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Although some samples were collected as part of the laboratory testing and workups allergy treatment dublin cheap 100mcg entocort, additional biospecimens samples were collected from study participants at each exam cycle and preserved to allergy medicine with decongestant order 100mcg entocort otc be used for future analyses allergy medicine yorkie purchase generic entocort on line. Serum and urine were collected longitudinally across multiple cycles allergy vs autoimmune purchase entocort online pills, while semen and whole blood were collected at a single exam cycle. M ultiple blood samples were drawn for a subset of the population for use in dioxin biological halflife and other studies. When the questionnairederived indexes were applied within each job classifcation, days of skin exposure added statistical signifcance, but not substantially, to the variability explained by job alone. Exposure could occur during operation of spray equipment and through contact with herbicides in the aircraft. For example, rank was used as a surrogate of exposure because offcers (pilots, copilots, and navigators) were unlikely to handle the herbicides. W ith respect to the development of cancer, service in 1968 or earlier was considered to have been in the critical exposure period, whereas for diabetes, the critical exposure period was considered to be 1969 or earlier. Days of spraying were grouped into 30day blocks for cancer, and into blocks of 90 or more days for diabetes. This also raises questions about the stability of positive fndings; this is somewhat less of a problem if the fndings are repeated over examination cycles, although the results of the examination cycles themselves are not fully independent repetitions. After the model had been adjusted for several demographic and clinical factors, Ranch Hands were found to have a 2. The authors found that low testosterone levels in men were an inde pendent risk factor (comparable to aging and obesity) for high fasting glucose and, therefore, that testosterone was a weak predictor of a diagnosis of type 2 diabetes. The 50 Vietnamdeployed veterans were then stratifed into those who sprayed herbicides and those who did not, based on selfreported information. It required that an epide miologic study be conducted to examine the longterm adverse health effects on female Vietnam veterans who had exposure to traumatic events, exposure to herbicides such as Agent Orange or other chemicals or medications, or any other related experience or exposure during such service. Female Army and Navy personnel were identifed from morning reports and muster rolls of hospi tals and administrative support units where women were likely to have served. Military personnel were identifed as female by their names, leaving open the possibility that some women may have been inadvertently excluded from the analysis. Demographic information and infor mation on overseas tours of duty, unit assignments, jobs, and principal duties were abstracted from military records. W omen whose service in the military fell outside the period of interest, whose records were missing data, or who served in South east Asia but not in Vietnam were excluded. The analysis included 132 deaths among 4, 582 female Vietnam veterans and 232 deaths among 5, 324 comparison veterans who served in the military from July 4, 1965, to M arch 28, 1973, which was when combat operations occurred. Causespecifc mortality was derived for both groups of veterans and compared with mortality in U. Cypel and Kang (2008) conducted a mortality study of female vet erans who deployed to Vietnam, comparing them with a control group of women veterans matched on rank and military occupation who were in the military at the same time period but who were not deployed to Vietnam. The frst group included 4, 734 female veterans who served in Vietnam, the second group consisted of 2, 062 female veterans who served near Vietnam, and the third group included 5, 313 female veterans who did not deploy outside of the United States. The cancer mortality rate was approximately equal between the female Vietnam veterans group and both the U. Vietnamveteran cohort provide direct information on the health and mortality status of female military personnel who served in Vietnam, the limitations of the results must be kept in mind. Specif cally, female veterans likely experienced low herbicide exposure because they were not involved in applying herbicides or engaged in direct combat, and their incountry tours of duty were generally limited to 1 year and at fxed locations that were not in proximity to known defoliated areas. Army veterans were identifed from a list obtained by the Army and Joint Services Environmental Support Group; computerized lists were also provided by the Air Force, Navy, and M arine Corps. From a pool of 6, 657 women whose military units did not serve in Vietnam, 4, 390 veterans who were alive on January 1, 1992, were randomly selected as controls. The information collected included demographic background, general health, lifestyle, menstrual history, pregnancy history, preg nancy outcomes, and military experience, including nursing occupation and combat exposure. Information on pregnancy risks and complications— including smoking, infections, medications, exposure to Xrays, occupational history, and exposure to anesthetic gases, ethylene oxide, herbicides, and pesticides— was collected for each pregnancy. For the comparison group, the frst pregnancy after July 4, 1965, was designated as the index pregnancy. The authors did not provide specifc data on diagnosis