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After Hours: Administration Coordinator Who: Anyone in the Employee Health Office James A. Haley Veterans Administration Hospital Occupational and Employee Health Where: Occupational & Employee Health, 6N, Rm 650 Ph: (813) 972-7628 or (813) 972-7199 When: 8:00am ­ 4:00pm, Mon. After hours, the library will be opened for physicians and students to obtain information necessary for patient care. Key may be obtained from Medical Administrative Assistant 24 hours a day by Housestaff or students with proper identification. The housestaff are given a meal card at the beginning of each year to use for their meals while on call. A refrigerator and microwave are available in the Housestaff Lounge on the fourth floor for storage of food brought from home. Meals are provided for the Housestaff on the days which they are on call, Monday through Friday (supper meals); Saturday, Sunday and holidays (breakfast, lunch and supper meals). Refrigerator is available in the Housestaff Lounge (7th floor) for storage of food brought from home. All meals are served in the Cafeteria, which has a copy of the night call schedule. These rooms are designed to afford privacy, safety and a restful environment so that the residents can rest and/or sleep when their services are not required. All attempts have been made to optimize the safety of the residents while on call. While there have been no problems in the past, security personnel are available in case any problems arise. Tampa General Hospital Parking transponders are issued by the Tampa General Hospital Housestaff Office for the parking lot. Out of-state license tags will have ten days to purchase Florida tags or be subject to ticketing. Paychecks are drawn from a Common Pay Source, regardless of which hospital you are rotating through. Photocopies of library material only, one copy per article (no page limitations) is available in the Tampa General Hospital Medical Library. The privilege of copying should not be abused, for while you do not pay for it, someone does! Each resident is encouraged to prepare clinical case reports, original articles and reviews to be submitted to primary or specialty internal medicine journals or general professional journals. An indication of intent to prepare such a paper should be made through a full-time faculty member, the Chief of Service or the Chairman of the Department. Any paper submitted for publication must be reviewed by a full-time faculty member. The Department will assist the resident in obtaining the requisite illustrations and typing and preparation of the paper in final form. All residents are required to submit an abstract to a meeting or a paper for publication during residency training. This block must be approved by the Program Director and the research mentor must be assigned. The resident and mentor will need to develop the goals and objectives on the research elective form provided by the residency administration. At the end of the academic year, any resident given a research elective must do a presentation during didactic time to their peers on the research completed during the elective. If the research is to be conducted according to a specific protocol, that protocol must be cleared by the Chief of the Division and the Chairman of the Department. In addition, this research must be approved by the University of South Florida Human Resources Committee and the respective Chairmen of the Research Committees of each hospital. Informed consent, protocol, data tabulation and statistical methods must be prepared and submitted for approval prior to the performance of any research. In any Department of Medicine there are a variety of clinical research projects being conducted as part of our professional obligation to augment medical knowledge.

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In in vivo studies using mouse red blood cells, the micronucleus test and assays for chromosome aberrations were also positive at inhalation doses consistent with the doses inducing mouse tumors (Allen et al. An exception occurs when there is convincing toxicokinetic data that absorption does not occur by other routes. For dichloromethane, systemic tumors were observed in mice following inhalation and oral exposure. No animal cancer bioassay data following dermal exposure to dichloromethane are available. Based on the observance of systemic tumors following oral exposure and inhalation exposure, and in the absence of information to indicate otherwise, it is assumed that an internal dose will be achieved regardless of the route of exposure. Therefore, dichloromethane is "likely to be carcinogenic to humans" by all routes of exposure. The available epidemiologic studies provide evidence of an association between dichloromethane and brain cancer, liver and biliary tract cancer, and some hematopoietic cancers (specifically non-Hodgkin lymphoma and multiple myeloma). Cohort 1 is an inception cohort, following workers from the beginning of employment, and thus is methodologically more robust than Cohort 2 of Hearne and Pifer (1999), which only included workers who were working between 1964 and 1970. These observations are supported by the data from a case-control study of brain cancer using lifetime job history data that reported relatively strong trends (p < 0. This difference in results among different exposure measures could reflect