Ian A. Reid PhD

• Professor Emeritus, Department of Physiology, University of California, San Francisco

https://cs.adelaide.edu.au/~ianr/

Global climate change and fragmentation of native brook trout distribution in the southern Appalachian Mountains asthma definition ethics order 250mcg advair diskus with amex. Conservation and restoration of native trout in the face of climate change asthmatic bronchitis lung sounds generic advair diskus 250mcg with amex, invasive species asthma definition 6000 generic advair diskus 500 mcg mastercard, and development asthmatic bronchitis untreated discount 250mcg advair diskus otc. A case history in fishing regulations in Great Smoky Mountains National Park: 1934-2004. Fish and Wildlife Service ends investments in Merrimack River Atlantic Salmon program; shifts focus to shad, other fish species. So rather than get into specifics here regarding climate change, let us just proceed on the notion that this warming will likely occur, and that wild trout in the future will likely be affected by climate change in meaningful ways (Jonsson and Jonsson 2009; Wenger et al. My second caveat is that it was hard enough for me to think about what is happening now and what is likely to happen in the future regarding wild trout management in North America, let alone Europe, New Zealand, South America, and other areas of the globe where anglers pursue wild trout. So although this symposium has overseas attendees, herein I focus on North America, though much of the material I cover will hopefully apply to other areas of the globe as well. Having laid this groundwork, how do you predict what the future of wild trout management will be like? In fact, one could ponder the history of "wild trout management in the future" talks that have been given at past Wild Trout Symposiums. The first was sort of a compilation of concluding statements at Wild Trout I in 1974, given by Willis King, Nathanial Reed, and Bill Luch. Their general conclusions were that wild trout habitat was being destroyed, that hatchery stocking was ruining wild trout stocks, and that these two things needed to be turned around soon or there would not be any wild trout left to manage. His opening line was, "It is one of the great joys of my life that I have lived long enough to see us turn the corner in trout management and know that we are swinging back upward toward great trout fishing in the future. The major problem he railed against was the need for more restrictive angling regulations, including catch-and-release, which actually was a big issue because this was back in the day when most anglers kept everything that they caught. By this time, depending on who was speaking, the focus had turned to native trout, protecting quality trout habitat, providing a diversity of angling opportunities, and helping to solve overcrowding and social conflicts on wild trout waters. One was given by Peter van Gytenbeek, who concluded that in the next twenty years, wild trout management probably would not change much at all. I think we can all see some trends that will likely continue for the foreseeable future. One is that we will probably see more catch-and-release regulations on wild trout fisheries. We have already seen catch-and-release waters grow in popularity, and it is hard to imagine that not continuing. As people have recognized for decades, anglers who live farthest from trout fishing waters, in urban environments, are usually the ones who want more restrictive harvest or catch-andrelease regulations. In contrast, anglers who live near trout streams in rural areas are usually the ones that still want to harvest wild trout. Since the world is becoming more and more urbanized, and will increasingly do so in the future, there will likely be a continued push for more catch-and-release waters. So, some level of expansion of catch-and-release waters for wild trout anglers is probably inevitable. However, we have to continually ask ourselves, now and in the future, whether catch-and-release regulations are really necessary or helpful on any given water to provide quality wild trout fishing, because catch-and-release regulations can be sort of a cop-out by fish managers. In these days, when most anglers voluntarily release their catch, regardless of the angling regulations, will adding more catch-andrelease regulations really help to grow substantially more fish, or bigger fish, or both? Is the small amount of harvest that now goes on in wild trout fisheries really having big impacts on the populations? Anglers, and even biologists, are often under the impression that if wild trout populations were left alone, mortality in the population would be extremely low, and you would have larger trout and more of them in every run, riffle and pool in the stream. In reality, in most instances, about half of each age class is lost each year to natural causes. So in many instances, you can have some fish harvested by anglers, or lost to natural mortality, but either way, a lot of wild trout this year are not going to be around next year. Of course, each species of trout has a different capacity to withstand angler harvest. Brook Trout Salvelinus fontinalis, for example, which mature early in life, have a short lifespan, and are highly fecund for their size, can in some areas withstand exceptionally high levels of