confrmation for the three sites other than the breast, but they stated that Vietnam status was not associated with a greater likelihood of fnding confrmatory medical records. The legislation covers 18 birth defects, including cleft lip or palate, congenital heart disease, hypospadias, neuraltube defects, and W illiams syndrome. From this list, 75, 617 individuals were randomly selected for inclusion in the study. The information extracted from the selected military records included duty stations, dates of tours, branch of military service, date of birth, sex, race, military oc cupation specialty codes, education level, type of discharge, and confrmation of service in Vietnam. Death from any cancer was elevated among marines who served in Vietnam but not Army veterans. An additional 11, 325 deceased Army and Marine Corps Vietnamera veterans were identifed from the period and included in the study. The fnal study included 70, 630 veterans—33, 833 who had served in Vietnam and 36, 797 who had never served in Southeast Asia. Army Vietnam veterans had statistically signifcant excesses of deaths for laryngeal cancer and lung cancer when compared to both Army nonVietnam veterans and all nonVietnam veterans. Results showing statistical signifcance for Marine Corps Vietnam veterans varied according to the referent population used (nonVietnam marine veterans or all nonVietnam veterans). Proportionate mortality ratios for deaths due to respiratory and digestive diseases were statisti cally signifcantly lower among marine Vietnam veterans than all nonVietnam veterans. Lung cancer deaths were signifcantly higher among both Army veteran groups and the Marine Corps Vietnamdeployed group compared with the U. The study was designed to compare a retrospective cohort of Vietnam veterans, with all service branches represented, with Vietnamera veter ans who were deployed to countries other than Vietnam, Cambodia, or Laos and with members of the U. The questionnaire col lected information on the following topics: military service (combat experience, chemical and other exposures, reentry into civilian life, or no military service), general health (neurologic conditions, infections, presumptive conditions, cancer, hypertension, and mental health conditions), experience with aging, lifestyle fac tors (tobacco use, health care use, living arrangements), and health experiences of descendants (nine questions on birth defects and other conditions of children and grandchildren). A medical records review is being conducted of a small subset of participants (n = 4, 000) to validate the questionnaire information (Davey, 2017). Beginning in 2011, eligibility has been expanded to include veterans who served along the Korean Demilitarized Zone between 1968 and 1971, veterans who served in certain units in Thailand, and veterans who were involved in the testing, transporting, or spraying of herbicides for military purposes (Dick, 2015). The studies have been included for completeness, but the outcomes that they address are outside the purview of this committee. Vietnam veterans were selected for the study on the basis of the number of herbicide exposure events that they were thought to have experienced, based on the number of days their unit was within 2 kilometers and 6 days of a recorded herbicidespraying event. Blood samples were obtained from 66% of 646 Vietnam veterans and from 49% of the eligible comparison group of 97 veterans. The assessment of average exposure does not eliminate the possibility that some Vietnam veterans had heavy exposures. Army veterans who served in Vietnam and in 8, 989 Vietnamera Army veterans who served in Germany, Korea, or the United States (Boyle et al. Vietnam Veteran Studies Am erican Legion Study the American Legion, a voluntary service organization for veterans, con ducted a cohort study of the health and wellbeing of Vietnam veterans who were members. State Studies Several states have conducted studies of Vietnam veterans, most of which have not been published in the scientifc literature. The second (2014b) assessed the health of the family members with more emphasis placed on the details of psychological and social wellbeing, rather than adverse impacts on physical health. The wide range of outcomes examined for the family members them selves included mental health outcomes, pregnancy and birth defect outcomes, physical health, social functioning, and mortality. Because many of the health outcomes reported for these family members are not central to the charge of the committee. From the roster of Australian Vietnam veterans, more than 10, 000 Austra lians who had served in the Vietnam W ar were randomly selected and contacted, along with their family members, for potential participation in the study. The Vietnam veterans who were identifed and ultimately selected included 3, 940 who were randomly selected and 2, 569 who selfselected into the study based on media publications announcing that the study would be conducted. The primary comparison group consisted of family members of non deployed Vietnamera personnel. These personnel comprised 3, 967 randomly selected nondeployed era veterans and 418 who selfselected into the study. Thus, there were far more Australian Vietnam veterans who selfselected into the study than nondeployed Australian Vietnamera veterans who selfselected, and the percentage of the Vietnam veterans who selfselected was much higher than the percentage of nondeployed Vietnamera veterans who selfselected. Some analyses have been conducted among all study participants, and some analyses were stratifed by the type of enroll ment (random versus selfselected).

