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Inhalation of agents (respiratory exposure) results in deposition of infectious or toxic particles within the lungs which may provide a further direct pathway to the systemic circulatory system depending on the size of the droplet (see Figure 4-B). However, these relatively large particles are filtered by natural processes and are too large to reach the systemic circulation. Aerosol delivery systems aim to generate invisible clouds with particles or droplets between 0. Smaller sized particles are not efficiently retained by the human respiratory tract and are relatively unstable under environmental conditions. Infection by the respiratory route may induce disease at doses lower than those generally associated with naturally acquired infections by the oral route. The subsequent illness may differ from the natural pattern, and the incubation period may be much shorter. Intact skin provides an excellent barrier for most, but not all, biological agents. However, mucous membranes and damaged skin constitute breaches in this normal barrier through which agents may readily pass. Agents passing through the skin may cause skin lesions, or more rarely, can enter the systemic circulation to cause more generalized disease anywhere in the body. Generally, disease symptoms from skin exposure take longer to occur than those from aerosol exposure (3 to 10 days versus 1 to 3 days). Direct contamination of consumables, such as drinking water, foodstuffs, or medications, could be used as a means to disseminate infectious agents or toxins. This method of attack would be most suitable for sabotage activities and might be used against limited targets such as water supplies or food supplies of a military unit or base. Filtration and adequate chlorination significantly reduce this hazard as it pertains to water. However, survivability of the infectious agent or toxin in water is highly variable (see Table 4-C). Vector-Borne Attacks: Large number of infected live vectors can be produced to spread vector borne diseases by releasing infected arthropod hosts such as mosquitoes, ticks or fleas. Agent Survival: There is potential for delayed generation of secondary aerosols from previously contaminated surfaces. To a lesser extent, particles may adhere to individuals (skin or clothing) creating additional, but less significant, exposure hazards. Person-to-person spread: Humans, as unaware and highly effective carriers of a communicable agent, could readily become a source of dissemination of certain agents by direct contact (skin or clothing) or aerosol droplet spread. Enterotoxins Yes Probably stable Unknown Microcystins Yes Probably stable Resistant at 100 ppm Anatoxin A Probable Inactivated in days Unknown Tetrodotoxin Yes Unknown Inactivated 0. Downwind hazard prediction for biological agents is very similar to procedures for chemical agents. The resulting prediction provides a general, minimal estimate of danger zones before actual agent has been identified, and before sampling is done to further identify areas affected. Each unit evaluates the report and distributes it to subordinate units that might be affected. This warning will be adequate for the first 1-5 hours (depending on wind speed), and will relate to about half of Zone I of a simplified biological hazard prediction. All attacks in daytime and all toxin attacks are presumed to have a period of 8 hours in which the agent cloud retains its effectiveness. Hazard area predictions become less reliable as distance and time from the point of attack increase. Toxins and microorganisms will probably be the primary form of contamination of food and water. It is unlikely that a biological agent will materially affect the appearance, taste or smell enough for the change to be apparent. The normal packaging and packing of food provides protection against most biological agents. Decontamination procedures are only necessary for spore-forming agents such as anthrax. Operational rations are packaged in metal containers or aluminum laminated plastics that can withstand boiling and are resistant to arthropod penetration, thus making them highly resistant to biological agents. Food stored in freezers, refrigerators, and in refrigerated trucks or rail cars will be safe if the containers remain sealed until the outer surfaces are decontaminated. The inspection and monitoring of food and water is absolutely essential for rapid identification. No field expedient method exists for the identification of food suspected of being contaminated with a biological agent. The fact that the source of the exposure may have been artificially created by deliberate, hostile means will not change the basic principles of treatment. For instance, in the event of a biological attack, the most important factor in providing operationally relevant information and adequate medical management will be the rapid establishment of an accurate, specific identification of the agent. In contrast to naturally occurring epidemics in which the disease incidence increases over a period of weeks or months, an artificially induced epidemic will peak in a few hours or days. Since a biological attack may be silent or nearly so, the first indication of a problem may well be the appearance of a wave of casualties in which medical personnel are unable to differentiate natural disease epidemics from covert enemy attacks. Onset of illness following exposure to toxic agents may range from minutes to as long as 3 weeks. An increasing casualty load is anticipated with relatively few initial casualties and a greater number over successive hours or days until a peak is reached. An exception to this aspect would be an attack with a biological toxin that might create an immediate and dramatic mass casualty situation. Therefore, the combatant commander must plan to use directive authority to ensure the proper coordination of health service to the force, to include adequate shelter, food, medical prophylaxis, and fluids. Medical management must provide reasonably adequate shelter, establish uncontaminated food and water intake, and ensure specific treatment is available. Demands for military medical support to neighboring civilian populations following such an attack will probably be intense, especially if the attack contaminated neighboring civilian populations with concentrations of very young, very old, and those already suffering from underlying disease or other forms of weakening stress. The tendency of individuals in an emergency situation to become careless regarding food and water sanitation, general hygiene, and other common disease control measures could be a significant cause of secondary spread of disease. The problems of maintaining safer water and food conditions will differ for military personnel deployed throughout the operations area and for the civilian. Protective measures must be practiced by those who transport, store, prepare, and serve food, as well as by those who consume the food. In addition, consideration must be given to the application of control measures necessary to prevent contamination of consumables by insects, rodents, and other vectors. It is difficult to maintain satisfactory personal and area field sanitation, particularly in unfamiliar climates. For further information on purification of water contaminated with biological agents, see Medical Issues Information Paper No. Patient decontamination requires manpower, and will reduce the number of personnel available to treat casualties. Establishing and maintaining a facility with collective protection support and continuously monitoring the air inside the shelter for contaminants calls for additional personnel. These procedures decrease the ability to treat patients as efficiently and effectively. Immediately obtaining very large amounts of the appropriate treatment (if any) is critical. Commanders, soldiers, host nation leaders and populations and national leaders will immediately ask for more information than will be available. Although newer production plants have been designed for potential operation in such a state, generally production will be stopped until air quality improves. Product transfer operations (gaseous and liquid) will also be curtailed unless medical and flight line requirements demand such. Supply and medical units must develop plans to resupply critical gases and cryogenic liquids in the contaminated area from primary and alternate sources. These sources include production and storage capabilities organic to the unit from other services, from host nation support, and from commercial contracts.

