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C. Kayor, M.A., M.D., Ph.D.

Medical Instructor, University of Toledo College of Medicine

Training and adult learning strategies for the care and use of laboratory animals. Monitoring the Care and Use of Animals A Resource Book for Lay Members of Local Ethical Review Processes, 2nd ed. Supplementary Resources for Lay Members of Local Ethical Review Processes: Projects Involving Genetically Modified Animals. The International Symposium on Regulatory Testing and Animal Welfare: Recommendations on best scientific practices for animal care committees and animal use oversight. Biosafety in the Laboratory: Prudent Practices for Handling and Disposal of Infectious Materials. Laboratory Animals: An Annotated Bibliography of Informational Resources Covering Medicine, Science (Including Husbandry), Technology. A review of environmental enrichment for pigs housed in intensive housing systems. Annotated Bibliography on Refinement and Environmental Enrichment for Primates Kept in Laboratories, 8th ed. Artificial turf foraging boards as environmental enrichment for pair-housed female squirrel monkeys. Assessment of the use of two commercially available environmental enrichments by laboratory mice by preference testing. Effects of a cage enrichment program on heart rate, blood pressure, and activity of male Sprague-Dawley and spontaneously hypertensive rats monitored by radiotelemetry. Environmental enrichment in mice decreases anxiety, attenuates stress responses and enhances natural killer cell activity. Guidelines for developing and managing an environmental enrichment program for nonhuman primates. The effect of non-nutritive environmental enrichment on the social behavior of group-housed cynomolgus macaques (Macaca fascicularis). Through the Looking Glass: Issues of Psychological Well-Being in Captive Nonhuman Primates. Genetics and Genetically Modified Animals A Primer of Population Genetics, 3rd ed. Behavioral phenotyping of transgenic and knockout mice: Experimental design and evaluation of general health, sensory functions, motor abilities, and specific behavioral tests. Mouse functional genomics requires standardization of mouse handling and housing conditions. Taming and training of pregnant sheep and goats and of newborn lambs, kids and calves before experimentation. Welfare concerns for farm animals used in agriculture and biomedical research and teaching. Joint publication of the American Fisheries Society, the American Society of Ichthyologists and Herpetologists, and the American Institute of Fisheries Research Biologists. Guidelines for the Use of Live Amphibians and Reptiles in Field and Laboratory Research, 2nd ed, rev. Herpetological Animal Care and Use Committee, American Society of Ichthyologists and Herpetologists. Important ethological and other considerations of the study and maintenance of reptiles in captivity. Information Resources for Reptiles, Amphibians, Fish, and Cephalopods Used in Biomedical Research. Chicken welfare is influenced more by housing conditions than by stocking density. Feline behavioral guidelines from the American Association of Feline Practitioners. The Canine as a Biomedical Research Model: Immunological, Hematological, and Oncological Aspects. Exotic, Wild, and Zoo Animals Animal Training: Successful Animal Management Through Positive Reinforcement. Implementation of permanent group housing for cynomolgus macaques on a large scale for regulatory toxicology studies. London: National Centre for the Replacement, Refinement and Reduction of Animals in Research.

A work site visit to identify characteristics and physical demands of specific jobs. Nursing evaluation - 30 minutes: Nursing assessment of medical status and needs in relationship to rehabilitation. These components include such tests as active range of motion, motor power using the 5/5 scale, and sensation. Additional 15-minute increments may be added if multiple body parts are reviewed and time exceeds 45 minutes. Additional 15 minute increments may be added to measure additional body parts, to establish endurance and to project tolerances. Social worker evaluation - 30 minutes: Psychosocial evaluation to determine psychological strength and support system in relationship to successful outcome. Therapeutic education - group - each additional 15 minutes Video Review: Review of video requested by an insurer or a managed care organization. Vocational evaluation - 30 minutes: Evaluation of work history, education, and transferable skills coupled with physical limitations in relationship to return-to-work options. Additional 15 minute increments (per additional body part) may be added to determine endurance. Work simulation - group - each additional 30 minutes Work simulation - individual 1 hour: Real or simulated work activities addressing productivity, safety, physical tolerance, and work behaviors. Programs must identify the extent, frequency, and duration of services to be provided. Examples: hearing aids, eye glasses, crutches, wheelchairs, scooters, artificial limbs, etc. The insurer must pay for the repair or replacement of prosthetic appliances damaged as a result of a compensable injury, even if the worker received no other injury. If the appliance is not repairable, the insurer must replace the appliance with a new appliance comparable to the one damaged. However, without approval from the insurer or director, the payment for hearing aids may not exceed $7000 for a pair of hearing aids, or $3500 for a single hearing aid. If the worker chooses to upgrade the prescribed hearing aid, the worker may do so but must pay the difference in price. However, a patient may insist on receiving the brand-name drug and either pay the total cost of the brand-name drug out of pocket or pay the difference between the cost of the brand-name drug and generic to the pharmacy. The patient clients; (B) the interpreter routinely notifies all clients of the missedmay choose a family member, a friend, an employee of the appointment policy; medical provider, or an interpreter. However, if the the service is final, if the interpreter receives written notice of insurer denies the claim, interpreters may bill the patient. No payment allowed the private vehicle mileage rate published in Bulletin 112 $60. The insurer must provide specific information about what is needed to process the invoice. All the information on the written explanation must be in 10 point size font or larger.

