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Patricia B. Crawford DrPH, RD

• Adjunct Professor

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Room 307 reactive arthritis diet nutrition buy line plaquenil, Third Level Moscone South Room 159 arthritis relief exercise buy plaquenil uk, Upper Mezzanine Moscone South Chair: Moscone South Chair: Kenneth S rheumatoid arthritis fatal purchase plaquenil 400 mg online. Look at the Psychiatrists Role Obsessive-Compulsive Disorder Sean Arayasirikul rheumatoid arthritis panel order plaquenil visa, Ph. Managing Complex Co-Occurring Moscone South Room 25, Exhibition Level Disorders Like an Addiction Expert: Chair: Moscone North Applying Current Research and John Raymond Peteet, M. Moscone North Chair: Policing and Mental Health: How Revitalize Family Psychiatry: Ray C. Include, Engage, and Innovate Presenters: 5 Addressing the Needs of Jeremy Douglas Kidd, M. The Evaluation and Health Services, and Prevention Treatment of Mood Disorders in Asian-American Mental Health U. Substance Abuse and Mental Case Examples of Pregnant Women Treatment and Engagement: Health Services Administration An Update on Challenges 1:00 p. Rooms 205/213, Second Level 4 A Room 152, Upper Mezzanine Moscone South Moscone South 1:00 p. Telepsychiatry to Achieve the Psychiatrists Can Decrease Barriers Triple Aim and Provide Gender-Afrming Care Learning Labs 4 1:00 p. Room 22, Exhibition Level Presenter: Moscone North the Impact of Technology Change Tamar C. Chair: on Human Behavior (and How to Evaluate It in Clinical Practice) Mary Kay Smith, M. Chairs: Moscone South Room 23, Exhibition Level Robert Kennedy Chair: Moscone North John Luo, M. Room 306, Third Level Room 21, Exhibition Level Moscone South Moscone North Chair: Chair: Paul Mark Elizondo, D. Courses require advance Innovative Techniques General Sessions registration and an 1:00 p. Diagnosis Patients Room 10, Exhibition Level American Psychiatric Association 1 Moscone South Medical Student Elective in 1:00 p. Presenters: the Psychiatrist as Expert Witness: Patrick Sheppard the Ins and Outs of Being a Luke Wallace Carson, M. Can We Tailor Care for Children All scientifc sessions listed Room 7, Exhibition Level With Autism Spectrum Disorder Room 308, Third Level Chair: Rooms 310/311, Third Level Moscone South George David Annas, M. American Society for Adolescent Rooms 305/309, Third Level Room 202, Second Level Psychiatry Moscone South Moscone South 2 5 Chair: Lindsey Zimmerman Chair: 3:00 p. Room 157, Upper Mezzanine Presenter: Moscone South Mark Freeman Presenters: Sara Becker, Ph. Versus Counterpoint Approaches to the Use of 1 Addiction Psychiatry Clozapine in Patients With Persistent Psychosis 2 Child and Adolescent Psychiatry 3:00 p. Fictional Mindfully Addressing the Opioid Pioneering Projects Within the Field Depictions of Suicide, Copycat, Epidemic: Is Pain a Sensation or a of Emergency Psychiatry and Contagion Thought Room 304, Third Level Room 153, Upper Mezzanine Rooms 205/213, Second Level Moscone South Moscone South Moscone South Chair: Chair: Chair: Jurgen Eelco Cornelis, M. Ansam Barakat Medication-Assisted Treatment Hans Nusselder and Behavioral Strategies to New Guideline Recommendations Treat Adolescents and Young for Strengthening Podcasting in Psychiatry: Listening, Adults With Substance Use and Psychiatric Practice Creating, and Transforming the Related Disorders Steering Committee on Practice Mental Health Learning Landscape 1 2 Guidelines 8 3:00 p. Room 158, Upper Mezzanine Moscone North Room 160, Upper Mezzanine Moscone South Chair: Moscone South Chair: Hector Colon-Rivera, M. Room 156, Upper Mezzanine Presenters: Presenters: Moscone South Etheldreda Nakimuli-Mpungu, M. Reducing Health Care Disparities Presenters: Through Careers in Public Gino Anthony Mortillaro, M. Room 212, Second Level Moscone South Moscone South Chairs: Chair: Enrico Guanzon Castillo, M. All scientifc sessions listed Presenters: Presenters: in the Scientifc Program Christina V. Substance Abuse and Mental in the Age of Climate Change: What Future: From Aftermath Psychiatry Health Services Administration Do We Know and What Can We Do Room 152, Upper Mezzanine Room 204, Second Level Room 21, Exhibition Level Moscone South Moscone South Moscone North Chair: Chairs: Chair: Anita Everett, M. Caucus on Positive Psychiatry Room 151, Upper Mezzanine Room 20, Exhibition Level Moscone South Moscone North 3:00 p. Moscone South Room 25, Exhibition Level Chair: Moscone North Danielle Hairston, M. Allied Organizations Academy of Cognitive Therapy American College of Psychiatrists Lynn McFarr, Ph. Academy of Organizational and Occupational American College of Surgeons Psychiatry Barbara L. American Group Psychotherapy Association American Academy of Addiction Psychiatry Eleanor Counselman, Ed. American Medical Association American Academy of Child and Adolescent Psychiatry Andrew Gurman, M. American Medical Womens Association American Academy of Family Physicians Connie Newman, M. American Neuropsychiatric Association American Academy of Psychiatry and the Law John J. American Nurses Association American Academy of Psychodynamic Psychiatry and Ernest Grant, M. American Association for Emergency Psychiatry American Psychological Association Jack Rozel, M. American Association for Geriatric