harvest without having hardly any measurable impact on the population. About 10 years ago I evaluated a Brook Trout eradication effort, and found that total annual mortality in the population was already 92% before the removal began, so all the eradication effort did was substitute eradication mortality for what used to be natural mortality, and total mortality did not change at all. Sometimes harvest actually improves Brook Trout fisheries by reducing their overabundance and improving growth and size of the catch by anglers. In contrast, Cutthroat Trout Oncorhynchus clarkii, because they are easy to catch, tend to be quite susceptible to overharvest by anglers, and there are lots of examples of overexploitation in Cutthroat Trout populations. A debate that may gain momentum in the relatively near future is whether innovations in bait hooks may reduce the historical incompatibility between bait fishing for trout and catch-and-release angling. Circle hook use in marine fisheries usually reduces deep hooking and, consequently, hooking mortality. These hooks appear to also work well in stream settings for wild trout (Sullivan et al. Whether it ever becomes common to allow bait fishing in catch-andrelease trout waters as long as you use circle hooks remains to be seen. That seems unlikely because in reality, there is little demand these days to harvest trout or to use bait to fish for wild trout in streams. In reservoirs or community ponds, harvest and bait fishing by trout anglers is still very popular, but usually these types of waters do not support wild trout to begin with, so those people wanting to harvest trout are already focusing their time and energy on waters that are usually supported by hatchery trout, and they have pretty much lost interest in fishing for wild trout in streams, because so often they cannot keep fish anyway. A debate that is gaining momentum in Europe is whether catch-and-release angling should be allowed at all. Animal rights activists argue that it is inhumane to catch and release a fish because angling causes pain and stress in fish. Their argument is that you should either not be allowed to angle at all, or you should at least be required to keep what you catch and stop fishing when you reach your limit. If there is less desire to harvest wild trout, then presumably there will be even less need to stock hatchery trout in streams, since the main reason for stocking hatchery trout is to allow harvest opportunities. Anyone who is still concerned with genetic introgression between wild native trout and hatchery trout can stock sterile fish and eliminate that concern, and many states and provinces do that, including the agency I work for (Kozfkay et al. I think that hatchery trout get an unsubstantiated bad rap among wild trout enthusiasts; in my opinion we should look at them as a useful tool for wild trout management, because they can divert harvest-oriented anglers away from wild trout waters and onto waters that do not support wild trout but can support harvest opportunities on hatchery-stocked fish. For wild trout, the overwhelming evidence in the literature suggests that you can release fish quicker with barbless hooks, and they may cause less severe injuries, but they appear to have no impact on fish survival. What they do appear to impact, according to a recently published study, is angler landing success, especially for novice anglers (Bloom 2013). It is usually the experienced anglers who are the ones pushing for barbless hook regulations, probably because using barbless hooks does not reduce their landing success very much. The people who see the big drop-off in landing success with barbless hooks are the inexperienced anglers, the ones we always say we are so concerned about in trying to recruit them to the sport of angling, to be another voice (or voter) that supports wild trout conservation. So it seems to me that we are shooting ourselves in the foot by requiring novice anglers who want to fish in catch-and-release waters to use terminal tackle that does not improve survival of released fish but does reduce the number of fish they are likely to have the satisfaction of landing. There has been a surge of interest in the last decade or two in preserving and protecting native trout, and that will probably continue for the foreseeable future. These days, more anglers are interested in catching not just wild trout, but wild native trout. Yet despite this relative surge of interest in native trout, the vast majority of anglers these days still do not really care what wild trout they are catching, as long as they are wild. In fact, your average angler does not even know which species are native and which are not. For example, in western North America many anglers use the name "German brown trout" to describe the fish they are catching without it dawning on them that that is where Brown Trout Salmo trutta are native, not North America. Even though there will probably be less angler harvest of wild trout in the future, there will be even more pressure on wild trout resources due simply to an expanding human population. It is estimated that the human population in North America and the rest of the globe will stabilize by about the year 2050, so the heavy impact that human population growth has on natural resources may soon stabilize in many areas.

