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The technical materials cited and hyperlinked throughout this document provide specific information for individual exposure assessment situations order glyset 50mg online. At the time of publication buy glyset 50 mg visa, all cited materials and hyperlinks were correct and functional order cheap glyset on line. This mission is purchase glyset 50mg on line, in part, accomplished by understanding, characterizing and managing health risks associated with exposure to environmental contaminants and other agents. Exposure science characterizes, estimates and predicts exposures; it also provides information for preparing exposure assessments and for developing effective strategies to reduce exposure and manage risk. This Guidelines for Human Exposure Assessment provides an updated resource on assessing human exposure for exposure and risk assessors in the Agency, and for consultants, contractors or others who perform this type of work under Agency contract or sponsorship. This document builds on and supersedes the 1992 Guidelines for Exposure Assessment (U. It briefly describes the principles of exposure science and assessment, provides guidance on the various approaches for conducting an exposure assessment and presents references for more detailed information. It does not serve as a detailed instructional manual or supplant specific exposure guidance in use by Agency programs, nor does it endorse specific models or approaches that could have limited applicability or have become outdated. This document does not include an exhaustive description of emerging topics, such as high-throughput exposure assessment or the implications of in vitro-based risk assessments on the field of exposure assessment. Aspects of these advances that have been published in the peer-reviewed literature, however, are included. Finally, this Guidelines provides links to exposure assessment tools and technical documents that address particular exposure assessment needs. The focus of this Guidelines for Human Exposure Assessment is on human exposure to chemical agents in the non-occupational environment. This document is organized in chapters, each of which explores a component of the exposure assessment process. Chapter 1 introduces this Guidelines for Human Exposure Assessment and discusses the purpose and scope of the document. Chapter 2 provides a general review of exposure science concepts and principles, including approaches and tools for consideration when planning and conducting exposure assessments. Topics include an overview of exposure science, the role of exposure assessment in the risk assessment process, concepts and types of exposure assessments, equations and input variables for estimating exposure, presentation of exposure assessment findings and a brief history of exposure science. Page xiv Exposure characterization is an important step in all exposure assessments, and the chapter presents guidance regarding the synthesis of exposure information. Chapter 3 describes a process for the planning and scoping and problem formulation steps for an exposure assessment. It emphasizes the importance of establishing goals and objectives; building an interdisciplinary team; developing a conceptual model; identifying assessment options, available resources and data needs; producing an overall assessment plan; engaging and involving appropriate stakeholders; engaging and involving the community; establishing data quality objectives; and conducting peer review. Chapter 4 discusses possible increased risk of adverse health effects from environmental contaminants for different lifestages, vulnerable groups and populations of concern because of disproportionate exposure or varied responses to exposure. These factors can include age, sex, genetic susceptibility, cultural characteristics, behaviors, occupation, socioeconomic status, access to a healthy diet, race/ethnicity and geographic location. This chapter assembles other existing Agency guidance, along with examples of case studies, to discuss where techniques and considerations associated with lifestages, vulnerable groups and populations of concern can be applied in exposure assessments. Chapter 5 discusses various aspects of data used for exposure assessments, including determining the data needed; whether data are currently available and their quality; and when data are not available, whether they need to be developed. Understanding data availability, applicability, characteristics, quality issues and limitations is critical to conducting a scientifically-sound exposure assessment. This chapter presents guidance on the assessment of data uncertainty and variability. It also emphasizes the importance of transparency and communication of findings to the risk manager/decision maker and stakeholders. Chapter 6 highlights basic concepts in modeling, including the principles of the modeling process. It provides an overview of modeling for exposure assessment, outlines the criteria for choosing appropriate models based on the goals and data quality objectives and describes how to evaluate a model that might be useful for an exposure assessment. Chapter 6 includes information on modeling inventories and clearinghouses and describes resources that support the use of models of various levels of complexity, including probabilistic models. Chapter 7 provides details on planning an observational human exposure measurement study. The studies involve measurements of chemical, physical or biological agents in environmental media; collection of information about study participants and their homes, work environments and activities; and collection of personal Page xv exposure and biological samples. This chapter discusses the aspects of planning an observational human exposure measurement study, including budget and logistical planning, establishing a study design, planning and executing a pilot study and a full field study and the importance of conducting peer review.