a relatively more valid measure of relevant exposures in the brain from the intensity measure, as suggested by the study in rats reported by Savolainen et al. No other cohort study has reported an increased risk of liver cancer mortality, although it should be noted that there is no other inception cohort study of a population with exposure levels similar to those of the Rock Hill plant, and no data from a case-control study of liver cancer are available pertaining to dichloromethane exposure. The primary limitation of all of the available dichloromethane cohort studies is the limited statistical power for the estimation of effects relating to relatively rare cancers (such as brain cancer, liver cancer, and leukemia). With respect to breast cancer, the only cohort that included a significant percentage of women had limited exposure information (analysis was based on a dichotomous exposure variable) and exposures to other solvents that also exhibited associations of similar magnitude to that seen with dichloromethane (Radican et al. Thus, in this situation, potential confounding by these other exposures should be considered. The only breast cancer case-control study available used death certificate data to classify disease and occupational exposure (Cantor et al. The available epidemiologic studies do not provide a definitive evaluation of non-Hodgkin lymphoma, but the consistent observations of associations seen in three large case-control studies in Germany (Seidler et al. These studies are limited by relatively small number of exposed cases, resulting in imprecise effect estimates. In addition to the epidemiologic studies, several dichloromethane cancer bioassays in animals are available. In the only oral exposure cancer bioassay involving lifetime exposure, 143 increases in incidence of liver adenomas and carcinomas were observed in male but not female B6C3F1 mice exposed for 2 years (Table 4-29 for males; female data not presented in the summary reports) (Serota et al. The authors concluded that these increases were "within the normal fluctuation of this type of tumor incidence," noting that there was no dose-related trend and that there were no significant differences comparing the individual dose groups with the combined control group. With respect to comparisons with historical controls, the incidence in the control groups was almost identical to the mean seen in the historical controls from this laboratory (17. Although the occurrence of one elevated rate in an exposed group may be within the normal fluctuations of this type of tumor incidence (described for this laboratory as 5­40%, with a mean of 17. The incidence of hepatocellular adenomas or carcinomas was 18 and 20% in the two control groups, and the combined group is used for the subsequent analysis because of the improved statistical precision of estimates based on the larger sample size (n = 125 compared with n = 60 and 65 for the individual control groups). Incidence of liver tumors in male B6C3F1 mice exposed to dichloromethane in a 2-year oral exposure (drinking water) studya Estimated mean intake (mg/kg-d)a Number of male mice Hepatocellular adenoma or carcinoma Mortality-adjusted percentd Mortality-adjusted p-valued 0 (Controls) 125b 61 200 124 177 100 99 Number of cancers (%) 30 (30) 31 (31) (34) (35) p = 0. The mortality-adjusted incidence in control groups 1 and 2 were 20 and 23%, respectively. Information was not provided which would allow characterization of the nodules as benign or malignant. Statistically significant increases in incidences were observed in the 50 and 250 mg/kg-day groups (incidence rates of 0, 3, 10, 3, and 14%, respectively, for the 0, 5, 50, 125, and 250 mg/kg-day groups) and in the group exposed to 250 mg/kg-day for 78 weeks followed by a 26-week period of no exposure (incidence rate 10%). A similar pattern, but with more sparse data, was seen for hepatocellular carcinomas, with two incidences in the 50 mg/kgday and two in the 250 mg/kg-day groups. The authors concluded that dichloromethane exposure did not result in an increased incidence of liver tumors because the increase was based on a low rate (0%) in the controls and because of a lack of monotonicity. Gavage exposure studies in Sprague-Dawley rats and in Swiss mice provide limited data concerning cancer incidence because the study was terminated early (at 64 weeks) due to high treatment-related mortality (Maltoni et al.

However, the general population may be exposed via food or water sources containing glyphosate residues from glyphosate-based formulations registered for use in agricultural and residential environments. Selection of the Critical Effect: Several acute-duration oral studies were available regarding the toxicity of glyphosate technical following acute-duration oral exposure (see Table A-1). Based on available data, gastrointestinal disturbance is considered to represent the most sensitive effect of glyphosate toxicity following oral exposure in laboratory animals. Groups of sperm-positive female New Zealand white rabbits (20/group) were administered glyphosate acid (95. External, visceral, and skeletal examinations were performed; brains were subjected to macroscopic examination. At 175 and 300 mg/kg/day, maternal rabbits exhibited diarrhea and reduced production of feces. The depressed maternal body weight was <10% in magnitude, and was therefore not considered to represent an