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By: X. Kalesch, M.A.S., M.D.

Professor, University of Kentucky College of Medicine

Building roads has produced a car-oriented society in which the other modal alternatives have little opportunity to coexist allergy bracelets buy 5mg clarinex with visa. Car ownership is beyond the ability of the transport planner to control directly and the question remains if it should allergy to semen clarinex 5 mg overnight delivery. But car use and ownership is affected by land use and density allergy forecast greenwich ct buy clarinex 5 mg lowest price, both elements that planners can affect allergy hair loss purchase clarinex 5 mg without prescription. High population densities, in particular, favor walking, bicycling and public transit use. It is for this reason that a great deal of attention in planning is being paid to densi cation and integration. This includes concentrating development along well-served transport corridors (transitoriented development) and increasing densities in areas undergoing rehabilitation. Managing the demand for transport is made up of a large number of small interventions that cumulatively can impact car use, but in particular improve the livability of cities. Parking spaces are provided, usually close to an expressway, where drivers can board buses that provide service to the city center. Measures that seek to reduce the speed of vehicles in urban areas, such as speed bumps and street narrowing. For residential streets the goal is to make their use by car drivers unattractive because of the obstacles; for thoroughfares the objective is to reduce the average speeds. The measures indicate the need for much greater attention to street design and layout. Lanes on major thoroughfares and expressways that are reserved for buses, taxis and passenger vehicles with several occupants. This has become an important feature of transport planning in North America, where major highway expansion projects offer priority lanes. The goal is to encourage use of buses and high occupancy vehicles that can be seen to travel at higher speeds along the reserved lanes by other drivers who may be stuck in traf c jams. One of the great problems in transport planning is that demand is concentrated in two main peak periods. In the past, efforts were made to meet this demand by increasing road capacity, which was never suf cient, and resulted in an underuse of the capacity the other 20 hours each day. Promoting exible schedules and encouraging telecommuting are policies that are seeking to spread out the demand for transport over more hours and even reducing the demand altogether. In some countries, particularly the Netherlands, the bicycle is an important mode of travel. It is a green and healthy mode, but in automobile-dependent cities, the bicycle does not share the roads easily with trucks and cars. Encouraging greater use of the bicycle requires signi cant planning adjustments, such as the provision of bicycle lanes and bike stands. In many areas of high population density, the quality of life (enhanced safety, less pollution, etc. In Europe this has become a distinctive feature of the historic cores of many cities. Yet it is the only major alternative to the car in these cities, and thus enhancing the use of transit has become a major planning objective. Improvements include making transit more attractive, by improving bus schedules and improving the appearance and comfort of transit vehicles and stations. These include extending commuter rail services, and constructing new systems such as light and heavy rail modes. While planning interventions may have a positive cumulative effect in shaping transport demand, some economists suggest that a more direct approach involving imposing more stringent cost measures on car users is necessary. It is widely accepted that car users pay only a small proportion of the actual costs of their vehicle use. Decision makers have dif culty in agreeing to impose charges when there is a diversity of evidence about external costs.