Emergence of Insects Insects will begin to feed and deposit eggs when the temperatures rise to 50 to 65 F or above and remain in this range for one to two weeks purchase glyset 50 mg online. In some years order glyset 50mg without a prescription, pests may appear one to two weeks earlier or later than in other years because of an early or late spring glyset 50mg visa. Effective Spraying Insecticides are most effective when they are applied to the parts of the plant on which the young larvae or nymphs are feeding order 50 mg glyset with visa. Stop spraying when the plant surfaces are wet to the point of run-off or dripping. Repeat the spray applications at regular intervals to control the late-hatching, emerging or migrating insects. The temperatures should be in the 60 to 80 F range with a wind velocity of less than five miles per hour, with no rain forecast for 24 hours. If one-half inch or more of rainfall occurs within 12 hours after spraying, repeat the application. Ornamental Pests Host & Pest Stage Where to Treat What to Use Updated April 2018 When to Treat Aphids E N&A Crevices of bark on twigs of most deciduous plants Undersides of leaves of elm, linden, maple, oak and many other plants; also twigs; also needles of some conifers. Entomopathogenic nematodes can be applied to the trunk from May to September to control borers in an infested tree or shrub. Lilac Borer/Ash Borer and Banded Ash Clearwing L A Bore into branches and trunk, scar wounds. Ornamental Pests Host & Pest Stage Where to Treat What to Use When to Treat Emerald Ash Borer L A Larvae bore into the trunk and branches. The vascular tissue beneath the bark is devoured, effectively girdling the tree and killing it within a few years. May-September L Two-banded L&A Japanese Weevil Southern Red E, N & A Mite Roots Foliage, roots. Foliage of birch and other hardwoods such as oak, maple, hickory, crabapple, quince, elm, butternut, walnut and locust. Merit, Marathon or Discus L drench around February to mid-April the base of the tree as an alternative to trunk sprays. New leaf growth Talstar, Malathion, Orthene, Dimethoate, Apply Merit to the soil (not mulch) in attacked generally in early Merit, Marathon, Acelepryn, TriStar, February-March as a soil drench or a season. The false boxelder bug or red shoulder bug is similarly associated with the goldenraintree. Bark of twigs, especially lilac, also ash, rhododendron, birch (locate and spray nest) Thorough coverage of foliage of boxwood. Treat at first permethrin (Astro, Perm-Up and others), sign of attack, usually when tree Dursban (use ambrosia beetle rate), Onyx, is just about to come out of Onyx Pro winter dormancy. Look for tiny shotholes in tree with toothpick diameter protrusions composed of sawdust- like frass. March-May when flying adults caught in ethyl alcohol baited traps or when attack first seen. This usually corresponds with warm (70 F or higher) temperatures for several consecutive days. Meridian, Arena TriStar, Distance, Talus, Fulcrum, Aria, May, July-August as a foliar Kontos application. Treat at first permethrin (Astro, Perm-Up and others), March-May when flying adults caught sign of attack, usually when tree Dursban (use ambrosia beetle rate), Onyx, in ethyl alcohol baited traps or when is just about to come out of Onyx Pro attack first seen. Look for tiny corresponds with warm (70 degrees shotholes in tree with toothpick F or higher) temperatures for several diameter protrusions composed consecutive days. Dursban, Onyx, Onyx Pro, permethrin (Astro, Perm-Up and others) Late-April, mid-July, and earlySeptember. Ornamental Pests Host & Pest Stage Where to Treat What to Use When to Treat Dogwood A Club Gall L (Midge) Dogwood Twig L Borer Leaves and small branches. Mid-May Rose Leafhopper N A A Whitefringed Beetle A Tunnels in limbs, holes and boring Marathon, Discus L, or Merit, drench dust along underside of around the base of the tree as an infested wilting limb. Prune and burn infested limbs in Dursban, permethrin May or June before borer (Astro, Perm-Up and others) matures. Sevin, Carbaryl, Malathion, Flagship, Discus L, Marathon, Merit, TriStar, Meridian, Safari, Zylam Liquid, Talus, Aria, Kontos, BotaniGard, Sanmite, Provaunt, Altus Larvae girdle trunk and roots Sevin, Carbaryl, Imidan below soil line, especially on Mow and rake before spraying.
