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A variety of industries use and produce chemicals that pose hazards to individuals if exposed to sufficient quantities or concentrations my medicine buy cheapest mentat and mentat. I-5) Chemical Agents: "Chemical agents are poisonous vapors medications used to treat bipolar generic mentat 60 caps with visa, aerosols symptoms you have diabetes generic mentat 60 caps fast delivery, liquids medications known to cause miscarriage order mentat 60 caps without prescription, and solids that have toxic effects on people, animals, or plants. They can have an immediate effect (a few seconds to a few minutes) or a delayed effect (2 to 48 hours). While potentially lethal, chemical agents are difficult to deliver in lethal concentrations. Many of these are common commercial and industrial chemicals that can be easily weaponized. Signs of a chemical release include people having difficulty breathing; experiencing eye irritation; losing coordination; becoming nauseated; or having a burning sensation in the nose, throat, and lungs. Also, the presence of many dead insects or birds may indicate a chemical agent release. Chemical, biological, radiological, nuclear, and high-yield explosive hazards include those created from accidental releases, toxic industrial materials (especially air and water poisons), biological pathogens, radioactive matter, and high-yield explosives. Also included are any hazards resulting from the deliberate employment of weapons of mass destruction during military operations. The Department of Homeland Security has issued Chemical Facility Anti-Terrorism Standards for any facility that manufactures, uses, stores, or distributes certain chemicals above a specified quantity. Under the rule, if a facility possesses a chemical of interest at or above the screening threshold quantity, the facility must complete and submit a consequence assessment known as a Top-Screen. Facilities that possess chemicals of interest at or above the listed screening threshold quantities are required to complete the Top-Screen within 60 calendar days of the publication of Appendix A. Assignment of tiers is based on an assessment of the potential consequences of a successful attack on assets associated with chemicals of interest. The highest tier facilities, or Phase 1 facilities, are those specifically requested by the Assistant Security to complete the Top Screen. Tier 3 and 4 facilities may choose to submit an Alternative Security Plan for the Site Security Plan for consideration by the Department. Army have assisted communities surrounding the eight chemical stockpile sites to enhance their abilities to respond to the unlikely event of a chemical agent emergency. Subsequently, in 1988 Congress ordered "maximum protection" of the public near the installations until the chemical weapons were gone. Since riot control agents and herbicides are not considered to be chemical warfare agents, those two items will be referred to separately or under the broader term "chemical," which will be used to include all types of chemical munitions/agents collectively. A service, sponsored by the chemical industry, which provides two stages of assistance to responders dealing with potentially hazardous materials. Whether a child has personally experienced trauma, has merely seen the event on television, or has heard it discussed by adults, it is important for parents and teachers to be informed and ready to help if reactions to stress begin to occur. Children may respond to disaster by demonstrating fears, sadness, or behavioral problems. Younger children may return to earlier behavior patterns, such as bedwetting, sleep problems, and separation anxiety. Older children may also display anger, aggression, school problems, or withdrawal. Some children who have only indirect contact with the disaster but witness it on television may develop distress. For many children, reactions to disasters are brief and represent normal reactions to "abnormal events. On-going stress from the secondary effects of disaster, such as temporarily living elsewhere, loss of friends and social networks, loss of personal property, parental unemployment, and costs incurred during recovery to return the family to pre-disaster life and living conditions. In the absence of severe threat to life, injury, loss of loved ones, or secondary problems such as loss of home, moves, etc. For those that were directly exposed to the disaster, reminders of the disaster such as high winds, smoke, cloudy skies, sirens, or other reminders of the disaster may cause upsetting feelings to return. Having a prior history of some type of traumatic event or severe stress may contribute to these feelings.

