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Public Health Significance: Every year in the United States there are millions of cases of foodborne illness (Scallan et al. Investigation of these reports of illness is of paramount importance to: a) stop additional people from being exposed and becoming ill; b) understand the system failure within a food establishment that led people to become ill; and c) identify a source of contaminated food that may have entered the food establishment. Conducting investigations into how people became sick is an integral part of a food safety program. By understanding the system failures that resulted in a foodborne outbreak, practices can be changed to prevent the failure from happening in the future. Additionally, the important nature of this work has developed additional advanced courses. Conference for Food Protection 2020 Issue Form Issue: 2020 I-016 Council Recommendation: Delegate Action: Accepted as Submitted Accepted Accepted as Amended Rejected No Action All information above the line is for conference use only. Title: Interpretation of Food Code for obtaining consumer purchase records Issue you would like the Conference to consider: We would like for the U. In addition, quickly identifying the source of outbreaks through consumer purchase records is crucial to identify the specific product so that public health advisories can warn consumers to avoid certain implicated products instead of broad categories (such as Romaine, tomatoes or papayas). Such advisories have an enormous economic impact on the food sector and retail food establishments. Solving outbreaks quickly using consumer purchase records also reduces the number of people that may become ill and subsequent industry liability. Some regulatory authorities have been denied access to consumer food product purchase information, and clarification that the Food Code provides authority to access these records will reduce illnesses and associated economic impacts. Both documents include the need for investigating foodborne illness outbreaks and having the ability to trace food back to its source. Conference for Food Protection 2020 Issue Form Issue: 2020 I-017 Council Recommendation: Delegate Action: Accepted as Submitted Accepted Accepted as Amended Rejected No Action All information above the line is for conference use only. Issue History: this issue was submitted for consideration at a previous biennial meeting, see issue: 2018l-027; new or additional information has been included or attached and the recommended solution has been revised. Title: Obtain Purchase Information as part of a Foodborne Outbreak Investigation Issue you would like the Conference to consider: We would like for the U. This will codify an existing practice and provide uniformity to both regulatory and industry segments about expectations, processes, and use of data. Many retailers already provide consumer purchase information; however, variations exist in the processes that retailers use to share this information, and the timeliness with which they provide it. While these multistate outbreaks comprise 3% of all reported outbreaks they account for 11% of the reported illnesses, 34% of the reported hospitalizations, and 56% of the reported deaths attributable to foodborne outbreaks (Crowe, Mahon, Vieira, Gould, & Report, 2015). Quick and efficient identification of hazardous food products and their removal from commerce is critically important to minimize the number of people that become ill. Challenges to solving foodborne outbreaks include delays in reporting illnesses and consumer recall of potential exposures (such as brand and variety of food purchased). During multistate outbreaks, when people are geographically dispersed, purchase information is critical to identify a common source. Using consumer purchase data has assisted in the identification of contaminated product in outbreaks and allowed for its removal from commerce (Barret et al. However, the structure and language of the authorizing legislation varies tremendously between States. By harmonizing the language in the Food Code, it will provide a uniform standard for industry to address requests for consumer purchase information. Once an individual is diagnosed with a foodborne illness, they typically are interviewed about potential exposures by the public health program. During this interview, the patient may be asked where they have shopped for food, if investigators can access their purchase records, and for the account number or last several digits of their credit card. Provision of the account number or last several digits of the credit card number by the patient to investigators should suffice as evidence of consent. Once an individual is diagnosed with a foodborne illness, public health officials may interview them about potential exposures including their food history and where they have shopped.