adverse effect. Gross pathologic examination of maternal rabbits revealed no treatment-related effects. There were no treatment-related effects on pregnancy rate, numbers of corpora lutea, total number of implantation sites, litter size, sex ratio, or pre- or post-implantation loss. As shown in Table A-2, gastrointestinal endpoints are the most sensitive to intermediate-duration oral exposure of laboratory animals to glyphosate technical. Thus, rats appear to be much more sensitive than mice to glyphosate treatment-related effects on salivary glands. Selection of the Critical Effect: Several chronic-duration oral animal studies were available for glyphosate technical (see Table A-3). Furthermore, the toxicological significance of the glyphosate treatment-related effects on salivary glands is uncertain. Groups of albino Sprague Dawley rats (60/sex/group) were administered technical glyphosate (96. Rats were subjected to ophthalmologic examinations prior to the initiation of treatment and twice prior to scheduled terminal sacrifice. Blood and urine samples were collected at 6, 12, 18, and 24 months for hematology, clinical chemistry, and urinalysis. Evaluations of all rats that died or survived until scheduled sacrifice included organ weight determinations (brain, liver, kidneys, testes, epididymides, prostate) and comprehensive gross and histopathologic examinations. There were no indications of glyphosate-related clinical signs or effects on survival. Mean body weights of all glyphosate-treated male rats were not significantly different from that of controls. Mean body weights and of high-dose female rats were significantly lower than that of controls at weeks 7, 13, 81, and 104 (approximately 3­4% less than that of controls); by week 81, the magnitude of the mean body weight difference between high-dose females and their controls reached 13% (470. There were no significant differences between controls and glyphosate-treated groups regarding food consumption. Glyphosate treatment-related nonneoplastic effects included increased incidence of ocular effects (lens abnormalities), renal effects (increased specific gravity and decreased pH of urine) in high-dose (940 mg/kg/day) male rats, and significantly increased incidence of inflammation of gastric squamous mucosa in female rats at 457 and 1,183 mg/kg/day (incidences of 0/59, 3/60, 9/60 [p=0. The high-dose (1,183 mg/kg/day) group of female rats exhibited as much as 13% lower mean body weight at treatment week 81. Relative liver weight was significantly increased in high-dose male rats evaluated at 12 months and terminal sacrifice (13­14% greater than controls); however, histopathologic examinations of liver sections revealed no evidence of significant treatment-related nonneoplastic effects. Incidences of female rats with gastric lesions were 0/59, 3/60, 9/60, and 6/59 for controls, low-, mid-, and high-dose groups, respectively. None of the models produced adequate fit to the dataset, likely due to 33% lower incidence for the gastric lesion in the high-dose group compared to the mid-dose group. The inclusion criteria used to identify relevant studies examining the health effects of glyphosate are presented in Table B-1. Regulations applicable to glyphosate were identified by searching international and U. Review articles were identified and used for the purpose of providing background information and identifying additional references. The ToxProfiles rely on peer reviewed data such as published studies and reports from government agencies or international organizations. Within the reference library, titles and abstracts were screened manually for relevance.

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A summary of households representation status per elevation class in the study areas Sub county Households frequency (%) per altitude range (m) Total 2201-2900 1801-2200 1281-1800 700-1280 Muranga north 11 (22) 33 (66) 6 (12) 0 (0) 50 (100) Muranga south 0 (0) 0 (0) 47 (94) 3 (6) 50 (100) Muranga east 0 (0) 1 (2) 39 (96) 1 (2) 41 (100) Elevation categories (Jaetzold and Schidt (1983)) > 2900 m = Afro-alpine highland 2201-2900 = Upper highland 1801-2200 = Lower highland 1281-1800 = Upper midland 700-1280 = Lower midland < 700 = Inland lowland Most of the households surveyed in Muranga north lies in the upper highland category while majority of the studied farms in Muranga south and east are in the upper midlands. Selection was purposively framed so as to represent various heterogeneity features especially land use systems and altitudinal elevation, of each sub-county, constituency and ward levels. Two constituencies, Mathioya and Kangema, represented this zone while the selected locations include Gakuyu, Githiga, Ichichi, Kaero, Kanyenyaini, Kiriti, Kiru, Kiruri, Mioro, Njumbi, Nyakianga and Rwathia. Several locations that were a true representation of coffee zone were chosen as Njoguini, Gikandu, Gakandu, Wangu, Gaturi, Kiria, Mugoiri, Mushungusha, Mbiri, Nyakihae, Gakuyu, Kigetuine, Wethaga and Kahuhia. Simple random sampling was finally at village level to select households that were subjected to data collection. Working with a confidence level of 95 % and a confidence interval of 5 (margin error of 0. Results and discussions Tree growing history - general status of trees growing upon acquisition of land In the sampled farmers, majority of their farms had trees already by the time of