By C. Pakwan. Blue Mountain College. 2019.

The use of the spray pistol required frequent activation with simultaneous exertion of the right hand 100 mg januvia, and the right wrist was exposed to very awkward working postures in the coating of the roof surfaces 100mg januvia. The injured person developed a right-hand carpal tunnel syndrome after work as a roof coater for 2 januvia 100 mg. The work was very stressful for the right wrist januvia 100mg, with repeated work movements many times per minute , which required a great deal of exertion of his right hand . The work was furthermore performed in working postures that were very awkward for the wrist . Example 8: Recognition of carpal tunnel syndrome (fitter for 3 years) The injured person worked for well over 3 years as a fitter in a business manufacturing lamps and ceiling fittings . For about three fourths of the working day she was shaping fittings at a bending machine . One fourth of the working day she was hand-assembling reflectors for ceiling fittings , assembling the units with a rivet pistol. She was able to assemble 100-300 fittings per day, leading to many repeated work movements per minute. The work with the rivet pistol required some exertion of her right hand and involved frequent twisting, turning and flexion movements of the wrist. In connection with the bending work she took a pile of aluminium plates of varying sizes to a work table, where she held each of the units into a bending machine activated with a foot pedal. This meant that she had to reach out and lift at a maximum reaching distance with twisting of the wrist, but with limited exertion. Her production amounted to 300 units per hour, and each unit was handled several times. After 3 years work she developed symptoms in her right forearm, and a medical specialist made the diagnosis of right-hand carpal tunnel syndrome. The injured person had wrist-loading fitting work for 3 years and then developed a right-hand carpal tunnel syndrome. The work was characterised by many repeated work movements with the right hand and simultaneous exertion in awkward, wrist- loading working postures. Example 9: Recognition of carpal tunnel syndrome (cleaner for 6 years) 169 The injured person worked as a cleaner in the morning in a big super market, 30 hours a week. The 2 work mainly consisted in cleaning a big, 3,000 m linoleum floor, using a wash pump machine run by batteries. When moving forward the machine she had to push the handles down, and when moving it backwards she had to push them up. Floor washing in narrow corridors involved repeated turns of the machine and twisting of the wrists. The operation of machine furthermore required the application of a great deal of hand force. After well over 6 years work she developed severe pain and sensory disturbances of her right hand and wrist as well as moderate pain of her left wrist. The claim qualifies for recognition on the basis of the list as far the right-sided carpal tunnel syndrome is concerned. The pain of the left wrist is not covered by the recognition as there is no documentation of the disease carpal tunnel syndrome in the left wrist. The injured person had wrist-loading work as a cleaner for 6 years, operating a big and heavy floor washer. In connection with cleaning offices he had to clean office premises of more than 1,000 2 m every day, mopping floors 70 per cent of the time or about 5-6 hours per day. He did wet mopping for 2-3 hours and subsequent wiping of wet floors with dry mops. Both types of mopping included slightly to moderately strenuous, monotonous and very quickly repeated movements with mopping in 8-patterns up to about 60 times per minute, in combination with turning and bending movements of the wrists. The work of wiping and vacuum cleaning for less than 30 per cent of the working time was not described a particularly strenuous or repetitive. The cleaning mainly consisted in using a high-pressure hose up to 4-5 hours a days, including quickly repeated movements of the wrists in combination with powerful and awkward movements of the wrists. To this should be added many heavy lifts and much pushing when handling garbage and machines in connection with tidying up. Towards the end of his employment in the slaughterhouse he developed symptoms of carpal tunnel syndrome and was operated in both wrists. The cleaner was diagnosed with bilateral carpal tunnel syndrome, for which he has had an operation. He had been a cleaner for many years, more than 3-4 hours per day performing quickly repeated and awkward movements of the wrists by mopping. The wet as well as the dry mopping (wiping off the wet floor) involved much application of wrist force. Towards the end of the period he had cleaning work in a slaughterhouse, which likewise involved quickly repeated, strenuous and awkward movements for both wrists in connection with high- pressure hosing and heavy tidying up for many hours a day. Example 11: Recognition of carpal tunnel syndrome (violinist for 4 years) A woman worked full time as a professional violinist in a large symphony orchestra. The work involved many hours of daily practice as well as frequent concert performances and recordings in a 170 studio. When playing she held the violin in her left hand, whereas the right hand was taking the violin bow back and forth at a quick pace in awkward postures, with constant twisting and turning movements of the right wrist. After well over 4 years work she developed pain and sensory disturbances of her right wrist. The injured person developed a right-sided carpal tunnel syndrome after very wrist-loading work as a violinist for several years. Her work had the effect that her right wrist was exposed to very quickly repeated movements in awkward wrist-loading working postures for a great part of the working day. There is furthermore good time correlation between the work and the development of the disease. Example 12: Recognition of carpal tunnel syndrome (fisherman for 7 years) A man worked as a fisherman for well over 7 years. One third of the time he set out the nets, and two thirds of the time he pulled in nets and emptied them. When emptying the nets, he pulled out the fishes with both hands with strenuous gripping movements, holding the net as well as the fishes. He was holding the fish with his right hand and at the same time, with a strenuous gripping and cutting movement of his left hand, cut into the fish and removed its intestinal system. The work involved in setting nets and pulling them up again also led to strenuous gripping loads for both wrists. Towards the end of the period he developed pain of both wrists and forearms and a neuro- physiological examination established bilateral carpal tunnel syndrome. For several years the fisherman had repetitive and strenuous, wrist-loading work with typically awkward posture for both wrists in connection with setting nets and pulling them in, and handling fishes