Cheapest generic montelukast uk
HigH-Yield PrinciPles 100 Section I: General Principles · Answers Answer E is incorrect asthma treatment quick relief discount 5 mg montelukast overnight delivery. Ziehl-Neelsen stain is used to asthma film generic 4 mg montelukast with mastercard stain acid-fast mycobacteria such as Mycobacterium tuberculosis define asthma triad discount 10mg montelukast overnight delivery. The first step in answering this question is to recognize that Ziehl-Neelsen stain is what is used for the acid-fast test. The presence of acid-fast rods in the blood indicates that this man has a disseminated mycobacterial infection. It can include gut pain (from mycobacterial enteritis), pulmonary symptoms, or adenopathy. Mycobacterium marinum is a species native to fresh-water and saltwater environments. It is a rare cause of cutaneous wound infection in anglers, swimmers, and aquarium owners. It is not commonly associated with disseminated infection in immunocompromised patients. Nocardia is eliminated as the correct answer by the given morphology of the observed bacteria. Although Nocardia can stain weakly acid-fast, they demonstrate a branching filamentous morphology that resembles fungal hyphae. Fluoroquinolones have good coverage against gram-negative and select gram-positive organisms, and are often used to treat urinary tract infections and community-acquired pneumonia. Additionally, fluoroquinolones are a class C substance, as they have the potential to cause teratogenic or embryocidal effects. Giving fluoroquinolones during pregnancy is not recommended unless the benefits justify the potential risks to the fetus. The operation was a success, and the transplanted kidney started producing urine "on the operating table. An infant boy experiences multiple bacterial, viral, and fungal infections during his first year of life. A 45-year-old woman presents to her family physician with complaints of two months of joint stiffness and pain that is worst in the morning. Physical examination reveals swelling of the left metacarpophalangeal joints and of the wrists bilaterally. She is diagnosed with a condition associated with the release of proin- flammatory cytokines. The image depicts a cell that is activated by bacterial products, upregulates costimulatory molecules, and migrates to the draining lymph node. Which of the following types of cells is shown in this image, and of which type of immune cell is it a specialized form? To assess the risk of erythroblastosis fetalis during the future pregnancy of an Rh-negative woman, a clinician sends a sample of serum for detection of anti-Rh blood group antibodies. After receiving this test result, the clinician would be correct to conclude which of the following? A 68-year-old woman has been hospitalized for three days after an exacerbation of emphysema. Her clinical course progresses well until the fourth hospital day, when she develops shortness of breath, fatigue, and cough productive of yellow sputum. Her oxygen saturation drops by 10%, and she is started on vancomycin and gentamicin via rapid infusion. Thirty minutes after the initiation of antibiotics, the patient develops erythema of the face and neck, itchiness, and hypotension. The patient has no known drug allergies and has not been treated with vancomycin prior to this hospitalization. A 1-year-old child whose parents just emigrated from Mexico presents to the emergency room with stridor. Which of the following characteristics of the causative organism makes necessary the addition of the diphtheria toxoid to the vaccine? A type B blood group, Rh-positive recipient mistakenly receives a kidney from a type A blood group, Rh-negative donor. Which of the following best describes the mechanism of transplant rejection that is most likely to ensue in this recipient? A 60-year-old postmenopausal woman presents with fatigue, mild jaundice, and tingling in the lower extremities. Laboratory studies show elevated serum levels of homocysteine and methylmalonic acid, and mild thrombocytopenia. In which of the following disorders would a peripheral blood smear be similar to the one seen in this case? A 10-month-old boy is brought to the pediatrician by his parents because of fever, cough, and difficulty breathing. Which of the following is the most likely etiology of the increased level of IgM in this patient? A 40-year-old man presents to his physician with numbness and tingling on the dorsal surface of his right hand and forearm, and raised "varicose veins" that are firm to the touch along the same distribution. An immune complex disease is suspected, and assays for autoantibodies inside neutrophils are conducted. What diseases are associated with the identification of antimyeloperoxidase and anti-proteinase-3 antibodies, respectively? A 35-year-old woman presents to the clinician with symptoms suggestive of an autoimmune etiology. A biopsy is sent for immunofluorescent staining, and the results indicate the presence of anticentromere antibodies. A 24-year-old woman presents with a fourmonth history of fever, night sweats, and weight loss. From which of the following cell types is the cell with the bilobed nucleus derived? A 6-month old boy is noted at his well-child visit to have very poor growth and weight gain since his last visit. His mother states that he was hospitalized for pneumococcal pneumonia, and has had several bad colds with purulent nasal discharge since he was born. His physician suspects an immunodeficiency, and laboratory results indeed reveal deficiency of a complement protein. Which of the following antibodies functions in the same manner as the missing complement protein in this child? A 29-year-old intravenous drug user has suffered from recurrent pneumonias, fungal infections in the axillae, and a recent ear infection. Cells with which of the following markers are most likely to be deficient in this patient? Patients who share similar clinical symptoms and disease pathology may nevertheless present differently based on age at disease onset.
