"Effective zyprexa 10mg, treatment quadricep strain".

E. Tufail, M.A., M.D.

Assistant Professor, Marian University College of Osteopathic Medicine

The impact of a regular erythrocytapheresis programme on the acute and chronic complications of sickle cell disease in adults. Use of red blood cell exchange for treating acute complications of sickle cell disease. Hyperhemolysis syndrome in patients with sickle cell anemia: report of three cases. Comparison of automated red cell exchange transfusion and simple transfusion for the treatment of children with sickle cell disease acute chest syndrome. Impact of erythrocytapheresis on natural anticoagulant levels in children with sickle cell disease: a pilot study. Exchange versus simple transfusion for acute chest syndrome in sickle cell anemia adults. Erythrocytapheresis in children with sickle cell disease and acute chest syndrome. Shortterm central venous catheter complications in patients with sickle cell disease who undergo apheresis. Complications from chronic therapy, such as iron overload and alloimmunization, are also common, particularly from simple blood transfusions. The trial was terminated prematurely due to the marked (90%) stroke risk reduction by chronic transfusion. In the setting of chronic transfusion therapy during which time the patient is clinically stable, targeting a pre-transfusion threshold of 50% HbS may be as effective as 30%. Hematopoietic stem cell transplantation is a potentially curative therapy, however, indications, appropriate donor sources and preparative regimens are being defined to optimize outcomes. Although iron overload can be treated with chelation or phlebotomy, its effectiveness has been limited by poor compliance. Vortex ports have been used successfully in adults though with longer procedures and more complications. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. Impact of long-term erythrocytapheresis on growth and peak height velocity of children with sickle cell disease. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. Long-term red blood cell exchange in children with sickle cell disease: manual or automatic Red cell exchange transfusions lower cerebral blood flow and oxygen extraction fraction in pediatric sickle cell anemia. Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and metaanalysis. Immunohematologic tolerance of chronic transfusion exchanges with erythrocytapheresis in sickle cell disease. Use of a dual lumen port for automated red cell exchange in adults with sickle cell disease. Regular automated red cell exchange transfusion in the management of pulmonary hypertension in sickle cell disease. For most patients (~75%), it may present as an indolent form associated with depression, confusion, cognitive decline, myoclonus, tremors, and fluctuations in level of consciousness. The less common type is an acute onset of episodes of stroke-like symptoms, seizure, and psychosis, and this presentation is usually associated with a relapsing-remitting course. The mean age of onset is about 40-50 years and like most autoimmune disorders, females are affected more than men (4:1). Despite the elevated levels of antithyroid antibodies, most patients are euthyroid at the time of diagnosis. Furthermore, the titer of antithyroid antibodies does not correlate well with clinical symptoms of the disease or with its severity. However, persistent elevated titers of the antithyroid antibodies appear to be predictive of relapse, a prolonged disease course, less response to steroids, and a worse prognosis. Description of the disease Current management/treatment High dose corticosteroids are the first line therapy, with 88% of cases achieving response.

The Board of Elections further objects to this Request as more properly directed to the Secretary because it requests documents concerning procedures, practices, rules, regulations Affidavit of Amber McReynolds - Exhibit 1 81 and/or instructions that have been or will be promulgated or established by the Secretary or the Department. The Board of Elections will not produce documents that have been or will be promulgated by the Secretary or the Department, as the Secretary is a party to this Action and is able to produce those documents, and any production of such documents by the Boards of Elections would be duplicative. Please produce all Procedures, Practices, Rules, Regulations, and/or Instructions You implemented, used, followed, and/or communicated in the June 2, 2020 Primary Election, and all Procedures, Practices, Rules, Regulations, and/or Instructions that You intend to implement, use, follow, and/or communicate in the November 3, 2020 General Election, concerning or relating to the issuance of absentee and/or mail-in ballots to registered voters, including without limitation sending absentee or mail-in ballots to all registered voters or qualified electors in Your county without a signed written request or application form from such voters or electors, and/or franking or pre-paying the postage for voted absentee and/or mail-in ballots, and all correspondence, memoranda, email messages, postings, or other documents reflecting communications, whether in writing or made orally, that (a) were made by, to , and/or between You and any other person, including without limitation: (i) any political party or body, political committee, non-profit organization, or other body of citizens; (ii) any voter/elector in the Commonwealth of Pennsylvania; (iii) any other County Election Board; (iv) any District Election Board; (v) any of Your employees, agents, or other representatives acting on Your behalf; and/or (vi) Secretary Boockvar and/or the Elections Department; and (b) concern, relate to , describe, explain, or justify the Procedures, Practices, Rules, Regulations, and/or Instructions, including without limitation