and cleaning them. There is good correlation between the work and the development of bilateral carpal tunnel syndrome. Example 13: Recognition of carpal tunnel syndrome (carpenter/roofer for 12 years) A 44-year-old carpenter for a 12-year period installed Decra roofs. For the major part of the day, the work consisted in holding tight laths or roof tiles with a powerful, left-hand grip while shooting nails from a nail gun with his right hand. It appeared that the work involved continuous blows to the palm of the left hand when he was using the nail gun. After a number of years he developed a tingling sensation in the fingers of his left hand and was diagnosed in the end with carpal tunnel syndrome. The left-side carpal tunnel syndrome qualifies for recognition on the basis of the list. The carpenter for many years performed work that was stressful for his left wrist/forearm in connection with holding onto laths and roof tiles with strenuous gripping movements which were awkward for the wrist. To this should be added that using the nail gun also led to continuous, powerful blows to the left hand. Example 14: Recognition of bilateral carpal tunnel syndrome (baker for 9 years) A 27-year-old man worked as a baker for 9 years. The work consisted in preparing dough (45 per cent of the time), scraping dough (10 per cent), flattening dough (40 per cent) and various other tasks (5 per cent). After about 5 years he was beginning to develop pain of both wrists and a tendency to tingling in his fingers after long working days. The bilateral carpal tunnel syndrome qualifies for recognition on the basis of the list. The baker for a great part of the working day and for many years performed quick, powerful and awkward movements of both wrists when handling large quantities of dough, in particular in connection with kneading, flattening and scraping. Example 15: Claim turned down carpal tunnel syndrome (packer for years) The injured person worked in a large meat manufacturing business, packing frozen burgers for 8-9 months. She stacked the burgers, seven at a time, and put them in a cylindrical bag at chest height. The packed burger bag was then lifted onto a packing belt at the same height and closed by a colleague. The work was quick, and she packed up to 1,500 bags per day with frequent handlings each minute. After well over years work she developed a right-hand carpal tunnel syndrome and had a successful operation. The injured person developed a right- hand carpal tunnel syndrome after 8-9 months work as a packer, the work being quick and characterised by frequent handlings of burgers every minute. Even though she performed wrist-loading, very quickly repeated work in moderately awkward working postures, the claim does not meet the list requirements with regard to the duration of the exposure. To recognise the claim there must have been an exposure for at least 2 years, but the packer only performed wrist-loading work for about 9 months. Example 16: Claim turned down carpal tunnel syndrome (packer for 7 years) The injured person worked in a nappy factory for well over 7 years. She took about 20 nappies from a belt, turned them 90 degrees and put them down in a packing machine and pushed a button. The work was performed at a good working height and with very limited turning of the wrists. After 6-7 years work she developed symptoms of a right-hand carpal tunnel syndrome, diagnosed by a medical specialist. The injured person developed a right- hand carpal tunnel syndrome after well over 7 years work packing nappies. The work involved a limited number of repeated work movements per minute (4-5 movements) and was not characterised by considerable strenuousness and/or awkward working postures. Therefore, the requirement that at least two of the load factors of quickly repeated work movements, strenuousness and awkward working postures should be present was not met. Example 17: Claim turned down carpal tunnel syndrome (social and healthcare helper for 4 years) The injured person worked as a social and healthcare helper in a nursing home for well over 4 years. The work consisted in offering help in connection with personal care, getting dressed, and visits to the bathroom, as well as serving food and administering medicine for typically four residents. After 4 years work she had pain in her left wrist and a medical specialist made the diagnosis of left-hand carpal tunnel syndrome. The injured persons work with personal care in a nursing home for well over 4 years did not involve quickly repeated, strenuous and/or awkward work movements that strained the left wrist several times per minute. Therefore the claim does not meet the requirements for recognition set out in the list of occupational diseases. It furthermore appeared from the medical information that she suffered from a metabolic disease, in the form of myxedema, for which she was receiving treatment. The competitive disease, causing accumulation of fluid, constituted a considerable risk of developing carpal tunnel syndrome. Her symptoms set on a little less than 1 year after she began as a cleaner in the town hall. The cleaner was diagnosed with bilateral carpal tunnel syndrome after a little less than 1 years cleaning work. The basic principle for recognising carpal tunnel syndrome is 2 years of preceding relevant stress. This requirement may be reduced to 1 year if there have been substantial exposures. To this should be added that there is a substantially competitive disease in the form of myxedema, which causes some disposition for developing carpal tunnel syndrome due to accumulation of fluid in the wrists. The case has furthermore been submitted to the Occupational Diseases Committee for an assessment not based on the list. The Committee did not find, however, that the disease was only or predominantly work-related. The Committee took into consideration that there was no description of any extraordinary stresses that might increase the risk of developing carpal tunnel syndrome and that besides there was a competitive disease which in itself was able to cause carpal tunnel syndrome. His work mainly consisted in fitting heavy metal bands on big metal plates with metal nuts. During the fitting he used a big monkey wrench, which involved a nearly constant pressure against the median nerve for a great part of the working day. After almost 2 years work he developed pain in his forearm and hand, and a medical specialist made the diagnosis of right-hand carpal tunnel syndrome. The injured person has a right-hand carpal tunnel syndrome as a consequence of his work as a fitter. For almost 2 years he was exposed to a nearly constant pressure from a big wrench against the median nerve in the carpal tunnel. The work consisted in the manufacture of elements for grid constructions and, to a lesser extent, fitting/welding. The pipes were placed in a rack, and then he lifted one pipe at a time and milled both ends.