Discount montelukast 10 mg online
For instance asthma treatment massage 10mg montelukast visa, good drainage of the soil is important for the performance of many crops asthma treatment in er cheap montelukast 4 mg without prescription, but has also positive effects on the possibilities for timely mechanization and on the efficiency of N utilization  cardiac asthma definition discount 5 mg montelukast otc. It is common knowledge that an increase in crop yield decreases the fixed costs per unit of product. De Wit  adds to this that `yield increases due to technical advance may often require more of some inputs per unit area, but, at the same time, require less of most inputs per unit product. Innovations that lead to yield increases are therefore advantageous under most economic regimes, provided that the crop can be grown economically. De Wit  concludes that in high yielding situations, less external inputs are required and wasted for a certain total production. Although several examples are given to show its general validity , it seems in flat contradiction with the strong increase of environmental problems associated with the intensification of crop and animal production. Apparently, this is caused by 2 characteristics of modern agriculture, mentioned below: (1) the liberal use of relatively cheap external inputs, like chemical fertilizers. In modern agriculture, chemical fertilizers are cheap compared to other means of production [8, 9]. As a consequence, the economically optimum rates of application are high and often some extra fertilizer is given to be sure that deficiencies do not occur. According to the Law of Diminishing Returns, the efficiency of nutrient use decreases and emissions increase strongly when the rate of application approaches or exceeds the economic optimum . In traditional agriculture, animal manures had a very important role in crop nutrition and maintenance of soil fertility, and crop yields depended largely on plant nutrients provided by animal manures, soil reserves and biological N fixation. Under these conditions, effective utilization of animal manures was essential for food production. Since the 1960s, ample availability of chemical fertilizers at low costs has decreased the interest to utilize livestock manures as a source of nutrients for crops. Moreover, storage, handling and application of chemical fertilizers are easier and less costly, and the availability of nutrients, in particular of N, is often more reliable (Chapter 7). As a consequence, animal manures have been replaced by chemical fertilizers in crop production, and are being wasted causing pollution of atmosphere, soil and water. It is evident that the mentioned observations of De Wit and co-workers apply to situations of judicious management and fertilization of individual crops. However, this is a too limited frame of reference because agriculture generally includes both crop and livestock production and nutrient use efficiency and environmental impact should be assessed in the whole soil-crop-livestock system. Moreover, agricultural practice may differ from theory due to the fact that efficient utilization of plant nutrients is often not an important objective of farmers. Many specialized animal production farms are partly land-based: they grow a part of the feed requirements on the farm and buy the remaining part from outside. Livestock production also requires land and crops for a proper (sustainable) utilization of animal manures. On land-based livestock farms, animal manure generally can be used for forage and feed production. Landless animal production units should find other farms without animals or with a low animal density which are prepared to include animal manure in the fertilization plan of the crops. This is essential for sustainable utilization of manures produced on land-less livestock farms. Similarly, crop residues and by-products of the food industry, in particular those with a high content of plant nutrients, should be utilized as much as possible in livestock rations. This was triggered by food shortages during and shortly after the Second World War and stimulated by the increase in prosperity and the demand for more luxurious food in the following decades. The essence of agricultural policy in this period was that farming should be supported by the state, and this in turn would ensure the well being of rural areas . Especially in the Netherlands, the efforts to increase agricultural production have been very successful. In particular, the following measures contributed to this: · · · · · Effective research, advisory and education programs. Reclamation and improvement of land, with measures such as re-allotment, land drainage and leveling, and improvement of farm infrastructure. Promotion of ample supplies of production inputs, including credits and, in some cases, subsidies on investments. These supporting measures, as well as the favorable climate and topography, and the strategic situation of Dutch agriculture regarding markets and supplies, particularly stimulated the growth of animal husbandry (dairy, pig and poultry production) and horticulture 15 (vegetables, flowers, ornamental plants). The following developments strongly contributed to the expansion of livestock numbers and production: · Increased use of imported concentrates. After approximately 1960, livestock numbers and production per head could increase as a result of the ample supply of (mostly) imported concentrate ingredients at relatively low costs. This was favored by the proximity of the harbor of Rotterdam and the good transport infrastructure of the hinterland. As a consequence, pig and poultry production developed mainly on imported feeds in almost landless units. Dairy farming remained largely land-based, although imported concentrates increased milk production per cow and allowed higher animal densities on many farms than the available area of land could support. In general, forages were produced on-farm, whereas concentrate ingredients were produced elsewhere. Total consumption of manufactured concentrates by Dutch livestock increased to ca. Between 75 and 80% of the concentrate ingredients were imported from other countries, containing ca. Extensive research programs were carried out between 1960 and 1980 to determine the effects of fertilizer N on herbage yield and quality [8, 13]. Prins  concluded from the results of cutting experiments that, at an assumed marginal profitability of 7. This was close to the official recommendation at that time of 400 kg N ha-1 year-1 (effective N from animal manure + fertilizer N) on sand, clay and wet peat soils, and 250 kg N ha-1 year-1 on drained peat soils. The average use of fertilizer N on grassland increased from ca 50 kg ha-1 in 1950 to as much as 315 kg ha-1 in 1985. The development of the use of chemical fertilizers in Dutch agriculture is shown in Table 3. This Table shows a strong increase of the use of nitrogenous fertilizers between 1950 and 1980 and a decrease afterwards, illustrating the growing awareness of environmental pollution and related legislation. Consumption of P and K containing chemical fertilizers decreased since 1950, probably as a result of the increased availability of animal manures and the practice of regular soil sampling and analysis on many farms. Mechanization and automation of the whole production process to replace expensive labour and improve management. Important developments were: (1) modern livestock housing systems with facilities for collection, storage and application of liquid manure (slurry), (2) manufacturing and handling of concentrates, (3) conservation of herbage and fodder crops as silage, and (4) milking machines and, recently, milking robots. Milk and beef production decreased slightly in the last decades, owing to the introduction of the milk quota system by the European Community in 1984 . Poultry numbers were not yet recorded in that year, but amounted to 38 million laying hens and 4. The numbers presented indicate the standing population at the moment of the agricultural census (May), often referred to as animal places. The number of pigs decreased after 1997 because of outbreaks of classical swine fever in 1997/1998 and foot and mouth disease in 2001 .
