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The usual incubation period is 3 to vacuna antiviral aftosa cheap 5 mg prograf otc 6 days anti viral oil order prograf 1mg visa, except for acute hemorrhagic conjunc tivitis antiviral resistant herpes prograf 1mg low price, in which the incubation period is 24 to hiv infection white blood cells generic prograf 5 mg line 72 hours. Although used less frequently for diagnosis, acute infection with a known enterovi rus serotype can be determined at reference laboratories by demonstration of a change in neutralizing or other serotype-specifc antibody titer between acute and convalescent serum specimens or detection of serotype-specifc IgM, but these methods are relatively insensitive, and commercially available serologic assays may lack specifcity. Interferons occasionally have been used for treatment of enterovirus-associated myocar ditis, again without defnitive proof of effcacy. The antiviral drug pleconaril has activ ity against enteroviruses but is not available commercially. Other measures include avoidance of contaminated utensils and fomites and disinfection of surfaces. Fatal disseminated infection or B-lymphocyte or T-lymphocyte lymphomas can occur in children with no detectable immunologic abnor mality as well as in children with congenital or acquired cellular immune defciencies. The highest incidence of these disorders occurs in liver and heart transplant recipients, in whom the proliferative states range from benign lymph node hypertrophy to monoclonal lymphomas. Infection commonly is contracted early in life, particularly among members of lower socioeconomic groups, in which intrafamilial spread is common. Nonspecifc tests for heterophile antibody, including the Paul-Bunnell test and slide agglutination reaction test, are available most commonly. The heterophile antibody response primarily is immu noglobulin (Ig) M, which appears during the frst 2 weeks of illness and gradually disap pears over a 6-month period. An absolute increase in atypical lympho cytes during the second week of illness with infectious mononucleosis is a characteristic but nonspecifc fnding. Schematic representation of the evolution of antibodies to various Epstein-Barr virus antigens in patients with infectious mononucleosis. Contact sports should be avoided until the patient is recovered fully from infectious mononucleosis and the spleen no longer is palpable. Following the initial 3-week period, clearance for contact sport participation is determined primarily by the presence of splenomegaly and secondarily by the severity of clinical symptoms. Imaging modalities, such as ultrasonography or computerized tomography, offer greater sensitivity and accuracy and may be useful in determining whether an athlete safely can be returned to competition in a contact sport. Other important gram-negative bacilli causing neonatal septicemia include non-K1 strains of E coli and Klebsiella species, Enterobacter species, Proteus species, Citrobacter species, Salmonella species, Pseudomonas species, Acinetobacter species, and Serratia species. Reservoirs for gram-negative bacilli also can be present within the health care environment. Acquisition of gram-negative organisms can occur through person-to person transmission from hospital nursery personnel and from nursery environmental sites, such as sinks, countertops, powdered infant formula, and respiratory therapy equipment, especially among very preterm infants who require prolonged neonatal intensive care management. Metabolic abnormalities (eg, galactose mia), fetal hypoxia, and acidosis have been implicated as predisposing factors. Neonates with defects in the integrity of skin or mucosa (eg, myelomeningocele) or abnormalities of gastrointestinal or genitourinary tracts are at increased risk of gram-negative bacterial infections. Multiple mechanisms of resistance in gram-negative bacilli can be present simul taneously. Carbapenem-resistant strains have emerged among Enterobacteriaceae, especially Klebsiella pneumoniae. The incubation period is variable; time of onset of infection ranges from birth to several weeks after birth or longer in very low birth weight, preterm infants with pro longed hospitalizations. Special screen ing and confrmatory laboratory procedures are required to detect some multiply drug resistant gram-negative organisms. Expert advice from an infectious disease specialist can be helpful for management of meningitis. Periodic review of in vitro antimicrobial susceptibility patterns of clinically important bacterial isolates from newborn infants, especially infants in the neonatal intensive care unit, can provide useful epidemiologic and therapeutic infor mation. Illness occurs almost exclusively in children younger than 2 years of age and predominantly in resource-limited countries, either sporadically or in epidemics. Each pathotype comprises characteristic serotypes, indicated by somatic (O) and fagellar (H) antigens. Many food vehicles have caused E coli O157 outbreaks, including undercooked ground beef (a major source), raw leafy greens, and unpasteurized milk and juice. Outbreak investigations also have implicated petting zoos, drinking