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Ci11#53 Sarpigudas: Use of Ghrtas for those Scorched, Wasted and Emaciated: ** Means of making Ghrtas "Viscous" ([Palatable]) by Turning Into Boluses: these very ghritas (listed above) should be administered to those scorched, wasted and emaciated after making them viscous [thick] by adding powders of twakksiri, sugar, and parched paddy [i. After taking these boluses of ghee mixed with honey [A)the ghrta formulas have honey in them, B)add honey when making the boluses, or C) eat the bolus along with honey? Ci11#56-61 "Third sarpirguda": this bolus alleviates cough, hiccup, fever, phthisis, bronchial asthma, internal hemorrhage, halimaka, loss of semen and sleep, thirst, emaciation and jaundice: 40gm. Ci11#62-65 ** "Fourth sarpirguda": these should be taken by wasted, wounded and scorched person, thus he attains corpulence shortly by increase of the dhatus: 795 400gm. Ci11#66-69 "Fifth sarpirmodaka": this is efficacious in disorders of V, "rakta pitta"[rakta-pitta/ rakta, P], chest lesions, cough and wasting and is beneficial for those affected with phthisis, deficiency of semen, congestion of blood in chest and who are emaciated, debilitated, old desiring corpulence, lustre and strength, women afflicted with discharges due to genital disorders, desirous of progeny, and those suffering from abortion and fetal death. Ci11#70-77 Treatment in case V produces disorders in pelvic region in one indulged in intercourse: Give V-alleviating, bulk-promoting and semen-promoting formulas. Ci11#80 Treatment of person suffering from chest wound and wasting but with good digestion: Take the following saturating drink [mantha]: parched grain flour sifted through cloth + honey ghee [water] Prepare the above together into a drink. Ci11#81 797 Method/Formula to increase relish in the wasted patient: Take the following soup: Meat soup of wild animals ghee Fry the above together. Ci11#82 Or, he may be given: Barley diet with milk and meat soup of cow, buffalow, horse, elephant and goat and soups of sour fruits processed with ghee. Ci11#84 * Saindhavadi Curna: this powder is relish-improving, appetizer, strength-promoting and alleviator of pain in sides, asthma and cough: 40gm. It should be "used in condition of appetite and diarrhea of the patients of phthisis": 40gm. This application is and excellent promoter of corpulence, lifespan, strength and health. Ni1#16 these words are synonyms of "nidan" [general cause]: hetu, nimitta, ayatana, kartta, karana, pratyaya and samutthana [These are etiological factors of any disease, not just fever. Ci3#4-10 Synonyms of Jwara: vikara, roga, vyadhi, atanka Ci11#11 the Source of Origin of Fever: the (deranged) doshas of body and mind. Ci11#14 801 Insert here/ to somewhere in this chptr: Vi3#39-40 (On trtmnt of fever with hot water) [Mythical] Origin of Fever: In the second age (treta yuga) when Lord Siva was observing the vow of wrathlessness (penance), the demons living on obstacles to penance, created mischief for thousand divine years in order to put obstacles in the penance of the great soul. Moreover, he did not give due place to the offerings to Lord Siva in the sacrifice (organized by him) in spite of having been advised by the gods to do so. Thus he made the sacrifice devoid of the mantras relating to the Lord of animals and offerings pertaining to Lord Siva which were necessary for the success of the sacrifice. When after completion of the vow, the god Rudra came to know the lackings of Daksa, he, the knower of the self, came into the wrathful state and by creating a (third) eye in his forehead the potent one, reduced all these demons to ashes and created a boy, heated with the fire of anger, who could destroy the celebrations of the sacrifice. After this the sacrifice was destroyed, the gods were pained and the living beings afflicted with heat and pain were moving here and there in all directions. Then the congregation of gods along with the seven sages praised the omnipresent Lord with incantations till Lord Siva returned to his normal benevolent state. Ni1#20 Symptoms of V-type Fever: irregular onset and remission irregular temperature unstable mildness and severity of fever emergence or aggravation of fever at the end of digestion (of food), day, night and summer particular roughness and reddishness in nails, eyes, face, urine, stool and skin excessive tearing of nails, etc. Ni1#26 Symptoms of K-type Fever: emergence or aggravation of fever in the whole body simultaneously particularly immediately after meals, forenoon, early night or the spring season heaviness in body aversion to food excessive salivation sweetness in mouthy nausea plastering of heart cold sensation vomiting mildness of appetite excessive sleep stiffness drowsiness cough dyspnea coryza cold whiteness in nails, eyes, face, urine, stool and skin 805 excessive appearance of urticarial patches in the body liking for heat unsuitability of the etiological factors suitability of factors opposite to the etiological ones Ni1#27 Etiology of Dual- or Tri-doshic Type Fevers: irregular meals fasting change in usual food seasonal disturbances unsuitable smell use of poisonous water, poisonous substances contact with the mountains improper administration of unction, sweating, emesis, purgation, non-unctuous and unctuous enema and head-evacuation; improper after-evacuative dietetic regimen women are particularly susceptible abnormal delivery and improper post-partum management mixing up of etiological factors mentioned earlier (The involved etiology will determine the involved doshas. Ni1#30 Etiology, Symptoms, Pathology and Types of Exogenous Types of Fevers: `The exogenous one is the 8th type of fever initiated with pain and caused by injury, evil organisms, spell and curse. Amongst them, that caused by injury is associated with V located in affected blood; That caused by evil organisms with V and P and those by spell and curse with sannipata. Ni1#31 Prodromal Symptoms of [All Types] of Fever: these are the prodromal symptoms which appear before the rise of temperature and also continue in the stage of pyrexia: loss of taste in the mouth, heaviness in body parts aversion to food congestion in eyes lachrymation oversleep uneasiness yawning bending trembling exhaustion giddiness delirium vigils horripilation sensation in the teeth (unstable) tolerance and intolerance to sound, cold, wind and sun anorexia, indigestion debility body ache malaise diminished vitality lethargy lassitude diminution in normal activities aversion to own activities intolerance to the words of elders, dislike for children unmindfulness to own duties feeling difficulty in the use of garlands, paste and food dislike for sweet edibles liking for sour, salty, pungent things Ni1#33 Spiritual Etiology of Fever: it is caused by the anger of Maheshwara Ni1#35 807 Symptoms [and Secondary Complications] of [All Types of] Fever: it takes away the life of all living beings [charaka describes elsewhere that fever is always present at death] causes disturbance in body, sense organs and mind diminishes intellect, strength, complexion, pleasure and enthusiasm produces tiredness, exhaustion, confusion and difficulty in intake of food it is called jwara because it brings about unhappiness in the person no other disease is so severe, complicated and difficult in management as this. It is the king of all diseases and is known by different terms in various animals. All living beings are born with fever and die with it, it is the great bewilderment, oppressed by it the living beings do not recollect any event of their previous birth, fever itself takes away the life of the living beings in the end. Ni1#35 Prodromal Symptoms of Fever: lassitude, congested eyes, yawning, heaviness, exhaustion, unstable desire and aversion to fire, sun, air and water, indigestion, distaste in mouth, loss of strength and complexion and slight derangement in behavior. Ci11#28-29 Location of Fever: the entire body along with the mind Ci11#30 Time of Exacerbation:. Perhaps they have been/will be listed earlier or later] -this chart Ci11#32-35 Differentiating Psychic and Somatic [(of the body)] Fevers: (Though fever is by nature psychosomatic), the somatic fever first arises in the body while the psychic fever starts with the mind. Ci11#36 809 Symptoms of Psychic Fever: Mental detraction, restlessness and malaise are the symptoms of psychic heat (affliction). Ci11#36 Somatic Fever Causes Psychic Abnormality: "Pyrexia also causes abnormality in senses. Ci11#39-40 Symptoms of External Fever: Excessive external heat, mildness of thirst, etc. Ci11#41 Seasonal Influence On Fever: the natural [notice the use of this word "natural"] fever arisen in the seasons of spring and autumn is easily curable. In the rainy season, P is accumulated due to water and plants having amlavipaka (acidity on digestion) and the same being vitiated due to (intense) heat of the autumn gives rise to fever quickly. In such condition, there is no harm by fasting because of the nature of visarga (releasing). On the other hand, K is accumulated due to sweet water and plants during hemanta (early winter) and gets vitiated in spring due to heat of the sun. Hence the person suffers from fever due to K in spring in the middle of the adana (recieving) period. Ci11#42-46 the wise physician should treat the case of fever in autumn and early spring by considering strength and weakness of dosas in the beginning, the end and the middle. Ci11#47 the fever is termed as prakrta (natural) on the basis of prakrti (nature) of time but the V fever even a prakrta one is often troublesome. Fatal: if it is caused by numerous and potent etiological factors, has numerous symptoms and destroys the senses quickly. The person is killed within 7, 10 or 12 days: In acute fever associated with delirium, giddiness and dyspnea kills the person in a week, 10 or 12 days. Incurable: Deep-seated, long-standing and severe fever and the one which marks the parting line of the hair (particularly) in emaciated and swollen persons is incurable. Ci11#50-52 Santata Jwara (Remittent Fever): the heavy dosas spread all over the body through the channels carrying rasa and stiffened give rise to santata jwara. Being unbearable and quick-acting it gets subsided or kills the patient by the period of 7, 10 or 12 days. Dosa equal in respect of time, dusya (affected tissue) and constitution and having no counter-acting factor causes the remittent fever and as such is quite unbearable. In remittent fever, as a rule, the doshas also effect urine and feces simultaneously as the dhatus. When they are not purified completely or entirely the remittent fever gets lodged in the 12 entities (7 dhatus, 3 doshas, urine and feces). Ci11#53-60 Satataka Jwara: Dosa often lodged in rakta dhatu and with some counteracting factor causes satataka jwara which rises and falls according to corresponding time. Ci11#61-62 Anyeduska Jwara (quotidian fever): Anyeduska jwara is caused by dosa which getting support from one of the factors such as time, constitution and dusya obstructs the vessels carrying medas in the presence of the counteracting factor. The dosha lodged in asthi (bone) and majja (marrow) causes Tertian and Quartan Fevers. If it goes to the channels of mamsa, it causes tertian fever while it gives rise to quartan fever if it is lodged in the channels of medas. Ci11#63-67 Why fever returns/ How doshas hide in the dhatus: As a seed lies dormant in the soil (for a while) and grows up in (favorable) time, dosas stay in dhatus and get vitiated in opportune time. The dosa having attained exacerbation and timely strength due to the weakening of the counteracting factor gives rise to the tertian as well as the quartan fever.