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The meeting is subject to change upon Toro, Department of Elder Affairs, Planning and Evaluation, chairpersons request. The Agency for Health Care Administration announces a meeting of the State Consumer Health Information and Policy Physicians Data Technical Workgroup to which all interested parties are invited. Special Accommodations requests under the Walker Bos, Agency for Health Care Administration, 2727 Americans with Disabilities Act should be made at least seven Mahan Drive, Bldg. Pilot Commissioners, (850)922-6096 at least forty-eight (48) For more information about the meeting, for a copy of the hours prior to the meeting. Such record must Act, any person requiring special accommodations to include the testimony and evidence upon which the appeal is to participate in this workshop/hearing/meeting is asked to advise be based. Portions of the probable cause the Florida Board of Pilot Commissioners announces a proceedings are not open to the public. Any person who desires a special accommodation at this A copy of the agenda may be obtained by writing to: Lori meeting because of a disability or physical impairment should Crawford, Deputy Clerk, Division of Real Estate, 400 West contact the Division of Real Estate at (407)245-0800 (between Robinson Street, Hurston Building, North Tower, Suite N802, the hours of 8:30 a. Official business of the Florida Mobile Home Relocation All or part of this meeting may be conducted as a Corporation. Review of mobile home owner applications for teleconference in order to permit maximum participation of the compensation for relocation and/or abandonment due to Commission members or its counsel. A schedule for the next meeting will be Commission, with respect to any matter considered at this determined. Act, any person requiring special accommodations to A copy of the agenda may be obtained by writing: Deputy participate in this meeting is asked to advise the agency at least Clerk of the Florida Real Estate Commission, 400 W. Any person requiring special accommodations at this meeting because of a disability or physical impairment should contact the Department of Environmental Protection, Designated the Board, (850)245-4355, at least 48 hours prior to the Uses and Classification Refinement Policy Advisory meeting. Act, any person requiring special accommodations to Pursuant to the provisions of the Americans with Disabilities participate in this workshop/meeting is asked to advise the Act, any person requiring special accommodations to agency at least 48 hours before the workshop/meeting by participate in this workshop/meeting is asked to advise the contacting Stacey Feken at (850)245-8421. The Board of Chiropractic Medicine will hold a duly noticed For more information, you may contact: Pamela E. If any person decides to appeal any decision made by the If any person decides to appeal any decision made by the Board with respect to any matter considered at this meeting or Board with respect to any matter considered at this meeting or hearing, he/she will need to ensure that a verbatim record of hearing, he/she will need to ensure that a verbatim record of the proceeding is made, which record includes the testimony the proceeding is made, which record includes the testimony and evidence from which the appeal is to be issued. This meeting Any person requiring special accommodations at this meeting will be via conference call. A copy of the agenda may be obtained by writing: Council of the Department of Children and Family Services, Assistant Licensed Midwifery, 4052 Bald Cypress Way, Bin C-06, Secretary for Substance Abuse and Mental Health Office Tallahassee, Florida 32399-3256. Consider appointment of professionals including but not Manatee County, Florida 34222. The owner and operator of the limited to trustee and/or originator/servicer for upcoming development is Tuscany Lakes, Ltd. Any persons desiring to present oral upcoming single-family bond issues including initiation comments should appear at the hearing. Consideration of approval of underwriters for inclusion on approved master list and teams. A copy of the agenda may be obtained by contacting: Wayne Conner, Deputy Development Officer, Florida Housing 9. Consideration of all necessary actions with regard to the Finance Corporation at (850)488-4197. Consideration of all necessary actions with regard to the contacting: Wayne Conner, Deputy Development Officer, Homeownership Programs. Consideration of all necessary actions for initiating new rules or rule amendments on an emergency or non-emergency basis. Consideration of workouts or modifications for existing Pursuant to the provisions of the Americans with Disabilities projects funded by the Corporation. Consideration of matters relating to the stated purpose of participate in this workshop/meeting is asked to advise the the Corporation to provide safe and sanitary housing that agency at least 5 days before the workshop/meeting by is affordable for the residents of Florida. Such other matters as may be included on the Agenda for Executive Center Circle, East, Suite 201, Tallahassee, Florida the October 20, 2006, Board Meeting. If you are unable to attend this public hearing, the Office of Insurance Regulation announces a hearing to please forward your comments to the Office of Insurance which all persons are invited. Room 212-F, Larson Building, 200 East Gaines Street, For more information, you may contact Rhoda K. Sunshine State Insurance Company has requested the For more information, you may contact: James Watford, following average statewide increases for its homeowners Actuary, Room 212-F, Larson Building, 200 East Gaines insurance: 70. Please call 1(800)342-0825 to confirm the time and place of Multi-Program Council meetings the meeting. January 10, 2007; February 14, 2007; March 14, 2007; April 11, 2007; May 9, 2007; June 13, 2007, 6:00 p. The Petition requests Purchasing guidance regarding the extinguishment requirements for a high rise mixed occupancy condominium building. The Declaratory Statement declines to sealed bids until the dates and times shown for the following make findings on the meaning of provisions in Chapter 718, projects. Bidder must reference bid number, copy of the order is also available on the Division of State Fire opening date and time on outside of bid package to insure Marshal website which may be accessed at. Application packages are to be returned to the Architect at the time of the materials will not be returned. The in the discipline of Architecture will be required for the project selected consultant must warrant that it will neither utilize the listed below: services of, nor contract with, any supplier, subcontractor, or Project No. Florida State University, Tallahassee, Florida Professional Qualifications Supplement forms, descriptive the project consists of constructing an addition of project information, and selection criteria may be obtained approximately 23,000 gross square feet and the renovation of through our website, The new addition Mendenhall, Building A, Florida State University, Tallahassee, will allow the Middle and Secondary Education Department to Florida 32306-4152, (850)644-3591 telephone, (850)644-8351 collocate to the Stone Building. The selected firm will be asked to consider other aspects of the Copies of the Program may be obtained at the Applicants existing building and its current site. The existing site electronic submittals are not acceptable and will not be features, parking and landscaping should appear as a cohesive, considered. A completed Florida State University Professional with the option to renew for two additional one-year periods. A copy of the applicants current Professional Registration Firms interested in being considered for the Continuing Certificate from the appropriate governing board. Information on the selection process can be found at the results of the short-list and final selection will be posted at: Any protests of the selection must be made within 72 Notices for the Board of Trustees of the Internal Improvement hours of the posting. Applicants are advised that plans and specifications for A/E projects may be reused. Such actions may cause your proposal, or the the outside of the package containing the proposal must be proposal you are supporting, to be rejected. Key personnel, their titles and/or classification denied to applicants so convicted until such applicant is 4. Subconsultants that may be used for the project properly reinstated pursuant to Section 337. Interested parties are encouraged to attend presentations and proceed with selection on November 6. The Request for Proposal may be For details please visit the Departments website listed below downloaded from the website There will be a Mandatory Applicants under this competitive grant process must be completed by Conference on Wednesday, October 18th at 1:00 p. Only the Statewide Competitive Grants to retrofitting public hurricane evacuation shelters is an efficient Structurally Enhance or Retrofit Public Hurricane Evacuation and economical method of accelerating state and local efforts Shelters Application found at The City of Key West is a designated area of critical state chairman of the governing board, or duly authorized chief concern. A copy of such petition or complaint must also be sent by U. Mail: If no petitions or complaints are received within 30 days the Honorable Morgan McPherson of the date of publication, a final order will be issued by the Mayor, City of Key West Department of Highway Safety and Motor Vehicles approving the establishment of the dealership, subject to the applicants P. Box 1409 compliance with the provisions of Chapter 320, Florida Key West, Florida 33041 Statutes. Cheryl Smith Notice of Publication for a New Point Clerk to the City Commission Franchise Motor Vehicle Dealer in a County of More P.