any incidents, complaints, concerns, changes, modifications, or supplementation to such Procedures, Practices, Rules, Regulations, and/or Instructions. The Board of Elections will not produce documents that have been or will be Affidavit of Amber McReynolds - Exhibit 1 83 promulgated by the Secretary or the Department, as the Secretary is a party to this Action and is able to produce those documents, and any production of such documents by the Boards of Elections would be duplicative. Affidavit of Amber McReynolds - Exhibit 1 84 the Board of Elections further objects to this Request No. Please produce all Procedures, Practices, Rules, Regulations, and/or Instructions You implemented, used, followed, and/or communicated in the June 2, 2020 Primary Election, and all Procedures, Practices, Rules, Regulations, and/or Instructions that You intend to implement, use, follow, and/or communicate in the November 3, 2020 General Election, Affidavit of Amber McReynolds - Exhibit 1 85 concerning or relating to how You ensure that electors who voted via absentee or mail-in ballot do not vote again in-person on Election Day, or if they do, they do not have more than one of their votes counted, including without limitation how You notify or inform the District Election Board which voters are entitled to vote on Election Day, either by way of a paper ballot, on a machine, or via a provisional ballot, and how You mark or supplement the poll books that are delivered to the District Election Boards with such information, and all correspondence, memoranda, email messages, postings, or other documents reflecting communications, whether in writing or made orally, that (a) were made by, to , and/or between You and any other person, including without limitation: (i) any political party or body, political committee, non-profit organization, or other body of citizens; (ii) any voter/elector in the Commonwealth of Pennsylvania; (iii) any other County Election Board; (iv) any District Election Board; (v) any of Your employees, agents, or other representatives acting on Your behalf; and/or (vi) Secretary Boockvar and/or the Elections Department; and (b) concern, relate to , describe, explain, or justify the Procedures, Practices, Rules, Regulations, and/or Instructions, including without limitation any incidents, complaints, concerns, changes, modifications, or supplementation to such Procedures, Practices, Rules, Regulations, and/or Instructions. For these reasons, the Affidavit of Amber McReynolds - Exhibit 1 86 Board of Elections also objects to this Request as untimely, unduly burdensome, and disproportional. Please produce all documents concerning or relating to all incidents known or reported to You during the June 2, 2020 Primary Election and involving either: a. Electors who applied for and/or voted an absentee or mail-in ballot and also voted in-person, either on a voting machine or via a paper or provisional ballot, on Election Day at a polling place; b. Non-disabled electors whose absentee or mail-in ballots were mailed or delivered in-person by a person other [than] the non-disabled electors who voted the absentee or mail-in ballots; and/or d. Electors who claimed that someone had impersonated them and/or cast either in-person, absentee, and/or mail-in ballots for them without their knowledge, consent, or authorization; including without limitation all investigative or case files, law enforcement or other civil, criminal, or administrative referrals or proceedings, notes, memoranda, correspondence, email messages, and other documents reflecting communications, whether in writing or made orally, that (a) were made by, to , and/or between You and any other person, including without limitation: i)) any political party or body, political committee, non-profit organization, or other body of citizens; (ii) any voter/elector in the Commonwealth of Pennsylvania; (iii) any other County Election Board; (iv) any District Election Board; (v) any of Your employees, agents, or other representatives acting on Your behalf; and/or (vi) Secretary Boockvar and/or the Elections Department; and (b) concern, relate to , describe, or explain such incidents and the determinations made about such incidents. The Board of Elections Affidavit of Amber McReynolds - Exhibit 1 89 also objects to this Request No. The Board of Elections further objects to this Request as more properly directed to law enforcement agencies, courts, or other public entities. Subject to and without waiving these objections, the Board of Elections will produce the documents discussed in their Response to Request No. To the extent not produced by Secretary Boockvar and/or the Elections Department, please produce all data submitted by You to the Pennsylvania Department of State under 71 P. The Board of Elections will not produce documents that are generally publicly available and accessible, such as the Election Code. The Board of Elections further objects to this Request as more properly directed to the Secretary because it requests documents concerning procedures, practices, rules, regulations and/or instructions that have been or will be promulgated or established by the Secretary or the Department. I verify under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. DeMarco; Danielle Graham Robinson; and Kathleen Wise in the above-captioned litigation. Attached as Exhibit 1 is a true and correct copy of e-mail correspondence from Jonathan Marks, Deputy Secretary for Elections and Commissions, to County Boards of Elections dated May 28, 2020. Attached as Exhibit 2 is a true and correct copy of the Preliminary Report of Ronald Stroman, Deputy Postmaster General of the United States Postal Service, entered in Crossey v. The department has received some questions from county officials in recent days regarding the proper disposition