Generic 4mg montelukast with amex
The greater the amount of blood in the subarachnoid cisterns asthma kazakhstan purchase montelukast 4 mg amex, the more likely that vasospasm and delayed cerebral ischemia will occur; the risk is highest between days 4 and 12 asthma complications purchase 10 mg montelukast with visa. Clotted blood blocking the ventricular system or the arachnoid villi can lead to asthmatic bronchitis questions discount montelukast online amex hydrocephalus, of obstructive or malresorptive type, respectively (p. Other complications include cerebral edema, hyponatremia, neurogenic pulmonary edema, seizures, and cardiac arrhythmias. Intracerebral Hemorrhage Intraparenchymal hemorrhages of arterial origin are to be distinguished from secondary hemorrhages into arterial or venous infarcts. Sudden onset of headache, impairment of consciousness, nausea, vomiting, and focal neurological signs, with acute progression over minutes or hours. Putaminal hemorrhage produces contralateral hemipare- 176 Central Nervous System Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Massive hypertensive hemorrhage is thought to be caused by pressure-induced rupture of arterioles and microaneurysms. The high pressure and a kind of chain reaction involving multiple microaneurysms is thought to explain the size of these hemorrhages (despite the small caliber of the ruptured vessels). The recurrent, mainly cortical, bleeding associated with cerebral amyloid angiopathy is due to the fragility of leptomeningeal and cortical small vessels in whose walls amyloid deposits have accumulated. Dural fistula is an abnormal anastomosis between dural arteries and a venous sinus. Hemorrhage is rare; they may cause pulsating tinnitus, headache, papilledema, and visual disturbances. Another 10 % are caused by nonaneurysmal lesions (whose nature is not, at present, understood), with bleeding mainly in the perimesencephalic cisterns (p. An aneurysm is not a congenital lesion, but a progressive, localized dilatation of an arterial wall. Spontaneous hemorrhage is rare; ischemia due to arterioarterial embolism is more common. The rare septic-embolic aneurysms (mycotic aneurysms) may be secondary to endocarditis, meningoencephalitis, hemodialysis, or intravenous drug administration. They become clinically manifest either through a hemorrhage or through headache, seizures, or focal neurological signs (aphasia, hemiparesis, hemianopsia). Cavernomas are compact, often calcified, aggregations of dilated blood vessels and connective tissue in the brain and leptomeninges. Hypertension is the most common cause; other causes include Central Nervous System Treatment Aneurysmal hemorrhage. Cautious transport, bed rest, analgesia, admission to a neurosurgical unit, and angiography to establish the diagnosis and define the anatomy of the aneurysm(s). Intracerebral hemorrhage is often treated conservatively, unless it impairs consciousness or causes a progressive neurological deficit. Major cerebellar hemorrhage (rule of thumb: 3 cm) is life-threatening unless treated neurosurgically. Central Nervous System Stroke: Sinus Thrombosis, Vasculitis Sinus Thrombosis Symptoms and signs. Aseptic sinus thrombosis most commonly affects the superior sagittal sinus and produces initial headache, vomiting, and focal epileptic seizures, followed by monoparesis or hemiparesis, papilledema, abulia, and impairment of consciousness. Blockage of venous outflow causes cerebral edema and rupture of the distended cerebral veins upstream from the thrombosis. Pain, redness, and swelling of the eye or ear may develop, in addition to focal neurological signs. Transverse and sigmoid sinus thromboses are often secondary to ear and mastoid infections, while cavernous sinus thrombosis is often due to infections about the face (orbit, paranasal sinuses, teeth). Septic sinus thrombosis often occurs by secondary spread of infections about the head (sinusitis, otitis media, mastoiditis, facial furuncle). Cerebral Vasculitis Primary vasculitis arises in the cerebral arteries and veins themselves, while secondary vasculitis is a sequela of another disease (see Causes, below). Cerebral vasculitis produces variable symptoms and signs, including recurrent ischemia, intracerebral or subarachnoid hemorrhage, persistent headache, focal epilepsy, gradually progressive focal neurological signs, dementia, behavioral abnormalities, cranial nerve palsies, and meningismus. Vasculitis may also affect vessels of the spinal cord (transverse cord syndrome) and those supplying the peripheral nerves (painful mononeuropathy). Infectious vasculitis is treated with antiviral or antibacterial agents, as needed, while autoimmune vasculitis is treated with corticosteroids and immune suppressants (cyclophosphamide, azathioprine). Central Nervous System Headache the actual vascular event (arterial dissection, arteriovenous malformation, vasculitis), may occur simultaneously with the event (subarachnoid hemorrhage, intracerebral hemorrhage, epidural hematoma, cerebral venous thrombosis, giant cell arteritis, carotidynia, venous outflow obstruction in goiter or mediastinal processes, pheochromocytoma, preeclampsia, malignant hypertension), or may follow the event (subdural hematoma, intracerebral hemorrhage, endarterectomy). Tension Headache Tension headache often involves painful cervical muscle spasm, may change with the weather, and is frequently ascribed by patients and others to cervical spinal degenerative disease, visual disturbance, or life stress. It consists of a bilateral, prominent nuchal pressure sensation that progresses over the course of the day. Patients may report feeling as if their head were being squeezed in a vise or by a band being drawn ever more tightly around it, or as if their head were about to explode, though the pain is rarely so severe as to impede performance of the usual daily tasks. It may be accompanied by malaise, anorexia, lack of concentration, emotional lability, chest pain, and mild hypersensitivity to light and noise. It can be episodic (15 days/month, pain lasting from 30 minutes to 1 week) or chronic (15 days/month for at least 6 months). Some patients suffer from pericranial tenderness (posterior cervical, masticatory, and cranial muscles). Isolated attacks of sudden, stabbing pain (ice-pick headache) may occur on one side of the head or neck. Its cause usually cannot be determined, though it may be due to disorders of the temporomandibular joint or psychosomatic troubles such as stress, depression, anxiety, inadequate sleep, or substance abuse. Central Nervous System Chronic Daily Headache Rational treatment is based on the classification of primary daily headache by clinical characteristics (see Table 23, p. Headache Due to Vascular Processes (Other than Migraine) the nociceptive innervation of the extracranial and intracranial vessels is of such a nature that pain arising from them is often projected to a site in the head that is some distance away from the responsible lesion. Thus, specific diagnostic studies are usually needed to pinpoint the location of the disturbance. The pain may precede 182 Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Headache Persistent, variably severe headache Depression Anxiety Stress Episodic Noise Alcohol Medications Chronic Transient stabbing pain Tension headache Carotid artery (common, external, internal) Internal carotid a. Central Nervous System Headache often accompanied by anorexia, malaise, nausea, and vomiting. This phase is characterized by listlessness, lack of concentration, and increased pain sensitivity in the head. Pathogenesis During the interval between attacks, various disturbances (genetically determined) may be observed. The cumulative effect of these disturbances is a heightened sensitivity to nociceptive stimuli (migraine pain threshold). Impulses from the cortex, thalamus, and hypothalamus activate the so-called migraine center responsible for the generation of migraine attacks, putatively located in the brain stem (serotonergic raphe nuclei, locus ceruleus).