In 1974 asthma treatment alternative treatments discount advair diskus 500mcg overnight delivery, Yellowstone National Park supported some of the most progressive wild trout regulations in the country asthma heart rate order advair diskus 500mcg with mastercard. The role of Yellowstone National Park in the Wild Trout Symposiums can hardly be exaggerated asthma 6 steps generic 250 mcg advair diskus fast delivery. Virtually all superintendents asthmatic bronchitis june trusted advair diskus 250 mcg, or their representatives, have attended the meetings. Fish and Wildlife Service (1973-1980), Varley played an influential role shifting the emphasis of the fishery program in the park from consumption to ecosystem management. From the beginning, the Wild Trout Symposium series has been a forum for interactions with leading conservationists. Although there were many factors interacting during the period that made this plethora of environmental legislation possible, Reed provided the leadership necessary for success. He has remained active as a board member of numerous conservation groups such as the Nature Conservancy, the Natural Resources Defense Council, American Rivers, and the Everglades Foundation, and he is a staunch advocate for wild trout. Starker had a strong reputation as a scientist and conservationist long before the first Wild Trout Symposium report. For example, he chaired a panel of scientists appointed by the Secretary of the Interior, Stewart Udall, to examine wildlife management in national parks; the resulting report is still being used to guide wildlife management today. Starker acted as science advisor to Assistant Secretary Reed, and he was also an ardent fly fisher. During the first Wild Trout Symposium, he presented a paper on the deterioration of public lands under a policy of multiple use in which he expressed concern about the effects of grazing on stream habitat. Indeed, concern about aquatic habitats continues as a theme of Wild Trout Symposiums today. Of course, the participation of individuals making extraordinary contributions to wild trout management has continued through the years. Researchers, managers, and philosophers, such as Luna Leopold, Bob Hunt, Bob Behnke, Ray White, and Paul Schullery, have provided numerous innovative ideas. In addition, these meetings have been a forum for angler conservationists, including Lee Wulff, Gardiner Grant, Bud Lily, Otto Teller, Nick Lyons, and Ernie Schwiebert. Contributions of these individuals to the perpetuation aquatic systems and the wild trout they support have been extensive. Beyond the opportunity to be exposed to new and thought-provoking ideas, the Wild Trout Symposium series has provided the environment for dynamic collegial interaction. It has been a place where discussions are focused for days on the issue of wild trout and the factors that affect their persistence, and a place where old friends and new acquaintances can talk about problems, concerns, and innovations. Recipients are chosen in two categories, professional and non-professional, and each is provided a medal originally designed by Ernie Schwiebert. The first individuals to receive the award were Bob Behnke (professional) and Marty Seldon (nonprofessional), two people that continued to influence wild trout management throughout their lives. Themes of biology, aquatic habitat, and angler relationships have continued to provide the framework for the Wild Trout Symposium through the years. For example, the effects of natural disturbances, such as fire, on fish populations and aquatic habitats have been explored in detail. Issues associated with invasive species, including the exotic disease organism that causes whirling disease, are a growing concern in many parts of the country. More recently, discussion concerning the effects of climate change on wild trout populations and possible adaptation strategies is common. Over the past four decades, however, emphasis of Wild Trout Symposiums has shifted from wild trout to native salmonids. Indeed, at the beginning of the 21st century, efforts to reestablish or protect populations of native trout often include removal of existing populations of wild trout introduced from stocks originating from other parts of North America, or in some cases Europe. The interval between symposiums was reduced from 5 years to 3 years because the issues associated with wild trout management had become more pressing since the inception of the series. Under the direction of symposium organizer Pat Dwyer, the program was opened to contributed papers for the first time. This was a significant change because it not only provided the opportunity for individuals conducting interesting new, but often unrecognized, work to inform others, but it substantially broadened the base of participants in the symposium series. Furthermore, the top-down structure of the organizing committee that had been so important for establishing and initially perpetuating the symposium, was replaced by a more bottom-up, volunteer-driven group of individuals. It also marked the first time that a Wild Trout Symposium was held outside of Yellowstone National Park; meeting dates were in mid-August instead of late September. Facilities at Montana State University included a substantially improved sound system, but it was not