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• Professor and Academic Chair, Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden

Because of the capacity of the Trident missiles antibiotic resistance fact sheet discount minocycline 50mg with mastercard, the number of warheads in the British strategic nuclear arsenal was scheduled to filamentous bacteria 0041 generic minocycline 50 mg rise over the 1990s antibiotic not working for uti generic 50mg minocycline otc. The government promised to antibiotics for acne dry skin buy discount minocycline 50 mg on line keep warhead numbers down as an informal response to the changing political climate. This promise may also have been influenced by production problems with the warheads. Just before it entered service, Secretary of Defence Tom King confirmed that Trident would not "carry the maximum" number of warheads: We have long emphasized that each Trident submarine would carry no more than 128 warheads. This has always been an upper limit, not a specification: the number to be deployed in the mid-1990s onwards will be decided in the light of circumstances at the time. In practice, this still meant more warheads than Polaris, as each was of lower yield. In the autumn of 1991, it was these included four batteries of three Lance short-range missiles, plus 16 M-110 203mm self-propelled howitzer and 101 M-109 155mm self-propelled howitzer. The M-110 launched a shell of 2 kilotons to a distance of 14 kilometres with accuracy from 0. The M-109 had comparable accuracy and a slightly longer range with a yield of 2 kilotons. The 50 Missile Regiment and the 56 Special Weapons Battery Royal Artillery were disbanded. The bill for Trident had been largely paid: A significant portion of future nuclear expenditure would be used to decommission old weapons and facilities and would have had to be spent even if Trident itself was abandoned. It was decided that each of the four Trident submarines would now carry no more than 48 warheads, down from 96. This would leave Britain with the smallest stockpile of all the established nuclear powers, with a total yield representing less than 1 percent of the global total. After looking at a range of alternatives, in the end it was decided to configure Trident for possible use in a sub-strategic role, though this would be an enormously expensive method of delivering a small warhead. The 1998 Strategic Defence Review defined a "sub-strategic" role as, "an option for a limited strike that would not automatically lead to a full scale nuclear exchange. The full possible meaning of a "minimum" deterrent was explored further by not running the submarines intensively and by operating with only one crew per boat (compared with two during the Cold War). The missiles would not be on quick reaction alert but kept days away from operational readiness and not targeted against anyone in particular. Although the government claimed to be investigating all options, there was never much doubt that any replacement would follow the same path as before with a submarine-based system. There was no longer a serious air-based option and ground-based options all failed tests of survivability to first strikes. At the end of 2006, the Labour government produced a White Paper setting out the case for retention of the nuclear deterrent. The best argument against modernizing Trident appeared to be that the expenditure would be wasteful and meet no evident security purpose. As both sets of arguments were speculative, the debate was conducted with little passion and scant public interest. Labour dissidence was not as high as with the 2003 Iraq vote, although when the vote came in March 2007, Conservative support was still necessary for a majority. To mollify his backbenchers, Prime Minister Blair indicated that, "it is always open to us to come back and look at these issues. That would be absurd, unnecessary and, indeed, incompatible with the nuclear proliferation treaty. On 14 June 2007, the Scottish Parliament voted against renewing Trident by a 71 to 16 vote, with only the Conservatives in favor and most Labour members abstaining, other than five who voted with the opponents. A working group, chaired by Bruce Crawford, the Minister for Parliamentary Business, was established with an extremely broad remit, which includes questions of the legality of nuclear weapons and how to promote international peace and reconciliation, as well as more mundane but potentially significant issues, such as the licensing and regulatory framework relating to the main nuclear submarine base on the Clyde and the economic impact of ending its nuclear weapons role. In practice, little could be done about this issue by a devolved government, because defense and foreign policy are reserved powers under the 1998 Scotland Act. However, it would be an issue that an independent Scotland would undoubtedly address. There are questions of transport and planning over which it has some influence, but any attempt to use these to frustrate the policies of central government with regard to fundamental questions of national security would create a constitutional crisis.