Psychiatrists American Psychosomatic Society Rajesh Tampi, M. American Association for the Advancement of Science American Society of Addiction Medicine Susan Hockfeld, M. American Association of Chairs of Departments of American Society of Clinical Psychopharmacology, Inc Psychiatry Michael E. American Society of Hispanic Psychiatry American Association of Community Psychiatrists Bernardo Ng, M. Association for Academic Psychiatry American Association of Directors of Psychiatric John Teshima, M. Association of Directors of Medical Student Education in Psychiatry American College of Obstetricians and Gynecologists Susan W. Allied Organizations Association of Gay and Lesbian Psychiatrists National Association of Psychiatric Health Systems Eric Yarbrough, M. Association of Korean American Psychiatrists National Association of Social Workers, Inc Jaesu Han, M. Association of Women Psychiatrists National Council for Community Behavioral Healthcare Geetha Jayaram, M. Hellenic American Psychiatric Association Nigerian American Psychiatric Association Philip J. Indo-American Psychiatric Association Philippine Psychiatrists in America Dilipkumar Patel, M. Mental Health America Substance Abuse and Mental Health Services Tom Starling, Ed. National Association of County Behavioral Health and Developmental Disability Directors Mitchell Anderson, M. Presidents of International Allied Organizations Afghanistan National Psychiatrist Association Association of Free Psychiatrists of Romania Dr. Aurel Romila Albanian Psychiatric Association Association of Neurologists, Psychiatrists and Dr. Nadir Ismayilov 100 Presidents of International Allied Organizations Bangladesh Association of Psychiatrists Ethiopian Psychiatric Association Dr. Dawit Assefa Barbados Association of Psychiatrists European Psychiatric Association Dr. Silvana Galderisi Belarusian Psychiatric Association Finnish Psychiatric Association Dr. Chris Bervoets Botswana Psychiatric Association Foundation for Interdisciplinary Investigation of Dr.

In the worst cases rheumatoid arthritis etiology purchase plaquenil 200 mg without a prescription, the disease progresses through weakness arthritis shoulder pain buy plaquenil australia, depression horse arthritis definition buy plaquenil online now, rapid weight loss arthritis in knee feels like best 200 mg plaquenil, prostration, and death. Concern over the spread of individual serotypes by trade in animals and animal products has engendered costly worldwide trade barriers. Only modifed-live (attenuated) virus vaccines are available and a vaccine for only one serotype is currently available in the United States. In the chronic form, the signs of depression, anorexia, and fever are less severe than in the acute form, and recovery is occasionally seen in mature animals. Hog cholera virus is a lipid enveloped pathogen belonging to the family Flaviviridae, genus Pestivirus. Introduction of infected pigs is the principal source of infection in classical swine fever-free herds. Farming activities such as auction sales, livestock shows, visits by feed dealers, and rendering trucks also are potential sources of contagion. During the warm season, insect vectors common to the farm environment may spread hog cholera virus mechanically. Many of the routinely used disinfectants will effectively inactivate the organism. Although it has been reported that the domestic buffalo (Bubalus bubalis) is susceptible, the disease is diffcult to produce experimentally in this species. Outbreaks usually begin as the result of movement of an infected animal into a naive herd. Mycoplasma F-38, the probable cause of the classic disease, does not cause disease in sheep or cattle. These organisms often persist in the face of an immune response due to their protected intracellular status. Rickettsias in natural conditions are found in mammals and blood-sucking arthropods. Recommended precautions include incineration of fsh, tissues, blood and materials (gloves, laboratory coats, etc. General principles of laboratory safety should be practiced in handling and processing fsh samples for diagnostic or investigative studies. The virus can be propagated in certain primary or secondary cell cultures such as bovine thyroid and testis cells. The disease cannot be transmitted by natural means from one clinically susceptible host to another, because there is essentially no cell-free virus in tissues or secretions of diseased animals. Fruit bats are considered to be the natural host of the virus and their proximity to the affected premises led to an incidental infection in the pig population. Laboratory Safety and Containment Recommendations Laboratory practices for MenV are principally designed to prevent transmission to susceptible livestock, but also to protect workers. If isolates of moderate to high virulence for chickens are used for human cancer therapies, those isolates are probably of greater risk for inadvertent exposure of birds and poultry than they are to the humans handling or being treated with those viruses. There is no carrier state, and animals recovering from natural infection have lifetime immunity. It is immunologically related to canine distemper virus, human measles virus, peste des petits ruminants virus, and marine mammal morbilliviruses. Laboratory workers should have no