The Contractor must maintain at all times dust control measures to the satisfaction of the Owner. The Owner reserves the right to increase or decrease the quantities of the Work to be performed at the Unit Price by amounts up to 30 percent of the listed estimated quantities. For quantities over 130% or below 70% of the estimated quantity, the Owner may negotiate a Unit Price with the Contractor, or direct a unilateral change, or bid that Work under separate contract. Any adjusted Unit Price agreed upon by the Owner will only apply to the actual quantities above 130% or below 70% of the estimated quantity. Prevailing Wage Rates for Houghton County will be distributed via Addendum to the Project Manual. Each Bid submittal must include acknowledgement of receipt and review of all Addenda issued during the Bidding period. Dividing the regional operations into smaller manageable geographic areas allowed for prioritization of the proposed investigative approach, while also establishing a phased process for assessing environmental concerns regionally. The Hubbell Processing Area is bordered by residential (single family residences and an apartment complex), commercial (restaurant and retail business), and industrial (sand and gravel pit, construction company, and storage facility) properties, and Torch Lake. The Hubbell Coal Dock is located along the shoreline of Torch Lake, between the stamp mill complex (Lake Linden Processing Area) and the C&H Hubbell smelter complex. A chain link fence has been established along the western and northern property boundaries. The property is generally vacant and runoff into the lake has been observed during investigative mobilizations. The Mineral Building would have received the processed copper ore from the stamp mills located in the Lake Linden Processing Area. A chain link fence has been established along the western and southern property boundaries. During the fall of 2016, 16 abandoned drums were removed from the property and disposed. The July 1945 issue of C&H News and Views, an employee periodical, includes photographs of burning of secondary waste materials, specifically the outer sheathings, insulation, and coatings on copper-rich materials, prior to treating the recovered copper in the smelter. The soil and fill encountered at the properties are largely sand, gravel, coal, stamp sand, slag, and burnt debris covering the ground surface. The deposits range in thickness from approximately 11 to 50 ft below the ground surface (bgs), but have been observed in thicker deposits with interbedded clay, silt, and gravel units. In the lower plateau along Torch Lake groundwater was encountered between 2-ft and 4. Cap the Coal Dock Burn Area to prevent direct contact with affected soil and eliminate impacted soil runoff into Torch Lake. Improve the southern drainage ditch to restore channel capacity and prevent overflowing onto the newly placed cap. The Contractor will be required to improve the drainage ditch between the two work areas, including cutting off the existing culverts, brush and tree removal, excavation/grading, and geotextile fabric and rip-rap placement. The Contractor will be required to grade the work area to promote positive drainage, including tree and brush removal as required. The Contractor will be required to place 6-inches of sandy loam soil as a cap over the areas depicted on Sheet C-7 of the Drawings. The Contractor will be required to restore all disturbed areas (within and outside of the work limits) to pre-work conditions including grading, topsoil (if topsoil is currently present), seeding, and mulch. Restoration work will occur in the capping areas depicted on Sheet C-7 of the drawing set, and any other areas disturbed by the Contractor. The Contractor will be required to perform the parts of the Work designated by the Alternates identified in the Schedule of Alternates, if any, if they are awarded by the Owner. The Contractor will be required to sequence all parts of the Work awarded as defined by the Base Bid. The Work to be completed under this Contract includes, but is not limited to , the following activities: 1. Prepare all required plans including Work Plan with a Site Access and Traffic Control Plan, Health and Safety Plan, Borrow Area Restoration Plan, and Soil Erosion and Sedimentation Control Implementation Plan. Plan and implement Mobilization, Site Access, Site Security, Site Preparation, Temporary Utilities, and Temporary Facilities. Coordinate with the Owner, the Professional, and Federal, state and local agencies, and utilities to begin Work.