Rheumatic heart disease Amyloidosis Iron overload Hypothyroidism Carcinoid heart disease Cardiovascular System 183 174 generic glyset 50mg with mastercard. A 59-year-old patient receiving chemotherapy with the anthracycline Adriamycin develops severe heart failure discount glyset 50mg on-line. Sections from an endocardial biopsy specimen reveal vacuolization of the endoplasmic reticulum of the myocytes buy glyset 50mg otc. Dilated cardiomyopathy Hyperplastic cardiomyopathy Hypertrophic cardiomyopathy Obliterative cardiomyopathy Restrictive cardiomyopathy 175 generic 50 mg glyset mastercard. Histologic sections from this area reveal disorganization of the myofibers, which are thicker than normal and have hyperchromatic nuclei. Hypertrophic cardiomyopathy Dilated cardiomyopathy Constrictive cardiomyopathy Secondary cardiomyopathy Endomyocardial fibrosis 184 Pathology 176. The familial form of the abnormality seen in this gross photograph of the heart is a. An autosomal recessive disorder associated with decreased acid maltase formation d. An elderly patient who becomes acutely short of breath presents with the combination of hypotension, elevated jugular venous pressure, and muffled heart sounds. Chronic pericarditis Chronic pericardial effusion Cardiac tamponade Dissecting aortic aneurysm Right heart failure 178. The most common primary tumor of the heart in adults is usually located in the left atrium and is called a a. The combination of a ventricular septal defect with an aorta that overrides the septal defect, stenosis of the pulmonic valve, and increased thickness of the right ventricle is diagnostic of a. Which one of the following is the most common congenital heart defect to cause an initial left-to-right shunt Tetralogy of Fallot Coarctation of the aorta Ventricular septal defect Atrial septal defect Patent ductus arteriosus 186 Pathology 181. Aorta to pulmonary artery to lungs to left atrium to left ventricle to aorta Left atrium to right atrium to right ventricle to lungs to left atrium Left ventricle to right ventricle to lungs to left atrium to right ventricle Right atrium to left atrium to left ventricle to aorta to right atrium Right ventricle to left ventricle to aorta to right atrium to right ventricle 182. Prior to surgery, what is the most appropriate medical therapy for a newborn infant with transposition of the pulmonary artery and aorta Prostaglandin E2 should be given to keep the ductus arteriosus open Prostaglandin E2 should be given to close the ductus arteriosus Oxygen should be given to keep the ductus arteriosus open Indomethacin should be given to keep the ductus arteriosus open Indomethacin should be given to close the ductus arteriosus Cardiovascular System Answers 141. Abnormalities of this lipid transport or metabolism result in hyperlipoproteinemias, which are responsible for most syndromes of premature atherosclerosis. The primary hyperlipidemias are divided into five distinct electrophoretic patterns. Type I hyperlipoproteinemia, caused by a mutation in the lipoprotein lipase gene, results in increased chylomicrons and triglycerides. Homozygotes for this gene defect have markedly increased plasma cholesterol levels and develop severe atherosclerosis at an early age. The genetic defect causing this abnormality is a mutation in the lipoprotein lipase gene. Secondary increased cholesterol may be due to diet, hypothyroidism, or nephrotic syndrome, while secondary increased triglycerides may be due to diet or diabetes mellitus and increased cholesterol and triglycerides 187 188 Pathology together may be due to alcohol ingestion, pregnancy, or decreased albumin due to liver or kidney disease. The reason for this is that with decreased levels of insulin with diabetes mellitus there is increased mobilization of free fatty acids from adipose tissue (increased lipolysis). This is because ethanol also increases lipolysis of adipose tissue, which increases delivery of free fatty acids to the liver. Ethanol also increases the esterification of fatty acid to triglycerides in the liver and inhibits the release of lipoproteins from the liver. In contrast to the mechanisms involved in producing secondary hyperlipidemia, increased binding of bile salts in the gut to decrease the enterohepatic circulation of cholesterol is the mechanism by which cholestyramine can decrease serum cholesterol levels. These risk factors are either quite significant (major factors) or less significant (minor factors). Major factors include diet and hyperlipidemia (hypercholesterolemia and hypertriglyceridemia), hypertension, cigarette smoking, and diabetes mellitus.
