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By: L. Jens, M.A., M.D., M.P.H.

Clinical Director, Albany Medical College

In a study of acute vaccine reactions in dogs utilizing a large database treatment 32 for bad breath cheap 500mg tranexamic with mastercard, vaccines containing leptospiral antigen were no more reactive than other vaccines for dogs medicine quinidine discount tranexamic. Consequently nioxin scalp treatment purchase tranexamic with a visa, annual vaccination with the four-serovar vaccine is recommended for at-risk dogs medicine 2015 lyrics buy tranexamic 500 mg, regardless of breed, with the understanding that the definition of at-risk may vary geographically. Annual vaccination for dogs that have recovered from leptospirosis should be considered because such dogs are at risk of ongoing exposure and lifelong immunity may not be provided after natural infection. In fact, in some cases no measurable titre is found after vaccination for some of the serovars in the vaccine. Titres immediately after vaccination can be quite high, in some cases up to 1:12,800. There is no cut off above which one can be confident that a titre is due to natural infection rather than vaccination. Typically, titres decline to <1:100 to 1:200 after about 16 weeks, although there are no detailed studies on the increase and decrease seen over time secondary to vaccination. It is not possible to make a rapid definitive diagnosis of clinical leptospirosis in a recently-vaccinated dog. However, evaluation of the convalescent titre should provide a diagnosis; a four-fold increase is expected in natural infection, whereas stable to decreased titres are expected in a vaccinated dog, depending on the timing of vaccination. Knowledge of the environments that support Leptospira organisms improves the chance of avoidance. Areas to avoid are damp areas in moderately warm climates, with access by wild animals. There is debate as to whether cats are also one of the animals carrying Leptospira organisms, with resultant shedding in the environment. Feline Leptospirosis Clinical feline leptospirosis is rare; there are sporadic reports in the literature. The rare reports that do exist have renal manifestations of disease, rather than hepatic. There are conflicting reports about the significance of the feline population in carrying the Leptospira organism and therefore potentially shedding it into the environment. Many studies have indicated that the importance of the feline population as asymptomatic carriers of the Leptospira organism is underestimated, while some studies have indicated a low proportion of carriers. Likely there is geographic variability in the proportion of cats shedding the bacteria. Treatment of cats proven to carry Leptospira is the same as for dogs; doxycycline, at a dosage of 5mg/kg orally q12hr for 14 days. As with dogs, care must be taken to ensure that the doxycycline pill is completely swallowed, as esophageal erosion can occur readily. As there is no vaccine licensed for cats, prevention is solely by reducing exposure to the wild animal population. There does seem to be an increase in clinical cases noted, but vaccination will help to reduce the number of cases. Testing for leptospirosis can be complex, however there are guidelines available to assist in selection of appropriate tests. Feline leptospirosis is rare, but the degree to which cats infect the environment is yet to been proven. Evaluation of clinical, laboratory, imaging findings and outcome in 99 dogs with leptospirosis. Evaluation of 3 Serological Tests for Early Detection Of Leptospira-specific Antibodies in Experimentally Infected Dogs. Evaluation of a rapid IgM detection test for diagnosis of acute leptospirosis in dogs. Adult parasites reside within the small intestine of definitive hosts, which are primarily wild canids. However, in some areas, domestic dogs, and to a lesser extent cats, may act as definitive hosts. Eggs shed in the feces of these species are morphologically indistinguishable from Taenia-type eggs and are immediately infective for intermediate hosts which include various species of wild rodents. Subsequent to ingestion, a hexacanth embryo is released from the egg, travels to the liver via the hepatic portal circulation and develops into the intermediate, metacestode, stage (Eckert and Deplazes 2004). This larval stage of the parasite is comprised of numerous small vesicles lined with a germinal epithelium from which multiple protoscolices may develop, undergoes exogenous budding, and behaves like an invasive tumour (Eckert and Deplazes 2004).