They are characterized, however, by a preoccupation with body image and weight as well as concern regarding eating. Dieting, that is restrictive eating for the purpose of losing weight, appears to be the primary precursor to the development of eating disorders. The prevalence of disordered eating in athletes is high and, in general, studies have suggested that it is higher than in non-athletes. In these sports, female athletes often feel under pressure to reduce weight in order to perform well. Particularly in sports or activities that emphasize leanness, there may be a distorted view as to what is an acceptable energy intake. Female dancers are a good example: dance students and professional ballerinas have been reported to consume less than 70% of the energy needed to meet body weight targets. Disordered eating is not, however, a pre-requisite for low energy availability in very active women. An athlete may be eating normally for a non-athlete but not realize that her energy intake is insufficient to meet her enhanced energy needs because appetite is not necessarily a reliable indicator of energy requirements in athletes. This may be a particular problem among girls as their food intake must also cover the energy costs of growth. However, this observation is probably accounted for by self-selection of late-maturing girls into these activities, rather than by a cause-andeffect relationship. By contrast, the high prevalence of menstrual dysfunction among women athletes is clearly associated with their eating and exercise behaviours. Reports of the prevalence of menstrual disorders in athletes vary widely but, consistent with findings for eating disorders, it is highest in sports where leanness influences performance or where weight categories restrict competition. In rhythmic gymnasts, for example, as many as 61% have been reported to have oligomenorrhoea (irregular, long cycles), as have 21% of a group of English runners. Even in regularly menstruating athletes, asymptomatic subclinical disorders of reproductive function are common (these are evident only when researchers measure the concentrations of ovarian steroid hormones over at least one menstrual cycle). For example, in regularly menstruating recreational runners, the prevalence of luteal suppression and anovulation was 78%, much higher than in either the general population or in an age-matched group of sedentary women (~9%) (de Souza et al. Intense training for non-sporting activity is also associated with amenorrhoea; for example, around 40% of ballet dancers are amenorrhoeic. Predisposing factors include youth (women who take up a sport as adults are less likely to become amenorrhoeic), a low level of body fatness and a high training intensity or volume. Reproductive function is often impaired, however, even in women who have a normal pattern of menstrual bleeding. Researchers have undertaken careful comparisons of the characteristics of menstrual cycles of recreational runners with those of sedentary age- and weight-matched controls (de Souza et al. Even though all the exercising women had repeatable menstrual cycle lengths in the normal range, their ovarian function was frequently abnormal: 55% of cycles monitored demonstrated either luteal phase deficiency (too short and/or inadequate because of low progesterone) (43%) or anovulation (12%). Cycles were more likely to be anovulatory as the severity of the disruption to endocrine function progressed. For example, women and girls with anorexia nervosa may self-select into sports where low body mass confers a competitive advantage. The increase in follicle-stimulating hormone in the luteal-to-follicular transition is also attenuated. These abnormalities reflect disturbances of the neuroendocrine functions of the hypothalamus and impair or prevent the normal processes of ovulation and implantation. Cross-sectional comparison of amenorrhoeic and normally menstruating athletes have failed to demonstrate a consistent association between menstrual status and body mass or composition. According to this hypothesis, the vital links between the hypothalamus and the pituitary are disrupted when some unknown signal, possibly leptin, indicates that dietary energy intake is inadequate to cover the energy costs of both reproduction and the considerable amount of energy expended in exercise.