contact with susceptible hosts for fve days after working with the agent. The virus can cause infection experimentally by intravenous, intradermal, intranasal, or subcutaneous inoculation. Laboratory Safety and Containment Recommendations Humans are not susceptible to infection by these poxviruses. Infections have occurred in common and koi carp (Cyprinus carpio), grass carp (Crenopharyngodon idellus), silver carp (Hypophthalmichthys molitix), bighead (Aristichthys nobilis), cruian carp (Carassius carassius), goldfsh (C. Long indigenous to Europe, the Middle East and Asia, the disease was reported recently in South and North America. In: Manual of standards for diagnostic tests and vaccines for terrestrial animals: mammals, birds and bees. Department of Agriculture Animal and Plant Health Inspection Service Veterinary Services, National Center for Import and Export 4700 River Road, Unit 133 Riverdale, Maryland 20737-1231 Telephone: (301) 734-5960 Fax: (301) 734-3256 Internet. Department of Agriculture Animal and Plant Health Inspection Service Plant Protection and Quarantine, Permits, Agricultural Bioterrorism 4700 River Road, Unit 2 Riverdale, Maryland 20737-1231 Telephone: (301) 734-5960 Internet. The Principles of Risk Assessment that discusses arthropods in the usual context. They also consider the following: Biological containment is a signifcant factor that reduces the hazards associated with accidental escape of arthropods. The Agricultural Bioterrorism Protection Act of 2002, Subtitle B of Public Law 107-188 (7 U. The regulations set out a procedure for excluding an attenuated strain of a select agent or toxin and exemptions for certain products and for select agents or toxins identifed in specimens presented for diagnosis, verifcation, or profciency testing. Many pests, such as fies and cockroaches, can mechanically transmit disease pathogens and compromise the research environment. Sanitation and Facility Maintenance Many pest problems can be prevented or corrected by ensuring proper sanitation, reducing clutter and pest habitat, and by performing repairs that exclude pests. Reports communicated verbally and in writing concerning pest activity and improvement recommendations for personnel, practices and facility conditions should be provided to the designated personnel. Appendix G: Integrated Pest Management 381 Pest Control with Pesticides Preventive applications of pesticides should be discouraged, and treatments should be restricted to areas of known pest activity. There are reports of infection of laboratory workers handling primary rhesus monkey kidney cells,1 and the bloodborne pathogen risks from working with primary human cells, tissues and body fuids are widely recognized. Tumorigenic human cells also are potential hazards as a result of self-inoculation. All laboratory staff working with human cells and tissues should be enrolled in an occupational medicine program specifc for bloodborne pathogens and should work under the policies and guidelines established by the institutions Exposure Control Plan. Guidelines for prevention of transmission of human immunodefciency virus and hepatitis B virus to healthcare and public safety workers. Toxins can be handled using established general guidelines for toxic or highly-toxic chemicals with the incorporation of additional safety and security measures based upon a risk assessment for each specifc laboratory operation. Training and Laboratory Planning Each laboratory worker must be trained in the theory and practice of the toxins to be used, with special emphasis on the nature of the practical hazards associated with laboratory operations. Laboratory work with toxins should be done only in designated rooms with controlled access and at pre-determined bench areas. Operations that expose toxin solutions to vacuum or pressure, for example sterilization of toxin solutions by membrane fltration, should always be handled in this manner, and the operator should also use appropriate respiratory protection. Glass Pasteur pipettes are particularly dangerous for transferring toxin solutions and should be replaced with disposable plastic pipettes. Additional Precautions Experiments should be planned to eliminate or minimize work with dry toxin. While removing exposed animals from the hoodline, and for required animal handling during the frst 24 h after exposure, workers should take additional precautions, including wearing protective clothing. Literature values for dry heat inactivation of toxins can be misleading due to variations in experimental conditions, matrix composition, and experimental criteria for assessing toxin activity. Moreover, inactivation is not always a linear function of heating time; some protein toxins possess a capacity to re-fold and partially reverse 388 Biosafety in Microbiological and Biomedical Laboratories inactivation caused by heating. All disposable material used for toxin work should be placed in secondary containers, autoclaved and disposed of as toxic waste. Select Agent Toxins Due diligence should be taken in shipment or storage of any amount of toxin. In the liquid state with a preservative (sodium azide), ricin can be stored at 4C for years with little loss in potency. Cages and bedding from animals exposed to T-2 mycotoxin or brevetoxin should be treated with 0.