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Childhood Obesity: Costs allergy forecast montgomery al order entocort pills in toronto, treatment patterns allergy medicine ear pressure purchase genuine entocort line, disparities in care allergy forecast joplin mo purchase entocort 100 mcg amex, and prevalent medical conditions allergy relief číńňđóęöč˙ order entocort 100mcg overnight delivery. Toward improved instruction in decision making to adolescents: A conceptual framework and pilot program. Family rigidity, adolescent problemsolving defcits, and suicidal ideation: A media tional model [Electronic version]. Teaching the foundations of social decision making and problem solv ing in the elementary school. Role of general and specifc competence skills in protecting innercity adoles cents from alcohol use [Electronic version]. Neural substrates of choice selection in adults and adolescents: Development of the ventrolateral prefrontal and anterior cingulate cortices. Costs and benefts of a decision: Decision making competence in adolescents and adults. Gender diferences in adolescent depression: Gendertyped characteristics or problemsolving skills defcitsfi Judgments about risk and perceived invulnerability in adolescents and young adults. Growth patterns in the developing brain detected by using continuum mechanical tensor maps. Beyond invulnerability: The importance of benefts in adolescents’ decision to drink alcohol. The association of school transitions in early adolescence with developmental trajectories through high school. The impact of stageenvironment ft on young adolescents’ experiences in schools and in families. Developmental patterns and gender diferences in the experience of peer companionship during adolescence. Stress, risk and resilience in children and adolescents: Processes, mechanisms and interventions. Stress, risk, and resilience in children and adolescents: Processes, mechanisms, and interventions. Developmental and contextual factors and mental health among lesbian, gay, and bisexual youths. Parents’ ethnicracial socialization prac tices: A review of research and directions for future study. Sexual possibility situations and sexual behaviors among young adolescents: the moderating role of protective factors. Adolescent decision making: A broadly based theory and its application to the prevention of early pregnancy [Electronic version]. The role of sequential and concurrent sexual relationships in the risk of sexually transmitted diseases among adolescents. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States. Adolescent oral sex, peer popularity, and perceptions of best friends’ sexual behavior. Finding faith, losing faith: The prevalence and context of religious transformations during adolescence. See Romantic interests through peer relationships, 33–34 Lowincome, 18 typical stages of, 14, 31–35 unique patterns of, 2, 8, 87 Emotional disturbance, 54–56 Emotions, 32, 33, 54–56 M Empathy, 3, 32–33, 35, 85 Mastery. See Competence, sense of See also Social awareness Masturbation, 62, 63 Environment, 3, 17, 56, 87 Maturation rates, 8, 9, 22, 62–64 Estrogen, 32, 62 See also Physical development Ethnic identities, 49–50, 71, 73 Media images, 13, 35, 60 See also Cultural infuences Medical issues, 10–11, 17 Exercise, 11, 19 Menstruation, 8–9, 62 Mental health, 54–56 Metacognition, 22 Midbrain, 16 F Morality, 3, 15 Faith. See Spiritual development Muscle dysmorphia, 11 “Flame war, ” 42 Forebrain, 16 Friendships. See Tobacco use Nutrition, 10, 17–18, 33 G Gangs, 48 Gender, 34, 41, 42 O Gender identity, 51, 52, 62 Obesity, 9, 17–19 Growth spurts. For additional information about the Guide and to order additional copies, please contact: Center for Adolescent Health Johns Hopkins Bloomberg School of Public Health 615 N. In partnership with city government, communitybased organizations, and others, Good Neighbor provides incentives to innercity retailers to increase their stocks of fresh and nutritious foods and to reduce tobacco and alcohol advertising in their stores (see Case Study # 6 on page 24. Promoting Health Equity A Resource to Help Communities Address Social Determinants of Health Laura K. Promoting Health Equity: A Resource > National Center for Chronic Disease Prevention and Health Promotion to Help Communities Address Social Determinants of Health. Division of Adult and Community Health Department of Health and Human Services, Centers for Disease Control and Prevention Research Centers Prevention; 2008. Community Health and Program Services Branch For More Information > National Center for Injury Prevention and Control Email: ccdinfo@cdc. Web site addresses of nonfederal organizations are provided solely as a service Mail: Community Health and Program Services Branch to our readers. Acknowledgements the authors would like to thank the following people for their valuable contributions to the publication