Some diseases of the skin develop in people with a genetic predisposition to allergies. Others occur in anyone who has been sensitized to an allergen, such as poison ivy. Urticaria (Hives) Urticaria, or hives, results from a vascular reaction of the skin to an allergen. Urticaria is a common skin condition that affects up to 20% of the population at some point in their lives. Having an allergy or family members with urticaria increases the risk of developing urticaria. Wheals usually appear first on the covered areas of the skin such as the trunk and upper parts of the arms and legs and appear in batches. Corticosteroids decrease inflammation, antihistamines control pruritis, and topically applied calamine lotion relieves pruritus. If the cause of the allergic reaction can be determined, the allergen should be avoided. Allergic contact dermatitis is a localized inflammation of the skin caused by contact with an allergen. The prevalence is not known, because many cases are mild or go unreported to doctors. Dermatitis Dermatitis is a broad term covering many different disorders characterized by a rash accompanied by pruritus and erythema. Initial exposure to an allergen does not cause a reaction, but it does sensitize the skin so that it will react to the next exposure. The allergic reaction is usually confined to the area where the allergen touched the skin. Allergic contact dermatitis can be prevented by avoiding contact with the allergen. If contact does occur, the allergen should be washed off immediately with soap and water. If exposure cannot be easily avoided, gloves and protective clothing may be helpful. Barrier creams are also available that can block certain substances, such as poison ivy, from contacting the skin. Atopic dermatitis is the most common type of eczema, a chronic skin disease that is frequently associated with other allergic conditions such as asthma and hay fever. It occurs especially among people with a family or personal history of allergic disease. Others at risk include infants and young children and people exposed to skin irritants and extremes in temperature. Atopic dermatitis in older children, teenagers, and adults usually involves the skin inside the creases of the inward bend of the elbow, as well as the knee, ankle or wrist joints, hands, and upper eyelids. The etiology of atopic dermatitis is idiopathic, but people who have it usually have many allergic disorders, particularly asthma, hay fever, and food allergies. The relationship between atopic dermatitis and these disorders is not clear because atopic dermatitis is not an allergy to a particular substance.
It may periodically become necessary to have special meetings to resolve project conflicts in which all parties shall be required to attend. Review changes proposed by the Owner for: 01-17 Bidding and Contract Document Project Name: Hubbell Processing Area File No. If the Contractor fails or refuses to attend or otherwise comply with the project meetings requirements, the Owner may issue an order to stop all or part of the Work until satisfactory progress has been make to correct such deficiencies. Submittals may be provided to the Professional and Owner electronically in Adobe portable document format (pdf) via electronic mail. Resubmittals shall be identified by the original submittal number followed by the suffix "A" for the first resubmittal, the suffix "B" for the second resubmittal, etc. With prior approval from the Professional, submittals may be provided via electronic mail. Upon return of a submittal marked "Approved" or "Approved as Corrected", the Contractor may conduct work in accordance with the submitted plan, schedule, or form. If a submittal marked "Approved as Corrected" has extensive corrections or corrections affecting other plans or work, the Professional may require that the Contractor make the corrections indicated thereon and resubmit the plans or schedules for record 01-19 Bidding and Contract Document Project Name: Hubbell Processing Area File No. The "Not Approved" notation is used to indicate a plan or schedule that is not acceptable. Upon return of a submittal so marked, the Contractor shall repeat the initial approval procedure to resubmit the appropriately revised schedule or plan. Any work performed without the "Approved" or "Approved as Corrected" plans, schedules, and forms will be at the sole responsibility of the Contractor. Submittals shall be provided to the Professional well in advance of the need to begin the Site work. The Contractor shall furnish required submittals with complete information and accuracy in order to achieve required approval of an item within three submittals. All costs to the Professional involved with subsequent submittals requiring approval, will be back charged to the Contractor, at the rate of 3. The Contractor shall not initiate field activities until all of these submittals have been reviewed and accepted by the Owner: 1. The Contractor, prior to conducting Work, must submit necessary substitutions due to change of employment status and other unforeseen circumstances in writing for acceptance. The Contractor shall identify sources of off-site borrow and provide evidence of written access from each property owner for each borrow source if commercial sources are not used. The Contractor shall provide all appropriate permits and licenses for review by the Owner and the Professional. If necessary, Site inspections may be requested to verify adequacy and compliance status. In addition, the Contractor shall identify the location, size, and type of vehicle and personnel decontamination units. The Contractor shall also provide a Certified Construction Storm Water Operator for the project. The Site Manager for this Contract shall be an individual experienced in remedial excavation, dewatering, backfilling, and compaction and whose responsibility is to insure compliance with the Contract plans and specifications. All on-site Contractor and subcontractor staff shall be under the direction of the Site Manager at all times. The air-monitoring plan at a minimum shall include perimeter air monitoring including real-time particulate monitoring and dedicated portable air sampling pumps with cassettes for asbestos fiber sampling. A minimum of six locations shall be monitored daily when work activities are disturbing soil, debris, and waste piles, and when vehicles or equipment are driving across uncapped ground. The air-monitoring plan shall include personnel monitoring for asbestos fibers as required for asbestos workers conducting renovation work. Two permanent stations shall be established, with one being along the south fence 1. The remaining four locations will be determined daily by the Contractor based on the prevailing wind direction and as approved by the Professional. The real time particulate monitoring shall be completed on an as needed basis but not less than in one (1) hour intervals during the aforementioned activities.