It is also notable that although rare arthritis in dogs and treatment generic plaquenil 400mg overnight delivery, small amounts of snow and ice in the urbanized Phoenix Metropolitan Area can cause businesses and schools to shut down due to lack of equipment or capacity to deal with snow covered streets and roadways arthritis medial knee pain plaquenil 400mg fast delivery, and a general public that is unfamiliar with winter driving conditions and hazards arthritis treatment dogs buy 400 mg plaquenil with mastercard. The only notable exceptions include the higher elevation portions of Graham and Greenlee Counties rheumatoid arthritis therapy order generic plaquenil canada, the small community of Summerhaven at the top of Mount Lemmon, and areas near the Dragoon Mountains in Cochise County. Vulnerable Population Groups the entire 2015 estimated population of 1,458,367 people are considered to be exposed to winter storm events. Local Jurisdiction Vulnerability None of the South Region counties included winter storm in their risk assessments. Specific Areas of Concern the community of Summerhaven can quickly become isolated if the Catalina Hwy becomes impassable due to heavy snow and ice, or snow triggered mudslides and debris flows. It is also notable that although rare, small amounts of snow and ice in the urbanized Tucson Metropolitan Area can cause schools and businesses to shut down due to lack of equipment or capacity to deal with snow covered streets and roadways, and a general public that is unfamiliar with winter driving conditions and hazards. Heavy snowfalls can collapse roofs, close roads, and leave residents and travelers stranded in their homes or vehicles with potentially disastrous results like exposure, hypothermia, and carbon-monoxide poisoning. Snow, sleet and icy conditions can make driving treacherous and is a leading cause of fatalities and injuries on the northern and higher altitude interstates and highways of the state. Associated power outages can leave homes, businesses, and others without heat or water for days or possibly longer. Property/Facilities/Infrastructure Properties and structures may be vulnerable to roof damage or collapse during severe winter storms due to heavy snow. Public and private road clearing can be expensive and even dangerous in steep, mountainous 2018 242 2018 State of Arizona Hazard Mitigation Plan areas that are susceptible to avalanches. Power and cable outages can also occur from heavy snowfall and ice accumulation on overhead lines causing damage to the wires or breaking wooden poles. Air traffic can become grounded for significant periods of time until runways can be cleared. Responders Incident responders face the same threats as the general public, but on a more significant and probable level, as they are often directly exposed during the worst part of the storms. Responders can be hurt while responding to , or investigating, traffic accidents, by collision from other drivers who are unaware of the crash due to low visibility or loss of control due to poor road conditions. Responders also face injury when accessing victims in vehicles that may have driven off the roadway into areas that have rough or steep terrain. The chance of injury, illness, and death is significantly elevated for responders during winter storm events. Other threats to responders may include exhaustion, hypothermia, and exposure or physical injuries due to extremely cold temperatures. Additionally, significant snow storms can hinder both ground and air emergency service vehicles from responding to accidents or other emergencies. Continuity of Operations/Delivery of Services the performance and delivery of services may easily be hindered during a winter storm event due to damaged, closed and impassable roads that prevent employees from getting to their place of work, or damaged buildings that displace employees and functions served by the damaged building. Power outages can also affect the ability of the state to provide services, and especially at a local level. Access to remote areas of the state can be significantly hindered, and may cause small, isolated jurisdictions to shut down without support or assistance from neighboring jurisdictions to remain operational and self-sustaining during and after a significant event. Environment/Cultural Typically, there is not a significant risk posed to the environment from the effects of winter storms. There is a concern for areas that use salt to de-ice roadways as it can wash into lakes, streams, and seep into groundwater supplies. It is estimated 1 that about 137 pounds of salt per person annually is used in the United States to melt ice, the equivalent of 22 million tons. Flagstaff, for example, has experimented with using volcanic cinders on roads, as well as chemical de-icers such as Ice Slicer. This prompted some agencies to switch back to the use of cinders as they were locally available and caused less harm to the environment. The cultural impacts due to a winter storm are generally