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Assistant Professor, State University of New York Upstate Medical University

The checklist is organized into three sections-building information quantum herbals order generic geriforte online, home interior and room interior herbals good for the heart buy geriforte 100 mg mastercard. The room interior is further subdivided by categories (such as bedding and sleeping arrangements herbals bestellen discount geriforte line, flooring herbs lower blood pressure 100 mg geriforte, window treatments, and moisture control). This checklist covers the following allergens and irritants, which are commonly found in homes. Information is also provided on chemical irritants-found in some scented and unscented consumer products-which may worsen asthma symptoms. Also found in carpeting, curtains and draperies, upholstered furniture, and stuffed toys. Dust mites are too small to be seen with the naked eye and are found in almost every home. Where Found: Often found in areas with food and water such as kitchens, bathrooms, and basements. Warm-Blooded Pets (such as cats and dogs) Triggers: Skin flakes, urine, and saliva. Mold Triggers: H Mold and mold spores which may begin growing indoors when they land on damp or wet surfaces. Where Found: Often found in areas with excess moisture such as kitchens, bathrooms, and basements. Where Found: Associated with gas cooking appliances, fireplaces, woodstoves, and unvented kerosene and gas space heaters. H O M E I N T E R I O R Y N Secondhand Smoke Does anyone smoke in the home or car Take the smoke-free home pledge and post a smokefree home decal or magnet to show that the house is a "smoke-free" zone. S S H O M E I N T E R I O R (continued) Y N Does the heating system use a fuelburning appliance (such as an oil or gas furnace) Notes: Have the heating system - including furnaces, flues and chimneys - professionally inspected annually. If using a fireplace, make sure it is properly vented to help ensure smoke escapes through the chimney. Notes: Y N Run window air conditioner with the vent control open to increase the outdoor ventilation rate during the cooling season. If it is necessary for the patient to sleep on upholstered furniture such as a sofa, then cover furniture with washable slipcovers or sheets and vacuum furniture regularly (including removing cushions and vacuuming in cracks and crevices). R O O M Flooring I N T E R I O R (continued) Carpeting Hardwood floor, tile, or vinyl flooring Throw rugs Other What type of floor covering is present Someone besides the patient should vacuum, sweep, empty the dust canister and change the vacuum bag. If possible, the patient should stay out of rooms when they are being vacuumed or swept. If the patient vacuums, sweeps, empties the dust canister, or changes the vacuum bag, he or she should wear a dust mask. Notes: Upholstered Furniture and Stuffed Toys Is there upholstered furniture present Vacuum upholstered furniture regularly, including removing cushions and vacuuming in cracks and crevices. S If replacing furniture, consider purchasing a nonupholstered furniture - such as vinyl, wood, or leather that can be easily wiped down. Dust window sills, blinds, and shades regularly using a damp cloth with warm, soapy water. S If possible, replace curtains or drapes with plastic, vinyl, wood, or aluminum blinds.

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Care in manipulating faucet handles to prevent contamination of cleaned hands or the use of sinks equipped with remote water control devices herbs near me purchase 100 mg geriforte visa, such as foot pedals worldwide herbals order geriforte once a day, is highly recommended herbals for blood pressure discount 100 mg geriforte overnight delivery. Salmonella Typhi Recent taxonomic studies have organized the genus Salmonella into two species herbals for horses geriforte 100mg on line, S. Typhi is a motile gram-negative enteric bacterium that is easily cultivated on standard bacteriologic media, although enrichment and selective media may be required for isolation of this organism from clinical materials. Secondary transmission to other individuals outside of the laboratory is also a concern. Typhi infections usually present with symptoms of septicemia, headache, abdominal pain, and high fever. The infectious dose is low (<103 organisms) and the incubation period may vary from one to six weeks, depending upon the dose of the organism. The natural mode of transmission is by ingestion of food or water contaminated by feces or urine of patients or asymptomatic carriers. Ingestion and parenteral inoculation of the organism represent the primary laboratory hazards. Typhi are available and should be considered for personnel regularly working with potentially infectious materials. Shiga toxin (Verocytotoxin)-producing Escherichia coli Escherichi coli is one of five species in the gram-negative genus Escherichia. This organism is a common inhabitant of the bowel flora of healthy humans and other mammals and is one of the most intensively studied prokaryotes. This summary statement provides recommendations for safe manipulation of Shiga toxin-producing E. Transmission usually occurs by ingestion of contaminated food, including raw milk, fruits, vegetables, and particularly ground beef. Human-to-human transmission has been observed in families, day care centers, and custodial institutions. Water-borne transmission has been reported from outbreaks 154 Biosafety in Microbiological and Biomedical Laboratories associated with swimming in a crowded lake and drinking unchlorinated municipal water. However, a variety of food specimens contaminated with the organisms including uncooked ground beef, unpasteurized dairy products and contaminated produce may present laboratory hazards. This agent may be found in blood or urine specimens from infected humans or animals. Personal protective equipment, such as splash shields, face protection, gowns, and gloves should be used in accordance with a risk assessment. The importance of proper gloving techniques and frequent and thorough hand washing is emphasized. Shigella the genus Shigella is composed of nonmotile gram-negative bacteria in the family Enterobacteriaceae. There are four subgroups that have been historically treated as separate species, even though more recent genetic analysis indicates that they are members of the same species. Members of the genus Shigella have been recognized since the late 19th century as causative agents of bacillary dysentery, or shigellosis. Most transmission is by fecal-oral route; infection also is caused by ingestion of contaminated food or water. Complications of shigellosis include hemolytic uremic syndrome, which is associated with S. Laboratory Safety and Containment Recommendations the agent may be present in feces and, rarely, in the blood of infected humans or animals. Accidental ingestion and parenteral inoculation of the agent are the primary laboratory hazards. The 50% infectious dose (oral) of Shigella for humans is only a few hundred organisms. Special attention to the timely and appropriate decontamination of work surfaces, including potentially contaminated equipment and laboratory fixtures, is strongly advised. Treponema pallidum Treponema pallidum is a species of extremely fastidious spirochetes that die readily upon desiccation or exposure to atmospheric levels of oxygen, and have not been cultured continuously in vitro. No cases of laboratory animal-associated infections are reported; however, rabbit-adapted T.