  • Lowry Yong syndrome
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Serous atrophy ofpericardialand perirenalfat file:///C:/versam m elt/index m eister. In m oderate to lightinfestations the lesions are rem oved and the carcass is passed. Atroom tem perature,the virus is persistentfora few m onths in urine,dried blood,faeces and serum. Subcutaneous edem a ofthe head,neck,brisket,thorax and ventralabdom en Pulm onary form 7. Gelatinous edem a in the periorbitaltissue,neck m uscles and ligam entum nuchae. Equine infectious anaem ia Equine infectious anaem ia is an acute,subacute,chronic and latentdisease ofsolipeds caused by a virus. Itis m anifested with interm ittentfever,depression,weakness,edem a,anaem ia and icterus. Transm ission:Close continued contactwith susceptible anim als and biting insects m ainly Tabanidae and m osquitoes. Contam inated surgicalinstrum ents,needles,contam inated feed, bedding and intrauterine infection. Horse m ay die ofanaem ia during early viraem ia orm ay recoverand have recurrentepisodes ofviraem ia. Exertion m ay cause an increase in tem perature and pulse,sweating and incoordination. Recurrence ofdisease in a one to three m onth period file:///C:/versam m elt/index m eister. Reactoranim als m ay have the carcass approved forlim ited distribution ifno system ic lesions are noted on postm ortem exam ination. Differentialdiagnosis:Em aciation,otheracute septicem ias,anthrax,piroplasm osis,glanders, file:///C:/versam m elt/index m eister. Replacem entofbone m arrow fatwith dark red hem opoietic tissue (erythroid hyperplasia). Viralencephalom yelitis ofhorses Viralencephalom yelitis ofhorses is characterized by disturbed consciousness,m otorirritation and com m only high m ortality. Transm ission:The disease is m ostly spread from birds through insects to horses and file:///C:/versam m elt/index m eister. Hypersensitivity to sounds and touch,fascialm uscle twitch and walking blindly into objects orin circles 5. Histologicalfindings include the lesions in the brain showing perivascularaccum ulation of leucocytes and dam age to neurons Judgem ent:Carcass and viscera ofthe anim alshowing clinicalsigns ofthis disease are condem ned. The carcass ofreactoranim alm ay have a lim ited distribution through specially licensed and closely supervised com m ercialchannels. Transm ission:Venereal,contam inated fom ites,personnelexam ining infected anim als and rarely stud handlers. Inflam m ation ofthe vagina (vaginitis)and copious m ucopurulentvaginaldischarge. Ifacute inflam m ation ofthe vagina and uterus is associated with septicem ia,the carcass is condem ned. Itis m anifested by spasm odic contraction ofthe voluntary m uscles and increased sensitivity to stim uli. Transm ission:M ostfrequenttransm ission ofagentin horses is caused by nailwounds. In sheep,the agentm ay enteraftercastration and docking;in cows itm ay enterduring puerperal infection,dehorning orcastration. In swine,tetanus is m ostly seen as a resultofwound infection,castration orum bilicalinfection in new born anim als. Clostridium tetaniform s spores which are extrem ely resistantand m ay rem ain viable foryears ifprotected from lightand heat. Clostridium tetaniproduces toxins which are responsible forthe clinicalpicture oftetanus. Neurom uscularactivity favours m igration of tetanus toxins through peripheralnerves which reach the lum barand cervicalregion ofthe cord and the brain stem. In this ascending form ofthe disease,tetanus develops firstin the lim bs,followed by the m uscles ofthe trunk. Toxins circulate in the blood and lym ph and cause tetanus in the m uscles ofthe forelim bs,uppertrunk and hind lim bs. The firstsym ptom s are the protrusion ofthe nictitating m em brane,and the involvem entoffacialand jaw m uscles leading to lock jaw. The m usculature is usually grey yellow in colourand the carcass is inadequately bled. Differentialdiagnosis:Strychnine poisoning,hypocalcem ia (eclam psia)ofm ares,cerebrospinal m eningitis,lactation tetany ofcattle,enzootic m usculardystrophy,enterotoxaem ia oflam bs, polioencephalom alacia Glanders Glanders is a bacterialdisease ofhorses and othersolipeds characterized by lesions in lym ph glands,lym ph vessels,respiratory tractand skin. Transm ission:Ingestion offood and drinking ofwatercontam inated with secretions and excretions ofsick anim als. W ound infection and the respiratory route in acute glanders, contam inated needles,groom ing equipm ent,urine,nasaldischarges,purulentskin lesions are also associated with the transm ission ofthis disease. Granulom atous nodules along the lym phatics underthe skin,especially on the legs. Necrosis in the internalorgans and testicles Judgem ent:Carcass ofan anim alaffected with glanders is condem ned. Differentialdiagnosis:Epizootic lym phangitis,ulcerative lym phangitis,strangles,dourine and m elioidosis Strangles (Distem per) Strangles is a contagious disease ofequines characterized by inflam m ation ofthe upper respiratory tractand purulentlesions in the regionallym ph nodes. Transm ission:Source ofinfection is nasaldischarge from infected anim als and contam inated food and water. Infection is spread by ingestion orvia respiratory route by inhalation of droplets. Itm ay spread foratleast4 weeks afterthe initialattack due to organism developing resistance to diverse environm entalconditions. The spread ofinfection is also caused by parasites and infected anim als during copulation. Purulentinflam m ation ofthe brain followed by excitem ent,neck rigidity and term inal paralysis 11. Lam eness and difficultbreathing Atypicalform ofstrangles is m anifested by subclinicalinfection and m ild disease. Abscesses in the m esenteric lym ph nodes Bastard stranglesdenotes m ultiple abscessation in the vitalorgans and generalized system ic infection. Judgem ent:Carcass ofan anim alaffected with strangles is condem ned ifthe anim alshows signs ofacute infectious disease accom panied with feverand system ic generalized lesions. Differentialdiagnosis:Epizootic lym phangitis,ulcerative lym phangitis,dourine,m elioidosis, equine viralrhinopneum onitis,equine influenza and equine viralenteritis Parasitic diseases file:///C:/versam m elt/index m eister. Transm ission:Transm ission by coitus and rarely by bloodsucking flies (Tabanidae and Stom oxys) Antem ortem findings: 1. Acquired loss in cutaneous pigm entation (vitiligo)noted as white discrete patches of various shapes and sizes in the skin and externalgenitalia. Transitory urticarialplaques which do notulcerate,appearon the m ucosa and skin, particularly on the flanks. Edem a ofthe scrotum,prepuce and penis in stallions and the udderedem a in m ares 10. Nervous signs are m anifested by incoordination,irregularm uscularcontractions,facial file:///C:/versam m elt/index m eister. Em aciation,anaem ia and characteristic depigm entation in the skin and externalgenitalia 3. Edem atous fluid in the pleural,pericardialand peritonealcavities Judgem ent:Carcass ofan anim alshowing chronic lesions oftrypanosom iasis without system ic involvem entand the carcass ofrecovered anim als is approved. Horse carcass affected with the disease is condem ned ifclinicalsigns are accom panied with em aciation and edem a oranaem ia. Itis seen as an occupationalhazard,prim arily to those associated with varied activities in the poultry industry;em ployees in abattoirs,vaccinators,laboratory staff and otherpersonnel. In m ostcases the clinicalpicture is thatofconjunctivitiswith rare system ic reactions. Transm ission:Secretions from infected birds,by wild birds and contam inated feed,equipm ent and people.

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However, privacy regulations allow the transfer or sharing of member information, which may be requested by Priority Partners to conduct business and make decisions about care, such as a members medical record, authorization determinations or payment appeal resolutions. When faxing information to Priority Partners, verify the receiving fax number is correct, notify the appropriate staf at Priority Partners and verify the fax was appropriately received. The information should be in a sealed envelope marked confdential and addressed to a specifc individual, P. When leaving messages for Priority Partners associates, leave only the minimum amount of member information required to accomplish the intended purpose. The record usually contains your symptoms, examination and test results, diagnoses, and treatment. Tat information, referred to as your health or medical record, and legally regulated as health information may be used for a variety of purposes. The following are some examples of our possible uses and disclosures of health information. For example, your health care provider may send claims for payment of medical services provided to you. Examples of these oversight activities are audits, inspections, investigations, accreditations, and licensure. Inspect and copy: You have a right to see your health information upon your written request. If you want copies of your health information, you may be charged a fee for copying, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying. If you request an amendment to records that we did not create, we will consider your request only if the creator of the records in unavailable. Accounting of disclosures: You have a right to request a list of the disclosures made up of your health information after April 14, 2003. Exceptions are health information that has been used for treatment, payment, and operations. Notice: You have the right to receive a paper copy of this notice and/or an electronic copy by email upon request. For More Information this document is available in other languages and alternate formats that meet the guidelines for the Americans with Disabilities Act. To Report a Problem about our Privacy Practices If you believe your privacy rights have been violated, you may fle a complaint. Providers further agree to inform benefciaries of their right to appeal a coverage determination pursuant to the applicable grievance procedures and according to law. Please note that information changes frequently and should not be used to determine member eligibility. Please contact your Provider Relations network manager at 410-762-5385 or 888-895-4998 or the Credentialing department at 410-424-4619 if you have questions about the credentialing process. The credentialing manager or designee will convene an appeal panel comprised of three qualifed practitioners. For the purpose of this requirement, a clinical peer is a provider with the same type of license. The panel shall not include any individual who is in direct economic competition with the afected provider or who is professionally associated with or related to the provider or who otherwise might directly beneft from the outcome. Knowledge of the matter shall not preclude any individual from serving as a member of the panel; however, involvement with any earlier decision concerning the initial determination or corrective action will require the individual to remove him/herself from the panel. Within 10 calendar days of either a frst or second-level panel review, and after reviewing any written statements submitted by the provider and any other relevant information, the panel will render a decision. The credentialing department designee will notify the afected provider in writing within fve calendar days