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In the absence of such data, an assessor might rely on existing datasets, such as those in the Exposure Factors Handbook: 2011 Edition (U. Existing data can serve as an important reference for evaluating potential exposure factors for various segments of the population. Regardless of the data source, an assessor considers how data uncertainty and variability in the datasets used affect estimated exposures and decisions based on an exposure assessment. The extent of the evaluation depends on many factors, including the type of assessment, data quality objectives and data availability. In the planning stage, an assessor balances the cost of conducting uncertainty and variability evaluations that are more advanced. Likewise, evaluating decision uncertainty is iterative, which can help stakeholders provide input regarding whether more resources could reduce uncertainty and provide consequential benefits. In most instances, spending more resources to obtain data that are more certain is important only if the new information would change the choices a risk manager/decision maker makes. Whether a particular level of uncertainty is acceptable is a matter of context. Clearly communicating information about an uncertainty (data and decision) and variability evaluation, however, can be difficult. Risk managers/decision makers and stakeholders might ask questions about how uncertainty shapes decisions, affects confidence in an exposure assessment or influences the application of the results to specific groups or populations. When risk Page 151 managers/decision makers determine which uncertainties contribute the greatest influence on the exposure assessment results. Determining and evaluating decision uncertainty can facilitate communication because stakeholders will be able to explain the influence of the compounded uncertainties on the resulting exposure assessment (Stahl and Cimorelli 2005). A Tiered Approach to Data and Decision Uncertainty and Variability Evaluations Data uncertainty and variability evaluations are increasing in complexity as evaluation tools. Not all exposure evaluations, however, require the most complex evaluation possible. The level of complexity of the evaluation relates to the complexity of the assessment and the potential use of the exposure information in the risk management decision. In its simplest form, the tiered approach to understanding the effects of data uncertainty and variability on the exposure assessment outcomes involves starting with basic screening methods and then sequentially employing more sophisticated methods as needed to support the decision (U. This section describes the tiered approach and discusses the methods most commonly used for each tier. Assessors need to identify and use the methods that best meet their needs and coordinate with their programs for specific guidance. In addition to data uncertainty and variability, uncertainties related to agreements about planning, scoping and problem formulation, data and model selection, what role expert judgment plays and how stakeholders intend to use the data need evaluation to understand the compounded effect of all these aspects on the resulting exposure assessment. Although traditional statistical tools and methods can be useful in reducing data uncertainty and better understanding variability, other, more stakeholder-focused approaches need to be engaged to determine and evaluate decision uncertainty (Belzer et al. In moving through each tier, from simple to complex, an assessor determines whether additional, case-by-case evaluations are needed or whether the uncertainty (data and decision) and variability have been addressed or reduced to acceptable levels. This process involves: Page 152 Selecting input parameters for an exposure assessment (data uncertainty and variability) Developing a deterministic analysis to identify potential exposures to provide a baseline for a sensitivity and more sophisticated analyses (data uncertainty and variability) Conducting a sensitivity analysis to characterize decision uncertainty that includes the compounded impacts of uncertainty or variability on exposure assessment outcomes (data uncertainty, variability and decision uncertainty) When high decision uncertainty is an issue, implementing further analyses to refine the input parameters to an exposure assessment and reduce uncertainty and better understand variability in the assessment (data uncertainty, variability and decision uncertainty). The information generated when refining input parameters at one tier of the evaluation. Assessors are encouraged to consult with their programs to identify preferred evaluation tools and default input parameters. As the data uncertainty and variability evaluation becomes more sophisticated, an assessor will revisit and, as necessary, refine the input parameters. The decision uncertainty and the results of the exposure assessment are influenced not just by the people. At the beginning of an exposure assessment, an assessor often uses a screening-level approach (see Section 8. At the screening level, an assessor typically selects a single data point estimate to represent a central tendency, maximum or other exposure level. This step also is the first step of a data uncertainty and variability evaluation.