An alternative method of extending therapy is to greatly increase dialysis treatment time (from the usual 2. Various frequency schedules for nocturnal dialysis have been reported, from 3 to 6 times per week. Given the lack of maturity of the research data in this field, the Work Group decided to refrain from making specific recommendations about the usefulness of these therapies in terms of a guideline or from proposing guidelines regarding minimally adequate therapy given more frequently than 3 times per week. One of the main benefits of more frequent therapies may be ridding the body of solutes that are difficult to remove, such as phosphate, 2M, or some still unknown uremic toxins. Another benefit may be in better control of salt and water balance, which may impact on patient survival as much as solute control. In particular, the Work Group was impressed with observational data linking hard outcomes to calcium-phosphorus product,286 as well as better control of serum phosphorus levels with more intensive daily dialysis schedules200 and most nocturnal dialysis schedules. Phosphate, while clearly linked to outcome, has complex and as yet poorly defined kinetics, and serum levels are affected not only by dialysis, but also by diet and consumption of phosphorus binders. One of the major disadvantages of urea is the rapidity of its diffusion among body compartments (high intercompartmental mass transfer area coefficient). Because highly sequestered solutes will have a large rebound after dialysis, the time-averaged blood level will be close to the mean predialysis level. This is the level obtained when one dialyzes using a thrice-weekly schedule to an spKt/V of approximately 1. Kinetic modeling was used to examine the levels of spKt/V per treatment that would be required to reach a weekly stdKt/V value of 2. It is especially important to note that extending dialysis time is much more effective for controlling solute levels when frequency is increased to 4 to 7 treatments per week. Particularly in short-daily therapies, longer treatment times markedly improve phosphate removal. Usually the Kt/V for an 8-hour treatment, even at reduced dialysate and blood-flow rates, will be greater than 1. For this reason, the Work Group recommended targeting an spKt/V value that is about 15% higher than the recommended minimum targets in Table 19 in the Appendix. The Work Group was of the opinion that, at the present state of incomplete knowledge, the best way to adjust for residual renal urea clearance is to add it to the weekly stdKt/V. Residual urea clearance of 2 mL/min is approximately 20 L/wk of clearance; accordingly, in a patient with V 30 L, it represents about a 0. Table 13 shows spKt/V values per treatment corresponding to a weekly stdKt/V value of 2. Patients who were receiving a markedly reduced dose of dialysis because of a higher Kr then might be underdialyzed for a few months until the reduction in Kr was recognized and acted upon. For these reasons, the Work Group developed an alternative scheme that limited the downward adjustment in spKt/V for Kr to 2 mL/min, even for patients with higher levels of Kr. The wisdom of recommending this fully incremental approach was intensely debated in the Work Group. Opinions differed, so it was decided to leave further reductions in dialysis dose, below values suggested in Table 13, to the discretion of the clinician. Second, it was recommended that in patients for whom treatments are reduced because of Kr of 2. However, because the Work Group did not want to impose a burden of verifying Kr for all patients in a dialysis clinic, the recommendation is to verify it only in patients for whom the target dialysis dose is reduced. The overall benefit for men and women was close to zero because an opposite nonsignificant trend for increased mortality in men assigned to the higher dose of dialysis also was found. For the most part, this happens naturally because most women have a smaller value for V; thus, the same prescription applied to a man and a woman, even considering patients of equal weight, will result in a higher Kt/V in the woman. A separate issue is whether smaller nonundernourished patients who are at or near their expected weight might require more dialysis. The argument has been made that V is determined substantially by skeletal muscle mass, which may be relatively quiescent in terms of generation of uremic toxins.