water, and ingestion of recreational water. The incubation period for most E coli strains is 10 hours to 6 days; for E coli O157:H7, the incubation period usually is 3 to 4 days (range, 1–8). Most 1 E coli O157:H7 isolates can be identifed presumptively when grown on sorbitol-containing selective media, because they cannot ferment sorbitol within 24 hours. Antimotility agents should not 2 be administered to children with infammatory or bloody diarrhea. Careful monitoring of patients with hemorrhagic colitis (including complete blood cell count with smear, blood 1 Centers for Disease Control and Prevention. Recommendations for diagnosis of Shiga toxin-producing Escherichia coli infections by clinical laboratories. However, a controlled trial has not been performed, and a benefcial effect of antimicrobial treatment has not been proven. Strict attention to hand hygiene is important but can be insuffcient to prevent transmis sion. The child care center should be closed to new admissions during an outbreak, and care should be exercised to prevent transfer of exposed children to other centers. Exposed patients should be observed closely, their stools should be cul tured for the causative organism, and they should be separated from unexposed infants (also see Children in Out-of-Home Child Care, p 133). Travelers should be advised to drink only bottled or canned beverages and boiled or bottled water; travelers should avoid ice, raw produce including salads, and fruit that they have not peeled themselves. Antimicrobial therapy generally is recommended for trav elers in resource-limited areas when diarrhea is moderate to severe or is associated with fever or bloody stools. Several antimicrobial agents, such as azithromycin, doxycycline, rifaximin, and ciprofoxacin, can be effective in treatment of travelers’ diarrhea. The drug of frst choice for children is azithromycin and for adults is ciprofoxacin. Packets of oral rehydration salts can be added to boiled or bottled water and ingested to help maintain fuid balance. Fungal Diseases In addition to the mycoses listed by individual agents (aspergillosis, blastomycosis, candi diasis, coccidioidomycosis, cryptococcosis, paracoccidioidomycosis, and sporotrichosis) in section 3, infants and children with immunosuppression or other underlying conditions can become infected by uncommonly encountered fungi. Children can acquire infection with these fungi through inhalation via the respiratory tract or direct inoculation after traumatic disruption of cutaneous barriers. Consultation with a pediatric infectious disease specialist experienced in the diagnosis and treatment of invasive fungal infections should be considered when caring for a child infected with one of these mycoses. Invasive disease attributable to Fusobacterium species has been reported following otitis media, tonsillitis, gingivitis, and oropharyngeal trauma. Otogenic infection is the most frequent primary source in children younger than 5 years of age and can be complicated by meningitis and thrombosis of dural venous sinuses. Fever and sore throat are followed by severe neck pain (anginal pain) that can be accompanied by unilateral neck swelling, trismus, and dysphagia. People with classic Lemierre disease have a sepsis syndrome with multiple organ dysfunction, disseminated intravascular coagulation, empyema, pyogenic arthritis, or osteomyelitis. Fusobacterium infections are most common in ado lescents and young adults, but infections, including fatal cases of Lemierre disease, have been reported in infants and young children. Children with sickle cell disease may be at greater risk of infection, particularly osteomyelitis. The accurate identifcation of anaerobes to the species level has become important with the increasing incidence of microorganisms that are resistant to multiple drugs. Febrile children and adolescents, especially those with sore throat or neck pain who are suffciently ill to warrant a blood culture, should have an anaerobic blood culture in addition to aerobic blood culture performed to detect invasive Fusobacterium species infec tion. Metronidazole is the treatment preferred by many experts, because the drug has excellent activity against all Fusobacterium species and good tissue penetration. Fusobacterium species intrinsically are resistant to gentamicin and fuoroquinolone agents. Up to 50% of F nucleatum and 20% of F necrophorum isolates produce beta-lactamases, rendering them resistant to penicillin, ampicillin, and some cephalosporins. Because Fusobacterium infections often are polymicrobial, multiple antimicrobial agents frequently are necessary. Therapy has been advocated with a penicillin-beta-lactamase inhibitor combination (piperacillin-tazobactam or ticarcillin-clavulanate) or a carbap enem (meropenem or imipenem) or combination therapy with metronidazole in addition to other agents active against aerobic oral and respiratory tract pathogens (cefotaxime, ceftriaxone, or cefuroxime). Surgical intervention involv ing debridement or incision and drainage of abscesses may be necessary. In cases with extensive thrombosis, anticoagulation therapy may decrease the risk of clot extension and shorten recovery time.