Others complications include irritability, insomnia and memory loss, necrotizing cellulitis, iatrogenic Cushing`s syndrome and other complications which have even proven fatal (Mahe, Ly, & Peret, 2005). Faye, Keita, Diakite, Konare and Ndiaye (2005) conducted a study in a hospital in Mali, aimed at quantifying the risk of cutaneous complications connected with the use of cosmetic skin-bleaching products. The chemicals in the skin-lightening products are toxic and dangerous to not only the skin, but other organs and functions. Ajose (2005) conducted a similar study in a skin clinic in Nigeria where in a survey, 92% of female patients and 5% of male patients over 16, who used the clinic between February and October 2004, reported using skin-bleaching creams. The results of Ajose`s (2005) study found that the side-effects extended beyond being dermatological. The dermatology related consequences included: (a) Disease modification, for example, atypical scabies, overwhelming mycoses and disseminated warts, (b) dyschromias, for example ochronosis and confetti hypomelanosis, (c) sun damage, including elastosis and sunburn, (d) skin infections, for example pyoderma, erysipelas and dermatophytoses, (e) fragile skin, for example extensive striae and telagiestasia, (f) acne, for example acneform eruptions and rosacea, (g) hypertichosis, and (h) body odor. Medical consequences were: (a) induced Cushing`s syndrome, (b) renal impairment leading to dialysis in two cases, and (c) immunosuppression: five long-term uses had tuberculosis and three had widespread vulval warts. Surgical consequences were fragile skin, poor wound healing, bad scarring and the need for corrective dermabrasion. Other side effects of bleaching creams include skin cancer, thinning of the skin, irreversible stretch marks, easy bruising and tearing of the skin, rashes, enlarged blood vessels, susceptibility to infection, delayed wound healing, hyper pigmentation, acne and hormonal disturbances. Andrew (2002) provided commentary on the skin-bleaching practice in Jamaica and reported that the author of Acne in Black Women, Dr. Neil Perdasingh, a leading dermatologist in Jamaica added: Some of these creams work by killing the melanin, the substance that lends skin pigmentation and protects the skin from the cancer-causing ultraviolet rays of the sun. All people have melanin in their skin; the more melanin present, the darker the skin. In addition, he says, the preparations contain large amounts of hydroquinone- a white crystalline de-pigmenting agent that is fatal in large concentrations. Damage to the skin- wrinkles, severe acne marks- may be irreversible after prolonged use. When we are faced with this type of damage, there is nothing that we can do except to advise the patient to live with their condition. The prolonged and continued use of these creams will lead to a face looking like a grater. With this in mind, it suggests that there is a need to address the root cause of the problem and not merely the symptoms. Given the influence of colonialism on the nation and the significance of skin color, it is important to examine the skin-bleaching practice in Jamaica. It is important to study the issue because of the health issues related to the practice as well as for 78 understanding the motivations-sociocultural and psychological that influence individuals to bleach their skin. Summary this chapter has presented an in-depth review of the literature relevant to the issue of skin bleaching in postcolonial Jamaica. It examined issues related to skin color`s significance on a global scale as well as in Jamaica, the Imperialist and Colonialist influences on Jamaica in areas of culture including sports, religion, music, education, social life, and language. The review covered aspects of the tension between Eurocentric and Afrocentric values and how they influence economics, class and social distinctions, marital choices, beauty and social capital. The chapter also provided a review of the skin-bleaching practice, both globally and in Jamaica and it cited specific studies which provided details of the many consequences of the practice. Interestingly, the research suggests that these consequences have farreaching implications in the areas of health, finance, psychology and culture. Additionally, the study outlined the nation`s efforts to combat the skinbleaching phenomenon. It describes the theoretical assumptions or paradigms that guided the collection and analysis of the data and provides a description of the research design by detailing the specific methods used in the data collection and analysis. The chapter first presents the research design and methodological rationale followed by a discussion of data collection, management and data analysis. Research Design and Methodological Approach According to Morgan (2007), paradigms are a set of beliefs and practices that influence how researchers select both the questions they study and methods they use to study (p. Indeed, the paradigm selected informs the specific techniques and procedures of the research design. Of principal concern in this study are the psychological and socio-cultural factors that influence the practice of skin-bleaching.