acquisition, with Muranga north and east leading. Most of the trees found in the farms were indigenous in all the sub-counties, with Muranga south leading with 83 % (Table 2). Status of trees growing upon acquisition of land Presence of trees on farm upon land acquisition by Type of trees initially present Sub county households (%) on farm by households (%) Trees present Trees absent Exotic Indigenous Muranga north 66 34 41 59 Muranga south Muranga east Total 60 66 64 40 34 36 17 26 29 83 74 71 522 Changes in initial tree species composition and reasons All the respondents in both Muranga north and south have changed their initial tree species composition. In Muranga east, about 98 % have changed their species composition while only 2 % have not changed. The most significant change is an increase in exotic trees (58 %) of all the respondents and a decrease in indigenous trees (27 %) (Table 3). Kind of change of tree composition on farms Kind of change of tree composition by respondents (%) Increased Decreased Sub county Increased Decreased Increased Decreased indigenous indigenous exotic trees exotic trees both both trees trees Muranga north 4 26 54 6 6 4 Muranga south Muranga east 14 2 26 32 27 58 66 58 2 0 3 0 0 2 0 0 1 Total (Average) 7 Reasons for the tree composition changes the main reasons for the tree composition changes include growing tree species with capacity to provide timber/ poles (28 %) and fuel (26 %) and also to give way for agriculture or house construction (14 %), among other reasons (Table 4). Reasons for tree composition changes Reasons for tree composition changes by respondents (%) Sub county Environ mental conserva tion Agricult ure/ homestea d Fuel Income Fast growth Shade Wind break Timber/ poles Fruits Muranga north 34 Muranga 12 south Muranga 32 east Total 26 4 8 22 11 2 2 2 2 2 4 2 3 2 2 5 3 6 8 2 5 22 42 19 28 4 4 5 4 22 14 5 14 Elsewhere, the type of seedlings raised depended mainly on growth characteristics and end uses. For example, Eucalyptus saligna, Cupressus lusitanica and Grevillea robusta are fast growing species and were targeted for fuelwood and timber (Ogweno et al. Furthermore, seeds from these species are cheap and readily available through local collection. Farmers in Kipkaren catchment had varied preferences for different tree species as 523 discussed by Imo et al. The most preferred indigenous trees were Prunus africana (70 ­ 91 % of the farmers), Zizygium quineense (60 to 80 %), Erythrina tomentosa (50 to 70 %) and Croton macrostychus (60 to 75 %), and had been retained in farmlands for timber, construction poles and firewood. Major tree species present in Muranga County the major 10 tree species in the three studied sub-counties of Muranga are summarized in the Table 5. Grevillea robusta was ranked highest in both Muranga east and south, being present in all the farms visited, while Eucalyptus was the most grown tree species in Muranga north. Major tree species in Muranga County Muranga east Muranga north H/hol ds Rank Tree species (%) Tree species 100 1 Grevillea robusta Eucalyptus spp 95 2 Mangifera indica Persea americana 90 3 Bridelia micrantha Grevillea robusta Eriobotrya 90 4 Persea americana japonica Croton 87 5 macrostachyus Acacia mearnsii Commiphora Cyphomandra 83 6 eminii betacea Croton Cupressus 78 7 megalocarpus lusitanica Croton 75 8 Psidium guajava macrostachyus Croton 68 9 Carica papaya megalocarpus Commiphora 68 10 Markhamia lutea eminii Muranga south H/hol ds (%) 92 92 80 76 74 74 62 60 48 46 H/hold s (%) Tree species Grevillea robusta Mangifera indica 100 100 80 Persea americana Croton 70 macrostachyus Bridelia 68 micrantha Carica papaya Psidium guajava Commiphora eminii Cassia spectabilis Markhamia lutea 66 66 54 50 48 Among tree species present and ranked among the 10 most popular in all sub-counties include G. These are the species that are valued by most farmers and can grow well in high, mid and relatively lower altitudes. Muranga east had the highest number 524 of tree species (94) while both Muranga north and south had 84 tree species (Appendix I). There were, however, some species that were exclusively found in a particular sub-county, probably dictated by their ecological growth requirements among other factors. Juniperus procera, Macaranga kilimandschariensis, Araucaria caninghamii, Araucaria heterophylla, Cussonia spicata and Maesa lanceolata were exclusively recorded in M. Elsewhere, Grevillia robusta is considered by farmers in the highlands of East Africa to be an outstanding agroforestry tree. It is thought to be deep rooted and to possess few lateral roots, which suggests good potential for below-ground complementarity (Lott et al. Tree size distribution the diameter of trees on the studied farms indicated that trees of smaller diameter were generally more than those of bigger diameter classes, as shown in the Figure 2. Tree size distribution this is a desired pattern for any tree growing initiative since it shows that there is a prospective continuous provision of tree products in future. A reversed J-shaped size distribution has been regarded as a proxy of population growth or dynamic equilibrium while a unimodal 525 distribution, with comparatively fewer juveniles relative to adults, has been taken as evidence of population decline (Deb and Sundriyal, 2008). Tree density and configuration in Muranga County the total land size of the studied households was about 329.