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Yet januvia 100 mg, especially when dealing with an endangered species 100mg januvia, adequate scientifc documentation of the project implementation including individual veterinary records is crucial januvia 100mg. Every single individual 100 mg januvia, alive or dead , is a truly valuable source of information , for the present and for the future . Thus , even if disease risk assessment reveals that there are no diseases of concern in the frame of the translocation project , emphasis should still be placed on extensive sampling and information collection . On the one hand, all procedures, results from physical exams, complementary diagnostic tests and laboratory analysis need to be recorded in detail. Data on pathogens that are apparently not infuencing the health status of the animals should, as far as possible, also be collected in order to learn about the species and about the pathogens. On the other hand, biological samples should be stored for eventual retrospective studies. For example, an apparently emerging pathogen that was not considered at the time of translocation might be detected in the release area several years after translocation. If appropriate samples of the translocated animals have been stored, it will be possible to use them for a retrospective analysis in order to determine whether the translocated animals were already infected with this apparently new pathogen at the time of translocation. Decisions whether or not to proceed with wild animal translocations may be determined by the results of health risk analysis, but they also may be infuenced by a variety of other factors such as political and/or conservation issues. Health risk analysis informs decision makers regarding potential health risks and provides them with options to reduce risk if it is decided to proceed with the translocation (Leighton, 2002). For example, in case of a highly endangered species, it might be very diffcult to capture animals for translocation that are free of any pathogen that could represent a risk for another, widely distributed species in the destination environment. If this risk appears to be rather low, the conservation goals of animal translocation might be of higher priority than the avoidance of introducing pathogens into the destination environment. Furthermore, it is fundamental to differentiate between optimal and minimal or essential requirements. It is always interesting to perform testing for numerous infectious agents in all animals. However, it is necessary to establish clear criteria to decide which are the minimum standards to render an individual acceptable for translocation. The selected key agents should have frst priority, and the tests should be done as soon as possible. Overall, veterinary planning must take into account a number of points, which are summarized in Table 1. A comprehensive checklist for health risk analysis and protocol development is provided by the Offce International des Epizooties and the canadian cooperative Wildlife Health centre (Anonymous). Dental problems, such as fractured teeth with pulp exposure, are common problems in captive non-domestic cats and severe cases could be life-threatening due to a potentially secondary systemic disease (Roelke et al. Once in quarantine, newly arrived individuals might refuse to eat as a result of the stress caused by the changes in their environment (Roelke et al. Freshly killed, whole animals with the abdominal cavity opened can provide an effective feeding stimulus to some cats (Blomqvist et al. Although a minimal duration of 30 days is generally recommended for the quarantine of non domestic cats (Blomqvist et al. There are thorough overviews of common pathogens to be included in the health screening protocols of non domestic cats, and recommended vaccinations and anti-parasitic treatments (Blomqvist et al. Further general information on diseases of non-domestic felids is reported by Terio et al. Recommendations for the design of transport boxes for wild cats are presented in Blomqvist et al. A crated felid should be left in quiet, dimly lit surroundings and the attention of curious bystanders kept to a minimum (Blomqvist et al. Losses of single individuals in small populations can have a signifcant impact on future population characteristics. Furthermore, even if epidemics are considered improbable, they still can play an important role in the long-term viability of a population (Ballou, 1993). Valuable information can be gained from blood samples, faecal samples, and post-mortem material (Blomqvist et al. In order to learn from experiences and to allow for a long-term approach to conservation, documentation is essential (Breitenmoser et al. Hence, all recorded data should be maintained in a database and presented in written reports, ideally in form of internationally available publications. Information such as anaesthesia protocols that are considered safe and effcient, reference data for the species (e. International Zoo Yearbook protocols for wildlife prior to translocation and release 41, 24-37. Rationale for surveillance and prevention of infectious and parasitic disease transmission among free-ranging and captive Florida panthers (Felis concolor coryi). A la hora de manejar este tipo de programas, se debe tener en cuenta que la supervivencia fnal de la poblacin que tratamos de conservar se ve ltimamente infuenciada por cmo la sociedad en general percibe y prioriza el problema de su conservacin y por cmo nos organizamos los profesionales de la conservacin para evitar la extincin de una especie. Resulta crucial tener una visin lo ms completa posible de este contexto social para gestionarlo efcientemente, evitando bloqueos interinstitucionales y confictos destructivos. Aunque el conficto tiende a ser visto como un proceso negativo, si se maneja adecuadamente, puede convertirse en una fuerza creativa de mejora constante de un programa. Para lograr esto, se propone: 1) incentivar el desarrollo de relaciones colaborativas frente a otras ms competitivas entre proyectos e instituciones; 2) incluir a profesionales en gestin de confictos dentro de los programas de conservacin, y 3) fomentar el amplio reparto de recursos no distributivos. Igualmente, se destaca la importancia que los aspectos organizativos pueden tener sobre la recuperacin de una especie amenazada. En este sentido, se propone: 1) desarrollar procesos de planifcacin colaborativa; 2) incentivar la creacin de equipos de trabajo efectivos adecuadamente liderados y con capacidad de trabajo sobre el terreno; 3) evitar que las estructuras de control institucional detengan el desempeo de acciones concretas y necesarias sobre el terreno, y 4) identifcar y minimizar procesos de desplazamiento de objetivos. Finalmente, se hace una llamada a la mltiple y frecuente evaluacin de los programas de recuperacin de especies amenazadas para asegurar su mejora constante y sistemtica. When managing a recovery programme, we need to be aware that the fnal survival of any population of concern will be ultimately determined by how society perceives and prioritises its conservation, and by how professional conservationists organize themselves to avoid its extinction. Any conservation programme of public relevance involves a complex arrangement of stakeholders with distinct identities, perspectives, demands and resources. It is key to achieve a clear picture of this social context in order to manage it effectively, and to avoid inter-institutional gridlocks and destructive confict. Even though confict tends to be perceived as a negative process, when properly managed it can become a creative force, encouraging programme improvement. To achieve this, I propose to: 1) include professionals with experience in confict management within conservation programmes; 2) promote the establishment of collaborative instead of competitive relationships between projects; and 3) encourage the open exchange of non-distributive values. In this regard, I propose to: 1) develop collaborative planning processes; 2) establish on the ground teams with effective leadership and strong capabilities; 3) avoid institutional arrangements focused on process control, which end up hindering actual implementation of necessary actions, and 4) identify and defuse goal displacement processes. There is a fnal call for multiple and regular evaluation of recovery programmes to promote constant and systematic improvement. This has been said in enough places and occasions to astonish any seasoned conservationist. What is most surprising is the wide gap that still remains between accepting the previous proposition and really bringing it into our daily practice. We repeat this and similar phrases, nodding sympathetically when someone proclaims these kind of statements in each 503503 congress or professional meeting and, afterwards, it seems like we almost forget about it. It sounds like a concept that it is always nice to say, but we M dont really need to turn it into actual actions. One might even fnd a certain