limited to temporary closures of culturally significant facilities during or after events, or the potential to permanently displace a cultural group due to structure damage. Economic/Financial Condition of Jurisdiction Responding to severe winter events can be costly in terms of both deployed resources and human life and safety. Severe winter storms affect transportation, utilities, agriculture and the supply of basic subsistence. Significant damage to these areas can cause economic hardship through loss of revenue, business and increased costs of necessary supplies to a shortage of supply. Damage and/or loss of crops and livestock can also result in revenue and supply losses. Public Confidence in Jurisdictions Governance As with all disaster events, the swiftness of response and recovery, as well as dissemination of information about the event, will have a direct impact on the publics confidence in the jurisdictions governance. The impacts of winter storms such as road or facility closures or loss of power, can erode the public confidence if the situations linger or take what the public might perceive as too long to repair. Cascading/Secondary Impacts Secondary effects of winter storms can include triggering of landslides or mudslides, avalanche, erosion of hillsides due to loss of trees from avalanches, springtime flooding from large winter snowpack, winter flooding due to rain-on-snow events, power outages, and the potential for hypothermia from exposure and disruption of heat sources. Lower elevation desert areas may experience runoff from rapid snowmelt following winter storm events that may lead to flooding and erosion. Freestone, Scott Brent, 2006, A Review of Climatological Data for Ground Snow Loads in Arizona. Climate Change Impacts in the United States: the Third 2018 244 2018 State of Arizona Hazard Mitigation Plan National Climate Assessment, J. They were revised to reflect our dedication to building capabilities and resilience, while involving the Whole Community. The goal and objectives are as follows: Hazard Mitigation Goal Increase resilience throughout the State of Arizona by reducing the vulnerability of people and property to natural and human-caused hazards. Ensure the wellbeing of Arizonas citizens and visitors by lessening the impact of hazards 5. Reduce the vulnerability of critical facilities and infrastructure from natural and human caused hazards 6. The hazards identified in the risk assessment are inclusive of all major hazards, and therefore encompasses the major risks and vulnerabilities of local, county, and tribal jurisdictions. The State of Arizona, in partnership with local, county, and tribal governments, utilizes a holistic, decentralized approach for hazard mitigation in an attempt to attain the common goal of reducing and/or eliminating the impact from hazards resulting in increased resilience. The 2013 Plans Mitigation Strategy was evaluated to determine the status and disposition of the mitigation measures. The 2013 Plans mitigation measures with status and disposition and supporting information are located in Appendix A. The mitigation measures included in this Plan update were prioritized using a model that allowed lead agencies to prioritize the mitigation measures they are responsible for implementing. New measures within the mitigation strategy were categorized with high, medium, or low designations based on which measures would be completed first to last. The strategies agencies were encouraged to use to prioritize their mitigation measures include, in order, but are not limited to: Direct impact on life Direct impact on property Long-term solution Benefit vs. Hazard Addressed: All climatic hazards Action: Promote and disseminate climate change research and workshop information and data to state agencies, local, county, and tribal jurisdictions in order to enable all parties to prepare for the potential future conditions of the state. Hazard Addressed: Flooding Priority: High Action: Assist local jurisdictions in acquiring, or otherwise mitigating, property located in the 100-year floodplain, beginning with repetitive loss properties. Estimated Completion: Ongoing/Annually Funding Source: Existing Staff/Budget 2013 Update: Some local jurisdictions have acquired homes in the floodplain that was converted to open space. The construction of the repairs at Magma Dam in Pinal County is complete and the safety deficiency is removed. Interim dam safety measures have been implemented at Powerline Dam in Pinal County. The owner is currently designing measures that will replace the dam with a conveyance structure. There is a design project currently underway to address the safety deficiencies at Fredonia Dam. Due to the economic recession and legislative sweeps of the Dam Repair Fund, no additional dam projects have been funded since 2009. Staff created two outreach brochures for distribution to communities and residents: Manufactured Homes, Recreational Vehicles, Park Trailers and Floodplains and Wildfire and Flood Risks.

