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Power is usually maintained but may be decreased infrequently around the ankle joint menstruation with large blood clots ginette-35 2 mg for sale. Sensation involving light touch is mostly intact but is perceived as painful or dysaesthetic or hyperaesthetic particularly on the soles of the feet and palms menstruation or pregnancy bleeding buy ginette-35 with amex. Symptomatic relief from pain may be obtained using simple analgesics and/or amitriptyline women's health issues powerpoint order ginette-35 pills in toronto. The use of carbamazepine or gabapentin either alone or in combination with low dose tricyclics is helpful in some patients embarrassing women's health issues order 2 mg ginette-35. In particular this occurs with the use of the nucleoside reverse transcriptase inhibitors, stavudine (d4T). Care should be taken to ensure that pyridoxine 20 mg/po/daily has been prescribed in those patients taking isoniazid, and thiamine 100 mg/po/daily should be given in suspected cases of B-1 vitamin defciency. It is characterized by a painful marked proximal muscle weakness afecting the limbs and trunk. William Howlett Neurology in Africa 205 Chapter 8 neurologiCal illness in hiv disease Myopathy Proximal weakness & wasting Figure 8. Central nervous system disorders after starting antiretroviral therapy in South Africa. Neurologic manifestations of human immunodefciency virus-2: dementia, myelopathy, and neuropathy in West Africa. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution infammatory syndrome: a case series. This can be transient lasting seconds or minutes as occurs in syncope and seizures or more prolonged as occurs in coma. Coma is by defnition a state of impaired consciousness during which the patient is unrousable by external stimuli. In states of coma the patient remains in a sleep like state with no purposeful movements or response to any external stimuli. Coma can be caused by disorders that afect either a part of the brain focally or the whole brain difusely (Figs. The causes of coma are generally classifed as intracranial or extracranial and are outlined in Table 9. Episodes of transient loss of consciousness are by defnition intermittent and usually sudden events from which the patient recovers fully. Tese arise either from the disorders of the cardiovascular system with an acute reduction of blood fow to the brain (syncope) or a disruption in brain electrical activity (seizure). The chapter outlines the main mechanisms, causes, investigations and management of coma and syncope. The student should aim to be familiar with these and be able to investigate and manage a patient presenting with loss of consciousness. Pathophysiology Consciousness is a person’s awareness of themselves and their surroundings. Normal consciousness is maintained by an intact reticular activating system in the brain stem and its central connections to the thalamus and cerebral hemispheres. Disorders that physically afect these areas can lead to disordered arousal, awareness and to altered states of consciousness. Firstly check that the airway is clear without secretions and that no cyanosis is present. Secondly ensure that breathing rate is satisfactory (rate >10-12/min), that there are William Howlett Neurology in Africa 213 Chapter 9 Coma and transient loss of ConsCiousness infratentorial mass lesion Figure 9. All comatose patients should have their blood glucose checked on arrival and treated immediately if hypoglycaemic (blood sugar <2. The history The history is the most important part of the assessment as it frequently points to the underlying cause of coma. The diagnosis may already be obvious from the circumstances surrounding the coma. If the cause is not obvious then it is necessary to obtain a history from the patient’s family members, friends or colleagues. The history should include information and details concerning the immediate circumstances and the possible cause of the coma. It should also include the patient’s previous medical history, medications, allergies, possible toxins and details of social and family history including recent travel or anything relevant. Key points · loss of consciousness is a medical emergency · cause may be obvious & reversible causes · assessment needs to be brief and focused need to be considered · history is the most important part of the initial · main causes are head injuries, assessment encephalopathies, infections & strokes Table 9. Signs pointing to an underlying illness include paresis, hypertension, tongue biting, ketoacidosis, jaundice and evidence of infection including fever, meningitis, and pneumonia or discharging ear. Altered states of consciousness range from confusion and delirium to stupor and coma (appendix 1). Confusion is characterized by the patient being fully conscious but with impaired attention, concentration and orientation. Confusion can be tested at the bedside by checking if the patient is fully orientated in time, person and place with a score of 10/10 being fully orientated (Table 9. In a state of stupor, the patient is in coma but is rousable after intense stimulation; this is in contrast to coma where the patient is unrousable. This measures eye opening, best motor and verbal response, and is a reliable method for measuring and monitoring level of consciousness. If the patient is not responding to voice then test eye opening and limb movement response to deep pain by applying pressure to sternum or supra orbital ridge or nail beds. Its advantages are that it assesses the main levels of consciousness quickly and is easy and quick to use and communicate. The neurological assessment in coma is necessarily shortened concentrating on the possible neurological causes of coma. Note the level of consciousness and any obvious neurological abnormalities such as seizures, the pattern of breathing and the position of the eyes and posture of the trunk and limbs. In particular, record pupil size, equality, response to light and eye position or movements. Abnormalities include