roles are aligned in such a way that a dominant view on sexual and gender relations, identities, and expressions is produced. The forms of resistance to the effects of heteronormativity can likewise be located on a sliding scale of subversion. The forms of subversion range from struggles for sexual rights (political struggles for legal reform and social policies) to material (economic) resistance and to symbolic forms of subversion. Symbolic subversion extends from self-defeating strategies, via various forms of adaptation, to more or less public forms of rebellion. Just as cultural and religious norms determine the particular construct of heteronormativity in a given society, they also shape the salience of particular types of resistance and make certain forms of subversion intelligible.

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The story of Xie Jianshun helps illuminate the broader contours of sinophone culture asthma treatment delhi generic albuterol 100mcg without prescription, because its epistemological and historical underpinnings are rooted outside ``China' as conceived in a narrow geopolitical sense asthma treatment at hospital 100 mcg albuterol mastercard. Tracing the dispersed circuits of knowledge that condensed in the public representations of Xie Jianshun allows us to see the ``Chinese Christine' not as a cheap knock-off of a Western original but rather as a figure through which to read inter- and intra-Asian regional dynamics and conditions of subjectivity asthma prevention order albuterol 100mcg without a prescription. He is the editor of Transgender China (2012) asthma uri purchase albuterol 100mcg line, Queer Sinophone Cultures (2013, with Ari Larissa Heinrich), Psychiatry and Chinese History (forthcoming), and Historical Epistemology and the Making of Modern Chinese Medicine (forthcoming). He is currently working on a manuscript tentatively titled ``Sex Changed China: Science, Medicine, and Visions of Transformation. The aim of the event was to articulate the diverse ways in which all bodies-not simply those that are tattooed or those that have undergone some sort of transformative surgical procedure-are always already modified. One of the keynote speakers at the conference was Susan Stryker, whose work in the field of transgender studies problematized the ``common-sense' understanding of technology, which, at the time, underpinned the dominant model of the transsexual body as either requiring or having undergone technological intervention. Following the conference, Stryker and her colleagues at Macquarie coined the term somatechnics in an attempt to highlight what they saw ґ as the inextricability of soma and techne, of the body (as a culturally intelligible construct) and the techniques (dispositifs and hard technologies) in and through which corporealities are formed and transformed. From the outset, then, somatechnics has addressed and been shaped by transgender issues, and this connection was explicitly articulated at the Transsomatechnics conference held at Simon Fraser University in 2008. Rather, technes are the dynamic means in and through which corporealities are crafted: that is, continuously engendered in relation to others and to a world. What we see here, then, is ґ a chiasmatic interdependence of soma and techne: of bodily being (or corporealities) as always already technologized and technologies (which are never simply ``machinic') as always already enfleshed. Anna Munster nicely articulates this vision when she writes that technologies are ``always in a dynamic relation to the matter which gives [them their] substance and to the other machines -aesthetic, social, economic-which substantiate [them] as. To put it slightly differently, the categories of being that are integral to our (un) becoming-with, and the orientation(s) that shape them, are somatechnological (rather than simply natural or cultural, internal or external to us, enabling or oppressive). For example, transgender, like forms of bodily being commonly presumed not to be technologically produced, is a heterogeneous somatechnological construct that comes to matter in contextually specific ways and in relation to other discursive formations. In making this claim, I am not suggesting that modes and practices of embodiment (such as those we call transgender) are not ``real. Given this, the primary aim of somatechnics as a critical orientation is-at least as I understand it-to queer orderability by bringing to light the operations of power, the soma-techno-logic, that constitute(s) (un)becoming-with in situated ways. The history of Western thought is, as Elizabeth Grosz and others have argued, subtended by ``a profound somatophobia' (1994: 1). From the ancient Greeks, to Enlightenment thinkers (Descartes, Rousseau, Kant, Hobbes), to the common-sense fictions that shape contemporary life, the body has been conceived (and thus constituted) as a natural, biological entity, the fleshly shell of a soul, a self, and/or a mind that is superior to it. Given its status as both prison and property, the brute matter of the body (as object) is constituted in and through this particular imaginary as that which the subject must transcend, transform, master, and/or shape, and nowhere is this more apparent than in autobiographical transsexual narratives published in the west in the twentieth century. There have, of course, been various challenges posed, particularly from the midtwentieth century on, to the kind of determinism associated with this model of Downloaded from read. This ontological tendency is apparent, for example, in accounts of selfhood (often found in discussions of transgender) that rely on a presumed distinction between sex and gender-the idea that the sexed body is a natural biological substrate onto which contextually specific (that is, culturally determined) attributes, roles, and capacities are imposed -as well as in dominant conceptions of, and debates about, technology. Technology, claimed Martin Heidegger in his influential essay, ``The Question Concerning Technology,' is commonly conceived both as a human activity and as a means to an end. The effect of this instrumentalist conception is that debates about technology tend to revolve around ``our manipulating technology in the proper manner as a means' ([1954] 1977: 5). Little has changed, it seems, in the sixty years since Heidegger first made these claims, and this is clear if one looks at accounts of so-called gender reassignment surgeries. In brief, such practices are framed by some as medical treatments that will enhance the lives of those who undergo them, while others have argued that such practices are (for a variety of reasons) unethical and/or immoral; that they constitute a misuse of technology. Some argue that individuals have a right to bodily self-determination, and others argue (variously) that such a right, if it exists, is never absolute and that therefore the use of technologies that (re)shape the body requires strict regulation. Despite the differences of opinion expressed in these claims, what they share is an instrumentalist view of technology, one in which technology is (constituted as) an object external to and manipulable by the subject(s) who deploy it to their own ends (whether those ends be a sense of bodily integrity, the fulfilment of a religious obligation, the construction of the self as altruistic, appropriately professional, morally responsible, or whatever). Indeed, each is subtended by a will to mastery which, Heidegger and Foucault would argue, is itself technological. Technology, suggests Heidegger in his critique of instrumentalist logic, is less a thing that is external to the self than an orientation, a way of thinking/knowing/ seeing that brings forth (or engenders, shapes, and ``orders') being, or, more accurately, (un)becoming. Technology, then, is at once the (contextually specific) means by which we order the world and the ways of thinking/knowing/seeing that precede us and make us be(come). Somatechnics adds another (heterogeneous) voice to these attempts to think otherwise, but it does so from the possibly unique position of having always already been shaped by trans*. Nikki Sullivan is an associate professor of critical and cultural studies in the Department of Media, Music, Communication, and Cultural Studies at Macquarie University.