Scrapes and abrasions to forehead, face, chin, arms, and knees; bruises all over body; sore neck; swollen cheek; tingling in fingers; welts on back and legs; chipped 2 teeth; bankart lesion on shoulder that led to subsequent dislocation; shoulder pain expected to continue. Permanent facial scar, permanent facial droop; swelling and bruising resolved; headaches for 6 months resolved; struck with beer bottle tossed over shoulder; loss of boxing career. Gash on top of his head and cut from bridge of his nose to down beside his right eye and under it. Page 4 General Plaintiff Defendant Year Citation Court Judge Sex Age Female 60 years Non-Pecuniary General Damages $55,000. Plaintiff: Male, Wife, Son, daughter Page 5 General Plaintiff Defendant Year Citation Court Judge Sex Age Male Non-Pecuniary General Damages $75,000. The Plaintiff claims to suffer from neck pains and regular severe headaches since the accident. He is no longer able to concentrate and practice for a sufficient length of time to be able to audition and obtain a position with a large romantic size symphony orchestra. Page 6 General Plaintiff Defendant Year Citation Court Judge Sex Age Male 43 years Non-Pecuniary General Damages $90,000. Page 8 General Plaintiff Defendant Year Citation Court Judge Sex Age Non-Pecuniary General Damages Other Damages Comments Nyamadi Mississauga (City) 2005 October 7 [2005] O. T Headaches, neck strain, right shoulder strain, back pain, chest pain, lower back pain, pain in the arms, bladder injury, muscle spasm, myofascial injuries throughout her body, and contusions. Page 9 General Plaintiff Defendant Year Citation Court Judge Sex Age Female Non-Pecuniary General Damages $100,000 Other Damages Comments Fall was "horrific. Slipped and fell heavily to the ground, falling on her right side and striking her head. She suffered an injury to her head, ribs, leg, and shoulder, as well as multiple bruises and abrasions. Pre existing conditions: the plaintiff suffered from diabetes, high blood pressure, lower back pain and a heart condition that caused fatigue and weakness. Page 12 General Plaintiff Defendant Year Citation Court Judge Sex Age Female 57 years Non-Pecuniary General Damages $60,000. Injuries sustained from assault include visual impairment, diminished cognitive abilities, short term memory loss, limited depth perception, reduced flexibility, and difficulty balancing self while walking and standing upright. Assailant 50% liable for unlawfully causing serious and permanent Page 14 General Plaintiff Defendant Year Citation Court Judge Sex Age Non-Pecuniary General Damages Other Damages Comments Lid Blepharoplasty: $3,000. Page 15 General Plaintiff Defendant Year Citation Court Judge Sex Age Male 20 years Non-Pecuniary General Damages $312,000 Other Damages Comments Marcoccia (Litigation Guardian of) Ford Credit Canada Ltd. He may require an intraoral stabilization orthotic, which will require adjustment periodically. Page 16 General Plaintiff Defendant Year Citation Court Judge Sex Age Female 44 Years Non-Pecuniary General Damages $35,000 Other Damages Comments Ayana Skin Klinic 2009 July 29th [2009] O. Future Care Costs: $1,200 Special Damages: $695 Recovery of Cost of Treatments: $675 Family Law Act: Husband $3,500 Son - $5,000 Daughter - $500 Family Law Act: First Daughter (primary caregiver) $20,000 2nd Daughter $10,000 Faulty hair removal procedure causing second degree burns to neck and chin, permanent scarring. Page 17 General Plaintiff Defendant Year Citation Court Judge Sex Age Male Non-Pecuniary General Damages $7,500 Other Damages Comments Abebe-Deres VanDaalen 2010 September 22 [2010] O. Page 18 General Plaintiff Defendant Year Citation Court Judge Sex Age Male 46 Non-Pecuniary General Damages $200,000 Other Damages Comments James Harper 2010 August 30 [2010] O. Aggravated damages: Because of the vicious and the brutal assault plaintiff is entitled to aggravated damages Page 19 General Plaintiff Defendant Year Citation Court Judge Sex Age Male 25 (at time of injury) Non-Pecuniary General Damages $125,000 Other Damages Comments Georgiou Vassos 2010 November 30 [2010] O. Plaintiff suffers from chonic pain in head and neck, numbness in left arm, hand, left trunk, leg and foot. Page 20 General Plaintiff Defendant Year Citation Court Judge Sex Age Female 24 Non-Pecuniary General Damages $30,000 Other Damages Comments Ramotar La Fontaine Jeunesse 2010 November 25 [2010] O. Dermatologist described injury as "post inflammatory hyper pigmentation of face and neck, secondary to burns from laser hair removal". The burns have left scars which has lead to depression, weight gain and social introversion, Damages calculated but not awarded.