fxed dilated pupil (s), >7 mm in size and non reactive to light. In states of coma the most common cause of a unilateral fxed pupil is herniation (Table 9. The presence or absence of the corneal refexes should be noted and fundi checked for papilloedema. If there William Howlett Neurology in Africa 217 Chapter 9 Coma and transient loss of ConsCiousness is no contra indication to moving the neck such as spinal or head injury neck stifness should be tested although its absence is unreliable in coma. In the comatose patient eye position and movements are observed and examined at rest and during head and neck movement. The details concerning the methods of stimulation (Doll’s eyes and caloric tests), are outlined in appendix 1. Note the presence of any cranial nerve palsies, the position of the limbs and any signs of limb paralysis. Motor response to pain can be checked by noting limb movement in response to a painful stimulus. A fexor response in the arms and concurrent extension of the legs indicates a cortical site of origin (decorticate) whereas an extensor response at the elbow coupled with internal arm rotation and extension of the legs (decerebrate) indicates an upper brain stem injury. Unilateral or asymmetrical posturing indicates a contralateral focal brain lesion/injury. Tese include unresponsiveness of psychogenic origin locked-in syndrome, persistent vegetative state and brain death (appendix 1). Psychogenic this can be a manifestation of severe schizophrenia (catatonia), hysteria (conversion disorder) and malingering. Tese are all diagnoses of exclusion and should only be considered when other causes have been excluded and there is strong evidence in their favour. Neurological exam in these patients is invariably normal and most will exhibit resistance to eye opening and tensing or withdrawal to a painful stimulus. Locked-in syndrome The term locked-in is a rare syndrome which describes patients who though fully conscious are quadriplegic and unable to speak. The main causes are stroke and trauma afecting the brain stem at the level of the pons/midbrain. The patients are usually able to see and hear but are unable to move or communicate apart from moving their eyes/eye lids. The diagnosis can be confrmed by saying/indicating with your own eye movements to the patient to “open your eyes”, “look up”, “down” and “towards the tip of your nose”. Teir eyes open and close normally and they have a sleep-wake cycle because of an intact brain stem but they show no purposeful response to any external stimuli.

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Results: the final sample used in the analyses was 254 womens health exam order ginette-35 overnight, 249 women's health clinic surrey bc ginette-35 2 mg discount, 258 women's health clinic va boise ginette-35 2mg discount, and 245 women at 12 women's health healthy recipes order ginette-35 2 mg on-line, 24, 30, and 36 weeks of pregnancy, respectively. As pregnancy progressed, less number of participants attributed pain to a specific movement. Further research may change estimates of effect, and larger, high-quality randomized controlled trials with robust comparison groups are recommended. Key Points — Question: Does prenatal antidepressant exposure increase the risk for autism spectrum disorders Findings: this systematic review and meta-analysis suggests an association between increased autism spectrum disorder risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. Meaning: Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for autism spectrum disorders. For the review, studies were included if they had been published and were cohort or case-control studies, and for the meta-analysis, studies were included if they were published studies and the data were not derived from the same cohorts. Data Extraction and Synthesis: Three reviewers independently screened titles and abstracts, read full-text articles, and extracted data. Results: Our literature search identified 10 relevant studies with inconsistent results. No association was found when the 2 cohort studies were pooled (772,331 patients) for the whole pregnancy (hazard ratio, 1. Methods: A randomized, single-blind (patients and evaluators) pilot trial was performed to compare foot manipulation to a comparative group at 6-weekly treatment sessions at 5 physiotherapy outpatient clinics in Skaraborg primary care (Skovde, Sweden). Women with a twin pregnancy, low back pain, rheumatoid arthritis, or other serious diseases and those who had previous foot manipulation were excluded. Visual analog scale scores were recorded before study start, before and after each treatment session, and 3 months after delivery. Results: One-hundred and two women were eligible, and 97 were included (group 1: foot manipulation, n = 47; group 2: comparative treatment, n = 50); 40 and 36 in the foot manipulation and comparative treatment groups, respectively, completed the study. The foot manipulation group had a nonsignificant pain relief score compared with that of the comparative group, which had higher pain relief scores. A power analysis showed that at least 250 individuals would be needed in each group to confirm the effect of foot manipulation. A new larger study should choose a different comparative method and test this hypothesis in a full-scale trial. Methods: We reviewed published peer-reviewed primary research articles in the last 26 years from nine databases (Medline Ovid, Embase, Web of Science, Physiotherapy Evidence Database, Osteopathic Medicine Digital Repository, Cochrane (all databases), Index of Chiropractic Literature, Open Access Theses and Dissertations and Cumulative Index to Nursing and Allied Health Literature). Our inclusion criteria were: manual therapy (by regulated or registered professionals) of unsettled, distressed and excessively crying infants who were otherwise healthy and treated in a primary care setting. Outcomes of interest were: crying, feeding, sleep, parent–child relations, parent experience/satisfaction and parent-reported global change. Results: Nineteen studies were selected for full review: seven randomised controlled trials, seven case series, three cohort studies, one service evaluation study and one qualitative study. We found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time (favourable: 1. The risk of reported adverse events was low: seven non-serious events per 1,000 infants exposed to manual therapy (n=1308) and 110 per 1,000 in those not exposed. Conclusions: Some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action. Findings: In this case-control study of 420 children, those with autism spectrum disorder were exposed to greater mean depth of ultrasonographic penetration during the first and second trimesters compared with typically developing children and during the first trimester compared with developmentally delayed children. No association between the number of scans or duration of ultrasound exposure and later autism spectrum disorder was found. Meaning: Increased depth of prenatal ultrasonographic penetration may be associated with perturbations in fetal neuronal cortical migration and later autism spectrum disorder; this correlation deserves further study. Simultaneously, use of prenatal ultrasonography has increased substantially, with limited investigation into its safety and effects on brain development. Animal studies have demonstrated that prenatal ultrasonography can adversely affect neuronal migration. Participants were identified from medical records based on prenatal care and delivery at Boston Medical Center, a diverse, academic, safety-net medical center, from July 1, 2006, through December 31, 2014, with a gestational age at birth of at least 37 weeks. Exposures: Ultrasonographic exposure was quantified by the number and timing of scans, duration of exposure, mean strength (depth, frame rate, mechanical index, and thermal index), and time of Doppler and 3 and 4-dimensional imaging. Further research is needed to determine whether other variables of ultrasound exposure also have adverse effects on the developing fetus. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention and National Institutes of Health Fourth Edition April 1999 U. For additional copies, contact the Government Printing Office at (202) 512-1800, fax number is (202) 512-2250, or write to: Superintendent of Documents, U. Richardson was a pioneer in and ceaseless advocate for biological safety and education. He shaped the programs for quarantining animals imported into the United States and for handling dangerous biological organisms in research laboratories. He was a charter member and former President of the American Biological Safety Association, and helped develop its certification program for biological safety professionals. After a long and distinguished career in the Public Health Service, he served as Director of the Environmental Safety and Health Office of Emory University before becoming a widely sought biosafety consultant. Richardson will be missed by the many friends and associates who were privileged to know and work with him. Director, Office of Health and Safety Public Health Service Centers for Disease Control and Prevention 1600 Clifton Road N. Chief, Epidemiology Section Arbovirus Disease Branch National Center for Infectious Diseases Mark L. Chief Biology and Diagnostics Branch Division of Parasitic Diseases National Center for Infectious Diseases Thomas Folks, Ph. Senior Laboratory Advisor Division of Bacteriology and Mycotic Diseases National Center for Infectious Diseases Richard C. Division of Viral and Rickettsial Diseases National Center for Infectious Diseases ii C. Chief Special Pathogens Branch National Center for Infectious Diseases Margaret A. Chief External Activities Program Office of Health and Safety National Institutes of Health John Bennett, M. Chief, Mycology Section National Institute for Allergies and Infectious Diseases David Hackstadt, Ph. Director, Tulane Regional Primate Research Center Tulane University Medical Center Covington, Louisiana Thom as Hamm, D. Director, Biological Safety and Infection Control Duke University Medical Center Durham, North Carolina Peter Jahrling,Ph. Summary of Recomm ended Biosafety Levels for Activities in Which Experimentally or Naturally Infected Vertebrate Animals Are Used. Arboviruses and Certain Other Viruses Assigned to Biosafety Level 3 (on the basis of insufficient experience). They are intended to provide a voluntary guide or code of practice as well as goals for upgrading operations. They also are offered as a guide and reference in the construction of new laboratory facilities and in the renovation of existing facilities. However, the application of these recommendations to a particular laboratory operation should be based on a risk assessment of the special agents and activities, rather than used as a universal and generic code applicable to all situations. Since the publication of the third edition of Biosafety in Microbiological and Microbiological Laboratories, a number of events have occurred that influenced some of the changes made in this fourth edition. C In response to global concern about emerging and re emerging infectious diseases, the section on Risk Assessment has been enlarged to provide the laboratorian with additional information to make such determinations easier. C A considerable increase in the design and construction of biomedical and microbiological laboratories has occurred, particularly at Biosafety Levels 3 and 4. In response, an appendix has been added to viii address the varied biosafety concerns associated with working with these agents. C Several laboratory-associated infections have occurred involving both known and previously unknown agents. In response, various Agent Summary Statements have been modified or added to this edition. C Concern has increased regarding the national and international transfer of infectious microorganisms. Each Agent Summary Statement now contains information regarding the requirements to obtain appropriate perm its before transferring the agents from one laboratory to another.