Yellowstone National Park. The message from participants (and most of those who chose not to participate) was "move the Symposium back to Yellowstone. One unique occurrence was the participation of the first "talking trout" in the session on public outreach. Although there was some concern that outreach was not real science, it proved to be a harbinger of science communication in the 21st century. Perhaps more intriguing were negative comments about the number and complexity of talks focused on genetics. This seems almost unbelievable now considering the important and ever increasing role of genetics in the management of native trout, but it is a very real example of the evolution in trout management over the past 40 years. During this period, the Wild Trout Symposium became incorporated, a move that provided a means to more efficiently manage funds associated with the meetings and a broader array of fund raising options. The emphasis on native trout has increased and the geographic scale of interest has broadened. Interest in management of Brook Trout across the historic range of this iconic species of the eastern portion of the continent now rivals that of western native trout. In the West, Artic Grayling and Bull Trout are species that are at the center of numerous landscape-scale management programs. In recent years, interagency, interstate working groups for the management of native trout have become common, even in the absence of listing under the Endangered Species Act. The effects of scale, both spatial and temporal, on understanding and managing aquatic habitats are topics that have become common in recent Wild Trout Symposiums. Regional assessments have become more common, and therefore, decisions concerning where and when habitat restoration is warranted have become strategic and less reactive. In addition to the more general approaches to wild trout biology and management, changes in the mechanics of the meeting also continue. Virtually all attending the session were actively participating in discussions with presenters. New awards have been incorporated into the Wild Trout Symposium series in recent years. The Trout Unlimited/Federation of Fly Fishers Wild Trout Stewardship award was presented for the first time at Wild Trout X. This award is presented to groups "for significant contributions to the conservation, protection, restoration, or enhancement of a coldwater fishery. These two awards recognize outstanding students with an interest in wild trout management. More generally, these student awards reflect the importance of encouraging new meeting participants and wild trout advocates. The Ron Remmick Undergraduate Student Award was presented to Charles Cathcart at Wild Trout X, and Bradly Allen Trumbo and Daniel A. At the beginning of this discussion, I suggested that the evolution of the Wild Trout Symposium series was a reflection of social change over the past 40 years. This evolution is probably most apparent in the gradual shift away from a top-down process directed by a few key individuals to an increasingly broad bottom-up organization. It could be argued that the series would not have emerged and certainly would not have persisted without the strong leadership from a few individuals during the early years. On the other hand, without the evolution to a bottom-up organization driven by a large number of volunteers, the series could well have withered on the vine decades ago. A brief perusal of photographs of the organizing committee for the last three symposiums provides evidence of this change. A gradual, but significant shift in the gender balance of the committee provides a strong reflection of similar changes that have occurred in resource management science and practice during that time period. These are all positive signs that suggest to me that even considering the enormity of challenges to the persistence of native salmonids throughout the northern hemisphere, there has been, and continues to be, a growing number of highly motivated and skilled scientists and managers that are ready to take up the challenge. Furthermore, and maybe most importantly, there appears to growing support for wild native trout among the public at large; without their continued support, it will be impossible to succeed.

Ideally asthma symptoms diagnosis and treatment buy advair diskus 250mcg cheap, the drug should provide clear benefits to the mother without harming the fetus asthma without wheezing effective advair diskus 250 mcg. Although animal studies show risks asthmatic bronchitis 36 buy generic advair diskus 250 mcg on line, adequate asthma respiratory alkalosis purchase 250 mcg advair diskus overnight delivery, well-controlled human studies are lacking. Despite the potential fetal risks, use of the drug may be acceptable because of benefits to the mother. Studies in animals or humans or reports of adverse reactions show evidence of fetal risk that clearly outweighs any possible benefit to the patient. During the course of drug therapy, monitor the patient to determine drug efficacy and detect signs and symptoms of an adverse reaction or interaction. Teach the patient the name of the prescribed drug, its dosage, administration route, dosing frequency and times, and duration of therapy. Schedules of controlled substances the Controlled Substances