of this resource: the workshop participants (listed on page 5), Lynda Andersen, Ellen Barnidge, Adam Becker, Joe Benitez, Julie Claus, Sandy Ciske, Tonie Covelli, Gail Gentling, Wayne Giles, Melissa Hall, Donna Higgins, Bethany Young Holt, Jim Holt, Bill Jenkins, Margaret Kaniewski, Joe Karolczak, Leandris Liburd, Jim Mercy, Eveliz Metellus, Amanda Navarro, Geraldine Perry, Amy Schulz, Eduardo Simoes, Kristine Suozzi and Karen Voetsch. A special thanks to Innovative Graphic Services for the design and layout of this book. Content is drawn from Social Determinants of of Medicine defned public health as “what we as a society do to collectively Disparities in Health: Learning from Doing, a forum sponsored by the U. Forum participants included representatives from community organizations, academic settings, and public Early efforts to describe the relationship between these conditions and health or 3 health practice who have experience developing, implementing, and evaluating health outcomes focused on factors such as water and air quality and food safety. The workbook More recent public health efforts, particularly in the past decade, have identifed a refects the views of experts from multiple arenas, including local community broader array of conditions affecting health, including community design, housing, employment, access to health care, access to healthy foods, environmental pollutants, and occupational safety. The link between social determinants of health, including social, economic, and Research documents that poverty, income and wealth inequality, poor environmental conditions, and health outcomes is widely recognized in the public quality of life, racism, sex discrimination, and low socioeconomic health literature. Moreover, it is increasingly understood that inequitable distribution conditions are the major risk factors for ill health and health inequalities of these conditions across various populations is a signifcant contributor to conditions such as polluted environments, inadequate housing, absence persistent and pervasive health disparities. Great social costs arise from increasing the quality and years of healthy life and eliminating health disparities. To be successful, this approach requires community, policy, planning, community economic development, environmental sciences, and housing. Readers that traditionally may not have been part of public health initiatives, including are provided with information and tools from these efforts to develop, implement, community organizations and representatives from government, academia, and evaluate interventions that address social determinants of health equity. Participants October 28–29, 2003 Social Determinants of Disparities in Health: Learning From Doing Alex Allen Stephanie Farquhar James Krieger William J. People in such groups not only experience worse health but also tend to have less access to the social determinants or conditions. Health disparities are referred to as health inequities when they are the result of the systematic and unjust distribution of these critical conditions. Health equity, then, as understood in public health literature and practice, is when everyone has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of their social position or other socially determined circumstance. In 2004, the mortality rate for infants of mothers with less than 12 years of Infant mortality 12, 13 education was 1. Between 2001 and 2004, more than twice as many children (2–5 years) from poor families experienced a greater number of untreated Tooth decay dental caries than children from nonpoor families. Of those children living below 100% of poverty level, Mexican American children (35%) and African American children (26%) were more likely to experience untreated dental caries than White children (20%). In addition, Asian American and Hispanic adults (75% and 68%, respectively) were less likely to have visited a doctor or other health professional in the past year compared to White adults (79%). Yet nearly 40 years later, only 33% of fourthgraders are profcient readers at grade level. Hispanic/Latino adults had the lowest average health literacy score compared to adults in other racial/ethnic groups. However, as of 2005, Hispanics/Latinos and African Americans were signifcantly more likely to have dropped out of high school (22% and 10%, respectively) compared to Whites (6%). The homeless population also varies by race and ethnicity: 42% AfricanAmericans, 39% Whites, 13% Hispanics/ Latinos, 4% American Indians or Native Americans and 2% Asian Americans. An average of 16% of homeless people are considered mentally ill; 26% are substance abusers. Multiple models describing how social determinants infuence health outcomes have been proposed. The model presented here contains many of these elements and pathways and focuses on the distribution of social determinants (see ure 1.