Specifically menopause irregular bleeding generic ginette-35 2mg mastercard, a full agonist may have diminished efficacy/effectiveness over time because of agonist-induced desensitization menopause symptoms after hysterectomy buy ginette-35 line, and a full agonist may cause excitotoxicity breast cancer elite socks purchase ginette-35 discount. Thus women's health clinic baton rouge proven 2mg ginette-35, D-cycloserine, a partial glycine agonist, may be expected to better retain efficacy/effectiveness upon chronic administration, while not being associated with increased risk for excitotoxicity; however, this is an empirical question that we will pursue in future studies. Because an unbalanced increase in protein synthesis in basilar dendrites is thought to contribute to the pathophysiological disturbance of Fragile X Syndrome, which has a high co-morbid prevalence of autism spectrum disorders, mGluR5 antagonism is emerging as a promising therapeutic strategy for this X-linked disorder. The high comorbid prevalence of autism spectrum disorders among persons with Fragile X Syndrome and the beneficial effect of mGluR5 antagonism in mouse models of Fragile X Syndrome stimulated exploration of mGluR5 antagonism in another genetically-inbred mouse model of autism spectrum disorders (Silverman et al. Repetitive self-grooming is thought to reflect and model the symptom domain of “restricted repetitive and stereotyped patterns of behavior,” which is an important dimension of psychopathology in autism spectrum disorders. Because the baseline level of stereotypies in the Balb/c strain is low, it is hard to detect drug effects on stereotypy outcome measures in this strain. Given the fact administration of glutamate “agonists” lack specificity and bind to a diverse variety of metabotropic and ionotropic glutamate receptors, in addition to their potential for excitotoxicity, interest has shifted to development of positive and negative allosteric modulators to selectively increase and decrease, respectively, signal transduction by metabotropic glutamate receptors (Conn et al. Unlike the agonist recognition sites themselves that show conservation of their electronic architecture for recognition of glutamate and its analogues, allosteric modulatory sites show diversity of structure among glutamate receptors, affording “selectivity. Very importantly, preclinical studies must also include chronic dosing conditions and the demonstration of sustained efficacy. Moreover, in addition to stimulation of the glycineB site with agonists, a strategy that is supported by the results of the D-serine and D-cycloserine experiments discussed in this review, interference with presynaptic reuptake of glycine via the use of glycine-1 transporter inhibitors. The genetically-inbred, sociability impaired Balb/c mouse may also be used to study the effects of neurosteroids on sociability; neurosteroids act at the level of cell surface ionotropic receptors. Clearly, this is a highly speculative discussion, but the availability of genetic mouse models of autism spectrum disorders in general, and impaired sociability in particular, tested in a standard paradigm to assess sociability encourage and make this type of systematic examination possible. There are provocative data suggesting that D-cycloserine improved social withdrawal in a small sample of 10 children with autism (Posey et al. Clearly, the therapeutic effect of a medication in this neurodevelopmental disorder is expected to be small and clinical trials must minimize “noise” associated with subject differences that may obscure a positive effect of treatment. Nonetheless, a medication that targets domains of sociability and cognition in the context of a well-designed interdisciplinary, individualized treatment plan that includes components of special education, speech and language therapy, occupational therapy and vocational assessment and training may contribute to significantly improved quality of life for many persons suffering with autism spectrum disorders. An outline for an integrated therapeutic strategy to address the sociability deficit of persons with autism spectrum disorders is shown in Table 3; clearly, medications will be only one component, albeit an important one, of a comprehensive individualized, interdisciplinary, multimodal treatment plan. Recent efficient, high-throughput strategies for interrogating the human genome in large populations of referred persons with developmental disabilities showed that microdeletions of 15q13. Interaction of stress and strain on glutamatergic neurotransmission: relevance to schizophrenia. Neuroligin-1 deletion results in impaired spatial memory and increased repetitive behavior. Copy number variation characteristics in subpopulations of patients with autism spectrum disorders. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 156, 2, 115-24. Locomotor activity of the genetically inbred mouse strain is suppressed by a socially-salient stimulus. Genetically inbred Balb/C mice are more sensitive to an effect of flurazepam and more resistant to an effect of stress than a genetically outbred mouse strain. Divergent Effects of mGluR5 Antagonism on Sociability and Stereotypic Behaviors in Mice: Possible Implications for the Pharmacotherapy of Autism Spectrum Disorders, submitted manuscript. Activation of metabotropic glutamate receptors as a novel approach for the treatment of schizophrenia. Interaction of N-methyl-D-aspartate and group 5 metabotropic glutamate receptors on behavioral flexibility using a novel operant set-shift paradigm. Pharmacotherapeutic Implications of the Association between Genomic Instability at Chromosome 15q13. Allosteric modulation of metabotropic glutamate receptors: structural insights and therapeutic potential. D-serine Improves Dimensions of the Sociability Deficit of the Genetically-Inbred Balb/c Mouse Strain. D-Cycloserine enhances social behavior in individually-housed mice in the resident-intruder test. N-Methyl-D-aspartate receptors as a target for improved antipsychotic agents: novel insights and clinical perspectives. Part 9 Sensory Motor and Visual Perspective Taking 20 Sensory Motor Development in Autism Yesim Fazlioglu and M. Introduction Autism is a syndrome that emerges in the first three years of life and is defined by a pattern of qualitative abnormalities in reciprocal social interaction, communication, and repetitive interests and behaviors. One of the characteristics which is most noticeable in those young children with autism who remain severely intellectually disabled is their propensity to engage in repetitive self-stimulatory actions, such as rocking, twirling