Ethacrynic acid is a phenoxyacetic acid derivative that essentially has the same action as furosemide asthma symptoms kid cheapest montelukast. It is used in patients who are likely to asthma symptoms 9 weeks best montelukast 10mg be allergic to asthma dogs buy montelukast overnight furosemide, and it is contraindicated in this patient because it will worsen her metabolic alkalosis. Furosemide is a strong diuretic that inhibits the Na+/K+/2Cl- cotransporter of the thick ascending loop of Henle and, like the thiazides, is contraindicated in this patient because it will worsen her metabolic alkalosis. Hodgkin lymphoma is a lymphoproliferative neoplasm that typically affects young adults, especially men, and presents with fever, night sweats, and weight loss. Infectious mononucleosis is caused by Epstein-Barr virus and demonstrates characteristic atypical (reactive) lymphocytes on a blood smear. Clinical characteristics include prominent sore throat, fever, fatigue, generalized lymphadenopathy, and often hepatosplenomegaly. Hydrochlorothiazide inhibits sodium chloride reabsorption in the early distal tubule. It is contraindicated in this patient because it leads to hypokalemic metabolic alkalosis, which would only worsen her acid-base balance. It passes through the diaphragm with the aorta and azygous vein posteriorly at the level of T12. The right chest, back, arm, neck, and head, however, are drained via the right lymphatic duct, which empties into the angle between the internal jugular and subclavian veins. With symptoms of swelling in the right upper quadrant of the body, one must consider disruption of this structure, especially in a patient with a history of surgery and/or radiation in the right breast and axilla. The thoracic duct drains all of the lymph in the body except that from the right upper quadrant, which includes the right arm and right side of the face. Therefore, a lesion of the thoracic duct could not explain the edema in this patient. Metastatic disease to bone is common in advanced breast cancer, and most metastatic disease occurs in the central skeleton (vertebrae, pelvis, ribs, upper legs, and upper arms). This method is considered one of the four mature defense mechanisms, along with altruism, humor, and suppression. Displacement is an immature defense mechanism in which avoided ideas and feelings are transferred to a neutral person or object. An example of this is a woman who is angry at her boss and instead yells at her sister on the phone. Projection is an immature defense mechanism in which an unacceptable internal impulse is attributed to an external source. An example of this is a man who is attracted to another woman and accuses his wife of cheating on him. Reaction formation is an immature defense mechanism in which a warded-off idea or feeling is replaced by an unconsciously derived emphasis on its opposite. Suppression is another mature defense mechanism in which unwanted feelings are voluntarily (unlike other defenses) withheld from conscious awareness. An example of this is a patient with pancreatic cancer who decides that he will only think about his illness 15 minutes per day. Bisphosphonates, such as alendronate and risedronate, are used to treat metastatic bone diseases and osteoporosis. Bisphosphonates decrease pain and fractures by reducing the number and activity of osteoclasts and inhibiting bone resorption. Cephalosporins are b-lactam antibiotics used to treat infections caused by gram-positive and gram-negative bacteria. The vinca alkaloids, such as vincristine and vinblastine, are microtubule inhibitors used in the treatment of testicular carcinoma and Hodgkin and nonHodgkin lymphomas. Despite its potent bacteriostatic activity, chloramphenicol is now used rarely because of its toxicities (gray baby syndrome and aplastic anemia). Aplastic anemia with chloramphenicol use is a dosedependent adverse event that can occur after only a short course of therapy and can be fatal. Because it is inexpensive, chloramphenicol is often used in resource-limited settings overseas. Gentamicin binds to the 30S subunit and is associated with nephrotoxicity and ototoxicity with prolonged use. Erythromycin is associated with cholestatic hepatitis, eosinophilia, and skin rashes. Azithromycin, a related macrolide, is better tolerated and results in fewer adverse events. The sulfonamides act by inhibiting dihydropteroate synthetase, an enzyme involved in folate synthesis. They can cause serious allergic reactions, urinary tract disorders, and porphyria. Although the sulfonamides can cause aplastic anemia, it occurs far less frequently than with chloramphenicol. The more unique complications include tendonitis and tendon rupture in adults, and cartilage malformation in children and in the developing fetus. Clindamycin is classically associated with intestinal colonization by Clostridium difficile. This leads to pseudomembranous colitis, in which patients usually present with cramping, watery diarrhea, and a low-grade fever. This is characterized by pain symptoms that are inconsistent with physiological processes. There is typically a close temporal relationship with psychological factors, and such disorders are seen more commonly in females than males. Treatment typically includes rehabilitation, such as behavioral therapy, physical therapy, and psychotherapy. However, the patient has had test Block 7 Full-length exams Test Block 7 · Answers 723 extensive laboratory and clinical assessments, with no indication of an infectious process. Group therapy is helpful for many psychiatric conditions, including hypochondriasis. In this disorder there is preoccupation with or fear of having a serious disease despite medical reassurance. This leads to significant distress and impairment, and often involves a history of prior physical disease. This patient has not described a preoccupation about her illness, so it is unlikely that she is suffering from hypochondriasis. Analgesia, including opioid treatment, is generally not indicated for pain disorder. Moreover, pain disorder may not resolve on its own once it has been persistent for several years. Patients with conversion disorder present with symptoms or deficits of voluntary or sensory function (eg, blindness, seizure, or paralysis). These symptoms often occur in close temporal relationship to stress or intense emotion. Conversion disorder is more common in young females, less-educated people, and those from lower socioeconomic classes.
Purchase montelukast 5mg visa
Alternative methods are houseby-house administration of drug by volunteers asthma definition 600d order 4mg montelukast amex, organization of special community gatherings or use of existing programmes targeting children (such as Child Health Days) to asthmatic bronchitis toddler order montelukast 5mg with mastercard administer anthelminthics together with other health interventions (vaccinations asthmatic bronchitis test discount montelukast 10 mg without a prescription, vitamin A, etc. Announcement of treatment days by radio, television, music, theatre or "town criers" can convey the information to the population and help sustain coverage. Extending anthelminthic coverage to non-enrolled school-age children using a simple and low-cost method. Transactions of the Royal Society of Tropical Medicine and Hygiene; 102:1201-1206. The effect of a school-based weekly iron supplementation delivery system among anemic schoolchildren in the Philippines. Strengthening interventions to reduce helminth infections as an entry point for the development of health-promoting schools. Assuring the safety of preventive chemotherapy interventions for the control of neglected tropical diseases. Long-term efficacy of single-dose combinations of albendazole, ivermectin and diethylcarbamazine for the treatment of bancroftian filariasis. Appreciation of school deworming program by parents in Ha Giang Province (Vietnam). Development and validation of