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As mentioned previously cholesterol test before eating cheap vytorin online master card, open source accounts mention at least 54cases in which a terrorist group allegedly had an interest in biological agents cholesterol chart 2014 buy vytorin 30mg mastercard, but there is little evidence to confirm most of the cases cholesterol in shrimp lo mein buy vytorin 30mg on-line. Thus, there are only 27 cases in which there is more than minimal evidence that a terrorist group possessed, attempted to acquire, threatened to use, or expressed interest in biological agents. Even in some of confirmed cases, there is no way to determine the seriousness of the interest in biological agents. Terrorists have used biological agents, but rarely and with relatively little effect. A review of the cases researched for this study confirms only five groups that used or tried to use biological agents. Although there may be other examples that have never been publicly identified, only one of these cases is known to have resulted in harm to people. The perpetrators were members of the Rajneeshee, a religious cult that established a large commune in Wasco County, a rural area east of Portland, Oregon. The Rajneeshees used Salmonella typhimurium, which causes salmonellosis or food poisoning, to contaminate restaurant salad bars. An estimated 751 people became ill because of that attack, including about 45 who were hospitalized. A brief explanation for the decision to include or exclude each specific case is provided in Appendix A. Aum Shinrikyo: In addition to using sarin nerve gas in the Tokyo subway system, Aum Shinrikyo produced biological agents and tried to use them. The Aum expressed an interest in several biological agents, allegedly including B. Mau Mau: the British believe that in late 1952 individuals associated with the Mau Mau African independence movement were responsible for using a plant toxin to poison livestock in what is now Kenya. Polish Resistance: Multiple reports suggest that Polish resistance organizations used biological agents against German forces during the early part of the World War Two. At least one Polish official claimed that 200 Germans were killed in this fashion, but the claim was never confirmed. Motives for use the review of cases identifies a number of reasons that led terrorists and criminals to become interested in biological agents: Sheryl WuDunn, Judith Miller, and William J. In principle, such groups also could be motivated by desires for revenge against a specific political or ethnic group. Aum Shinrikyo also wanted to murder large numbers of people as part of their efforts to seize control of Japan. Murder: Several terrorist groups are known to have considered biological agents as weapons to kill specific individuals. In general, the perceived attractiveness of biological agents results from the belief that the victim will appear to have died a natural death. The perpetrators hoped that it would prove impossible either to detect the biological agent (especially if it was a toxin) or to determine that the victim was deliberately infected (especially if it was a pathogen). Incapacitation: In at least two instances, the perpetrators wanted to incapacitate large numbers of people without necessarily killing anyone. According to press accounts, the Weathermen attempted to obtain biological agents to infect water supplies. They hoped the repressive reaction of the government to such an incident would radicalize the general population and create additional supporters for their cause. The Table 2: Objectives for using biological agents Type Murder Terrorize Extortion Disruption Anti-animal/crops Mass Murder Revenge Incapacitation Political statement Unknown Terrorist 4 6 0 0 1 4 0 2 1 9 Criminal 17 9 13 5 2 0 3 0 0 7 Other/ Uncertain 0 22 3 0 0 0 0 0 0 72 Total Cases 21 37 16 5 4 3 3 2 1 88 Note: Because some perpetrators had multiple objectives, the totals in this table may exceed the total number of cases. Rajneeshees also wanted to incapacitate the citizens of the Dalles, Oregon, so that the people of the community could not vote in an upcoming election. While the circumstances of that attack are unlikely to reappear, the case demonstrated that biological agents have utility as mass incapacitants. Political statement: In one case, the perpetrators used biological agents to make a political statement. This was the objective of Dark Harvest, a group that apparently was uninterested in causing harm to people or property, but was willing to "use" of biological agents to send a political message. Besides this instance, there are no confirmed cases of threats against 11 Lester C.