As Huntington wrote: on the one hand medicine werx purchase tranexamic without a prescription, civilian authorities grant a professional officer corps autonomy in the realm of military affairs treatment neuroleptic malignant syndrome discount 500 mg tranexamic amex. On the other treatment 10 500 mg tranexamic with visa, "a highly professional officer corps stands ready to carry out the wishes of any civilian group which secures legitimate authority within the state medicine 7 years nigeria discount 500 mg tranexamic with amex. Eliot Cohen calls this the "normal" theory of civil-military relations but points out that it has often been violated in practice. In other words is there something that might be called a "calculus of dissent" that military leaders can invoke in cases where they believe civilian decisions are dangerous to the health of the country These issues, addressed below, are part and parcel of what officers need to know about civil-military relations. What constitutes an acceptable level of military influence on the other spheres of society Does it go beyond what Samuel Huntington called in the Soldier and the State, his classic study of civilmilitary relations, the "management of violence The United States has answered this question differently at different times and under different circumstances. It permanently oriented itself toward large-scale conflicts against foreign enemies only in the 1930s. All of the other questions mean little if the military instrument is unable to ensure the survival of the state. Does effectiveness require a military culture distinct in some ways from the society it serves What impact does the pattern of civil military relations have on the effectiveness of strategic decision-making processes Obviously, questions regarding military service have been answered differently by Americans at different times under different circumstances. During wartime, the several states were responsible for raising soldiers for federal service, either as militia or volunteers. But even now the force continues to evolve, as debates over such issues as the role of the reserve components in the post-9/11 military force, women in combat, gays in the services, and the recruitment of religious minorities make clear. First, it is important to realize that civil-military tensions in the United States are not new; examples of civil-military tensions in the past include: Washington at Newburgh Federalists vs. Republicans regarding a Military Establishment Andrew Jackson and Spanish Florida Mexican War: Whigs and Democrats Civil War: Lincoln and McClellan Reconstruction: Johnson Urged to Use the Military to Suppress Congress Preparedness Movement Election of 1920: Leonard Wood 99 F P R I Second, the absence of a coup does not necessarily mean that civil-military relations are healthy. This pushback has manifested itself in "foot dragging," "slow rolling" and leaks to the press designed to undercut policy or individual policy-makers. Such actions were rampant during the Clinton presidency and during the tenure of Donald Rumsfeld as secretary of defense. Such pushback is based on the claim that civilians were making decisions without paying sufficient attention to the military point of view. Third, civilian control involves not only the Executive Branch but Congress as well. As the constitutional scholar Edwin Corwin, once famously observed, the Constitution is an "invitation to struggle for the privilege of directing American foreign policy" between Congress and the president. Those who neglect the congressional role in American civil-military relations are missing an important element. Doing so should not be treated as an "end run" undermining civilian control of the military. For instance, during the Civil War, Abraham Lincoln constantly prodded George McClellan to take the offensive in Virginia in 1862. George Marshall, the greatest soldierstatesman since Washington, opposed arms shipments to Great Britain in 1940 and argued for a cross-channel invasion before the United States was ready. Similarly, many observers, especially those in the uniformed military, have been inclined to blame the U.

Conning towers symptoms pneumonia 500 mg tranexamic for sale, guns symptoms pregnancy order tranexamic 500mg line, and other topside gear did not seriously hamper undersea performance at low speeds for short periods symptoms tonsillitis order tranexamic 500mg fast delivery. Attempts after the war to achieve greater submerged speeds showed that the long symptoms yellow eyes purchase tranexamic 500 mg with amex, narrow hull was unstable. Experiments by the Bureau of Ships at the David Taylor Model Basin resulted in a new design. The Albacore was an unarmed, experimental vessel driven by unusually powerful batteries. The Bureau of Ships used data from the Albacore trials in designing the last three conventional submarines for the fleet. Nomenclature By the fall of 1955 the Navy project had so many reactors in operation or under development that the nomenclature was becoming confusing. The number following the initial letter denoted the model of that type of plant by that designer, and the final letter designated the designer- "W" for Westinghouse, "G" for General Electric, "C" for Combustion Engineering, and "X" for unassigned projects. The form which this list of reactor plants took late in 1955 can be seen in table 4. Fi E 271 Propulsion for the Fleet the Development Task the proliferation of Navy requirements in 1955 placed new demands on Rickover and his staff in Code 1500. As in the past, Bettis and Knolls would actually design and develop the hardware, but it fell to Code 1500 to translate ship specifications into design criteria for the laboratories to follow. Through the project officers and technical groups Rickover would influence the organization of the laboratories, approve the appointment of key technical personnel, direct technical activities, and assess contractor performance. Nothing about the Nautilus experience had suggested to him that he should abandon his system of rigorous controls. The basic organization of Code 1500 and the laboratories was in terms of specific reactor projects, but there were many development activities of a general nature and of long-term significance that did not fall within the scope of a single project. While new types of propulsion plants were being designed and built, Rockwell, Mandil, Radkowsky, Marks, Grigg, Shaw, and others in the technical groups were struggling with basic problems in reactor physics, engineering, component and system design, and fabrication techniques. The whole range of fundamental studies undertaken in 1949 and described in chapter 5 continued as a permanent and vital part of the nuclear program. The results of long-term development were often hard to measure; but in some instances, such as the development of better fuel elements, the evidence was dramatic. Rickover and Code 1500 insisted that the laboratories continue devoting substantial effort to improving the design and performance of fuel elements. The development of better materials, such as new alloys of zirconium, improved mechanical design, and the use of burnable poisons all 272 Chapter Nine helped to improve corrosion resistance and increase core life. Savings were realized not only in lower fabricating costs but also in longer periods of operation between overhauls. Changing Direction at Knolls the new requirements for nuclear-powered submarines had little direct impact on the engineers and scientists employed by General Electric at the Knolls Atomic Power Laboratory. In the summer of 1955 Code 1500 was still struggling with the Knolls staff to bring the Mark A prototype (now called the S1G) into full operation at West Milton. Now more than two years behind the Mark I prototype (S1W), the sodium-cooled plant was not yet a fully reliable system. As explained in chapter 3, General Electric had established Knolls as a laboratory for general research in the nuclear sciences. Although Knolls had made some progress toward becoming an effective reactor engineering organization under the Navy project, Rickover and his staff were still largely dissatisfied with the Knolls operation. Rickover insisted that Knolls would never be able to build reliable reactors until the company accepted this kind of transformation. The slightest leak from the primary system containing sodium to the secondary steam system could lead to disaster. To reduce this possibility to a minimum, the engineers at Knolls had designed double-walled tubes for the steam gen- 273 Propulsion for the Fleet erators. A third fluid, mercury, was placed between the walls of the tubes to serve as a leak detector. The presence of any mercury in the sodium or steam in the mercury would indicate a leak in the steam generators.

