A S K T H E E X P E R T
Children exposed to bats: Evidence-based
management strategies
John S. Murray, Marcia K. Stephens, and Parag M. Amin
Column Editor: Martin Schiavenato
Ask the Expert provides research-based answers to practice questions submitted by JSPN readers.
Search terms
Bat exposure, children, rabies
Author contact
[email protected], with a copy to the Editor:
[email protected]
Disclosure: The authors report no actual or
potential conflicts of interest.
doi: 10.1111/jspn.12082
Question: What are the current recommenda-
tions for pediatric healthcare professionals
managing bat exposure in children?
John S. Murray, PhD, RN, CPNP, FAAN, Marcia
K. Stephens, RN, and Parag M. Amin, MD
respond: In the United States, there are approxi-
mately 40 different species of bats. While most bats are
harmless, and various types are even beneficial (e.g.,
those that feed on insects harmful to crops), some may
be infected with, and transmit, rabies. Public health
concern regarding rabies has changed dramatically
over the past several decades. Before the 1960s, most
cases of rabies involved domestic animals (e.g., dogs
and cats). Today the primary hosts for rabies are wild
predatory animals (e.g., raccoon, fox, and coyote) and
bats. In fact, in the United States, the most common
source of rabies transmission to humans is from bats
(Figure 1; Baker, 2012; Centers for Disease Control
and Prevention [CDC], 2011a; CDC Advisory
Committee on Immunization Practices [ACIP], 2008;
National Association of State Public Health
Veterinarians, 2011). While death from rabies is a rare
occurrence in the United States, it is estimated that
16,000–39,000 people annually are exposed to poten-
tially rabid animals requiring post-exposure care (CDC
Immunization Action Coalition, 2013).
TYPES OF EXPOSURE
Under most circumstances, two types of exposure to
bats are possible: bite and non-bite (CDC, 2011b; CDC
ACIP, 2008; DeMaria, 2014). Bites are defined as any
penetration of the skin by the teeth of a bat. This route
of exposure is considered to be the most serious.
However, bat bites are often so small, and with limited
injury, that they go unnoticed (Figure 2). Rabies
exposure can also occur when the virus, from poten-
tially infectious secretions of the bat such as saliva,
come in contact with open cuts, scratches, abrasions,
or the mucous membranes of a child. Other situations
that qualify as exposure include a bat found in prox-
imity to a child who is not able to describe what hap-
pened or who is unable to rule out the occurrence of
direct contact, or a parent who witnesses a live bat in a
room where a child was unattended at the time (e.g.,
bedroom, playroom). Additionally, a bat located on
the floor where an infant, toddler, or child with
sensory or mental impairment is situated is also con-
sidered to be a contact risk. If there is ever a question
regarding exposure, state and local health depart-
ments should be contacted for guidance. The type of
c.
alhajji1alhajji 2Jafar AlhajjiVaccines Safety and Effectiven.docxsimonlbentley59018
alhajji1
alhajji 2
Jafar Alhajji
Vaccines Safety and Effectiveness
Do you think vaccination is an important or just harmful substance forced by pharmaceutical companies cooperating with the governments to inject into people? Vaccine can be defined as “biological preparations that, when introduced into the body, cause an individual to acquire immunity to a specific disease” (Davidson. 7). So, for decades, vaccines have been considered one of the best revaluation in medical practice. A long time ago, people all around the world tried to fight with different kinds of fatal diseases by different ways, and one of the most Significant ways is to make a vaccine, to prevent such life- threatening diseases. The first vaccine was against the Smallpox disease. Smallpox is a highly contagious disease and caused a lot of fatalities all around the world, and it is transmitted between people by inhalation of droplets of virus or direct contact with smallpox lesion secretions (Davidson 25). It is a deadly disease, it caused blindness and permanent scars in the patients that survived. Finally, after several attempts to make a vaccine for Smallpox, Edward succeeded to produce an effective and safe vaccine in 1796 by using the cowpox vaccine to protect from smallpox. Cowpox is a disease cause by cows and transferred to human, and Jenner’s theory was based that whoever had cowpox will be immunized against smallpox (Davidson 29). “Edward Jenner was an English country doctor who introduced the vaccine for smallpox. Previously a keen practitioner of smallpox inoculation.”
Then, century after century, vaccine after vaccine was developed for different kinds of diseases. In the 20th century, one of the most known vaccines was Diphtheria and Tetanus vaccines. Diphtheria is a respiratory illness, causing the release of exotoxin from Corynebacterium diphtheriae bacteria which leads to death of mucus cells in the throat, mouth and nose, and as a result of cells accumulation the pseudo-membrane are build up and block the airways of the patients which causes death (Davidson 42) After years of experiments and trials to make a vaccine to fight this disease, Gaston Ramon a French veterinarian and biologist who realized that attenuated Diphtheria toxin is able to activate the immune system of people without causing serious side effects, and by 1927, the toxoid vaccine was freely used all around the world, and it succeeds to drop the number of cases of diphtheria. Then, by using the same way of toxoid, combined Diphtheria and Tetanus Toxoid vaccines were produced. Tetanus can be described as a nerves system infection that leads to spasm and contract of body muscles, especially jaw muscles which make the patients unable to open their mouths (Davidson. 44)
Another example of one of the most significant vaccine is a Polio vaccine. Polio disease, mainly affecting children under 5 years old, and leading to paralysis and often to death due to immobilization of respi.
Rotavirus is commonly spread from person to person through the fecal-oral route. It infects the small intestine where replication occurs. Infected children begin shedding the virus in their stool before symptoms appear and can shed over 1 trillion viral particles per gram of stool. Transmission can be reduced through frequent handwashing and treating contaminated materials at high temperatures. Rotavirus infections in adults are generally milder than in children. Vaccines have been developed to help prevent rotavirus infection and gastroenteritis in infants and young children.
Alhajji 1
Alhajji 6
JafarAlhajji
Professor:
English homework
May 1, 2019
Vaccines safety and effectiveness
Do you think vaccination is an important or just harmful substance forced by pharmaceutical companies cooperating with the governments to inject into people? A vaccine can be defined as "biological preparations that, when introduced into the body, cause an individual to acquire immunity to a specific disease” (Davidson. 7). So, for decades, vaccines have been considered one of the best revaluation in medical practice. A long time ago, people all around the world tried to fight with different kinds of fatal diseases by different ways, and one of the most Significant ways is to make a vaccine, to prevent such life-threatening diseases. The first vaccine was against the Smallpox disease. Smallpox is a highly contagious disease and caused a lot of fatalities all around the world, and it is transmitted between people by inhalation of droplets of virus or direct contact with smallpox lesion secretions (Davidson 25). It is a deadly disease, it caused blindness and permanent scars in the patients that survived. Finally, after several attempts to make a vaccine for Smallpox, Edward succeeded to produce an effective and safe vaccine in 1796 by using the cowpox vaccine to protect from smallpox. Cowpox is a disease caused by cows and transferred to a human, and Jenner's theory was based that whoever had cowpox will be immunized against smallpox (Davidson29).“Edward Jenner was an English country doctor who introduced the vaccine for smallpox. Previously a keen practitioner of smallpox inoculation.”
Then, century after century, the vaccine after the vaccine was developed for different kinds of diseases. In the 20th century, one of the most known vaccines was Diphtheria and Tetanus vaccines. Diphtheria is a respiratory illness, causing the release of exotoxin from Corynebacterium diphtheria bacteria which leads to the death of mucous cells in the throat, mouth, and nose, and as a result of cells accumulation the pseudo-membrane are build up and block the airways of the patients which causes death (Davidson42) After years of experiments and trials to make a vaccine to fight this disease, Gaston Ramona French veterinarian and biologist who realized that attenuated Diphtheria toxin is able to activate the immune system of people without causing serious side effects, and by 1927, the toxoid vaccine was freely used all around the world, and it succeeds to drop the number of cases of diphtheria. Then, by using the same way of toxoid, combined Diphtheria and Tetanus Toxoid vaccines were produced. Tetanus can be described as a nerves system infection that leads to spasm and contract of body muscles, especially jaw muscles which make the patients unable to open their mouths (Davidson. 44)
Another example of one of the most significant vaccine is a Polio vaccine. Polio disease, mainly affecting children under 5 years old, and leading to paralysis and often to .
This paper discusses the importance of vaccines for eradicating disease. It argues that vaccines are both safe and cost-effective compared to treating diseases. While some parents resist vaccines due to disproven claims about side effects, studies show that vaccines do not cause autism or weaken the immune system. Widespread vaccination through herd immunity is vital for preventing outbreaks of contagious diseases like measles, which cost millions to contain. The evidence overwhelmingly shows that vaccines are safe and essential public health tools.