Act of 1970 regulates the production and distribution of stimulants, narcotics, depressants, hallucinogens, and anabolic steroids. Drugs regulated by this law fall into five categories, or schedules, based on their abuse potential, medicinal value, and harmfulness. Schedule I: High potential for abuse; no currently accepted medical use in the United States. Emergency telephone orders for limited quantities may be authorized, but the prescriber must provide a written, signed prescription order. Abuse may lead to a moderate or low degree of physical dependence or high psychological dependence. Schedule V: Low abuse potential compared to drugs in other schedules; currently accepted medical use in the United States. Some schedule V drugs may be available in limited quantities without a prescription (if state law permits). Part 1: A to Z drug monographs Part 1 presents individual drug monographs in alphabetical order by generic name. Where applicable, the top banner of the monograph includes an icon or logo denoting that the drug is a highalert drug () or a hazardous drug (). As defined by the Institute of Safe Medication Practices, high-alert drugs are those that can cause an increased risk of significant patient harm when used in error, and deserve special attention, caution, and safeguards. Drugs designated as hazardous by the National Institute for Occupational Safety and Health, American Society of Health-System Pharmacists, and the Centers for Disease Control and Prevention include cancer chemotherapy agents, some antivirals, certain hormones, some bioengineered drugs, and selected miscellaneous drugs. These agents meet one or more of the following criteria: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, or structure and toxicity profiles that mimic existing drugs determined to be hazardous by the above criteria. These drugs must be handled within an established safety program (see "Guidelines for preparing, handling, and administering hazardous drugs," in the "Safe drug administration" insert). Below the banner, each monograph is presented in the following order: Generic name. When more than one therapeutic form of the drug is available, generic names of these forms are listed alphabetically. High-alert drug classes and categories Specific high-alert drugs adrenergic agonists, I. Trade-name and generic drugs are therapeutically equivalent in strength, quality, performance, and use; when interchanged, they have the same effects and no differences. However, they may vary in preservatives, color, shape, labeling and, possibly, scoring. The Drug Enforcement Agency assigns each of these drugs a category, or schedule, based on its abuse potential and other factors. Be sure to review the complete package insert before administering the drug in question. This section summarizes how the drug achieves its therapeutic effect-the action that takes place when it reaches its target site and combines with cellular drug receptors to cause certain physiologic responses. This section lists the physical forms in which the drug is produced and dispensed, plus available strengths (the amount of active ingredient present) for each form. This section tells which patient groups (such as children or elderly patients), diseases, or disorders (such as renal or hepatic dysfunction) may necessitate dosage adjustment. This section lists conditions that contraindicate use of the drug, such as preexisting diseases. As a rule, never give a drug to a patient who has a history of hypersensitivity to that drug. Drugs commonly implicated in hypersensitivity reactions include antibiotics, histamines, iodides, phenothiazines, tranquilizers, anesthetics, diagnostic agents (such as iodinated contrast media), and biologic agents (such as insulin, vaccines, and antitoxins). For some patients, a specific drug may pose an increased risk of untoward effects-yet the physician prescribes it because, in his judgment, the potential benefits outweigh the risks. For instance, many drugs can be dangerous for elderly patients, pregnant or breastfeeding women, young children, and patients with renal or hepatic dysfunction. Presented in table form, this section provides a pharmacokinetic profile- onset of action, peak blood level, and duration of action-for each route by which the drug is administered. Occurring in roughly 30% of hospital patients, reactions can range from mild to lifethreatening. The sickest patients-those in intensive care-typically receive anywhere from 20 to 40 different drugs. These patients are the most vulnerable to adverse reactions, drug interactions, and life-threatening consequences of a medication error. In this section, we list the most commonly reported adverse reactions by body system. Close patient monitoring is essential during drug therapy (and in some cases, even after therapy ends) to help gauge whether the drug is effective and to detect untoward reactions or interactions. Early detection of troublesome side effects or drug inefficacy allows timely adjustments in therapy and may prevent patient injury or avoid a treatment delay. You must also determine whether this drug might interact with other drugs that your patient is receiving, and determine whether his medical condition, vital signs, or recent laboratory findings make him more vulnerable to interactions or