contradiction in the title of this book, which calls for an interdisciplinary approach to ex situ conservation and then invests most of its space discussing biological aspects focused on husbandry, genetic management, veterinary aspects and reproductive physiology. Does the width and detail of subjects included in the book adequately represent the challenges that will determine the fnal success or any recovery programme? I believe that the answer to this question does not lie in a deliberate effort to ignore pressing and uncomfortable non biological issues, but in our professional training. Through several years of reading books, attending meetings and workshops, we have been taught in a very indirect subtle way, never explicitly that conservation is mostly a biological challenge. When a certain group of subjects are repeatedly taught, discussed and written, they become the only subjects that exist. Such process is best described through what the economist and political scientist Herbet Simon (1983) called bounded rationality: the ability of the human mind to perceive and comprehend our environment through certain flters and approaches that allow us to selectively reject and ignore facts and views that are alien to our personality and education. Thus, it looks like we, conservationists, refuse to explicitly and systematically incorporate most social issues in our professional algorithms. This rejection is carried on even if we hear and read about the importance of such issues or while we might be actually dealing with them most of our time. I think of my present professional situation: I must coordinate two ex situ conservation programmes for locally endangered mammals in Argentina: one for the giant anteater and the other for the pampas deer. Very seldom do I carry out some deer census on the feld or supervise the capture, handling and transport of anteaters; these being the few clearly biological moments of my work. It is clear to me that my biological-scientifc training has been and still is extremely useful to guide my decisions and to help me convince other stakeholders. But it is also true that most of the time I see myself navigating through and trying to manage problems that are essentially non biological and will eventually determine if we achieve our conservation goals. And I do not see myself as an exception among professionals managing ex situ conservation programmes. As an example, the captive Breeding Programme for the Iberian lynx was blocked for years by interpersonal and interinstitutional confict. As a result of such confict, a measurable biological result was obtained: no Iberian lynx were born in captivity. Only when this history of destructive confict was properly managed through the establishment of a consensus policy and a widely respected captive breeding team, we started witnessing the history of biological success so well described in this book. The lesson is simple: social and political problems can be behind the fnal failure or, at least, signifcant delay of many recovery programmes. Hence, my purpose with this chapter is to join my voice to many others (clark et al. To do so, Ill present some themes and recommendations that might guide professionals involved in these programmes. Whenever possible, and in order to ft the chapter within the spirit of this book, I will use examples from the Iberian lynx conservation process, of which I have been an external but passionate witness for more than 10 years. To specialists with a background in natural sciences who are involved in ex situ/in situ conservation programmes: be aware of your conceptual and academic biases your bounded rationality and be sensitive to the need for calling social scientists and professionals to bring their knowledge and expertise into the conservation challenge. To conservation professionals involved in actual management of ex situ and in situ populations: open your mind to a wide transdisciplinary understanding of the challenge at hand and try to set up interdisciplinary teams that can comprehend and handle it in its myriad of biological and social aspects. At the end, success will depend of the fnal balance between reproduction and mortality. These two processes are directly infuenced by the species own biology and some proximate biological threats affecting it, both in a potential reintroduction site as well as in captivity. There are social factors that affect and are also affected by the previous biological issues and wield an enormous effect on the recovery or extinction of an endangered species or population. On the other hand, the arrangement and interplay of stakeholders who are interested, affected or opposed to the conservation programme can affect its overall economical, political or legal support. As a result of this, the whole programme can fourish within its social context, get gridlocked in the middle of rampant confict or dwindle from general public indifference. Fa c t o r e s q u e a F ec ta n a la recuperacin d e u n a p o b l a c i n en p r o g r a m a s d e c o n s e r v a c i n ex s i t u e in s i t u. These interactions can be expressed in psychological, scientifc, economic, communicational or organizational terms. It is no small paradox that some of the worst and most destructive conficts blocking and threatening conservation programmes happen amongst conservationists; the previous example about the Iberian Lynx captive Breeding Programme being a good example of this point. As an example of social complexity surrounding a recovery programme we could check the stakeholders involved in the Iberian lynx reintroduction programme lead by the Andalusian Environmental Agency (Simn et al. This institution holds the legal mandate and authority to conserve lynxes within its territory, and it can muster signifcant technical, fnancial and political resources to this task. The European Union stands out as an essential funding agency of such programme, which bestows a signifcant power to infuence, if not veto, the whole process. There are also two other agencies or ministries of the Andalusian government Public Infrastructures and Agriculture with less legal authority on the species conservation and, arguably, less interest on it, but much more clout over the general political process for the whole region. Other groups should be added to this list: the Spanish central Government, represented by the Ministry of Rural, Marine and natural Environment, is funding some components of the Programme and the neighboring government of Extremadura is an offcial partner of the Programme. Meanwhile, the government of Portugal and other regional governments in Spain have expressed their interest to gain access to the Andalusian lynxes to start their own ex situ programmes (Sarmento et al. Each of these institutions and the many individual actors working for and within them bring into the overall conservation process a complex set of beliefs, demands, expectations, attitudes and approaches; many of which point towards interpersonal or interinstitutional confict. Within this framework, it becomes especially relevant to analyze the social context surrounding an ex situ/in situ conservation programme. This implies identifying and understanding individuals and institutions whose very distinct interests are involved or affected by such programmes, and who can mobilize resources in order to arrive to results that favor those interests. The key issue is that these values are not equally shared and sought by each person and institution. Even though we often assume that we all look for the same things, this is not usually the case. For example, in the Iberian lynx reintroduction programme some institutions typically treasure and deploy power (i. Even within these general groups there are interpersonal struggles, alliances and conficts directed to trade and obtain any of the eight basic values. The startling fact is that many destructive conficts are caused by people and institutions that claim the conservation of species as their main goal. Once we start seeing who gets or wants to get what from whom, we will be able to understand these conficts and manage the social play of conservation in a much more effcient way. Achieving this does not require as much of a scientifc-quantitative analysis of social process but a systematic and alert predisposition to study and understand human behavior. Any open-minded conservation professional armed with enough curiosity and patience should be able to achieve this. Thus, confict occurs when two or more players disagree over the distribution of material or symbolic values all of them related to the eight basic values described above, and start acting based on these perceived incompatibilities. Hence, convergence of multiple individuals and stakeholder groups with unique expectations, demands and identifcations make confict an inevitable ingredient of any conservation process receiving signifcant public attention. The key issue is that, depending on how we manage any public confict, it can either promote or harm actual conservation.