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It is also fair to say that few diagnoses are made solely on the basis of the sensory examination; more often the exercise serves simply to complement the motor examination medicine for pink eye 60 caps mentat with mastercard. Quite often medicine omeprazole discount mentat 60caps overnight delivery, no objective sensory loss can be demonstrated despite symptoms that suggest the presence of such an abnormality symptoms uti generic 60caps mentat fast delivery. In the former instance medications quotes buy mentat discount, sensory symptoms in the nature of paresthesias or dysesthesias may be generated along axons of nerves not sufficiently diseased to impair or reduce sensory function; in the latter instance, loss of function may have been so mild and gradual as to pass unnoticed. At times, children and relatively uneducated persons, by virtue of their simple and direct responses, are better witnesses than more sophisticated individuals, who are likely to analyze their feelings minutely and report small and insignificant differences in stimulus intensity. General Considerations Before proceeding to sensory testing, the physician should question patients about their symptoms, and this too poses special problems. The "sensory homunculus," or cortical representation of sensation in the postcentral gyrus; compare this to the distribution of body areas in the motor cortex (see also. They may say that a limb feels "numb" and "dead" when in fact they mean that it is weak. But more often disease induces new and unnatural sensory experiences such as a band of tightness, a feeling of the feet being encased in cement, lancinating pains, an unnatural feeling when stroking the skin, and so on. If nerves, sensory roots, or spinal tracts are damaged or partially interrupted, the patient may complain of tingling or prickling feelings ("like Novocain" or like the feelings in a limb that has "fallen asleep," the common colloquialism for nerve compression), cramp-like sensations, or burning or cutting pain occurring either spontaneously or in response to stimulation. Experimental data support the view that partially damaged touch, pressure, thermal, and pain fibers become hyperexcitable and generate ectopic impulses along their course, either spontaneously or in response to a natural volley of stimulus-evoked impulses (Ochoa and Torebjork). These abnormal sensations are called paresthesias, or dysesthesias if they are severe and distressing, as alluded to in Table 8-2 in the prior chapter. Another positive sensory symptom is allodynia, referring to a phenomenon in which one type of stimulus evokes another type of sensation-. The clinical characteristics of a sensation may divulge the particular sensory fibers involved (Table 9-1). It is known that stimulation of touch fibers gives rise to a sensation of tingling and buzzing; of muscle proprioceptors, to pseudocramp (the sensation of cramping without actual muscle contraction; of thermal fibers, to hotness (including burning) and coldness; and of A- fibers, to prickling and pain. Paresthesias arising from ectopic discharges in large sensory fibers can be induced by nerve compression, hypocalcemia, and diverse diseases of nerves. Band-like sensations are the result of dysfunction in large sensory fibers, either in the periphery or their continuation in the posterior columns. Also, certain sensory symptoms suggest an anatomical location of nerve disease; for example, lancinating pains that radiate to the back or neck implicate root or, less often, sensory ganglion disease. The presence of persistent paresthesias should always raise the suspicion of a lesion involving sensory pathways in nerves, spinal cord, or higher structures. Most often, the large fibers in the peripheral nerves or posterior columns are implicated. Every person has had the experience of resting a limb on the ulnar, sciatic, or peroneal nerve and having the extremity "fall asleep. However, these sensory experiences are transient and should not be confused with the persistent, albeit frequently fluctuating, paresthesias of structural disease of the nervous system. Severe acral and peripheral paresthesias with perversion of hot and cold sensations are characteristic of certain neurotoxic shellfish poisonings (ciguatera). Also worth comment are vibratory paresthesias, which we have encountered in only a handful of patients. One articulate physician described the sensation as a high-amplitude, low-frequency "buzz" that was distinctly different from the more common prickling paresthesias, burning, numbness, etc. We have the impression that these sensations are almost always a manifestation of central sensory disease, in one case probably attributable to the posterior columns and in another to cerebral disease. Effect of Age on Sensory Function A matter of importance in the testing of sensation is the progressive impairment of sensory perception that occurs with advancing age. This requires that sensory thresholds, particularly in the feet and legs, always be assessed in relation to age standards. The effect of aging is most evident in relation to vibratory sense, but proprioception, as well as the perception of touch, and fast pain are also diminished with age. Receptors in the skin and special sense organs (taste, smell) also wither with age. Terminology (See also Table 8-1) A few additional terms require definition, since they may be encountered in discussions of sensation. Anesthesia refers to a complete loss and hypesthesia to a partial loss of all forms of sensation.