The document discusses immunization and its importance as a public health intervention. It notes that immunization prevents millions of deaths each year by stimulating the body's immune system to develop immunity against diseases. However, some challenges remain as an estimated 22 million children still lack basic vaccines. The document then focuses on polio immunization efforts in Nigeria, with the specific aim of assessing oral polio vaccine implementation activities in an urban slum. It reviews factors that influence vaccine uptake and outlines strategies to improve access.
Vaccine Issues and the World Small Animal Veterinary Association (WSAVA) Guid...Yotam Copelovitz
Vaccination practices worldwide are changing. Various associations and organisations are updating their advice for vaccination best practices in dogs and cats upon an evidence-based research, and here is a recent update written by the honourable Dr. Jean Dodds.
The document discusses chickenpox (varicella) and the chickenpox vaccine. It begins by describing the symptoms of chickenpox which include a rash, fever, and blisters. It then notes that before the vaccine was introduced in the 1990s, around 4 million cases of chickenpox occurred annually in the US. Hospitalizations due to chickenpox have declined by around 90% since the vaccine was introduced. The document concludes by stating that widespread chickenpox vaccination has led to a significant decline in cases of the disease.
Ahmed Almousa
ECE211
Jennifer Marley
10/15/2018
Should Vaccination of Children be Mandatory?
Main Argument:
Nowadays vaccines can be termed as the most essential modern medical prevention
procedure that tends to save hundred millions of lives around the globe. They have also led to the
complete eradication of viral diseases. In various under develop countries due to improper
distribution of vaccinations a large number of children lose their lives. As a research done by Bill
and Melinda Gates reveals that “; one child dies every 20 seconds from vaccine preventable
diseases,” [1]. Hence vaccines should be mandatory because it is safe, cost effective, and do not
cause side effects for healthy people, but may cause side effects for people with health
conditions.
Though in various countries where effective vaccines are willingly available, some of the
parents reject to vaccinate their kids. For example, up to 5% of parents in the UK and 9% in the
United States refuse to allow their children to be vaccinated with the measles, mumps, and
rubella (MMR) vaccine. [1] Consequently, on the off chance that you take a gander at a few US
episodes of measles or mumps - which something like 90% of the populace has been inoculated
against since 2000 - the general population who become ill are normally the individuals who
have not been vaccinated. In any case, even a few people who have been inoculated have turned
out to be wiped out amid a flare-up [1]. Even some who received the vaccination got the
diseases. The 2014 measles outbreak in the United States, and the 2015 death of a German
Ahmed
Pencil
Ahmed
Pencil
toddler from measles during an outbreak in Europe. [3], have proved the importance of vaccines
and they should be mandatory to reduce these sort of viral diseases.
Sub-argument 1: Vaccines are safe and should be mandatory.
The United States' established a vaccine safety system that ensures the vaccines are safe. In
fact, now, the United States comprises the safest, and the most operative vaccine supply in
history. The monitoring of vaccines starts with the U.S. Food and Drug Administration (FDA).
The organization guarantees the effectiveness, safety, and accessibility of vaccines for the whole
country. Before a vaccine is approved by the FDA for use by the public it is also tested via
various approaches by scientists and doctors [2].
Sub-argument 2: Vaccines are also cost effective.
Moreover, Vaccines are also cost effective, they not only save lives of people, they save
money too. As it is more economical to prevent an ailment than to treat it. There are many
programs operating by the government to provide the public with childhood immunization as it
saves about 29.9 million dollars which are spent by people in treating these sort of diseases in a
whole year [3].
Sub-argument 3: Vaccinations caused an intense decline in the number of diseases caused by
viral .
alhajji1alhajji 2Jafar AlhajjiVaccines Safety and Effectiven.docxsimonlbentley59018
alhajji1
alhajji 2
Jafar Alhajji
Vaccines Safety and Effectiveness
Do you think vaccination is an important or just harmful substance forced by pharmaceutical companies cooperating with the governments to inject into people? Vaccine can be defined as “biological preparations that, when introduced into the body, cause an individual to acquire immunity to a specific disease” (Davidson. 7). So, for decades, vaccines have been considered one of the best revaluation in medical practice. A long time ago, people all around the world tried to fight with different kinds of fatal diseases by different ways, and one of the most Significant ways is to make a vaccine, to prevent such life- threatening diseases. The first vaccine was against the Smallpox disease. Smallpox is a highly contagious disease and caused a lot of fatalities all around the world, and it is transmitted between people by inhalation of droplets of virus or direct contact with smallpox lesion secretions (Davidson 25). It is a deadly disease, it caused blindness and permanent scars in the patients that survived. Finally, after several attempts to make a vaccine for Smallpox, Edward succeeded to produce an effective and safe vaccine in 1796 by using the cowpox vaccine to protect from smallpox. Cowpox is a disease cause by cows and transferred to human, and Jenner’s theory was based that whoever had cowpox will be immunized against smallpox (Davidson 29). “Edward Jenner was an English country doctor who introduced the vaccine for smallpox. Previously a keen practitioner of smallpox inoculation.”
Then, century after century, vaccine after vaccine was developed for different kinds of diseases. In the 20th century, one of the most known vaccines was Diphtheria and Tetanus vaccines. Diphtheria is a respiratory illness, causing the release of exotoxin from Corynebacterium diphtheriae bacteria which leads to death of mucus cells in the throat, mouth and nose, and as a result of cells accumulation the pseudo-membrane are build up and block the airways of the patients which causes death (Davidson 42) After years of experiments and trials to make a vaccine to fight this disease, Gaston Ramon a French veterinarian and biologist who realized that attenuated Diphtheria toxin is able to activate the immune system of people without causing serious side effects, and by 1927, the toxoid vaccine was freely used all around the world, and it succeeds to drop the number of cases of diphtheria. Then, by using the same way of toxoid, combined Diphtheria and Tetanus Toxoid vaccines were produced. Tetanus can be described as a nerves system infection that leads to spasm and contract of body muscles, especially jaw muscles which make the patients unable to open their mouths (Davidson. 44)
Another example of one of the most significant vaccine is a Polio vaccine. Polio disease, mainly affecting children under 5 years old, and leading to paralysis and often to death due to immobilization of respi.
Rotavirus is commonly spread from person to person through the fecal-oral route. It infects the small intestine where replication occurs. Infected children begin shedding the virus in their stool before symptoms appear and can shed over 1 trillion viral particles per gram of stool. Transmission can be reduced through frequent handwashing and treating contaminated materials at high temperatures. Rotavirus infections in adults are generally milder than in children. Vaccines have been developed to help prevent rotavirus infection and gastroenteritis in infants and young children.
Alhajji 1
Alhajji 6
JafarAlhajji
Professor:
English homework
May 1, 2019
Vaccines safety and effectiveness
Do you think vaccination is an important or just harmful substance forced by pharmaceutical companies cooperating with the governments to inject into people? A vaccine can be defined as "biological preparations that, when introduced into the body, cause an individual to acquire immunity to a specific disease” (Davidson. 7). So, for decades, vaccines have been considered one of the best revaluation in medical practice. A long time ago, people all around the world tried to fight with different kinds of fatal diseases by different ways, and one of the most Significant ways is to make a vaccine, to prevent such life-threatening diseases. The first vaccine was against the Smallpox disease. Smallpox is a highly contagious disease and caused a lot of fatalities all around the world, and it is transmitted between people by inhalation of droplets of virus or direct contact with smallpox lesion secretions (Davidson 25). It is a deadly disease, it caused blindness and permanent scars in the patients that survived. Finally, after several attempts to make a vaccine for Smallpox, Edward succeeded to produce an effective and safe vaccine in 1796 by using the cowpox vaccine to protect from smallpox. Cowpox is a disease caused by cows and transferred to a human, and Jenner's theory was based that whoever had cowpox will be immunized against smallpox (Davidson29).“Edward Jenner was an English country doctor who introduced the vaccine for smallpox. Previously a keen practitioner of smallpox inoculation.”