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This is a wise investment of time, saving the trouble of investing in research that does not succeed in answering the question posed. After the hypothesis is posed and the treatments and repetitions decided on, it is time to plan when and how the experiment will actually be carried out. Unless the problem addressed is urgent (that is, interferes with production), it may be most economical to wait until the nursery has an order to produce the species that is part of the research. The production of these plants carried out according to the usual protocol will be the control. Extra plants can be planted at the same time from the same seed source and on the same day, with only the independent variable manipulated. A few tips for starting and carrying out the experiment include the following: Have one person in charge of the experiment, making observations and collecting all data. If special materials are needed for the experiment (for example, a different microbial inoculant, a new seed source, a special growing medium ingredient), be sure to have them on hand before the experiment starts. Nothing is worse than discovering a group of plants performing outstandingly but with no record of what was done differently. If the experimental subjects turn out to be of high quality and saleable, that will be a side benefit. Experimental plants, however, will likely be different in size or performance from the bulk of the order. If growing on contract, the client may be interested in accepting research plants to continue the trial in the field. Take careful notes and keep a journal documenting every step of the experiment as it is carried out. Sometimes the independent variable will affect one brief but important stage of plant development. Keep data organized, ideally entered into a computer spreadsheet just after taking measurements and observations. The nursery should not count on being able to use any of the seeds from the experiment (the new method may increase,decrease,or have no effect on germination percentages). So,the procedures produce the correct number of seedlings to meet the order should be carried out as usual. Seeds should be collected and processed as described in the protocol and records for that species. If an order for 100 plants of the species with the usual expected 25 percent germination is received, according to the established protocol,the nursery will probably need to sow about 450 seeds to compensate for the low germination and other losses. At the same time, additional seeds from the same seedlot would be scarified using mechanical scarification. A minimum of 30 seeds should be treated and sown, although, if the supply of seeds is abundant, the researcher might choose to treat more seeds with the new method for a good-sized sample. All these seeds are planted on the same day and placed in the same environment as the control treatment. If they are in separate trays, they should be placed side by side to eliminate any other variables (such as differences in light or humidity) that might affect the germination rate. For a larger experiment, replicating the trial in three or four different locations in the nursery helps eliminate outside variables. If a third treatment (20 seconds with hot-water scarification) is used on a third set of seeds,it,too,should be handled identically otherwise and clearly marked. The control, scarified,and hot-water treated seeds are placed side by side in the same environment or in replicated blocks,as the control. When gathering data, keep the process as simple and straightforward as possible, and reduce risks of nonapplicable or meaningless results. For example, the wet weight of live plants will vary considerably depending on irrigation and time of day; therefore, weighing live plants does not usually generate meaningful data for experiments. For small experiments, have just one person take measurements and gather "hard" data in order to reduce variations in the way data are collected. If several people will be collecting data, make sure each person is trained to measure using the same procedures. Although information on how to keep records of crop progress is provided in Chapter 3, Planning Crops and Developing Propagation Protocols, data collection for the experiment should focus on the dependent variable for that experiment (in the example, percentage of germination). Other data and observations, if available, however, may be collected as well if time allows. Even if they are not quantified, observations about the appearance and vitality of plants can be especially useful for many experiments. The best timing for data collection also varies depending on what is being studied. Although any period of rapid change for the crop can be a useful time to gather data, in general, the most meaningful results tend to be gathered: During germination (as in the example in this chapter). After outplanting (usually after the first 3 to 12 months in the field, up to 5 years). Measurements may include the following but not every experiment will require all these measurements- only the ones relevant to the study. Height can be measured from the growing medium surface to the top of the growing point on the stem (not the top of the leaf) (figure 17. Shoot-to-root ratios are taken only periodically and usually only as small samples, because these measurements destroy the plants sampled. A convenient way to handle plants is to put them into paper lunch bags before placing them into an oven. After the plants are dry, cut the sample at the place where the stem meets the roots (the root collar; often a change of color occurs here) and weigh the shoots and roots separately to get the ratio. Plants can be subjectively rated at the beginning and end of each of the growth phases using a numeric rating system, such as 1 to 5. Clear guidelines must be developed for the numerical scale to give a relative estimate of plant vigor. For example, 1 = no vigor, plant appears on verge of death; 2 = poor and slow growth; 3 = some growth, some vigor; 4 = plant looking vigorous; 5 = plant appears to be thriving and very vigorous. A percentage of germination can be determined by comparing the total number of seeds planted with the number of healthy germinants that emerge for each seed treatment. Timing is very important to monitor: sometimes the percentage of germination will ultimately be the same but one treatment may facilitate uniform and rapid germination while another treatment may be uneven or delayed. Encourage daily or weekly measurements to capture differences in rate of germination. These measurements are useful to compare changes to the timing and development of plants to the control and to quantifying, the presence of disease or insects can be done regularly. Good times to make notes are during emergence and at the ends of the establishment, rapid growth, and hardening phases. Samples of pests or diseases can be sent to the local agricultural extension office for identification, if necessary. Field survival and performance after outplanting can also be evaluated using most of the previously described techniques. A simple tabular format is fine for most types of data and makes capturing and assessing the data easier. If feasible, only one person should be taking measurements and recording data in the journal in order to eliminate variable styles of measurements (figure 17. Others may contribute to subjective evaluations, however, and the person in charge of the research project may solicit the observations of other staff members and enter these observations in the journal as well. Some types of experiments may focus on just one phase of growth, such as the germination phase. Regardless, when the final phase is complete, it is time to step back and assess the data and observations collected. If percentages were used, the data can be converted into a graph or chart to visually show differences between the control and the experiment. If the experiment was focused on producing one species, the results should be entered into the protocol for that species, even if no difference was observed. If a difference was observed, and the experimental seedlings had better germination, survival, or quality than the control, the experiment should be repeated at least once or twice more to verify the results. In the interim, however, the "new" production technique can tentatively become the new protocol, with the old technique repeated on the smaller scale for comparison purposes. If, after a few repetitions, the same results are found, the old method can be retired and the new one adopted as the official protocol. If no difference was observed, or if the experimental treatment performed more poorly than the control, that is still very valuable information.