It may be a good idea to hiv infection statistics 2012 generic prograf 1mg with mastercard make a test panel to hiv infection chart generic 5 mg prograf mastercard evaluate the degree of surface preparation required and the compatibility of the finish system functional assessment of hiv infection questionnaire buy discount prograf 5mg line. For full keel boats or power boats lemon antiviral cheap prograf 1 mg line, add approxi Mini Pumps 1pr 1pr 1pr 1pr 1pr mately 10% to the product 407 Low-Density 1 -0 -0 -0 -0 -0 quantity. You 407 Low-Density 2 18oz 27oz 36oz 54oz 108oz may find it more economical 407 Low-Density 3 36 oz 54 oz 72 oz 108 oz 216 oz to purchase supplies in larger quantities. When purchasing resin and hardener, be sure both containers are labeled with the same Group Size letter (A, B or C). Package size/quantity Coating coverage Group Resin Hardener Mixed Saturation coat Buildup coats Size quantity quantity quantity porous surfaces non-porous surfaces 205-A or 206-A 90–105 sq. Epoxy tips Thinning epoxy Epoxy storage/shelf life There are epoxy-based products specifically designed to penetrate and reinforce Store at room temperature. These products, basically an epoxy thinned with solvents, do a good containers closed to preventcontami job of penetrating wood. If you chose to thin the epoxy, keep in mind that the strength, especially Hardeners may darken with age, but compressive strength, and moisture protection of the epoxy are lost in proportion physical properties are not affected to the amount of solvent added. There is a better solution to get good penetration without losing strength or mois Mini Pumps may be left in containers ture resistance. On contact with the warmed is a good idea to verify the metering wood, the epoxy will thin out, penetrating cavities and pores, and will be drawn accuracy of the pumps and mix a even deeper into pores as the wood cools. Although the working life of the epoxy small test batch to assure proper will be considerable shortened, slower hardeners (206, 207, 209) will have a lon curing. When the epoxy cures it will retain all of its strength and effectiveness as a storage may cause crystallization of moisture barrier, which we feel more than offsets any advantages gained by 105 Resin. Tools and Equipment 47 Tools and Equipment Moisture Meters There are several non-destructive J. Keep in mind that these read (800) 321-4878 ings can indicate relative dryness at different locations, and not accurate true measurements of the moisture content throughout the laminate. Moisture meters are available from: Roller cover brushes Used to tip off fresh coats of epoxy A 7" wide roller cover brush for large areas 1 Cut an 800 Roller cover into two segments and attach to a A32" wide roller cover brush for small areas long handle. Drag the brush over fresh epoxy with light, even pres 12 Roller cover sured, overlapping strokes. In longer than what would be ex warm climates the cooler can pected at high temperatures. In cool weather, fill the box with A warm water to keep the viscosity of Apply fillets at all inside corners and coat the epoxy thin and easy to apply. The box Designed by John Koeck 48 Cold Temperature Bonding Cold Temperature Bonding Techniques for Bonding and Coating at Low Temperatures Epoxy can be used under cold weather conditions, but you must use special application techniques. These precautions are not elaborate or difficult, but they are necessary to achieve acceptable long-term epoxy performance. In fact, due to differences in formu lation, not all epoxies possess the necessary characteristics to ever cure well under cold weather conditions. Chemical characteristics When you mix an epoxy resin and hardener together, you start a chemical reaction which, as a byproduct, produces heat. The ambient tempera ture in which an epoxy chemical reaction takes place affects the rate of reaction. Warmer temperatures accelerate the reaction time, while cooler temperatures retard it. Duration of reaction, among other variables, influences inter-bonding of the epoxy mole cules. If the reaction is too slow, even though the epoxy may harden, it may not cure com pletely and possibly never achieve its