a "tablet pole" for the administration of praziquantel in sub-Saharan Africa. Outreach to non-enrolled school-age children the School Health Programme in Zanzibar (Montresor et al. Objective of the outreach activities To provide school-age children not enrolled in or not attending school with anthelminthic treatment and health education. Strategy During district-level teacher meetings, there was discussion on how to reach the 20 000 non-enrolled school-age children. Each group of teachers identified ways of informing families about the availability of anthelminthic treatment at the school on special "treatment days". Possible outreach approaches identified were: (a) posters, handmade by pupils; (b) traditional music group performing in the school on the treatment day; (c) messages distributed via megaphones and radio, and by religious leaders, to inform the community about treatment days; (d) child-to-child communication (enrolled children letting non-enrolled siblings and friends know about treatment days). Results the most cost-effective intervention was a combination of approaches (c) and (d). More than 60% of non-enrolled school-age children were treated at marginal additional cost. It is important that the results of monitoring and evaluation activities be shared with communities, relevant government ministries and donors to maintain their interest in and support for the programme. Monitoring and evaluation should be carried out with as little expense as possible, so as not to divert resources away from implementation activities. At the planning stage, it is recommended that approximately 510% of the programme budget be reserved for monitoring activities. Process and performance indicators are used for monitoring, and performance and impact indicators for evaluation (see Figure 4. Not all the indicators listed need to be collected in fact, only a few are considered essential. Collection of additional indicators should be based on a clear rationale for their use and on resources available. Examples of suitable forms are given in Annexes 4, 5, 6, 7, 8 and 9; programme managers may decide to adapt these forms for their own particular programmes. These data are normally derived from forms completed when the drugs and other materials are received in the central pharmacy and during training activities. Additional aspects may also be evaluated, such as the content of health education activities and drug storage conditions. The condition of latrines and the quality of water supplies in schools may also be monitored if their improvement is one of the objectives of the programme. Time of collection of process indicators Process indicators are normally more accurate if collected immediately after the relevant event (for example, for attendance at training sessions it is better to collect the list of participants immediately after the training). The process indicators, their calculation and use, and the expectations or goals of an effective deworming programme are summarized in Table 4. Target the deworming programme aimed to treat more than 75% of the school population (250 000 schoolchildren in approximately 2000 public primary schools in 12 districts). Procurement of drugs Albendazole (400 mg) was procured from a local manufacturer after evaluation of the drug quality and competitiveness of the price. Training In 1998, the Ministry of Health organized four training-of-trainers workshops for the district health and education staff from the 12 project districts. The participants, in turn, provided second-level training to schoolteachers and parents in each school in the programme. In each school, trained teachers administered albendazole tablets to schoolchildren. Monitoring Monitoring forms were developed to be filled in by teachers and district health officials for reporting data on training activities. The indicators evaluate the number and percentage of participating schools and the percentage of children receiving treatment and health education interventions. The data are normally obtained from the forms filled in during drug administration in the schools. The most important of these indicators is drug coverage (that is, the proportion of school-age children, both enrolled and non-enrolled, that received the drugs). If data collected by forms are considered doubtful, a central team may conduct a "confirmation survey" in a small sample of schools, to compare the data reported by teachers with those directly collected in the schools (see Example 6). Time of collection of performance indicators Performance indicators focus on the capacity of the programme to reach a large number of school-age children. To increase accuracy, these indicators should be collected immediately after the administration of a round of deworming drugs. The deworming programme was undertaken in two phases: the first phase targeted more than 1 million school-age children in 11 provinces and the second targeted the entire school-age population in the country (3. Method the Ministry of Health monitored the programme coverage in two ways: · with standardized forms filled in by teachers in the 5850 schools in the country, and summarized at district and provincial level and transmitted to the Ministry of Health; · with coverage-confirmation surveys conducted in 97 schools in 36 districts by the Ministry of Health central team; in each school visited, the team estimated the drug coverage children who received drugs in each class were asked to stand up and the data collected were then compared with the form filled in by the headmaster. Results Forms the Ministry of Health received more than 5800 forms from the schools, accounting for treatment of 2 774 564 schoolchildren (over 94% of enrolled children and 84% of the school-age population). Impact indicators evaluate the effects of programme activities on improving health status. The indicators in this group are of two kinds: · parasitological indicators directly related to drug action. In particular, these indicators show whether the proportion of infected children at baseline, and especially those with heavy-intensity infection, is declining. Time of collection of parasitological indicators At least 2 years of intervention are normally necessary before improvements in the health of school-age children can be measured with parasitological indicators.
Buy montelukast 4mg lowest price
Bordetella pertussis is a gram-negative rod that causes whooping cough asthma treatment zones order montelukast amex, characterized by paroxysms of coughing followed by a loud inspiration asthma definition x-ray buy 5 mg montelukast overnight delivery, or "whoop asthmatic bronchitis in toddlers generic 10 mg montelukast free shipping. Haemophilus influen zae type B is a gram-negative rod commonly associated with acute epiglottitis or meningitis. It is an exclusively human pathogen that is transmitted by aerosolized droplets or direct contact with secretions. The H influenzae type B vaccine has rendered these infections far less common, making it an unlikely agent in this scenario. This phase of disease is typically a chronic process characterized by low-grade fever, night sweats, weight loss, and a productive cough. Streptococcus pneu moniae presents acutely and is a significant cause of bacterial pneumonia in adults. Unlike L pneumophila, however, sputum culture in S pneumoniae infection would reveal significant growth of gram-positive diplococci. Isoniazid depletes pyridoxine (vitamin B6), which is required for the production of dopamine, epinephrine, norepinephrine, and monoamine neurotransmitters. Hence, one of the adverse effects of isoniazid therapy is peripheral neuropathy, which can be prevented by co-administration of vitamin B6. Vitamin B12 is used to treat patients with deficiency who are showing neurologic symptoms and macrocytic anemia. Vitamin B12 is a coenzyme that facilitates arrangement of a hydrogen atom between two adjacent atoms and