Decontamination of food itself will be attempted only in emergency situations when there is no alternative supply of food infectious arthritis definition order cheapest plaquenil. The general decontamination procedure to be followed in sequence is: (1) Trimming of surface fat and/or grossly contaminated areas rheumatoid arthritis first symptoms buy plaquenil 400mg with amex. Frying arthritis in back legs of dog order plaquenil 400mg with mastercard, roasting or boiling will not remove traces of nerve or blister agents from meats rheumatoid arthritis youtube buy genuine plaquenil line. In general, salvage of foods contaminated with droplets of the blister agents is not practical. Contamination of water may lead to a toxic hazard when it is used for drinking, washing, and food preparation. Although many agents hydrolyse in water, this is not satisfactory as a method of decontamination. Arsenical agents leave degradation products that are toxic even when hydrolysis is complete. The appearance of water does not indicate contamination, and any water exposed to high concentrations of vapor, or any liquid contamination must be regarded as toxic until tests have been made. Open water sources subjected to chemical attack should be considered contaminated until tested. Water in closed metal tanks will be safe provided that the tap and air inlets are decontaminated. Water with a pH less than 3 is condemned since this high acidity may be due to contamination with mustard, but if free chlorine is present throughout 30 minutes mustard will be destroyed. Chlorine in excess of 5 ppm will, however, interfere with the testing and should be reduced. The water testing kits will not detect mental incapacitants, biological agents, or nuclear fallout. The following methods are available for decontaminating water and may be used in combination: A. In a small scale emergency, water may be decontaminated by running it through a spare unused respirator canister, provided that the flow rate is such that the water emerges drop by drop; any water coming through at first faster than this should be discarded. Simple chlorination, as is used to disinfect water from naturally occurring bacterial contaminants, is not sufficient to decontaminate water suspected of being contaminated with chemical agents. Larger quantities of water may be treated by flocculation with metal salts, after which the water is treated with chlorine. Reverse osmosis is an effective method of removing contamination, including heavy metals. Wash other (vapor) foods with 2% sodium foods with 2% sodium bicarbonate solution, peel bicarbonate solution, peel where applicable, and where applicable, and cook by boiling. Blister Condemn Condemn Condemn agents (liquid) Blister Condemn Expose dry food to the air Expose dry food to the air agents for 48 hours. Choking Wash food with water Wash food with water Wash food with water agents * where possible and where possible and expose where possible and expose expose to the air for 24 to the air for 24 hours. Food may be Food may be unpalatable Food may be unpalatable unpalatable due to the due to the acid product of due to the acid product of acid product of hydrolysis. Cyanide Unlikely to produce Unlikely to produce Unlikely to produce type agents dangerous dangerous contamination dangerous contamination contamination of of foodstuffs. Riot Food may be Food may be unpalatable Food may be unpalatable control unpalatable to the to the extent of being to the extent of being agents extent of being inedible. The absence of these signs must not be relied upon in deciding that exposed food is fit for consumption. Wooden boxes not sealed for the exclusion of air gives almost no protection against vapor and liquid. Waxed paper boxes sealed for the exclusion of air give good protection against vapor and fair protection against liquid. Untreated wrapping papers give poor protection against vapor and very little against liquid. Ordinary textiles in a single layer packaging give almost no protection against vapor and liquid. Closed buildings give protection against liquids but often not against vapors, unless overpressured with filtered air. Generally, double layers greatly increase the protective efficiency of packaging materials. Field rations are packaged to protect the enclosed foods for hours even when the outside of the package is heavily contaminated with a liquid agent. Decontamination of the skin should be accomplished quickly if it is to be fully effective. Decontamination personnel should wear a mask and protective equipment while decontamination is performed. Once a casualty has been decontaminated, or the agent fully removed, no further risk of contamination exists. The affected tissues should be flushed immediately with water from the water bottle (canteen). The eyes can be flushed with copious amounts of water, or, if available, isotonic sodium bicarbonate (1. Each soldier is given the means for preliminary decontamination of the skin, the means being based on physical adsorption or on the combination of physical adsorption and chemical inactivation. Chemical inactivation is often effected by chlorinating compounds incorporated into adsorbing powders, ointments, solutions, or organic solvents. Within 2 minutes contact time, a drop of mustard on the skin can cause serious damage. In the case of thickened mustard, where the usual procedure is inadequate, the agent may be scraped off with a knife or similar hard object, taking care not to spread the agent or abrade the skin. This may be followed by wetting the surface with a cloth drenched in an organic solvent. If water is available in abundant amounts, copious washing should follow these procedures. Wounds should be irrigated using a solution containing 3000-5000 ppm (parts per million) free chlorine (dilute "milton" solution) with a dwell time of approximately 2 minutes. Irrigation of the contaminated wound should not be used in the abdominal, or thoracic cavities, or with intracranial head injuries. Chemical inactivation using alkalis is effective, whereas chlorinating is ineffective against phosgene oxide. The eyes should be flushed immediately using water or isotonic sodium bicarbonate solution if available. Because of its physical properties, hydrogen cyanide will not remain for long in its liquid state. Because of its physical and chemical properties, the agent will not remain in its liquid form for long, and decontamination is not required except when it is used in very cold climates. Complete cleansing of the skin with soap and water should be accomplished at the earliest opportunity. Symptoms may appear as late as 36 hours after percutaneous exposure, even if the skin is washed within an hour. This time should be used to prepare for the possibility of an epidemic outbreak 6 to 24 hours after the attack. Exposed persons should if possible move to fresh air, separate from fellow sufferers, face into the wind with eyes open and breathe deeply. Following exposure, clothing and individual equipment should be inspected for residue. If a residue is found, individuals should change and wash their clothing to protect themselves and other unmasked persons. Detailed Troop Unit Decon *The techniques become increasingly less effective the longer they are delayed. One of the most difficult aspects of chemical warfare is that the chemical agents may persist in the environment for extended periods of time. On the chemical battlefield, three types of environments may exist: (1) Uncontaminated areas where there are no chemical agents present. Complete decontamination of a contaminated environment may be difficult or impossible.