The Skate symptoms 3 days past ovulation best purchase for tranexamic, built by Electric Boat and driven by the S3W submarine fleet reactor symptoms 1974 cheap tranexamic 500 mg amex, had voyaged beneath the Pole in August 1958 medications ending in pril purchase tranexamic 500 mg without prescription. Driven by two S4G reactors treatment jalapeno skin burn purchase tranexamic 500 mg fast delivery, the largest submarine ever built circumnavigated the globe, submerged, in 83 days and 10 hours. The hydrodynamic shape of the hull was modified in Polaris submarines to accommodate the missile tubes aft of the sail. The Ethan Allen was the lead ship in the second class of Polaris submarines, the first to be designed from the keel up for missile launching. The tremendous power of her eight-reactor propulsion system is dramatically demonstrated in this high-speed turn. Navy 36 376 Chapter Eleven establishment, however, who opposed the large-scale construction of nuclear surface ships. The question was not whether nuclear-powered ships were more effective but whether the extra cost in terms of construction and skilled personnel purchased commensurate military advantages. The interpretation of financial and performance data would spawn heated debates in the Department of Defense and in the Congress during the 1960s and 1970s. Rickover and others supported the latter thesis but they were not immediately successful. Nuclear power had revolutionized submarine warfare and had offered decisive advantages for surface ships. Less dramatic but probably more significant were the new standards of ship design and construction, of crew training and qualifications, of ship operation and safety which the adaptation of nuclear power brought to the Navy. Nuclear propulsion had demonstrated clear superiority over conventional systems in both submarines and surface ships. All future submarines and an increasing number of new surface ships would be nuclear-powered. Although Rickover and his staff were to continue their efforts to improve nuclear plants, later development would be less concerned with the problems of innovation and more with the scope and rapidity of adoption, matters which raised a series of questions outside the scope of this book. Although many issues involving its commercial use were yet to be resolved, these lay increasingly in legislative and regulatory fields and less in technological development. The years spanned by this book represent a period of rapidly accelerating technological development. In addition to nuclear propulsion, the postwar decade produced jet propulsion for aircraft, the transistor, the high-speed digital computer, man-made earth satellites, inertial guidance systems, longrange ballistic missiles, and thermonuclear weapons, to mention only a few of the developments with significant military applications. Yet for every project which was successful, dozens failed to reach their objectives even when the theory on which they were based was sound. Of those projects which were completed, many suffered from huge cost overruns and repeated schedule delays. Often the final product fell far short of the performance specifications required to make it useful. Against this background the achievements described in the preceding chapters are exceptional. As technology has become more sophisticated, innovation has required increasing numbers of specialists both in government and industry. It is not likely that any single technique or philosophy can be applied universally without considerable adaptation, but the Rickover experience does offer a promising approach. The Accomplishment In engineering development the most significant measure of accomplishment is the hardware produced. The difficulty of the undertaking and the amount of time and resources required are beside the point if the goal of the project is not achieved. In the Navy project Rickover and his associates clearly accomplished their initial task: to build land-based prototypes and operational submarines using two different types of propulsion systems. The Rickover team reached its goal on a self-imposed schedule which many experienced engineers considered impossible. Not only were the first two prototypes and ships constructed as planned; they also met or exceeded design specifications almost from startup. Even before they had completed the Nautilus and the Seawolf Rickover and his staff had begun to develop new types of nuclear propulsion plants for both surface ships and submarines. Once again the absence of start-up difficulties was virtually unprecedented outside the Navy project.