designed physical properties. This is where danger lies, for improperly cured epoxy may possess enough strength to hold a structure together, yet it may fail after repeated loadings during normal operation. Working properties Temperature has a profound effect on the working properties of uncured epoxy. Ambient temperature changes will drastically change the epoxy’s viscosity (thickness). Viscosity of water varies little with temperature changes until it either boils or freezes. Epoxy, however, is made of heavier molecules and temperature can have a 10 times greater effect on epoxy molecules than on water molecules over a temperature change of 30°F (16°C). The colder it gets, the thicker the epoxy becomes, reducing its ability to flow out. This kind of change has three important consequences for working with epoxy under cold condi tions. First, it is more difficult to mix the resin and hardener thoroughly: the resin flows through the dispensing pumps and out of containers with greater difficulty; the cold epoxy and hardener are prone to clinging to the surfaces of the pumps, containers and mixing tools; and they resist being completely blended unless mixed very thoroughly. Remember, be cause of the low temperature, the chemical reaction isn’t going off as well either. Com pounding a less efficient exothermic reaction with potential for incomplete and/or inaccurate mixing, you have the recipe for a permanently deficient bond. If you’ve ever tried to spoon honey right out of the refrigerator instead of at room temperature, you know just what we’re referring to: the chilled mixture has become stiff. When cold temperatures make epoxy stiff, it’s ex tremely difficult to coat and wet out surfaces. Third, air bubbles may be introduced when mixing and held in suspension due to the chilled epoxy’s increased surface tension. Cold weather techniques Up to this point, we’ve told you all of the reasons why cold weather epoxy usage is difficult and potentially dangerous. However, with a little advance planning and certain simple pre cautions, all of these problems can be addressed and their consequences avoided. It exhibits a faster cure characteristic than 206 Slow Hardener and offers less uncured exposure time which reduces the chances of incomplete cure due to cold temperatures. All epoxies have been formulated for a specific mixing ratio of resin to hardener. It is im portant to mix your epoxy in the precise ratio recommended by the manufacturer. Increas ing the amount of hardener will not accelerate cure, but it will seriously compromise the epoxy’s ultimate strength. As we discussed above, the warmer the resin and hardener, the lower the viscosity. And thinner resin and hardener will flow through mechanical pumps better, cling less to con tainers and mixing equipment, and exhibit superior handling and wet-out characteristics. The epoxy can be warmed using heat lamps or can simply be kept in a warm area until you are ready to use it. Another simple method of warming the resin and hardener is to con struct a small hot box out of rigid sheets of foil-backed insulation. Place a regular light bulb or an electric heating pad inside to maintain a temperature of no greater than 90°F (32°C). Use extra care when mixing the resin and hardener, and mix for longer than normal periods of time. Scrape the sides and bottom of the mixing container, using a flat-ended mixing stick to reach the corners. Using a smaller diameter mixing pot will also improve the chemi cal activity because the limited surface area will not dissipate heat produced by the reaction. Applying warmed epoxy to a cold structure will quickly retard the molecular bonding ac tivity of the epoxy. Be certain the structure, as well as the area surrounding the structure, is brought up to temperature. A hull, for example, which is colder than the surrounding air may experience condensation and result in water contamination to epoxy applied on it. This can be done by constructing tents around small areas and heating with portable heaters or warming the area with hot air guns or heat lamps. Small components or materials (such as fiberglass cloth) can be warmed before use in a hot box as described above.