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A transformative program in Nepal and another in Malawi reduced unmet need for contraceptives (O’Donnell allergy testing quackery cheap 100 mcg entocort with mastercard, 2009; Shattuck et al allergy medicine without antihistamines generic entocort 100 mcg visa. The majority of Led to allergy quotes funny buy 100mcg entocort safer sex practices these programs affected change in (Schensul et al allergy symptoms 11 entocort 100 mcg otc. Its strategies were community Reduced stigma over condom use mobilization and collectivization (Paine et al. Avahan was implemented in six Indian states that accounted for 83 percent of India’s population living with the virus. They strengthened the health systems’ response to preventing violence, offered services to those experiencing violence, and affected change in related indicators (Budiharsana and Tung, 2009; Turan et al. In South Asia, Important Outcomes accommodating and transformative programs increased Increased breastfeeding women’s food intake during pregnancy and encouraged men to support their wives in seeking facilitybased Reduced stunting care and access to nutritious food (Intrahealth Increased child immunization International, 2012; Sinha, 2008). In South Asia, accommodating programs improved neonatal health outcomes such as reducing perinatal and neonatal mortality and increasing breastfeeding of newborns. They also increased fathers’ knowledge of newborn and child care (Innovations for Maternal, Neonatal and Child Health, 2013; Nasreen, 2012; Varkey et al. One evaluation in Bangladesh examined whether a structural intervention to improve child health brought about “gender and socioeconomic equity in health, ” by comparing stunting rates in children in intervention and control areas (Tran et al. Interestingly, the evaluation found that stunting prevalence decreased among girls but increased among boys. A possible explanation was that mothers were redistributing limited resources more equitably among their female and male children, and as a result, male children were getting less to eat than before. This is the only study in the review that demonstrated reductions in gender disparities related to child wellbeing. Transformative programs conveyed health benefits to mothers, as well, including increased use of skilled pregnancy care, increased consumption of iron and folic acid supplements, and increased institutional deliveries. In contrast, most of the accommodating programs in South Asia achieved outcomes in two or more health areas. The combination of outcomes achieved by health area differed slightly by genderaware category and region (see Tables 7 and 8). To a great extent, accommodating programs changed the level of knowledge and, to a lesser extent, attitudes across these multiple health areas. Transformative programs, in contrast, tended not only to facilitate positive shifts in attitudes but also to engender healthy behavior in the health areas they addressed. Not surprising, behavioral and health status outcomes were more commonly achieved in a certain health area when it was the primary focus. Knowledge and attitudinal outcomes were more commonly achieved in the supplementary health areas. For example, program strategies should take into account genderbased differences in healthcareseeking behavior. Among the reasons for this delay are a woman’s economic dependence on her husband, restricted mobility, resistance to seeking services from a male provider, and fear of treatment’s financial burden (Ahsan et al. The attendant shame and reduced selfesteem that men experience can keep them from disclosing their symptoms and seeking treatment (Atre et al. Implementing a service scheme on such a large scale, however, can lead to 24 Findings complacency and inadequate attention to gender and the unique and different needs of women and men. For example, gender based differences exist in terms of access to and use of health services, which in turn are influenced by access to and control of household resources, power and decisionmaking roles within a household and in the wider community, and harmful traditions and cultural practices (Gerber, 2013; Rodin, 2013). In general, transformative programs may have been more likely to report having achieved gender outcomes, simply because they were more likely to measure them. A majority of transformative genderaware programs, irrespective of their health focus, promoted genderequitable attitudes and beliefs, and enhanced women’s selfconfidence, selfefficacy, and self determination. Programs in South Asia improved women’s and girls’ decisionmaking power, beliefs on women’s right to refuse sex, community and partner support, and building social networks and life and social skills. These findings suggest that inequitable gender norms manifest in different ways across cultures and