of absentee or mail-in ballots cast by voters who did not enclose their voted ballots in the official election ballot envelope ("secrecy" or "inner" envelope). Though the Election Code requires county boards of elections to set aside absentee or mailin ballots enclosed in official election ballot envelopes that contain "any text, mark or symbol which reveals the identity of the elector," there is no statutory requirement, nor is there any statutory authority, for setting aside an absentee or mail-in ballot solely because the voter forgot to properly insert it into the official election ballot envelope. Please consult with your solicitor about your plans to deal with such instances should they occur during the pre-canvass or canvass. Kathy Boockvar, Secretary of the Commonwealth, Jessica Mathis, Director of the Bureau of Election Services and Notaries, Respondents. I am over the age of 18 and I prepared this preliminary report based upon my personal knowledge of the facts below and my experience. I worked closely with state and local election officials across the country Affidavit of Lori A. Martin - Exhibit 2 for approximately five years to implement these improvements in the voting by mail system. In the process of working with these officials, I became very familiar with state laws governing voting by mail. My training and experience as a lawyer, including working as Assistant Counsel on the Judiciary Committee of the U. My work on voting by mail as the Deputy Postmaster General has also provided me with a detailed understanding of the resources and procedures that election officials and the Affidavit of Lori A.

It must be noted that there are regional differences in names assigned each set of field disease signs but through the efforts of the Coral Disease and Health Consortium ( It should also be noted that any similarities in field signs of disease between regions does not necessarily imply the diseases have the same etiology. After histopathological analysis it was found that a number of coral lesions found during surveys were not associated with infectious agents or underlying pathologic process. These include lesions due to predation, barnacle infestation and mucous sheathing. This confirms the critical component histology plays in understanding disease processes. There were differences in prevalence of disease among coral genera with Acropora having the highest prevalence. In contrast, Montipora comprised 40% of the coral community but had a disease prevalence of 0. This suggests that there may differences in disease susceptibility among coral genera and that pathogens do not necessarily affect the most common or abundant corals. The sites surveyed had differences in coral community which would be a factor in what diseases and what levels of disease would be found at a particular reef. No pattern emerged suggesting that disease levels were directly related to anthropogenic watershed stress. We opted to be conservative and to include only those cases where snails were visible, however, this is probably an underestimate. Lesions presumably attributable to snails were generally peripheral on encrusting colonies and this pattern was more prevalent in certain sites versus others. Quantifying populations of corallivores in conjunction with measurement of lesions would be helpful in evaluating their effects on reefs. For example, patchy tissue loss and discoloration with presence of a crustacean in the center of the lesion is indicative of barnacle infestations. Determining the species of barnacles affected and the types of bites produced by particular fish may be useful in the future. In the case of faviids, mottled discoloration is probably indicative of mucus shedding. Determining how fast these grow and what effect they have on the health of the corals should be the focus of future investigations. There is a need to refine the description of gross lesions in corals in order to better understand whether certain gross lesions can be related to microscopic findings in a more consistent manner. Prophet E, Mills B, Arrington J, Sobin L (1992) Laboratory methods in histotechnology, Vol. Santavy D, Mueller E, Peters E, MacLaughlin L, Porter J, Patterson K, Campbell J (2001) Quantitative assessment of coral diseases in the Florida Keys: strategy and methodology. The state of coral reef ecosystems of the United States and Pacific freely associated states: 2002. Johnston Atoll is not part of the Hawaiian Islands, but is more closely associated with a subsurface mountain range called the Marcus-Necker Rise (Amerson and Shelton, 1976). In 1985, a chemical weapons disposal plant (Johnston Atoll Chemical Agents Disposal System) was built on the Western end of the main island (Johnston). Johnston Atoll is composed of a fringing reef surrounding 4 islands, two of which (Haukau and Hikinau) are man made. The lagoon becomes progressively deeper from northwest to southeast and supports a variety of corals, reef fish, sea turtles, and seabirds (see Coles et al. Compared to other atolls and reef environments, the marine fauna of Johston Atoll is depauperate by species, although coral coverage is high. Maragos and Jokiel (1986) classified the lagoon into 4 area with the northwest portion harboring the greatest abundance of corals. Much work has been done to identify the identity and extent of organisms at Johnston Atoll (see Coles et al. However, relatively little effort has been spent looking at health parameters of marine fauna. The trip had the following objectives: 1) Conduct manta tow and spot surveys for lesions in dominant coral species in the northern lagoon and sites off Johnston and East islands. Site 2 (Agent Orange) was immediately offshore the northwestern portion of Johnston Island where the herbicide Agent Orange had been stored during the Vietnam war.