However, follow-up stool examinations should be performed to verify eradication of infection. For the treatment of individual patients, retreatment may be considered at intervals as short as 3 months. While we have made an effort to provide information that is current at the time of its issue, the information may not be as current or comprehensive when you view it. We strongly recommend that you consult your counsel, reimbursement specialist or payor organization with regard to reimbursement policies. Physicians should refer to their provider Carrier Manual for their geographic payment. Type of Report and Period Covered Office of Aerospace Medicine Federal Aviation Administration 800 Independence Ave. Ionizing radiation is a subatomic particle of matter or packet of energy (photon) with sufficient energy to eject an orbital electron from an atom. Charged subatomic particles from exploding stars (supernovae) are a constant source of ionizing radiation in the atmosphere and in space. In space another constant source of ionizing radiation is the solar wind from the Sun. The solar wind consists mostly of electrons and protons with energies between 10 and 100 keV. The Sun undergoes an approximately 11-year cycle of rise and decline in activity and during its active phase there is an increased emission of the solar wind and occasional eruptions of high-energy particles (coronal mass ejections). Other sources of ionizing radiation during air travel include radioactive cargo, radioactive substances released into the atmosphere as a result of a nuclear reactor accident or terrorist activity, lightning, and terrestrial gamma-ray flashes. A health effect following exposure to ionizing radiation for which the severity is radiation dose related is called a deterministic effect (non-stochastic effect, tissue reaction). For example, nausea and vomiting might be experienced by a space traveler a few hours after receiving a large dose of ionizing radiation while outside a space vehicle during a coronal mass ejection. If the probability (risk) of a health effect after exposure to ionizing radiation is dose related, it is called a stochastic effect. If one or both parents are irradiated prior to conceiving a child, there is a risk of genetic disorders in the child and in its progeny. The report can be used as a source book for instruction on ionizing radiation exposure of air and space travelers. Key Words Ionizing Radiation, Cosmic Radiation, Radioactive Contamination, Space Weather, Geoomagnetism, Radiation Exposure Limits, Flight Doses, Radiation Health Risks 19. Sauer of the National Geophysical Data Center, National Oceanic and Atmospheric Administration; Dr. Parker (Professor Emeritus) of the University of Oklahoma Health Sciences Center; Dr. Ionizing radiation is a subatomic particle or photon sufficiently energetic to directly or indirectly eject an orbital electron from an atom. Photons and electrically-charged particles ionize directly by means of electromagnetism. Neutral pions decay so rapidly that they are unlikely to impact an atom before decaying. Neutrinos and antineutrinos pass through matter with almost no effect, and usually they are not considered in dose calculations. Wilhelm Conrad Roentgen in 1895 discovered ionizing radiation while experimenting with a Crookes tube (a primitive vacuum tube) (2). Roentgen concluded that an invisible radiation from the tube, which he called X-rays, penetrated the wall of the carton and traveled to the barium platinocyanide. He could not deflect the radiation with a magnetic field, and he found that objects in the path of the radiation showed variable transparency. Antoine-Henri Becquerel in 1896 discovered a natural source of ionizing radiation while investigating phosphorescence (4). He observed that a photographic plate covered with an opaque paper was fogged when placed near uranyl potassium sulfate (a uranium salt).

International cooperation in the environmental field is growing, and in a number of cases trade provisions in multilateral environment agreements have played a role in tackling global environmental challenges. Trade measures have thus been used in certain specific instances, where considered necessary, to enhance the effectiveness of environmental regulations for the protection of the environment. Such regulations should address the root causes of environmental degradation so as not to result in unjustified restrictions on trade. The challenge is to ensure that trade and environment policies are consistent and reinforce the process of sustainable development. However, account should be taken of the fact that environmental standards valid for developed countries may have unwarranted social and economic costs in developing countries. Elaborate adequate studies for the better understanding of the relationship between trade and environment for the promotion of sustainable development; b. In those cases when trade measures related to environment are used, ensure transparency and compatibility with international obligations; d. Deal with the root causes of environment and development problems in a manner that avoids the adoption of environmental measures resulting in unjustified restrictions on trade;. Seek to avoid the use of trade restrictions or distortions as a means to offset differences in cost arising from differences in environmental standards and regulations, since their application could lead to trade distortions and increase protectionist tendencies; f. Ensure that environment -related regulations or standards, including those related to health and safety standards, do not constitute a means of arbitrary or unjustifiable discrimination or a disguised restriction on trade; c. Ensure that special factors affecting environment and trade policies in t he developing countries are borne in mind in the application of environmental standards, as well as in the use of any trade measures. It is worth noting that standards that are valid in the most advanced countries may be inappropriate and of unwarranted social cost for the developing countries; Encourage participation of developing countries in multilateral agreements through such mechanisms as special transitional rules; Avoid unilateral actions to deal with environmental challenges outside the jurisdiction of the importing country. Environmental measures addressing transborder or global environmental problems should, as far as possible, be based on an international consensus. Providing adequate financial resources to developing countries Basis for action 2. Investment is critical to the ability of developing countries to achieve