Then, century after century, the vaccine after the vaccine was developed for different kinds of diseases. In the 20th century, one of the most known vaccines was Diphtheria and Tetanus vaccines. Diphtheria is a respiratory illness, causing the release of exotoxin from Corynebacterium diphtheria bacteria which leads to the death of mucous cells in the throat, mouth, and nose, and as a result of cells accumulation the pseudo-membrane are build up and block the airways of the patients which causes death (Davidson42) After years of experiments and trials to make a vaccine to fight this disease, Gaston Ramona French veterinarian and biologist who realized that attenuated Diphtheria toxin is able to activate the immune system of people without causing serious side effects, and by 1927, the toxoid vaccine was freely used all around the world, and it succeeds to drop the number of cases of diphtheria. Then, by using the same way of toxoid, combined Diphtheria and Tetanus Toxoid vaccines were produced. Tetanus can be described as a nerves system infection that leads to spasm and contract of body muscles, especially jaw muscles which make the patients unable to open their mouths (Davidson. 44)
Another example of one of the most significant vaccine is a Polio vaccine. Polio disease, mainly affecting children under 5 years old, and leading to paralysis and often to .
This paper discusses the importance of vaccines for eradicating disease. It argues that vaccines are both safe and cost-effective compared to treating diseases. While some parents resist vaccines due to disproven claims about side effects, studies show that vaccines do not cause autism or weaken the immune system. Widespread vaccination through herd immunity is vital for preventing outbreaks of contagious diseases like measles, which cost millions to contain. The evidence overwhelmingly shows that vaccines are safe and essential public health tools.
The document discusses immunization and its importance as a public health intervention. It notes that immunization prevents millions of deaths each year by stimulating the body's immune system to develop immunity against diseases. However, some challenges remain as an estimated 22 million children still lack basic vaccines. The document then focuses on polio immunization efforts in Nigeria, with the specific aim of assessing oral polio vaccine implementation activities in an urban slum. It reviews factors that influence vaccine uptake and outlines strategies to improve access.
Vaccine Issues and the World Small Animal Veterinary Association (WSAVA) Guid...Yotam Copelovitz
Vaccination practices worldwide are changing. Various associations and organisations are updating their advice for vaccination best practices in dogs and cats upon an evidence-based research, and here is a recent update written by the honourable Dr. Jean Dodds.
The document discusses chickenpox (varicella) and the chickenpox vaccine. It begins by describing the symptoms of chickenpox which include a rash, fever, and blisters. It then notes that before the vaccine was introduced in the 1990s, around 4 million cases of chickenpox occurred annually in the US. Hospitalizations due to chickenpox have declined by around 90% since the vaccine was introduced. The document concludes by stating that widespread chickenpox vaccination has led to a significant decline in cases of the disease.
Ahmed Almousa
ECE211
Jennifer Marley
10/15/2018
Should Vaccination of Children be Mandatory?
Main Argument:
Nowadays vaccines can be termed as the most essential modern medical prevention
procedure that tends to save hundred millions of lives around the globe. They have also led to the
complete eradication of viral diseases. In various under develop countries due to improper
distribution of vaccinations a large number of children lose their lives. As a research done by Bill
and Melinda Gates reveals that “; one child dies every 20 seconds from vaccine preventable
diseases,” [1]. Hence vaccines should be mandatory because it is safe, cost effective, and do not
cause side effects for healthy people, but may cause side effects for people with health
conditions.
Though in various countries where effective vaccines are willingly available, some of the
parents reject to vaccinate their kids. For example, up to 5% of parents in the UK and 9% in the
United States refuse to allow their children to be vaccinated with the measles, mumps, and
rubella (MMR) vaccine. [1] Consequently, on the off chance that you take a gander at a few US
episodes of measles or mumps - which something like 90% of the populace has been inoculated
against since 2000 - the general population who become ill are normally the individuals who
have not been vaccinated. In any case, even a few people who have been inoculated have turned
out to be wiped out amid a flare-up [1]. Even some who received the vaccination got the
diseases. The 2014 measles outbreak in the United States, and the 2015 death of a German
Ahmed
Pencil
Ahmed
Pencil
toddler from measles during an outbreak in Europe. [3], have proved the importance of vaccines
and they should be mandatory to reduce these sort of viral diseases.
Sub-argument 1: Vaccines are safe and should be mandatory.
The United States' established a vaccine safety system that ensures the vaccines are safe. In
fact, now, the United States comprises the safest, and the most operative vaccine supply in
history. The monitoring of vaccines starts with the U.S. Food and Drug Administration (FDA).
The organization guarantees the effectiveness, safety, and accessibility of vaccines for the whole
country. Before a vaccine is approved by the FDA for use by the public it is also tested via
various approaches by scientists and doctors [2].
Sub-argument 2: Vaccines are also cost effective.
Moreover, Vaccines are also cost effective, they not only save lives of people, they save
money too. As it is more economical to prevent an ailment than to treat it. There are many
programs operating by the government to provide the public with childhood immunization as it
saves about 29.9 million dollars which are spent by people in treating these sort of diseases in a
whole year [3].
Sub-argument 3: Vaccinations caused an intense decline in the number of diseases caused by
viral .
This document presents arguments for both requiring vaccinations for children (the pro position) and allowing exemptions (the con position).
The pro position argues that vaccines are safe and effective, saving millions of lives each year. Major health organizations affirm vaccine safety. While rare, adverse reactions are typically minor. Vaccines protect community immunity. Several deadly diseases have been eradicated through vaccination.
The con position contends that vaccines can cause serious side effects in rare cases. Some argue certain ingredients in vaccines, like thimerosal, aluminum, and formaldehyde, are potentially harmful. Others believe medical choice should be left to individuals and parents, and that mandates infringe on religious freedom.
This document provides an overview of arguments for and against requiring vaccinations for children. It outlines the key pro arguments that vaccines have greatly reduced deaths from diseases like smallpox, measles, and polio. Major medical organizations affirm the safety of vaccines. Adverse reactions are extremely rare. Vaccines also protect vulnerable groups through "herd immunity." The document aims to guide students in evaluating both sides of the issue to form their own evidence-based conclusions.
Considerations of the Ebola Outbreak, Haddon's Matrix and Reason's Swiss Chee...Wes Chapman
In 1970, Dr. William Haddon wrote a brilliant editorial that changed forever how we evaluate accidents and other failures in complex systems. The paper was titled, On the Escape of Tigers: An Ecological Note, and it looked at accidents through an etiological rather than descriptive approach. The work was immediately applied to automotive and aviation safety, beginning the enormous reduction in accidents in both fields that continues to this day. In 1990, Dr. James T. Reason published his first work on the role of barriers to sequential failure, and how they fail in truly catastrophic accidents. Together, their combined work forms the basis for much of the best practice for risk mitigation in the automotive, airline, oil & gas and healthcare industries. In this article, I take a look at the failed efforts to control the Ebola outbreak relative to the concepts of Drs. Haddon and Reason.
This document provides a review of adult immunization for several infectious diseases including anthrax, chikungunya, cholera, dengue, and influenza. It discusses the disease entities, modes of transmission, symptoms, diagnosis, and treatment options. It also reviews the current global vaccination guidelines and status of available vaccines for prevention of these diseases. Promoting adult immunization is important as prevention can help reduce treatment costs and burden on healthcare systems.
This document provides a review of adult immunization for several infectious diseases including anthrax, chikungunya, cholera, dengue, and influenza. It discusses the disease entities, modes of transmission, symptoms, diagnosis, and treatment options. It also reviews the current global vaccination guidelines and status of available vaccines for prevention of these diseases. Promoting adult immunization is important for reducing disease burden and healthcare costs in developing countries like India.
This is a CLC assigment, I have attached topic 1, 2 and 3 , APA form.docxgasciognecaren
This is a CLC assigment, I have attached topic 1, 2 and 3 , APA format, 3 references, 500 words
This is a Collaborative Learning Community (CLC) assignment.
In your Collaborative Learning Community, write a formal paper of 500-1,000 words that examines the previously addressed aspects of health policies, finance, global/national prevention, or treatment initiatives related to the health issue by identifying applicable ethics principles.
Differentiate how application of the identified ethics principles to the health issue has resulted in population disparities.
Hypothesize how existing disparities might be eliminated using alternate ethics principles.
Critique whether the applicable ethics principles are consistent with the ANA's Code of Ethics for Nurses.
Topic 1
Influenza CLC group essay 11-28-2017
Introduction
Influenza commonly known as flu is a contagious respiratory infection that attacks the general respiratory system that is, the nose, throat, and even the lungs. It is caused by the two types of influenza viruses which are influenza A, influenza B and influenza C (Wang & Tao, 2010). Attacks from both viruses are epidemic and seasonal as they are common within specific periods within a year. Attack mechanisms for influenza A viruses depends on the genes on the surface protein of a patient. They are normally spread through sneezing and coughing from an infected individual to the surrounding air (Wang & Tao, 2010).
