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To be sure allergy symptoms like flu cheap 5mg zyrtec visa, paralysis ignites many emotions and feelings allergy buyers club purchase zyrtec 10 mg line, most of them negative allergy symptoms in august buy generic zyrtec. For example allergy forecast little rock ar buy zyrtec 10 mg amex, a person who feels worthless may not take proper care of his or her bladder or skin or nutrition allergy forecast austin kvue buy 5mg zyrtec. Also allergy quinoa discount 5mg zyrtec with visa, people with a history of alcohol and/or substance abuse may return to old patterns of selfdestruction. Generally, at some point following paralysis, people may begin to admit that they have a serious condition, though they may hold on to the belief that the situation is not a long-term problem. As the process continues, it is important for people to contact others who share similar experiences. There are peer support groups for every sort of condition related to paralysis in most communities, including the Reeve Foundation Peer and Family Support Program. The Internet is a great tool for connecting with paralysis survivors who have been down the same path and can testify that there is still a future ahead full of life and rewarding experience. Given time, a person will eventually come to terms with their loss and reach the final stage of the grieving process: acceptance. Most people come to accept a realistic view of their condition, find meaning in life, and begin to make plans for the life ahead of them. Early on, people may be motivated to work hard at therapy to gain strength and function, still believing, perhaps, that paralysis can be beaten by sheer will power. While treatments for paralysis are coming, the best approach is to move forward and live a full life now. People who set these kinds of goals report greater life satisfaction, and they feel less shameful about their condition. Most people have the same personality, the same sense of style and humor as they did before being paralyzed; there is no reason not to strive for the same things. It may be necessary to ask others for help, even when doing everything on your own becomes a stubborn way to assert your independence. Life will always deliver your share of frustration, pain, loss, and the unpredictable actions of others. Simple relaxation techniques, such as deep breathing and pleasing imagery, can help calm down angry feelings. In 1979 he survived a nasty automobile accident which left him paralyzed from the chest down. Tapping into his reserves of compassion, he has armed himself to ride out the storms. But we all have a certain narrative in our head how to fix this, how it will happen. Live the life you have instead of waiting for the life you want or longing for the life you had. One of the most comforting ways to deal with the confusion and to begin to see a full and active life ahead is to connect with someone who has already been where you have been, had the same questions and is now thriving in life. Peer mentors empower people impacted by paralysis to live as independently as possible, engage with their communities, and navigate life transitions. Craig met his wife after he was injured and subsequently had three little boys; he was able to ofer great insights and advice on being a husband and a dad while living with a spinal cord injury. As we continued to meet, Craig was very helpful in suggesting what kind of goals I should set for my rehab. I did exceptionally well, and I give a lot of the credit for my success to the support and guidance I received from Craig at the time. Once I was discharged and went home, I sought out Craig for advice on how to adjust to my new life in the wheelchair away from the rehabilitation center. Craig gave me a lot of encouragement and shared specifcs of how he lives his daily life. Craig helped me determine what kind of vehicle my family should buy in terms of what would work best for me at that moment and would also be easily adapted for me to drive in the near future. In addition to the relationship that I had with Craig, his wife really helped my wife to understand what to expect and how to handle certain situations. Throughout our relationship, the most important thing Craig taught me is that I am still the same man, father and husband that I was before my injury and to not let the injury change that about myself. If you are living with paralysis, or you are the parent, spouse, or family member of an individual living with paralysis, you might benefit from someone who has experienced what you are experiencing. The Reeve Foundation peer mentors are adept at sharing their personal knowledge in order to help you. Although these approaches to wellness and healing fall outside of mainstream traditions, they may offer a bridge between eastern and western medicine. But according to Johnston, only 10-20 percent of what physicians practice has been scientifically proven. Certain spices are recommended for clearing toxins after any sort of injury, including turmeric, black pepper, ginger, coriander, fennel, and licorice. Alas, people with paralysis can now expect many of the same health problems as their nondisabled contemporaries. Higher rates of diabetes and obesity, lower levels of physical activity, and changes in body composition add to the risk. Fresh extract of skullcap (of the mint family) may reduce nerve inflammation; a tincture of milky oats. Aromatherapy: Essential oils are used to prevent respiratory infections, promote mucus clearing, fight depression, and promote sleep. Magnets: There are claims they enhance circulation, promote wound healing, and reduce carpal tunnel syndrome. Mindfulness meditation is not hard, there is no right or wrong way to do it, but it may take practice to quiet the mind for an extended period of time. Most people meditate with closed eyes, but you can focus on an object, a candle, for example. The main idea is to focusing your attention; this is what helps free your mind from the many distractions that cause stress and worry. As your meditation skills increase, consciously visualize the release of tension, beginning at the head, eyelids, shoulders, fngers, and moving slowly down to the toes. Mindfulness is taught at many medical centers to help people cope with a broad range of physical and psychological symptoms, including reducing anxiety, pain, and depression, enhancing mood and self-esteem, and decreasing stress. Exercise is good for mind and body, and almost anyone can do it, regardless of functional capabilities. Others do it to get stronger, to build endurance and stamina, to help keep joints loose and flexible, to reduce stress, to get more restful sleep, or just because it makes them feel better. It prevents secondary conditions such as heart disease, diabetes, pressure injuries, carpal tunnel syndrome, obstructive pulmonary disease, hypertension, urinary tract infections and respiratory disease. Research shows that people with multiple sclerosis who joined an aerobic exercise program had better cardiovascular fitness, better bladder and bowel function, less fatigue and depression, a more positive attitude and increased participation in social activities. In 2002, seven years after his injury, Christopher Reeve demonstrated to the world that he had recovered modest movement and sensation. Five years later, when he first noticed that he could voluntarily move an index finger, Reeve began an intense exercise program under the supervision of Dr. Louis, who suggested that these activities may have awakened dormant nerve pathways, thus leading to recovery. Reeve included daily electrical stimulation to build mass in his arms, quadriceps, hamstrings and other muscle groups. In 1998 and 1999, Reeve underwent treadmill (locomotor) training to encourage functional stepping. Neuroscience research supports the notion that exercise enhances brain cell proliferation, fights degenerative disease and improves memory. A number of human studies have shown that exercise increases alertness and helps people think more clearly. Unfortunately, people Paralysis Resource Guide | 130 2 with disabilities are even more prone to carrying excess weight due to a combination of altered metabolism and decreased muscle mass, along with a generally