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Clinical Review
BMJ 2016;353:i1937 doi: 10.1136/bmj.i1937 Page 1 of 9 Clinical Review CLINICAL REVIEW Travellers’ diarrhoea 1 Jessica Barrett infectious diseases registrar , Mike Brown consultant in infectious diseases and tropical medicine 1 2 1Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London WC1E 6AU, UK; 2Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Correspondence to: J Barrett [email protected] Diarrhoea is a common problem affecting between 20% and lasting more than two weeks. Cyclospora catayensis, another 60% of travellers,1 particularly those visiting low and middle protozoan cause of diarrhoea, was identified in an increased income countries. Travellers’ diarrhoea is defined as an increase number of symptomatic travellers returning from Mexico to the in frequency of bowel movements to three or more loose stools UK and Canada in 2015.13 per day during a trip abroad, usually to a less economically Table 1⇓ illustrates overall prevalence of causative agents in developed region. This is usually an acute, self limiting returning travellers with diarrhoea. However relative importance condition and is rarely life threatening. In mild cases it can affect varies with country of exposure. Rates of enterotoxigenic E coli the enjoyment of a holiday, and in severe cases it can cause (ETEC) are lower in travellers returning from South East Asia dehydration and sepsis. We review the current epidemiology of than in those returning from South Asia, sub-Saharan Africa, travellers’ diarrhoea, evidence for different management and Latin America, whereas rates of Campylobacter jejuni are strategies, and the investigation and treatment of persistent higher. -
Yellowstone Loadout Package
Yellowstone Loadout Package Yellowstone National Park “Heart Lake & Snake River” Expedition Loadout Package By the AcadianX Outdoor Adventure Group https://www.facebook.com/AcadianX/ Yellowstone Loadout Package P a g e | 1 Adventure Summary First of it’s Kind "The Yelowstone Park is something absolutely unique in the world...This Park was created and is now administered for the benefit and enjoyment of the people...it is the property of Uncle Sam and therefore of us all." - President Theodore Roosevelt - Speech dedicating the North Entrance Arch, April 1903. Heart Lake/Snake River Trail The Heart Lake - Snake River Loop is a diverse hike in the southern half of Yellowstone featuring incredible natural history, thermal activity, wildlife viewing opportunities, soaking in hot springs, and an ascent of Mount Sheridan. Wildlife and Geology Yellowstone National Park is the centerpiece of the 20 million acre/31,250 square-mile (8,093,712 ha/80,937 km2) Greater Yellowstone Ecosystem, a region that includes Grand Teton National Park, adjacent National Forests and expansive wilderness areas in those forests. The ecosystem is the largest remaining continuous stretch of mostly undeveloped pristine land in the contiguous United States, considered the world's largest intact ecosystem in the northern temperate zone. With the successful wolf reintroduction program, which began in the 1990s, virtually all the original faunal species known to inhabit the region when white explorers first entered the area can still be found there. Fees & Permits Fees need to be paid for the park entrance and to secure a backcountry itinerary. Entrance fees are paid on arrival whereas backcountry permits need to be paid and applied for at the Backcountry office prior to your trip beginning. -
ALMA-10.08.00.00-011-D-MAN Date : 2012-02-14 ALMA Safety Manual Status : Draft
Doc # : ALMA-10.08.00.00-011-D-MAN Date : 2012-02-14 ALMA Safety Manual Status : Draft Page : 2 of 272 TABLE OF CONTENTS I. ALMA DIRECTOR’S STATEMENT ON SAFETY ........................................................ 5 II. SCOPE ................................................................................................................................. 6 III. REFERENCE DOCUMENTS (RD) / APPLICABLE DOCUMENTS (AD) ................ 6 IV. ALMA ABBREVIATIONS, ACRONYMS, DEFINITIONS: ........................................ 7 V. MISSION ............................................................................................................................... 8 VI. VISION ................................................................................................................................ 8 VII. VALUES .............................................................................................................................. 8 VIII. SAFETY OFFICE ORGANIZATION ............................................................................. 9 1. EMERGENCY PREPAREDNESS ....................................................................................... 16 1-1 Accident Investigation Procedures .................................................................................. 16 1-2 Accident Reporting Requirements ................................................................................... 18 1-3 Emergency Procedures / Contacts ................................................................................... 22 1-4 Inclement -
Packing List
PACKING LIST The following packing list has proven itself during our numerous journeys. But it is only meant as a guideline and shall help you while packing. Don’t pack more than 15 kg. (Then you will have more space for souvenirs when returning!) Please pay attention to the fact that clothes and equipment shall be hard-wearing and in dark colours. Bright colours are not only unfavourable for animal watching but the dust from the African bush is likely to make white colours look like grey. Dark green, brown and khaki coloured clothes are ideal. On your way you will also have the possibility to wash several clothes. Our recommendation: Travelling bag, duffel bag or big backpack as main piece of luggage 1 little back bag for the day Clothes: Light windbreaker / rain shield Warm pullover 2 sweatshirts or light pullovers 2 trousers for replacement, comfortable and hard-wearing Chemises, t-Shirts 2 short trousers Pyjama Underwear, socks Swim suit Headgear Shoes: Solid sneakers or light hiking boots Thongs or sports sandals Others: Photo equipment Flight tickets Vaccination card Films (memory chips for digital cameras) Traveller cheques, hard cash, credit card Passport (valid for at least 6 months) Glasses for replacement Sun glasses Replacement batteries Little writing pad and pen First-aid kid (medicine for insect bites, diarrhoea, dressing material etc.) Travelling clock Medicine Insect repellent Malaria prophylaxis Suncream (with high sun protection factor) Washing accessories Our recommendation for your Kilimanjaro trekking: Bags/Sleeping -
ALMA Safety Manual ALMA-10.08.00.00-011-C-MAN Version: C Status: Released 2009-July-21
ALMA Safety Manual ALMA-10.08.00.00-011-C-MAN Version: C Status: Released 2009-July-21 Prepared By: Organization Date Jacques Lassalle ALMA Safety Manager 2009-07-21 Reviewed by: R.Daniels National Radio Astronomy Observatory Safety Representative Michael Boecker European Executive Safety Representative Masahiko Ohta National Astronomical Observatory of Japan Executive Safety Representative Approval and Release Richard Kurz JAO Project Manager Thijs de Graauw ALMA Director Doc # : ALMA-10.08.00.00-011-C-MAN Date : 2009-07-20 ALMA Safety Manual Status : Released Page : 2 of 253 Change record VERSION DATE AFFECTED SECTION REASON/INITIATION /REMARKS A 2006/02/23 All First Issue Added definitions, clarify management role, B 2006/08/31 All Sec 6 - AST inspection requirement, Sec 19 - Executive and visitor exam requirements, Sec 21 - O2 use responsibilities, Sec 30/37 – Operation Safety Sec 27 and 51 - wind speed restrictions for cranes and scaffold, Sec 43 - restrictions for offsite access, Sec 44 - night conditions for AOS access Added Sections in Environmental Protection, High Altitude Medical, and Operations Safety B Section 33 P141 ; Chapter 33.3.3 added Revision 1 2007/09/05 Accident reporting flow chart Ch 3.4.4.1 modification Police/ Mutual link deleted Section 19 Physical exam requirement Section 21 Ch 21.3.1 : last point added Section 22 Ch 22.3.3 : added Ch 22.3.4 : added Section 48 Ch 48.3.2 :the 2 first points added Ch 48.3.9.Driving sanctions Section 5 Added All Sections numbers C 2009/03/18 ALMA Director statement P 6 Section