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Leptin A peptide hormone produced by fat cells and involved in the regulation of body weight by acting on the hypothalamus to suppress appetite and burn fat stored in connective tissue. Melatonin A vertebrate hormone that has been linked to circadian rhythm regulation, is derived from serotonin, and is secreted by the pineal gland especially in response to darkness. Myoclonic epilepsy Epilepsy characterized by myoclonic seizures, which involve brief and involuntary contractions of a muscle. Narcolepsy A chronic neurological condition marked by transient attacks of deep sleep, with symptoms of cataplexy, hypnagogic hallucinations, sleep disruption, and sleep paralysis. Typically initiated by a loud scream associated with panic, followed by intense motor activity, which can result in injury. Nocturnal groaning Characterized by disruptive groaning that occurs during expiration, particularly during the second half of night. P20 grant Federally supported research program project grant that is sponsored by the National Institutes of Health and that funds exploratory grants. Provides support for the development of new or interdisciplinary programs or the expansion of existing resources. P30 grant Federally supported center core grant that is sponsored by the National Institutes of Health and that provides funds to develop an infrastructure that supports centralized research, facilities, and resources. Core grants provide resources to investigators to help them achieve a higher level of productivity. P50 grant Federally supported specialized center grant that is sponsored by the National Institutes of Health and that provides funds for multiinvestigator, multidisciplinary research. Parasomnia Unpleasant or undesirable behaviors or experiences that occur during entry into sleep, during sleep, or during arousals from sleep. Polysomnogram A sleep test that continuously acquires physiological data obtained during sleep, including brain wave activity, eye movements, muscle activity (chin and legs), heart rate, body position, and respiratory variables, including oxygen saturation. Polysomnography Use of a polygraph to record multiple physiological variables during sleep. Prader-Willi syndrome A genetic disorder marked by mental retardation, below average height, hypotonia, abnormally small hands and feet, gonadal incompetence, and excessive appetite resulting in extreme obesity. R01 award Federal research project grant that supports specific healthbased research for 1 to 5 years. It can be investigator initiated or submitted in response to a request for application or program announcement. R03 award Federal grant that supports small research projects for a limited period of time and with limited resources. Grants are awarded for up to 2 years with direct costs limited to $50,000 per year. Provides support for a symposium, seminar, workshop, or other formal conference assembled to exchange and disseminate information or to explore a subject, problem, or field of knowledge. Grants are awarded for up to 2 years, with total direct costs not to exceed $275,000 for the length of the project. Provides support to develop a program in education, information, training, technical assistance, or evaluation. Rapid eye movement sleep A state of sleep that is experienced in several cycles during a normal period of sleep and is marked by increased forebrain and midbrain neuronal activity and by reduced muscle tone. Rapid eye movement sleep behavior disorder A complex set of behaviors, including mild to harmful body movements associated with dreams and nightmares and loss of muscle atonia. Sleep drunkenness Difficulty waking up and being foggy for long periods of time after wake onset. Sleep medicine A branch of clinical medicine devoted to the diagnosis and treatment of individuals suffering from chronic sleep loss or sleep disorders. Sleep-related eating disorder Marked by repeated episodes of involuntary eating and drinking during arousals from sleep. Sleep-related hallucination Hallucinatory images that occur at sleep onset or on awakening from sleep. Sleep restriction therapy A method to curtail time in bed to the actual sleep time, thereby creating mild sleep deprivation, which results in more consolidated and more efficient sleep. Involves a series of behaviors initiated during arousals from slowwave sleep that culminate in walking around in an altered state of consciousness. Spasticity A state of increased muscular tone in which abnormal stretch reflexes intensify muscle resistance to passive movements. T32 training grant National Research Service Award Institutional Research Training Grants. Provides support to institutions to develop or enhance research training opportunities for predoctoral and postdoctoral students. T34 training grant National Research Service Award Institutional Undergraduate Research Training Grant. Provides support to institutions to promote undergraduate research training to underrepresented groups in the biomedical and behavioral sciences. Provides support to institutions for predoctoral and postdoctoral training focused on biomedical and behavioral research. Type 2 diabetes mellitus Diabetes that develops especially in adults and especially in obese individuals. Marked by high blood sugar that is a consequence of impaired insulin utilization and a physiological inability to compensate with increased insulin production. U Cooperative Agreements Provided to support any part of the full range of research and development activities composing a multidisciplinary attack on a specific disease entity or biomedical problem area. Establishment Not later than 1 year after June 10, 1993, the Director of the Institute shall establish the National Center on Sleep Disorders Research (in this section referred to as the "Center"). The Center shall be headed by a director, who shall be appointed by the Director of the Institute. The Director of the National Institutes of Health shall establish a board to be known as the Sleep Disorders Research Advisory Board (in this section referred to as the "Advisory Board"). The Advisory Board shall advise, assist, consult with, and make recommendations to the Director of the National Institutes of Health, through the Director of the Institute, and the Director of the Center concerning matters relating to the scientific activities carried out by and through the Center and the policies respecting such activities, including recommendations with respect to the plan required in subsection (c)1 of this section. The Director of the National Institutes of Health shall appoint to the Advisory Board 12 appropriately qualified representatives of the public who are not officers or employees of the Federal Government. Of such members, eight shall be representatives of health and scientific disciplines with respect to sleep disorders and four shall be individuals representing the interests of individuals with or undergoing treatment for sleep disorders. The following officials shall serve as ex officio members of the Advisory Board: i. The members of the Advisory Board shall, from among the members of the Advisory Board, designate an individual to serve as the chair of the Advisory Board. Except as inconsistent with, or inapplicable to, this section, the provisions of section 284a of this title shall apply to the advisory board established under this section in the same manner as such provisions apply to any advisory council established under such section. After consultation with the Director of the Center and the advisory board established under subsection (c) of this section, the Director of the National Institutes of Health shall develop a comprehensive plan for the conduct and support of sleep disorders research. The plan developed under paragraph (1) shall identify priorities with respect to such research and shall provide for the coordination of such research conducted or supported by the agencies of the National Institutes of Health. The Director of the National Institutes of Health (after consultation with the Director of the Center and the advisory board2 established under subsection (c) of this section) shall revise the plan developed under paragraph (1) as appropriate. Collection and dissemination of information the Director of the Center, in cooperation with the Centers for Disease Control and Prevention, is authorized to coordinate activities with the Department of Transportation, the Department of Defense, the Department of Education, the Department of Labor, and the Department of Commerce to collect data, conduct studies, and disseminate public information concerning the impact of sleep disorders and sleep deprivation. R01 1998 Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. R01 2002 Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. The numbers for each grant reflect individual, unduplicated counts for a given year (Table G-1 and Figure G-1). Note that every abstract from 1995 and 2004 was analyzed to determine its relevance to somnology and somnopathy (see Table 6-3). This analysis was not performed on grants awarded from 1996 to 2003; therefore these numbers may be slightly inflated. Abstracts were reviewed and only those grants with these terms listed in both the thesaurus and abstract, and not the abstract alone, were considered in the counts. The numbers for each grant reflect individual, unduplicated counts for a given year. K07 grants are designed to provide 5 years of funding to develop or improve curricula changes that emphasize development and leadership skills of scientists. Abstracts were reviewed and only those grants with these terms listed in both the thesaurus terms and abstract, not the abstract alone, were considered in the counts.

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Ci29#72 the following ghrta alleviates vatarakta and severe V disorders pertaining to the entire body: decoction of- jivaka, rsabhaka, meda, rsyaprokta, satavari, madhuka, madhuparni, kakoli, ksirakakoli, mudgaparni, masaparni, dasamula, punarnava, bala, amrta, vidari, aswagandha, pasanabheda + paste of- the same drugs listed above ghee oil (If available)- fat and marrow of wild, pecking and gallinaceous birds 4 times- milk Cook all the above together. Ci29#73-75 the following ghrta should be taken in vatarakta caused by 3 doshas: decoction of- salaparni, goksura, brhati, sariva, kasmarya fruits, kapikacchu, vrscira, bala, atibala + oil, ghee Cook the oil and ghee separately in 2 batches of the above decoction. Ci29#79 "In the same way" the following formula may be used: Milk + Ghee, oil, sugar, honey Mix all the above together. Ci29#80 the following drink alleviates V disorders: bala, satavari, rasna, dasamula, pilu, syama, eranda, salaparni + milk Boil the above together. Ci29#82 Procedure for one having much impurity: 1) take castor oil with milk for purgation regularly 2) after digestion [of the above] take diet of milk and rice. Ci29#83 One having much impurity should take the following formula: Decoction of- haritake + ghee Fry the above together. Ci29#84 One having much impurity should take the following formula: Powder of- trivrt + milk or grape juice Mix the above together. Ci29#84 the following decoction should be taken for purgation: decoction of- kasmarya fruit, trivrt, draksa, triphala, parusaka + salt honey Mix the above together. Ci29#85 In predominance of K, take: decoction of - triphala honey Ci29#86 In predominance of K, take: decoction of -amalaki, haridra, musta honey Ci29#86 Treatment in case V is Covered with Feces: the patient should be purgated frequently with formulations mentioned in kalpasthana, which should be mild and added with some uncting substance. Ci29#87 Importance of/ Use of Enema for Vatarakta: 916 Or his excrements should be eliminated by administering milk enemas mixed with ghee. Ci29#88 Non-unctuous and Unctuous enemas are commended in case of pain in pelvis, groin, sides, thighs, joints, bones and abdomen and of udavarta. Ci29#89 the following oil (taila) formulas listed should be used by the wise physician as enema and also as snuff, massage and sprinkling for pacification of burning sensation and pain: Ci29#90 Madhuparnyadi Taila: this oil, used in 4 ways (intake, massage, snuff and enema) alleviates vatarakta associated with complications, pain in body and involving the whole body. It destroys vatarakta, P, burning sensation, distress and fever and promotes strength and complexion: 4Kg. Ci29#91-95 Sukumaraka Taila: this oil should be applied as snuff, massage, intake and enema in all V disorders, stiffness of neck, lockjaw, V generalized or localized, wasting and fever due to chest wound. This taila alleviates vatarakta, promotes voice and complexion and provides health, strength and corpulence: 4Kg. Ci29#96-102 Amrtadya Taila: this oil is useful in all ways in vatarakta, wasting due to chest wound, affliction by overload, deficiency of semen, trembling, convulsions, fractures and diseases generalized or localized. This is the best among oil and alleviates diseases of female genital track, epilepsy, insanity, limping and lameness and makes delivery of fetus easy: 4Kg. Ci29#103-109 Mahapadma(ka) Taila: this taila alleviates vatarakta and fever: 200gm. Ci29#110-113 918 Khuddaka Padmaka Taila: this taila alleviates vatarakta and burning sensation: decoction of- padmaka, usira, madhuyasti, haridra paste of- sarja, manjistha, vira, kakoli, candana + oil Process all the above into a tailam. Ci29#115 Madhuka Taila cooked 100 times: this taila should be used in vatarakta caused by 3 doshas. It also alleviates dyspnea, cough, cardiac disorders, anemia, erysipelas, jaundice and burning sensation: 40gm. Ci29#116-118 Balataila cooked 100 or 1000 times: this oil alleviates vatarakta and vatika disorders. It is an excellent rasayana, cleanser of senses, vitalizer, bulk-promoting, promoter of voice and alleviator of the defects of semen and ovum: 919 decoction of- bala paste of- bala + oil "Equal quantity"- milk Cook the above together. Ci29#119-120 the following oil alleviates vatarakta: Juice of- guduci + milk oil Prepare the above together. Ci29#121 the following oil alleviates vatarakta: Juice of- grape + oil Prepare the above together. Ci29#121 the following oil alleviates vatarakta: Juice of- madhuka, kasmarya + oil Prepare the above together. Ci29#121 the following [oil/gruel/drink/soup] is and excellent alleviator of fever, burning sensation and distress: 2. Ci29#123 920 Treatment of vatarakta predominant in V: Milk boiled with dasamula removes pain immediately. But perhaps by all means together -oral, sprinkling, enema, nasal] Also, sprinkling with warm ghee removes pain quickly. Ci29#124 Treatment of stiffness, convulsion and pain: Sprinkle over with 4-fats processed with sweet drugs. Similarly, the milk of cow, sheep and goat mixed with oil or decoction of vitalizer drugs or pancamula should be used for sprinkling. Similarly, juice of grapes and sugar cane, wine, curd water, sour gruel, water of rice, honey and sugar are also useful for sprinkling. Ci29#125-127 Treatment in case of burning sensation [with stiffness, convulsion and pain]: Sprinkle over with 4-fats with sweet drugs. Ci29#125 Treatment in case of burning sensation: Sponging and contact with flowers of kumuda, utpala (water lily), lotus etc. Also: the patient lying on a bed moistened with dews of moonrays, covered with flax and lotus leaves and fanned with breeze cooled by contact of sandy beach should be attended by beloved and sweet-spoken women with their breasts and hands pasted with sandal and with cold and pleasing touch who remove burning sensation, pain and exhaustion. Ci29#128-130 Treatment of burning sensation associated with redness and pain: Blood-letting should be done followed by application of paste of madhuka, aswattha bark, mamsi, vira, udumbara, durva. Ci29#133 Application of paste with prapaundarika, manjistha, daruharidra, madhuka, candana, sugar candy, eraka, parched grain flour, lentils, usira and padmaka alleviates pain, burning sensation, erysipelas, redness and swelling. Ci29#135 Treatment for Vatarakta Predominant in V: Ksara (rice cooked with pulse [kitchari]) and mudgapayasa (green gram cooked in 921 milk) processed with V-alleviating drugs and added with uncting substance or bolus made of sesamum and mustard applied as poultice alleviates pain. Ci29#136 Preparation of vasavara made of the meat of aquatic, snatching and marshy animals, well-processed with vitalizer drugs and added with uncting substance are useful as poultice. These alleviate stiffness, piercing pain, distress, stretching, swelling and immobility of body parts. Ci29#139 Similarly: pounded sesamum seeds roasted and immersed in milk should be applied. Ci29#139 If there is predominance of V, paste should be applied of linseed pounded with milk, castor seeds and satahva for alleviating pain. Ci29#140 the following paste is used in bodyache, sandhivata, vatarakta, dislocation, fracture, limping and humpedness: Decoction of- eranda (whole plant) 40gm. Ci29#141-142 Treatment of Vatarakta Predominant in K: Treatment in predominance of K and swelling, heaviness, itching etc. Ci29#143 Ghee cooked with padmaka, twak, madhuka and sariva along with madhusukta (a type of vinegar) is useful as sprinkling sprinkling and massage in predominance of K. Ci29#145 Similarly, paste of mustard, nimba, arka, himsra, milk and sesamum or that of kapittha bark, ghee and milk mixed with parched grain flour is useful. Ci29#146 922 Treatment of Vatarakta Predominant in V and K: Soot, vaca, kustha, satahva, haridra, daruharidra- this paste alleviates pain in vatarakta predominant in V and K. Ci29#147 Tagara, twak, satahva, ela, kustha, musta, harenuka, devadaru and vyaghranakhathese pounded with sour liquid and applied as pastes alleviate the disorders of rakta associated with V and K. Ci29#148 Similarly, the seeds of madhusigru pounded with sour gruel are pasted for a while and then washed with sour liquids for treating cases predominant in V and K. Ci29#149 the following paste is very efficacious in pain of vatarakta even caused by all the doshas [jointly]: Equal quantity of each- triphala, trikatu, patra, ela, tvakksiri, citraka, vaca, vidanga, pippalimula, kasisa, vasa bark, rddhi, tamalaki, cavya Pound all the above together. The paste should be applied on an iron utensil in early morning and then the paste should be eaten at noon. Ci29#150-153 Curd, sukta (vinegar), alkali and incompatible [heating and channel-blocking] food items should be avoided. Ci29#154 the above treatment [referring to just the single formula above] should be applied by one conversant in reasoning and variation after considering specific positions and strength or otherwise of dosas. Instead, K and medas should be diminished with physical exercises, evacuation, intake of arista and urine, purgation and administration of buttermilk and haritaki. Ci29#158 Besides (K and medas should be diminished) by use of old cereals of barley and wheat, sidhu, arista, sura, asava (fermented beverage), silajatu, guggulu and maksika. Ci29#159 Treatment of the deep type of the disease, when the blood is affected: In the deep type of the disease if blood is affected, it should be treated like V. Ci29#160 Treatment of joint/ body part with inflammation or torn, discharging blood or immature pus: 923 the disordered part, due to excessive aggravation of rakta and P, gets inflamed or torn discharging blood or immature pus. Ci29#161 Treatment/ Management of the Complications of Vatarakta: "The complications should be managed according to their respective treatment. Ci29#162 924 Fainting and Coma Diagnosis Etiology Narcosis- Symptoms Fainting- Symptoms Coma- Symptoms Treatment Treatment of Coma Treatment of Fainting and Narcosis 925 [Note: this chapter was originally in the Charaka with the chapter on blood disorders, so it should be considered as related.

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Work on permanent evening shifts can be associated with difficulties initiating the major sleep episode. Excessive sleepiness usually occurs during shifts (mainly night) and is associated with the need to nap and impaired mental ability because of the reduced alertness. These figures, however, do not involve individuals with early morning work, which may comprise another group at risk. Associated Features: Reduced alertness, which occurs not only during the work shift, may be associated with reduced performance capacity, with consequences for safety. There have also been reports of increased irritability, presumably related to the lack of sleep or to the conflict between demands for sleep and demands for social activities. Gastrointestinal disorders may be exacerbated or produced by the effects of shift work. Polysomnographic recordings may be useful if the sleep disorder is severe or the etiology of the sleep disturbance is in question. Ideally, the sleep recording is performed during the habitual "shifted" sleep period and in the work environment of the individual. A 24-hour recording over the first and last of the series of rotating shifts should be performed. If excessive sleepiness is part of the complaint, a multiple sleep latency test should be carried out in the standard manner at least three times: at the beginning, middle, and end of the work shift. If field (at home and at work) polysomnography is not feasible, an alternative evaluation involves polysomnography in the sleep laboratory during simulated shift work sleep and wake patterns. After rotation to another shift from the night shift, sleep-onset disorders rather than maintenance difficulties can occur for several days. It appears that most individuals experience sleep difficulties after a night shift. Depending on which country is considered, between 5% and 8% of the population is exposed to night work on a regular or irregular basis. Shift work: the level of adjustment to schedule reversal assessed by a sleep study. Differential Diagnosis: Sleep disturbances before early morning work may be mistaken for another disorder of initiating sleep, whereas the disturbance after the night shift might be mistaken for another disorder of sleep maintenance. Furthermore, both the insomnia and the excessive sleepiness might be mistakenly attributed to a persistent circadian rhythm sleep disorder. However, historic information on the relation between the occurrence of disturbed sleep and work-hour distribution should provide sufficient information to indicate the correct diagnosis. Essential Features: Irregular sleep-wake pattern consists of temporally disorganized and variable episodes of sleeping and waking behavior. Although patients with irregular sleep-wake patterns may have a total 24-hour average sleep time that is within normal limits for age, no single sleep period is of normal length, and the likelihood of being asleep at any particular time of day is unpredictable. Ambulatory patients living in the community may emphasize the nocturnal insomnia and view the daytime napping as a necessary result of their difficulty at night. The primary complaint is temporally associated with a work period (usually night work) that occurs during the habitual sleep phase. Severity Criteria: Mild: Mild insomnia or mild excessive sleepiness, as defined on page 23; the sleep deficit is often one to two hours. Associated Features: Subjective cognitive impairment and sleepiness characterize the awake intervals between the sleep episodes, particularly in ambulatory outpatients. Rhythms of endocrine, temperature, and other functions that normally display regular circadian periodicity may lose their expected fluctuations and show flattened amplitudes. Other Laboratory Test Features: Brain-imaging tests may demonstrate the presence of intracerebral pathology in patients with the intrinsic form of the disorder. The prevalence in patients with diffuse brain dysfunction is unknown, but the syndrome is probably not uncommon in severely impaired, institutionalized patients. Age of Onset: Presumably dependent on the age of onset of diffuse brain dysfunction. For example, police and fire departments often use rapidly shifting work schedules. Complications: Significant drug dependence or toxicity may occur, the former more likely in cognitively intact outpatients, the latter in elderly patients with chronic brain dysfunction. Polysomnographic Features: Polysomnographic confirmation of this syndrome has seldom been reported, and all reported