of the panels decision. This notice will be sent either by certifed mail return receipt requested or express mail with receipt of delivery. In accordance with the Maryland Annotated Code, Health General Article 15-1005, we must mail or transmit payment to our providers eligible for reimbursement for covered services within 30 days after receipt of a clean claim. If additional information is necessary, we shall reimburse providers for covered services within 30 days after receipt of all reasonable and necessary documentation. We shall pay interest on the amount of the clean claim that remains unpaid 30 days after the claim is fled. Priority Partners is not responsible for payment of any remaining days of a hospital admission that began prior to a Medicaid participants enrollment in Priority Partners. However, we are responsible for reimbursement to providers for professional services rendered during the remaining days of the admission if the member remains Medicaid eligible. Children with special health care needs may self-refer to providers outside of the Priority Partners network under certain conditions. Self-referral for children with special needs is intended to ensure continuity of care and appropriate plans of care. We are obliged to grant the members request unless we have a local in-network specialty provider with the same professional training and expertise who is reasonably available and provides the same services and service modalities. Under Maryland law, insurers must provide a copy of the preauthorization within 10 days of the members request. For all conditions other than pregnancy, the time limit is 90 days or until the course of treatment is completed, whichever is sooner. The 90-day limit is measured from the date the members coverage starts under the new plan. For pregnancy, the time limit lasts through the pregnancy and the frst visit to a health practitioner after the baby is born. Right to use non-participating providers Members can contact Priority Partners to request the right to continue to see a non-participating provider. Tere is a time limit for how long we must allow the member to receive services from an out of network provider. For pregnancy, the time limit lasts through the pregnancy and the frst visit to a health care provider after the baby is born. If the member has any questions they should call Priority Partners Member Services at 800-654-9728 or the states HealthChoice Help Line at 800-284-4510. Requests for Member Services may be submitted by telephone, electronically (via the website) or by faxing in a completed Member Services Referral Form. Additionally, we provide non-emergency transportation to access a covered service if we choose to provide the service at a location that is outside of the closest county in which the service is available. Telephone County Company Number Alleghany 301-759-5123 Anne Arundel 410-222-7152 Baltimore City Problem Resolution 410-396-7007 Enrollment & Scheduling 410-396-6422 Facilities and Professional Offces 410-396-6665 Baltimore County TransDev 410-783-2465 410-887-2828 Calvert 410-414-2489 Caroline 410-479-8014 Carroll 410-876-4813 Cecil 410-996-5171 Charles 301-609-7917 Dorchester 410-901-2426 Frederick 301-600-1725 Garrett Garrett Community Action 301-334-9431 Harford 410-638-1671 26 Marys 301-475-4296 Somerset 443-523-1722 Talbot 410-819-5609 Washington 240-313-3264 Wicomico 410-548-5142 Opt. Priority Partners has revised its member transportation program with the goals of reducing no-shows and cancellations. To assist members with transportation needs, Priority Partners has a transportation specialist who can help members apply for other services, such as Mobility and Paratransit, which are designed for people who are unable to use local bus, metro or light rail services. The transportation specialist also has access to community resources throughout Maryland to assist members with transportation. Reimbursement for gas is available to members who arrange transportation on their own and meet the criteria for reimbursement. If you have additional questions about our transportation program, please call Priority Partners Member Services at 800-654-9728.


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Develop mechanisms, where appropriate, to collectively process and issue permits and authorizations that are similar based on species, region, or activity. To develop programmatic environmental impact statements and assessments and to identify mechanisms to collectively process and issue permits and authorizations especially for repetitive activities that do not change over time; ii. To achieve better timing linkages between the process for authorization and permitting, securing funding, and scheduling research operations to minimize potential issues; iii. To identify innovative ways to meet regulatory requirements through reductions in potential impacts on marine mammals. While the Coastal Commission is concerned about the welfare of marine mammals and would not like to see anything done that could harm or kill any individual, its primary concern is to obtain information that will enable it to regulate activities that produce sound in such a way as to eliminate or minimize the effects of that sound. This technique provides for the determination of hearing abilities of animals and may also expand the knowledge base to include the hearing values of a variety of species that may likely not be kept in captive situations, but the use of this technique calls for ethical guidelines. Nothing should be allowed that will compromise an animals ability to survive the stranding. Thus even a well-designed experiment may not eliminate controversy over a particular activity or project, but may only shift the nature of the debate. Unfortunately, our ignorance regarding the biology and physiology of many marine mammal species is so great that the potential effects of noise and the sound exposures causing these effects is poorly understood. Lastly, research that can yield conclusive results with less risk of harm to the animals should be preferred. Systematic studies of ongoing sound producing activities can strengthen monitoring efforts required as mitigation, while retaining the benefit that such studies do not introduce additional sound directed at the mammals. The advantages of observational studies are increased as more attention is given to optimizing measurement methods and study designs with the greatest power to detect real effects and provide convincing results. Monitoring will always be required for regulated activities, and if monitoring data are collected systematically, gathered, and analyzed, they can provide important information on effects. The management system should address chronic and acute anthropogenic noise, long-term and short-term effects, cumulative and synergistic effects, and impacts on individuals and populations. The Services should allow for a limited number of members of the public to be present during necropsies to increase the transparency of the process. That program should have procedures in place to minimize bias and the perception of bias and should include diversification of funding, a prohibition on the pre-publication vetting by funders, and a requirement that all data obtained with public funds be publicly available. Conclusion Although we know that anthropogenic sound in the ocean is a serious threat, we do not have sufficient information at this time to understand the full extent of the problem. One of the biggest challenges faced in regulating the effects of noise is our ignorance of the characteristics and levels of sound exposures that may pose risks to marine mammals. Given the current state of our knowledge we must therefore take a precautionary approach in the regulation of noise. In addition, we must commit to understanding this problem better by funding a national research program. Navy 2001, Joint Interim Report; Bahamas Marine Mammal Stranding Event of 15-16 March 2000. Las Palmas, Gran Canaria, 8th March 2003, European Cetacean Society; Fernandez, A. Ocean ambient sound: Comparing the 1960s with the 1990s for a receiver off the California coast. Acoustic Research Letters Online 3(2): 65-70; International Whaling Commission, 2004 Report of the Scientific Committee Annex K; Rise in sound levels: National Research Council 2003: Sound and Marine Mammals (Washington D. National Academies Press 2003); Rise in sound levels: National Research Council: Sound and Marine Mammals (Washington D. The western Pacific gray whale: a review of past exploitation, current status, and potential threats. Presentation at the Third Plenary Meeting of the Advisory Committee on Acoustic Impacts on Marine Mammals, 27-29 July, San Francisco. See, for example, International Whaling Commission, 2004 Report of the Scientific Committee: Annex K. Fox, Low-frequency whale and seismic airgun sounds recorded in the mid-Atlantic Ocean, J. Ljungblad, A change in sperm whale (Physeter macrocephalus) distribution correlated to seismic surveys in the Gulf of Mexico, J. Signal-to-noise: funding structure versus ethics as a solution to conflict of interest. Special thanks to Zoe Crutchfield and Colleen Corrigan, without whom this meeting would not have been possible Workshop graphic design by Dave Johnston Available online. The workshop included individual and panel presentations as well as small-group and plenary discussion sessions. Nevertheless, a number of information and institutional gaps, as well as means to address these gaps, emerged as themes from the workshop. When responses occur, documented effects range from short-term behavioral change to physical injury, stranding, and death. Such understanding should include knowledge of dose-response relationships and thresholds of exposure that trigger given effects. Scientists and policy-makers need to understand the type and scale of effects that would have long-term or irreversible consequences for an individual or a population. For example, displacement of a few animals belonging to an endangered population could be highly significant, whereas it might be unimportant for a large, healthy population. However, the potential cumulative, synergistic, and long-term effects, although much more difficult to detect, characterize, and measure, may be as important, or even more important, to marine mammal populations. When such tools are used, the potential impacts on marine mammals from anthropogenic sound are frequently overlooked. Use of these tools and consideration of these potential impacts should become routine. In other words, a mitigation strategy that is appropriate for one situation may not be appropriate for another: one size does not fit all. Shipping is an international enterprise, with many aspects regulated through the International Maritime Organization. Technologies are available for making quieter ships, and the industrys own interests may converge with the conservation imperative to employ those technologies through, for example, a green shipping certification initiative. Many ship owners may be willing to work with scientists and conservationists to develop and implement a strategy for managing ship noise, particularly if the risks of ship noise to marine mammals are clearly communicated. Monitoring and experimentation should be conducted to test the effectiveness of these and other mitigation techniques.