that gender aware programs are sensitive and responsive to these cultural nuances. Qualitative methods were often used with these quantitative methods, largely to supplement and confirm findings from the surveys (N = 69). Seventeen interventions were assessed only qualitatively, typically using indepth interviews and focus group discussions. A higher share of accommodating and transformative programs used quasiexperimental and nonexperimental methods in South Asia than in the other five regions (see ure 8). More transformative than accommodating programs used a mix of quantitative and qualitative methods, particularly in regions other than South Asia. ures 9 and 10 show the proportions of these study designs employed in South Asia and in the five other regions. Everywhere, the quasiexperimental pre and posttest design was more common than the posttestonly design. Among nonexperimental designs, crosssectional studies conducted at two or more 26 Findings points in time and longitudinal studies were most common. Qualitative assessments typically involved in depth interviews, focus groups discussions, or both. Eleven of the sixteen programs were transformative and only two were implemented in South Asia. In some, these assessments were conducted a few weeks or one month apart, while in others, there was a gap of 12 months to two years between assessments. Changes in knowledge and attitudes showed 27 Transforming Gender Norms, Roles, and Power Dynamics for Better Health mixed results over time across interventions, with some interventions reporting some decline in knowledge and attitudes over time and others reporting maintenance or improvements at successive measurements. ure 10 highlights the different evaluation designs measuring the effect of genderaware programs addressing different health issues. Another difference between South Asia and the other five regions was use of qualitativeonly studies. ure 11 shows the study designs used to evaluate programs in South Asia and the other five regions. Program evaluations using quasiexperimental designs were mostly effective or promising. As demonstrated in ure 12, a higher proportion of program evaluations using nonexperimental or qualitativeonly methods for evaluation were ranked unclear than of those using more rigorous quantitative methods. Among transformative programs, onequarter were effective, onethird were promising, and a little less than half were unclear. Qualitative assessments of accommodating programs using qualitativeonly evaluation methods were few and rated as promising (N = 2) or unclear (N = 3). Notably, threefourths of the qualitative studies documented positive changes in gender outcomes. Box 13: Examples of Gender Measures Used in Evaluations Gender Equitable Men scale. The evaluation found that the microfinanceonly intervention achieved outcomes related to economic wellbeing. Of these, 35 (most of them transformative) used gender scales to measure changes in gender outcomes (see Box 13). Other programs constructed and used different scales comprising several items measuring one or more gender domains. Among programs that did not include a specific gender scale, the quantitative surveys added individual items on gender attitudes and norms, social networks, or financial agency to the larger questionnaire. These programs facilitated progressive gender attitudes toward male participation and support, facilitated more gender equitable attitudes, and encouraged partner communication. One of the Avahan projects, in India, examined impact on sex workers’ empowerment using a scale measuring three domains: power within (selfconfidence); power over resources. In Burkina Faso, the Filles Eveillees intervention, which worked with migrant female domestic workers, used a scale that measured attitudes about gender roles, social capital, and self confidence (Engebretsen, 2013). Some programs did not use an index or scale, but included individual items in surveys to assess girls’ access to social support (Erulkar et al. One intervention in Nepal, for instance, used participatory qualitative methods with adolescents—pile sorts, storytelling, pie charts, and projective drawings of change—to assess how gender norms and roles shifted as a result of the program. Although scaleup was not a core objective of this review, insights into how and which intervention components are scalable and at what cost could have better informed recommendations, particularly for governments seeking to enhance their current and future health programs. Varying quality of documents: this review included documents from peerreviewed journals as well as gray literature from online sources. Consequently, the depth of information provided and data quality varied across documents. Some studies furnished insufficient details on the intervention components, evaluation methodologies, and even the findings.