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The medical examiner may use his/her clinical expertise and results of the individual driver examination to hiv infection lawsuit cheap prograf 5mg free shipping determine the length of time between recertification examinations hiv infection more condition symptoms purchase prograf 5mg free shipping. Figure 10 Medical Examination Report Form: Blood Pressure/Pulse Rate Recommendation Table the following table corresponds to hiv dual infection symptoms purchase prograf 1mg line the first two columns of the recommendation table in the Medical Examination Report form side effects of antiviral meds purchase prograf 1mg with amex. Use the Expiration Date and Recertification columns to assist you in determining driver certification decisions. Expiration Date Recertification 1 year 1 year if less than or equal to 140/90 1 year from date of examination if less than One-time certificate for 3 months or equal to 140/90 6 months from date of examination if less 6 months if less than or equal to 140/90 than or equal to 140/90 Table 3 Blood Pressure/Pulse Rate Recommendation Table Columns 3 and 4 A driver with Stage 3 hypertension (greater than or equal to 180/110) is at an unacceptable risk for an acute hypertensive event and should be disqualified. Urinalysis the Medical Examiner Completes section 6: Table 4 Medical Examination Report Form: Laboratory and Other Test Findings Laboratory and Other Test Findings — Medical Examiner Instructions Regulations — You must perform a urinalysis (dip stick) Test for: • Specific gravity. Additional Tests and/or Evaluation from a Specialist Abnormal dip stick readings may indicate a need for further testing. Page 38 of 260 Physical Examination the Medical Examiner completes section 7: Figure 11 Medical Examination Report Form: Physical Evaluation Physical Examination — Record Driver Height and Weight Regulations — You must measure and record driver height (inches) and weight (pounds) the physical qualification standards do not include any maximum or minimum height and weight requirements. You should consider height and weight factors as part of the overall driver medical fitness for duty. You must document abnormal findings on the Medical Examination Report form, even if not disqualifying. Page 39 of 260 Start your comments using the number to indicate the body system. Your comments should: • Indicate whether or not the abnormality affects driving ability. Is an eye abnormality an indicator that additional evaluation, perhaps by a specialist, is needed to assess the nature and severity of the underlying condition At a minimum, you must check for scarring of the tympanic membrane, occlusion of the external canal, and perforated eardrums. Should the driver consult with a primary care provider or hearing specialist for possible treatment that might improve hearing test results Mouth and Throat Does the condition or treatment require long-term follow-up and monitoring to ensure that the disease is stabilized, and the treatment is effective and well tolerated Heart You must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator. Does your examination find any abnormalities that indicate the driver may have a current cardiovascular disease accompanied by and/or likely to cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure The commercial driver must be able to perform all job related tasks, including lifting, to be certified. Check for fixed deficits of the extremities caused by loss, impairment, or deformity of an arm, hand, finger, leg, foot, or toe. Does the driver have clubbing or edema that may indicate the presence of an underlying heart, lung, or vascular condition Neurological You must examine the driver for impaired equilibrium, coordination, and speech pattern. However, you should complete the examination to determine if the driver has more than one disqualifying condition. When you: Certify — discussion may include: • Reason for periodic monitoring and shortened examination interval. Medical Examination Report Form • You are to retain the driver medical records for a minimum of 3 years. Although you cannot exceed the maximum certification period, you are never required to certify a driver for a certification interval longer than what you deem necessary to adequately monitor driver medical fitness for duty. Certify — Determine Certification Interval Overview Regulations — Maximum certification 2 years Qualify for 2-Year Certificate Page 44 of 260 Figure 12 Medical Examination Report: 2 Year Certification When your examination finds that the driver meets all physical qualification standards, you can certify the driver for the maximum 2 years. You are never required to certify a driver for a certification interval longer than what you deem necessary to adequately monitor driver medical fitness for duty. Page 45 of 260 Certify — Require Driver to Wear Corrective Lenses and/or Hearing Aid Regulations — Maximum certification 2 years with corrective lenses and/or hearing