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Parameters for control of Listeria Behavior of pathogenic bacteria in the oyster, monocytogenes in smoked fshery products: Crassostrea commercialis, during depuration, sodium chloride and packaging method. Bacteriological survey of the blue crab Foodborne pathogenic microorganisms industry. Incidence Food/FoodSafety/FoodborneIllness/ and enterotoxigenicity of Clostridium rneIllnessFoodbornePathogensNaturalToxins/ perfringens and Bacillus cereus from retail BadBugBook/default. Quantitative risk assessment on the Bacterial growth at foodservice operating public health impact of pathogenic Vibrio temperatures. Quantitative An unexpected correlation between cardinal assessment of the relative risk to public health temperature of microbial growth highlighted from foodborne Listeria monocytogenes among by a new mode. Incidence of highly genetically diversifed Vibrio parahaemolyticus in seafood imported from Asian countries. Symptoms start from 18 and after the cooking process performed hours to 36 hours after consumption. Everyone immediately before reduced oxygen packaging is susceptible to intoxication by C. The toxin can be is a safety concern with these products because destroyed by heat. As the shelf life of refrigerated foods is increased, more time is available for C. The spores some point during storage, distribution, display, of the proteolytic group are much more resistant or consumer handling of refrigerated foods, safe to heat than are those of the non-proteolytic refrigeration temperatures will not be maintained group. However, there are some indications that substances that may be naturally present In reduced oxygen packaged products in which in some products. Even a product in which it is present is exposed to in pasteurized products where non-proteolytic temperatures favorable for growth for suffcient C. Table A-1 (Appendix 4) provides guidance pasteurization process, and vegetative pathogens, about the conditions under which C. In this case, toxin formation in reduced oxygen packaged fsh refrigeration serves as a prudent second barrier. However, in reduced oxygen packaged products Alternatively, products of this type may be safely in which refrigeration is the sole barrier to marketed frozen, with appropriate labeling outgrowth of non-proteolytic C. For some reduced oxygen packaged packaged refrigerated raw fsh, vacuum-packaged products, control of C. It is also possible for both means of overcoming these problems in the non-proteolytic and proteolytic C. Types the safety of foods, Journal of Food Protection, A and B are generally found on land but may 61:1154-1160 (1998), describe a safe time and also be occasionally found in water. Without rate (in the fnal package) of at least 10,000 cc/ evisceration, toxin formation is possible during the 2 m /24 hours at 24C can be regarded as an process, even with strict control of temperature. The oxygen transmission rate of removal of all internal organs in the body cavity packaging material is listed in the packaging without puncturing or cutting them, including specifcations that can be obtained from the gonads. Uneviscerated small An oxygen-permeable package should provide fsh, less than 5 inches in length. Particular care should be taken in content of 10% in refrigerated fnished products, determining the safety of a packaging material for a or a water activity of below 0. The generally recommended 10,000 cc/m2/24 hours at 24C evisceration recommendation. Use of an oxygen-permeable package may not Note: the water activity value of below 0. These packaging methods processing, storage, and distribution of fnished generally directly reduce the amount of fsh and fshery products. This strategy is covered 114, and these controls are not required to be in this chapter. This strategy is covered by Chapter 14; Relationship of Water Activity to Water Phase 1 Salt in NaCl/Water Solutions 1. This relationship is generally valid for fsh products when salt (sodium chloride) is the primary means of binding water. The specifc food matrix and the use of other salts or water binding agents could affect the exact relationship. If you intend to use this relationship in your control strategy, you should determine the exact relationship in your product by conducting a study. Drying E and non-proteolytic types B and F, and is covered in Chapter 14, controlling the then minimizing the risk of recontamination growth of proteolytic C. Controlling the growth of non container in a sanitary, continuous, closed proteolytic C. Specialized cooking processes preservatives, such as sodium nitrite, in are covered in Chapter 16, prevention of the fnished product, in combination with recontamination after specialized cooking other barriers, such as smoke, heat damage, processes is covered in Chapter 18, and competitive bacteria, suffciently to controlling the growth of proteolytic C. It is important to note, damage from pasteurization in the fnished however, that this same heating process also product container, suffciently to prevent reduces the numbers of naturally occurring the growth of C. The spoilage organisms nonproteolytic types B and F, and then would otherwise have competed with, and controlling the growth of C. Controlling the growth because spoilage organisms must be present of non-proteolytic C. Control bacteria through refrigeration is covered in of the temperature during the cold-smoking Chapter 12. Control of the brining or dry Achieving the proper concentration of salting process is clearly critical to ensure that salt and nitrite in the fesh of refrigerated, there is suffcient salt in the fnished product. Proper drying with smoke and any nitrites that are added during smoking is also critical in order to to prevent growth and toxin formation by C. Note that nitrites should be used the water portion of the fsh fesh) needed only in salmon, sable, shad, chubs, and tuna, to inhibit growth and toxin formation by C. You by naturally occurring substances, such as should treat brine to minimize microbial lysozyme. Cooking and pasteurization are contamination or periodically replace it as a covered in Chapter 16, and controlling the good manufacturing practice control. The combination of inhibitory effects that are present in smoked and smoke-favored fsh In the second category of products, flling are not adequate to prevent toxin formation the product into the fnal container while it is by C. This control other pathogens that may be present in strategy applies to products such as soups, these products. Controlling the growth of chowders, and sauces that are flled directly proteolytic C. It may not growth of other pathogenic bacteria through apply to products such as crabmeat, lobster refrigeration is covered in Chapter 12. These controls may be critical are cooked in a kettle and then hot flled to the safety of both categories of products. In both follow: fsh and fshery products generally cases, ordinarily the heating process should. Control of the brining, pickling, In some pasteurized surimi-based or formulation steps is, therefore, critical to products, salt, in combination with a milder ensure that there are suffcient barriers in the pasteurization process, in the fnished product fnished product to prevent the growth and container works to prevent growth and toxin toxin formation of C. These control procedures properly pasteurized surimi-based product are covered in this chapter.