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Type of impact Behavioral Examples Lethargy Locomotive and muscle incoordination or ataxia Tremors and convulsions Reduced nest attentiveness and protection of eggs Embryo mortality resulting in decreased hatchability of eggs Decreased egg production Egg shell thinning Accumulation of fluid within the pericardial sac or hydropericardium Excess fluid or edema in body tissues and organs Atrophy of bursa of Fabricius, spleen, and other lymphoid tissues Enlarged livers that are firm and light colored Bill and foot deformities (from embryonic exposure) Increased susceptibility to infectious disease Weight loss Debilitation Reproductive Pathological Immunological Other a condition analogous to chick edema disease. This condition results in the leakage of body fluids into various organs and tissues. Detection of subacute effects, such as poor reproductive performance and immunosuppression, is also confounded by these same factors. Residue levels alone will generally not be sufficient data for making a diagnosis. Bird use of heavily contaminated sites should be prevented to the extent feasible by habitat manipulation, physical barriers, scaring devices, and other appropriate means. Residues in wildlife can only be transferred to humans by consuming contaminated tissues. As with most chlorinated hydrocarbons, the greatest concentrations of residues are in fat tissue, and removing fatty parts of the carcass prior to cooking can significantly reduce potential human exposure. Always wear gloves or use other physical barriers to prevent personal contact with the carcass. Polychlorinated Biphenyls 307 308 Field Manual of Wildlife Diseases: Birds Chapter 42 Oil Synonyms Petroleum Each year, an average of 14 million gallons of oil from more than 10,000 accidental spills flow into fresh and saltwater environments in and around the United States. Most accidental oil spills occur when oil is transported by tankers or barges, but oil is also spilled during highway, rail, and pipeline transport, and by nontransportation-related facilities, such as refinery, bulk storage, and marine and land facilities. Accidental releases, however, account for only a small percentage of all oil entering the environment; in heavily used urban estuaries, the total petroleum hydrocarbon contributions due to transportation activities may be 10 percent or less. Most oil is introduced to the environment by intentional discharges from normal transport and refining operations, industrial and municipal discharges, used lubricant and other waste oil disposal, urban runoff, river runoff, atmospheric deposition, and natural seeps. Discharges of oil field brines are a major source of the petroleum crude oil that enters estuaries in Texas. Cause Birds that are exposed to spilled or waste petroleum can be affected both externally and internally. Pipelines 12 percent Marine facilities and vessels 29 percent Fixed facilities (refineries, storage) 36 percent Land transport 14 percent Unknown 6 percent Other 3 percent Figure 42. Oiled birds lose the ability to fly, and they frequently die from hypothermia, starvation, exhaustion, or drowning. Birds that are exposed to oil during their reproductive season can also transfer lethal doses of the contaminant to their eggs during incubation. Birds can also ingest, inhale, or absorb oil when exposed to a spill or while preening contaminated plumage. The toxic effects of ingested oil vary, depending on the type of oil and on the species of birds affected. These effects include gastrointestinal irritation and hemorrhaging, anemia, reproductive impairment, depressed growth, and osmoregulatory dysfunction (Table 42. Unfortunately, the effects of petroleum pollution can persist long after the visible spill is cleaned or dispersed. Petroleum persistence in the water column is usually less than 6 months, but it can be much longer (more than 10 years) in other components of the environment. For example, oil from the 1989 Exxon Valdez spill is still se- Photo by Milton Friend Oil 309 Photo by Nancy J. Thomas questered in bivalve communities within the areas of contamination and, thus, is still available to birds and other wildlife that feed on bivalves. Subtle effects on reproduction, such as decreased egg production, reduced fertility and hatchability, and decreased sperm production, as well as reduced immunologic function and impaired disease resistance, may occur as a result of ingesting oil-contaminated food (Table 42. Impact Mechanical Loss of waterproofing and insulation value of feathers Consequences Wetting, chilling, and hypothermia leading to death Exhaustion due to depletion of body stores, inability to feed, and greater expenditure of energy to maintain body heat and stay afloat Altered behavior Drowning Toxicological Pathological changes in tissue Inflammation of gastrointestinal lining Malformations Embryotoxicity Physiologic disruptions Altered endocrine function Liver and kidney disorders Altered blood chemistry Blood disorders including anemia Impaired salt (nasal) gland function resulting in disruption of osmoregulation Reproductive Embryotoxicity Impaired reproduction Other Reduced growth and development Reduced immunologic function Impaired disease resistance 310 Field Manual of Wildlife Diseases: Birds Species Affected A wide variety of birds and other wildlife have been affected by oil. The bird species affected depend on the location of the oil and the behavior of the birds.