aid Qualify – With Requirement to Wear Corrective Sensory Perception Device Figure 14 – Medical Examination Report: Certification with Requirement to Wear Corrective Sensory Perception Device As a medical examiner, you must specify, as a requirement for certification, that a driver wear corrective lenses and/or a hearing aid when that driver has to use one or both to meet the vision and/or hearing physical qualification requirements. A copy of the Medical Examination Report form is required with both the initial and renewal Federal exemption applications. Qualify – Driving Within an Exempt Intracity Zone • Intracity zones are geographical areas defined in the regulations. Disqualify — Discuss and Document Decision Regulations — Disqualify driver who does not meet standards As a medical examiner, you must disqualify the driver who: • Fails to meet a physical qualification requirement cited in the standards. Disqualify (Does Not Meet Standards) Figure 17 Medical Examination Form: Disqualify Page 48 of 260 Document the decision to disqualify on the Medical Examination Report form. Disqualify Temporarily Figure 18 Medical Examination Form: Disqualify Temporarily When the disqualifying condition or treatment has a clinical course likely to restore driver medical fitness for duty, you may complete the: • “Temporarily disqualified due to (condition or medication): ” line. When a recommended waiting period is applicable, the date: • Should be greater than or equal to the waiting period. Have the driver sign the certificate and compare this with the information provided by the driver. Verify that the expiration date does not exceed the certification interval (maximum certification period is 2 years). Whereas guidelines, such as advisory criteria and medical conference reports, are recommendations. While not law, the guidelines are intended as best practices for medical examiners. Proposed changes to guidelines will accompany the standards as guidance and are subject to public notice-and-comment rulemaking. The driver must perceive the relative distance of objects, and react appropriately to vehicles in adjacent lanes or reflected in the mirrors, to pass, make lane changes, and avoid other vehicles on the road. The visual demands of driving are magnified by vehicles that have larger blind spots, longer turning radiuses, and increased stopping times. Health History and Physical Examination Health History Here are the vision questions that are asked in the health history. Eyeglasses or contact lenses may be worn to meet distant visual acuity requirements. Figure 20 Snellen Chart Snellen chart is illustrative only and not suitable for vision testing Page 54 of 260 Visual Acuity Test Results the Snellen eye test results use 20 feet as the norm, represented by the numerator in the Snellen test result. The number of the last line of type the driver read accurately is recorded as the denominator in the Snellen test result. The minimum qualification requirement is distant visual acuity of at least 20/40 in each eye and distant Figure 22 Visual Acuity Test Results binocular acuity of at least 20/40. If a test other than the Snellen is used to test visual acuity, the test results should be recorded in Snellen-equivalent values. Peripheral vision Figure 21 Snellen Eye Chart – Illiterate the requirement for peripheral vision is at least 70° in the horizontal meridian for each eye. In the clinical setting, some Snellen chart is illustrative only and form of confrontational testing is often used to evaluate not suitable for vision testing peripheral vision. Some form of confrontational testing that tests vision of selected horizontal points is generally used in the clinical setting. A "Protocol for Screening the Visual Field Using a Confrontation Method" is found in Appendix E of the Visual Requirements and Commercial Drivers report. Extend your arms forward and position your hands halfway between yourself and the driver. Position your right hand one foot to the right of the straight-ahead axis and six inches above the horizontal plane. Repeat the procedure with your hands positioned six inches below the horizontal meridian. Color vision the color vision requirement is met by the ability to recognize and distinguish among red, amber, and green, the standard colors of traffic control signals and devices. Additional Evaluation and/or Ancillary Tests Eye trauma and ophthalmic disease can adversely impact visual performance and interfere with safe driving. The medical examiner then considers the documented results and the specialist opinion when determining if the vision meets qualification requirements. Certification and Documentation the qualified driver meets all of the following requirements: • Distant acuity of at least 20/40 in each eye, • Binocular acuity of at least 20/40, • Horizontal field of vision of at least 70° measured in each eye, and • the ability to recognize and distinguish among traffic control signals and devices showing standard red, amber, and green colors.