lower activity level. Research shows that people who use wheelchairs are at risk for shoulder pain, joint deterioration and even painful rotator cuff tears, due to the amount of stress they place on their arms. As people gain weight, the skin traps moisture, greatly increasing the risk of pressure sores. Inactivity can also result in loss of trunk control, shortening or weakness of muscles, decreased bone density and inefficient breathing. Significant health benefits can be obtained with a moderate amount of physical activity, preferably daily. Additional health benefits can be gained through greater degrees of physical activity. People who can maintain a regular routine of physical activity that is of longer duration or of greater intensity are likely to derive greater benefit. Stop exercising if you feel any pain, discomfort, nausea, dizziness, lightheadedness, chest pain, irregular heartbeat, shortness of breath or clammy hands. People with paralysis should consult a physician before beginning a new program of physical activity. For example, in people with multiple sclerosis, exercise can lead to a condition called cardiovascular dysautonomia, which lowers heart rate and decreases blood pressure. Electrodes may be applied to the skin as needed or they may be implanted under the skin. McDonald clearly likes the concept; he helped start a company, Restorative Therapies, Inc. It is a whole category of medical devices and therapies that interact with the human nervous system. They can be used in various ways; to provide meaningful function, to treat a specifc condition or to supplement therapy. Devices can be applied externally such as to the surface of the skin or implanted with a surgical procedure. It is important to frst learn about the technologies then consult with a trained medical professional prior to initiating any program. I have been using neurotechnology devices since my spinal cord injury in 1998 from a snowboarding accident. The system allows me to fght of common secondary conditions such as muscle atrophy and pressure injuries. In my wheelchair, I use it for trunk control and to aid in propelling my manual wheelchair. It also gives me the freedom to stand out of my wheelchair; to reach high items, make difcult transfers, join a standing ovation and walk down the aisle at my wedding.

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Peer reviewer comments are also used by authors of rejected articles (or those asked to revise and re-submit) to improve their manuscripts for resubmission to the same journal or to another social science journal allergy xyzal order zyrtec 10mg with amex. These are not now paid for by taxpayer dollars; but in a free public access world allergy forecast spokane generic zyrtec 5mg without prescription, federally-funded and non-funded social science researchers will have to find the resources to pay to have their scientific contributions published in our peer-reviewed journals allergy hair dye generic zyrtec 10mg amex. This is already happening in some journals and social scientists are unhappy about the costs allergy testing queenstown buy zyrtec 10 mg. None of this is desirable for obvious reasons: universities should not be in the position of picking and choosing which science/scholars to subsidize; scholars with limited resources should not be left outside the scientific publication process; and federal funders should not have to add dollars to research grants to cover dissemination allergy forecast honolulu hi order cheap zyrtec on-line. It is hard to see how any process with these characteristics advances scientific knowledge building in the U pollen allergy symptoms uk order zyrtec line. Over time, free public access to our journal content is likely to seriously erode and eventually jeopardize our financial ability 4 to perform the critical, value-added peer review and editorial functions of scientific publishing because, at this time in the social sciences, there is no viable alternative to library subscription income as a means of recovering our costs. In sociology, as in other social sciences, the federal government often provides grant support for only part of the research costs that go into a single scientific study (and it is often only a small part). It should also not lay claim to copyrighted scholarship that is published years after the conclusion of the federal grant just because the author uses some data from a federal grant made years previously. Long-term retention of scholarly content carries significant costs that are already being borne by scholarly publishers and will continue to be. In an era of dwindling federal resources, federal repositories not only do not contain the Version of Record, but they are also a recurring financial burden that may not be sustainable for long-term stewardship of this content. It is, has been, and always will be, our organizational responsibility to the discipline of sociology to maintain permanent access to all scholarship published in our journals. As a scholarly society, we must protect the scientific knowledge that has been placed in our care by scholars who transfer copyright for the Version of Record to us for that purpose. We cannot abandon this responsibility even if the federal government creates repositories. Several research funders already do this including the Howard Hughes Medical Institute, the Wellcome Trust, and the MaxPlanck Institutes. But we will not be able to continue publishing nine scholarly journals and add journals in new areas of science without the revenue that sustains our publishing program. Anything that undermines this revenue source will hurt scientific communication in sociology and other social sciences. As a half-owner of a Mom and Pop consulting firm, the results of government research are an important resource for the work we do. The President needs to decide, finally, whether he is on the side of the rent-seeking, campaign-funding 1% or on the side of the public. The Oberlin Group of Libraries is a consortium representing 80 libraries of selective liberal arts colleges (see. Our institutions are critical training grounds for young scientists, innovators, and entrepreneurs; we help fill the pipeline for graduate-trained scientists and inventors. Our faculty publish sponsored research in collaboration with their undergraduate students. However, our schools do not receive the level of research funding available to larger institutions. Our faculty and students require access to cutting-edge research reports and data to assure they remain current with research in their fields and learn current science as science is actually practiced. In these comments, we recommend that peer-reviewed published articles reporting research funded by any U. Immediate free access to federally funded research will maximize both educational and commercial potential. These papers should be searchable through open repositories (if there is more than one federal repository, then the policy should mandate interoperability; see our answers to question 5). Access should be free of charge and should include a broad range of re-use rights so that users can build on and innovate from the research that they find. Moreover, open access levels the educational playing field for teachers and students alike, helping teachers at both the high school and college levels stay current with their fields and giving students a more direct look at science as it is practiced, complementing the syntheses presented by textbooks. Open access also levels the economic playing field, giving new and established enterprises equal opportunity to compete. We urge full open access as the norm: free, immediate access with full rights of re-use. As a for-profit publisher of open-access journals, BioMed Central makes a particularly interesting case study. Finally, we note that an openly accessible database of research papers can itself become the target of innovative commercial or not-for-profit services that analyze, select, or present the results. In considering intellectual property protection, it is important to be clear about the different kinds of intellectual contribution made by the various participants in the research and publication chain, and to reward them according to their value (we are specifically addressing