In an exposure assessment order 50mg glyset with amex, computational models are tools the assessor uses to analyze and characterize processes that are too complex for capturing completely by empirical data or for which empirical data are not available discount glyset 50 mg online. Models help extrapolate monitoring data to non-surveyed populations cheap glyset 50mg free shipping, reconstruct past exposures or predict future exposures order glyset 50mg on-line. Models also serve as a framework for assembling various types of data to develop estimates of exposure that are consistent with all available empirical data. In general, the modeling process within an exposure assessment might include interactions among public policy processes, represented by the planning and scoping and problem formulation steps of an exposure assessment, model development and model application (U. Depending on the analysis plan developed during the problem formulation phase of an exposure assessment (see Section 3. After the project team has identified the problem that modeling will address, they determine the specifications of the problem, including the model type that addresses the purpose of the assessment, meets the data criteria and considers the spatial, temporal and physical boundaries of the problem. Page 107 the process of developing and validating a new model or modifying and evaluating an existing model is beyond the scope of this document, but Guidance on the Development, Evaluation, and Application of Environmental Models (U. This model guidance document recommends that model developers and users: Subject their model to a credible and objective peer review Assess the quality of the data used in the creation and evaluation of the model Corroborate their model by evaluating the degree to which it corresponds to the system being modeled Perform sensitivity and uncertainty analyses Document all aspects of a modeling project Communicate effectively with analysts and risk managers/decision makers. Model applications also involve evaluating and refining the model and comparing the model results to assessment goals and data quality objectives to ensure that they are achieved (see Section 5. An assessor might need to refine the model further or use a new one if the model does not meet the criteria. Provides a simplified, comprehensive resource on the principles of good modeling practice. Selecting the Type of Model for Exposure Assessments the process of model selection first involves identifying the type of model needed to meet the risk management objectives of the assessment and then determining the complexity of the model necessary to reach a decision. After defining the type of model needed, the assessor and individuals with modeling expertise determine whether such a model exists to meet those needs or a new model needs to be developed. Selection of an appropriate model is critical for accurately estimating exposure concentrations. Assessors generally choose from multiple models that are relevant for the populations and exposure sources of interest. Page 108 When selecting and using models, assessors, in collaboration with individuals experienced in modeling, need to review the modeling literature. Several factors help an exposure assessor select an appropriate model for an exposure assessment: the study objectives, technical capabilities of the model, model availability and ease of use (U. An equally critical step in the process is to choose appropriate default values for exposure factors when data are missing or incomplete. The best model is less reliable without good data and appropriate default factors. Presentation of the rationale for selecting the model is essential to promoting transparency in the assessment (see Section 6. Models used for site characterization, conducting groundwater flow and transport simulations, determining wellhead protection areas and selecting groundwater remediation at Resource Conservation and Recovery Act and Superfund sites. Emissions data, modeling platforms, emission modeling software resources and ancillary data. Environmental Protection Agency Model Clearinghouse Information Storage and Retrieval System Includes 12 fate/transport models, 15 exposure Williams et al. Air quality models and other mathematical simulation techniques used in assessing control strategies and source impacts. Center Office of Pollution Website from which users can download or Prevention and Toxics access tools and models the Office of Pollution Prevention and Toxics uses in its programs. Office of Pesticide Programs Website from which users can access exposure models, model-related resources. Models described at this site are used to predict exposures for a range of ecological receptors and to predict exposures for humans from dietary and non-dietary sources. Users typically begin with simpler models that, when combined with conservative inputs, can screen out exposures of low concern (see Section 6. For example, if the goal is to determine whether the level of a chemical in a product or the level of a chemical observed to occur in an environmental medium is of low concern, a bounding analysis using a deterministic model might be sufficient. Questions concerning the fraction of the population a source affects or regarding the quantitative characterization of uncertainty immediately dictate the need for probabilistic models (see Section 6.