methyl group transfer between two molecules. Deficiency is seen in chronic alcoholics, pure vegans, and those with pernicious anemia. Thiamine deficiency leads to beriberi, WernickeKorsakoff syndrome, and lactic acidosis. Vitamin E is a potent lipid-soluble antioxidant that protects the cell membranes from lipid peroxide. Pneumonia complicates approximately 4% of measles cases in the United States and as many as 50% of cases abroad. Measles-infected respiratory cells will fuse and form multinucleated giant cells, which can be detected in sputum samples. In immunocompromised hosts, measles pneumonia may evolve to giant cell pneumonia, which is often fatal. Acid-fast bacilli would be expected in the sputum of a child infected with mycobacteria such as Mycobacterium tu berculosis. Cells with nuclei surrounded by a halo and clear cytoplasm are koilocytes and would be found in cells infected with human papillomavirus. Gram-negative coccobacilli and polymorphonuclear leukocytes are commonly associated with Haemophilus influ enzae, which is a common cause of pneumonia in children. This child suffers from a congenital diaphragmatic hernia caused by the failure of the diaphragm to properly form and close. The presence of bowel sounds in a lung zone indicates that abdominal contents have herniated past the boundary of the diaphragm into the thorax. The developing diaphragm is derived from the Septum transversum, Pleuroperitoneal folds, Body wall, and Dorsal mesentery of the esophagus. These four components can be remembered by the mnemonic "Several Parts Build the Diaphragm. A continuous cardiac murmur (ie, present during both systole and diastole) could be the consequence of a patent ductus arteriosus, but is not related to the pleuroperitoneal folds and is unlikely to cause the presentation in this patient. Marked splenomegaly in children has many etiologies, but is unlikely to be consistent with the features of this vignette. Causes of splenomegaly include congenital infections and metabolic genetic disorders. These infections often cause hepatosplenomegaly, jaundice, mental retardation, and intrauterine growth retardation. Lysosomal storage diseases such as Gaucher disease, Niemann-Pick disease, Hunter syndrome, and Hurler syndrome also have symptoms of hepatosplenomegaly. Midline deviation of the trachea is commonly associated with pneumothorax or space-occupying lesions of the cervical region. Choice D represents the residual volume, which is the volume that remains in the lungs after a maximal expiration. Choice A represents the inspiratory reserve volume, which is the volume that can be inspired after inspiration of the tidal volume. Choice B represents the tidal volume, which is the volume inspired or expired with each normal breath. Choice C represents the expiratory reserve volume, which is the volume that can be expired after the expiration of the tidal volume. Choice E represents the inspiratory capacity, which is the sum of tidal volume and inspiratory reserve volume. It is the sum of the expiratory reserve volume and the residual volume, and it is the volume that remains in the lungs after a tidal volume is expired. Choice G represents vital capacity, which is the sum of tidal volume, inspiratory reserve volume, and expiratory reserve volume. This patient is showing signs of Cushing syndrome with a buffalo hump and purple striae. Of the different histological classifications of lung cancer listed above, small cell carcinoma is the most likely in the case for several reasons: Squamous cell and small cell carcinomas are most closely linked to smoking history (>98% are associated with smoking) and both present as central lesions such as that shown on the x-ray film. Adenocarcinoma is the most common lung cancer found in women and nonsmokers (although 75% are found in smokers). Adenocarcinomas are usually peripherally located, and are less likely to cause para-neoplastic conditions such as Cushing syndrome. Bronchial carcinoid is a rare neuroendocrine lung tumor that is not linked to smoking. These tumors cause cough, hemoptysis, and an increase the number of respiratory infections. Some of them are capable of producing serotonin and causes the classic "carcinoid syndrome" characterized by episodic attacks of diarrhea, flushing, and cyanosis. The picture shown here is that of a single solitary lesion, which is more likely to be a primary lung cancer. Squamous cell carcinoma accounts for 25%-40% of lung cancers and is closely linked to smoking. Like small cell carcinoma, squamous cell carcinoma also arises centrally and is associated with paraneoplastic syndromes. This question requires knowledge of both the anatomy and the physiology of the sucking chest wound, as described in this patient. A penetrating wound to the chest can puncture the pleura, making an opening for air to be sucked into the pleural space. If there is a communication directly between the pleural space and the outside world, air is sucked into this negative-pressure space and collapses the lung.
Order montelukast 4mg mastercard
The costs and fees shall be paid by the state body and shall not become a personal liability of any public officer or employee thereof asthma cough purchase montelukast 4mg with mastercard. Offenses Each member of a state body who attends a meeting of that body in violation of any provision of this article asthma symptoms chest pain montelukast 4mg on line, and where the member intends to asthmatic bronchitis sore throat montelukast 5 mg on-line deprive the public of information to which the member knows or has reason to know the public is entitled under this article, is guilty of a misdemeanor. Prohibition against use of certain facilities No state agency shall conduct any meeting, conference, or other function in any facility that prohibits the admittance of any person, or persons, on the basis of ancestry or any characteristic listed or defined in Section 11135, or that is inaccessible to disabled persons, or where members of the public may not be present without making a payment or purchase. As used in this section, "state agency" means and includes every state body, office, officer, department, division, bureau, board, council, commission, or other state agency. Prohibition against closed sessions except as expressly authorized Except as expressly authorized by this article, no closed session may be held by any state body. Identification of crime victim No notice, agenda, announcement, or report required under this article need identify any victim or alleged victim of crime, tortious sexual conduct, or child abuse unless the identity of the person has been publicly disclosed. Discrimination by licensing board (a) It shall be unlawful for a licensing board to require any examination or establish any other qualification for licensing that has an adverse impact on any class by virtue of its race, creed, color, national origin or ancestry, sex, gender, gender identity, gender expression, age, medical condition, genetic information, physical disability, mental disability, or sexual orientation, unless the practice can be demonstrated to be job related. Where the commission, after hearing, determines that an examination is unlawful under this subdivision, the licensing board may continue to use and rely on the examination until such time as judicial review by the superior court of the determination is exhausted. If an examination or other qualification for licensing is determined to be unlawful under this section, that determination shall not void, limit, repeal, or otherwise affect any right, privilege, status, or responsibility previously conferred upon any person by the examination or by a license issued in reliance on the examination or qualification. Nothing in this subdivision shall prohibit any licensing board, in connection with prospective examinations, licensure, or certification, from inviting individuals with physical or mental disabilities to