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Revisions published in 2001 clarify (1996) had a more standardized methodology and arthritis center of riverside plaquenil 200 mg amex, as the facility was not open the defnition of temporary arthritis feet physical therapy plaquenil 200mg otc, but still allow maintenance in such enclosures to the public and the dolphins did not have to perform shows arthritis in back between shoulder blades trusted 200mg plaquenil, their study was at the discretion of the facility veterinarian rheumatoid arthritis causes discount plaquenil online visa, which can lead to prolonged not compromised by these potentially confounding factors. One example of this practice involved Finna, a male orca exhibited at Oceanic and Atmospheric Admin. In a mate, Bjossa, to allow the mother and calf privacy in the main display tank. For more on the provisions of these pre-1994 permits, see Legacy), was held in the SeaWorld Orlando medical enclosure, in which he Rally et al. He was moved into the main enclosure complex only when Morgan was transferred 312. Occasionally, the cause of death is both obvious and unique to captivity: were periodically given water baths and checked hourly. In another situation unique to captivity, a beluga died after ingesting 9 kg (20 lb) of oak leaves that had blown into her tank. For information on the practice of administering routine medications, leaves may have scratched the inside of her throat, creating pathways for a see Stoskopf (2018) and Gulland et al. Belugas in the wild would never Mammalogy (2014), which has guidelines produced by its Ethics Committee. Nootka, a 13-year-old female orca held by SeaWorld Orlando, died in fecal coliform standards and noted the need to test for potentially pathogenic September 1994. She was reported by SeaWorld personnel to be doing fne, (disease-causing) Enterococci, Pseudomonas, or Staphylococcus bacterial appeared lethargic and uninterested in food one morning, and died by that levels, but the proposal required a facility to conduct tests for only one of evening (Leithauser, 1994). Quitz, a 5-year-old male Pacifc white-sided dolphin, these types of bacteria, not all, and which to choose was up to the facility. He was these tests each address a diferent health threat and water quality concern, reported by Shedd personnel as appearing healthy, exhibited subtle changes facilities should test for all three, as well as other pathogens and chemicals in behavior one evening, did not eat normally the next morning, and died by that might negatively afect the animals health (such as chlorine, copper, that night (Puente, 1995). Kotar, a 19-year-old male orca, died at SeaWorld San ozone, nitrates, and ammonia; see Couquiaud, 2005), with guidelines as to Antonio in April 1995. He was reported to have died unexpectedly, exhibiting what levels are a potential health concern (Rose et al. In a veterinary presentation specifcally about sudden, unexpected deaths involved dolphins at Gulf World in Florida (Smith, captive cetaceans, it was noted that pneumonia can be considered a disease 2016) and the Brookfeld Zoo in Chicago (Ruppenthal, 2018b). Captive dolphins are 15 times more likely to express been trying unsuccessfully to obtain these reports for Tilikum, who died at elevated iron levels in their bodies (a precursor to developing the disease of SeaWorld Orlando on 6 January 2017; Kasatka, who died at SeaWorld San hemochromatosis) than free-ranging dolphins. Hemochromatosis can lead to Diego on 25 August 2017; and Kyara, Tilikums granddaughter, who died at a variety of problems, including liver, heart, and reproductive organ problems, SeaWorld San Antonio on 24 July 2017. Captive dolphins, who are fed a limited diet (of fsh species often containing for that position. See high levels of iron, such as herring), may not ingest enough saturated fatty Complaint for Declaratory and Injunctive Relief, Animal Welfare Inst. Natl acids, which are protective factors against high iron levels (similar to people 121 who develop various health problems because they do not consume enough they suggested refected diferent environmental conditions at diferent omega-3 fatty acids) (Wells et al. They noted that the lesions were more common in males than Activity patterns in the wild may also be a factor in protecting against females (31. Very large lesions were also more common in males than wide variety of fsh in small bouts throughout the day and night. The researchers speculated that captive dolphins are active for longer periods during the day (and are captive male bottlenose dolphins are more vulnerable to tattoo lesions than relatively inactive at night) and are fed larger amounts of a limited diet a few females because of diferences in immune response and because males may times a day. Free-ranging dolphins also range more widely and routinely dive be more susceptible to captivity-related