copyright here, and not patents or trademarks). Scientists and other scholarly authors are the primary creators of the intellectual property in research articles, and these researchers are rewarded through the institutions that support them rather than through direct payment or royalties on sales. The interests of these authors are best advanced through wide dissemination of their work, as attested by the numerous studies that show that open access to scholarly articles increases the pace and number of citations by other researchers (see, inter alia, Eysenbach, G. In this respect, scholarly authorship is special, and copyright is not the best policy tool to create incentive for innovation. The contributions of publishers are important, too, but those interests should not overshadow the interests of their authors. As we note in our answer to question #1, we urge that after that embargo period, full rights of re-use be granted. Repository services for managing and maintaining long-term public access to peer-reviewed scholarly publications from federally funded research require these basic elements: open access, technical interoperability, and long-term stewardship. A centralized repository may be able to enforce these expectations more easily than a decentralized set of repositories. On the other hand, there will be some differences in the practices of the different disciplines funded by the various federal agencies, and a small set of decentralized repositories (each perhaps with its own advisory group) might be more successful in accommodating these differences. Whether centralized or interlinked, this repository structure must be open to commercial search engines like Google Scholar, since even advanced researchers often start there for an information search. Any repository in this system must also support access and use conditions that allow all interested parties (human and machine readers alike) to read the work, re-use it in ways that respect attribution, and create new services and products on top of this publicly funded information. The repositories must be able to ensure that the information contained in them will remain fully useable over the long term (decades, not years). Even non-commercial third-party projects are not keeping pace with the quantity of research needing long-term preservation. The funding agencies themselves should collect the papers and data they sponsor and provide unrestricted access for the educational, research, and commercial sectors to utilize. Members of the Oberlin Group of Libraries believe that research universities represent the best candidates for partnership with federal agencies in ensuring access and preservation for publicly funded research papers (and data). We urge, however, that if non-governmental agencies (including universities) serve as hosts to the database of research papers then federal agencies must maintain an open mirror site to ensure ongoing accessibility for the public. Among models of partnerships, we suggest that particular attention be given to ArXiv, the e-print server for Physics, Mathematics, Computer Science, and related subjects, which was started at Los Alamos National Laboratory and later moved to Cornell University arxiv. Any partnership should be predicated on clearly articulated standards for access, interoperability, and preservation. In addition, the metadata must carry information about the rights of re-use associated with research papers (and data). These metadata must be both human-readable and machine-readable, to ensure that the papers can be mined for the greatest benefit. Maximizing the accessibility of the research corpus and the metadata to machine processing will enhance research and educational use, optimize return on taxpayer investment, and lessen the compliance burden on researchers. The Oberlin Group of Libraries believes that open-access requirements can be implemented without creating a burden for the stakeholders. Journal articles, along with research data (to which the articles should be linked), represent the highest priorities for open access. There would be benefits to open-access release of other kinds of material that result from federally funded research, but the benefits would be smaller and should not distract attention from the primary goal of opening access to journal articles and their research data. The Oberlin Group of Libraries recommend giving next priority to educational materials, especially materials targeted to the K-12 sector. For such materials, longer embargoes or shorter terms of copyright (with dedication to the public domain at the end of the term) might be in order. Immediate access is the best way to leverage taxpayer investment in research for educational, scientific, and commercial progress. Even so, we recognize that journal subscriptions are an important source of revenue for publishers and that an embargo period might be necessary to protect them against loss. A period between 6 and 12 months has emerged as a world-wide norm for such an embargo. As librarians, however, we also want to urge that any argument based on anticipated subscription cancellations by libraries be analyzed and tested carefully. Evidence needs to be presented that immediate access would actually cause economic harm. Among the key reasons are local budget reductions; price and price history (high annual percentage increases are flagged for review and cancellation in many libraries); emergence of new journals that have higher priority for the local academic program; and changes in the local academic or research program. In our collective experience, libraries rarely if ever cancel journal subscriptions based on any single reason, including open-access availability with or without an embargo. Please kill this act; denying the public access to research we have *already paid for* is infuriating. We are delighted to invite you to join the international liver community at the Reed Messe congress centre in Vienna from 10 to 14 April 2019. For hepatitis C attention is moving to case-finding and treatment of difficult to access cohorts. Recognising the multi-disciplinary nature of modern hepatology we are forming new alliances with diabetes, obesity and oncology associations to enhance educational programming and clinical care. We look forward to seeing you for an exciting week of liver discoveries and exchange. The city of Emperors, of so many wars and peace, past alliances and treaties, in the centre of our beloved old Europe. It is therefore recommended to arrive at least 30 minutes before your first session. We ask that you please avoid downloading heavy files, movies or music during the congress as it will affect the connection speed for other attendees. Tuesday 09 April 16:00-19:00 Wednesday 10 to Saturday 13 April 07:00-19:00 Sunday 14 April 07:00-14:00 On-site technicians will assist speakers during the above hours. Thursday 11 April 09:00*-18:30 Friday 12 and Saturday 13 April 09:00*-17:00 *Access will be granted 1 hour before public opening hours to poster presenters. Presenter poster collection** Thursday 11 April 18:30-19:00 Friday 12 and Saturday 13 April 16:00-17:00 **Should you wish to recover your poster, you can do so on your presentation day. All unremoved posters will be dismantled and destroyed by on-site staff after 19:00 on Thursday 11 April and after 17:00 on Friday 12 and Saturday 13 April. Patient lounge Thursday 11 April 09:00-18:30 Friday 12 and Saturday 13 April 09:00-17:00 A patient lounge will be available everyday throughout the congress for delegates looking for a private space or needing to rest. A small number of catering outlets are available on-site where delegates can purchase food and beverages. Exhibitors are admitted into the exhibition area as well as the catering areas but have no access to the lecture halls. Exhibitors They can also attend the industry satellite symposia of their respective company. Nurses and Allied Health Professionals are granted access only Nurses & Friday 12 April 2019. If both badges are brought back at the registration desk, the administrative fee will be refunded. To verify physical presence on-site, poster presenters need to check-in before noon on the day of their presentation, at the poster help desk in Hall B next to the poster area.