In addition medicine expiration dates order tranexamic 500mg, the presence of both the Main Park Road and the Old Ingraham Highway within this unit provides human access greater than in any other unit and may allow better opportunities to manage both prescribed fires and wildfires such that they would pose a reduced risk to the persistence of the sparrow subpopulation medicine 751 m buy tranexamic online. The unit consists of the prairies that flank both sides of the relatively narrow Taylor Slough symptoms you have worms 500 mg tranexamic overnight delivery. The area is bisected by Main Park Road in the southern portion of the unit symptoms pancreatitis buy tranexamic 500mg mastercard, but the remainder of the unit consists of contiguous marl prairies. At the time of discovery, sparrows were found to be widely distributed and abundant in this area (Werner 1975, p. Since 1981, the sparrow subpopulation at this site has declined and has ranged from zero to 144 sparrows between 1995 and the present (Pimm et al. When sparrows were abundant in the area, the area was in a relatively dry condition, and water levels only rose above ground level for limited periods. In these overdrained areas, frequent fires impacted the habitat and resulted in reduced sparrow numbers (Pimm et al. This area provides a contiguous expanse of habitat that is largely separated from other nearby subpopulations in an area that is uniquely influenced by hydrologic characteristics. Sparrows were reported to reoccupy burned sites in this region within 1 to 2 years following fire (Werner and Woolfenden 1983, p. Portions of the area are also overdrained, resulting in the possibility of high fire frequency. The location of this unit relative to other sparrow subpopulations is significant in that it occurs in the center of the five sparrow subpopulations that occur east of Shark River Slough in the vicinity of Taylor Slough (subpopulations B through F). When sparrows were first recorded in the area during 1974 to 1975 surveys, they were abundant and widespread (Werner 1975, pp. The area is the largest contiguous patch of marl prairie east of Shark River Slough. It is currently occupied, and has consistently supported the largest sparrow subpopulation since 1992 (Pimm et al. The natural characteristics of this area make it relatively immune to risk of flooding or frequent fires (Walters et al. Its location south of the high-elevation pine rocklands provides it a degree of protection from high water levels that do not occur within any other units. Within the southern portion of the greater Everglades watershed, water flows from north to south, with most water moving through Shark River Slough, and to a lesser extent through Taylor Slough. The pinelands block the southward flow of water across this area such that the primary influences on water levels are rainfall and overflow from the flanking sloughs. In addition, portions of the area occur on relatively high elevations and remain relatively dry. Consequently, this area is not easily flooded as a result of managed water releases or upstream events, and the high water levels that may occur within other sparrow subpopulations are dampened by its relative position and topographic characteristics. It is not overdrained as a result of local hydrologic management actions, and the fire frequency is primarily influenced by natural ignition and managed prescribed fire. Unit 3-Subpopulation D Unit 3-subpopulation D consists of 10,700 ac (4,330 ha) of marl prairie vegetation in an area that lies on the eastern side of the lower portion of Taylor Slough. The area is bordered on the south by the longhydroperiod Eleocharis vegetation and mangroves that flank Florida Bay, on the west by the sawgrass marshes and deepwater vegetation of Taylor Slough, on the east by long-hydroperiod Eleocharis vegetation and overdrained areas with shrub encroachment in the vicinity of U. Highway 1, and on the north by agricultural lands and development in the vicinity of Homestead and Florida City. This is the easternmost area where sparrows occur and is the only subpopulation that occurs on the eastern side of Taylor Slough. These discontinuities in the landscape would tend to prevent fires from spreading from the area which supports sparrow subpopulations B, C, E, and F into the subpopulation D area. Similarly, hydrologic conditions in this region are different than those that affect the other subpopulations because water levels would are attenuated by Taylor Slough and influenced by flood protection and water supply infrastructure in the urban/agricultural areas to the north. Loss of suitable habitat and the sparrow subpopulation within this area would result in a reduction in the geographic range of the sparrow. The 1981 comprehensive survey of potential sparrow habitat estimated 400 sparrows within this region (Pimm et al.

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