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M29 E77 D55 A96 Lexile measure ; Ages ; Gr. N C58 L43 J34 Age ; PrK-Gr. K67 C45 Ages A P38 Who is king? M33 P Y43 T56 F.

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S2 O44 U R35 Lexile measure ; Ages ; PrK-Gr. U F67 U D44 Papa do you love me? Joosse ; illustrated by Barbara Lavallee. O63 P37 Lexile measure ; Book level 2. I B86 D54 A38 R A65 Book level 4; Ages ; Gr. K36 A3 Lexile L; Ages I33 O F. U C48 Lexile measure ; Ages , gr. Lippert ; illustrated by Julie Paschkis. D36 P39 W54 H33 The present study examined reproductive effects in fathead minnows exposed Summary The U. Geological Survey USGS utilizes light detection and ranging lidar and enabling technologies to support many science research activities. Lidar-derived metrics and products have become a fundamental input to complex hydrologic and hydraulic models, flood inundation models, fault detection and geologic mapping, topographic and In synoptic surveys of surface-water quality across the United States, a large group of organic chemicals associated with agricultural, household, and industrial waste have been detected.

These chemicals are referred to collectively as chemicals of emerging concern CECs and include prescription drugs and antibiotics, over-the-counter medications Alkylphenolic chemicals APCs and hormones were measured six times from February through October in three Minnesota streams receiving wastewater to identify spatial and temporal patterns in concentrations and in estrogen equivalency.

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Fish were collected once during the study to evaluate endpoints indicative of endocrine disruption. The most The present study investigated whether a combination of targeted analytical chemistry information with unsupervised, data-rich biological methodology i. The effects of WWTP effluents on fish exposed to Skip to main content.

Search Search. Kathy E Lee. Publications Filter Total Items: Munn, Mark D. View Citation. Munn, M. Geological Survey Circular , 80 p. Year Published: Contaminants of emerging concern presence and adverse effects in fish: A case study in the Laurentian Great Lakes The Laurentian Great Lakes are a valuable natural resource that is affected by contaminants of emerging concern CECs , including sex steroid hormones, personal care products, pharmaceuticals, industrial chemicals, and new generation pesticides.

Kathy E Lee

Jorgenson, Zachary G. Jorgenson, Z. Patterns of occurrence Human activities introduce a variety of chemicals to the Laurentian Great Lakes including pesticides, pharmaceuticals, flame retardants, plasticizers, and solvents collectively referred to as contaminants of emerging concern or CECs potentially threatening the vitality of these valuable ecosystems.

Elliott, Sarah M. Patterns of occurrence.

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Year Published: Contaminants of emerging concern in the Great Lakes Basin: A report on sediment, water, and fish tissue chemistry collected in Despite being detected at low levels in surface waters and sediments across the United States, contaminants of emerging concern CECs in the Great Lakes Basin are not well characterized in terms of spatial and temporal occurrence. Choy, Steven J.

Year Published: Prior knowledge-based approach for associating contaminants with biological effects: A case study in the St. Cases were selected without regard to treatment and are likely to represent typical cases that present for medical attention, as is common practice with patient registries [ 14 ]. We observed that infection with H5N1 carries a high mortality rate These data were abstracted from various sources, some data were missing, and the data that were obtained reflect the various recording conventions of individual clinicians and institutions.

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Because all subjects did not have detailed information on the number of doses of oseltamivir received, patients who received even a single dose of oseltamivir before death were classified as having been treated with oseltamivir. One can speculate that these were patients in extremis, and their inclusion may understate the clinical utility of oseltamivir in patients who are not immediately moribund. Sensitivity analyses were performed to examine the extent to which our findings were dependent on recorded source, country, and background mortality from H5N1.

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A clear benefit was evident from treatment with oseltamivir, even when treatment was delayed, with maximum benefit accruing when therapy was administered within 2 days of onset of illness. Progressive infections associated with multiorgan dysfunction and a high lethality suggest immune dysfunction [ 41 ]; indeed, previous work points strongly to cytokine dysregulation playing a role in the pathogenesis of H5N1 mortality [ 42 , 43 ]. This is compatible with the notion that early intervention with antivirals prevents viral load accumulating to a level that it triggers an injurious and ongoing immune response, including hypercytokinemia.

De Jong et al [ 43 ] showed a correlation between H5N1 viral load and a number of immune parameters and found higher cytokine and chemokine levels in H5N1 patients than those detected patients with seasonal influenza, and especially so in H5N1 patients who died. The immune response to H5N1 infection is doubtless complex, with Deng et al [ 44 ] having reported finding quite different cytokine response patterns in 2 lethal cases of infection.

Whatever type of hypercytokinemia results, however, the trigger is likely to be a high viral load, underpinning the argument in favor of early antiviral therapy in human H5N1 infections. Prolonged viral shedding and a high viral reproduction rate, as seen with H5N1, suggest that higher doses and longer durations of antiviral therapy may be needed, and registry cases treated with nonstandard regimens did not appear to suffer adverse outcomes and may have benefited. The missing part of the puzzle required to reduce mortality even further, once higher antiviral exposures have been fully explored, may be therapies directed at blunting detrimental inflammatory responses.

Although this registry represents the largest global detailed patient data set on H5N1 cases, many questions remain unanswered. For example, it has been suggested that oseltamivir be used in combination with other antivirals, principally amantadine, where resistance patterns make this a rational combination, in that such combination therapy may promote efficacy and retard emergence of transmissible resistant virus strains.

The very small number of patients in this study who had received a combination that contained oseltamivir, 3 in all, unfortunately precludes the drawing of any conclusions on the clinical efficacy of such combinations. Nonetheless, these registry data, by virtue of their numbers and scope, provide important information on treatment patterns and outcomes for a wide variety of patients treated under a variety of conditions across the world.

These findings have important implications for clinical management. These data show that humans infected with H5N1 face near certain death unless prescribed effective antiviral treatment, preferably within 2 days of symptom onset, although benefit remains even with treatment initiation up to about 5—6 days after symptom onset, possibly a reflection of prolonged viral replication in human H5N1 infection.

Thus, there is still benefit from initiating treatment with oseltamivir in patients who present relatively late in the course of their illness, and clinicians should be mindful not to assume that all is lost in such patients.

We thank Anna Layton and Priscilla Velentgas for their diligent work in data acquisition and analysis. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search.


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