adverse effects. This section discusses important nursing assessments and interventions to perform, such as monitoring blood drug levels to help determine the correct dosage and to prevent toxicity. Part 2: Drug classes, vitamins and minerals, herbs and supplements Part 2 presents collective monographs on therapeutic drug classes and abbreviated monographs on vitamins, minerals, herbs, and nutritional supplements. These monographs also tell you which drugs the prescriber may order if a particular drug in the same class is unsuitable for your patient. This section gives basic information that may help your patients use herbs more safely. Part 3: Appendices, references, and index Appendices serve as handy references on important drug topics and related issues-everything from normal laboratory values for monitoring and detecting drug levels to the top 200 most commonly prescribed drugs. Also, this website will provide access to the full text of the Nursing Spectrum Drug Handbook 2010, which you can download free to your personal digital assistant. I want to thank them all; in particular, Minnie Rose, our clinical manager, whose patience, knowledge, and attention to detail add so much to the success of this project; also Kathy Goldberg, editorial manager; Karen Comerford, copyedit supervisor; Stephanie Peters, design manager; and Julia Knipe, administrator extraordinaire. The entire McGraw-Hill team deserve a heartfelt thank you, especially John Williams, Phil Galea, Arushi Chawla, and Joseph Morita. I also wish to thank our advisors, contributors, and reviewers for continuing to share their expertise-and their valuable time. And a most-important thank you to all you wonderful nurses who give unselfishly of yourselves to ensure the best care and protection of your patients. I appreciate your enthusiastic support and will continue to work hard to bring you the tools you need to safeguard your patients. Before establishing MedVantage Publishing, she held executive management positions with the top medical publishers in the world. Before entering the publishing industry, she practiced for many years as a professional nurse and held various nursing positions in hospital management, direct patient care, and staff education. She has a Master of Science degree in Nursing, a Bachelor of Science degree and a Registered Nurse Diploma. Acknowledgments A project of this scope and intensity demands incredible effort, hard work, and the expertise of a dedicated team. After hypersensitivity reaction, never restart drug or other agents containing it, because more severe symptoms (including severe hypotension and death) may arise within hours. Safe drug administration the following guidelines on preparing, administering, and monitoring drug therapy will help you ensure patient safety and drug effectiveness.

Most commonly asthma bronchitis or pneumonia buy generic advair diskus 250 mcg online, drugs inhibit the enzyme competitively asthma treatment over the counter 500 mcg advair diskus overnight delivery, which may be either reversible or irreversible asthma definition quantitative cheap advair diskus 250mcg online. This prevents the formation of certain prostaglandins that would otherwise cause inflammation and pain asthma exacerbation buy cheap advair diskus 500 mcg on-line. Other drugs act as false substrates for the enzyme so that an abnormal product is made instead of the normal one. Some drugs need conversion by an enzyme from an inactive pro-drug into an active form before they can be of therapeutic use. Methyldopa, above, could be said to be a prodrug and methylnoradrenaline the active drug. Adverse reactions can occur by a variety of mechanisms and some of them are well known. At extremes of life absorption, distribution, metabolism and excretion can all be different to normal so that drug action becomes unpredictable. In particular, plasma protein binding, liver and kidney function and the number of drugs being taken concurrently become important in older patients. Special care is needed when prescribing for infants and children and drug use should be avoided if possible in pregnancy and breast feeding. In order to have a therapeutic effect, a drug has to interact with a receptor or other site of action in the body. Receptors are divided into four types according to their location, structure and effects when activated. Case studies the following two case studies are hypothetical, but any health care professional should be able to provide professional advice to patients in such situations. Annie tells you that her doctor has said that she must not take any medication during her pregnancy without checking with the doctor first. Annie is a little puzzled by this but says she did not have time to talk to the doctor about it. She has been back at home for two days after being in hospital with a broken hip sustained after a fall. Despite her age and current frailty, Mrs Howe is mentally very alert but she is worried about how she will remember to take all her drugs at the right time. What advice can you offer her about how to make sure she remembers when to take the various drugs she has been prescribed? Mrs Howe also tells you that she has noticed an itchy skin rash that was not there before she left hospital. She wonders whether it could be due to the complex mixture of