objects or flapping their hand and finger. These actions appear to have no constructive use other than to provide some sensory stimulation (Attwood, 1993). These abnormalities have been described in the perception of sound, vision, touch, taste, and sm ell, as w ell as kinesthetic and proprioceptive sensations. These include reports of both hypo and hyper responsiveness to sensory input, raising the possibility that two groups of sensory responders may exist within the autism spectrum. Comparing children with autism and children with other developmental disorders have concluded that prototypical developmental profile for children with autism is one of motor skills that are relatively more advanced than social skills, even when all delayed. Early hand-eye coordination significant predicted later vocational skills and independent functioning, while earlier fine motor skills predicted later leisure skills. Also motor development plays an important role in learning young children typically use motor skills to explore the environment, engage in social interaction, engage in physical activities, and develop basic academic skills. Given that most educational environment involve many sensorial demands, such as: noise level in classroom (O’Neill & Jones, 1997; Dawson & Watling, 2000). These problems make the life of the child and his/her family more difficult and they prevent the child from learning new skills and having interaction with the environment. In solving sensory problems, it is important to support autistic children in gaining different sensory experiences. Because the sensory integration therapy provides a child-centered and playful approach that is often appealing to even the most unmotivated or disengaged child (Case Smith & Brayn, 1999; Fazlioglu & Baran, 2008). This chapter will focus on sensory and motor development in autism, which are aimed at determining sensory problems that characterize the disorder. In addition, this chapter will comprehensive sensory integration therapy approaches, given the intensity and importance of these intervention in treatment planning. Definition and development of sensory integration Sensory integration theory was developed by Jean Ayres during 1970s. The aim of this theory is to stimulate specific locations of the body in order to ensure coordinated function of sensors. Ayres developed this theory in an attempt to better explain the relation between the sensory process, neural functions and behavior. Sensory integration treatment is used for children with autism as well as those with hyperactivity, cerebral palsy and premature birth (Fisher & Murray, 1991; Kranowitz, 1998; Bahr, 2001). Sensory integration is a neurological process which compasses the analysis, synthesis and organization of the data received from the body and the environment. Sensory integration takes role in developing body perception, selection of concurrent stimuli, and the ability to act in convenience with the environment. Brain promptly analyses, collates associates and integrates the respective sensory signals through neurologic processing. For instance; when someone says “I love you”, vocal response is “I love you, too” whereas the emotional response is euphoria. Sensory integration mechanism in childhood continues through lifetime (Kranowitz, 1998). It develops through new activities in daily life, experimenting, effort and exploring the environment. Developmental mechanism of sensory integration does not change and the development is constant. First, the foundation of the structure is laid which is followed by the construction of the first, second, third and fourth floor respectively. Ayres defines the integration mechanism in four levels: First Level: this level constitutes tactile, balance and movement (vestibular), deep sensory (proprioceptive), visual and auditory sensory. Babies begin to show interest in sensorial information as of second month therefore forming a basis for future learning skills.

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For example pregnancy 0-8 weeks discount ginette-35 online mastercard, no previous study has focused on specific vegetables or fruits despite those that have used unspecified fruits and vegetable waste streams reporting excellent development rates and low mortalities (Carruthers menstruation calendar order 2mg ginette-35 mastercard, 2014) menstrual cycle 9 days late purchase ginette-35 2 mg overnight delivery. Therefore commercial scale application of the technology will demand usage of substrates that can yield quality larvae within a short duration and reduce losses through mortality is a necessary breast cancer quotes for family discount ginette-35 2mg line. Organic waste materials are also highly heterogeneous in nature and variable in terms of moisture and nutrient content and therefore generalized applications of findings is almost impossible (Holmes et al. In Kenya no legal restriction exists on usage of fruit and organic waste such as spoilt fruits and vegetables. Again, large quantities of fruits and their byproducts accumulate at production farms in peaky seasons and present disposal and public health concerns whereas the only cost to be considered for these substrates relates to collection, transportation and some moderate processing such as cutting into small pieces and removal of inorganic materials (Nguyen et al. In addition, the selection of avocado was also mitigated by a high fat content (refer to Table 2), which is known to be a source of metabolic energy and can therefore spare the protein amount for growth and development (Sang-Min and Tae-Jun, 2005; Emebu and Anyika, 2011. A suitable rearing substrate should contain at least 20% crude protein content to be considered a source of protein in a feeding diet (Ramos-Elorduy et al. Among the selected substrates for this study only food remains (20%) brewers waste (26%) and mixture of vegetable and fruit wastes (20%) met this criterion (Munguti et al. The three substrates were therefore selected on this basis amid others such as ease of availability and low cost that relates mainly to transportation from collection sites. Performance of food waste and faecal sludge in previous studies also mitigated for their selection. Fritzi (2015) reported that among the four substrates used in the study food remains produced the heaviest prepupa and highest yield followed by brewers waste with feacal sludge in third place. These findings concur with those of Barry (2004), hence the justification for the usage of the substrate in the current study. This was also the main consideration for selecting the substrate in this study, coupled by the good performance