request reasonable accommodations or from making inquiries related to reasonable accommodations. Consumer fraud investigations; Access by district attorney to records of other agencies. Consumer fraud investigations; Access by district attorney to records of other agencies (a) Notwithstanding any other provision of law, including any provision making records confidential, and including Title 1. It includes, but is not limited to, all of the following: (1) the Dental Board of California. Amended and renumbered by Stats 1980 ch 676 § 113; Amended Stats 1988 ch 1448 § 30; Stats 1989 ch 886 § 84. Former Division 10, entitled "Narcotics," consisting of §§ 1100011853, was enacted Stats 1939 ch 60 and repealed Stats 1972 ch 1407 § 2. Nomenclature of substances listed the controlled substances listed or to be listed in the schedules in this chapter are included by whatever official, common, usual, chemical, or trade name designated. Schedule I list of controlled substances (a) the controlled substances listed in this section are included in Schedule I. Unless specifically excepted or unless listed in another schedule, any of the following opiates, including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers whenever the existence of those isomers, esters, ethers, and salts is possible within the specific chemical designation: (1) Acetylmethadol. Unless specifically excepted or unless listed in another schedule, any of the following opium derivatives, its salts, isomers, and salts of isomers whenever the existence of those salts, isomers, and salts of isomers is possible within the specific chemical designation: (1) Acetorphine. Synthetic equivalents of the substances contained in the plant, or in the resinous extractives of Cannabis, sp. Because nomenclature of these substances is not internationally standardized, compounds of these structures, regardless of numerical designation of atomic positionscovered. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect on the central nervous system, including its salts, isomers, and salts of isomers whenever the existence of those salts, isomers, and salts of isomers is possible within the specific chemical designation: (1) Mecloqualone. Unless specifically excepted or unless in another schedule, any of the following opiates, including its isomers, esters, ethers, salts, and salts of isomers, esters, and ethers whenever the existence of those isomers, esters, ethers, and salts is possible within the specific chemical designation, dextrorphan and levopropoxyphene excepted: (1) Alfentanyl. This substance is authorized for the treatment of narcotic addicts under federal law (see Part 291 (commencing with Section 291. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a stimulant effect on the central nervous system: (1) Amphetamine, its salts, optical isomers, and salts of its optical isomers. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect on the central nervous system, including its salts, isomers, and salts of isomers whenever the existence of those salts, isomers, and salts of isomers is possible within the specific chemical designation: (1) Amobarbital. The Attorney General, or his or her designee, may, by rule or regulation, add additional analogs of phencyclidine to those enumerated in this paragraph after notice, posting, and hearing pursuant to Chapter 3. The Attorney General shall, in the calendar year of the regular session of the Legislature in which the rule or regulation is adopted, submit a draft of a proposed bill to each house of the Legislature which would incorporate the analogs into this code. No rule or regulation shall remain in effect beyond January 1 after the calendar year of the regular session in which the draft of the proposed bill is submitted to each house. However, if the draft of the proposed bill is submitted during a recess of the Legislature exceeding 45 calendar days, the rule or regulation shall be effective until January 1 after the next calendar year. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances: (1) Immediate precursor to amphetamine and methamphetamine: (A) Phenylacetone. Some trade or other names: phenyl-2 propanone; P2P; benzyl methyl ketone; methyl benzyl ketone. Amended Stats 1985 ch 3 § 1, effective January 29, 1985, ch 21 § 3, effective April 2, 1985, ch 1098 § 1. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation that contains any quantity of the following substances having a depressant effect on the central nervous system: (1) Any compound, mixture, or preparation containing any of the following: (A) Amobarbital (B) Secobarbital (C) Pentobarbital or any salt thereof and one or more other active medicinal ingredients that are not listed in any schedule. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below: (1) Not more than 1. Any material, compound, mixture, or preparation containing chorionic gonadotropin or an anabolic steroid (excluding anabolic steroid products listed in the "Table of Exempt Anabolic Steroid Products" (Section 1308. Any of the following hallucinogenic substances: dronabinol (synthetic) in sesame oil and encapsulated in a soft gelatin capsule in a drug product approved by the federal Food and Drug Administration. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below: (1) Not more than 1 milligram of difenoxin and not less than 25 micrograms of atropine sulfate per dosage unit. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of isomers whenever the existence of those salts, isomers, and salts of isomers is possible within the specific chemical designation: (1) Alprazolam. Any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers (whether optical, position, or geometric), and salts of those isomers, whenever the existence of those salts, isomers, and salts of isomers is possible: (1) Fenfluramine. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture or preparation which contains any quantity of pentazocine, including its salts. Schedule V list of controlled substances (a) the controlled substances listed in this section are included in Schedule V. Any compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below, which shall include one or more nonnarcotic active medicinal ingredients in sufficient proportion to confer upon the compound, mixture, or preparation valuable medicinal qualities other than those possessed by narcotic drugs alone: (1) Not more than 200 milligrams of codeine per 100 milliliters or per 100 grams. When prescription for controlled substance issued by prescriber in another state for delivery to patient in another state may be dispensed by California pharmacy; Report to Department of Justice. Request for, or release of, controlled substance history; Guidelines; Initiation by Department of Justice; Confidentiality [Operative term contingent; Repealed effective January 1, 2022]. Application to access controlled substance history; Guidelines; Referral by Department of Justice; Confidentiality; Liability [Operative July 1, 2021]. Persons permitted to write prescription No person other than a physician, dentist, podiatrist, or veterinarian, or naturopathic doctor acting pursuant to Section 3640. Requirements for prescriptions; Oral or electronic prescription; Written records Except as provided in Section 11167, no person shall prescribe a controlled substance, nor shall any person fill, compound, or dispense a prescription for a controlled substance, unless it complies with the requirements of this section. If the prescriber does not specify this address on the prescription, the pharmacist filling the prescription or an employee acting under the direction of the pharmacist shall write or type the address on the prescription or maintain this information in a readily retrievable form in the pharmacy. Any person who transmits, maintains, or receives any electronically transmitted prescription shall ensure the security, integrity, authority, and confidentiality of the prescription.