Every chapter in the textbook has a corresponding lesson in the Medical Language Lab. A designated icon found within the chapters tells students when it is most advantageous to integrate the activities on the Medical Language Lab into their studies. Students can be confident that every activity in the Medical Language Lab is relevant to the language of medicine and helps facilitate the learning process. It provides activities to accelerate learning and reinforce information presented in each chapter. A designated icon found within the chapters tells students when it is most advantageous to integrate the activities on the DavisPlus website into their studies. These teaching aids are designed to help instructors plan course work, enhance presentations, and make teaching medical terminology easier and more effective. Instructors can use these teaching tools in various educational settings, including the traditional classroom, distance learning, or independent studies. When the instructor integrates them into course content, they will provide a sound foundation for developing an extensive medical vocabulary and guarantee a full program of medical terminology excellence for all students. Suggested course outlines help the instructor determine a comfortable pace and plan the best method of covering the material presented in the textbook. These activities integrate clinical scenarios in each chapter as a solid reinforcement of content. Instructors should feel free to select activities they deem suitable for their course and decide whether the students should complete the activity independently, with peers, or as a group project. The research projects provide an opportunity for students to hone their research skills. The Community and Internet Resources section offers an updated list of technical journals, community organizations, and Internet sources that students can use to complete the oral and written projects. This section also includes an evaluation template for the oral and written research projects. These projects will add variety and interest to the course while reinforcing the learning process. Instructors can use the anatomy test questions for anatomy review or as a testing device. We have updated the supplemental medical record activities and added new activities to this edition. As in the textbook, these medical record activities use common clinical scenarios to show how the student would use medical terminology in the clinical area to document patient care. Each medical record includes activities for terminology, pronunciation, and medical record analysis. Instructors can use these records for group activities, oral reports, medical coding activities, or individual assignments. The medical records are designed to reinforce and enhance terminology presented in the textbook. These fun, educational activities reinforce material covered in each body system chapter. Instructors can use them for an individual or group activity, an extra credit opportunity, or just for fun. Anatomy coloring activities, included for each body system chapter, help reinforce the positions of the main organs that compose a particular body system. In response to requests from instructors, this section summarizes the answers to the Terminology tables in the medical records sections of the textbook. This added feature provides instructional support in using the textbook and assists instructors in correcting terminology assignments. We have developed over 1,270 slides for this edition, including numerous, full-color illustrations with captions from the textbook and other sources. The PowerPoint Lecture Notes slides also contain pedagogical notes for each chapter (at the bottom of the slide) to reinforce comprehension and offer suggestions for a higher retention level for material discussed. In addition, instructors can also arrange to use the PowerPoint presentations for independent study purposes. The PowerPoint Lecture Notes provide an outline-based presentation for each body system chapter. Each presentation contains a chapter overview, the structure and functions of each body system, and selected pathology, vocabulary, and diagnostic medical and surgical procedures for each body system chapter.