Tell them to bring this log book or wallet card with them when they go to any doctor januvia 100mg. This is very important because sometimes people want to stop taking their medicines when they think they have gotten better januvia 100 mg, but that can have very bad health effects 100 mg januvia. Just because the blood pressure is controlled while the person is on medication does not mean that they are cured and can stop these drugs control of the problem tells you only that the medications are working 100mg januvia. So , tell them that they need to keep taking the medicines so that they can remain well . If they still want to stop taking the medicines or have any questions about them , urge them to call their doctor to talk about their concerns . Let them pick the cast members they would like to be , and let the group perform (read) the fotonovela together . If anyone in the group cant read give them another role; maybe they can ask questions to clarify anything they heard. Being active (engaging in moderate to vigorous activity) for at least 150 minutes a week. The client is told that he or she will feel some pressure on the arm that will be used. Usually, people take medicine for many yearsoften the rest of their livesto control their high blood pressure. Eat more fruits and vegetables, whole-grain breads and cereals, and low-fat dairy products. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Get the Facts: Sources of Sodium in Your Diet Activity 7-3 All across the United States, high sodium intake is a major problem. On average, American adults eat more than 3,300 milligrams (mg) of sodium a day, more than double the recommended limit for most adults. The Dietary Guidelines for Americans, 2010 recommend that Americans aged 2 and up reduce sodium intake to less than 2,300 mg per day. People 51 and older and those of any age who are African Americans or who have high blood pressure, diabetes, or chronic kidney disease about half the U. Having accurate information about where dietary salt comes from can help Americans stick to the recommendations. First number (systolic pressure): ________________ Second number (diastolic pressure): ________________ What should your goal numbers be? First number: ________________ Second number: ________________ National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Other Questions to Ask Your Doctor Can someone show me how to check my blood pressure with my own blood pressure monitor? Should I take just one reading, or should I take three readings and then average them? My Blood Pressure Wallet Card Activity 7-5 It is important to know your blood pressure numbers. Be sure to ask what your blood pressure numbers are each time someone takes your blood pressure. You may want to give copies of the card to others in the community, and if you like you can order more copies of the card (please see Appendix A). One of the most important parts of taking a blood pressure is helping the patient to feel comfortable and relaxed beforehand. Sit and talk with the person for a few minutes and help them relax before you put on the blood pressure cuff. There should be an armrest or table on which they can rest their arm when it comes time to take their blood pressure. Blood pressure measurements will be more accurate if you place the cuff directly on the patients skin. If their shirt or blouse is tight, the person may have to take their arm out of the sleeve. If their clothing is very loose, they can roll it up until the upper arm is exposed. When the upper arm is free of clothing, rest the persons arm on a table or other stable surface with the palm facing upward. The whole arm should be relaxed, and the upper arm should be about at the same level as the persons heart as shown in the picture. Arm at Correct Position Before putting the cuff on the patients arm, make sure that all the air is out of the cuff. Turn the screw valve counterclockwise, and then squeeze the cuff tightly to force out any air. Once you are sure that all the air is out, turn the screw valve clockwise until it is snugly in place. You need to pick the right size for the person whose blood pressure you are measuring. Using a cuff that does not ft right will not give the correct measurement of their blood pressure. The cuffs have a bulb at one end of the tube that you will squeeze to infate the cuff. Different-sized Blood Pressure Cuffs Most cuffs will have an arrow or index mark near the end of the cuff (viewed lengthwise) on the surface that is facing you as you wrap the cuff around the persons upper arm. Toward the other end of the cuff (again viewed lengthwise), on the surface facing the patients skin, there will be another set of markings, called the range. If the cuff is the right size, the index mark should lie within the range markings after you wrap the cuff snugly around the patients upper arm. On the other hand, the cuff is too small if the index line and range marks never get close enough to overlap. Once you have the correct cuff size, go to the next step, which is applying the cuff to the patients arm. Double-check to see that the persons arm is relaxed and slightly bent, resting on a frm surface with the palm facing upward. Double-Check for Proper Fit Wrap the blood pressure cuff snugly around the persons bare upper arm. As you wrap the cuff around the patients arm, make sure that the center of the cuff will fall on the midline of that arm. The middle of the cuff is usually marked with an arrow or marking along the lower edge of the cuff. When the cuff is centered correctly, this marking should lie in the midline of the arm directly above the crease of the persons elbow. In the picture, you can see that the bottom edge of the cuff is an inch or so above the crease of the elbow. As you bring the ends over each other, overlap them smoothly so that there are no gaps or large wrinkles in the cuff, and press gently so that the Velcro that lines the inside of the cuff sticks (stays in place). The cuff should be snug enough that it stays in place and does not slide down the arm. Place your stethoscope where you will be able to hear the sounds of blood fowing Before