drugs she is taking and asks you what she should do about it. Chapter review questions You should be able to answer the following review questions from the topics covered in the preceding chapter. Why should health care workers look out for potential allergic reactions in patients and how might you predict if a patient is likely to have an allergic reaction to a particular drug? Discuss the reasons why absorption, distribution, metabolism and excretion of drugs are likely to be altered in older people. Explain why adverse reactions to drugs occur more frequently in older people than in the general population. Briefly describe the four main types of receptors that can be targets for drug action. This is a huge area of therapeutics and there are many drugs available to treat these conditions. Common heart disorders are cardiac failure, ischaemic heart disease and disorders of heart rhythm (arrhythmias). Hypertension is included here because many of the drugs used to treat heart disorders are also used in hypertension. A basic knowledge of the physiology of the heart, the mechanism of contraction, electrical activity and control of rate and rhythm, maintenance of blood pressure and what can go wrong is needed in order to understand how the drugs work. The heart functions as a double pump to circulate blood through the lungs and round the rest of the body. The atrium contracts and from here the blood passes through the tricuspid valve to the right ventricle. The ventricle contracts and blood flows through the pulmonary valve and pulmonary arteries to the lungs. The atrium contracts and blood passes through the bicuspid valve into the left ventricle. As the ventricle contracts blood leaves via the aorta passing through the aortic valve. Blood flow through the heart and round the body is maintained by contraction of the atria in unison followed by contraction of the ventricles in unison. The pulmonary and aortic valves close while the atria contract; the tricuspid and bicuspid valves close while the ventricles contract. The contraction phase is known as systole and the relaxation phase of the heart is known as diastole. Stroke volume is the amount of blood ejected by the left ventricle during one contraction and the heart rate is the number of beats per minute. For an average person at rest, stroke volume is around 70 ml and heart rate is about 75 beats per minute. Normally, the force of contraction of cardiac muscle depends on its resting length. Afterload is a function of total peripheral vascular resistance and blood pressure. In either case, the increase in force of contraction results in an increase in cardiac work and oxygen consumption. This is a group of cardiac muscle cells in the right atrium that depolarize spontaneously. The pacemaker forms part of a conduction system that transmits electrical activity through the heart by means of action potentials so that contractions are coordinated and the heart can function as an efficient pump. Action potentials are generated by depolarization followed by repolarization of the cardiac muscle cell membrane. Depolarization is initiated by an influx of sodium ions into the cardiac muscle cells, followed by an influx of calcium ions. The refractory period is the time interval when a second contraction cannot occur and repolarization is the recovery of the resting potential due to efflux of potassium ions. Analysis of the size and shape of the waves can indicate abnormalities of the heart. Heart rate can be altered by the autonomic nervous system to meet changes in demand for blood supply. Sympathetic stimulation increases the rate and force of contraction in response to exercise, threats and emotions. Parasympathetic stimulation reduces heart rate and force of contraction under resting conditions. This is commonly known as blood pressure and can be measured in mmHg (millimeters of mercury). A normal blood pressure measurement would be 120/80 mmHg, where the higher figure is the (systolic) blood pressure when the ventricles are contracting and the lower figure is the (diastolic) blood pressure when the ventricles are relaxed. Blood pressure is highest in the aorta and reduces in blood vessels further away from the heart until it reaches 0 mmHg as blood returns to the right side of the heart. As the heart and circulation is a closed system, the blood pressure is maintained with each contraction of the ventricles. Blood pressure depends on the total volume of blood in the system and on the resistance provided by all the blood vessels. Peripheral vascular resistance depends on the diameter of blood vessels, the viscosity of blood and the total blood vessel length. Under normal circumstances, blood viscosity and total blood vessel length remain the same and do not affect blood pressure. Blood vessel diameter, however, can and does change from moment to moment by vasoconstriction (narrowing) or vasodilation (widening). For example, if body temperature rises above normal, one of the changes that happen is dilation of blood vessels in the skin to allow heat loss. Essentially, blood pressure is monitored by baroreceptors found in the aorta and carotid arteries and regulated by the cardiovascular centre in the medulla of the brain. If blood pressure rises, the rate of impulses being sent to the cardiovascular centre increases.