needed economic growth to improve the welfare of their populations and to meet their basic needs in a sustainable manner, all without deteriorating or depleting the resource base that underpins development. Sustainable development requires increased investment, for which domestic and external financial resources are needed. Foreign private investment and the return of flight capital, which depend on a healthy investment climate, are an important source of financial resources. Many developing countries have experienced a decade-long situation of negative net transfer of financial resources, during which their financial receipts were exceeded by payments they had to make, in particular for debt-servicing. As a result, domestically mobilized resources had to be transferred abroad instead of being invested locally in order to promote sustainable economic development. For many developing countries, the reactivation of development will not take place without an early and durable solution to the problems of external indebtedness, taking into account the fact that, for many developing countries, external debt burdens are a significant problem. The burden of debtservice payments on those countries has imposed severe constraints on their ability to accelerate growth and eradicate poverty and has led to a contraction in imports, investment and consumption. External indebtedness has emerged as a main factor in the economic stalemate in the developing countries. In this context, additional financial resources in favour of developing countries and the efficient utilization of such resources are essential. The specific requirements for the implementation of the sectoral and cross-sectoral programmes included in Agenda 21 are dealt with in the relevant programme areas and in chapter 33 (Financial resources and mechanisms). Activities (a) Meeting international targets of official development assistance funding 2. As discussed in chapter 33, new and additional resources should be provided to support Agenda 21 programmes. In regard to the external debt incurred with commercial banks, the progress being made under the strengthened debt strategy is recognized and a more rapid implementation of this strategy is encouraged. Some countries have already benefited from the combination of sound adjustment policies and commercial bank debt reduction or equivalent measures. Other countries with heavy debts to banks to negotiate similar commercial bank debt reduction with their creditors; the parties to such a negotiation to take due account of both the medium-term debt reduction and new money requirements of the debtor country; Multilateral institutions actively engaged in the strengthened international debt strategy to continue to support debt-reduction packages related to commercial bank debt with a view to ensuring that the magnitude of such financing is consonant with the evolving debt strategy; Creditor banks to participate in debt and debt -service reduction; Strengthened policies to attract direct investment, avoid unsustainable levels of debt and foster the return of flight capital. With regard to debt owed to official bilateral creditors, the recent measures taken by the Paris Club with regard to more generous terms of relief to the poorest most indebted countries are welcomed. Ongoing efforts to implement these "Trinidad terms" measures in a manner commensurate with the payments capacity of those countries and in a way that gives additional support to their economic reform efforts are welcomed.

To this end, water resources have to be protected, taking into account the functioning of aquatic ecosystems and the perenniality of the resource, in order to satisfy and reconcile needs for water in human activities. In developing and using water resources, priority has to be given to the satisfaction of basic needs and the safeguarding of ecosystems. Integrated water resources management, including the integration of land- and water-related aspects, should be carried out at the level of the catchment basin or sub-basin. To promote a dynamic, interactive, iterative and multisectoral approach to water resources management, including the identification and protection of potential sources of freshwater supply, that integrates technological, socio-economic, environmental and human health considerations; To plan for the sustainable and rational utilization, protection, conservation and management of water resources based on community needs and priorities within the framework of national economic development policy; To design, implement and evaluate projects and programmes that are both economically efficient and socially appropriate within clearly defined strategies, based on an approach of full public participation, including that of women, youth, indigenous people and local communities in water management policy-making and decision-making; To identify and strengthen or develop, as required, in particular in developing countries, the appropriate institutional, legal and financial mechanisms to ensure that water policy and its implementation are a catalyst for sustainable social progress and economic growth. In the case of transboundary water resources, there is a need for riparian States to formulate water resources strategies, prepare water resources action programmes and consider, where appropriate, the harmonization of those strategies and action programmes. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including the United Nations and other relevant organizations as appropriate, could set the following targets: a. To have designed and initiated costed and targeted national action programmes, and to have put in place appropriate institutional structures and legal instruments; To have established efficient water-use programmes to attain sustainable resource utilization patterns; By the year 2025: i. It is understood that the fulfilment of the targets quantified in (i) and (ii) above will depend upon new and additional financial resources that will be made available to developing countries in accordance with the relevant provisions of General Assembly resolution 44/228. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including the United Nations and other relevant organizations as appropriate, could implement the following activities to improve integrated water resources management: a. Formulation of costed and targeted national action plans and investment programmes; Integration of measures for the protection and conservation of potential sources of freshwater supply, including the inventorying of water resources, with land-use planning, forest resource utilization, protection of mountain slopes and riverbanks and other relevant development and conservation activities; Development of interactive databases, forecasting models, economic planning models and methods for water management and planning, including environmental impact assessment methods; Optimization of water resources allocation under physical and socio-economic constraints; Implementation of allocation decisions through demand management, pricing mechanisms and regulatory measures; Flood and drought management, including risk analysis and environmental and social impact assessment; Promotion of schemes for rational water use through public awareness-raising, educational programmes and levying of water tariffs and other economic instruments; Mobilization of water resources, particularly in arid and semi-arid areas; Promotion of international scientific research cooperation on freshwater resources; Development of new and alternative sources of water-supply such as sea-water desalination, artificial groundwater recharge, use of marginal-quality water, waste-water reuse and water recycling; Integration of water (including surface and underground water resources) quantity and quality management; Promotion of water conservation through improved water-use efficiency and wastage minimization schemes for all users, including the development of water-saving devices; c. Development of public participatory techniques and their implementation in decisionmaking, particularly the enhancement of the role of women in water resources planning and management; Development and strengthening, as appropriate, of cooperation, including mechanisms where appropriate, at all levels concerned, namely: a. At the lowest appropriate level, delegation of water resources management, generally, to such a level, in accordance with national legislation, including decentralization of government services to local authorities, private enterprises and communities; At the national level, integrated water resources planning and management in the framework of the national planning process and, where appropriate, establishment of independent regulation and monitoring of freshwater, based on national legislation and economic measures; At the regional level, consideration, where appropriate, of the harmonization of national strategies and action programmes; At the global level, improved delineation of responsibilities, division of labour and coordination of international organizations and programmes, including facilitating discussions and sharing of experiences in areas related to water resources management; o. Dissemination of information, including operational guidelines, and promotion of education for water users, including the consideration by the United Nations of a World Water Day. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme t o be about $115 million from the international community on grant or concessional terms. The development of interactive databases, forecasting methods and economic planning models appropriate to the task of managing water resources in an efficient and sustainable manner will require the application of new techniques such as geographical information systems and expert systems to gather, assimilate, analyse and display multisectoral information and to optimize decisionmaking. In addition, the development of new and alternative sources of water-supply and low-cost water technologies will require innovative applied research. This will involve the transfer, adaptation and diffusion of new techniques and technology among developing countries, as well as the development of endogenous capacity, for the purpose of being able to deal with the added dimension of integrating engineering, economic, environmental and social aspects of water resources management and predicting the effects in terms of human impact. Pursuant to the recognition of water as a social and economic good, the various available options for charging water users (including domestic, urban, industrial and agricultural water-user groups) have to be further evaluated and field-tested. Field studies on the willingness to pay should be conducted in rural and urban situations. Water resources development and management should be planned in an integrated manner, taking into account long-term planning needs as well as those with narrower horizons, that is to say, they should incorporate environmental, economic and social considerations based on the principle of sustainability; include the requirements of all users as well as those relating to the prevention and mitigation of water-related hazards; and constitute an integral part of the socio-economic development planning process. A prerequisite for the sustainable management of water as a scarce vulnerable resource is the obligation to acknowledge in all planning and development its full costs. Planning considerations should reflect benefits investment, environmental protection and operation costs, as well as the opportunity costs reflecting the most valuable alternative use of water. Actual charging need not necessarily burden all beneficiaries with the consequences of those considerations. Charging mechanisms should, however, reflect as far as possible both the true cost of water when used as an economic good and the ability of the communities to pay. The role of water as a social, economic and life-sustaining good should be reflected in demand management mechanisms and implemented through water conservation and reuse, resource assessment and financial instruments. The setting afresh of priorities for private and public investment strategies should take into account (a) maximum utilization of existing projects, through maintenance, rehabilitation and optimal operation; (b) new or alternative clean technologies; and (c) environmentally and socially benign hydropower. The delegation of water resources management to the lowest appropriate level necessitates educating and training water management staff at all levels and ensuring that women participate equally in the education and training programmes. Particular emphasis has to be placed on the introduction of public participatory techniques, including enhancement of the role of women, youth, indigenous people and local communities. Skills related to various water management functions have to be developed by municipal government and water authorities, as well as in the private sector, local/national non-governmental organizations, cooperatives, corporations and other water-user groups. Education of the public regarding the importance of water and its proper management is also needed.