placing your stethoscope, you need to fnd the right location. The fow of blood (the pulse) in the brachial artery, which is the main artery of the arm, will show you the right location. The easiest way to feel the pulse is to place your index and middle fngers (the index fnger is located right next to your thumb) of one hand in the crease of a relaxed elbow. As blood is pumped by the heart the arteries expand and then contract (shrinks) in the arteries. The result is a pulse that can be felt with fngers at different points throughout the body and heard through a listening Find the Flow of the Brachial Artery device called a stethoscope. Feel for a pulsating (throbbing) pressure under your fngers, about one pulse each second. You may have to try a few different spots because every persons body is different, but the right spot is usually near the middle of the crease of the elbow. Place the fat side of the end of the stethoscope on the same spot where you felt the pulse. The end of the stethoscope should be directly on the patients skin and below the lower edge of the cuff. Continue holding the head of the stethoscope in place so that it stays in contact with the skin. It is best to do this with your non-dominant hand (your left hand if you are right- handed) so that you can operate the pump with your dominant hand. Use your thumb and index fnger to twist the screw valve in a clockwise manner until the valve is tight. While doing this, watch the dial to keep track of how much pressure is in the cuff. When you infate the cuff, you are temporarily stopping blood fow in the brachial artery, the main artery of the arm. This is necessary to let you take a blood pressure, but take care not to leave the cuff fully infated for more than 1520 seconds before defating it. Use your thumb and index fnger (the fnger next to the thumb) to twist the screw slightly to the left (counterclockwise) so that a little air can escape. The proper rate of defation is 23 mmHg (millimeters of mercury) per second (equals one line on the dial every second). As the air is escaping, listen to the sounds coming through the stethoscope while you watch the dial. If you hear thumping sounds right away, quickly turn the screw to the right and immediately pump the cuff up to a higher pressure, perhaps 220, before letting air out again. You will then hear a thump, which will be followed by several other similar thumping sounds. The number on the dial when you heard the frst thump is your patients systolic blood pressure. Write down the two blood pressure numbers right away, writing the systolic (frst) number above the line and the diastolic (second) number below the line. Normal, healthy blood pressures are 120 mmHg or less for systolic and 80 mmHg or less for diastolic pressure. If a patients systolic pressure is 135 mmHg or more and/or they have a diastolic of 85 mmHg or more, they should make an appointment with their doctor to talk about their blood pressure and get a checkup. If a patients systolic pressure is 160 mmHg or higher and/or the diastolic pressure is 100 mmHg or higher, she or he needs to call a doctor right away. Remind people that most of them will be using an automatic blood pressure monitor they are now cheaper than the manual type and less prone to error by users. Measuring Blood Pressure with an Automatic Monitor Activity 7-7 Automatic Blood Pressure Monitor 1. Also make sure that they are seated with their back straight, legs uncrossed, and feet fat on the foor. Because the cuff should be directly on the persons skin, the person whose blood pressure is being taken should remove clothing from their upper arm. The person will have to take off any clothes that are too tight to be pushed up the arm. Remember to rest the persons arm on a table or other stable surface with the palm facing upward. The whole arm should be relaxed, and the upper arm should be at the same level as their heart. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention 3. As you wrap it around the arm, before you fasten the Velcro straps, make sure to leave 1 inch of space between the bottom edge of the cuff and the crease of the elbow. Figuring out the correct cuff size for an automated cuff is similar to the technique for manual cuffs (see Activity 7-6). The difference is that with an automated monitor you may need to take one cuff off and connect a cuff with a different size to the monitor. Make sure that the bottom edge of the cuff is 1 inch above the elbow and is centered correctly. As you bring the ends over each other, overlap them smoothly so that there are no gaps or large wrinkles, and press gently so that the Velcro on the inner side of the cuff sticks. Different brands of monitors will differ slightly, but all will have something to start this process. Often, it will be a button that says something like On, Start, or something similar. When it is fnished, the systolic and diastolic values will appear on the monitors screen. Check the manufacturers guide for specifc questions or if the machine does not work in any way. Put the systolic (frst) number above the line and the diastolic (second) number below the line. Recall that an ideal blood pressure has a systolic value lower than 120 and a diastolic value lower than 80. If the systolic value is 138 or higher and/or the diastolic value is 85 or higher, encourage the person to meet with their doctor. If their blood pressure values are above 159 systolic and/or 99 diastolic, tell them to contact their doctor right away. Then unfasten the Velcro within the cuff so that you can remove it from the patients arm. If they miss or did not see any of the errors below, take the time to talk about them. All of these common things can lead to incorrect blood pressure readings The cuff is too small (one of the two most common causes of error in clinical practice! Patient did not rest 35 minutes after activity before the blood pressure measurement. Source: Improving the screening, prevention and management of hypertension: an implementation tool for clinical practice teams. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention What is Wrong with this Picture?