Carlina acaulis (Carlina). Stromectol.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96142
This is the route taken by microorganims degrading biomass from other organisms, and to a lesser extent in the biodegradation of some xenobiotic materials. The substances that are cometabolized are called secondary substrates because they are not the main compounds for which the enzymatic processes are designed. Commonly known as the white rot fungus, this organism has an enzyme system that normally breaks down lignin, the degradation-resistant "glue" that holds cellulose together in wood and woody plants. Under certain stressed conditions, however, the enzyme will act to cometabolize synthetic organochlorine compounds and was once widely promoted as a means of remediating hazardous waste sites contaminated with such compounds. In the simplest case, the change to the substrate molecule is relatively minor, such as addition, deletion, or modification of a functional group. An important step in biodegradation is the modification of a substance to reduce its toxicity. In some cases, however, action of microorganisms in the environment may produce a much more toxic material. A number of factors are involved in determining the effectiveness and rate of biodegradation. Biodegradability is influenced by both physical properties, such as water solubility, and chemical characteristics including the presence of functional groups amenable to microbial attack. It should be noted that even very poorly biodegradable compounds can often be degraded under suitable conditions. However, in dilute solution and under the appropriate conditions, phenol can be destroyed by bacteria. An important aspect of biodegradation of resistant compounds is to use microorganisms acclimated to the particular kind of compounds. Populations of such microorganisms are found in locations where the kinds of compounds to be treated have been spilled, such as in petroleum spills on soil. This is especially true of "consumable" materials that are dissipated to the environment. This is especially true now that there is such an explosion in the understanding of biological sciences. The realization that the biosphere can contribute immeasurably to the benefit of humankind through such things as the provision of renewable feedstocks as raw materials provides a strong incentive to use technology to the benefit of the biosphere. The most direct interface between the biosphere and technology occurs in agriculture. The production of biomass per unit area of land has increased in a spectacular fashion in recent decades with the use of fertilizers, herbicides, insecticides, and sophisticated means of cultivation and harvesting. In the past, the ways in which techniques for improved agricultural productivity were applied were largely divorced from considerations of the natural ways in which plants and animals grow on land. Fortunately, there is a growing realization of the important information that nature can provide in maintaining agricultural productivity. For example, in the prevention of water erosion, terraces constructed on land are designed to funnel excess water runoff onto grassed waterways. By planting these waterways to native grasses, a tough, erosion-resistant sod can be established that stands up under the punishment of occasional deluges of runoff water while surviving intermittent severe droughts. On a larger scale, in place of cultivating drought-prone prairie land to grow grain to feed to cattle, a better approach may be to reseed these lands to tough native grasses and allow bison to feed upon the grass as a source of meat (less fat and more healthy than beef from cattle). The restoration and development of "natural" areas has become an important endeavor commonly termed restorationecology. This often is advised with farmland 246Green Chemistry, 2nd ed that is too marginal to support profitable agricultural operations. Much of the rocky, hilly, unproductive farmland in New England is now reverting to forests. In such restoration efforts, modern construction machinery with the capacity to move enormous quantities of dirt have proven useful. One example in which such machinery is used is in leveling large areas for the construction of wetlands. Rivers that were once straightened to facilitate water flow - with catastrophic results in the form of flooding and erosion - are now being restored with the bends and meanders that characterize a healthy river. Following the catastrophic 500-year floods on the Missouri and Mississippi Rivers in 1993, large areas of cropland in the river bottoms were purchased by the Federal Government, river dikes designed to prevent flooding were breached, and the land was allowed to to revert to a wild state.
