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Because the data are limited blood pressure chart india hydrochlorothiazide 25mg mastercard, both in the number of data points and the representativeness of the data blood pressure chart age group hydrochlorothiazide 25mg lowest price. These stormwater control types may require enhancements to blood pressure variation chart order hydrochlorothiazide pills in toronto improve specific additional treatment processes such as filtration and sedimentation. Disinfection is a costly active treatment alternative that may be considered for specific situations such as swim beaches where runoff is consolidated into a single discharge pipe near the receiving water. Disinfection has been used most effectively in the context of lowflow or baseflow diversions, rather than for treatment of all runoff events. Representative examples include individual bioretention studies, a wetland basin and a few detention basins. Care should be taken to understand both site-specific and stormwater control design characteristics in these studies before assuming that similar performance will occur at other locations. Paired watershed studies of non-structural stormwater control practices such as pet waste controls, urban wildlife management programs, storm sewer cleaning, etc. Urban successes may exist that were not identified during development of this report. Even when such strategies are implemented, it is unclear whether instream recreational water quality criteria are consistently attainable in urban areas, given technical, practical and economic considerations. Documentation and data collection should be conducted in a systematic manner, thinking forward to potential solutions and implementation strategies. Focus improvements in areas where actual recreational uses are documented to exist and where stream hydrology supports recreation. Public recreation on urban streams is weighted toward tranquil flow, and warm weather conditions, making summertime impairments highest priority in most communities (Stiles 2008). Focus on identification of human fecal sources first, then consider non-human sources. Implement source controls first, then consider structural controls if source controls are unsuccessful. Additionally, public education and enforcement of pet waste ordinances and leash laws, and equipping parks and trails with proper pet waste disposal cans in open space areas are basic source control steps. Work with local wildlife managers to assess the need for population controls or active management of urban wildlife. Before embarking on capital investments in structural stormwater controls and treatment programs, conduct a systematic evaluation to prioritize implementation of practices that are most likely to provide meaningful benefits and reduce human health risk. Water quality models can help to select and screen potential alternatives and help to develop cost estimates. Assuming that sources are correctly targeted, the expected effectiveness of structural controls will also vary and many unknowns remain. Once human sources are corrected and basic source controls are implemented, municipalities enter a phase of significant uncertainty regarding attainability of recreational stream standards. At this stage, regulatory and policy discussions are needed regarding use attainability, regulatory off-ramps and evaluation of risks to human health. The river extends over 52 miles with a watershed area of approximately 434 square miles. The river ultimately discharges to the Pacific Ocean at Dog Beach in the Ocean Beach community within the City of San Diego. Load reductions are required during both dry weather and wet weather conditions within a 10- and 20-year compliance timeline, respectively. The compliance points for this watershed are the Pacific Ocean shoreline at the mouth of the San Diego River, as well as two locations within the main stems of the San Diego River and Forester Creek. These opportunities are ranked based on factors such as effectiveness, cost, and maintenance requirements. Other structural controls also considered in the plan included low-flow diversions to the sanitary sewer as a structural option to treat dry weather flows, streambank stabilization, and other practices. Table 9-3 provides a cost estimate associated with implementation of the program elements. This economic study also reports an expected economic benefit to San Diego residents of $617 million, primarily associated with reduced economic losses due to beach closures and human health-related expenses. This translates to a $57/yr benefit per resident and a $351/yr cost per resident for 20 years.