cases have been of patients with varying but generally severe degrees of diffuse brain dysfunction. Disturbed chronobiologic rhythmicity is demonstrated by either of the following: 1. Continuous polysomnographic monitoring for at least 24 hours shows a loss of the normal sleep-wake pattern 2. Continuous temperature monitoring for at least 24 hours shows a loss of the normal temperature F. The symptoms do not meet the criteria for any other sleep disorder causing insomnia or excessive sleepiness. Note: If the sleep disorder is believed to be socially or environmentally induced, state and code as irregular sleep-wake pattern (extrinsic type). If there is evidence that the sleep disorder is due to an abnormal circadian pacemaker, its entrainment mechanism, or brain dysfunction, state and code as irregular sleep-wake pattern (intrinsic type). Essential Features: Delayed sleep-phase syndrome is a disorder in which the major sleep episode is delayed in relation to the desired clock time, resulting in symptoms of sleep-onset insomnia or difficulty in awakening at the desired time. Their efforts to advance the timing of sleep onset (early bedtime, help from family or friends in getting up in the morning, relaxation techniques, or the ingestion of hypnotic medications) yield little permanent success. Chronic dependence on hypnotics or alcohol for sleep is unusual but, when present, complicates the clinical situation. More commonly, patients give a history of having tried multiple sedating agents, which were abandoned because of only transient efficacy. Sleep-wake logs obtained during periods when morning social obligations are lessened or absent (vacations, long weekends, unemployment, school suspension) show fairly consistent, but also consistently "late," sleep and arising times. However, the histories of some adult patients extend back to early childhood, and pediatric sleep clinicians have described prepubertal children with the syndrome. In such cases, the onset of the disorder is precipitated by the dark period of the seasonal light-dark cycle. By contrast, in normal age- and sex-matched subjects, the absolute low temperature occurred before the mid-low phase. Differential Diagnosis: A pattern of delayed sleep onset occurs in some previously unaffected individuals with the start of major mental disturbances, in particular in the excited phase of bipolar affective disorder and during schizophrenic decompensations. In bipolar mania, however, sleep is also typically shortened, and such patients have no difficulty arising at a conventional hour. Another important differentiation is from non-24-hour sleep-wake syndrome, in which incremental sequential delays of the sleep phase occur even during periods of vacation or unemployment. In addition, nocturnal polysomnographic sleep latency in insufficient sleepers is normal to short, and an increase in delta sleep is also often present. These sleep disorders include limit-setting sleep disorder, sleep-onset association disorder, and idiopathic insomnia. Differentiation can usually be made on the basis of history and polysomnographic study. If there is evidence that the sleep disorder is due to an abnormal circadian pacemaker or its entrainment mechanism, state and code as delayed sleep-phase syndrome (intrinsic type). Severity Criteria: Mild: the patient has a habitual inability to fall asleep within a mean of two hours of the desired sleep time, over at least a one-month period, and the disorder is associated with little or mild impairment of social or occupational functioning. Moderate: the patient has a habitual inability to fall asleep within a mean of three hours of the desired sleep time, over at least a one-month period, and the disorder is associated with moderate impairment of social or occupational functioning. The patient has a complaint of an inability to fall asleep at the desired clock time, an inability to awaken spontaneously at the desired time of awakening, or excessive sleepiness. There is a phase delay of the major sleep episode in relation to the desired time for sleep. Sleep-wake logs that are maintained daily for a period of at least two weeks must demonstrate evidence of a delay in the timing of the habitual sleep period. One of the following laboratory methods must demonstrate a delay in the timing of the habitual sleep period: 1. Continuous temperature monitoring showing that the time of the absolute temperature nadir is delayed into the second half of the habitual (delayed) sleep episode G.

Syndromes

  • Swollen abdomen (abdominal distention)
  • Loss of appetite
  • Pain in the front of the ribs or breastbone
  • Low blood pressure
  • Whether lung damage has occurred from too much blood flowing to the lungs for a long period of time
  • Infection in the wound or vertebral bones

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Methicillin-resistant Staphylococcus aureus carrying the new mecC gene-a metaanalysis. Interspecies spread of Staphylococcus aureus clones among companion animals and human close contacts in a veterinary teaching hospital. Methicillin-resistant Staphylococcus aureus in dogs and cats: an emerging problem? Detection of new methicillin-resistant Staphylococcus aureus clones containing the toxic shock syndrome toxin 1 gene responsible for hospital- and community-acquired infections in France. Staphylococci in cattle and buffaloes with mastitis in Dakahlia Governorate, Egypt. Trends in antibacterial susceptibility of mastitis pathogens during a seven-year period. Individual predisposition to Staphylococcus aureus colonization in pigs on the basis of quantification, carriage dynamics, and serological profiles. Inducible clindamycinresistance in methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus pseudintermedius isolates from dogs and cats. An investigation of methicillinresistant Staphylococcus aureus colonization in people and pets in the same household with an infected person or infected pet. A Livestock-associated, multidrug-resistant, methicillin-resistant Staphylococcus aureus clonal complex 97 lineage spreading in dairy cattle and pigs in Italy. Detection of airborne methicillin-resistant Staphylococcus aureus inside and downwind of a swine building, and in animal feed: Potential occupational, animal health, and environmental implications. Transmission of methicillin-resistant Staphylococcus aureus between human and hamster. Evolutionary genomics of Staphylococcus aureus: insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic. Sequence type 398 meticillin-resistant Staphylococcus aureus infection and colonisation in dogs. Isolation and characterization of methicillin-resistant Staphylococcus aureus from pork farms and visiting veterinary students. Molecular characterization of spa type t127, sequence type 1 methicillin-resistant Staphylococcus aureus from pigs. Occurrence of livestock-associated methicillin-resistant Staphylococcus aureus in turkey and broiler barns and contamination of air and soil surfaces in their vicinity. Prevalence of methicillin-resistant staphylococci in northern Colorado shelter animals. Livestock-associated methicillinresistant Staphylococcus aureus sequence type 398 in humans, Canada. A preliminary guideline for the assignment of methicillin-resistant Staphylococcus aureus to a Canadian pulsed-field gel electrophoresis epidemic type using spa typing. Goni P, Vergara Y, Ruiz J, Albizu I, Vila J, Gomez-Lus R Antibiotic resistance and epidemiological typing of Staphylococcus aureus strains from ovine and rabbit mastitis. Screening for skin carriage of methicillin-resistant coagulasepositive staphylococci and Staphylococcus schleiferi in dogs with healthy and inflamed skin. Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated from Australian veterinarians. Methicillin-resistant staphylococcal colonization in dogs entering a veterinary teaching hospital. Prevalence and characterization of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, isolated from bulk tank milk from Minnesota dairy farms. Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, Bandiera-Clerc C, Renzi G, Vernaz N, Sax H, Pittet D. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. Pigassociated methicillin-resistant Staphylococcus aureus: family transmission and severe pneumonia in a newborn. Genetic variation among Staphylococcus aureus strains from bovine milk and their relevance to methicillin-resistant isolates from humans. Longitudinal study of Clostridium difficile and methicillin-resistant Staphylococcus aureus associated with pigs from weaning through to the end of processing. Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? Carriage of methicillin-resistant Staphylococcus aureus by wild urban Norway rats (Rattus norvegicus). Clonality and antimicrobial susceptibility of Staphylococcus aureus and methicillin-resistant S. Epidemiological profiling of methicillinresistant Staphylococcus aureus-positive dogs arriving at a veterinary teaching hospital. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. A study of the prevalence of methicillin-resistant Staphylococcus aureus in pigs and in personnel involved in the pig industry in Ireland. Clonally related methicillin-resistant Staphylococcus aureus isolated from short-finned pilot whales (Globicephala macrorhynchus), human volunteers, and a bayfront cetacean rehabilitation facility. Prevalence and characteristics of meticillin-resistant Staphylococcus aureus in humans in contact with farm animals, in livestock, and in food of animal origin, Switzerland, 2009. Methicillin-resistant Staphylococcus aureus and extended-spectrum and AmpC lactamase-producing Escherichia coli in broilers and in people living and/or working on organic broiler farms. Epidemiological analysis of methicillin-resistant Staphylococcus aureus carriage among veterinary staff of companion animals in Japan. Ishihara K, Shimokubo N, Sakagami A, Ueno H, Muramatsu Y, Kadosawa T, Yanagisawa C, Hanaki H, Nakajima C, Suzuki Y, Tamura Y. Occurrence and molecular characteristics of methicillin-resistant Staphylococcus aureus and methicillinresistant Staphylococcus pseudintermedius in an academic veterinary hospital. Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus. Recurrent methicillin-resistant Staphylococcus aureus cutaneous abscesses and selection of reduced chlorhexidine susceptibility during chlorhexidine use. An outbreak of community-acquired foodborne illness caused by methicillin-resistant Staphylococcus aureus. Carriage of methicillin-resistant Staphylococcus aureus by veterinarians in Australia. Staphylococci isolated from animals and food with phenotypically reduced susceptibility to betalactamase-resistant beta-lactam antibiotics. Antibiotic resistance of staphylococci from humans, food and different animal species according to data of the Hungarian resistance monitoring system in 2001. Isolation of methicillin-resistant coagulase-negative staphylococci from chickens. A survey of methicillin-resistant Staphylococcus aureus affecting patients in England and Wales. Characterization of methicillin-resistant Staphylococcus aureus isolated from retail raw chicken meat in Japan. Community-associated methicillin-resistant Staphylococcus aureus in outpatients, United States, 1999-2006. Methicillin-resistant Staphylococcus aureus in food products: cause for concern or case for complacency? Kluytmans J, van Leeuwen W, Goessens W, Hollis R, Messer S, Herwaldt L, Bruining H, Heck M, Rost J, van Leeuwen N, et al. Food-initiated outbreak of methicillin-resistant Staphylococcus aureus analyzed by pheno- and genotyping. Staphylococcus aureus infections: transmission within households and the community. Prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus carriage in three populations. Methicillin-resistant Staphylococcus aureus ulcerative keratitis in a Thoroughbred racehorse. Characteristics of methicillin resistant Staphylococcus aureus isolated from chicken meat and hospitalized dogs in Korea and their epidemiological relatedness. Screening for methicillin-resistant Staphylococcus aureus colonization using sponges. Methicillin (oxacillin)-resistant Staphylococcus aureus strains isolated from major food animals and their potential transmission to humans.