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Mouthing movements and a number of abnormal reflexes- grasping and sucking (in response to visual as well as tactile stimuli) medicine grace potter lyrics effective 60caps mentat, inability to inhibit blink on tapping the glabella treatment whiplash buy cheapest mentat, snout reflex (protrusion of the lips in response to perioral tapping) medications prescribed for depression purchase 60caps mentat, biting or jaw clamping (bulldog) reflex medications given for uti buy 60caps mentat with visa, corneomandibular reflex (jaw clenching when the cornea is touched), and palmomental reflex (retraction of one side of the mouth and chin caused by contraction of the mentalis muscle when the thenar eminence of the palm is stroked)- all occur with increasing frequency in the advanced stages of the dementia. Many of these abnormalities are considered to be motor disinhibitions that appear when the premotor areas of the brain are involved. Food intake, which may be increased at the onset of the illness, sometimes to the point of gluttony, is in the end reduced, with resulting emaciation. Finally, these patients remain in bed most of the time, oblivious of their surroundings, and succumb at this stage to pneumonia or some other intercurrent infection. Some patients, should they not die in this way, become virtually decorticate- totally unaware of their environment, unresponsive, mute, incontinent, and, in the end, adopting a posture of paraplegia in flexion. The term persistent vegetative state is appropriately applied to these patients, although it was originally devised to describe patients in this same state after cardiac arrest or head injury, as described in Chap. Occasionally, diffuse choreoathetotic movements or random myoclonic jerking can be observed, and seizures occur in a few advanced cases. The course of the prototype of dementia, Alzheimer disease, extends for 5 to 10 years or more from the time that the memory defect becomes evident. Not infrequently, a patient is brought to the physician because of an impaired facility with language. In other patients, impairment of retentive memory with relatively intact reasoning power may be the dominant clinical feature in the first months or even years of the disease; or low impulsivity (apathy and abulia) may be the most conspicuous feature, resulting in obscuration of all the more specialized higher cerebral functions. Gait disorder, though usually a late development, may occur early, particularly in patients in whom the dementia is associated with or superimposed on frontal lobe degeneration, Parkinson disease, normalpressure hydrocephalus, cerebellar ataxia, or progressive supranuclear palsy. Insofar as the several types of degenerative disease do not affect certain parts of the brain equally, it is not surprising that their symptomatology varies. Moreover, frank psychosis with delusions and hallucinations may be woven into the dementia and are particularly characteristic of certain diseases such as Lewy-body dementia. In other words, the symptoms are the primary manifestations of neurologic disease. For example, a demented person may seek solitude to hide his affliction and thus may appear to be asocial or apathetic. Again, excessive orderliness may be an attempt to compensate for failing memory; apprehension, gloom, and irritability may reflect a general dissatisfaction with a necessarily restricted life. According to Goldstein, who has written about these "catastrophic reactions," as he called them, even patients in a state of fairly advanced deterioration are still capable of reacting to their illness and to persons who care for them. In the early and intermediate stages of the illness, special psychologic tests aid in the quantitation of some of these abnormalities, as indicated in the later part of this chapter. Frontotemporal Dementia As indicated above, not all degenerative dementias have a uniform mode of onset and clinical course. Loss of memery function stands out in most descriptions of dementia because it is the core feature of Alzheimer disease, by far the most common cause of the condition. However, several clinical variants of dementia in which memory is not disproportionately affected have long been recognized, and in recent years three of them- frontotemporal dementia, primary progressive aphasia, and semantic dementia- have been subsumed under the newly minted term frontotemporal dementia. Several consensus statements on the clinical diagnostic criteria for these syndromes have been published, although not all writings on this subject are in agreement (see Morris). The most common clinical syndrome in this group is characterized by features that would be expected of diffuse cortical degeneration of the frontal lobes: early personality changes, particularly apathy or disinhibition, euphoria, perseveration in motor and cognitive tasks, ritualistic and repetitive behaviors, laconic speech leading to mutism- all with relative preservation of memory and orientation. With anterior temporal lobe involvement, hyperorality, excessive smoking, or overeating occur, and there may be added anxiety, depression, and anomia. Diminished capacity for abstraction, attention, planning, and problem solving may be observed as the degenerative process continues. Primary progressive (nonfluent) aphasia is a more highly circumscribed frontal syndrome, characterized by effortful speech, agrammatism, and impairment of reading and writing, with relative preservation of the understanding of the meaning of words. Such aphasic syndromes may persist in isolation for several years before other features of cognitive decline become evident. Semantic dementia is the least common and most poorly defined of the three syndromes.