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The second analytic question that arises simply involves identifying who is likely to blood pressure chart female purchase 25 mg hydrochlorothiazide amex be hurt in a hypothetical attack blood pressure chart print 25mg hydrochlorothiazide, and how: the nature of the harm defines the pool of potential plaintiffs and the types of the claims that they may bring pulse pressure 50 purchase hydrochlorothiazide online now. The central tort issue that will likely arise in connection with future maritime terrorist attacks involves the extent to which commercial defendants can be held liable for the independent criminal acts of terrorists. Traditional legal doctrines have tended to define the scope of negligence liability in terms of preventing "foreseeable" risks, with the result of substantially limiting liability for criminal acts committed by third parties (these mostly being viewed as unforeseeable). Summary xxi wake of September 11, the standard of foreseeability as applied to terrorist attacks is far from clear, and conceivably could be expansive. As a result, current tort liability risks associated with maritime terrorism are fundamentally ill-defined, but potentially quite large. Key Observations and Recommendations Based on the findings of our investigations into maritime terrorism risk and liability, we offer the following set of conclusions and recommendations for policymakers: · the greatest risks involving container shipping stem from scenarios involving radiological or nuclear detonation, or the extended disruption of operations at a port. Checking cargo containers moving through the container shipping system is impractical and imperfect because of the large number of containers and the inherent errors (both false positives and false negatives) of inspection technologies. These risks are most effectively reduced through planning to facilitate the restart of ports and container shipping systems in the wake of a terrorist attack or natural disaster. The most effective approach for minimizing the risks, however, involves reducing the vulnerabilities of ferries and cruise ships, by auditing the soundness of vessel and facility security practices, by improving security measures at ports for passengers and luggage, and by implementing rigorous procedures for documenting crew and staff. First, there is little evi- xxii Maritime Terrorism: Risk and Liability dence that terrorists and piracy syndicates are collaborating. The economic motivations for piracy (which depend for fulfillment on the stability of maritime trade) may be in direct conflict with the motivations of terrorists. Experts believe that improvised explosive devices would have limited capability to cause such failure. Because terrorist perpetrators are often a poor prospect for recovery in civil suits seeking compensation for victims, third-party firms and property owners are likely to be targeted in postattack tort litigation. As a result, firms engaged in maritime commerce need to recognize that they operate at risk and should investigate the extent of their own tort liability. Admiralty jurisdiction over these sorts of claims may preempt competing legal rules that would otherwise apply on land and may limit the compensation that can be sought by victims in some circumstances. Policymakers should Summary xxiii review these rules to confirm their appropriateness in application to future terrorist attacks. To the extent not already standard practice, parties to commercial contracts should specifically consider and address terrorism risks in connection with those contracts. The traditional criterion of foreseeability in negligence provides little guidance, in the wake of the September 11 attacks, regarding the scope of related responsibilities for potential defendants. We would like to acknowledge Maria Falvo for her dedication and patience and in helping us to prepare the manuscript. Politicians, academics, and diplomats alike began to forecast the establishment of a "new world order" that would be managed by liberal democratic institutions. It was assumed that as this new structure emerged and took root, destabilizing threats to national and international security would decline commensurately. However, the initial euphoria evoked by the end of the Cold War has been replaced by growing recognition that global stability has not been achieved and has, in fact, been decisively undermined by transnational security challenges. These new threats cannot readily be defeated by the traditional defenses that states have erected to protect their territories and their citizenry. Stated another way, the current geopolitical landscape lacks the relative stability of the linear Cold War division between East and West. By contrast, security, conflict, and threat definition have become far more opaque and diffuse in nature, often taking the form of amorphous challenges, "gray area phenomena," and acts of politically motivated violence by groups unaffiliated with sovereign governments, operating outside the mainstream of the international community. The maritime realm is particularly conducive to these types of threat contingencies, given its vast and largely unregulated nature. A complex lattice of territorial waters, estuaries, and riverine systems, which in many cases are poorly monitored, fringe and link these oceans. The basic characteristics of the maritime environment have increasingly galvanized concern on the part of academics, intelligence analysts, law enforcement officials, and politicians about the possible exploitation of the maritime realm to facilitate terrorist logistical and operational designs.