Two monitoring protocols were developed in the plan; a simple community based monitoring exercise and a more rigorous/science-based program to help monitor the changes in fish populations and coral reef cover and health. He is representing the Conservation Society of Pohnpei, Federated States of Micronesia at this workshop. She conducted her studies in the laboratory of Professor Yossi Loya where she studied strategies in the survival of corals from stressed environments, with an emphasis on reproduction and regeneration. She has continued her work in corals, merging coral ecology with cellular physiology and microscopic anatomy and physiology. Her interests lie in understanding processes of coral tissue repair particularly as they pertain to the ability to resist and recover from disease. Ariel Kushmaro of Ben Gurion University, she is currently investigating the role that symbiotic microorganisms (bacteria and protists) may have in coral holobiont physiology. She also serves as the lead for her office on coastal watershed management, land-based pollution, and coral disease-related issues in the states and Territories with coral resources and the U. Among her other interests Jennifer volunteered at the University of Maryland Center for Marine Biotechnology investigating microbial communities in marine sponges as possible sources of medically important anti-viral, anti-bacterial or anti-cancer compounds, and worked in a research lab at Aberdeen Proving grounds developing a molecular-based rapid test methodology for detecting waterborne pathogens in drinking water sources. Research activity includes investigation of the diversity, and distribution of microorganisms through approaches based on molecular. In addition his research work is aimed at understanding the structure and function of microbial communities and their dynamics with regard to the environment. Her research interests are in molecular virology, vaccine development and phylogeography. Viruses that infect aquatic organisms are important disease pathogens and their impact on aquacultured species such as salmon and trout can be devastating. Her laboratory is developing vaccines and other treatments to control these diseases in fish. After her arrival in Hawaii, Jo-Ann has become intrigued by the devastating diseases in corals and tropical fish and expanded her research into these research arenas. His current research is in the areas of analytical and environmental chemistry; marine pollution and toxicology, immunochemistry and antibody-based assays for environmental applications, phyto-remediation, bioremediation, microbial degradation, environmental metabolomics and proteomics. He has more than 100 peer-reviewed publications in these research areas and is interested in effects of pollutants on coral, particularly persistent organic pollutants. Her current research interest addresses the question of whether diver wetsuits can serve as a possible vector of disease, both for coral and humans. Kay has two daughters and five Thoroughbred horses, all of which necessitate her continued employment. Prior to these recent positions, he was the first employee and one of the scientific founders of Diversa Corporation. During his 12 year tenure at Diversa, he assembled the research organization, was instrumental in the development of their intellectual property portfolio and one of the lead technical scientists for business development. At various times he was responsible and had direct oversight for most of the research and development organization, including enzyme discovery, gene evolution, gene expression, cell engineering, sequencing, bioinformatics, subcloning and manufacturing. He eventually served as Vice President of Scientific Affairs and Molecular Diversity at Diversa Corporation. She has seven years of professional experience as a high school biology teacher, specializing in science literacy. Her education to date includes a Bachelor of Science Education in biology and chemistry from the University of Michigan, and a Master of Arts in Teaching from Marygrove College. Her goal in returning to graduate school is to gain significant laboratory and field experience. Ultimately, she wants to use her strong education background to help change global perceptions of the ocean and its importance. Her broad interests include coral ecology and disease, anthropogenic influences on marine ecosystems, macroalgae, and symbiotic relationships. She received an undergraduate degree from Indiana University and a doctorate in marine ecology from the University of North Carolina (Chapel Hill). Her dissertation involved ecological studies of non-reef building coral, Oculina spp, off North Carolina and factors that determined their growth and distribution. She then moved south to examine some "real" corals, in a three years post-doctoral position with the University of Miami. Her involvement with coral disease was forced upon her in the course of monitoring activities focused on Acropora palmata and A.