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The goal of the Bench-Scale Testing was to find reagent(s) and sediment mixtures that could meet the project S/S performance criteria in the laboratory allergy medicine over the counter best buy 5mg zyrtec with amex. Utilizing the information gained from the Bench-Scale Testing allergy forecast houston zyrtec 10mg online, a Pilot Program was carried out spring allergy symptoms 2013 purchase genuine zyrtec line. The Pilot Project utilized an in-situ S/S approach using interlocking steel sheet pile cells in the North and South Tar Pond allergy medicine coughing purchase 5 mg zyrtec with visa. Seven cells were constructed in the South Tar Pond and 6 cells were constructed in the North Tar 2 Pond allergy forecast santa fe order 10mg zyrtec overnight delivery, each with an approximate surface area of 27 m allergy shots for horses order 10mg zyrtec with amex. After the cells were homogenized using an excavator, known quantities of various combinations of cement, slag and/or flyash were mixed with the cell sediments. After mixing, samples were taken and analyzed with respect to meeting the desired performance 567 requirements (see Tables 1 and 2). The Pilot Program indicated that there were a number of reagent variations that had the potential of meeting the performance criteria. A report of the Pilot Program was prepared and made available to the potential bidders on the S/S project. Dewatering of the S/S Work Areas the Tar Ponds are a tidal estuary with 2 large brooks (Coke Ovens and Wash Brook) flowing into the South Tar Pond. To carry out S/S it was necessary to dewater the work areas prior to the S/S contractor beginning work in the area. To create dry work areas in the South and North Tar Ponds a multi-stage sequencing of pump stations was used. The pumping stations were comprised of inlet works, pumping equipment, 48-in pipelines for conveyance of the flows and discharge facilities with energy dissipation structures. The dewatering design initially involved pumping the 2 brooks around the South Tar Pond with the discharge introduced into the North Tar Pond. Once the flows had been diverted, pumping of the remaining water above the sediments was the responsibility of the S/S contractor. After completing the S/S of the South Tar Pond and construction of the channel, the pumping infrastructure would be moved to drain the upper portion of the North Tar Pond and then again to drain the lower portion of the North Tar Pond. The remixed cell would have to pass re-testing in order for the contractor to receive payment. Table 2 lists the 46 parameters tested using the Synthetic Precipitation Leaching Procedure. Table 1: Contractual Performance Criteria for S/S Work by Contractor (Ingraham, 2011) Property Test Method Criterion Unconfined fi 0. The contractor used hydraulic excavators to mix the solidifying agents (Portland cement) and gravel/slag, if required, according to an approved recipe. Below is a summary of some of the challenges encountered and the techniques utilized to overcome these challenges: 1. Water Management Issues associated with high groundwater flows and close proximity of ocean Although an issue throughout the project, this was a major challenge in the final phase (Phase 3) which located adjacent to the ocean. A combination steel sheet pile wall and armour stone barrier provided a physical separation and fairly impermeable barrier but the tidal water moved relatively freely through the existing slag area bordering the east side of the pond. The contractor strategically placed clay and S/S berms in areas to aid dewatering efforts. This enabled S/S and channel work to begin in specific locations while effective water management was being carried out in other locations. Constitution of impacted sediments varied throughout the North and South Tar Ponds the type, location, and amount of contaminant as well as the water content of the sediment varied throughout the north and south ponds. In order to overcome these issues, the contractor was constantly observing and analyzing the sediment for these changes. This permitted the contractor to recognize issues prior to mixing and make approved adjustments to mix deign and duration of mixing. In deeper areas (> 16 ft) bucket mixing began to be problematic resulting in some cells not meeting the criteria on the first S/S attempt. Odours Odour generation during S/S became a significant issue due to a combination of sediment disturbance/drying, the exothermic cement/sludge reaction and general warm weather mixing. Given that the work was being carried out in the middle of Sydney, significant odour generation was not acceptable. A comprehensive odour monitoring and management program was developed which involved utilizing odour suppression materials such as foams, liquid sprays and surface cover materials. For example, sediments were permanently relocated out of the channel footprint prior to S/S. Dust As with odour, significant dust generation within the city was not acceptable. As the dust budget was approached or exceeded, the contractor would stop work and alter work procedures to lessen dust generating practices. In a conscious effort, the contractor utilized a cement conveyance box which was fitted on top of the sediment to be mixed and then powder cement was blown into the box prior to mixing. The contractor then utilized significant wetting techniques during the mixing process. Cell Sediment Volume and Cement Initially each cell was of the same spatial size, however in the field it was soon realized that mixing a fraction of a cement tanker load into a cell was not practical. The procedure was modified to a volume-based approach so that the volume of the cell required 1 tanker load of cement per cell. At completion of the project it was estimated that over 70,000 pages of quality control documentation alone was generated and reviewed. Each of the 3,486 cells has a unique set of data associated with it (See Table 4). Overall for all 3 phases of the 3 project, 679,016 m of sediment were treated and over 100,000 laboratory quality control/assurance tests were carried out. The S/S component of the project was completed ahead of schedule and under budget at a cost of $73. As seen in Figure 5, Open Hearth Park includes a common area, an outdoor concert venue and skating area, an all weather multi-use sports field, natural turf field, a playground, a bike training facility, off-leash dog park, public art displays and a trail network complete with bridges that once again provides connectivity between downtown Sydney and the communities of Whitney Pier, Ashby and Sydney`s North End. Presentation to Randle Reef Contaminated Sediment Remendiation Project Members and Environment Canada. Managing Program and Project Requirements During Sediment Stabilization of the Sydney Tar Ponds. Sydney Tar Ponds and Coke Ovens: Integrating Broad Socio-Economic Considerations into a Contentious Remediation Project. The other site consisted of open burning trenches and pads where a variety of debris, ordnance waste, and explosives sludges were burned. The remedial action selected for the contaminated soil