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The contamination of fresh produce may occur at any stage from production to blood pressure medications that start with l cheap hydrochlorothiazide 12.5 mg amex consumption arrhythmia vs heart attack hydrochlorothiazide 12.5mg for sale. Fresh produce may become contaminated with viruses through contact with human sewage arrhythmia pvc treatment cheap 25 mg hydrochlorothiazide visa. Fresh produce may also become contaminated by viruses via contaminated hands of food handlers especially if they do not practise appropriate personal hand hygiene. A second important factor in food-handler associated spread of viruses is vomiting that can lead to widespread contamination of the environment. The annex also provides information that will be of interest to the food industry, consumers, and other interested parties. This annex covers general hygienic practices for the production, harvesting, processing, packing and storage of fresh produce for human consumption particularly for fresh produce intended to be consumed raw or partially treated. Specifically, this annex is applicable to fresh produce grown in the field (with or without cover) or in protected facilities (hydroponic systems, greenhouses). Fresh produce is grown and harvested under a wide range of climatic and diverse geographical conditions, using various agricultural inputs and technologies, under varying socioeconomic, hygienic and epidemiological circumstances, and on farms of different sizes. Viral hazards may therefore vary considerably from one type of production to another. In each primary production area, it is necessary to consider the particular agricultural practices that promote the production of safe fresh fruits and vegetables, taking into account the conditions that are specific to the primary production area, type of products, and methods used. Sewage treatments should ensure adequate (maximal) reduction of viral loads in treated sewage, as the following could be potential sources of contamination: Water contaminated with untreated or partially treated sewage discharges, by overflow from sewage and septic tank systems or from run-off associated with a heavy rainfall that is used for irrigation, washing of produce, or application of fertilizers and agrichemicals. The frequency of testing for indicators of faecal contamination should be established according to the source of the water (ground water, surface water, wells) and the conditions of the irrigation system. Personnel hygiene facilities and toilets (permanent or portable), including appropriate hand washing facilities, should be pr esent in close vicinity of the fields where agricultural workers are working. Refer to Section 6 (Sanitation) and Section 7 (Personal hygiene) of the main document for aspects of sanitation and personnel hygiene in primary production. Non-authorized persons and, to the extent possible, children, should not be on the premises where fresh produce is grown, harvested, washed, packed or stored. Control measures to prevent faecally contaminated water being used in primary production and processing. Control measures to prevent fresh produce becoming contaminated by contagious food handlers. Viral entry is the first step of the viral life cycle and is a significant determinant of cell tropism, host range, immune interactions, and pathogenesis. Bile salts and histo-blood group antigens are key mediators of norovirus entry; however, the molecular mechanisms by which these molecules promote infection and the identity of a potential human norovirus receptor remain unknown. Here, we will review the current understanding about norovirus attachment and entry and highlight important future directions. It is initiated by virus binding to the cell surface and culminates in the release of the viral genome into the host cell cytoplasm [5]. Elucidating the molecular mechanisms by which a virus enters its target cell has important implications for host range, cell tropism, and pathogenesis [5,6]. In addition, viral entry represents a well-validated therapeutic target for both small-molecule antagonists and vaccines that elicit neutralizing antibodies [7]. Here, we will review the current understanding of norovirus entry, highlight key recent advances, and propose potential strategies to further understand norovirus entry and pathogenesis. Norovirus particles are approximately 27­30 nm in diameter with T = 3 icosahedral symmetry, although smaller virions with T = 1 icosahedral symmetry have been described [20]. In contrast, the P domain is more variable and includes a P1 and a P2 subdomain that are discontinuous in primary amino acid sequence. The P1 domain, which consists of one helix and eight sheets links, the S and P2 domains. The Role of Glycans in Norovirus Attachment Non-enveloped virus entry is a multi-step process starting with viral attachment to target cells, followed by receptor engagement, endocytosis, cell membrane penetration, and uncoating that culminates in the delivery of the viral genome into the cytoplasm [5] (Figure 1).