Although this theory has been disputed over the years, it is notable that monogenic defects that lead to hypertension or hypotension are found exclusively in genes that encode either renal transporter proteins or proteins that regulate the function of renal transporter proteins and ultimately renal sodium handling. Instead, the serum sodium correlated well with the serum osmolality (particularly when corrections were made for the osmotic contributions of glucose and nonprotein nitrogen) (43). This interplay between the two is essential for water homeostasis, a critical factor in the maintenance of cell volume. Although cells have developed strategies to deal with excess or insufficient water, these volume regulatory changes require extrusion or inclusion of electrolytes, which alters the cellular interior milieu and wreaks havoc on normal cellular function. Later adaptations allow cells to return toward normalcy but only within a small range. Water reabsorption requires the ability to both establish an osmotic gradient in the kidney and to reabsorb water from the urinary filtrate. The kidney has an elegant strategy to concentrate or dilute the urine by its response to vasopressin and the ability to deploy aquaporins to the luminal membrane (45). At least seven aquaporin isoforms are expressed in the kidney and play important roles at different sites. In the proximal tubule and thin descending limb, aquaporin 1 appears to serve as the dominant gateway for water reabsorption, whereas trafficking of aquaporin 2 along cytoskeletal elements in the collecting duct cells allows reabsorption of water and urine concentration in the principal cells of the collecting ducts (46). Detailed study of the molecular structure and cell physiology of these transporters has allowed insight into the rare genetic diseases that affect aquaporins, such as congenital nephrogenic diabetes insipidus and the common acquired defects related to lithium, calcium, and even urinary obstruction. Similarly, study of the vasopressin receptor has resulted in new strategies and pharmacologic agents for the treatment of states of excess antidiuretic hormone and polycystic kidney disease. Although the exact mechanisms used to sense pH are still not yet understood, it is well known that the kidney plays a dominant role in the regulation of the acid-base balance (47). Indeed, with acidosis, a complex intracellular cascade ensues, including activation of the electroneutral sodiumcoupled amino acid transporter for glutamine, an increase in glutamine metabolism and ammoniagenesis, as well as an increase in the expression of the sodium hydrogen antiporter (48,49). By contrast, metabolic alkalosis can be easily and rapidly handled by the kidney by excretion of excess filtered bicarbonate or may be perpetuated by the kidney because of a response to volume depletion with secondary activation of the renin-angiotensin and aldosterone axis or from primary hyperaldosteronism. Finally, the kidney responds to the challenges of primary respiratory disorders to offset the effects of these disturbances in a predictable fashion (51,52). In chronic respiratory alkalosis, the kidney can decrease acid excretion by decreasing ammonia production and bicarbonate retention; in respiratory acidosis, activity of the Na-H antiporter is augmented so that more bicarbonate is reabsorbed (53). Understanding of these complex processes helps in the care of actual patients who develop acid-base disorders from a wide variety of insults. Potassium, the major cation in the body, must be maintained in high concentrations in the intracellular space and a low concentration in the extracellular fluid to allow both normal cellular function and the considerable gradient required for excitation of nerves and contractions of muscles. The kidney plays its role by reabsorption of nearly all of the filtered load proximally and variable secretion in the distal nephron. Both appear to play an important role in the secretion of potassium in the distal nephron dictated by the influence of aldosterone and magnitude of distal flow (58). Integrated control by parathyroid hormone and 1,25-dihydroxyvitamin D helps achieve this end (59). Each of these regions is controlled by local effects prescribed by the calcium sensing receptor and modulated by the pH (60). In parallel to calcium, the majority of filtered magnesium is reabsorbed in the proximal tubule and thick ascending limb by paracellular movement mediated, in part, by the claudin proteins, which govern ion movement through the otherwise tight junctions in those regions (63). At this segment, cation channels from the melastin transient receptor potential subfamily play a major role in this endeavor, evidenced by Mg21 wasting seen in the rare genetic disorders with defects in this channel (65). Emerging details on phosphate metabolism have identified a family of sodium phosphate transporters that help reabsorb the bulk of the filtered phosphate in the proximal tubule (66). These transporters appear to be affected by a series of factors, including the recently characterized fibroblast growth factor 23 and its obligate coreceptor Klotho, which together, via the fibroblast growth factor receptor, inhibit the reabsorption of sodium-dependent phosphate reabsorption and lower vitamin D levels by downregulating the gene for 1a-hydroxylase (67).