Although they are present most of the growing season, they are damaging only at high populations or in combination with other defoliators. This feeding introduces disease organisms into developing seeds, reduces germination and lowers milling quality. Adults and nymphs feed by inserting their piercing-sucking mouthparts into the stem a few inches above the soil line. This feeding around the stem girdles the plant, often causing it to lodge later in the season. Kudzu Bug: Infestations of kudzu bug on kudzu and soybean have been reported from most soybean producing areas of Tennessee, and this invasive insect is spreading rapidly through the state. Infestations often occur first and most heavily on field edges, and treatment decisions should be made based on thorough scouting of entire fields. Scouting Procedures A good sampling plan is to check 6 feet of row at 5 locations or take 25 sweeps at 4 locations in average sized fields (about 50 acres). The stems become woody and severe damage from seedling pests becomes less likely at this time. Look for insects that may be on the plant (threecornered alfalfa hopper) or in the soil around the base of the plants (lesser corn stalk borer, cutworms). Evaluate stand loss (percentage of dead or dying plants) and try to determine if future stand loss is probable (insects easily found and actively damaging plants). At each sample point, estimate percent foliage loss so that an average can be calculated for the field. Look for aphids on the undersides of upper leaves in vegetative and flowering soybeans. Pod-Feeders: After full bloom, when pods are forming, look closely for any pod-feeding caterpillars (corn earworms and fall armyworms) and stink bugs which are dislodged onto the shake cloth or into the sweep net. Stage of Plant Development Seedling V5 - R1 (Early flowering) R1 - R5 (Early flowering to early podfill) R5 + (mid to late podfill) Common Pests Threecornered alfalfa hopper -Stink bugs, green cloverworm Stink bugs, loopers, green cloverworm Occasional Pests Thrips, grasshoppers, bean leaf beetle, cutworms, grape colaspis, white grubs Threecornered alfalfa hopper Threecornered alfalfa hopper, blister beetles, corn earworm, fall armyworm, loopers, soybean aphid, kudzu bug Blister beetles, fall armyworm, loopers, soybean aphid, kudzu bug Insecticide Seed Treatments Insecticide seed treatments such as thiamethoxam. Seed treatments will help control some seed and seedling pests such as thrips, bean leaf beetle, grape colaspis, threecornered alfalfa hopper, wireworms and white grubs. Data indicates that insecticide seed treatments provide an average yield increase of 1-2 bushels per acre in Tennessee. Insecticide seed treatments are recommended when cover crops are planted and persist in fields within 3 to 4 weeks of planting, particularly if the cover crop includes a legume species such as vetch or winter peas. When to Treat Treat if 10 percent of young plants (up to 10-12 inches) are infested with adults or nymphs. Bend small plants over to check for girdling and consider treatment if 50 percent or more of plants are girdled. Treat at 30 percent defoliation until bloom (R1), 20 percent from bloom to full seed (R1-R6), and 30 percent after R6 to R6 plus 7-10 days. From R6 to R7, treat when an average of 18 or more stink bugs is found per 25 sweeps. Once blooming has begun, treat when an average of 9 or more larvae is found per 25 sweeps (or 1 or more larvae is found per foot of row). Fall armyworm may also feed on foliage, and severe infestations may originate on weedy grasses. Treatment can be based on the percent defoliation thresholds above under these circumstances. Threecornered Alfalfa Hopper Defoliating Pests (bean leaf beetles, green cloverworm, blister beetles, loopers, grasshoppers, Japanese beetles, etc. From R1 to R7, treat when an average of 1 or more immature kudzu bug is present per sweep (25 per 25 sweeps). In narrow-row soybeans, allow the normal arch of a sweep net to continue through the adjacent rows.

The endpoint for exposure science is the dose that the target internal tissue, organ or developing embryo/fetus receives: the location where the dose initiates the toxicity pathways that trigger the adverse effect. This endpoint serves as the starting point for toxicology (Pleil and Sheldon 2011). In this figure, the basic components from stressor release to adverse outcome are the same. On the left-hand side of Figure 2-2, actions or events might be sources for stressors that cause changes in human and natural factors or alter human behaviors or both. The outcomes on the right-hand side of the figure have feedback loops that, inherently, can Page 5 lead to stressors or to different actions or events. The figure shows the instrumental role human activities play both in describing the exposure event and in developing or mitigating exposures or risk. The figure departs from a simple linear depiction of exposure by incorporating feedback loops resulting from exposures or actions to those exposures. Concepts depicted in this systems framework will become increasingly important as the Agency addresses issues of sustainability. Multiple stressors can enter the environment at the same time from multiple sources. Stressors can remain unchanged or chemical, physical or biological processes can transform them. Stressors in their native forms or their transformation products can take many different pathways to reach human receptors. Exposure often is characterized for a single stressor, in a single medium or as a single pathway. Real-world scenarios involve multistressor, multimedia and multipathway exposures. Exposure scientists develop methods to characterize aggregate exposure, the sum of exposures to a single stressor from all sources, and cumulative exposure, which addresses exposures to multiple chemicals by multiple routes over multiple periods. A receptorbased approach has two important advantages over a source-based approach. It simplifies the problem by narrowing the universe to stressors that are actually important for human exposure and health risk, and it enables us to develop a real-world description of risk by considering the multiple stressors by which exposure actually occurs. Exposure science, however, often is applied in the broader context of the source-to-outcome continuum where informing risk assessment and risk management decisions using exposure scenario or other approaches is essential and where understanding relationships between sources and exposures is critical. Page 6 Receptors can be individuals, groups at specific lifestages within a population or the entire population. Understanding the characteristics of human receptors, their behaviors and the relationship between these factors and exposure or dose is crucial for a receptor-based approach. Variability in exposure occurs because of location, occupation, activities within a location, socioeconomic status, consumer preferences, dietary habits and other lifestyle choices. Behaviors relative to lifestage can be particularly influential determinants for exposure, especially for infants and toddlers and for the embryo/fetus during pregnancy. Lifestage, health status, sex and genetic differences also can be important factors that determine dose. The drivers for human activities are complex and, unlike stressors, cannot be predicted using first-principle models based on physical/chemical properties. Instead, human activities are treated as stochastic properties (random variables) described by population distributions based on available. Vulnerability refers to characteristics of individuals or populations that place them at increased risk of an adverse health effect (U. It includes economic, demographic, social, cultural, psychological and physical states of the receptor or population that influence patterns of exposure to environmental contaminants and those states that alter the relationship between the exposure of the environmental agent and its health effect on the receptor (Gee and Payne-Sturges 2004). Vulnerability also can include external stressors of socioeconomic/sociopolitical origins. In addition, during certain lifestages (such as fetal development), specific and characteristic exposure routes can predominate, during which exposure might enhance adverse outcomes.