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Many growers prefer powders because a number of prepared commercial products of varying strengths are available, they are easy to use, and large quantities of cuttings can be treated quickly. However, powder must be applied uniformly to all cuttings; variable amounts of rooting powder adhere to the base of a cutting, which can affect rooting results (figure 9. The following precautions and special techniques are needed when using powders: Wear gloves during application. Transfer enough hormone to a smaller container from the main stock container for use. Apply the hormone uniformly; make sure the base of the cutting is moist so that the powder adheres. Make certain that cut surfaces and other wounds are also covered with rooting hormone. Liquid products are formulated with alcohols and often must be diluted with great care to the desired strength. Some of the advantages of using solutions are a wide range of commercial preparations is available, specific concentrations can be formulated at the nursery, and they can be stored for longer periods under the right conditions. Some growers believe that using solutions is more accurate than powders are in regard to the amount of rooting hormone entering the stem tissue. The most common procedure for treating cuttings is using the concentrated-solution-dip method (quick-dip method) in which the base of the cutting is dipped into the solution for 3 to 10 seconds. Alternately, cuttings can be soaked for a longer period of time in a more dilute hormone solution. Direct striking into containers is more efficient and therefore more economical than striking into a special rooting environment because the cuttings are handled only once and expensive transplanting is avoided. Easy-to-root hardwood cuttings, such as those from redosier dogwood, willow, and cottonwood (figure 9. Often, a dibble of the same diameter and depth of the stem of the cutting is a useful tool for making openings in the medium into which the cutting can be struck. If using powdered rooting hormones, this practice will help keep the hormone from being brushed off. The following should be encouraged when striking cuttings: Wear gloves if the cuttings were treated with rooting hormones. When using stem cuttings, make certain that at least two nodes are below the surface of the rooting medium. Make certain that the solution was diluted to the right concentration correctly and precisely. Ensure that the treatment time is constant for a uniform application rate and to avoid damaging the plant tissue (phytotoxicity). Make certain that the basal ends are even to obtain uniform depth of dipping in the solution if bundles of cuttings are dipped. Allow the alcohol to evaporate from the stem of the cutting before striking cuttings into the propagation bed, a process that usually takes only a couple of minutes. Properly discard any remaining solution, because it is contaminated with plant material. Try to strike cuttings within 1 to 2 days so that all the plants will have the same level of root development and thus can be hardened off properly prior to lifting. Environmental Conditions for Direct Struck Cuttings In general, easy-to-root hardwood cuttings directly struck into containers can be treated similar to seedlings. Light Providing light for photosynthesis is necessary so that cuttings can continue to manufacture food during rooting, but too much sunlight can cause excessive air Figure 9. Shadecloths of 30 to 50 percent shade cover are most effective to reduce air temperature while providing sufficient light. Rooting Medium A good rooting medium provides aeration and moisture and physically supports the cuttings. Some common components of rooting media generally include a combination of two or more of the following: large-grade perlite, pumice, Sphagnum peat moss, sawdust, sand, and fine bark chips. Equipment controls for outdoor mist systems need to be adjusted to accommodate daily changes in wind, temperature, and rain. Selection of the rooting medium components influences rooting percentages and the quality of roots produced. Using very fine- or very coarse-grade sands tends to discourage the development of secondary roots. Roots that do form tend to be brittle and break off during the process of transplanting the cuttings into containers for further plant development. A good rooting medium promotes the development of fibrous root systems that retain rooting medium during transplanting, which reduces "transplant shock. See Chapter 4, Propagation Environments, for information about equipment necessary to regulate humidity, temperature, and light. Mycorrhizal Fungi Sanitation Always keep the propagation environment as clean as possible. Routinely inspect for and remove dead leaves or cuttings that could be a source of disease infection. Some growers inoculate the rooting medium with mycorrhizal fungi or other symbiotic organisms, which has improved rooting results with some plants (Scagel and others 2003). This practice may be especially important for those species that take a long time to form roots, such as Pacific yew, blueberries, cranberries, and rhododendrons. Humidity Until the root system forms, high levels of relative humidity must be provided to slow the rate of water loss from the cutting. Over time, the cuttings can become weakened, resulting in yellowing of the leaves or leaf and needle drop. Nutrients can be leached from the leaves by the long exposure to overhead misting. In these cases, the application of a dilute, complete foliar fertilizer through the mist line can improve cutting vigor and may aid in rooting. Because some species respond favorably to nutrient mist while others are adversely affected, you will need to do some preliminary trials before treating all the cuttings. Transplant only on cool, overcast days or during early morning hours to avoid transplant shock. Prepare containers, medium, labels, and transplanting tools before removing cuttings from the rooting medium. Moisten the growing media prior to transplanting to prevent tender roots from drying out. Remove cuttings from the rooting medium carefully and remove only a few at a time so roots will not dry out. Loosely wrap a moist paper towel around the root systems until they are transplanted. Handle cuttings carefully by holding the cutting by the stem and by leaving any rooting medium still attached to the root mass. Then add additional moistened medium and gently firm the medium with fingers without breaking the roots (figure 9. After transplanting the cuttings, they should be placed in a shadehouse or protected from full sun and wind for at least 2 weeks. When the cuttings appear to be well established, gradually increase the level of sunlight by moving them to a different area of the nursery or by exchanging the shadecloth for one with a more open weave. Adequate sunlight is needed for new shoot growth and adequate accumulation of carbohydrates prior to winter. Transplanting Cuttings from Special Rooting Environments A few weeks after striking cuttings into the rooting environment, they should be inspected for root development. Using a trowel, carefully lift a few cuttings by digging well below the end of the cutting. After most cuttings have initiated roots, turn off the bottom heat to encourage the development of secondary roots. When cuttings have developed adequate root systems, they need to be hardened for life outside the rooting environment. The goal is to condition stem and leaf tissues and promote secondary root development before transplanting. Cuttings can be hardened by following these guidelines: Gradually reduce the misting frequency over a period of 3 to 4 weeks. Increase the frequency and duration of ventilation in enclosed propagation systems.