stress than females (p. A worldwide study of 1,392 free-ranging small cetaceans, comprising 17 signifcant factor in the higher occurrence of this condition in captivity. For example, see Waples and Gales (2002), which describes the death of to depths greater than 450 m (1,476 ft) (Klatsky et al. In addition, dominance hierarchies in the In contrast, captive dolphins spend much of their time at or near the wild are relatively stable and clearly established, which reduces repeated surface. In fact, they spend at least 25 percent their time with their heads aggression (for example, see Sachser et al. In captivity, animals have fully above the water, waiting for food or direction from their trainers, and been frequently transferred between facilities and enclosures, which results never dive deeper than a tank allows; most dolphin tanks are shallower than in frequent new combinations of animals, destabilizing old and creating new 10 m (Galhardo et al. They rarely need to hold their breath for longer hierarchies, which leads to repeated aggressive interactions as animals try to than one minute. Therefore, there is no need for these large quantities of exert their dominance over newly introduced individuals. In one incident, a dolphin died after colliding mid-air with another terrestrial animals facing excessive iron levels (Rose et al. Most perplexing, despite the marked diference between the rates of As noted in endnote 314, the causes of death for captive marine iron overload seen in captive and free-ranging bottlenose dolphins and the mammals are at times unique to captivity. Dolphins have died due to eating implications of this diference for captive dolphin health and welfare, the coins and other foreign objects people have tossed into their tanks. A sea lion cetacean research team that made this discovery has not looked very closely died after bolting from a cage before staf could stop her and leaping out into at why this diference exists (but see Venn-Watson et al. Dima and Gache (2004) reported that the most common causes of death a limited diet) is not being examined from the perspective of dolphin welfare for the dolphins in Constanta dolphinarium in Romania were starvation by these researchers (or anyone else with access to a suitable sample of through refusing to eat and striking themselves against the sides of their tank captive dolphins). They as models to study the impacts of diabetes on humans (hemochromatosis can also noted that the average survival time for harbor porpoises in the facility cause diabetes through damage to the pancreas) (see. Captive orcas sometimes foat motionless near the surface in excess of stones, which are severely painful and debilitating. Although there are several 15 minutes, for up to hours at a time (Jett and Ventre, 2012; Worthy et al. This excessive level of logging is abnormal and does not Assimos, 2009), which might explain its higher frequency in captive dolphins, resemble the active, highly mobile behavior of free-ranging orcas at all (see. This type of lesion is related to the disease erysipelas, caused by than a minute or two at a time, when resting or sometimes when socializing. One symptom is widespread, slightly raised grey patches on the surface of a dolphins skin (Van Bressem et al. Keepers and trainers should strive to ofer fsh in such a way how the obvious poor dental health of orcas might lead to health problems that the animal is protected from looking directly at the sun (p. Another element of captive conditions that may exacerbate eye problems for cetaceans is oxidants in the water. Walker and Coe (1990) reported the frequency with which captive cetaceans consumed 332. They noted a number of animals in the United States and abroad who had died in 333. Graham and Dow (1990); Ventre and Jett (2015); Visser and Lisker (2016); captive facilities because of ingesting these items. Other marine mammals have been reasons for the high incidence of foreign body ingestion in captive cetaceans known to break their teeth in captivity, notably walruses. The captive environment, due to its obvious spatial limitations, have been known to break their tusks from trying to gouge the bottoms and is at best an abnormal one. The social behavior of these animals has been walls of their tanks (Kastelein, 2002). One female walrus at Six Flags Discovery Kingdom had to be ftted with titanium tusk caps because she wore 340. For examples and discussions of the behavioral problems experienced by down her tusks on the concrete of her tank (Gage et al. Tooth infection animals in captivity, including marine mammals, see Carter (1982); Markowitz was so widespread in walruses at the Moscow Zoo that management brought (1982); Ellis (1985); and Sweeney (1990). Dima and Gache (2004) noted in a dentist from the United Kingdom to assist with the problem (Wyatt, extreme examples in a dolphinarium in Romania, where animals refused 2000).