This inability to expel amniotic fluid at birth discount 50mg glyset with visa, frequently associated with prematurity order 50mg glyset mastercard, is characterized by squamous epithelial cells of amniotic origin in fetal terminal air spaces and larger bronchi order glyset 50mg free shipping. The disorder is manifest by enlarged buy glyset 50 mg low price, edematous placental villi in a loose stroma, grossly resembling a bunch of grapes. It characteristically occurs in early months of pregnancy and eventuates to choriocar cinoma in 2%-3% of cases. Clinical characteristics include vaginal bleeding and rapid increase in uterine size. A hydatidiform mole can be mistaken for a normal pregnancy, but the uterus is often too large for the supposed state of gestation. The usual result is 69 chromosomes derived from two paternal and one maternal hap loid set. Gestational choriocarcinoma is an aggressive malignant neoplasm that occurs more frequently than ovarian choriocarcinoma. This disorder is the most common cause of a palpable breast mass in patients between 25 and 50 years of age. Disease is postulated to result from increased activity of, or sensitivity to , estrogen or to decreased progesterone activity. Nonproliferative forms (stromal fibrosis and cyst formation) are not associated with an increased risk of breast cancer. Epithelial hyperplasia (with atypia) or sclerosing adeno sis carries a slightly increased risk, and the risk of cancer is clear when hyperplastic epithelium demonstrates atypia. Cysts are grossly visible or may be evident only on histologic examination; they may be filled with fluid, which may appear blue when seen through the cyst wall (blue dome cyst). Epithelial changes (1) the lining of the epithelium may be flattened, may show apocrine metaplasia, or may be hyperplastic. The fibroadenoma is morphologically well-demarcated from adjacent breast tissue; delicate fibrous stroma encloses the epithelial component consisting of gland-like or duct-like spaces lined by cuboidal or columnar cells. The stromal cells are neoplastic, and the ductal epithelial cells are thought to be reactive. The tumors may be classified into two types: (1) Intra canalicular fibroadenoma: stroma compresses and distorts glands into slitlike spaces (2) Pericanalicular fibroadenoma: glands retain round shape 2. This tumor is a large, bulky mass of variable malignancy with ulceration of overlying skin. Cystic spaces containing leaf-like projections from the cyst walls and myxoid contents are characteristic. This is a benign tumor of the major lactiferous ducts that must be distinguished from b. There are several histologic typ es; invasive ductal carcinoma occurs most frequently. Breast cancer demonstrates estrogen and progesterone receptors in some tumors but not in others; presence is correlated with a better prognosis and is thought to be a predictor of the efficacy of antiestrogen therapy. Conflict ing data from some studies indicate a slightly increased risk with high-dose post menopausal estrogen therapy. About 4 months earlier, she had a painless labial sore and swelling of a right inguinal lymph node, both of which had subsided unevent fully over a period of several weeks. About 3 weeks later she developed fever and a generalized maculopapular skin rash that involved the palms of the hands and the soles of the feet. A 24-year-old woman is seen because of high fever, prostration, vomiting, and diar rhea. Culture of which of the following specimens most likely leads to the correct diagnosis A 56-year-old diabetic woman has recently been treated with a 2-week course of antibiotics for a skin infection. She returns to the clinic for follow-up with a new complaint of a "cottage cheese-like" vaginal discharge with significant vaginal itching. A 25-year-old woman has cauliflower shaped perineal lesions that are diagnosed as condyloma acuminatum. A 26-year-old woman presents for routine gynecologic examination and Papanicolaou (Pap) smear. When potassium hydroxide is added to a wet mount of the sample, a fishy odor is noted.
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