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For those who indicated that science was their most important value antiviral kleenex purchase prograf 1mg overnight delivery, wearing the lab coat aYrmed an important domain antiviral research impact factor 2014 order 1mg prograf with amex. For others who indicated that science was not an important domain hiv infection and aids difference order prograf 5 mg free shipping, wearing a lab coat was not selfaYrming hiv infection rate with condom order 1 mg prograf visa. As predicted, with one exception, all groups showed the standard ‘‘spreading of alternatives’’ eVect. They inated the value of the option chosen and denigrated the value of the option foregone—a gardenvariety rationalization eVect. The exception was those scienceminded students who wore the lab coat, and who thus had the opportunity to restore their selfintegrity through the aYrmation of an important selfidentity. These participants did not defensively change their attitudes to make them concor dant with their choice (see also Steele & Liu, 1983). A full review of the theoretical debate concerning the circumstances under which selfaYrmation is a viable explanation for cognitive dissonance phe nomena is beyond the scope of this chapter (see Aronson et al. For example, Matz and Wood (2005) found that individuals report experiencing an aversive state of dissonance when others in a social group disagree with them. However, this dissonance discomfort was eliminated among participants who completed aselfaYrmation. Another study suggested that dissonance reduction results in overcondent judgments (Blanton, Pelham, Dettart, & Carvallo, 2001). That is, if one cares about the accuracy of one’s predictions then any cogni tions that call that accuracy into question are likely to arouse dissonance. This dissonance is reduced by nding reasons to bolster one’scondence in the accuracy of one’s predictions. However, this overcondence was eliminated among those who completed a selfaYrmation. Other studies have examined the conditions moderating the eVects of self aYrmation on dissonancereducing justications (as in Steele & Liu, 1983). When the selfaYrmations are in the same domain as the threatening infor mation, they have been found to exacerbate cognitive dissonance (Blanton, Cooper, Skurnik, & Aronson, 1997) because they make salient the personal standards that are violated with the dissonant behavior. Consequently, when given a choice, people tend to choose to aYrm the self in a domain unrelated to the perceived threat in order to reduce the dissonance they are experien cing (Aronson, Blanton, & Cooper, 1995). However, even aYrmations in alternative domains of selfworth are not impervious to disconrmation, and when they are disconrmed. Indeed, Dunning (2003) has argued that people are ‘‘zealous selfaYrmers’’ in that their social judgments often reect more about their own selfevaluative needs than about the target of judgment. When people dene what characteristics are likely to make a person have a successful marriage, they emphasize those character istics that they themselves possess rather than those they do not (Kunda, 1987). And they do so more after experiencing a threat to selfworth, than after experiencing an aYrmation of selfworth (Dunning & Beauregard, 2000; Dunning & Hayes, 1996; Dunning, Leuenberger, & Sherman, 1995). After experiencing a selfthreat, people may engage in any number of strategies to reaYrm selfintegrity via social judgment. These strategies include comparing the self with a clearly inferior other (Fein, Hoshino Browne, Davies, & Spencer, 2003), gossiping negatively about a third party (Wert, 2004; Wert & Salovey, 2004), or harshly judging a political ingroup member who fails to demonstrate as much fervor for the cause as one personally does (Beauregard & Dunning, 1998). At other times, esteem boosting social judgments take a more disturbing form; people may try to feel better about themselves by putting down members of a marginalized group (Fein & Spencer, 1997). Because stereotypes are ‘‘cognitively defensi ble’’ justications for denigrating others, people may be especially apt to use them to restore selfworth. Derogating an outgroup member would not only enhance one’s own selfworth via downward comparison processes, but also enhance the integrity of a person’s ingroup more generally. In one study, participants who were threatened with negative feedback on an intelligence task showed more stereotyping in their judgments of a gay male than those who received neutral feedback (Fein & Spencer, 1997). Thus, selfthreatening feedback can exacerbate outgroup derogation and the use of stereotypes. This nding suggests that selfimage maintenance concerns can motivate prejudicial responses. Is the converse true as well— can an aYrmation of an individual’s selfintegrity reduce the need to stereo type an outgroup member Fein and Spencer (1997) examined this possibili ty in one study where participants completed a selfaYrmation through writing about an important value (versus a control condition where they wrote about a relatively unimportant value). They