at these sites was stabilization, after bioremediation of the explosives was demonstrated to be cost-prohibitive. Objectives fi Remove the contaminated soil fi Treat to reduce the leachability of metals and explosives fi Place and compact the treated soil back into the excavation area fi Cap the site with a low permeability clay fi Restore the site Method the contaminated soil was treated with Portland cement and activated carbon to produce a treated material that met the performance criteria shown below. Confirmatory testing to verify that the treated material met the leachability performance criteria was carried out. Risk Drivers Public housing was constructed on top of soil contaminated from the past foundry activities. The contaminated soils required removal to prevent contact with the contaminated soil by the residents. The stabilization reagents used included moist ferrous sulfate, Portland cement, and granular blast furnace slag, which were placed directly over a treatment cell then mixed with an excavator to homogenize the reagent with the sediment throughout the cell. The mix area post-mixing (shown above) was almost completely inaccessible to equipment. The material was allowed to consolidate over a few months before the final geotextile cap was placed. West Doane Lake has received soil, sediment, surface water, and groundwater from the former pesticide manufacturing facility. The southern portion of the lake is approximately 60 ft wide, and the northern portion of the lake is approximately 40 ft wide. The southern portion of the lake is deeper than the northern portion, with typical water depths of 1 to 2 ft. Characterisation the West Doane Lake sediments primarily consist of very soft to soft, black to gray, -5 -8 overbank silt deposits. Permeability test results indicate a range of 10 to 10 cm/sec for particle sizes ranging from clayey sands to high plasticity silts. Coarse materials, believed to have sloughed off the railroad embankment, were often encountered on the northern edge of West Doane Lake, along with black and gray sands, believed to be foundry sands from a nearby property. Debris (brick, gravel, wire, concrete, and battery casings) was observed on the eastern edge of West Doane Lake from historic filling activities. Risk Drivers West Doane Lake may be a potential continuing source of constituents of interest to potential human and ecological receptors at the site. Activated carbon and organoclay were added dry to the surface of each treatment cell at 2% and 3% by weight, respectively. Structural fill was placed over the geotextile in compacted layers to the desired final cap grades. The appropriate amount of water 3 was metered into an initial 5 yd batch tank (equipped with a high-speed, high-shear mixer) and recorded. Each reagent was added separately to the mix tank and the scales on which the mix tank sets were tarred before each reagent was added to verify that the correct amount of reagent had been added. The pre-determined grout volume was pumped to the treatment area based on the soil density, reagent admixture ratio, and the treatment cell dimensions to add 3% by weight each of bentonite and organoclay. Portland cement was pneumatically transferred onto the surface of each treatment cell, along with supersacks of activated carbon to achieve 18% and 2% by weight, respectively. When both the grout and the dry reagents had been added to a treatment cell, the excavator mixed the sediment and reagents until visibly homogenous. Post-treatment samples were obtained from the top, middle, and bottom of each column. Equipment A mechanical system was employed to mix unsaturated or saturated contaminated soils while simultaneously injecting treatment or stabilization agents. A grout of the treatment reagents were injected through a vertical, hollow shaft and out into the soil through 0. The ground surface above the mixed region was covered by a 14-ft diameter shroud under a low vacuum to contain any air emissions and direct them to an off-gas treatment process. Two separated areas could be distinguished, each underneath former production halls. The spreading of the contaminated groundwater plume was defined as the driver for remediation. Characterisation Table 1 below shows the composition of one of the groundwater hotspots at area C. Objectives the remediation target for the site was derived via a risk assessment, with groundwater pollution in the vicinity as the risk driver. The same target values were applied to evaluate the leachability of the stabilized soils. However, this in-situ technique has disadvantages, such as uncertainty over product durability over time resulting in re-acidification), sensitivity to obstructions (stones, foundations, debris), negative impact on geotechnical soil stability, and the difficulty in accurate dosing of the lime. The soil was treated by means of a continuous mixing plant, with a throughput of 200 tonnes an hour. As can be seen, the stabilized soils complied with the site-specific reuse criteria. Abstract the objective of the study was to develop a low cost calcium and vitamin D supplement from the combination of chicken eggshell and sun-dried mushrooms (Agaricus bisporus). The calcium, vitamin D, B1, B6, C and B12 content was estimated in the developed supplement by laboratory analysis. The supplement prepared was subjected to sensory analysis to check its acceptability by incorporating it to six commonly consumed Indian food preparations items (dal curry, chapatti, parantha, curd, nankhatai and milk) as per the dosage in one serving i. Results infer that the prepared supplement can be best accepted in baked food products like nankhatai etc. The calcium and vitamin D supplement prepared can be promoted in the community to utilize the maximum benefits of low cost natural sources of calcium and vitamin D in comparison with traditional richer sources available in the market. Developed value added product also be used during emergencies and disasters to meet nutritional requirements of the deficit population. Keywords: Calcium; Vitamin D; Chicken; Egg shell; Sun-dried Low dietary calcium intake further amplifes the parathyroid mushroom response to vitamin D insufciency. They play an important role in signal determine absorption of 30% of dietary calcium and more than transduction pathways, where they act as a second messenger, in 60-80% during periods of growth, due to the high demand for calcium. Many enzymes require calcium ions as a growth and bone abnormalities, increasing the risk of fractures in cofactor. Tere are reports from Indian subcontinent of very low the potential diference across excitable cell membranes, as well as dietary intakes of calcium (<300 mg/day) causing osteomalacia, low proper bone formation [1]. The remaining calcium is found in the extracellular fuid (50%) and in Chicken eggshell various tissues, especially skeletal muscle. Tere are various complications associated manufactured that use egg in their products generate tons of eggshells with calcium defciency like: as waste product. This wastage of eggshells possess a series environmental problem due to its inadequate utilization and disposal.