The flu can also attack an individual in case they get into direct body tissue contact with an infected individual for example handshaking. Health professionals argue that the flu virus is stubborn and spreads mainly over tiny droplets which are produced when the infected individuals’ cough, talk, and sneeze (Wang & Tao, 2010). Such droplets are easily carried by the surrounding air and can be landed in the nose and mouths of the immediate persons. Additionally, it can enter into one’s system if he or she gets into direct contact with a surface or object that has the influenza bacteria and consequently rubs or touches their nose, mouth or even eyes (Wang & Tao, 2010).
Health departments have overtime identified initiative to address the problem of influenza, such initiatives include:
Reducing human exposure to the flu viruses, this initiative works by notifying the public on the safe ways to prevent and control the spread of the virus and it actively works to reduce infection opportunities and curbs the spread of the pandemic virus (Abramson, 2011).
They have built able capacities to cope with the pandemic, measures have been taken and put in place to cope with the virus since helping the society to stay free from the virus (Abramson, 2011).
They have innovated much on early warning and acknowledgments, information about influenza and its impacts to the society are made clear since it is effective for the society to stay free from the influenza virus (Abramson, 2011).
Necessary global scientific researches ...
Immunization clinic remains crucial regardless of what the media says. The relevance of
childhood vaccinations has been relegated to the background by the antivaccination
28.Jairaj A, Shirisha P, Abdul MSM, Fatima U, Tiwari RVC, Moothedath M. Adult Immunization - Need of the Hour. J Int Soc Prev Community Dent. 2018 Nov-Dec;8(6):475-481. doi: 10.4103/jispcd.JISPCD_347_18. Epub 2018 Nov 29. Review. PubMed PMID: 30596036; PubMed Central PMCID: PMC6280562.
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Writea minimum 300 word reflection in which you compare and.docxannetnash8266
Write
a minimum 300 word reflection in which you compare and
contrast the Chinese Spiritual Worldview with the Indian Spiritual
Worldview based on the textbook readings.
Describe the early Daoist teachers.
Explain basic Daoist teachings.
Characterize the ideal society according to Confucius.
Illustrate the influence of the natural world on Shinto belief and practice
.
Writea draft of the paper on case tools and include the followin.docxannetnash8266
Write
a draft of the paper on case tools and include the following:
·
Define the term
case tools
and provide at least three examples.
·
Describe how case tools are used in the design of a database.
·
Explain how three different case tools are used in database design, including their advantages and disadvantages.
Format
your paper consistent with APA guidelines.
.
Write To complete the assignment, open the OUTLINE ATTACHMENT fi.docxannetnash8266
Write:
To complete the assignment, open the OUTLINE ATTACHMENT fill it out entirely. Within the worksheet, you will state your thesis statement, provide an outline of your paper, and integrate the four sources (below),
and FIND two more sources being a (webpage and online magazine ONLY) on the topic “The Affordable Care Act 2010”, into your outline to showcase how these resources support your ideas. Provide a full APA references list with a minimum of six sources. Please be sure to utilize outline format and to support all statements with scholarly research. All references should be listed in full APA format and cited appropriately.
Source 1-
Burkhauser, R. V., Larrimore, J., & Simon, K. (2013). Measuring the impact of valuing health insurance on levels and trends in inequality and how the Affordable Care Act of 2010 could affect them.
Contemporary Economic Policy
,
31
(4), 779-794.
Source 2-
Cooper, R. W., & Gardner, L. A. (2016). Extensive Changes and Major Challenges Encountered in Health Insurance Markets under the Affordable Care Act.
Journal of Financial Service Professionals
,
70
(5).
Source 3-
Hester, R. D. (2017). The successful innovations of the affordable care act of 2010.
Journal of Innovation and Entrepreneurship
,
6
(1), 18
Source 4-
Martin, E. J. (2015). Healthcare policy legislation and administration: Patient Protection and Affordable Care Act of 2010.
Journal of health and human services administration
, 407-411.
Source 5-
Sparer, M. S. (2011). Federalism and the Patient Protection and Affordable Care Act of 2010: The founding fathers would not be surprised.
Journal of health politics, policy and law
,
36
(3), 461-468.
.
Write your proposal based on the criterias listed below Pr.docxannetnash8266
Write your proposal based on the criteria's listed below
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Write a 350- to no more than 700-word paper using APA format.D.docxannetnash8266
Write
a 350- to no more than 700-word paper using APA format.
Describe
the flow of information in your company, or in a company at which you have been employed. In your paper, discuss the following:
The intrapersonal, interpersonal, group, organizational, and intercultural levels of communication within your company
How information travels up, down, and across your organization, and how it relates to the basic communications model
The functions of the Y hierarchy of managerial communications. Does it apply to your organization's communication hierarchy?
A comparison of at least three managerial communication approaches you have observed in your organization
At least three potential barriers to effective communications that exist in your company
A minimum of one reference and one in-text citation is required.
First person is acceptable.
.
Write a 350- to 700-word paper in which you investigate the interr.docxannetnash8266
Write
a 350- to 700-word paper in which you investigate the interrelationship between culture and visual entertainment media, such as television and film. Include answers to the following questions:
·
In what ways have various forms of visual entertainment media shaped American culture and its values?
·
Are the social influences of visual entertainment media mostly positive or negative? Explain.
Illustrate
your answers with specific examples.
Conclude
your paper by summarizing how visual media either reflect or influence social behavior and attitudes.
Format
your paper consistent with APA guidelines.
.
Write a 350 word analysis about juvenile attitudes toward poli.docxannetnash8266
Write
a 350 word analysis about juvenile attitudes toward police. Consider recent cases in the media regarding juvenile interactions with police departments. Analyze the attitudes today's youth have toward police. Address the following:
Summary of current media piece you are analyzing
Evaluation of attitudes and factors influencing attitudes
Is remediation of these attitudes necessary?
.
Write a 350- to 700-word paper in which you do the followingExp.docxannetnash8266
Write
a 350- to 700-word paper in which you do the following:
Explain what database systems are and how they are used.
Define database architecture. Consider Microsoft
®
Access
®
, Microsoft
®
SQL Server
®
, Oracle
®
, and IBM DB2
®
software as possible examples.
Summarize your paper by describing the database systems in your workplace, identifying which database systems and architecture they fall under.
Include
2 to 4 references.
Format
your paper consistent with APA guidelines.
.
Write a 350- to 700- word response to the following questionsHo.docxannetnash8266
Write
a 350- to 700- word response to the following questions:
How did psychology evolve into a science?
What are some psychological perspectives that explain human behavior?
A long-standing debate in the field of psychology is the degree to which nature and nurture shape human behaviors and traits. How would you describe the interaction between genetic potential, environmental influences, and personal choice?
Format
your response consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
AND
Write
a 500- to 1000-word essay contrasting the roles of the temporal and frontal lobes on behavior. Include the types of behaviors for which each lobe is responsible, as well as the effects of heredity on the development of these behaviors. Additionally, include what may happen if there is damage to these lobes, including Broca's and Wernicke's aphasias.
Format
your essay consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
.
Write a 1,400- to 1,750 word APA format paper regarding a so.docxannetnash8266
Write
a 1,400- to 1,750 word
APA format paper
regarding a social networking interview.
Identify
whom you interviewed, their title, and years of working experience in the area of Operations Management.
Provide
insights into your subject's role and why Operations Management is vital to his/her organization.
Provide
the reason for selecting the individual you chose to interview.
List
the questions you asked.
Include
a summary of the organization.
Give
a summary of what you learned as a result of this interview.
Provide
a reflection of what is important about this assignment.
Discuss
any follow-up activities the person you interviewed suggested.
Provide
at least two peer reviewed academic references. Make sure that the in-text citations matched the reference list.
Format
your paper consistent with APA guidelines.
IMPORTANT:
Make sure to review your assignment submission for content similarity on Safe Assign before submission. Assignment is preferred to have no more than 10% content similarity.
.
Write a 350- to 500-word summary in which you answer the following.docxannetnash8266
Write
a 350- to 500-word summary in which you answer the following questions:
What were the major developments in the evolution of mass media during the last century?
How did each development influence American culture?
What is meant by the term
media convergence
, and how has it affected everyday life?
700 word max.
.
Write a 300- to 350-word response to the followingWhen thinki.docxannetnash8266
Write
a 300- to 350-word response to the following:
When thinking about all the types of diversity that can exist within a group, what is the most important thing for group members to keep in mind when interacting with each other? Explain.