Hennekam syndrome

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They become weak and lethargic but do not necessarily show signs of straining to breathe until they are dying. Both forms can be treated with antibiotics, usually a combination of at least two drugs. Turkeys can carry mycoplasma for life and often have chronic infections that can be difficult to treat. Chickens seem to be resistant to the effects of the infection, but they can be carriers. The protozoan causes considerable damage to the liver and ceca of infected turkeys and is usually fatal if untreated. The disease is treated with Metronidazole, which can be obtained from your veterinarian. Because of the risk of infection, we recommend waiting until turkeys are at least six months old before putting them with chickens. In crop stasis, the crop, which is a diverticulum of the esophagus, stops emptying and becomes distended with fermenting food and fluids. This condition can require multiple treatments, including the use of probiotics, antifungals, or antibiotics, depending on the cause. Without treatment, the bird can starve to death or aspirate when feed goes into the windpipe instead of the stomach. The crop, especially in commercial birds, can become impacted with grass, straw, feathers, or other debris and prevent food from passing. The crop may become too distended to function, in which case surgery may be required to reduce or remove the crop completely. In most cases, impacted crops can be easily identified by looking at the crop areas of all the birds before morning feeds. If any of the birds have a full crop at this time, it is important to identify the cause immediately. The males of this breed are so excessively large that, when a male mounts a female, he may tear her skin down to the muscle. Turkeys often develop leg joint infections from being down on their hocks for a majority of the day, either because they are overweight or because they have joint pain or arthritis. The keel or breast bone in turkeys is also an area that is prone to these types of pressure sores. The contact and pressure from the ground causes the formation of scabs or sores, and these can develop into wounds through which bacteria can enter. Usually wraps and antibiotics are necessary to treat this type of infection and, if it is not treated, the infection often spreads to the bone and requires surgery or cannot be treated. Checking these areas routinely on your birds is the best way to prevent this condition. Providing heavy bedding if there is a sign of keel or joint sores is also important. We advise that you consult your veterinarian whenever your turkey exhibits any unusual behavior or symptoms. Incoming Bird Procedures When birds arrive, they must be isolated in a strict quarantine area, and caretakers should wear coveralls and boot covers. If animals are in really bad shape, do not spread straw on your existing pastures. Instead, pile it in a separate area on the farm until any testing required is completed. If birds have signs of mouth or facial sores, nasal discharge, or respiratory disease, also use rubber gloves when handling anything they come into contact with. If you are aware that birds will be coming to the shelter, they must be tested prior to arrival and accompanied by proper paperwork. If a birds are dropped off and you have no idea of their origin, they must be taken immediately to the bird quarantine area and kept away from all other birds; do not allow even beak-to-beak contact. Birds should have a complete health check performed using all isolation procedures, including suits, boots, and rubber gloves. If animals are sick, they should be diagnosed by a vet and immediately started on treatments. If a contagious disease is present, you may need to report it, and you may need to adjust your cleaning procedures. If the birds are healthy enough to withstand treatment, use injectable Ivomec and either lice dust or spray depending on the temperature. All birds must remain in quarantine for at least 30 days and until all necessary blood work is complete and fecal exams come back negative to ensure your resident flock is not exposed to health issues. If birds are laying eggs, the eggs must be composted with their straw/bedding until you are sure that the animals are not sick. Turkeys are also territorial, however, so you must keep this in mind when you introduce birds to each other. Male turkeys, or Toms, can be very aggressive with each other and should be introduced only when mating season is over - in the fall or, preferably, in winter, to be safe. They may still fight, so you will need to be present to break up fights and ensure that no bird is severely injured, although they usually work out dominance quickly. Do not introduce birds in hot weather because this is likely to exacerbate problems. Female turkeys also fight, so, again, be available to stay with the birds when they are first introduced. Turkeys may also be aggressive with new chickens or other bird residents who are being introduced, so always be vigilant. If your males cannot live together without fighting, we have found that they do well with large-breed roosters and can be good companions for them. Resources for Turkey Care Please note: Many of the catalogs listed contain products commonly used in animal agriculture. Pneumonia can be in one area of a lung or be in several areas ("double" or "multilobar" pneumonia). Pneumonia is typically caused by a virus or bacteria you have been exposed to in the environment or is passed to you from another person. Infection can be passed between people from direct contact (usually the hands) or inhaling droplets in the air from coughing or sneezing. Sometimes a person who has a viral infection, such as influenza virus, will also develop a secondary infection from bacteria such as Staphylococcus aureus or Streptococcus pneumoniae while they are sick. Aspiration pneumonia is caused by a foreign material, usually food or vomit getting into the lungs from the throat, which irritates the airways and lung tissue and increases chances of a bacterial infection. Blood tests may be done to look at your white blood count and other tests that may be abnormal due to infection. Cultures and tests may be done of sputum (also called phlegm or mucus) from the lungs that is coughed out to see if a bacteria or virus can be found. People who are sick enough to be in the hospital are more often tested for the most likely viruses and bacteria. If a person is not getting better, has severe infection, or is at high risk of an unusual infection, a sample of mucus may be taken from the lung through the airways using a procedure called flexible bronchoscopy. Sometimes it can be hard to know what type of infection (for example what bacteria) is causing the pneumonia. This can be because the tests are not perfect, and/or you may have received some treatment before the tests were done. However, your healthcare provider will help you decide on a plan of treatment based on what is the most likely cause based from the information he or she has about you, what types of infection are being seen in your community, and what types of infection you might be at more risk for if you have a pre-existing health problem. Some people are at higher risk of pneumonia because they have preexisting lung diseases, poor nutrition, difficulty swallowing, other chronic health problems or problems with their immune system. People who smoke and people who are around tobacco smoke are at higher risk of developing pneumonia. People who have not had the yearly influenza vaccine or who have not been immunized for Streptococcus pneumoniae bacteria (Prevnar 13 and/or Pneumovax 23 pneumococcal vaccines) are also at higher risk for lung infections. The usual approach is to give antibiotics effective against the most likely bacteria causing the infection. If you develop pneumonia while in a hospital or another healthcare facility (such as a nursing home), you may need antibiotics that treat more resistant bacteria. If your immune system is suppressed, your healthcare provider may choose to treat fungal infections as well. If you are in the hospital and there is a concern for a highly contagious disease, such as influenza, Am J Respir Crit Care Med Vol.

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The underlying neurologic impairment in cerebral palsy can affect the gastrointestinal system, most notably oral-motor function and motility (especially colonic, which typically results in constipation). The possibility of autoimmune diseases, such as celiac disease, food allergy, or eosinophilic esophagitis should also be considered. Constipation Dysmotility, hypotonia, medications, and nonambulation contribute to constipation. Medications commonly used in this population that can cause constipation include Artane (Trihexyphenidyl), Robinul (Glycopyrrolate), Valium (Diazepam), or narcotics. A higher incidence was seen in individuals with a more severe disability and those who took medications contributing to constipation. Ensuring adequate fluid intake prior to increasing fiber intake can help prevent additional problems with constipation. Adjusting fluid and/or fiber intake does not always improve constipation, and increasing fiber can sometimes worsen constipation; therefore, medical management is frequently required. Pain from constipation may be confused with pain in other areas, particularly hip pain. More severe oral-motor dysfunction is seen with increased severity of the disability (23,24). The diagnosis and treatment of these issues can make feedings more pleasurable and better tolerated in addition to promoting positive weight gain. Prokinetic drugs (Metoclopramide) and positioning changes can be used to improve gastric motility. The feeding regimen can be changed by increasing or decreasing the infusion rate and/or formula volume to help promote gastric emptying and improve feeding tolerance. Sometimes, nighttime feedings may need to be changed to daytime feedings to assist with motility. Caregivers should always be involved in any discussions regarding changes in a feeding regimen, as they will be responsible for administering the feedings after discharge. The typical feeding pattern or schedule can be obtained from either caregivers or medical Table 6. Clinical practice has found previously undiagnosed malrotation and/or volvulus when individuals continue to have difficulty with feedings and weight gain. Monitoring in the Acute Care Setting Parameter Height Weight Skinfold measurements Laboratory measurements Oral intake/Enteral feedings Frequency Upon admission (monthly in pediatrics) Weekly Twice monthly Dependent on admission diagnosis, medications, treatment modalities Monitor tolerance daily until stable/well tolerated; then per facility protocol records. Adjustments may need to be made based on current medical status, such as postoperative status. Individuals that have been chronically undernourished can be at a higher risk of refeeding syndrome. In clinical practice, clinicians have noted increased energy expenditure resulting in growth failure or lack of weight gain with oral feeding due to the length of time and effort to eat. This should be considered when changing to enteral or parenteral feedings, which may reduce energy expenditure and result in rapid weight gain. Children who receive enteral feedings should be on a product that best meets their nutrient needs with minimal vitamin and mineral supplementation. This may result in a pediatric formula for a teenage individual, or a higher protein, 1 kcal/mL formula for a ten year old child undergoing complex spinal surgery. Table 7 has monitoring guidelines and Table 8 lists clinical pearls for use in individuals with developmental disabilities. A visual assessment is very important, consider what is "typical" for the diagnosis(es). Consider all possible contributors to energy needs, including: mobility status, respiratory status, and muscle tone. Assess drug/nutrient interactions, such as the effect of seizure medications and birth control medications on bone health. Ensure adequate protein and micronutrient intake, especially in hypometabolic or hypocalorically-fed individuals. During a nutrition assessment, ensure accurate and consistent anthropometric measurements, appropriately determinate energy, protein, fluid and micronutrient needs, and consider dysmotility and spinal anomalies. Care coordination in the medical home: Integrating health and related systems of care for children with special health care needs. The role of an interdisciplinary feeding team in the assessment and treatment of feeding problems. Assessment of linear growth of children with cerebral palsy: Use of alternative measures to height or length. Identification of malnutrition in children with cerebral palsy: poor performance of weight-forheight centiles. Anthropometric measures: poor predictors of body fat in children with moderate to severe cerebral palsy. Longitudinal change in muscle and fat thickness in children and adolescents with cerebral palsy. Caloric requirements of mentally retarded children with and without motor dysfunction. Measured energy expenditure of tube-fed patients with severe neurodevelopmental disabilities. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. A descriptive investigation of dysphagia in adults with intellectual disabilities. Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Please provide a cover letter that briefly summarizes the important aspects of the manuscript with recommendations for up to three reviewers who are qualified in the field as well as three reviewers who may have a conflict of interest with your study. Enver Bajraszewski Rod Carne* Robyn Kennedy Anna Lanigan Katherine Ong Melinda Randall Dinah Reddihough Bev Touzel * Currently working at the Monash Medical Centre. We also thank Simon Harvey and Tony Catto-Smith who provided advice about specific sections. The valuable assistance provided by the Association for Children with a Disability, particularly Anne Maree Newbold, Jenny McAllister, Diane McCarthy and Fiona Gullifer, and the Cerebral Palsy Support Network, particularly Victoria Garner, is also acknowledged. This book has been written primarily for parents who have a child with cerebral palsy. If your child has recently been diagnosed as having cerebral palsy, you are probably feeling shocked by the news and overwhelmed by the implications of the diagnosis. In some children the problem may be so slight that he or she is only a little clumsy with certain movements. They may not be able to answer all your questions, but they will honestly try to tell you what they do know. This book will discuss the different types of cerebral palsy, the causes of cerebral palsy, some associated problems and the range of treatments available. We have provided information about support services and where to turn to for help. We hope to convey the message that no matter how difficult things may seem at present, and despite the many problems that you and your family will face over the coming years, help is available. In cerebral palsy, there is damage to, or lack of development in, one of these areas of the brain. Children with cerebral palsy can have problems such as muscle weakness, stiffness, awkwardness, slowness, shakiness, and difficulty with balance. In mild cerebral palsy, the child may be slightly clumsy in one arm or leg, and the problem may be barely noticeable. In severe cerebral palsy, the child may have a lot of difficulties in performing everyday tasks and movements.