as a production substrate at Sanergy as reported by Fritzi (2015). These include aspects such as larvae feeding amounts (feed rate), feeding frequency (regime), substrate types and substrate combination ratios, substrate depth, larvae stocking densities, substrate moisture content, environmental rearing conditions such as temperature and relative humidity; and size of substrate particles among others (Holmes et al. The study subsequently predicted that a feeding rate of 100 mg of chicken feed at 60% moisture as the optimal tradeoff feed rate between nutrient rich prepupa and high waste consumption in the shortest time span and also proposed optimal feed rates for various feed sources: kitchen waste (61mg/l/d), vegetable waste (98 mg/l/d), green banana (103 mg/l/d), pig manure (158 mg/l/d); poultry manure (175 32 mg/l/d) and human faeces (130 mg/l/d). Whereas the study accurately established that optimal feed rates vary for different substrates, the predicted values have so far not been contradicted by latter findings. This shows that the feed rate may be related to the quality of the substrate (Liu et al. Larvae fed on lump sum mode were larger and heavier than those fed continuously but with slower maturation periods compared to those fed on continuous regimes contrary to the study of Mutafela (2015) where continuous regime fed larvae took an average of 2-3 days longer than the ones in batch feeding though the substrates were different. Consequently continuous replacement of feed (continuous feeding regime) has somehow developed as a standard protocol for feeding in literature though with no reported tangible biological benefit or lack of it (Sheppard et al. There is limited information on the optimal 33 regimes or feed rates when the larvae process agricultural wastes and on production systems designed for biomass production. Therefore, the waste mix in a developed country is different from that of a developing country and generally from place to place. Again, most of these researches were done in developed countries with only few in developing countries. The only known applications of the soldier fly technology in the tropics are the bioconversion of palm kernel meal in the Republic of Guinea and market waste in Indonesia (Hem et al. There is the need to try the usage of this technology especially on the role of mixed substrates in optimizing both dry matter reduction and growth and development of black soldier fly larvae for biomass production elsewhere. The little that has been published relates to distant places such as Asia and the Americas (Sheppard et al. This lack of knowledge concerning tropical and equatorial regions and substrates needs to be filled. These strategies have however, not been successful in the third world, mostly because of declining land sizes, stagnant farming technology, poor infrastructure and an ever-expanding population. As a result, fishing is touted as the only 34 sector with the potential to cope with the demands of the rising population (Kassahun et al. Nutritionally, fish is one of the cheapest and direct sources of protein, micro nutrient and income to many people in the world and especially in developing countries courtesy of its wide acceptability across social, cultural and religious backgrounds compared to other animal products (Bene and Heck, 2005; Gabriel et al. Fish represents almost 16% of all animal protein consumed globally and in Africa, as much as 5% of the population depends wholly or partly on the fisheries sector for their livelihood (Gabriel et al. Much of the fish currently consumed in Africa mostly comes from the natural rivers and lakes in the continent. The paradox is however that aquaculture uses wild caught fish for fishmeal production and therefore diverts a food source that could be consumed by humans. In Kenya, fishmeal is processed from the silver cyprinid (Rastrineobola argentea, locally known as “Omena”) and the Nile perch captured from Lake Victoria and the Indian Ocean waters (Bokea and Ikiara, 2000; Nyandat, 2007). It is estimated that between 50 and 65% of the silver cyprinid from Lake Victoria is used to produce fishmeal whose supply is about 30, 000 tonnes per annum (Abila, 2003). Consequently, fishmeal supply is considered the major constraint facing the animal feed industry as a whole (Bokea and Ikiara, 2000). The situation has negatively impacted food security and the livelihoods of lakeside populations as importation makes the product expensive and unaffordable (Nyandat, 2007). This has made aquaculture an 35 expensive venture and therefore hindered the potential of the sector to bridge the gap between fish demand and supply (Gabriel et al. There is therefore need for an alternative protein source, preferably produced on by-products and materials which are not suitable for direct human consumption and local production of fish feed from inexpensive and locally available feedstuffs to reduce the cost of production, provide a cheaper means of meeting the protein requirements, improve food security and reduce the level of poverty in developing countries (Hoffman et al. A number of organic wastes and by-products from agricultural and industrial sectors are available in Kenya, which are usually not utilized for human consumption, but may have a high potential for aquaculture. These can be used both as ingredients for locally compounded feeds and as production substrates for currently underutilized animal protein sources such as farmable edible insects for inclusion in the compounded feeds (Van Itterbeeck et al. The transformation of these locally available by-products low in protein into high quality fish protein can be a major contribution to improving the protein supply for the local human population. Global enthusiasm for insect farming is growing as its diverse range of potential commercial and environmental benefits become well recognised (Devic, 2016). Insects which can be produced on organic waste products provide a more sustainable source of protein for animal feed. Use of farmable edible insects as feed ingredients is associated with certain advantages: they are rich in proteins, fat, energy, vitamins and minerals; have higher feed conversion efficiency compared to livestock and therefore use less feed; less land than crop production; have great acceptance from poultry and fish as part of their natural diet and are mostly omnivorous and therefore grow on different substrates (van Huis et al. However despite the tremendous potential to be used as a feed item of many livestock animals, they are currently not widely used perhaps due to inadequate knowledge about their potential (Devic, 2016). To