Syndromes

• Abdominal pain
• Tuberculosis
• Acute anxiety
• Irritability
• Reactions to medicines
• How well the baby is doing in the womb.
• Depression
• Liver damage (hepatitis)
• Pain
• Most often, the catheter is inserted through the urethra. This is the tube that carries urine from the bladder to the outside of the body.

The lens may be dislocated in the vitreous, anterior chamber or subconjunctival space following trauma. A posterior dislocation or subluxation can also occur spontaneously in hypermature cataract. Deep anterior chamber, tremulousness of the iris and floating lens in the vitreous are the characteristic signs of the posterior dislocation of the lens. Since manometric measurements are not practical in human beings, indentation or flattening of a limited area of the cornea by a given weight is measured. The patient is asked to look down towards his feet and tips of the index fingers of the examiner are placed side-by-side on the upper lid just above the upper border of the tarsal plate. One finger is kept stationary while the other presses to indent the globe and an impression of fluctuation is felt by the stationary finger. An accurate determination of ocular tension is made by means of an instrument called tonometer. The tonometer measures the amount of indentation of the cornea produced by the weight of its plunger or any additional weights on it, which is indicated by the deflection of a pointer on a graduated scale. The instrument is calibrated so that the equivalent of readings in millimeter of mercury (mm Hg) can be read from a chart. Ocular tension measured by the tonometer is inaccurate because of wide individual variation in the rigidity of the sclera. Further readings are obtained by putting additional weights to make the final weight of the plunger 7. Besides scleral rigidity, a poorly calibrated tonometer, improper positioning of the tonometer on the cornea and an uncooperative patient are the common sources of error. The sensor measures the air pressure by indenting the cornea by a flow of gas against a flexible diaphragm. In the former, an intense beam of light is thrown from the fornicial conjunctiva and sclera, and pupil is visualized which normally appears red. However, if there lies a solid mass in the ciliary region, the pupil remains dark in the corresponding sector. When the cornea and the lens are opaque, transcorneal transillumination can be of help to localize lesions of the ciliary body. The ocular tension recorded by applanation tonometer ranges between 14 and 17 mm Hg, with an average of 15 mm Hg. Ophthalmoscopic Examination or Ophthalmoscopy the routine ophthalmoscopic examinations performed in a dark room are listed below. Preliminary examination with a mirror at 22 cm distance (distant direct ophthalmoscopy) 2. Generally, examination with a mirror at one meter distance gives information about the nature of the refractive status of the eye under examination, known as retinoscopy, and is already been covered in the Chapter on Determination of the Refraction. When the light is thrown with a plane mirror, the fundus reflex is normally seen as a uniform red glow. The nature of the opacities can be determined by asking the patient to move his eyes; opacities in the vitreous and aqueous will continue to move even after the eye is brought to rest. The exact position of the opacity can be determined by observing its parallactic displacement. By this method the opacities in the pupillary plane will appear stationary, those in front of that plane (cornea and anterior chamber) will move in the same direction, and those behind the plane (posterior surface of the lens and vitreous) will appear to move in opposite direction. The plane mirror examination clearly distinguishes between an iris hole and a mole and locates the edge of a dislocated lens or congenital coloboma of the lens. The edge of the lens appears as a black crescent in the pupillary area due to total reflection of light within the lens. The presence of a whitish or grayish uneven surface with black retinal vessels suggests a detached retina or a tumor arising from the retina. In place of the mirror, a self-illuminated ophthalmoscope can be used for the examination. Indirect Ophthalmoscopy the indirect ophthalmoscopic examination is an important procedure to examine the details of the fundus, particularly of the periphery. The optical principle utilized in this method is to make the eye highly myopic by placing a strong convex lens (+20 D spherical) about 10 cm in front of the eye so that a real inverted aerial image of the fundus, magnified about three times, is formed. Illumination Indirect True and inverted 3 to 5 times Bright (Funduscopy possible despite opacities in media) Present Nearly 8 diskdiameters Up to ora serrata Direct Virtual and erect About 15 times Not so bright (Funduscopy not possible if opacities in media) Absent Only 2 diskdiameters Up to equator 4.