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Seizure Brief partial seizure; no loss of Brief generalized seizure Multiple seizures despite Life-threatening; prolonged Death consciousness medical intervention repetitive seizures Definition: A disorder characterized by a sudden allergy shots for mosquitoes order zyrtec 5mg with visa, involuntary skeletal muscular contractions of cerebral or brain stem origin allergy testing elisa buy zyrtec 5mg visa. Spasticity Mild or slight increase in Moderate increase in muscle Severe increase in muscle Life-threatening; unable to Death muscle tone tone and increase in tone and increase in move active or passive range resistance through range of resistance through range of of motion motion motion Definition: A disorder characterized by increased involuntary muscle tone that affects the regions interfering with voluntary movement allergy spray proven 5mg zyrtec. Stroke Asymptomatic or mild Moderate neurologic deficit Severe neurologic deficit Life-threatening Death neurologic deficit; consequences; urgent radiographic findings only intervention indicated Definition: A disorder characterized by a sudden loss of sensory function due to an intracranial vascular event allergy medicine urination buy cheap zyrtec 10 mg on line. Transient ischemic attacks Mild neurologic deficit with or Moderate neurologic deficit without imaging confirmation with or without imaging confirmation Definition: A disorder characterized by a brief attack (less than 24 hours) of cerebral dysfunction of vascular origin allergy symptoms to peanuts 10 mg zyrtec, with no persistent neurological deficit allergy shots names cheap zyrtec 10mg amex. Pregnancy, puerperium and perinatal conditions Pregnancy, puerperium and perinatal conditions Grade Adverse Event 1 2 3 4 5 Fetal death Fetal loss at any gestational age Definition: A disorder characterized by death in utero; failure of the product of conception to show evidence of respiration, heartbeat, or definite movement of a voluntary muscle after expulsion from the uterus, without possibility of resuscitation. Typically, viability is achievable between the twentieth and thirty-seventh week of gestation. Unintended pregnancy Unintended pregnancy Definition: A disorder characterized by an unexpected pregnancy at the time of conception. Anorgasmia Inability to achieve orgasm not Inability to achieve orgasm adversely affecting adversely affecting relationship relationship Definition: A disorder characterized by an inability to achieve orgasm. Delayed orgasm Delay in achieving orgasm not Delay in achieving orgasm adversely affecting adversely affecting relationship relationship Definition: A disorder characterized by sexual dysfunction characterized by a delay in climax. Libido decreased Decrease in sexual interest Decrease in sexual interest not adversely affecting adversely affecting relationship relationship Definition: A disorder characterized by a decrease in sexual desire. Renal and urinary disorders Renal and urinary disorders Grade Adverse Event 1 2 3 4 5 Acute kidney injury Creatinine level increase of Creatinine 2 3 x above Creatinine >3 x baseline or Life-threatening Death >0. Bladder perforation Extraperitoneal perforation, Intraperitoneal perforation; Life-threatening Death indwelling catheter indicated elective radiologic, consequences; organ failure; endoscopic or operative urgent operative intervention intervention indicated indicated Definition: A disorder characterized by a rupture in the bladder wall. Bladder spasm Intervention not indicated Antispasmodics indicated Hospitalization indicated Definition: A disorder characterized by a sudden and involuntary contraction of the bladder wall. Hemoglobinuria Asymptomatic; clinical or diagnostic observations only; intervention not indicated Definition: A disorder characterized by laboratory test results that indicate the presence of free hemoglobin in the urine. Urinary retention Urinary, suprapubic or Placement of urinary, Elective operative or Life-threatening Death intermittent catheter suprapubic or intermittent radiologic intervention consequences; organ failure; placement not indicated; able catheter placement indicated; indicated; substantial loss of urgent operative intervention to void with some residual medication indicated affected kidney function or indicated mass Definition: A disorder characterized by accumulation of urine within the bladder because of the inability to urinate. Urine discoloration Present Definition: A disorder characterized by a change in the color of the urine. Reproductive system and breast disorders Reproductive system and breast disorders Grade Adverse Event 1 2 3 4 5 Azoospermia Absence of sperm in ejaculate Definition: A disorder characterized by laboratory test results that indicate complete absence of spermatozoa in the semen. Breast atrophy Minimal asymmetry; minimal Moderate asymmetry; Asymmetry >1/3 of breast atrophy moderate atrophy volume; severe atrophy Definition: A disorder characterized by underdevelopment of the breast. Dyspareunia Mild discomfort or pain Moderate discomfort or pain Severe discomfort or pain associated with vaginal associated with vaginal associated with vaginal penetration; discomfort penetration; discomfort or pain penetration; discomfort or pain relieved with use of vaginal partially relieved with use of unrelieved by vaginal lubricants or estrogen vaginal lubricants or estrogen lubricants or estrogen Definition: A disorder characterized by painful or difficult coitus. Ejaculation disorder Diminished ejaculation Anejaculation or retrograde ejaculation Definition: A disorder characterized by problems related to ejaculation. Fallopian tube stenosis Asymptomatic clinical or Symptomatic and intervention Severe symptoms; elective Life-threatening Death diagnostic observations only; not indicated operative intervention consequences; urgent intervention not indicated indicated operative intervention indicated. Feminization acquired Mild symptoms; intervention Moderate symptoms; medical not indicated intervention indicated Definition: A disorder characterized by the development of secondary female sex characteristics in males due to extrinsic factors. Hematosalpinx Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death imaging study or laparoscopy; intervention indicated indicated; radiologic or consequences; urgent intervention not indicated endoscopic intervention operative intervention indicated indicated Definition: A disorder characterized by the presence of blood in a fallopian tube. Lactation disorder Mild changes in lactation, not Changes in lactation, significantly affecting significantly affecting breast production or expression of production or expression of breast milk breast milk Definition: A disorder characterized by disturbances of milk secretion. Nipple deformity Asymptomatic; asymmetry Symptomatic; asymmetry