Sex Age Female 35 Non-Pecuniary General Damages $100,000 Other Damages Loss of Competative Edge: $50,000 Family Law Act Claim: Husband $15,000 Family Law Act Claim: Two Children $15,000 each Comments Plaintiff was in motor vehicle accident. Page 116 Neck Plaintiff Defendant Year Citation Court Judge Sex Age 2 Male Non-Pecuniary General Damages Plaintiff 1: $75,000. Soft tissue injury to neck and back, headaches and dizziness, chest pain, breathing problems, tingling in left arm, increased sleeping difficulty. Page 117 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male 33 years Non-Pecuniary General Damages $55,000. Jury verdict upheld despite trial judge not instructing jury properly re contributory negligence. Page 118 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male Brown Flaharty 2004 [2004] O. Page 119 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male 38 years Non-Pecuniary General Damages $75,000. Page 120 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male 56 years Non-Pecuniary General Damages $165,000. Page 121 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male 43 Non-Pecuniary General Damages $90,000 Other Damages Comments LaHay Henderson 2005 April 29 [2005] O. Future lost income was $804,100 based on annual income of $47,129 Figure was reduced by 30 per cent to reflect health problems associated with obesity Winters Loblaws Supermarkets Ltd. Developed spastic quadriparesis, chronic pain in her neck and shoulders, extreme fatigue, gait ataxia, gastrointestinal dysfunction, neurogenic bladder and bowel, decreased concentration and memory, sleep apnea/narcolepsy and depression. Page 122 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Male 52 years Non-Pecuniary General Damages $120,000. Page 123 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Female 23 years Non-Pecuniary General Damages $70,000. She claims that she suffers, and will continue to suffer permanent and serious psychological injuries, including hypertension, insomnia, fatigue, stress, depression, anxiety, irritability, memory loss, and cognitive difficulties. Page 124 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Female Non-Pecuniary General Damages $75,000 reduced 15% to reflect preexisting condition: $ 63,750 Other Damages Comments Garratt Orillia Power Distribution Corp. Page 125 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Female 18 years Non-Pecuniary General Damages *Jury assessed at $45,000. P complains of sore neck, pain in the left arm, tingling in the left arm, sore left shoulder area, sleep disturbance, concentration and memory problems, headaches, fatigue, anxiety or depression, low back pain (from about 2004) and flare-ups of pain. Page 126 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Female 32 years at trial Non-Pecuniary General Damages $25,000. Pain and discomfort prevents plaintiff from performing housekeeping and home maintenance services at her preaccident levels. Faulty hair removal procedure causing second degree burns to neck and chin, permanent scarring. Past Wage Loss: One week of fulltime earnings and two weeks of parttime earnings Sabourin Dominion of Canada General Insurance Co. Plaintiff now works at a diminished capacity, has a more troubled relationship with his wife, cannot do much physical activity with his son and is largely incapable of doing house maintenance that he previously did. Future income loss: $579,612 Loss of housekeeping capacity: $66,500 Family Law Act: $12,000 Future Cost of Care: $150,000. He is suing Dennis Stewart who threw another wrestler ("Hacker") out of the ring and hit the plaintiff. Page 130 Neck Plaintiff Defendant Year Citation Court Judge Sex Age Female 45 years Non-Pecuniary General Damages $15,000 Other Damages Comments Constantini Constantini March 18, 2013 [2013] O. She had a large bump on back of head, soft tissue injuries on right side of neck, headaches, aches and pains all over her body. She has emotional distress in the form of depression, insomnia, anxiety and pervasive fear.