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Shading is probably an overused treatment in nurseries, however, because most species (even those classified as shade tolerant) tend to grow best in full sunlight. In addition, many native plants tend to grow excessively in height ("stretch") under excessive shade, which may create a shoot-to-root imbalance. Nonetheless, if the species is shade loving and will be planted onto a site underneath an existing canopy, then shading may be a useful treatment. Plants that will be planted into full sun conditions should receive minimal or no shading at any point during nursery cultivation including during the hardening phase. Irrigation Reducing irrigation duration or frequency can help condition nursery stock to withstand droughty conditions on dry outplanting sites. Giving plants less water slows shoot growth, reducing the possibility of producing top-heavy plants, but nursery stock can also physiologically adjust to mild water stress. Less irrigation also encourages the formation of smaller leaves with thicker cuticles that transpire less after outplanting. Because moisture stress is the primary cause of transplant shock, it makes sense to precondition plants only before shipping them. Root Culturing Native plants that are grown in containers with root-controlling features encourage the formation of a healthy, fibrous root system that is not damaged during harvesting, is easily planted, and is able to rapidly proliferate after outplanting to access water and nutrients. Containers should always have vertical ribs to limit root spiraling and should be designed to promote good air pruning at the drainage hole (figure 12. Other root culturing features such as sideslit air pruning and copper pruning are effective, especially with very vigorous rooted species. Whether root culturing features are cost worthy for all species of native plants needs to be determined by nursery trials, as explained in Chapter 17, Discovering Ways to Improve Crop Production and Plant Quality. After plants are moved to a shadehouse or an outdoor compound, it is important not to place the containers directly on the ground. Instead, plants should be placed on benches or pallets to facilitate air pruning of roots (figure 12. Otherwise, roots may grow directly into the ground, which will require the added expense of root pruning during harvest. Shoot Pruning Pruning shoots ("top pruning") is sometimes required if the top is growing too large for the root system. Shoot pruning can maintain a proper shoot-toroot balance and reduce water stress resulting from an excessively high transpirational demand. In addition, the shock of pruning stimulates more stem and root growth and allows all plants to receive more irrigation and fertigation. One of the most important reasons to prune shoots is to make the height of the entire crop more uniform. When done properly, pruning occurs at the level just above the height of the smaller plants that have been overtopped (figure 12. This practice releases smaller plants and the additional light helps them re-establish a growth rate that is consistent with the rest of the crop (figure 12. It is critical that shoot pruning treatments not be too severe; a rule of thumb is never to remove more than one-third of the total shoot. Plants to be pruned should also be in general good health and have enough stored energy to rapidly grow new tissue. It is best to prune succulent tissue because woody stem tissue tends to split and has less regenerative ability (figure 12. Some native plants respond better than others, however, so a small trial is always recommended. Generally, grasses, forbs, and shrubs respond well to pruning and their shoots may be pruned several times during the growing season. B A A Other Conditioning Practices the horticultural techniques described previously prepare plants to endure the stresses that occur during the processes of lifting, handling, transport, and outplanting. Experience is the best teacher-experiment on a few plants and discover which treatment or combination of practices work best in your circumstances. Growers tried to replicate this effect by moving a pole through the crowns of the plants in both directions (figure 12. Nurseries with traveling irrigation booms have mechanized the process by attaching a polyvinyl chloride pipe to the boom. A good time to brush plants is right after overhead irrigation because the rod also shakes excess water from the foliage and reduces the potential for foliar diseases such as Botrytis later in the season. Increased distance between individual cells or containers allows more sunlight to reach lower leaves, improves air circulation, and promotes hardening. Increased spacing encourages the development of shorter plants with more root-collar diameter and also promotes thickening of the leaf cuticle. One real advantage of containers comprising individual, removable cells is that individual containers can be moved to every other slot to increase spacing within the trays during the hardening period (figure 12. Plants can be hardened by adjusting the type and amount of nitrogen fertilizer, A reducing irrigation frequency, moving plants from inside greenhouses to outdoor areas, increasing exposure to colder temperatures, and manipulating the intensity and duration of light. The hardening principle is connected directly to the target plant concept, which emphasizes the need for good communication between nursery managers and their clients. Because the "all-purpose" plant does not exist, hardening regimes will need to be developed for specific species and seed sources. Landis and Tara Luna 13 Plants are ready for harvest and delivery to clients after they have reached target specifications (see Chapter 2, the Target Plant Concept) and have been properly hardened (see Chapter 12, Hardening). Originally, nursery stock was grown in soil in fields; nursery managers would "lift" those seedlings out of the ground to harvest them. That traditional nursery term is still used today, and we refer to the traditional "lifting window" (usually late autumn to very early spring) as the time period during which plants are at maximum hardiness, most tolerant to stress, and therefore in the best condition for harvesting. Conifer trees were the main native plants used for restoration after fire or logging. Seedlings were grown bareroot and the traditional lifting window described above allowed foresters to have plants in time for the traditional "outplanting window," which was always springtime. Now, container stock allows a much wider planting window so plants can be outplanted almost year-round if site conditions are favorable (table 13. For example, in northern Idaho, native plants can be outplanted starting in February at the lowest elevations through July at the highest elevations, and, if autumn rains are sufficient, again in September and October. Still, most container stock is outplanted in the spring, when soil moisture and temperature are most favorable for survival and growth. Our primary focus in this chapter will be on lifting plants during the more traditional season (autumn through early spring) because storage, shipping, and outplanting require special techniques. Summer and fall lifting is discussed in the Special Outplanting Windows section found near the end of this chapter. In native plant nurseries, four different methods of scheduling seedling harvesting have been used: calendar and experience, foliar characteristics, time and temperature, and seedling quality tests. Calendar and Experience Scheduling harvesting according to the calendar is the most traditional technique, and, when based on the combined experience of the nursery staff, can be quite effective. The procedure is simple: if it takes 4 weeks to harvest the plants, then that amount of time is scheduled on the calendar. The dates are selected based on past weather records and how well plants harvested on those dates have survived and grown after outplanting. To estimate the autumn frost date, take the average date of the first frost in autumn and add 30 to 45 days before that. The spring frost date, which is calculated as 30 to 45 days before the last average frost, can be used to determine when to uncover plants in spring. Foliar Characteristics Native plant growers use several morphological indicators to help them determine when plants are Figure 13. Plants are harvested over the duration of the potential lifting season and outplanted to determine survival and growth. Because chilling hours will vary from year to year, data should be gathered for at least 3 to 5 years. Seedling performance data are then plotted against the accumulated chilling hours, and the resulting graph shows when it is safe to begin harvesting the plants. Foliar Changes All plants give visual cues when they are dormant and hardy enough to harvest. With grasses and sedges, the chlorophyll dies, so foliage becomes straw colored (figure 13.

References:

  • https://anest.ufl.edu/files/2015/06/2016-Cardiac-Ultrasound.pdf
  • https://www.aetnabetterhealth.com/pennsylvania/assets/pdf/pharmacy/pharmacy-bulletins/0634%20Non-myeloablative%20Hematopoietic%20Cell%20Transplantation%20(Mini-.pdf
  • https://www.who.int/immunization/sage/meetings/2017/october/3_FULL_PRIME_REPORT_2017Sep26.pdf
  • https://www.wiaawi.org/Portals/0/PDF/Forms/physicalcard.pdf
  • https://www.oncozine.com/wp-content/uploads/2020/09/VERZENIO-abemaciclib-PI.pdf