Despite the success of these modules cholesterol vitamins purchase 20mg vytorin amex, they have not completely operationalized key legal concepts stemming from new case law into operations cholesterol test healthy range buy discount vytorin 20mg. Many of the report writing issues were addressed by the training done in the Incident Screening and Use of Force Reporting course gluten free cholesterol lowering foods vytorin 30mg. That course also reinforced the importance clear articulation of the legal basis for detentions and seizures. Additional training will cover documentation of stops and detentions; including utilization of the appropriate form to collect necessary information. Further training will also be offered in regards to the "completed misdemeanors" section of the policy. The training program will emphasize an understanding of case law regarding social contacts, Terry stops and custodial arrests. One of the keys to the success of this program will be the integration of search and seizure training into reality-based scenario training. As discussed above, the department has spent considerable resources in the area of Bias Free policing over the last several years, including the delivery of the following: 1. With the changes in policy, training in 2014 will focus on operationalizing the concepts presented in these courses. Additionally, the Education and Training section is responsible for training officers on changes in criminal procedure based on evolving case law. These roles alone do not sufficiently describe the responsibility of the Section in providing in-service officer training. The true task is to operationalize the underlying philosophy of the Settlement Agreement and the policies resulting from the agreement in support of the cultural transformation of the Department. To meet these roles of training, the Education and Training Section will be creating a multi-phased approach to the Search & Seizure training in 2014 and moving forward. E-Learning Modules for all supervisors the first phase, Interim Training, is aimed primarily at ensuring that all sworn personnel are knowledgeable about the new Voluntary Contacts and Terry Stop policy; primarily through the use of e-learning, and Reader Board content. Within the Interim tier we will begin to transform to job level specific training. Specifically, officers and sergeants have similar knowledge level requirements, but with different goals of application. Typically, an officer needs to know how to perform the new criminal procedures resulting from new case law or policy. To a lesser extent than officers, Supervisors must also perform the new criminal procedures. Commander level training needs to focus on issue identification or on do-identify performance levels in regards to search and seizure issues stemming from case law. All sworn personnel need to understand new policies as they are issued and their ramifications on existing practices. Reader Board content addressing lessons learned from the Use of Force Review Board In the second phase, we will provide all sworn personnel with a comprehensive training course on Voluntary Contacts and Terry Stops. This course will be trained as part of a day of training including Bias Free Policing in an A/B format. Also during phase 2, we will issue roll call training periodically through-out 2014 and beyond to address emerging issues and new concepts. E-learning modules, Training Tips, and roll call training delivered on an ongoing basis drawn from the following topics: Legal updates on current case law and recent court decisions Social Contact vs. Reality-Based Scenario training requiring officers to demonstrate their understanding of key legal concepts In the third phase of the ongoing training, all sworn personnel will be provided with sustainment training on previously covered material, as well as training on new concepts established by evolving case law. In order to create the ongoing training, the Education and Training Section will re-institute the working group that worked together to devise the elearning projects completed in 2012 and 2013. Training across all ranks ensures that all personnel understand the vision for the future of the Seattle Police Department. The tenets of Procedural Justice are commonly presented as a relationship between law enforcers and the communities they serve, but the theories and relationships are every bit as relevant when applied inwardly toward the police organization and its members. The methods and teaching models utilized by the Education and Training Section are intentionally designed to encourage discussion and create understanding of policies, with the express intent of enhancing an understanding not only of the changes in policy, but also to create acceptance, adherence, and support.

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This highlights two fundamental points about infections in the compromised host: first cholesterol levels calculator generic 30mg vytorin mastercard, most infections are due to common pathogens ­ these are usually readily identified and controlled by appropriate therapy; second cholesterol ratio explained vytorin 20 mg with mastercard, difficult problems are those caused by opportunistic organisms because these are often elusive or impossible to isolate and they may not respond to available drugs cholesterol levels guide uk buy vytorin 20 mg amex. In practical terms, therefore, the clinician needs to know when to suspect opportunistic infections. Several studies have documented diagnostically helpful patterns of infection in the immunosuppressed host. The best-studied patients are those who have undergone renal transplantation (see. The major causes of infection in the first month are bacteria related to surgical wounds, indwelling cannulae or postoperative lung infections. After 1­4 months of therapeutic immunosuppression, cytomegalovirus infection dominates a picture that includes various fungal, viral and protozoal infections. Infections occurring beyond 4 months are due either to chronic viral infections, occasional opportunistic infections or infections normally present in the community. The major portal of entry of opportunistic organisms is the oropharynx, so the lung is the commonest site of infection in the compromised host. The clinical picture is non-specific: fever, dyspnoea and an unproductive cough with widespread pulmonary infiltrates on chest X-ray. Unfortunately, sputum, blood cultures and serology are of little help in identifying the organism; more invasive methods such as bronchoalveolar lavage, transbronchial biopsy or open lung biopsy are frequently needed. The importance of early diagnosis and treatment (where feasible) is emphasized by the grim results: the overall mortality usually exceeds 50%, largely due to rapid progression in immunocompromised patients combined with lack of effective specific therapies for many opportunistic pathogens. However septicaemia, meningitis and gastrointestinal infections with local spread to the liver