of with slight retraction and/or nipple areolar complex with thickening of the nipple moderate retraction and/or areolar complex thickening of the nipple areolar complex Definition: A disorder characterized by a malformation of the nipple. Premature menopause Present Definition: A disorder characterized by ovarian failure before the age of 40. Prostatic hemorrhage Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death imaging study; intervention intervention indicated indicated; radiologic or consequences; urgent not indicated endoscopic intervention operative intervention indicated indicated Definition: A disorder characterized by bleeding from the prostate gland. Prostatic obstruction Diagnostic observations only; Mild symptoms; elective Severe symptoms; elective intervention not indicated intervention indicated operative intervention indicated Definition: A disorder characterized by compression of the urethra secondary to enlargement of the prostate gland. Uterine hemorrhage Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death imaging study; intervention intervention indicated indicated; radiologic or consequences; urgent not indicated endoscopic intervention operative intervention indicated indicated Definition: A disorder characterized by bleeding from the uterus. Vaginal hemorrhage Minimal bleeding identified on Moderate bleeding; medical Severe bleeding; transfusion Life-threatening Death clinical exam or imaging intervention indicated indicated; radiologic or consequences; urgent study; intervention not endoscopic intervention operative intervention indicated indicated indicated Definition: A disorder characterized by bleeding from the vagina. Symptoms may include redness, edema, marked discomfort and an increase in vaginal discharge. Vaginal perforation Asymptomatic clinical or Symptomatic and intervention Severe symptoms; elective Life-threatening Death diagnostic observations only; not indicated operative intervention consequences; urgent intervention not indicated indicated intervention indicated Definition: A disorder characterized by a rupture in the vaginal wall. Vaginal stricture Asymptomatic; mild vaginal Vaginal narrowing and/or Vaginal narrowing and/or Death shortening or narrowing shortening not interfering with shortening interfering with the physical examination use of tampons, sexual activity or physical examination Definition: A disorder characterized by a narrowing of the vaginal canal. Allergic rhinitis Mild symptoms; intervention Moderate symptoms; medical not indicated intervention indicated Definition: A disorder characterized by an inflammation of the nasal mucous membranes caused by an IgE-mediated response to external allergens. Apnea Present; medical intervention Life-threatening respiratory or Death indicated hemodynamic compromise; intubation or urgent intervention indicated Definition: A disorder characterized by cessation of breathing. Hypoxia Decreased oxygen saturation Decreased oxygen saturation Life-threatening airway Death with exercise. Laryngeal mucositis Endoscopic findings only; mild Moderate discomfort; altered Severe pain; severely altered Life-threatening airway Death discomfort with normal intake oral intake eating/swallowing; medical compromise; urgent intervention indicated intervention indicated. Laryngospasm Transient episode; Recurrent episodes; Persistent or severe episodes Death intervention not indicated noninvasive intervention associated with syncope; indicated. Mediastinal hemorrhage Radiologic evidence only; Moderate symptoms; medical Transfusion, radiologic, Life-threatening Death minimal symptoms; intervention indicated endoscopic, or elective consequences; urgent intervention not indicated operative intervention intervention indicated indicated. Pharyngeal hemorrhage Mild symptoms; intervention Moderate symptoms; medical Transfusion, radiologic, Life-threatening respiratory or Death not indicated intervention indicated endoscopic, or operative hemodynamic compromise; intervention indicated. Pleural effusion Asymptomatic; clinical or Symptomatic; intervention Symptomatic with respiratory Life-threatening respiratory or Death diagnostic observations only; indicated. Pneumothorax Asymptomatic; clinical or Symptomatic; intervention Sclerosis and/or operative Life-threatening Death diagnostic observations only; indicated. Pulmonary fibrosis Mild hypoxemia; radiologic Moderate hypoxemia; Severe hypoxemia; evidence Life-threatening Death pulmonary fibrosis <25% of evidence of pulmonary of right-sided heart failure; consequences. Sneezing Mild symptoms; intervention Moderate symptoms; medical not indicated intervention indicated Definition: A disorder characterized by the involuntary expulsion of air from the nose. Body odor Mild odor; physician Pronounced odor; intervention not indicated; self psychosocial impact; patient care interventions seeks medical intervention Definition: A disorder characterized by an abnormal body smell resulting from the growth of bacteria on the body. Periorbital edema Soft or non-pitting Indurated or pitting edema; Edema associated with visual topical intervention indicated disturbance; increased intraocular pressure, glaucoma or retinal hemorrhage; optic neuritis; diuretics indicated; operative intervention indicated Definition: A disorder characterized by swelling due to an excessive accumulation of fluid around the orbits of the face. Older lesions are usually a darker purple color and eventually become a brownish-yellow color. The syndrome is thought to be a hypersensitivity complex affecting the skin and the mucous membranes. Vascular disorders Vascular disorders Grade Adverse Event 1 2 3 4 5 Capillary leak syndrome Symptomatic; medical Severe symptoms; Life-threatening Death intervention indicated intervention indicated consequences; urgent intervention indicated Definition: A disorder characterized by leakage of intravascular fluids into the extravascular space. This syndrome is observed in patients who demonstrate a state of generalized leaky capillaries following shock syndromes, low-flow states, ischemia-reperfusion injuries, toxemias, medications, or poisoning. Hypotension Asymptomatic, intervention Non-urgent medical Medical intervention or Life-threatening and urgent Death not indicated intervention indicated hospitalization indicated intervention indicated Definition: A disorder characterized by a blood pressure that is below the normal expected for an individual in a given environment. Vasculitis Asymptomatic, intervention Moderate symptoms, medical Severe symptoms, medical Life-threatening; evidence of Death not indicated intervention indicated intervention indicated. Etiology, type of injury, diagnostic process, treatment methods 4Private Urology Center, 34744, and complications of urologic injuries and success rate have been investigated. Injuries were Istanbul, Turkey categorized into two groups