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The outside funding and technical assistance that becomes available after a disaster can help your community make progress on its long-term goals medicine expiration dates discount generic mentat uk. Take the time and effort to unite the community behind agreed-upon goals and objectives treatment bipolar disorder buy mentat 60caps visa. Structure the planning process so that it is open and participatory medications for schizophrenia cheap 60caps mentat overnight delivery, but also quickly leads to agreement on a broad framework for recovery treatment menopause order 60 caps mentat fast delivery. Look for opportunities to reap multiple benefits when incorporating hazard mitigation and sustainable redevelopment concepts into your recovery efforts. If expertise is not locally available, seek experienced grant writing assistance from other sources, such as regional or State agencies and the private sector. Recruit local corporations, foundations, and nonprofit or civic organizations to participate in the planning process. Marshal local nonprofit groups and organizations to supplement Federal and State agency support. Prioritize immediate, short-term, and long-term recovery actions; detailed design, architectural, and engineering plans can follow later. The targeted point in time to which systems and data must be recovered after an outage as determined by the business unit. Related Terms: Alternate Site, Cold Site, Hot Site, Interim Site, Internal Hot Site, and Warm Site. Red Team/Red Teaming: "Analytical Red Teaming uses an adversary perspective to advance security by providing an alternative view of threats, vulnerabilities, and countermeasures. Without testing the physical limitations of antiterrorism measures analytical red teaming can offer insight to challenge prevailing views, prevent surprise, help allocate resources, and expand the bounds of imagination. This process indoctrinates participants into the mind-set of a specific adversary, modeled upon the results of the threat analysis. Once this perspective has been viably gained, participants use it to build a threat or attack that assaults the plan(s), policy(s), or procedure(s) under examination. When done at the system (rather than component) level, management can identify system improvements. This document aids red team operators, safety 10/27/08 1032 controllers, and evaluators in the conduct of safe and valid red team exercise activity. It also provides essential information (not included in any other exercise documents) to red team operators, which enables them to understand their roles in exercise execution. Includes mass exodus of peoples for reasons of conflict and natural disasters moving outside their country of origin. These are not shelters and will not have the same resources available to shelterees. A region can be a municipality, a single state (or province), or a portion of a state and may be multi-jurisdictional or cross national borders. Regions generally have certain accepted cultural characteristics and geographic boundaries and tend to coincide with the service areas of the infrastructures that serve them. It also provides policy guidance for Federal radiological incident management activities in support of State, local and Tribal government radiological emergency planning and preparedness activities. Tier 1: Chicago, Houston, Los Angeles/Long Beach, National Capital Region, Jersey City/Newark, New York, San Francisco Bay Area Tier 2: Boston, Honolulu, Norfolk, Seattle. Depending upon the nature and extent of the disaster or major incident, the Secretary may designate another official in this capacity. This marked a shift in strategy from a State- 10/27/08 1034 focused approach to a regional (multi-state) approach to more effectively integrate national, regional, territorial, tribal, state, and local preparedness exercises. While consideration may be given to requests for support to an individual State, territorial, tribal, and/or local exercise initiatives, priority will be given to those that support collaboration within a Region. Exercise support requests must be associated with the appropriate State/territory multi-year training and exercise plans and, as they are developed, the regional multi-year training and exercise plan. These plans should incorporate broader preparedness planning such as operational plans, State Preparedness Reports and applicable outputs from various other emergency management and homeland security program planning. Outcomes: the R-4C will establish a holistic planning process resulting in the creation and implementation of standardized operating procedures, consistent response plans, and development of comprehensive training and exercise programs. They facilitate prioritizing "in theater" interagency resource allocation and coordination. The type of risk analysis used should be appropriate for the available data and to the exposure, frequency and severity of potential loss. Press Release, July 23, 2003) Remediation: "Actions taken to correct known deficiencies and weaknesses.

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