First bacteria from bees possible alternative to antibiotics 50mg minocycline visa, they could be used as instruments for the purpose of specific political gains: as back-ups to bacteria webquest cheap 50mg minocycline fast delivery conventional forces used for intervention abroad infection urinaire minocycline 50mg fast delivery, or as instruments for coercing adversaries directly antibiotics heartburn buy cheap minocycline 50mg online. Second, as symbols of great power, nuclear weapons could conceivably be used as a platform for acquiring enhanced global status. At the regional level, India was long viewed as a "hegemon," and not a particularly benign one either, since it incorporated one small neighbor into its territory (Sikkim), signed unequal treaties with two others (Bhutan, Nepal) and intervened militarily in three (Pakistan in 1971, Sri Lanka in 1987, and the Maldives in 1988). India-Sri Lanka relations have reached a stage where Sri Lankan leaders have repeatedly pressed for free trade, a defence pact, and even Indian involvement in their ethnic crisis. India has signed a new and more egalitarian treaty with Bhutan and indicated its willingness to do the same with Nepal. Relations with Bangladesh have improved significantly, reflected in the April 2008 revival of cross-border train service after four decades. India, for its part, has shown no inclination to intervene in any of these states despite its growing power and despite the high level of instability in all except Bhutan. Given its low nuclear profile and the reorientation of its role in its neighborhood, it seems fair to say that India is highly unlikely to conceive of nuclear weapons as having any part to play in shaping its growth as a regional power. As a rising power, India has begun to spread its strategic wings to its neighboring regions. The "Look East" policy has seen its increasing involvement in Southeast Asia and a growing interest in the politics of Northeast Asia. The 1998 tests were explicitly said to be a response to China as "potential threat number one. It is well known that postindependence, India has sought a major role in world politics. The current "awakening of the sleeping giant" syndrome carries with it some of the flavor of the past and is widely expressed in the preoccupation with catching up with China and with acquiring a seat at the table of major world powers. In part, the Indian quest for permanent membership on the Security Council reflects this (though there are more practical benefits to be gained as well). The critics are mainly Americans, who tend to think that the expansion of an arsenal is easy to conceive of and implement if one has the means. There is nothing in ** A 2007 poll by Bertelsmann Stiftung found that 79 percent of Indians believed India would be a "world power" by 2020, whereas only 29 percent of respondents from eight other nations believed the same. India has learned from the experience that its "advantage"-India would suffer relatively less damage than Pakistan in the event of a nuclear exchange-offers no comfort when a nuclear conflict draws uncomfortably close. There are no signs of a shift to conceiving of nuclear weapons as instruments for the projection of Indian power. What this means is that nuclear weapons per se are not objects of high value, but rather that the nature of the international regime for their governance is. Though official data are not available, the following are widely accepted as reliable. Newer platforms will almost certainly be available with the major expansion envisaged by the Indian Air Force. The Prithvi-I land-based short-range ballistic missile (150 km) has been inducted into the army and is believed to be deployable. On one hand, India has adhered to its minimalist approach: its weapons remain in a non-deployed posture; it has declared and stayed committed to a self-imposed moratorium on further testing; and it has expressed a continuing interest in disarmament. The BrahMos short-range cruise missile (290 km) is officially dubbed a conventional weapon, but is reported to have the potential capability to carry a small nuclear weapon. While it is now assigned to the Army, air and naval versions are under development. Saraswat speculated in August 2007 that the need might arise for a 10,000 km-range missile in the future. The most elaborate statement of minimum deterrence doctrine made so far, an interview given by then External Affairs Minister Jaswant Singh in 1999, One report (Ibid. Rajat Pandit, "N-Submarine May Be Operational by 2012," Times of India (March 18, 2007). But there is little doubt that nuclear weapons are not viewed in a serious operational way by political decision makers. This is not surprising, for all the National Security Advisers since 1998 have been former bureaucrats with little exposure to the rarefied world of nuclear doctrine.

There is no specific treatment and the prognosis is poor antibiotics overview buy discount minocycline 50mg, with most patients dying less than a year after diagnosis antibiotic invention generic minocycline 50mg free shipping. The typical presentation is ventricular tachycardia or sudden death in a young man vyrus 987 c3 4v best minocycline 50mg. Other causes include uraemia antibiotic medical abbreviation buy 50 mg minocycline overnight delivery, autoimmune rheumatic diseases, trauma, infection (bacterial, tuberculosis, fungal) and malignancy (breast, lung, leukaemia and lymphoma). Clinical features There is sharp retrosternal chest pain which is characteristically relieved by leaning forward. Pericardial effusion and tamponade Pericardial effusion is an accumulation of fluid in the pericardial sac which may result from any of the causes of pericarditis. Hypothyroidism also causes a pericardial effusion which rarely compromises ventricular function. Pericardial tamponade is a medical emergency and occurs when a large amount of Pericardial disease 481 pericardial fluid (which has often accumulated rapidly) restricts diastolic ventricular filling and causes a marked reduction in cardiac output. Clinical features the effusion obscures the apex beat and the heart sounds are soft. This is the result of increased venous return to the right side of the heart during inspiration. The increased right ventricular volume thus occupies more space within the rigid pericardium and impairs left ventricular filling. Pericardial fluid is drained percutaneously by introducing a needle into the pericardial sac. If the effusion recurs, despite treatment of the underlying cause, excision of a pericardial segment allows fluid to be absorbed through the pleural and mediastinal lymphatics. Clinical features the heart becomes encased within a rigid fibrotic pericardial sac which prevents adequate diastolic filling of the ventricles. The clinical features resemble those of right-sided heart failure, with jugular venous distension, dependent oedema, hepatomegaly and ascites. Clinically, constrictive pericarditis cannot be distinguished from restrictive cardiomyopathy (p. Investigations A chest X-ray shows a normal heart size and pericardial calcification (best seen on the lateral film). The definition of hypertension is over 140/90 mmHg, based on at least two readings on separate occasions. The common causes are diabetic nephropathy, chronic glomerulonephritis, adult polycystic kidneys, chronic tubulointerstitial nephritis and renovascular disease. Secondary causes of hypertension may be suggested by specific features, such as attacks of sweating and tachycardia in phaeochromocytoma. The characteristic histological change is fibrinoid necrosis of the vessel wall and untreated it will result in end-organ damage in the kidneys (haematuria, proteinuria, progressive kidney disease), brain (cerebral oedema and haemorrhage), retina (flame-shaped haemorrhages, cotton wool spots, hard exudates and papilloedema) and cardiovascular system (acute heart failure and aortic dissection). Investigations are carried out to identify end-organ damage and those patients with secondary causes of hypertension. Patients under 40 years old with no risk factors or those where an underlying cause is suspected. In other patients, treatment is started if repeated measurements confirm sustained hypertension (Table 10. For patients with diabetes, chronic kidney disease or cardiovascular disease, a lower target of 130/80 mmHg is recommended. For each class of antihypertensive there will be indications and contraindications in specific patient groups.

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References:

• https://www.acc.org/~/media/clinical/pdf-files/approved-pdfs/2012/02/16/14/42/2011_pad_pktguide.pdf
• https://rsds.org/wp-content/uploads/2015/06/CRPS-Denver-2015-Chopra.pdf
• https://www.gene.com/download/pdf/avastin_crc_factsheet.pdf
• https://mariamontanavivas.files.wordpress.com/2014/03/pediatric-cardiology.pdf
• https://cancerpreventionresearch.aacrjournals.org/content/5/5/701.full-text.pdf