Therefore januvia 100 mg, the species cannot live in areas in which rabbits are absent or very scarce januvia 100mg. Ha b I t a t R e q u I R e m e n t s The Iberian lynx needs the Mediterranean scrubland to live (Palomares et al 100mg januvia. Remaining areas are usually strips of land between the scrubland and open habitats such as the edges of marshes or dehesas (Mediterranean savannah-like formations) (Fernndez et al 100 mg januvia. Rabbit abundance must be at least between 1 and 5 rabbits/ha in the least and most abundant seasons of the year , respectively for breeding to take place (Palomares et al . Dispersing individuals are not as demanding as residents in terms of habitat requirements . At that stage of their lives , they can use any kind of natural habitat as long as it is associated to some type of scrubland (Palomares et al . They are also less demanding with regard to rabbit abundance and can use areas with lower densities than those where they settle down (Palomares , 2001). Availability of suitable breeding dens and the presence of water are also important components in lynx habitat. In summer, the daily movements of lynx depend on the location of water sources, where they are often sighted drinking (Palomares et al. Most likely, the species habitat must also have places that can make good breeding dens, such as old hollow trees or rock cavities, and permanent water sources during the dry season. It is unusual to see two individuals together apart from the female with her young during the period of dependence on the mother, which usually ends when the cubs are 7-8 months old. Juvenile lynx abandon their mothers territory and disperse in search of new territories to settle as residents when there are between 1 and 2 years of age (Ferreras et al. Home ranges are smaller in areas where rabbits are abundant than in those where rabbits are scarcer. The areas of greatest use of resident adult lynx home ranges strongly overlap with those of individuals of the other sex, but not with territories of individuals of the same sex. Although lynx tend to be monogamous, the territories of some males may encompass those of more than one female. Re P R o d u c t I o n In the wild, female lynx normally breed only between 3 and 9 years of age (Palomares et al. Breeding has been recorded in 2-year-old captive females, but the cubs seem to have lower chances of survival. Although lynx usually breed once a year, sometimes they do not breed for unknown reasons. In most cases only two offspring of the litter survive until the age of dispersal. In the Doana area, a dispersing lynx travels an average distance of 172 km over a surface of 231 km and moves 2 a straight-line distance of 23 km away from the point of capture (Palomares et al. Lynx movements are determined by the structure and composition of habitats around breeding areas. They are therefore very sensitive to fragmentation or destruction of the natural scrubland habitats they need to move about without major problems. In a radio-tracking study of more than 50 individuals, the causes of mortality recorded were the following: direct shooting (21% of deaths), illegal trapping with leg-hold traps and snares and hunting with dogs (21%), road accidents (17%) and drowning in water wells (4%). Humans appear to have been and continue to be responsible for a high proportion of deaths in Doana as well as other areas of the species range. At least in the smaller carnivores Egyptian mongooses and genets, these interactions lead to densities between 10 and 20 times lower in areas inhabited by Iberian lynx than areas with similar vegetation but no lynx (Palomares et al. As for interactions between Iberian lynx and Egyptian mongoose, the abundance of mongoose has proven to be directly related to the abundance of lynx. This exclusion relation is not as clear with red foxes as it is with Egyptian mongooses and genets. However, red foxes have shown to be able to use areas with higher lynx densities mainly during the resting period of lynx, thus reducing the chances of encountering them (Fedriani et al. In spite of being predated by lynx, rabbits reach higher densities in areas with an abundance of lynx due to the control exerted by lynx on other carnivores that also consume rabbits (Palomares et al. Now, when the species is critically endangered and its survival in nature depend on the performance of these plans, systematic 10 applied research is even more important to help managers understand the response of individual free-ranging lynxes and populations to the conservation measures implemented. Adaptive management based on sound research will allow for founded modifcations of conservation plans if needed. Conradi and numerous students and collaborators have contributed to the current knowledge on the Iberian lynx refected in these pages. Impacto de depredacin y seleccin de presa du lynx pardelle (Lynx pardinus Temmick, 1824) et du chat sau- del lince ibrico y el zorro sobre el conejo. Doana, Acta Verte- European rabbits consumed by predators: relationship between brata 18, 113-122. El lince ibrico: ecologa y comportamiento rian lynxes (Lynx pardinus) from Doana, southwestern alimenticios en el Coto Doana, Huelva. Oecolo- res utilizados para la dispersin por el lince ibrico y fna- ga 121, 138-148. Junta de Andaluca y Consejo Superior de In- by the endangered Iberian lynx (Lynx pardinus): implications vestigaciones Cientfcas. The use of existence between Iberian lynx and Egyptian mongooses: breeding dens and kitten development in the Iberian lynx estimating interaction strength by structural equation mo- (Lynx pardinus). Landscape evaluation in conservation: molecular sampling and habitat Palomares, F. Iberian lynx in a fragmented landscape: ted heterogeneity in breeding in a metapopulation of the pre-dispersal, dispersal and post-dispersal habitats. Vegetation structure and prey abundance and causes of mortality in a fragmented population of Ibe- requirements of the Iberian lynx: implications for the de- rian lynx (Felis pardinus Temminck, 1824). Spatial ecology of the Iberian lynx and abun- rian lynx (Lynx pardinus Teminck, 1824). Reproduction and pre-dispersal survival of Ibe- rian lynx in a subpopulation of the Doana National Park. Nota sobre la alimentacin del lince ibrico en el Par- que Natural de la Sierra de Andjar (Sierra Morena Orien- Revilla, E, Wiegand, T. Effects of matrix heterogeneity on animal dispersal: from individual behavior to metapopulation-level parame- Guzmn, J. Non biological aspects to be considered in endangered species recovery programmes, in: Vargas, A. Positi- ve effects of top predators on game species by controlling smaller predator populations: an example with lynx, mon- gooses and rabbits. Spatial relationships between Iberian lynx and other carni- vores in an area of south-western Spain. I heard a thousand blended notes / While in a grove I sate reclined, In that sweet mood when pleasant thoughts / Bring sad thoughts to the mind. To her fair works did Nature link / The human soul that through me ran; And much it grieved my heart to / think What Man has made of Man. En la actualidad, el 13 manejo y recuperacin de las poblaciones de conejo silvestre es uno de los principales hitos en el mbito de la conservacin. Por otro lado, el uso indebido de las translocaciones surge como un obstculo aadido a la mejora de las poblaciones, debido a diversos mecanismos tales como la competencia mediada por la enfermedad que podran perjudicar la viabilidad de las poblaciones nativas. The misuse of translocations arose as an added obstacle to rabbit enhancement because of underlying mechanisms, such as