APA format
Include 2 references
.
WRITE A 2-page paper on the following questions. Your answers must.docxannetnash8266
WRITE
A 2-page paper on the following questions. Your answers must be written in paragraph style after each question.
1. What personal interests do you have in regard to the field of social work?
2. What are your personal values? List three or more
3. How do your identified values influence what you believe about how people should be served?
4. What do you think you will be doing in 7 years?
5. What are the values/interests/beliefs of your selected state representative or state senator (name them and cite their website) and how are they reflected in the policies of your state? Give concrete examples of your state policy.
.
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Introduction
Influenza commonly known as flu is a contagious respiratory infection that attacks the general respiratory system that is, the nose, throat, and even the lungs. It is caused by the two types of influenza viruses which are influenza A, influenza B and influenza C (Wang & Tao, 2010). Attacks from both viruses are epidemic and seasonal as they are common within specific periods within a year. Attack mechanisms for influenza A viruses depends on the genes on the surface protein of a patient. They are normally spread through sneezing and coughing from an infected individual to the surrounding air (Wang & Tao, 2010).
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Write
a minimum 300 word reflection in which you compare and
contrast the Chinese Spiritual Worldview with the Indian Spiritual
Worldview based on the textbook readings.
Describe the early Daoist teachers.
Explain basic Daoist teachings.
Characterize the ideal society according to Confucius.
Illustrate the influence of the natural world on Shinto belief and practice
.
Writea draft of the paper on case tools and include the followin.docxannetnash8266
Write
a draft of the paper on case tools and include the following:
·
Define the term
case tools
and provide at least three examples.
·
Describe how case tools are used in the design of a database.
·
Explain how three different case tools are used in database design, including their advantages and disadvantages.
Format
your paper consistent with APA guidelines.
.
Write To complete the assignment, open the OUTLINE ATTACHMENT fi.docxannetnash8266
Write:
To complete the assignment, open the OUTLINE ATTACHMENT fill it out entirely. Within the worksheet, you will state your thesis statement, provide an outline of your paper, and integrate the four sources (below),
and FIND two more sources being a (webpage and online magazine ONLY) on the topic “The Affordable Care Act 2010”, into your outline to showcase how these resources support your ideas. Provide a full APA references list with a minimum of six sources. Please be sure to utilize outline format and to support all statements with scholarly research. All references should be listed in full APA format and cited appropriately.
Source 1-
Burkhauser, R. V., Larrimore, J., & Simon, K. (2013). Measuring the impact of valuing health insurance on levels and trends in inequality and how the Affordable Care Act of 2010 could affect them.
Contemporary Economic Policy
,
31
(4), 779-794.
Source 2-
Cooper, R. W., & Gardner, L. A. (2016). Extensive Changes and Major Challenges Encountered in Health Insurance Markets under the Affordable Care Act.
Journal of Financial Service Professionals
,
70
(5).
Source 3-
Hester, R. D. (2017). The successful innovations of the affordable care act of 2010.
Journal of Innovation and Entrepreneurship
,
6
(1), 18
Source 4-
Martin, E. J. (2015). Healthcare policy legislation and administration: Patient Protection and Affordable Care Act of 2010.
Journal of health and human services administration
, 407-411.
Source 5-
Sparer, M. S. (2011). Federalism and the Patient Protection and Affordable Care Act of 2010: The founding fathers would not be surprised.
Journal of health politics, policy and law
,
36
(3), 461-468.
.
Write your proposal based on the criterias listed below Pr.docxannetnash8266
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Write a 350- to no more than 700-word paper using APA format.D.docxannetnash8266
Write
a 350- to no more than 700-word paper using APA format.
Describe
the flow of information in your company, or in a company at which you have been employed. In your paper, discuss the following:
The intrapersonal, interpersonal, group, organizational, and intercultural levels of communication within your company
How information travels up, down, and across your organization, and how it relates to the basic communications model
The functions of the Y hierarchy of managerial communications. Does it apply to your organization's communication hierarchy?
A comparison of at least three managerial communication approaches you have observed in your organization
At least three potential barriers to effective communications that exist in your company
A minimum of one reference and one in-text citation is required.
First person is acceptable.
.
Write a 350- to 700-word paper in which you investigate the interr.docxannetnash8266
Write
a 350- to 700-word paper in which you investigate the interrelationship between culture and visual entertainment media, such as television and film. Include answers to the following questions:
·
In what ways have various forms of visual entertainment media shaped American culture and its values?
·
Are the social influences of visual entertainment media mostly positive or negative? Explain.
Illustrate
your answers with specific examples.
Conclude
your paper by summarizing how visual media either reflect or influence social behavior and attitudes.
Format
your paper consistent with APA guidelines.
.
Write a 350 word analysis about juvenile attitudes toward poli.docxannetnash8266
Write
a 350 word analysis about juvenile attitudes toward police. Consider recent cases in the media regarding juvenile interactions with police departments. Analyze the attitudes today's youth have toward police. Address the following:
Summary of current media piece you are analyzing
Evaluation of attitudes and factors influencing attitudes
Is remediation of these attitudes necessary?
.
Write a 350- to 700-word paper in which you do the followingExp.docxannetnash8266
Write
a 350- to 700-word paper in which you do the following:
Explain what database systems are and how they are used.
Define database architecture. Consider Microsoft
®
Access
®
, Microsoft
®
SQL Server
®
, Oracle
®
, and IBM DB2
®
software as possible examples.
Summarize your paper by describing the database systems in your workplace, identifying which database systems and architecture they fall under.
Include
2 to 4 references.
Format
your paper consistent with APA guidelines.
.
Write a 350- to 700- word response to the following questionsHo.docxannetnash8266
Write
a 350- to 700- word response to the following questions:
How did psychology evolve into a science?
What are some psychological perspectives that explain human behavior?
A long-standing debate in the field of psychology is the degree to which nature and nurture shape human behaviors and traits. How would you describe the interaction between genetic potential, environmental influences, and personal choice?
Format
your response consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
AND
Write
a 500- to 1000-word essay contrasting the roles of the temporal and frontal lobes on behavior. Include the types of behaviors for which each lobe is responsible, as well as the effects of heredity on the development of these behaviors. Additionally, include what may happen if there is damage to these lobes, including Broca's and Wernicke's aphasias.
Format
your essay consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
.
Write a 1,400- to 1,750 word APA format paper regarding a so.docxannetnash8266
Write
a 1,400- to 1,750 word
APA format paper
regarding a social networking interview.
Identify
whom you interviewed, their title, and years of working experience in the area of Operations Management.
Provide
insights into your subject's role and why Operations Management is vital to his/her organization.
Provide
the reason for selecting the individual you chose to interview.
List
the questions you asked.
Include
a summary of the organization.
Give
a summary of what you learned as a result of this interview.
Provide
a reflection of what is important about this assignment.
Discuss
any follow-up activities the person you interviewed suggested.
Provide
at least two peer reviewed academic references. Make sure that the in-text citations matched the reference list.
Format
your paper consistent with APA guidelines.
IMPORTANT:
Make sure to review your assignment submission for content similarity on Safe Assign before submission. Assignment is preferred to have no more than 10% content similarity.
.
Write a 350- to 500-word summary in which you answer the following.docxannetnash8266
Write
a 350- to 500-word summary in which you answer the following questions:
What were the major developments in the evolution of mass media during the last century?
How did each development influence American culture?
What is meant by the term
media convergence
, and how has it affected everyday life?
700 word max.
.
Write a 300- to 350-word response to the followingWhen thinki.docxannetnash8266
Write
a 300- to 350-word response to the following:
When thinking about all the types of diversity that can exist within a group, what is the most important thing for group members to keep in mind when interacting with each other? Explain.
APA format
Include 2 references
.
WRITE A 2-page paper on the following questions. Your answers must.docxannetnash8266
WRITE
A 2-page paper on the following questions. Your answers must be written in paragraph style after each question.
1. What personal interests do you have in regard to the field of social work?
2. What are your personal values? List three or more
3. How do your identified values influence what you believe about how people should be served?
4. What do you think you will be doing in 7 years?
5. What are the values/interests/beliefs of your selected state representative or state senator (name them and cite their website) and how are they reflected in the policies of your state? Give concrete examples of your state policy.
.