as intra-operative early injuries and post-op late injuries. Early 5Private Obstetrics and Gynecology injuries were laceration, rupture, ligation and late injuries were hydronephrosis, contrast Center, 34744, Istanbul, Turkey material leakage or fistula. Results: Eight patients diagnosed in our clinic at intraoperative or post-op early period and 15 patients who were referred to our clinic after having operation in an external clinic were assessed. Ureteral injury and bladder injury was detected respectively in 6 and 2 patients getting early diagnosis. Fistula (5/15), hydronephrosis secondary to urethral stricture (3/15) and vaginal erosion (3/15) were detected as late diagnosed injuries. Conclusion: To reduce rate of urinary system injuries a sound knowledge of anatomy is required Correspondence: Dr. Early diagnosis and therapy may prevent Sokak No: 2, Kucukkoy, Gaziosmanpasa, complications and loss of organs that may lead to morbidity. Istanbul, Turkey, Key words: Bladder injury, ureteral injury, obstetric and gynecologic surgery, iatrogenic Efimail: drsbasaran@gmail. In practice of obstetrics, bladder and excessive blood loss, prolonged operation time, ureter injury risk increases as the number of Received: 11 July 2016, more frequent blood transfusions, fever and caesarean section and in hysterectomies done Accepted: 21 September 2016 longer hospitalization (1-3). Acute complications; diagnosed and treated intraoperatively, namely ureter ligation, bladder and ureter Eight patients diagnosed in our clinic at intraoperative or lacerations. Chronic complications are ureterovaginal and post-op early period and 15 patients who were referred to our vesicovaginal fstula occurring days or months afer primary clinic afer having operation in an external clinic were analyzed. Tirteen of the injuries were gynecologic and 10 of them were In this study, we aimed to present urinary system injuries obstetric. In 8 patients the diagnosis was established at intraoperative and their clinical consequences. In two patients who experienced bladder injury during caesarean In this study, twenty-three patients who had urological organ section primary repair was done and the patients were catheterized. In ureter ligation cases sutures were symptoms and conducted surgical procedures were derived from removed to check for any damage. First surgical intervention D&J catheter was inserted and the patients were followed. During assessment of urologic two patients with full thickness cutting ureter primary repair injuries etiology, type of injury, diagnostic process, treatment was done by the help of catheter. In a patient operated for cervical methods, complications and success rate have been investigated. Minimum 90 days later D&J catheters were laceration, rupture, ligation and late injuries were hydronephrosis, removed and no urinary fow abnormality was observed. Diagnosis was established stage injury fndings of 15 patients who were operated in external in each patient by physical examination, gynecologic examination, clinics and referred to our clinic were shown in Table 2. In our study 9 of expected that injury risk may be present only in complicated the patients (90%) have undergone hysterectomy and only one surgeries; however, injuries are observed during simple surgical patient (10%) has undergone ovarian cyst surgery. Pelvic adhesions, radiotherapy, large uterus, was determined as the most frequent cause of ureteral injuries gynecologic malignancies, endometriosis, anatomic anomalies and there was no ureteral injury secondary to obstetric causes. The most important factor determining gynecologic operations is bladder and the rate of injury was prognosis in ureter injuries is time from diagnosis to treatment. Bladder injuries may occur during Intraoperative diagnosis reduces morbidity and mortality but pelvic, abdominal or vaginal operations. Anatomic variations, delayed diagnosis may manifest itself as negative clinical signs inefcient exploration, adhesions, scar secondary to previous (15). Unfortunately, currently most of the ureter injuries are surgery, radiotherapy, presence of urinary infection, malignancy, diagnosed at a late stage (16,17). In our study 6 of early injuries The most frequent iatrogenic injuries are bladder laceration and and 4 of later stage were diagnosed. Incidence of bladder injury during caesarean clamp crush, diatermic injuries, ligation, segmental resection of section varies between 0. Chronic complications are ureter stricture, may lead to bladder injury during caesarean section were reported. Symptoms Previous caesarean section, urgent caesarean section, caesarean of patients are variable but may be manifested as fank pain, section performed during the second stage of labor and fever, prolonging ileus, ascites, urinary incontinence, anuria, intraabdominal adhesions may play a role in acute injuries. In follow up of 5 patients treated with proper of prolonged indwelling catheter are seem to be potential risk interventions in the early period no pathology has been observed. Fistula afer caesarean section may be observed clinical signs such as decrease in urinary output and uremia have in various locations. Tere the most frequent cause of vesicouterine fstula formation observed was no abnormality in the post-op follow up for 4 months. Among genitourinary fstula the catheter was placed to 3 patients referring at a late stage and they most frequent one is vesicovaginal fstula. Tere was no abnormality in the etiology are caesarean section, using of vacuum or forceps, follow up visits. Afer various tests it was determined that in one episiotomy and prolonged labor (27, 28). In our study, vesicovaginal patient non-functioning kidney has developed and nephrectomy fstula has formed afer normal delivery in 3 patients and history was carried out. Urinary tract injuries during obstetrics may facilitate detection and repair of urinary leakage or hematuria. Operative injuries to the ureter: Prevention, recognition diagnosed bladder injury. Iatrogenic ureteric of following bladder injuries were vesicourinary fstula in 2 injuries: Approaches to etiology and management. Secondary repair of fstula was accomplished in for bladder injury during cesarean delivery. Urinary complications of since they are easily applicable, reliable and their long term results gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics are successful (29). Incidence Iatrogenic ureteric injuries in a Nigerian teaching hospital: experience in of vaginal erosion afer incontinence surgery varies between 0. The role of urologists in the surgery and manifests its clinical signs within 9 months in average. Prophylactic ureteral catheterization in chronic diseases, use of corticosteroids, infections and inelaborate gynaecologic surgery: a 12-year randomized trial in a community hospital.

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