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Responders Responders, recovery personnel and volunteers would be quickly overwhelmed if a serious outbreak of disease were to occur in Arizona. Due to population density in the major metropolitan areas, the capabilities to quickly respond, identify and control such outbreaks are crucial. Potential dangers include the rapid onset of disease that moves faster than the response can actively follow, number of responders who could become unknowingly infected during initial onset causing loss of essential assets and risk of new introduction or spread of infectious diseases. The Department of Agriculture and Game and Fish Department are primarily concerned with plant, livestock and wild animal diseases and infections. The agencies are concerned with animal-to-animal diseases, as well as diseases transmitted from animals or arthropod vectors to humans. The scope and severity of an infectious outbreak could easily over task these departments causing requests for additional resources to be called from outside Arizona. Continuity of Operations/Delivery of Services Operational impacts could be catastrophic depending on the type, severity and spread of infectious diseases. This is particularly true of those capable of disrupting the human or animal food chain. During a pandemic, public health professionals may quarantine or recommend limited operation of facilities with contamination from an infectious disease. All non-essential infrastructure components could easily be affected as people would choose to stay home rather than risk possible infection. Additionally, facilities directly involved in the line of infection could be shut down for extended periods of time costing time and money. A regional pandemic could significantly hinder or even cripple a facilitys ability to function and provide service. Culturally, the greatest impacts would manifest in the closure of cultural centers due to sickness in personnel to run and operate the facilities. Social disruption may be greatest when rates of absenteeism impair essential services, such as power, transportation, and communications that serve the cultural needs. Culture could be significantly impacted if an outbreak were to occur within a population group that has strong cultural ties to a geographical location, or if an outbreak spread through a close knit community that has strong social ties. These costs include lost productivity, direct medical costs, and death associated costs. Assuming a statewide infection rate of 15%, the total economic cost range could be $35. Portions of this would be covered by health insurance, but non-covered expenses would likely fall to the local and state agencies and could result in a significant impact. This would be particularly impacting to small, rural areas with significant low-income populations. The potential for high rates of illness and worker absenteeism within the business and trade community, could lead to significant social and economic disruption. Infectious disease or pandemics that affect the farming community within the state would have serious negative effects on the economy. The loss of human and animal life, the loss of tax revenue, and the loss of business at these facilities and their supporting infrastructure, would inevitably be shut down until the disease is identified, controlled and cleaned up. Since crops are seasonal, the turn-around period could be lengthy if the product is a victim of infestation. This scenario could possibly cause a ripple effect in the supporting agriculture infrastructure causing a spike in prices and financial strain on those involved in all aspects of production, distribution and supply or agricultural products. Public Confidence in Jurisdictions Governance the ability of public agencies and medical services to quickly act during an outbreak of disease is in direct correlation to public confidence in jurisdictional governance. Failure of these entities to act in a reasonable manner warranted by the magnitude and severity as seen through the public eye, will drastically reduce the publics confidence in the governments ability to accurately control an outbreak. The magnitude of an outbreak can have severe psychological impacts the population. The media, if not monitored, can cause widespread panic resulting in a severe overload of resources and extreme financial costs to government and the public. Depending on the depth of public perceptions of safety, or lack of, public reaction could span from compliance to lawlessness. Office of Infectious Disease Services, Bureau of Epidemiology and Disease Control. Fukuda, 1999, the Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention. Other terms, such as mass movement or slope failure, are technically more accurate but are not as commonly used. Frequently, they accompany heavy rains, earthquakes, or volcanic eruptions, and are principally associated with mountainous areas, although they can occur in areas of low relief, as well. Common landslide triggers include heavy rain, rapid snow melt, earthquakes, volcanic eruptions, and freeze and thaw cycles. Landslides are classified by the type of movement and the type of material moving. Landslide types documented in Arizona are rotational and translational slides, rock falls and/or topples, and debris flows. Table 8 and Figure 10 combine to provide a matrix description and illustration of landslide types. Table 8: Landslide Types Type of Material Engineering Soils Type of Movement Predominantly Predominately Bedrock Coarse Fine Rock slide or Slides (Rotational or Translational) Debris slide Earth slide Toreva-block Falls Rock fall Debris fall Earth fall Topples Rock topple Debris topple Earth topple Earth flow (fast) Flows Rock flow Debris flow Earth creep (slow) Lateral Spreads Rock spread Debris spread Earth spread Complex Combination of two or more principal types of movement Source: Youberg, et. The sliding mass may move beyond the rupture plane to deposit on original ground surface, which is called the surface of separation. The shape of the rupture plane reflects the type of movement: rotational or translational. Slides can be found across the state and have been the cause of significant damages. Figure 10: Landslide Types Falls and Topples Downslope movement of soil and/or rock that detaches along a surface with little or no shear displacement and descends by falling through the air or bouncing and rolling on lower slopes. A topple begins by the forward rotation of rock or a soil mass out of a slope, pivoting about a point or axis. Topples may lead to falls or slides depending on the rock or soil mass and the geometry of the slope. Rock falls and topples are common in Arizona along steeper sections of slopes with cliff-forming strata. Oak Creek Canyon, Mount Lemmon Hwy, and the Vermillion Cliffs are just a few places where frequent rockfalls or topples occur. Flows Spatially continuous, non-cohesive, downslope movement of soil and/or rock with a behavior more similar to a plastic or viscous fluid. Flows velocities can range and often are triggered by slides that transition into flows. Debris flows are rapidly moving, saturated, unsteady, non-uniform, very poorly sorted sediment slurries that form in steep channels and gullies. Debris avalanches are similar to debris flows but form on and travel down open hillslopes instead of in channels. Faster moving 2018 144 2018 State of Arizona Hazard Mitigation Plan earth flows and slower moving earth creeps can occur on lower gradient slopes and are generally composed of fine-grained material, silt and clay, or very weathered bedrock. Debris flows occur across the state and are currently considered to be the most common landslide type in Arizona. It is noted, however, that several other state and federal declared events included impacts from post-wildfire and flood triggered debris flows. Costs to establish the Page Detour and repair the highway were approximately $60 million (Youberg, et. The southbound lanes of the four-lane divided highway were most severely affected. Repair costs were estimated to exceed $18 million and communities like Payson, Strawberry, Pine, Heber-Overgaard, and Forest Lakes were negatively impacted by a significant downturn in tourists and camping travelers (Arizona Republic, 2008). The cost to repair infrastructure destroyed in Sabino Canyon, near Tucson, was estimated to exceed $1. Tuba City was evacuated until the threat passed and no deaths or injuries were reported. The identified features were compiled into a database and attributed according to failure type, mechanism, and source.

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As a result, states may become more willing to sign treaties and thus entrench the guidelines as binding measures. In the short term, when it comes to multilateral agreements and international law, regional agreements probably offer more feasible options for addressing underwater sound than international instruments because they tend to be more specific to a regions biological characteristics, socioeconomic realities, and implementation capacities. The proliferation of environmental treaties and agreements since the Earth Summit in Rio de 84 85 Janeiro in 1992, and indeed since the Stockholm Conference in 1972, has led to agreement fatigue, a reluctance of some countries to sign onto more instruments and an insistence on improved implementation of those that exist. In some instances, resource limitations are a serious obstacle to further development of international or even regional legal instruments. Facilitator: Lee Langstaff Topic Specialists: Mardi Hastings, Bill Perrin, and Lorenzo Rojas-Bracho Recorder: Eunice Pinn Scientists and policy-makers often fail to understand each others language and needs, resulting in mutual incomprehension and, sometimes, mistrust. If science is to be used optimally to inform policies and laws, scientific findings and their limitations need to be interpreted accurately into non-technical terms and communicated effectively to policy-makers. For their part, policy makers need to be receptive to scientific input and avoid the temptation to ignore or knowingly misinterpret it. Science-based policy tends to be difficult to formulate and implement, even in the best of circumstances. Conversely, good science, properly interpreted and communicated, can have a positive influence on policy. Scientists need to be aware of the weight given to their statements and qualify what they say accordingly. Competition for reader, viewer, or listener attention prompts media to release information prematurely and to opt for sensational, rather than considered and balanced, reporting. The results of such work are often viewed with suspicion and considered biased toward the sponsors desired outcome, even when safeguards against conflict of interest are in place. Language barriers and shortages of technically trained people make it difficult in some regions and countries to inform and shape public policy with scientific knowledge. Concerned scientists may thus face barriers as they attempt to influence policy decisions. Even when they are willing to release information, the onus may remain on researchers to formulate their requests in particular ways to elicit all of the relevant data. Coordination of research is always a challenge, but is necessary to avoid duplication of effort and increase the chances of consistency and completeness of information on national, regional, and international scales. Further, procedures for obtaining permits may change, leading to further delays and confusion. In fact, project designs and methods can sometimes be selected or shaped to increase the likelihood that the findings will meet the needs of policy-makers. Medical science and some other sciences may provide useful models of this process. However, policies then need to be flexible and adaptive to allow adjustments when final results become available. Professional organizations can facilitate courses and training workshops to help build capacity in those regions or countries. Standardization, however, should not be allowed to stifle originality and prevent the development of improved methods. Making raw data available in this way, with due consideration for the proprietary interests of those who designed and conducted the original study, can improve credibility and encourage scientific discourse. The group began by focusing on what is needed to improve regulatory capacity at the national level. Although the nature and level of needs vary widely from country to country, all require additional political will and better technical, scientific, and management capacity to address sound-related issues. Countries with no suitable management regime may desire one but lack the necessary institutional capacity and resources. In some cases, countries with no management regime may have little or no interest in developing one. Few, if any, countries that do have management regimes in place have sufficient capacity to address the sound issue in a comprehensive manner. Six major categories of need apply to all countries, especially in the developing world. For each category, several tools and actions were identified that could improve management and regulatory regimes, as described below. At the national level, there is a need for greater institutional capacity for policy development, oversight, and enforcement. For example, mechanisms to provide funding for students might help increase the number of individuals trained to work on sound issues, and job-swap, secondment, or partnership programs could facilitate the transfer of relevant skills and knowledge across governments and institutions. In addition, training programs could be created, or specific topics could be built into existing courses. Such efforts in skill development and sensitization to the sound issue must be accompanied by the creation of outlets for the use of those skills and opportunities to express any heightened awareness. National and regional meetings and regular interdisciplinary conferences could help create communication networks and enhance public awareness. These, in turn, could be expected to reduce institutional fragmentation and build political will. The development of incentives to comply with existing laws and guidelines and to reduce sound production voluntarily is another area of need at the national level. In general, incentives can be produced by addressing multiple societal values concurrently, considering both conservation and socioeconomic goals. Solutions to sound-related issues may be linked to solutions to other conservation problems, as 63 Report of an International Workshop: Policy on Sound and Marine Mammals well as to economic benefits. It is important to make solutions attractive, or at least tolerable, to user groups. For example, some sound-producing industries may see public relations benefits in developing more environment-friendly practices. Such groups can capitalize on consumer choices in cases where a well-educated or conservation-minded public exists. It may also be possible to create government markets for new quieting technologies. Education and increased public awareness play a key role in creating and communicating incentives for sound reductions. There is a need for more effective and efficient mitigation and monitoring options that are affordable in a national context. Long-term approaches to mitigation can produce economies of scale and thereby improve efficiency, while short-term approaches that focus on low-hanging fruit. It is important to maintain flexibility and creativity as protocols are being developed, as this will maximize effectiveness while avoiding unnecessary expenditures or efforts. For example, seasonal restrictions are best applied in a manner that reflects the dynamics of the natural systems involved. Cumulative impacts (a concept often overlooked in mitigation schemes) should be addressed by placing various types of sound exposure into a wider context of animal health, reproduction, and survival. National regulatory capacity can be improved by better communication and coordination, heightened awareness about sound-related issues, and education and information-sharing efforts. For example, central clearinghouses can make information widely available, educational materials can aid policy-makers, and intergovernmental strategy-sharing can enhance management efforts. The development of public awareness and political will may require a stronger conservation ethic. In all efforts, culturally sensitive approaches that make concerns relevant to the affected parties are likely to be more effective and sustainable. For example, it may be more effective to address the impacts of underwater sound on marine mammals through integration with existing programs to conserve sea turtles in the Caribbean, rather than by creating new, entirely separate marine mammal initiatives in that region. Capacity for oversight, enforcement, and compliance is important at both national and international levels. In some cases, enforcement is complicated by a lack of clarity in existing laws or guidelines.