Write a 1- to 2-page report for the Director of IT describing .docxannetnash8266
Write
a 1- to 2-page report for the Director of IT describing the requirements you are considering as your team implements the wireless network. Include the following:
Design requirements that must be addressed
Justification to use different frequencies, channels, and antennae in the installation
Regulatory requirements to consider in implementation
Security requirements
Create
a 1/2- to 1-page table for your team. In the table, summarize possible frequency choices, including an explanation of the strength and weakness of each.
No plagiarism please use attached files for the scenario!!!!
.
Write a 1,400- to 2,100-word paper in which you assess criminal ju.docxannetnash8266
Write
a 1,400- to 2,100-word paper in which you assess criminal justice from a global perspective. In your paper be sure to analyze the following:
Assess the impact of globalization on the U.S. criminal justice system.
Compare and contrast international criminal justice systems (Civil Law, Common law, and Islamic Law and Socialist Law traditions).
Discuss the impact that cyber crime and technology have had on worldwide justice systems.
Differentiate the policing systems on a worldwide scale.
Identify major crimes and criminal issues that have a global impact on justice systems and processes (e.g., Somalia, Rwanda, Bosnia, Darfur, Congo, etc.).
Include
at least four peer reviewed references.
Format
your paper according to APA guidelines.
Submit
your assignment.
.
Write a 1,750-word paper that includes the following(UNITED.docxannetnash8266
Write
a 1,750-word paper that includes the following:
(UNITED STATES COAST GUARD)
The organizational overview.
Prioritized assessment of the strengths, weaknesses, threats and vulnerabilities of your selected organization's security system(s), including facilities, people, information systems, and other appropriate assets.
The influence of crime and criminology in your assessment, as well as applicable national and global issues.
Format
your assignment consistent with APA guidelines.
ATTACH TURN IT IN REPORT
.
Write a 1.400 to 1,700 word essay that summarizes your Week 4 .docxannetnash8266
Write
a 1.400 to 1,700 word essay that summarizes your Week 4 presentation and additionally includes the following:
Summary of each of the following from your Week 4 presentation:
What are cultural groups?
How can you work toward more effective intercultural communication?
How is globalization challenging traditional hierarchies of culture?
What are co-cultural groups?
What are the five belief domains and how do they influence intercultural communication? (Refer to Ch. 9)
Summary of the following Week 5 concepts:
Positive and negative examples of how the media acts as a cultural socialization agent
Discussion of one media theory as it relates to how you interact with mass media
How to develop media literacy
How technology has fostered global intercultural communication
The challenges and opportunities within intercultural communication for women and minority success in the future
.
Write a 1,400- to 1,750-word paper highlighting considerations for.docxannetnash8266
Write
a 1,400- to 1,750-word paper highlighting considerations for creating a security budget.
Include
the following:
Identify the key player involved in creating the budget.
Discuss liabilities a budget can create for an organization.
Consider how these liabilities can be addressed.
Determine the need for executive protection using a cost-benefit analysis.
Also Include
a
Created Tree Graph outlining the steps that make up the budgeting process.
Format
your assignment consistent with APA guidelines.
.
Write a 1,050-word minimum strategic implementation plan in wh.docxannetnash8266
Write
a 1,050-word minimum strategic implementation plan in which you include the following:
Create an implementation plan including:
Objectives
Functional tactics
Action items
Milestones and deadlines
Tasks and task ownership
Resource allocation
Recommend any organizational change management strategies that may enhance successful implementation.
Develop key success factors, budget, and forecasted financials, including a break-even chart.
Create a risk management plan including contingency plans for the identified risks.
Format
your paper according to APA guidelines.
.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
A S K T H E E X P E R TChildren exposed to bats Evidence-.docx
1. A S K T H E E X P E R T
Children exposed to bats: Evidence-based
management strategies
John S. Murray, Marcia K. Stephens, and Parag M. Amin
Column Editor: Martin Schiavenato
Ask the Expert provides research-based answers to practice
questions submitted by JSPN readers.
Search terms
Bat exposure, children, rabies
Author contact
[email protected], with a copy to the Editor:
[email protected]
Disclosure: The authors report no actual or
potential conflicts of interest.
doi: 10.1111/jspn.12082
Question: What are the current recommenda-
tions for pediatric healthcare professionals
managing bat exposure in children?
John S. Murray, PhD, RN, CPNP, FAAN, Marcia
K. Stephens, RN, and Parag M. Amin, MD
respond: In the United States, there are approxi-
mately 40 different species of bats. While most bats are
harmless, and various types are even beneficial (e.g.,
2. those that feed on insects harmful to crops), some may
be infected with, and transmit, rabies. Public health
concern regarding rabies has changed dramatically
over the past several decades. Before the 1960s, most
cases of rabies involved domestic animals (e.g., dogs
and cats). Today the primary hosts for rabies are wild
predatory animals (e.g., raccoon, fox, and coyote) and
bats. In fact, in the United States, the most common
source of rabies transmission to humans is from bats
(Figure 1; Baker, 2012; Centers for Disease Control
and Prevention [CDC], 2011a; CDC Advisory
Committee on Immunization Practices [ACIP], 2008;
National Association of State Public Health
Veterinarians, 2011). While death from rabies is a rare
occurrence in the United States, it is estimated that
16,000–39,000 people annually are exposed to poten-
tially rabid animals requiring post-exposure care (CDC
Immunization Action Coalition, 2013).
TYPES OF EXPOSURE
Under most circumstances, two types of exposure to
bats are possible: bite and non-bite (CDC, 2011b; CDC
ACIP, 2008; DeMaria, 2014). Bites are defined as any
penetration of the skin by the teeth of a bat. This route
of exposure is considered to be the most serious.
However, bat bites are often so small, and with limited
injury, that they go unnoticed (Figure 2). Rabies
exposure can also occur when the virus, from poten-
tially infectious secretions of the bat such as saliva,
come in contact with open cuts, scratches, abrasions,
or the mucous membranes of a child. Other situations
that qualify as exposure include a bat found in prox-
imity to a child who is not able to describe what hap-
pened or who is unable to rule out the occurrence of
4. any bites or scratches for 10–15 min using soap and
water. Care of the wound should occur immediately,
or as early as possible if access to soap and water is
not readily available (CDC ACIP, 2008; World Health
Organization [WHO], 2013). Administration of
rabies post-exposure prophylaxis (PEP) should be
considered urgent, but not a medical emergency.
Important to treatment is ensuring that the proper
exposure assessment takes place before PEP begins.
Discussion regarding appropriate rabies post-
exposure care should occur between pediatric
healthcare providers and local public health officials
(CDC ACIP, 2008). Excellent resources for guiding
conversations regarding treatment are the ACIP
rabies guidelines found at http://www.cdc.gov/
vaccines/hcp/acip-recs/vacc-specific/rabies.html as
well as the American Academy of Pediatrics (AAP,
2014) Red Book® Online (http://intl-aapredbook
.aappublications.org/).
Once it is determined that exposure occurred,
active immunization is accomplished by administer-
ing rabies vaccines. Rabies prophylaxis includes the
administration of two vaccines: rabies immune
globulin (RIG) and human diploid cell vaccine
(HDCV), or purified chick embryo cell vaccine
(PCECV). RIG provides temporary passive protection
while HDCV and PCECV offer longer-acting coverage
(Baker, 2012; CDC, 2011c). Typically RIG is adminis-
tered at a dose of 20 IU/kg in the emergency depart-
ment (ED) and is given only once on the day the child
presents for treatment. Administration of HDCV or
PCECV involves multiple doses at prescribed inter-
vals (days 0, 3, 7, and 14). Prior to 2009, ACIP recom-
mended a series of five doses of HDCV or PCECV.
5. Following a thorough review of evidence available
from basic and applied research of rabies prevention,
the number of vaccine doses was reduced to four
(CDC ACIP, 2010). The first dose (day 0) is adminis-
tered along with RIG on the day of presentation for
PEP. The recommended dose of HDCV or PCECV is
1 mL (2.5 IU of rabies antigen) regardless of the
child’s age or weight. The vaccine is administered
intramuscularly into the deltoid muscle (AAP
Committee on Infectious Diseases, 2011; Baker,
2012; CDC, 2009, 2011c; WHO, 2012). It is important
that the four doses of vaccine be given on schedule. If
there is any deviation from the timeline, the vaccine
manufacturer should be contacted for guidance on
completing the course of treatment. The vaccine
packaging contains the contact information to call for
assistance (Baker, 2012).
As with any vaccine administered to children,
pediatric healthcare professionals should be aware
of potential side effects. The most common reactions
to rabies vaccines are soreness, erythema, and
edema at the injection site. Other common com-
plaints include headache, nausea, myalgias, and diz-
ziness (CDC ACIP, 2008; WHO, 2012).