Buy cheap montelukast on line
The board shall not renew the license of any person who fails to asthma treatment xopenex buy montelukast 4mg on line comply with this section unless the person pays the penalty fee prescribed in Section 4905 asthma getting worse order montelukast from india. An applicant for the renewal of a license shall specify in his or her application whether he or she has changed his or her mailing address and the board may accept that statement as evidence of the fact nervous asthma definition generic montelukast 4 mg with amex. Registration of place of practice (a) All premises where veterinary medicine, veterinary dentistry, veterinary surgery, and the various branches thereof is being practiced shall be registered with the board. The certificate of registration shall be on a form prescribed in accordance with Section 164. Substitution of the responsible licensee manager may be accomplished by application to the board if the following conditions are met: (1) the person substituted qualifies by presenting satisfactory evidence that he or she possesses a valid, unexpired, and unrevoked license as provided by this chapter and that the license is not currently under suspension. Form for application to register premise; Application for renewal (a) Each application to register a premise pursuant to Section 4853 shall be made on a form provided by the board. Suspension or revocation of registration; Failure to keep premises clean When it has been adjudicated in an administrative hearing that the licensee manager has failed to keep the premises and all equipment therein in a clean and sanitary condition as provided for in subdivision (h) of Section 4883, or is in violation of any of the provisions of Section 4854, the board may withhold, suspend, or revoke the registration of veterinary premises, or assess a fine of not less than fifty dollars ($50) nor more than five hundred dollars ($500) per day until such violation has been rectified, or by both such suspension and fine. The total amount of any fine assessed pursuant to this section shall not exceed five thousand dollars ($5,000). Suspension or revocation of registration; When license ceases responsibility for premises or when license revoked or suspended the board shall withhold, suspend or revoke registration of veterinary premises: (a) When the licensee manager set forth in the application in accordance with Section 4853 ceases to become responsible for management of the registered premises and no substitution of the responsible licensee manager has been made by application as provided for in Section 4853. Premise registration expired for five years A premise registration that is not renewed within five years after its expiration may not be renewed and shall not be restored, reissued, or reinstated thereafter. However, an application for a new premise registration may be submitted and obtained if both of the following conditions are met: (a) No fact, circumstance, or condition exists that, if the premise registration was issued, would justify its revocation or suspension. Sanitation requirements for practice All premises where veterinary medicine, veterinary dentistry, or veterinary surgery is being practiced, and all instruments, apparatus and apparel used in connection with those practices, shall be kept clean and sanitary at all times, and shall conform to those minimum standards established by the board. Consumer notification of diagnosis and treatment by graduate students (a) Every off-campus educational program site shall display in a conspicuous place a consumer notification specifying that the veterinary facilities are also being used for 32 diagnosis and treatment of animals by graduate students enrolled in a veterinary medicine program. Written records A veterinarian subject to the provisions of this chapter shall, as required by regulation of the board, keep a written record of all animals receiving veterinary services, and provide a summary of that record to the owner of animals receiving veterinary services, when requested. The minimum amount of information which shall be included in written records and summaries shall be established by the board. The minimum duration of time for which a licensed premise shall retain the written record or a complete copy of the written record shall be determined by the board. Inspection of records by board; Inspection of equipment and drugs (a) All records required by law to be kept by a veterinarian subject to this chapter, including, but not limited to, records pertaining to diagnosis and treatment of animals and records pertaining to drugs or devices for use on animals, shall be open to inspection by the board, or its authorized representatives, during an inspection as part of a regular inspection program by the board, or during an investigation initiated in response to a complaint that a licensee has violated any law or regulation that constitutes grounds for disciplinary action by the board. Limits on disclosure of information about animals or about clients responsible for them (a) A veterinarian licensed under this chapter shall not disclose any information concerning an animal receiving veterinary services, the client responsible for the animal receiving veterinary services, or the veterinary care provided to an animal, except under any one of the following circumstances: (1) Upon written or witnessed oral authorization by knowing and informed consent of the client responsible for the animal receiving services or an authorized agent of the client. In these situations, the entire medical record for the horse shall be made available upon request to anyone responsible for the direct medical care of the horse, including the owner, trainer, or veterinarian, the California Horse Racing Board or any other state or local governmental entity, and the racing association or fair conducting the licensed horse race. In addition, any veterinarian who negligently releases confidential information shall be liable in a civil action for any damages caused by the release of that information. Legislative intent It is the intent of the Legislature that the Veterinary Medical Board seek ways and means to identify and rehabilitate veterinarians and registered veterinary technicians with impairment due to abuse of dangerous drugs or alcohol, affecting competency so that veterinarians and registered veterinary technicians so afflicted may be treated and returned to the practice of veterinary medicine in a manner that will not endanger the public health and safety. Committee composition One or more diversion evaluation committees is hereby authorized to be established by the board. Each diversion evaluation committee shall be composed of five persons appointed by the board. Each diversion evaluation committee shall have the following composition: (a) Three veterinarians licensed under this chapter. The board in making its appointments shall give consideration to recommendations of veterinary associations and local veterinary societies and shall consider, among others, where appropriate, the appointment of veterinarians who have recovered from impairment or who have knowledge and expertise in the management of impairment. Each person appointed to a diversion evaluation committee shall have experience or knowledge in the evaluation or management of persons who are impaired due to alcohol or drug abuse. It shall require the majority vote of the board to appoint a person to a diversion evaluation committee. Each appointment shall be at the pleasure of the board for a term not to exceed four years. In its discretion the board may stagger the terms of the initial members appointed. The board may appoint a program director and other personnel as necessary to carry out provisions of this article. Quorum Three members of a diversion evaluation committee shall constitute a quorum for the transaction of business at any meeting. Chairpersons Each diversion evaluation committee shall elect from its membership a chairperson and a vice chairperson. Administration of article the board shall administer the provisions of this article. Diversion program criteria; Examining physicians (a) the board shall establish criteria for the acceptance, denial, or termination of veterinarians and registered veterinary technicians in a diversion program. Any reports made under this article by the administrative physician shall constitute an exception to Sections 994 and 995 of the Evidence Code. Notice to participants of rights and responsibilities the diversion evaluation committee shall inform each veterinarian and registered veterinary technician who requests participation in a program of the procedures followed in the program, of the rights and responsibilities of the veterinarian and registered veterinary technician in the program, and of the possible results of noncompliance with the program. Duties and responsibilities Each diversion evaluation committee shall have the following duties and responsibilities: (a) To evaluate those veterinarians and registered veterinary technicians who request participation in the program according to the guidelines prescribed by the board and to consider the recommendation of the administrative physician on the admission of the veterinarian or registered veterinary technician to the diversion program. Closed sessions Notwithstanding the provisions of Article 9 (commencing with Section 11120) of 36 Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code, relating to public meetings, a diversion evaluation committee may convene in closed session to consider reports pertaining to any veterinarian or registered veterinary technician requesting or participating in a diversion program. A diversion evaluation committee shall only convene in closed session to the extent that it is necessary to protect the privacy of a veterinarian or registered veterinary technician. Required cooperation Each veterinarian and registered veterinary technician who requests participation in a diversion program shall agree to cooperate with the treatment program designed by a diversion evaluation committee. Providing legal representation the board shall provide for the representation of any persons making reports to a diversion evaluation committee or the board under this article in any action for defamation. Program registration fees the board shall charge each veterinarian and registered veterinary technician who is accepted to participate in the diversion program a diversion program registration fee. The diversion program registration fee shall be set by the board in an amount not to exceed four thousand dollars ($4,000). In the event that the diversion program registration exceeds five hundred dollars ($500), the board may provide for quarterly payments. Inspection of premises; Notice of deficiencies; Interim suspension order; Licensed investigators. Conduct of proceedings; Assessment and deposit of fine the board may revoke or suspend for a certain time the license or registration of any person to practice veterinary medicine or any branch thereof in this state after notice and hearing for any of the causes provided in this article. In addition to its authority to suspend or revoke a license or registration, the board shall have the authority to assess a fine not in excess of five thousand dollars ($5,000) against a licensee or registrant for any of the causes specified in Section 4883. The proceedings under this article shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the board shall have all the powers granted therein.