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Purpose: To publish regulations consistent with [references] for implementation of systems of clemency, parole, retention and enlistment of selected court-martialed offenders who were subject to the authority of the Secretary of the Navy at the time of their offense. To identify a class of specialized psychological materials, and provide policy in the use, security, and supervision of psychological testing procedures in medical treatment facilities and other medical and operational platforms. To provide policy guidance for the evaluation and disposition of patients presenting with suicidal ideation or behavior. This Order establishes the policies and responsibilities for the administration and personnel management of the Marine Corps reserve as outlined in [references]. This Order revises the policies, procedures, and standards for the operation of the Marine Corps Enlisted retention and Career Development Program. The publication of this Order synchronizes the Marine Corps Human resources Development Process. To provide current policy and procedures concerning conscientious objection applicable to all Marines. Establish management policies and procedures for the establishment and operations of Marine Corps Formal Learning Centers. To provide policy and procedural guidance for the Marine Corps Suicide Prevention Program. This Order establishes Service policy and tasks that support [references] and outlines procedures to conduct Marine Corps reserve Component (re) activation, integration, and deactivation as described in [references]. This Order is designed to support contingency planning, crisis action planning, and sustained operations leading to rapid augmentation and/or reinforcement of the [active component] of the U. All Marine Corps parachuting programs will be administered in compliance with this Order. Force preservation is a vital element of our combat readiness; death, serious injury, and the loss of materiel assets due to mishaps directly and negatively impacts the warfighting capability of the entire Marine Corps. Engaged leadership at all levels is the key to ensuring a command climate that demands the preservation of Marine Corps assets through risk management. This Order and [Marine Corps Safety Program] establishes the minimum requirements of the Marine Corps Safety Program based on the references and policies required by resources listed in [the enclosure]. To provide policy and procedural guidance to commanders, substance abuse personnel, and Marines in order to effectively utilize and execute the Marine Corps Substance Abuse Program, per [references]. This Order provides both policy and guidance to commanders so that they may improve their capability to treat and prevent alcohol and drug abuse problems that detract from unit performance and mission readiness. To promulgate policy and guidance for the establishment, management, training, and employment of a Security Augmentation Force at all Marine Corps installations per [references]. This Order is a complete revision of the last Marine Corps [law enforcement manual] and should be reviewed in its entirety. To establish standard licensing procedures for qualifying, testing, and licensing ordnance vehicle operators. Ordnance vehicles are defined as any wheeled or tracked vehicle configured to conduct a combat mission or support an ordnance/maintenance operation. Implementation of the provisions contained herein will enhance selection and certification of qualified ordnance vehicle operators, an essential element for safe and efficient operations. A listing of ordnance vehicles requiring licensed operators is provided in [earlier versions of the order]. To provide policy and procedures on implementing [Family and Medical Leave Act of 1993 (Pub. This manual establishes the criteria for enlistment, procedures governing the processing of applicants and summarizes recruiting support programs to be used in accomplishing the enlisted recruiting mission. To establish criteria and instructions relative to selecting, screening and preparing enlisted Marines for assignment to Special Duties (Drill Instructor, recruiting, Marine Security Guard, Marine Corps Security Forces) and Independent Duties. To establish training standards, regulations and policies regarding the training of Navy Chaplains and [rPs] assigned to the Marine Corps. Per the references, this manual establishes training standards, regulations and policies regarding the training of assigned Navy personnel in Health Services. Training resources must enhance safe and challenging live-fire training, enabling Marine units to train as they fight. This handbook is designed to heighten the awareness of commanders and functional managers to the potential for fraud and waste within their activities. This Directive elaborates upon procedures and methods and provides guidance for implementing the [Marine Corps Mentoring Program]. It also describes the disposition and management of members who have duty limitations and reporting requirements. It provides the basic requirements for Air Force deployment planning and execution at all levels of command to support contingency and exercise deployment operations. It sets the procedures for initiating aviation/parachutist service, awarding Air Force aeronautical ratings and aviation badges, and gives guidance that applies to administering initiation and termination of aviation/ parachutist service and award of ratings/badges. It provides guidance on general [special forces] duties and law enforcement operations. Gives war and peacetime requirements for arming [Air Force] personnel and the use of deadly force. It provides instructions for maintaining discipline and for taking disciplinary and adverse actions against certain civilian employees paid with appropriated funds only. The procedures implemented in this instruction are not [a] basis for change in numbers or type and kind of manpower requirements or authorizations. It describes procedures for the Casualty Services Program for all levels of command and all Air Force organizations. This instruction states how [the Air Force] administratively separate[s] enlisted members for all reasons except physical disability or court-martial. This instruction applies to all officer and enlisted members not serving on active duty with the regular Air Force.

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