apparent disease- mediated competition, that could yield harmful effects on native populations. The rabbit has 15 a deep impact on microclimates, foral composition and invertebrate biodiversity of these ecosystems, largely contributing to their maintenance. Moreover, rabbits contribute signifcantly to the food supply of more than 30 predator species in the Iberian Peninsula (Delibes and Hiraldo, 1981), including highly endangered native predator species that depend on rabbit abundance. For these reasons, the wild rabbit is a primary conservation concern in the Iberian Peninsula. The magnitude of rabbit populations collapse f0lations seems to be associated with bioclimatic factors traditionally related to habitat suitability and rabbit abundance. However, the high variability of current rabbit occurrence between and within habitats makes the relationships between mean rabbit abundance and these bioclimatic factors not so clear. This irregular distribution pattern suggests that unknown factors sometimes could be hindering and others promoting rabbit recovery at local level. Factors that could be invoked like putative and not mutually exclusive causes of this distribution pattern are: 1) variation of the impact of mortality factors (e. The main epidemiological feature of this disease is that lethality is frequently very high (about 80-90%) in rabbits older than 8 weeks of age, but less so in younger rabbits (see review of cooke, 2002). Despite these efforts, the scientifc knowledge generated to date still seems to be insuffcient to manage rabbit populations successfully. Indeed, the results obtained in many management experiences are negligible, and this failure is usually attributed to causes such as low habitat suitability, mortality by predation and the impact of viral diseases. In agreement with the outcomes of this model, in the range from K to K there was little variation in rabbit density. Differential transition times resulting from different population dynamics or the concurrence of factors limiting population growth at local scale may explain the currently highly variable pattern of rabbit distribution and population trends. In an attempt to enhance the rabbit population we would0 perform a habitat management programme that only increased habitat carrying capacity until values around K. This scenario could take place under poorly funded management programmes in which long-term habitat improvement was low or, also, under poorly designed programmes in which habitat improvement was high but only during a short time. Another example would be if habitat improvement was depending on the temporary (discontinuous) availability of funding and no habitat maintenance effort was performed when funding was unavailable. However, In situations in which a previous improvement of habitat has been performed, a temporary reduction of mortality would help to achieve a quicker increase in rabbit populations. Effective harvesting reduction should yield similar results on rabbit recovery as predation impact control. In general, the success of vaccination campaigns has been negligible, although their effectiveness has been tested in very limited short-term feld experiments, and only at the individual level (calvete et al. More recently, a transmissible recombinant vaccine has been developed to enhance the theoretical effectiveness of future vaccination campaigns (Torres et. Other different scenarios would arise if vaccination campaigns were carried out in populations that had not yet reached equilibrium with the disease. In this situation, vaccination, alone or in combination with other management tools, may facilitate a quicker recovery of populations. It is important therefore to evaluate the outcomes of vaccination campaigns performed under these scenarios. In addition, rabbit translocations have dramatically increased in the last years due to conservation programmes that not only work towards recuperating rabbit populations, but also use rabbits as a means to provide temporary prey to predators. It has been largely shown that short-term rabbit mortality is a critical issue in translocations, however, the few surveys carried out to evaluate the medium- to long-term success of rabbit translocations have shown that survival is generally low and that some of the main mechanisms underlying this management strategy remain unknown (Moreno et al. Many efforts are being carried out to enhance rabbit populations, trying to integrate hunting and conservation goals. Habitat managing aimed to increase habitat carrying capacity by mainly enhancing population productivity, either alone or in combination with mortality reduction, should be the main goal of rabbit recovery strategies. The primary mechanism by which habitat carrying capacity and rabbit productivity can be increased is managing habitat to increase refuge (mainly warrens) and the quantity and the quality of available food during breeding seasons. Therefore, replicating the landscape structure of traditional agricultural systems could help rabbit recovery. On the other hand, rabbit management programmes primarily based on scrub management to create natural pasture areas or the planting of crops that are cultivated only once, are probably not suffcient for long-term increases in population productivity. Myxomatosis is a viral disease that was introduced into Europe in the 1950s, and remains a major cause of mortality in wild populations. To date, however, there is no effective method to control mortality from this disease. On the other hand, predation impact reduction performed by means of predator control (e. The duration of this hypothetical transitional process is not known, but it is probably highly dependent on population dynamics. Thus, a well-designed management programme should acquire the funding necessary for the long-term maintenance of the increased habitat carrying capacity (perhaps during 3-5 years minimum), independent of the short-term results on rabbit abundance. In these cases, however, apparent competition mediated by disease would have dramatic effects if population reinforcement was not suffcient to allow rabbits to escape predator regulation. Under this scenario, the combined effects of predation, apparent competition and the subsequent loss of population ftness could result in the extinction of rabbit populations. In addition, translocations carry an inherent risk of the possible transmission of new disease agents into release areas. Since their effectiveness is highly uncertain, due to the number of possible mechanisms that can cause failure or result in harmful effects on restocked populations, their application should be supervised and highly restricted in current rabbit promotion programmes in order to avoid abuse in their use as a rabbit management tool. It is more likely that the new population would require several yearly cycles to reach this equilibrium, otherwise translocation would fail in the medium-term. Gestin gentica e inmunolgica para el manejo A new strategy for the conservation of the Iberian lynx, in: de las translocaciones y reintroducciones de conejo en Vargas, A. Rabbit haemorrhagic disease: feld epidemiology and the management of wild rabbit Angulo, E. Revue Scientifque et Technique de lOffce for the conservation of wild rabbit populations. Proceedings of the 1st World and body condition in the European rabbit: Applications for Lagomorph conference. An experimental study of Wild rabbit restocking for predator conservation in Spain. Wildlife Research 29, 627- disease and myxomatosis on long-term mortality rates of 633.

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