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These 22-person advisory teams can offer expertise and provide liaison to additional military assets at the federal level herbals for cholesterol purchase geriforte 100mg mastercard. When state capabilities are overwhelmed or insufficient herbals benefits buy geriforte 100mg overnight delivery, the state coordinating officer may alert the federal coordinating officer herbs under turkey skin order geriforte overnight delivery, who can herbs denver buy geriforte 100 mg, in turn, assist in activating the national response framework. The national response framework guides delivery of federal assets and provides for a coordinated multiagency federal response. Finally, several other federal agencies may play an important role in the response to disasters, including, in particular, those resulting from a biological attack. Step 9: Conduct an Epidemiological Investigation and Manage the Psychological Aftermath of a Biological Attack Clinicians must be versed in the basic principles of epidemiology and be prepared to assist in the epidemiological investigation, which will be of paramount importance after a suspected terrorist attack. Although the well-prepared clinician may positively impact the health and well-being of individual patients, it is only through the rapid conduct of a competent epidemiological investigation that large numbers of exposed persons are likely to be reached, and successful medical and psychological prophylaxis implemented, before the widespread outbreak of disease or panic. In addition to the instigation of an epidemiological investigation and the institution of specific medical countermeasures against biological agent exposures, the clinician should be prepared to address the psychological effects of known, suspected, or feared exposure to threat agents. Such a scenario might also follow the covert release of an agent once the resulting epidemic is characterized as being the consequence of a biological (or chemical or radiological) attack. Symptoms due to anxiety and autonomic arousal, as well as side effects from postexposure prophylactic drugs, may mimic prodromal disease due to biological agent exposure and pose dilemmas in differential diagnosis. Persons with symptoms arising from naturally occurring infectious diseases may likewise pose significant challenges to healthcare providers and public health officials. Public panic and behavioral contagion are best prevented by timely, accurate, well-coordinated, and realistic risk communication from health and government authorities. Such communication should include an assessment of the risk of exposure, information regarding the resulting disease, and a recommended course of action for suspected exposure. As the epidemic subsides and public knowledge increases, public anxiety will decrease to realistic and manageable levels. This cycle of uncertainty, panic, response, and resolution occurred during the October 2001 anthrax bioterror event. Effective risk communication is possible only in the presence of well-conceived risk communication plans and tactics, worked out well in advance of an actual event. Similar advanced planning must take into account the need to rapidly establish local centers for the initial evaluation and administration of postexposure prophylaxis. Finally, the development of patient and contact tracing mechanisms and vaccine screening tools, the mechanisms for accession of stockpiled vaccines and medications, and the means by which to identify and prepare local facilities and healthcare teams for the care of mass casualties must be clearly elucidated in advance. Military commanders and their units are typically well versed in planning and executing conventional field-training and command-post exercises. In the future, such exercises must account for the real possibility that military units may encounter biological weapons on the battlefield. Similarly, planning and exercises must account for the tandem threat posed by bioterrorist attacks against garrison activities. Local civilian exercises (which can often include military participants) are likewise a necessary component of disaster preparation. Such exercises should be designed so as to test incident command and control, communications, logistics, laboratory coordination, and clinical capabilities. These exercises may involve only the leadership of an organization and focus on planning and decision making (the command-post exercise), they may involve notional play around a tabletop exercise, or they may involve actual hands-on training and evaluation in a disaster drill or field-training exercise. The Joint Commission requires hospitals to conduct a hazard vulnerability analysis, develop an emergency operations plan, and evaluate this plan twice yearly; one of these evaluations must include a community-wide drill. Finally, as discussed under step 8 above, numerous governmental, military, and civilian organizations have now been organized, trained, and equipped to provide assistance and consultation to clinicians, first responders, and public health officials faced with planning for and treating the victims of a potential terrorist attack. It is assistance that, if incorporated into thorough planning efforts, will hopefully never be needed for actual patient care purposes. Lessons from the West Nile viral encephalitis outbreak in New York City, 1999: implications for bioterrorism preparedness. A field-expedient algorithmic approach to the clinical management of chemical and biological casualties.

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