date, studies of fish species fed black soldier fly 36 larvae have only been performed with rainbow trout, Oncorhynchusmykiss; channel catfish, Ictalurus punctatus; and blue tilapia, Oreochromis aureus. The studies report that the larvae can replace up to 25% of fishmeal use with zero adverse effects. This requirement has proved difficult and energy consuming to sustain in the temperate climates and during winter periods (Holmes et al. Use of greenhouses to ensure continued production during the cold seasons within the tropics and equatorial climates has made the enterprise expensive (Holmes et al. The duration of the life cycle ranges between several weeks to several months depending on temperatures, quality and quantity of the diet. The continued lack of legal framework and specific legislations on the use of insects discourages investment in the sector (Leek, 2017). This is in contrast to countries in Africa where there is virtually no restriction on the kind of substrates used (Leek, 2017). Most of these accumulate in ecosystems and in larva, and at higher 37 concentrations may be toxic both to the larvae and the consuming animals along the food chain (van Huis et al. Insects that fall under the category of ‘flies’ are commonly perceived as filthy and unsanitary (van Huis et al. This is perhaps because society associates them with houseflies which are a known health risk. Lack of collaboration among experts in the field to make necessary explanations to the naive public and create awareness on potential of insects as a food and feed resource has contributed to poor acceptance and persistence of the wrong perceptions (Smith and Barnes, 2015). However the perceived benefits of insects such as sustainable production, lowered dependence on imported protein sources and lower environmental impact are mitigating for improved change of attitude towards broad acceptance and are considered more important than the perceived risks such as microbiological contamination, chemical residues in the food chain and lower consumer acceptance of animal products (Verbeke, 2015). Healthy risks from a variety of pathogens, parasites and diseases are a major challenge in insect production systems (Leek, 2017). Knowledge of disease and health management in intensive insect rearing is still limited and population crashes sometimes involving the whole colony do occur (Leek, 2017). For instance in Georgia, a parastoid wasp of the Trichopria genus has been reported to infect 21-32% of Black Soldier Fly pupae (Mutafaela, 2015). Current mitigation measures involve minimizing the health risks by ensuring bio-security in a breeding colony, use of very ‘clean’ substrates and separate housing of the different stages of the breeding stock to avoid cross infection between the different stages (Leek, 2017). In addition, predators such as rats, mongooses and lizards do feed on larva and adults and can therefore significantly contribute to diminishing of populations and returns.

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Walker goes so far as to pregnancy after miscarriage purchase 2 mg ginette-35 amex call municipal police “delegated vigilantes women's health clinic rockdale purchase ginette-35 line,” entrusted with the power to women's health center roseville ca ginette-35 2mg low price use overwhelming force against the “dangerous classes” as a means of deterring criminality women's health clinic denton tx order 2mg ginette-35 otc. In the post-Civil War era, municipal police departments increasingly turned their attention to strike-breaking. By the late 19th century union organizing and labor unrest was widespread in the United States. New York City had 5,090 strikes, involving almost a million workers from 1880 to 1900; Chicago had 1,737 strikes, involving over a half a million workers in the same period (Barkan 2001; Harring 1983). Many of the “riots” which so concerned local economic elites were actually strikes called against specifc companies. The use of public employees to serve private economic interests and to use legally-ordained force against organizing workers was both cost-efective for manufacturing concerns and politically useful, in that it confused the issue of workers rights with the issue of crime (Harring 1981, 1983). The frst was the most obvious, the forced dispersal of demonstrating workers, usually through the use of extreme violence (Harring 1981). In order to prevent the organization of workers in the frst place, municipal police made staggering numbers of “public order” arrests. In fact, Harring concludes that 80% of all arrests were of workers for “public order” crimes (Harring 1983). On a day-to-day basis it hauled nearly a million workers of to jail between 1975 and 1900. In other cities police made use of ambiguous vagrancy laws, called the “Tramp Acts,” to arrest both union organized and unemployed workers (Harring 1977). Anti-labor activity also compelled major changes in the organization of police departments. Alarm boxes were set up throughout cities, and respectable citizens, meaning businessmen, were given keys so that they could call out the police force at a moment’s notice. The patrol wagon system was instituted so that large numbers of people could be arrested and transported all at once. Horseback patrols, particularly efective against strikers and demonstrators, and new, improved, longer nightsticks became standard issue. Tree compelling issues faced early American police departments: (1) should police be uniformed; (2) should they carry frearms; and (3) how much force could they use to carry out their duties. The local merchants and businessmen who had pushed the development of municipal policing wanted the police uniformed so that they could be easily identifed by persons seeking their assistance and so they would create an obvious police presence on the streets. They felt that uniforms would subject them to public ridicule and make them too easily identifable to the majority of citizens who bore the brunt of police power, perhaps making them targets for mob violence. Early police ofcers began carrying frearms even when this was not department policy despite widespread public fear that this gave the police and the state too much power. Police departments formally armed their ofcers only after ofcers had informally armed themselves. The use of force to efect an arrest was as controversial in the 1830s and 1840s as it is today. Because the police were primarily engaged in enforcing public order laws against gambling and drunkenness, surveilling immigrants and freed slaves, and harassing labor organizers, public opinion favored restrictions on the use of force. But