HOW PEDIATRIC HEALTHCARE PROVIDERS
CAN HELP
Key to addressing the concern of bat exposure and
rabies is raising awareness at the community level
regarding transmission and what to do when a child is
exposed to the virus. The CDC (2011d) recommends
Figure 1 Little Brown Bat (Myotis lucifugus) in Eave of a
House.
7. Pediatric healthcare professionals can also play a
significant role by providing guidance to patients and
parents regarding avoiding exposure to bats. Bats can
be found living in attic spaces, rafters, chimneys,
porches, and walls of homes. Bats are particularly
inclined to roost in older homes and buildings as
shelter from the weather and protection from other
animals. It is possible for bats to enter spaces as small
as one-fourth inch (CDC, n.d.). Reducing exposure to
bats entails understanding and sharing with families
specific recommendations. For many areas in the
United States, bats leave homes and other structures
beginning in the fall to hibernate. This provides an
opportunity for families to bat-proof their homes to
prevent bats from returning. All openings should be
sealed appropriately to prevent re-entrance. For
example, windows should have screens, chimneys
covered with screens, and openings for plumbing and
electrical fittings sealed with caulk, wire mesh, or
wood fittings. When in doubt regarding the most
appropriate preventive measures, families should
contact a licensed pest control expert specializing in
bat control or the local or state health department
(CDC, 2011e). Bat Conservation International
(2013) offers an excellent guide for families on bat-
proofing homes and buildings: http://www.batcon
.org/pdfs/education/fof_ug.pdf
CONCLUSION
Bats are of significant importance to the world’s eco-
systems. Nevertheless, most rabies cases in the United
States are caused by viruses associated with bats;
thus, potential exposures to bats involving children
do occur, often requiring PEP. Pediatric healthcare
8. professionals should have an understanding of PEP,
bat exposure resources, and always consult with local
public health experts for assistance in determining
the risk associated with a particular exposure to a bat
and the requisite treatment. Continued efforts
focused on preventing exposure of children to
sources of virus, and the recognition and adherence
to appropriate and timely prophylaxis after exposure
remain the most effective public health measures to
prevent human rabies (CDC ACIP, 2008).
CASE STUDY
The mother of TM (8 years old) and KM (6 years old)
reported to their pediatric primary care provider that
4 days ago, when the children were asleep in the
same room, they awoke to find a bat flying around
the room and hitting the window shades. Both
parents witnessed the same. The mother was
instructed to take her children to the local ED for
evaluation and treatment. Upon exam, neither child
had visible bites or scratches. Given the bat was
found in the same room as the children while sleep-
ing, the decision was made by the ED provider and
local public health officer to proceed with human
rabies immune globulin (20 IU/kg) and rabies
vaccination (RabAvert®) 1 mL intramuscularly.
Subsequently, repeat doses of RabAvert® were
administered on days 3, 7, and 14 at the primary
care practice. The only difficulty experienced by the
children was soreness at the injection site.
John S. Murray, PhD, RN, CPNP, FAAN
Pediatric Nurse
9. Centre Pediatric Associates, P.C.
Brookline, Massachusetts, USA
Marcia K. Stephens, RN
Newton, Massachusetts, USA
Parag M. Amin, MD
Pediatrician
Centre Pediatric Associates, P.C.
Brookline, Massachusetts, USA
SELECT RESOURCES
Organization Website
Centers for Disease Control
and Prevention Advisory
Committee on
Immunization Practices
http://www.cdc.gov/vaccines/acip/
Centers for Disease Control
and Prevention
http://www.cdc.gov/rabies/bats/
education/index.html
World Health Organization http://www.who.int/rabies/human/
11. Bat Conservation International. (2013). Bats in buildings: A
guide to safe & humane exclusions. Retrieved from
http://www.batcon.org/pdfs/education/fof_ug.pdf
Centers for Disease Control and Prevention. (2009). Rabies
vaccine: What you need to know. Retrieved from
http://www.immunize.org/vis/rabies.pdf
Centers for Disease Control and Prevention. (2011a).
Rabies in the U.S. Public health importance of rabies.
Retrieved from
http://www.cdc.gov/rabies/location/usa/index.html
Centers for Disease Control and Prevention. (2011b).
Rabies: What type of exposure occurred? Retrieved from
http://www.cdc.gov/rabies/exposure/type.html
Centers for Disease Control and Prevention. (2011c).
Human rabies immune globulin. Retrieved from
http://www.cdc.gov/rabies/medical_care/hrig.html
Centers for Disease Control and Prevention. (2011d).
Rabies training. Retrieved from http://www.cdc.gov/
rabies/resources/training/index.html
Centers for Disease Control and Prevention. (2011e).
Keeping bats out of your house. Retrieved from http://
www.cdc.gov/rabies/bats/management/index.html
Centers for Disease Control and Prevention. (n.d.). Bats:
Safety and risk management at camp. Retrieved from
http://www.cdc.gov/rabies/pdf/bats_final_508.pdf
Centers for Disease Control and Prevention Advisory
Committee on Immunization Practices. (2008). Human
12. rabies prevention—United States, 2008. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/
rr5703a1.htm
Centers for Disease Control and Prevention Advisory
Committee on Immunization Practices. (2010). Use of a
reduced (4-dose) vaccine schedule for postexposure prophylaxis
to prevent human rabies. Retrieved from
http://www.cdc.gov/mmwr/pdf/rr/rr5902.pdf
Centers for Disease Control and Prevention Immunization
Action Coalition. (2013). Rabies: Questions and answers.
Information about the disease and vaccines. Retrieved from
http://www.immunize.org/catg.d/p4216.pdf
DeMaria, A. (2014). When to use rabies prophylaxis.
Retrieved from http://www.uptodate.com/
contents/when-to-use-rabies-prophylaxis
De Serres, G., Skowronski, D. M., Mimault, P., Ouakki, M.,
Maranda-Aubut, R., & Duval, B. (2009). Bats in the
bedroom, bats in the belfry: Reanalysis of the rationale
for rabies postexposure prophylaxis. Clinical Infectious
Diseases, 48, 1493–1499. doi:10.1086/598998
National Association of State Public Health Veterinarians.
(2011). Compendium of animal rabies prevention and
control, 2011. Morbidity and Mortality Weekly Report.
Recommendations and Reports/Centers for Disease Control,
60(6), 1–14.
World Health Organization. (2012). Information sheet:
Observed rates of vaccine reaction—rabies vaccine. Retrieved
from http://www.who.int/vaccine_safety/initiative/
tools/Rabies_Vaccine_rates_information_sheet.pdf
15. Keywords
Applied research; Evidence based; Knowledge
transfer; Manager; Metaanalysis
Received 29 October 2013
Accepted 28 January 2014
Co-ordinating Editor: Michael Palmer
Milberg, P. ([email protected]): IFM Biology,
Conservation Ecology Group, Link€oping
University, Link€oping, SE-581 83, Sweden
Abstract
The effect of applied vegetation science on society has the
potential to increase
by adopting an evidence-based approach. However, this would
require a shift in
focus towards effect size and results suitable for meta-analyses,
a focus on practi-
tioners as potential readers, more emphasis on practical
problems rather than
mechanism, and an acceptance of all well-executed
experimental studies, even
if confirmatory. Thus, the prevailing editorial policies need to
16. be reconsidered,
as well as the methods of analysing, reporting and evaluating
research, for our
research efforts to be of better use within society.
Background
Some of us work in applied research, but what does
‘applied’ actually mean? I prefer to think of ‘applied
research’ as being of more direct interest to society and that
there are – beyond fellow researchers – two potential
groups targeted by such research (Cook et al. 2013)
1
. The
first group is policy-makers, a group that consists of people
who prepare and make new laws, as well as government
or company officials who set up rules for activities in
society or within their organization. The second group is
managers, which consists of people who make operational
decisions and their advisors (e.g. medical doctors, teach-
ers, foresters, farmers, extension officers). It is our hope
that the managers within our field regularly read Applied
17. Vegetation Science and similar journals. However, the pro-
cess of knowledge transfer from applied research to prac-
tice is often disappointing (e.g. Nutley et al. 2007; Braun &
Hadwiger 2011; Dagenais et al. 2012; Rojek et al. 2012).
Poor or slow knowledge transfer indicates missed opportu-
nities and a waste of resources, both in science and society.
But there are ways in which we researcher, the ‘donors’ of
knowledge, can facilitate this process.