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Overt fatal and Conference Comment: Encephalitozoon exhibits chronic subclinical Encephalitozoon cuniculi selective parasitism of vascular endothelium allergy treatment 5mm entocort 100mcg sale, microsporidiosis in a colony of captive emperor especially in the brain and kidney allergy forecast allen tx buy genuine entocort, as well as renal tamarins (Saguinus imperator) allergy symptoms but not allergic to anything purchase entocort 100mcg without prescription. Pathology of Laboratory and the sporoplasm allergy testing on 1 year old buy cheap entocort 100 mcg line, which contains the genetic Rodents and Rabbits. Serologic evidence of membrane, which thickens and allows spore organelles Encephalitozoon cuniculi infection in a colony of to form. Encephalitozoonosis in cells, or enter the vascular system or the renal tubular squirrel monkeys (Saimiri sciureus). Typical gross lesions in nonhuman primates include granulomatous meningoencephalitis and vasculitis, nonsuppurative interstitial nephritis and pneumonia, and granulomatous placentitis. A “classic” gross lesion in the rabbit is multifocal irregularly depressed pits in the kidneys with indistinct linear pale graywhite streaks on cut surface. In severe cases, hydrocephalus, thrombosis of meningeal blood vessels, and focal encephalomalacia can occur. Clinically normal animal, incidental finely stippled chromatin and a single magenta finding at necropsy. Multifocally, neoplastic cells surround numerous variablysized cystlike spaces that are Gross Pathology: A 5. All other organs are within normal are multifocal accumulations of lymphocytic infiltrate, limits. Variablysized masses of infiltrative, and densely to sparsely cellular neoplasm, neoplastic cells are present within lymphatic vessels, compressing preexisting ovarian stroma and preantral and there are focal areas at the periphery of the mass and antral follicles present in the periphery between the where neoplastic cells tend to breach the adjacent neoplasm and ovarian tunica albuginea, and sparing tunica albuginea. Contributor’s Morphologic Diagnosis: Right ova ry: dysgerminoma, rhesus monkey (Macaca mulatta). Contributor’s Comment: An incidental finding of unilateral ovarian dysgerminoma in a rhesus monkey (macaca mulatta) is examined histologically and immunohistochemically. To our knowledge there is only one documented report of ovarian dysgerminoma in a rhesus monkey. Ovary and fimbria, rhesus monkey: the majority of the ovary is replaced by an infiltrative cell tumors that arise from neoplasm (dysgerminoma). Ovary, rhesus monkey: Centrally, there is marked edema, apoptosis, with large nuclei, prominent nuclei, and often, clear cytoplasmic and necrosis with dropout (arrows) separate neoplastic cells and cause invaginations into the nucleus (arrows). This would reported in a variety of mammals and nonmammalian shed some light on the molecular pathways involved in species, including humans (girls and women)9; non the pathogenesis of this neoplastic condition, which human primates6; domestic animals7; and wildlife, remains to be determined. Ovarian neoplasm is usually unilateral but may be bilateral, dysgerminomas are considered to arise from the relatively soft, with smooth external surface, and may follicular oocytes or testicular homologues within the have cystic structures on cut surface. The the neoplasm is usually diffusely densely cellular with neoplastic cells share ultrastructural similarity to focal cystic and mineralized areas and high mitotic normal fetal oogonia. These neoplasms typically index, and neoplastic cells are round to polygonal with exhibit cytoplasmic and membranous granular cytoplasm. Although not prominent in carcinoma, malignant lymphoma, and granulosa cell this case, some neoplastic germ cells express vimentin tumor. On histopathological the stem cellrelated protein Oct4 mentioned by the examination, differential diagnosis should include any contributor is also positive in embryonal carcinomas, round cell neoplasm, especially lymphosarcoma. Diagnostic Immunohistochemistry, Theranostic are not widely available for veterinary diagnostics; and Genomic Applications. Dysgerminoma in an eastern rosella (Platycercus Dysgerminomas have been reported in related maned eximius exemius). In horses, dysgerminoma has been reported as a cause of hypertrophic osteopathy, which is more commonly associated with concurrent thoracic disease. High prevalence of ovarian tumors in maned wolves (Chrysocyon brachyurus) at the National Zoological Park. Theses monkeys received an amorphous extracellular antigen was evident in areas average inhaled dose of 729 colonyforming units of of necrosis or pyogranulomatous inflammation in Francisella tularensis (F. Organisms were included increases in body temperature, heart rate, readily identified within membranebound vacuoles peak cardiac pressure, and mean blood pressure. The bacteria varied in shape but were Gross Pathology: Prominent gross changes in all generally oval or elongate and measured 0. Bacteria contained a thin cell wall, a pale demarcated, necrotic foci