the value of armed, paramilitary presence, authorized to use, indeed deadly force, served the interests of local economic elites who had wanted organized police departments in the frst place. The presence of a paramilitary force, occupying the streets, was regarded as essential because such “organizations intervened between the propertied elites and propertyless masses who were regarded as politically dangerous as a class” (Bordua and Reiss 1967). State police agencies emerged Because the police were for many of the same reasons. This all-white, all-”native,” immigrants and freed paramilitary force was created slaves, and harassing labor specifcally to break strikes in the coal organizers, public opinion felds of Pennsylvania and to control local towns composed predominantly favored restrictions on the of Catholic, Irish, German and use of force. They were housed in barracks outside the towns so that they would not mingle with or develop friendships with local residents. In addition to strike-breaking they frequently engaged in anti-immigrant and anti-Catholic violence, such as attacking community social events on horseback, under the pretense of enforcing public order laws. Similarly, the Texas Rangers were originally created as a quasi-ofcial group of vigilantes and guerillas used to suppress Mexican communities and to drive the Commanche of their lands. By the end of 19th century municipal police departments were frmly entrenched in the day-to-day political afairs of big-city political machines. Police provided services and assistance to political allies of the machine and harassed, arrested and interfered with the political activities of machine opponents. Political machines at the turn of the century, were in fact, the primary modality through which crime was organized in urban areas. Politicians ran or supervised gambling, prostitution, drug distribution and racketeering. In fact, organized crime and the dominant political parties of American cities were one in the same. Politicians also employed and protected the many white youth gangs that roamed the cities, using them to intimidate opponents, to get out the vote (by force if necessary), and to extort “political contributions” from local businesses. At the dawn of the 20th century, police were, at least de facto, acting as the enforcement arm of organized crime in virtually every big city. Police also engaged in and helped organize widespread election fraud in their role as political functionaries for the machine. In return, police had virtual carte blanche in the use of force and had as their primary business not crime control, but the solicitation and acceptance of bribes. It is incorrect to say the late 19th and early 20th century police were corrupt, they were in fact, primary instruments for the creation of corruption in the frst place. Police departments during the machine-era provided a variety of community services other than law enforcement. In New York and Boston they sheltered the homeless, kept tabs on infectious epidemics, such as cholera, and even emptied public privies. While this service function of police continues to be important today, it is important to recall that in the context of political machine, government services were traded for votes and political loyalty. And while there is no doubt that these police services were of public value, they must be viewed as primarily political acts designed to curry public favor and ensure the continued dominance of their political patrons. The outlawing of alcohol combined with the fact that the overwhelming majority of urban residents drank and wished to continue to drink not only created new opportunities for police corruption but substantially changed the focus of that corruption. During prohibition lawlessness became more open, more organized, and more blatant. Major cities like New York, Chicago and Philadelphia has upwards of 20,000 speakeasies operating in them. Overlooking that level of publicly displayed crime required that corruption become total. But most important to policing, Prohibition marked a change in how corruption was organized. Criminal syndicates, set up to deliver alcohol to all those illegal outlets, acquired enormous sums of money, political power in their own right, no longer dependent on the machine’s largesse, and respectability. Organized crime was able to emerge from the shadows and deal directly with corrupt police. In many cities police became little more than watchmen for organized crime enterprises, or, on a more sinister vein, enforcement squads to harass the competition of the syndicate paying the corruption bill. The outrages perpetrated by municipal Organized crime was police departments in the ensuing years inevitably brought cries for reform. Initially, able to emerge from reform eforts took the form of investigative the shadows and deal commissions looking into both police and directly with corrupt political corruption. And, like today, those commissions upon investigating the specifc incident in their charge, uncovered widespread corruption, misfeasance and malfeasance. One of the earliest of these investigative commissions was the Lenox Committee, formed in 1894 to investigate police corruption related to gambling and prostitution and to investigate charges of police extortion. The Lenox Committee also determined that promotion within the New York Police Department required a bribe of $1,600 to be promoted to sergeant and up to $15,000 to be promoted to Captain. Subsequent investigatory commissions in New York City include the Curren Committee (1913), which investigated police collusion with gambling and prostitution; the Seabury Committee (1932), which investigated Prohibition-related corruption; the 1949 Brooklyn grand jury which investigated gambling payofs; the 1972 Knapp Commission which looked into corruption related to gambling and drugs; and the 1993 Mollen Commission which exposed massive drug corruption, organized theft by police ofcers, excessive use of force, and use of drugs by the police (Kappeler, Sluder and Alpert 1998). In Philadelphia a series of investigative grand juries exposed massive police collaboration with gambling and prostitution enterprises. Commissions also investigated police corruption in Louisville, San Francisco, Milwaukee, New Orleans, Indianapolis, Atlanta and Los Angeles.

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Early talks on the foundation of the SGA. The meeting was held in Professor Amstutz's office at the University of Heidelberg on 19./20. June 1965. Sitting (from left) A. Maucher, Lombard, P. Routhier, P. Ramdohr, G.L. Krol; standing: A. Bernard and C. Amstutz.