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Cascading/Secondary Impacts Levee failures result in flooding with the addition of a flood-wave pulse that dissipates as it moves further into the leveed areas. Development of cascading or secondary impacts is a magnified version of what might occur with regular flooding. Flood Control District of Maricopa County 1997, Storm Report, Tropical Storm Nora Sept 1997. National Committee on Levee Safety 2011, the Definition of a Levee under a National Levee Safety Program. For Arizona, severe winds typically result from either extreme pressure gradients that usually occur in the spring and early summer months, or from thunderstorms. Occasionally, tropical storm activity (remnant hurricanes) can be accompanied by severe winds, but the wind speeds usually dissipate by the time the tropical storm front approaches the state, with greater threat to the southern portions of the state. Thunderstorms can occur year-round and are usually associated with cold fronts in the winter, monsoon Dust Storm in Downtown Phoenix 2002 activity in the summer, and tropical storms in the late Source: Pinterest Patti Pettigrew summer or early fall. Three types of damaging wind-related features may accompany a typical Arizona thunderstorm; 1) downbursts, 2) straight-line winds, and infrequently, 3) tornadoes. When the air reaches the ground, it spreads out in all directions, creating horizontal wind gusts of 80 mph or higher. Some of the air curls back upward with the potential to generate a new thunderstorm cell. There can be either dry or wet downbursts, where the wet downburst contains precipitation that continues all the way down to the ground, while the precipitation in a dry downburst evaporates on the way to the ground, decreasing the air temperature and increasing the airspeed. In a microburst, the wind speeds are highest near the location where the downdraft reaches the surface, and are reduced as they move outward due to the friction of objects at the surface. Typical damage from downbursts includes uprooted trees, downed power lines, mobile homes knocked off their foundations, block walls and fences blown down, and porches and awnings blown off homes. Straight line winds are developed similar to downbursts, but are usually sustained for greater periods as a thunderstorm reaches the mature stage. Straight line winds travel (or are pushed), parallel to the ground surface on the leading edge of a thunderhead, reaching speeds of 75 mph or higher. These winds are frequently responsible for generating the large dust and sand storms seen moving across the desert regions of Central and Southern Arizona. The blowing dust can reduce visibility to near zero, creating hazardous driving conditions. Strong wind events not associated with thunderstorms can occur throughout the year, but are frequently strongest in the late winter to late spring months and can generate high-speed winds that last for hours and often include exceptionally strong gusts. A tornado is a rapidly rotating funnel (or vortex) of air that extends toward the ground from a cumulonimbus cloud. Most funnel clouds do not touch the ground, but when the lower tip of the 2018 173 2018 State of Arizona Hazard Mitigation Plan funnel cloud touches the earth, it becomes a tornado and can cause extensive damage. For Arizona, tornadoes are the least common severe wind to accompany a thunderstorm. Many of the trees fell on apartment buildings, houses, and vehicles and the roof of a church suffered severe wind damage. One person was electrocuted after coming in contact with a live downed wire but survived. One power pole was downed on a trailer leading to the evacuation of the trailer park near East Drexel and South Country Club Roads. Part of a roof was also blown off a residence on Valencia Road, blowing across the road into another home damaging the roof. A total of 101 homes suffered various levels of damage across the touchdown zones, with the area of Bellemont being the hardest hit. The Flagstaff Meadows subdivision had three homes completely destroyed, nine homes with major damage, and 15 homes with minor damage. Source: Coconino County 2018 174 2018 State of Arizona Hazard Mitigation Plan January 21, 2010 Three large trees were blown over at Bell Road and 16th Street. A large tent at the Russo Steele Auction in Scottsdale near Mayo Blvd and Scottsdale Rd was destroyed and blown into nearby Loop 101 when winds collapsed the tent onto many classic cars. About 31 homes were damaged at a trailer park on North Recker Road, with four roofs blown off. On Southern Avenue near Power Road, 15 poles were knocked down with lines impacting seven vehicles, including a bus. According to the Salt River Project, an estimated 65 power poles were blown down, in parts of Scottsdale, Tempe, and Mesa. However, winds at Williams Gateway Airport gusted to 86 mph and flipped a small twin engine plane atop another aircraft. There were also numerous trees and homes across the Phoenix Metro Area that were damaged by winds. A large thunderstorm complex, with strong microburst winds estimated at 100 mph struck Sky Harbor International Airport. Southerly winds and dense blowing dust initially spread across the East Valley and converged with a fast moving thunderstorm in north Phoenix. These merging systems developed into a severe thunderstorm with winds that uprooted trees took down power poles and damaged homes and businesses near the airport. Flying debris damaged five commercial aircraft, several private planes and hundreds of cars in the nearby parking lots. Numerous flights were diverted during the overnight hours due to the debris that was scattered on the runway. Winds from the first microburst heavily damaged the Arizona Public Service power sub-station at 7th Ave & Thomas. Utility companies reported that 22 power poles were downed, leaving at least 47,000 homes and businesses without electricity for many hours. Homes in Scottsdale and Ahwatukee were 2018 175 2018 State of Arizona Hazard Mitigation Plan struck by lightning and set on fire. Many homes and businesses sustained damage, with at least 19 power poles blown down. One pole landed on a vehicle near Scottsdale and Indian Bend roads, killing the driver. About 6,000 residents were left without power, including the nearby Radisson Resort. Winds ripped the roofs off four homes in the McCormick Ranch area and dumped them up to two blocks away. Two mobile homes were destroyed, and 17 other mobile homes and frame houses were unlivable. One injury occurred when the homeowner sought shelter in a tub in the mobile homes bathroom. As the mobile home rolled the toilet was ripped from its foundation and struck the homeowner in the head causing cuts and bruises. In addition, numerous pontoon boats were either flipped over or destroyed, and several windows were broken on homes and cars. Other towns that sustained damage were Sun City, Surprise, El Mirage, Tolleson, Avondale, Goodyear, and Buckeye. Two juvenile detention centers, the Adobe Mountain Secure Facility and the Black Canyon Secure Facility, both in north Phoenix, sustained an estimated $250,000 combined damage when strong winds damaged a perimeter fence, blew out a plastic glass window and damaged several roofs at the complex. In the last 10-years (2008 2017), there have been 476 days with reported severe thunderstorm events, or approximately 47. For the same period, the number of event days associated with thunderstorms is 358, or 75% of the total. Again based on history, the probability for tornado events in Arizona is low, and especially when compared to national standards. The strength and magnitude of severe wind events is primarily based on wind speed. The Beaufort Wind Scale provides a measure of overland wind magnitude versus expected damages. According to the Beaufort Scale, wind gusts of 55-63 mph can result in uprooted trees and considerable structural damage to poorly constructed buildings. Wind gusts between 64-73 mph can result in more widespread structural damage to moderately constructed buildings. Wind gusts over 74 mph are able to do widespread damage to moderately constructed buildings and even well-constructed buildings. Table 9 provides a summary of the Fujita scale values with a general description of damage associations. Spring-time winds are generally associated with regional atmospheric conditions that can be forecasted in hours or days.