In our field, managers who are potentially interested in
our work are often highly educated. However, do we have
them in mind when we write our papers? Or is it that our
focus has gradually shifted from the potential end-user of
our findings to a concentration on the continuously tight-
ening requirements by the scientific community to pass
the editorial and review processes?
A reform in the way we think about, analyse and
present our applied research is welcome, and it would
affect authors, referees and editorial policies. With such
18. a reform, our research might have a greater impact in
society, and this is what applied research should strive to
achieve.
An example of the failure to communicate
I recently experienced how my own research and that
of others was ignored (or not known) by policy-makers
and practitioners: a notion that I believe not to be uncom-
mon among applied researchers (Cook et al. 2013). More-
over, I realized that the fault was not entirely theirs:
nice ordination analyses do not communicate well with
busy managers. Furthermore, the results that I had pub-
lished did not provide any estimate of effect size, which
is often the main focus of a manager. Or put another
way, a significant P-value is of much less interest than
a number showing how much two treatments differ (Di
Stefano et al. 2005; Cumming 2012). It is only with an
effect size that a manager can properly weigh the costs
against benefits. I should have considered practitioners
20. available knowledge. This might appear as a rather trivial
statement, but new findings often take considerable time
before translating into action, thereby wasting the
resources society has invested in research. For example,
Gilbert et al. (2005) estimated that if a recommendation
(sleeping position of infants) had been changed when the
evidence was available, rather than after 25 yrs, 10,000
lives could have been saved in the UK alone. In another
example, a systematic review showed that costly methods
used (to increase salmonid fish abundance by in-stream
structures) for 80 yrs were of rather doubtful value
(Stewart et al. 2009). Within medicine, all parties includ-
ing taxpayers, insurance companies and patient’s next-of-
kin, expect doctors to make a well-informed decision. The
medical field is also where the evidence-based movement
has experienced its greatest achievements: evidence-based
medicine was voted among one of the ten most important
medical advances during the last centuries (Ferriman
21. 2007). Aided by meta-analyses, systematic reviews are the
foundation of evidence-based medicine. In such a review,
which focuses on a specific question rather than a conven-
tional review, a literature search is performed systemati-
cally, and studies are selected for inclusion according to
predefined criteria and, most often, the published numbers
are entered into meta-analyses. Thus, all relevant informa-
tion can be quantitatively summarized, and doctors can
base their treatment alternatives on such reviews.
Not all fields have such simple outcome variables as
medicine, and might involve more complex decisions by
managers. Furthermore, meta-analysis and systematic
reviews has created new challenges (Kueffer et al. 2011;
Lindenmayer & Likens 2013). However, this does not
preclude benefits to society by adopting an evidence-based
approach within an area (e.g. Hattie 2009). Furthermore,
within the last several years, evidence-based move-
ments within environmental management have emerged
22. (www.environmentalevidence.org, www.eviem.se, www.
cebc.bangor.ac.uk). In fact, there are already a number of
published systematic reviews focused on vegetation man-
agement (e.g. Newton et al. 2009; Kettenring & Adams
2011; Humbert et al. 2012).
The new statistics
Importantly, a ‘statistical reform’ is currently underway,
where a shift away from P-values to a focus on effect sizes
can be observed (Fidler et al. 2004; McCloskey & Ziliak
2009; Cumming 2012). This is a cornerstone in evidence-
based management and goes hand-in-hand with meta-
analyses. As an indication of how far this reform has come
in some fields, Epidemiology, a major journal in its field,
already in 1998 stated in the instructions for authors that,
“When writing for Epidemiology, you can also enhance your
prospects if you omit tests of statistical significance. . . In
Epidemiology, we do not publish them at all” (Rothman
1998). In contrast, ecologists seem to continue to think that
23. null hypotheses and P-values are essential for publication.
Neither meta-analyses nor ‘statistical reform’ is new to
ecology (e.g. Fidler et al. 2004; Koricheva et al. 2013;
Vetter et al. 2013). The use of meta-analyses among ecolo-
gists, however, has not been within the context of evi-
dence-based management, but rather to support reviews
primarily aimed for other researchers. So time should be
ripe for its usage also in management-related questions,
with a focus on (i) ‘what works best’ (rather than on pro-
cesses and mechanisms) and on (ii) practitioners as poten-
tial readers (rather than on researchers only). Another
new consideration, which has bearing on all research pub-
lished, is to ensure that your data presentation allows
inclusion in future meta-analyses (i.e. a focus on effect
sizes rather than P-values). Imagine the horror when you
realize that all of your research effort is nullified by being
excluded from the next systematic review. Thus, the
presence of systematic reviews has resulted in greater con-
24. formity in how the medical researcher decides to design
and particularly analyse and present data from clinical
trials (and more recently, also in placing data in data
repositories). In contrast, ecologists seem to strive for
diversity in analysis and presentation.
New tools needed to enable meta-analysis of
vegetation data
Vegetation is complex, often species-rich, and thus com-
plex to analyse, and our field has a long history of relying
on various multivariate methods of analysis (e.g. Kent &
Ballard 1988; Masing 1994). However, because the
vegetation composition varies over sites and situations, it
is not always easy to analytically compare results of
experiments from different studies with multivariate
methods. Of course, there are other methods to simplify
data that might be more appropriate for meta-analysis
(e.g. Diekmann 2003; Milberg et al. 2014), and which can
be used to supplement more conventional multivariate
26. journal (Pautasso & Sch€afer 2010). The increasing rejec-
tion rates, noted by many (e.g. Jackson 2009; Statzner &
Resh 2010) indicate that much more effort has to go into a
study than once required (Campos-Arceiz et al. 2013).
There is also a risk that sound trials that have been con-
ducted remain unpublished (Scherer et al. 2007).
When editors have many manuscripts to choose from,
the key for a successful manuscript in most journals is no
longer whether a study is well conducted and with justified
conclusions, but the somewhat subjective and elusive
‘novelty factor’. Thus, if a study is merely confirmatory, as
judged by referees, or with non-significant results, then it
is less likely to be published (Dwan et al. 2008; Hopewell
et al. 2009). In the history of scientific publishing, this can
be seen as a shift in focus from documenting research
(‘anything that is well described and with conclusions
that are justified is OK’), to publishers and editors trying
to maximize profit and bibliometric outcomes, respec-
27. tively (e.g. Wellcome Trust 2003; Falagas & Alexiou 2008;
Statzner & Resh 2010). Considering the enormous volume
of published literature per year, we as readers might wel-
come this filtering of findings. However, knowledge is not
well built if only based on novelty and the extraordinary
or when there is a strong bias towards ‘significant’ results
(e.g. Ioannidis 2005; Knight 2006; Moonesinghe et al.
2007; Ridley et al. 2007; Fang & Casadevall 2011; Fanelli
2012; Giner-Sorolla 2012; Brodeur et al. 2013; Schoenfeld
& Ioannidis 2013).
Evidence-based management works best when all
well-executed studies are published and without delay.
In reality, there is a bias favouring exceptional results
while punishing the ‘uninteresting’. Thus, a reform would
need a resurrection of the value of confirmatory studies
(Asendorpf et al. 2013). In addition, we need to find a way
to document non-significant results (e.g. Kotze et al.
2004) that are of interest, at least if a study appears to have
28. been properly replicated.
Reform for both applied vegetation science and
Applied Vegetation Science?
Taken together, to enable the emergence of evidence-
based vegetation management, researchers need the fol-
lowing: (i) a shift in focus towards effect size and results
that are suitable for meta-analysis; (ii) to consider practi-
tioners as potential readers; (iii) more focus on practical
problems rather than mechanism; and (iv) acceptance of
well-executed confirmatory studies.
These above points have implications for editorial poli-
cies of all journals claiming to be a source for applied
research. So if Applied Vegetation Science wants to fully live
up to its name, why not an editorial demand for papers
with practical relevance, to present results in a manner
that enables future meta-analysis and to allow space for
confirmatory studies? Both Journal of Applied Ecology and
Ecological Applications claim practitioners as a target audi-
29. ence, why should Applied Vegetation Science be different?
And it would be excellent if Applied Vegetation Science aimed
to be an avenue for publication of systematic reviews, as
do the journals Biological Conservation and Environmental
Evidence.
Acknowledgements
I would like to thank referees and Lars Westerberg for
comments on an earlier version of the manuscript, and
extend the thanks also to other colleagues with whom I
have discussed ‘knowledge transfer’, statistical reform and
publication policy.
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