present consistently in the central cytoplasm, and a darker rim of cytoplasm near lungs, mediastinal lymph nodes, and spleen but also the cell wall. An outer membrane was present in some seen in the heart, mediastinum, diaphragm, liver, organisms and appeared as an irregular or wavy urinary bladder, urethra, and mesentery. Many mediastinal lymph nodes, and spleen were most cells containing internal bacilli were seen in various severely affected, with as much as 50% of the tissue stages of degeneration characterized by swollen replaced by necrotic foci. Because severe mandibular, mediastinal, mesenteric, axillary, and degeneration and necrosis often hindered recognition inguinal lymph nodes; and in alveolar macrophages. Splenic borders are rounded, Division of Pathology, United States Army Medical Research Institute of indicating marked congestion. Lung, African green monkey: Foci of lytic necrosis (left) transition airways and extend into surrounding tissue. For instance, the antibiotic regimens most applicable for the treatment or postexposure prophylaxis of Contributor’s Morphologic Diagnosis: L ung: pneumonic tularemia, especially in a mass casualty Bronchopneumonia, necrotizing, multifocal, marked, event, are not completely certain. Also, vaccines that with hemorrhage, edema, necrohemorrhagic pleuritis, protect against ingestional or transdermal infection multifocal necrotizing vasculitis, and rare thrombi. Therefore, appropriate animal models of the causative agent of tularemia, also known as aerosolized tularemia are required to develop the ‘‘rabbitfever. The key exists among wildlife, particularly involving rabbits, pathologic features of inhalational tularemia in these hares, and rodents. Humans may become infected monkeys were numerous and widespread necrotizing through arthropod bites, through intact skin by pyogranulomatous lesions that especially targeted the handling infected animal carcasses, by ingesting lungs and lymphoid tissues. Bacteria were present in contaminated food or water, or by inhaling many cell types but were most readily present in contaminated aerosols. Ultrastructural features included the presence constituting an infectious dose, and it can survive for of bacteria within cytoplasmic vacuoles that were long periods in the environment. Lung, African green monkey: Electron micrograph of an alveolar neutrophils exhibit marked immunoreactivity for F. The wavy, lamellated cell membranes are characteristic of this bacterium when phagocytosed. We did not observe granulomas experimental model for investigating the nature of associated with epithelioid macrophages and hostpathogen interactions in macrophages, as well as multinucleated giant cells in the target organs of other aspects involved in the pathogenesis of tularemia. It is possible that the monkeys in this study succumbed to disease before such lesions had There are limited numbers of documented reports of sufficient time to fully develop. Another exception is experimental aerosolized tularemia in rhesus that the kidney is a reported target of human tularemia, macaques, mostly dating back to the 1960s. These yet none of our cases displayed gross or histologic reports describe acute bronchiolitis progressing to changes in the kidney. We did observe, however, that bronchopneumonia, lymphadenitis, splenitis, and most kidneys had positive immunohistochemistry hepatitis with neutrophilic and histiocytic labeling (for bacterial antigen) within glomerular inflammation with intrahistiocytic bacteria. One report did describe expensive and limited in supply in recent years, which histologic changes in the renal glomeruli of rhesus limits their usefulness as a model of tularemia. The tularemic lesions were present in the oral mucosa, tongue, lungs, liver, Our finding that F. It is essential to continue to phagolysosome fusion, and then replicate in these cells characterize the clinical and pathologic changes that is considered a key aspect of its pathogenesis. Experimental tularemia in gross and histologic lesions after exposure to Macaca mulatta: relationship of aerosol particle size to aerosolized F. Tularaemic necrosuppurative, multifocal, severe, with fibrinous pneumonia: pathogenesis of the aerosolinduced pleuritis. The automated bioaerosol Conference Comment: There are three strains that exposure system: preclinical platform development and cause tularemia: Francisella tularensis var tularensis, a respiratory dosimetry application with nonhuman the most virulent and commonly isolated form, F. In: Textbooks of Military Medicine, New World monkeys have been reported in the United Aspects of Biological Warfare. Typical gross findings include Borden Institute, Office of the Surgeon General, pyogranulomatous pneumonia and enteritis; United States Army Medical Department Center and necrosuppurative glossitis and gingivitis; and School; 2007:167184. Tularemia is difficult to differentiate from other causes Epizootic of tularemia in an outdoor housed group of of gram negative sepsis and often causes lesions cynomolgus monkeys (Macaca fascicularis).

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