are not uncommon (see Case 3. Others: Pneumocystis jirovecii Varicella zoster Mycobacterium Chapter 3: Immunodeficiency / 85 Case 3. The clinical diagnosis was nephrotic syndrome, probably due to systemic lupus erythematosus. This was supported by laboratory results: her haemoglobin was 91 g/l with a white-cell count of 3. However, 4 weeks later, she suddenly became unusually agitated and disorientated, with mild neck stiffness. The meningitis was treated with Ampicillin and her mental state rapidly returned to normal. Unfortunately, the term is often used loosely to describe any intolerance of environmental factors irrespective of any objective evidence of immunological reactivity to an identified antigen. Truly allergic diseases are common: about 20% of the population experience some form of allergy and this imposes a substantial physical and economic burden on the individual and society. Some patients have an occasional mild allergic reaction, some suffer life-long debilitating disease, while, more rarely, some react with severe or fatal anaphylactic shock. Allergic reactions to antigens that enter the systemic circulation, through an insect sting or intravenous administration of an antibiotic, can produce life-threatening anaphylactic reactions. More commonly, antigens are inhaled or ingested, trigger more local reactions in the upper or lower respiratory tracts (rhinitis or asthma) or in the mouth or upper gastrointestinal tract. However, some ingested (peanut) or inhaled (latex particles) antigens can cause anaphylaxis, a severe systemic reaction. Allergy ­ is used to define those conditions in which antigen specific IgE or sensitized T cells play a definite role 2. Atopy ­ is a state of disordered immunity in which Th2 lymphocytes drive an inherited tendency for hyperproduction of IgE antibodies after exposure to common environmental allergens 3. Hypersensitivity ­ as used in this chapter ­ refers to the Gell and Coombs classification for immunological diseases (see section 1. Intolerance ­ is used to describe all abnormal but reproducible reactions to food when the causative mechanism is unknown Box 4. Antigen-specific IgE plays a key role being synthe- sized on first exposure and causing allergy only on subsequent exposures. Antigen reacts with surface-bound IgE causing cross-linking of receptors, an influx of calcium ions into the cell and explosive degranulation with release of preformed mediators. Other mediators are newly generated and derived from the metabolism of arachidonic acid via two enzyme pathways: one leads to production of prostaglandins and thromboxane, the other to formation of leukotrienes. Histamine is a dominant mediator in the upper airways and leukotrienes in the lower airways disease.

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The types of hazards and impacts to internet and telecommunications infrastructure are very similar to electric power supply cholesterol ratio 4.2 purchase vytorin paypal. So cholesterol milk purchase vytorin on line, when weather events such as windstorm or winter weather cause lines to break cholesterol ratio mercola order vytorin 30mg on line, both electricity and telephone services experience outages. With the increasing utilization of cellular phones, hazard events such as tornado that can damage cellular repeaters can cause outages. In addition, during any hazard event, internet and telecommunications systems can become overwhelmed due to the surge in call/usage volume. Certified Areas of Telephone Exchanges in Kansas Source: Kansas Corporation Commission. The primary impacts of this event were to public roads and bridges with an estimated $9. The primary impacts of this event were to public roads and bridges with an estimated $11. Rolling Hills Electric Cooperative stated that around 750 power poles snapped in Republic, Washington, and Marshall Counties due to the weight on the lines. Specifically, Kansas Rural Electric Cooperatives reported 49,000 customers without power, Westar reported 76,000 customers, Kansas City Power & Light reported 4,300 customers, and Kansas City, Kansas Board of Public Utilities reported 800 customers without power. In Montgomery County, the Coffeyville Resources refinery and nitrogen fertilizer plant, and many local businesses were flooded. It began on December 28, 2006, and increased in intensity December 29 overnight into December 30. Numerous highways were closed for days in western Kansas, and there were major power outages because of icing. The ice was 1/4 inch thick on guide wires that brought several communication towers down. Summer 2006: During the summer of 2006, a heat wave caused two train derailments and rerouting of train traffic. The derailments were caused by sun kinks as the metal tracks expanded from the heat. One train derailed north of Topeka toward Atchison, and the other derailed immediately east of Neosho Rapids. The train that derailed near Neosho Rapids had five cars that contained hazardous materials; none of them were compromised. Particularly hard hit were Butler and Sedgwick Counties, which sustained an estimated $8. With one to two inches of ice accumulation, utility poles and power lines snapped, transportation was treacherous, and fallen trees damaged many structures. The resulting power outages affected nearly the entire region and lasted nearly a week in some areas. January 2001: A 143 million cubic feet of compressed natural gas leaked from a nearby storage field occurred. The natural gas migrated underground, and then rose to the surface through old brine wells creating about 15 gas blowholes. An explosion in downtown Hutchinson destroyed two businesses and damaged many others. Two residents died of injuries from the explosion and hundreds of people were evacuated as gas geysers began erupting in the area. Sumer of 1993: the 1993 flood is an extreme example of disruption of Kansas` Infrastructure. Not only were roads and rivers un-navigable for weeks and months following the flood, but power lines were swept away causing disruption of communications and power services. Probability of Future Hazard Events Based on historical records, utility failures occur annually across the State. For ranking purposes, the mitigation planning team elected to only factor significant failures for the probability ranking. A significant failure was considered to be failure where 10 percent of the population of an affected jurisdiction is impacted by the utility/infrastructure failure for 3 days. The south-central portion of the State is also has an increased vulnerability due to the population density, development, and economic activity in the Wichita area. Agricultural areas of the State are also vulnerable to prolonged outage events as modern agricultural practices are reliant on energy; such as electric milking machines, and irrigation pivots. In addition, generally the smaller utility suppliers such as small electrical suppliers have limited resources for mitigation.

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