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Employeescanpursueatleast fourpolicystrategiestoeliminate secondhandsmokeexposureinthe workplace:(1)changestateorlocal laws;(2)enactstateoccupational healthandsafetyregulations; (3)changecollectivebargaining agreements;and(4)asktheemployer toadoptavoluntaryrule blood pressure what is high discount 12.5 mg hydrochlorothiazide. A large body of scientific research has shown immediate improvementsinindoorairqualityandworkerhealth when smokefree policies go into effect blood pressure chart 3 year old order hydrochlorothiazide discount, so long as the policies are zero-tolerance pulse pressure 81 purchase 25mg hydrochlorothiazide overnight delivery. Surgeon General and the scientific communityhavefoundthattherisksofsecondhand smoke are not eliminated by the common practices ofseparatingsmokersfromnonsmokersinthesame airspace or installing ventilation systems. At least four options for eliminating secondhand smoke in the workplace are available: passing state orlocallaws;enactingstateoccupationalhealthand safety agency regulations; enforcing or changing collective bargaining agreements; and asking the employertoadoptavoluntaryrule. State or Local Laws Despitemanyrecentsuccessesofadvocatesforclean indoorair,asofMarch2008,tenstateslackanytype oflawrestrictingsmokinginprivateworkplaces. Local governments, such as thoseatthemunicipalorcounty levels, also have the legal authority to pass smokefree workplace laws. Employees can push for local smokefree workplace ordinances so long as their state does not have 2 a law with a preemption clause forbidding local governments from adopting their own smokingrelatedlaws. Laws have broad and generalapplicability,andtheycanbedraftedtoprovide for a range of government and citizen enforcement alternatives. Oncealawisenacted,ittendstohavepermanence because it has survived legislative and executive consideration and because it benefits from principles ofinertia. Stateandlocalsmokefreeworkplacelaws have had a proven and profound effect on smoking rates, indoor air quality, public health, and attitudes towardtobaccouse. This approach has been less popular withadvocatesforcleanindoorairandhashadmixed results. Inthemid-1990s,stateoccupationalsafetyandhealth agencies inWashington and Maryland implemented workplace smoking regulations. Third,enactingstateadministrative regulations requires a series of procedures, such as publiccommentperiodsandhearings,thatcanleadto aprolongedandprotractedrulemakingprocess. Finally,regulations donothavethesamedurabilityaslawsbecause-as evidenced in Maryland-a state legislature has the powertopasslegislationweakeningtheregulations. The National Labor Relations Board has ruled that smokingpoliciesareaconditionofemploymentand mustbenegotiatedthroughthecollectivebargaining process. Becauseunions representbothsmokingandnonsmokingemployees, it is unclear whether union leaders would support smoking restrictions if employers negotiated with themregardingthetermsoftherules. Voluntary Employer Rules A final policy option involves the adoption of smokefreeworkplacerulesbyemployers. Employees can press employers to adopt smokefree workplace rulesforanumberofreasons. Additionally,thereareno governmentagenciestoholdemployersaccountable for enforcing policies that they adopt voluntarily. However, an employer may be creating a binding obligation by establishing a smokefree workplace policyandinformingemployeesofthispolicy. An employee could file a disability discrimination claim that an employer failed to provide a "reasonable accommodation"-in this instance, protection from exposure to secondhand smoke -iftheworkerhasadisabilitythatisexacerbated byexposuretosecondhandsmoke. An employee could file a claim that the employer failed to provide a safe workplace, based on a commonlawduty. Often,advocatestendtofocusonthepassage of clean indoor air laws, which offer a wider range ofprotectionthanlitigation. Thestatelaws arenotbasedonfault;aninjuredworkercanrecover benefits, including compensation for temporary or permanent loss of income and medical expenses, without proving that the employer was negligent. State and Federal Disability Laws Ifan employeeis considered"disabled"understate orfederaldisabilitylawsandexposuretosecondhand smokeexacerbatesthatdisability,theemployermay berequiredtomakea"reasonableaccommodation" toprotecttheemployeefromexposuretosecondhand smoke. Courts especially take note of whethertheemployeeeversoughtmedicalcare,left workduetothecondition,orcontinuedtoparticipate inactivitiesofdailyliving. Union Pacific Railroad Company,anemployeehadsufferedseveralasthma attacks requiring medical treatment while working inlocomotivecabsinwhichcoworkershadrecently smoked. Anindividual still may be substantially limited in a major life activity, notwithstanding the use of a mitigating measure like medicine, which may only lessen the symptomsofanimpairment. A reasonable accommodation includes "modifications or adjustments to the work environment. Fair Employment and Housing Commission, the employees demonstrated that because of respiratory disorders, exposure to tobacco smoke limited their abilitytobreathe.

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