did so prior to evaluating a job candidate who was presented either as a member of a negatively stereotyped group (Julie Goldberg, who t with a ‘‘Jewish American Prin cess’’ stereotype widely in circulation on campus at the time) or not (Maria D’Agostino, an Italian American). In the noaYrmation condition, partici pants made more negative evaluations of the candidate’s qualication for the job and viewed the personality of the Jewish woman more negatively than that of the Italian woman. Thus, the extent to which a person is threatened or aYrmed will aVect whether or not they are likely to make prejudicial judg ments of an outgroup member (cf. Indeed, in this study, selfaYrmation did not simply attenuate preju dice and discrimination but eliminated it. Comparing oneself to another person who is faring worse is another way that people may aYrm selfintegrity via social perception. When people have a vulnerable or easily threatened selfimage, they generally respond with downward social comparisons (Taylor & Lobel, 1989; Wills, 1981). Shelley Taylor and her colleagues (Taylor, Wood, & Lichtman, 1983) found that women with breast cancer responded to their highly threatening situation by making downward social comparisons. They would assert that their illness was, at least, less severe than that of another patient, or that they were coping with their illness better than others. These downward comparisons, Taylor suggested, helped patients to maintain a sense of worth in a situation where they struggled to maintain their sense of control, predictability, and optimism. Such downward comparisons, while helping to sustain self integrity, may by themselves limit an individual’s opportunities to learn from others who are more experienced or performing more optimally (indeed, such ‘‘upward’’ comparisons also have motivational benets; see Lockwood & Kunda, 1997). If people engage in downward social comparisons to compensate for a threatened selfimage, then they should engage in them to a lesser extent when selfaYrmed. Indeed, they may even be more prone to engage in upward comparisons that they might otherwise view as threatening (Spencer, Fein, & Lomore, 2001). In one study, college students completed a test of intelli gence, and they were informed that they performed at the 47th percentile. This mediocre performance presumably threatened participants’ selfimage as intelligent college students. Half of the students then had the opportunity to aYrm the self by writing an essay about an important value, whereas the other half wrote about an unimportant value. Then the participants, in a separate task, were informed that another participant would interview them. For the ostensible purpose of preparing them for their interview, they then listened to excerpts of two previous interviews. This choice provided an opportunity to make an upward comparison (if they selected the superior interviewee) or a downward comparison (if they selected the inferior interviewee). In the noaYrmation condition, the participants generally made downward comparisons, as 83% chose to hear the inferior interviewee. By contrast, among those who completed the selfaYrmation, 83% chose to hear the superior interviewee, making an upward social com parison. Once again, selfaYrmation reduced threat and thereby encouraged people to expose themselves to an informative but potentially threatening learning opportunity. In summary, predictions derived from selfaYrmation theory (Steele, 1988) have been supported in a wide range of situations involving selfthreat. When selfintegrity is aYrmed, people are less biased in their judgments of information related to their political identity (Cohen et al. SelfaYrmation inoculates people against threat, and thus makes them more open to ideas that would otherwise be too painful to accept. Theoretically consistent eVects of selfaYrmation have been found on selfreport measures, physiological responses, and behavior. When selfintegrity is secured, people seem less concerned with the selfevaluative implications of social experiences and are more likely to engage their social world in a nondefensive, open manner. The research detailed in the previous sections extends this theorizing to many other situations where people contend with events that challenge a personal identity. A major advance in selfaYrmation theory concerns its relevance to the way people cope with threats to their social. This work begins with the premise that social identities—such as aYliation with a sports team, membership in a gender or racial group, citizenship in a country, involvement in an organization—constitute important sources of identity (Abrams & Hogg, 1988; Deaux, 1996; Tajfel & Turner, 1986). Consequently, people will defend against threats to collective aspects of the self much as they defend against threats to individual or personal aspects of self. When a fellow member of one’s racial group confronts the threat of a negative stereotype, it is threatening to self even when one personally faces no risk of being prejudiced against (Cohen & Garcia, 2005).

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