Dental Management Modifications When a medical risk assessment screening is completed, the dental provider develops an awareness of the medical complexity or risk status of the patient and can predict the possible complications related to the planned dental procedures. Minor complications can be prevented or managed easily at home or at chair-side, while major complications may require medical management and possible hospitalization. Detecting the medically compromised patient in dentistry by means of the medical risk-related history. Validity of health history data collected from dental patients and patient perception of health status. Detection of incidental carotid artery calcifications during dental examinations: panoramic radiography as an important aid in dentistry. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, V. The influence of systemic diseases on the diagnosis of oral diseases: a problem-based approach. MedicalHistory,PhysicalEvaluation,andRiskAssessment 23 Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. A summary of the update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. The dental treatment of patients with joint replacements: a position paper from the American Academy of Oral Medicine. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients. Pathogenesis/Etiology Ischemic heart disease is defined as a lack of oxygen to the heart muscles. It can be caused by coronary artery blockage by atherosclerotic plaque or thrombosis, narrowing because of coronary artery spasm, coronary arteritis, embolism, or shock secondary to hypotension. Other causes of ischemia include tachycardia, hyperthyroidism, catecholamine treatment, cardiac hypertrophy, anemia, advanced lung disease, congenital cyanotic heart disease, and carbon monoxide poisoning. Other less common causes of angina include aortic stenosis, arrhythmias, myocarditis, mitral valve prolapse, and hypertrophic cardiomyopathy. The area of infarct loses normal conduction and contraction, and may heal with nonfunctional scar tissue. Symptoms are severe substernal pain that may radiate to the left arm, neck, jaw, or back; shortness of breath; profuse sweating; loss of consciousness; or symptoms may be only very mild discomfort. If the infarct involves the full thickness of the ventricular wall, it is termed transmural; a subendocardial infarct is limited to the inner one-third to one-half of the ventricular wall. The remaining 10% have an identified etiology such as pheochromocytoma, aortic regurgitation, renal artery stenosis, and preeclampsia, or are drug-induced by corticosteroids, nonsteroidal anti-inflammatory drugs, or oral contraceptives. Symptoms may include shortness of breath, orthopnea, fatigue, and inability to cope with physical activity. These are structural problems that range from minor holes between chambers to major malformations that require surgical intervention. Damage to the valve leaflets may be part of the cause and the result of this condition. Vegetations form on the valves that consist of organisms, usually streptococci or staphylococci, fibrin, and inflammatory cells.
If a quantity of radiation is delivered to a body over a long period of time, the effect: (A) will be greater than if it were delivered all at one time (B) will be less than if it were delivered all at one time (C) has no relation to how it is delivered in time (D) is solely dependent on the radiation quality 6. What is used to account for the relative radiosensitivity of various tissues and organs: 1. The beam of x-ray photons leaving the x-ray tube focus can be described as having what sort of nature Stochastic effects occur randomly and are "all-or-nothing" type effects; that is, they do not occur with degrees of severity. Remember that in a nonthreshold curve there is no safe dose, that is, no dose below which there will definitely be no biologic response. The linear nonthreshold curve is the curve of choice to predict effects of low level. Skeletal anomalies usually appear if irradiation occurs in the early part of this time period, and neurologic anomalies are formed in the latter part; mental retardation and childhood malignant diseases, such as cancers or leukemia, can also result from irradiation during the first trimester. Fetal irradiation during the first 2 weeks of gestation can result in spontaneous abortion. It must be emphasized that the likelihood of producing fetal anomalies at doses below 0. Because different kinds of radiation have different degrees of penetration in different materials, it is also a useful way of expressing the quality of the radiation. If the radiation is delivered in portions over a period of time, it is said to be fractionated and has a less harmful effect than if the radiation was delivered all at once. This is accounted for by the fact that the incident electrons have different energies. Also, the incident electrons travel through several layers of tungsten target material, lose energy with each interaction, and therefore produce increasingly weaker x-ray photons. The radiation weighting factor (W r) is a number assigned to different types of ionizing radiations to better determine their effect on tissue. More energetic radiations have shorter wavelengths and higher frequency; thus, they are inversely related. The relationship between frequency, wavelength, and energy is illustrated in the electromagnetic spectrum. Some radiations are energetic enough to rearrange atoms in materials through which they pass, and can therefore be hazardous to living tissue. The emitted photons can therefore have a variety of energies and thus are termed heterogeneous or polyenergetic. It is only at extremely high energies that photon energy becomes more homogeneous; only gamma radiation can be accurately termed homogeneous or monoenergetic. An acute dose of approximately 200 rad would be required to cause radiogenic cataracts. Patient Protection All radiologic imaging professionals have the ethical responsibility to keep radiation exposure to patients (and themselves) to an absolute minimum. Statistics indicate that the number of radiologic imaging examinations performed annually is steadily increasing. One exceedingly important consideration in reducing patient exposure is good patient communication. Quality assurance programs are in place to ensure that retakes will not be required as a result of equipment malfunction. Employees receive orientation on new equipment to ensure that it is used to best advantage and to reduce retakes as a result of unfamiliarity with equipment operation. The following topics discuss important factors having impact on patient protection.
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