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Irrigation requires not only a source of water, but also water of good quality and a good drainage system to leach the soluble salts common in this Biome. The use of waste water from cities may bring additional problems, particularly contamination with heavy metals. Due to the sparse vegetation coverage and the presence of strong winds, it is common for wind erosion to increase after human intervention. The principal ecosystem service that may be afected is the productivity of the soils due to salinization. Status of the Worlds Soil Resources | Main Report Regional Assessment of Soil Changes 368368 in Latin America and the Caribbean Temperate Grasslands, Savannahs and Shrublands have been widely studied and documented by various authors (Paruelo, Guerschman and Veron, 2005; Satorre, 2005; Viglizzo and Frank, 2006; Alvarez et al. Its central plains are dominated by grasses on fat to gently sloping lands, with a temperate climate, and rains ranging from 1 500 mm in the northeast to 400 mm in the southwest. These areas have some of the most fertile soils of the world, the Phaeozems, although more than 13 million ha with natural saline-sodic soils. Despite the wide adoption of no-tillage, intensive annual cultivation (largely of soybean) and the lack of rotation with other crops or pastures have resulted in soil degradation by wind and water erosion, waterlogging, compaction, sealing/capping, and soil fertility depletion (Satorre, 2005; Lavado and Taboada, 2009; Alvarez et al. These zones share common characteristics: they are all situated below 1 000 m elevation, all experience high temperatures, and all have at least one dry season when the trees lose their leaves. These forests are more common in hilly and mountainous landscapes with soils of medium fertility such as Luvisols, and Cambisols. Large populations live in these areas and deforestation and annual burning are common. These forests occur in western Mexico, Costa Rica, Cuba, the north of Venezuela and Colombia, the coasts of Ecuador and Peru, and central and the north east of Brazil. The soils are fertile and the climatic conditions are favourable for human habitation and for the growth of many crops, including corn, beans, potatoes, sugarcane, fruits and cofee. Deforestation is the major threat, and is in practice irreversible as the dry period makes it difcult for natural regrowth to occur. As the accumulation of organic matter in these soils is medium or low, deforestation also brings the threat of organic carbon loss, and the increase of soil temperature in bare soils accelerates decomposition. Steeper slopes are hard to cultivate and here the most common land use after deforestation is extensive pasture. After a few years, soil compaction develops, particularly along the small terraces where the animals pass. This compaction also reduces rainfall infltration and consequently increases water erosion. Ecosystem services afected are principally the carbon and nitrogen cycles and climate regulation due to the decrease in organic matter. W ater production and quality may also decrease due to compaction by overgrazing and farm machinery which increases erosion. As erosion reaches high levels in many slopes, landscape stability can also be afected. Montane Grasslands and Shrublands are present at high altitudes throughout the Andes, but mostly in Peru and Bolivia. They occur above 3 000 m or even higher, and are dominated by grasses and small shrubs. Most of the pastures are natural, but some have been introduced and have adapted to the conditions. In these cases, conservation practices, irrigation and high inputs of organic and inorganic fertilizers are used throughout the year (Comerma, Larralde and Soriano, 1971). Although there are no data on impacts, it is Status of the Worlds Soil Resources | Main Report Regional Assessment of Soil Changes 369369 in Latin America and the Caribbean suspected that contamination of soils and water from excessive use of fertilizers and other agrochemicals may be occurring. This can also afect soil biodiversity, which may be very important given the unique vegetation and fauna of this Biome. This Biome is of high importance for certain ecosystem services, notably water production. It is located at the top of many watersheds and is a continuous source of pristine water, in many cases related to the process of thawing. Careful attention has to be paid to C and N cycles because of the services provided. The soil gene population, due to its unique nature, should also be studied and protected. Tropical and Subtropical Coniferous Forests occur at high and medium altitudes, mostly in Mexico and south to Nicaragua. Small patches also exist in the Dominican Republic, southern Brazil and along the Chile Argentine border. These forests occur mostly in mountainous landscapes and on many diferent geologic materials, including volcanic ashes. Deforestation for the establishment of pastures and wood harvesting are major land uses. Deforestation and burning create the threats of reduced organic carbon and of water erosion. The main ecosystem services afected are water production/ regulation, C and N cycling, and landscape stability. Temperate Broadleaf and Mixed Forest is confned to a temperate permanent forest in southern Chile. Because of the low temperatures and the rough relief, the land is largely a protected area, and only a few valleys are used for pasture. As human intervention is very low, threats and impacts for ecosystem services are very limited. The Pantanal, which stretches across all three countries, is the worlds largest tropical wetland, and is a highly productive environment. They all have in common the predominance of native pastures adapted to fooding, few trees at higher elevations, and a seasonal period of fooding alternating with a dry season. The predominant soils are Gleysols, Stagnosols, Vertisols, Plinthosols and Histosols. Its strategic importance in the production system is in the supply of green pastures for the dry season. Economic development in the Pantanal region, especially on the plateau of the Rio Taquari Basin, has intensifed the input of sediments to the Pantanal lowlands, causing serious social, economic and environmental impacts on the region (Galdino, Vieira and Pellegrin, 2006). The main ecosystem service is the provision of food and fber, interacting with the service of water regulation. Soil biodiversity is of prime importance and should be investigated and protected. The Biome has a warm temperate climate, dry during the warm period and rainy in the winter time. The vegetation, relief and soils are very heterogeneous, as they represent a transition between tropics and temperate, and between dry and Status of the Worlds Soil Resources | Main Report Regional Assessment of Soil Changes 370370 in Latin America and the Caribbean humid. The degree of human intervention is so complete that there are few remnants of the original vegetation. Because of its Mediterranean climate, the natural productivity of the area is very high. This has been utilized by Chileans to create very important agricultural development areas, especially in the valleys. Irrigation, tillage and large quantities of fertilizers and other agrochemicals are used to obtain high yields. Deforestation has resulted in signifcant erosion threats; high levels of input use have led to contamination; and in the drier zones salinization is a threat due to the quality of irrigation water. Negative efects are on water quality and possibly on human health, and loss of biodiversity related to contamination. Mangroves provide many ecological services and are considered very fragile as disturbances can produce irreversible consequences. Mangrove areas are mostly protected because they are hard to drain and the soils are poor, with predominance of reduced or organic soils. In cases where development projects have been implemented, the main land uses are pasture, rice, or plantation crops such as oil palm or bananas. Especially when mangroves are underlain by marine sediments, it is very common that after drainage, oxidation of Iron Sulphide (pyrite) will occur, producing extreme acidifcation and the formation of acid sulphate soils. This is an extreme case of the threat of acidifcation and reclamation is extremely difcult. The ecosystem service principally afected is the reduction of productivity, especially if acid sulphate soils are formed.


  • https://www2.census.gov/prod2/decennial/documents/1790m-02.pdf
  • http://soynewuses.org/wp-content/uploads/52724_1_SoyProductsGuide-2015_LR.pdf
  • https://openventio.org/wp-content/uploads/Diagnostic-Advances-in-Acute-Viral-Meningitis-Any-Novelty-for-the-Physician-EMOJ-4-150.pdf
  • https://bioinitiative.org/wp-content/uploads/2017/11/Hardell-2017-Sec11-Update-Use_of_Wireless_Phones.pdf

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