The low proportion of macropters in the Rhode Island populations could be an indication that the conditions in Willapa Bay are favorable for that ecotype allergy treatment delhi order clarinex 5 mg without prescription. So far allergy shots expensive cheap 5mg clarinex overnight delivery, these results suggest that the Rhode Island population may be best suited to the Willapa environment allergy pro 5mg clarinex otc, at least during the summer months allergy medicine cough buy clarinex 5mg amex. The timing of spring emergence, winter survival, and overall population growth from year to year will determine which population is most successful in the long term. In particular, the lowest tidal areas sustain high levels of disturbance during the winter and are unlikely to harbor dense populations of P. The use of multiple biological control agent species can enhance biocontrol effectiveness by contributing to control in different habitats (Nowierski et al. It can also enhance control by imposing additive stress on the plants (Harris 1981) and by increasing the odds that at least one very effective agent will be established (Myers 1985). Natural enemies of Spartina alterniflora from the Atlantic Coast of North America. The list is a compilation from personal field surveys and the following literature: Davis and Gray (1966); Denno (1977); McCoy and Rey (1981); Montague et al. We completed a literature review and field surveys along the Atlantic Coast in 2001 and 2002. These investigations revealed at least 22 insect species plus a fungus and a snail with apparent specialization on S. Two promising species are the picture-wing flies (Ottitidae) Chaetopsis aenea and Chaetopsis apicalis. The - 270 - Proceedings of the Third International Conference on Invasive Spartina Chapter 4: Spartina Control and Management larvae of these flies develop inside young S. The result is death of the shoot tip and no flower production in nearly 100% of the stems that are infested. By comparison, it takes approximately 200 planthoppers to kill a shoot (Daehler and Strong 1997). In our surveys, we found several sites where the rate of shoot death due to this insect was greater than 50%. Other promising candidates include the sapsucking insects, Trigonotylus uhleri, Haliaspis spartinae, and Prokelisia dolas. All three of these species have the advantage that they already occur in California, where the native Spartina foliosa occurs. Impacts to Spartina in the lab (Daehler and Strong 1997) and in field cages (Grevstad et al. Impacts on a much larger scale were beginning to be seen in 2007 prior to herbicide treatment of biocontol sites. The success of a biological control program for Spartina could be further improved with the screening and introduction of additional biocontrol agents. Several promising candidate agents have been selected from a diverse community of insects and other organisms that use S. Biological control could be a valuable tool in other parts of the world where Spartina has invaded, especially where complete eradication is too expensive or not feasible. Even where traditional control programs are underway, biological control can contribute to Spartina reduction in an integrated weed management approach, or it can serve as a backup in the case that complete eradication is not achieved. Unfortunately, San Francisco Bay is not a good target location for biological control because of the risk to the native S. However, it would be an excellent option in China, New Zealand, and Australia where there are no native Spartina species. In particular, the state and federal agencies involved in the control program increased capacity and improved the effectiveness of the herbicide control treatments and eventually sprayed all Spartina-infested areas in Washington including biocontrol sites in an effort to eradicate the plant. As of 2007, prior to herbicide treatment of the last remaining biocontrol site, the P. Department of Fish and Wildlife, Coastal Resource Alliance, Washington State Department of Agriculture, Washington State Department of Natural Resources, and the Willapa National Wildlife Refuge. The use of molecular assays to identify plant pathogenic organisms vectored by biological control agents.

Clones in soft mud substrates with proximity to fresh water sources exhibited significantly higher areal growth rates than those on sand allergy blood test results discount clarinex 5 mg without a prescription. Clones at higher elevations in general are growing more quickly than those at lower elevations allergy symptoms in 9 month old order 5mg clarinex with visa, although differences were not significant in all elevational classes allergy testing ct safe clarinex 5mg. Seedling recruitment is another demographic property that is critical to the successful spread of S allergy shots three times a week proven 5 mg clarinex. New individuals observed in 1997 (polygons less than three m in diameter without earlier counterparts) out-numbered those that were present in 1994 by an order of magnitude: over 46,000 single new plants versus 4,500 of similar size in 1994. By 2000, the number of new individuals recruiting into the population rose by another order of magnitude to more than 155,550 new plants. Again, recruitment was greatest on those parts of the bay with soft mud substrates and in proximity to fresh water sources (Civille 2005). The lateral growth and merger data are providing important insights into abiotic factors that control Spartina growth, and were used to populate and validate theoretical model development and exploration (Taylor et al. The high resolution spatial datasets have provided demographic and ecological information at a level of detail and bay-wide scale that could never have been collected by individual ecologists with transects and sampling hoops across such difficult and remote terrain. The photographic record that has been maintained and cataloged provides unique opportunities to look into the history of this invasion, and may provide insight into the mechanisms and characteristics of other invasions. The mapping and photogrammetry staff in these agencies provided invaluable advice, support and expertise as this project was developed. Earlier Spartina mapping efforts by Barb Aberle, Linda Kunze, Elizabeth Lanzer, and Tom Mumford made this more sophisticated approach possible. The Biology and Control of Introduced Spartina (cordgrass) Worldwide and Recommendations for its Control in Washington. Invasion ecology and pattern assessed through remote sensing: Spartina alterniflora in Willapa Bay, Washington. Reconstructing a century of Spartina invasion with historical records and contemporary remote sensing. Impacts of introduced smooth cordgrass (Spartina alterniflora) on Pacific estuaries. Partnerships and new technologies: the Joint Airborne Lidar Bathymetry Technical Center of Expertise. The transplanting of eastern oysters to Willapa Bay, Washington with notes on the native oyster industry. Over the four years of observation, yearly average estuary-wide recruitment varied from a low of 12 per hectare (ha) to a high of 500/ha. Variability across individual census plots was even greater, ranging from 0 per ha to over 4000/ha. These results have broad implications for the management of invasive Spartina populations. Poor recruitment years afford windows of opportunity for effective control, but could equally lead to complacency and an inadequate response during recruitment pulses. The strong relationship between local seed production and local recruitment suggests that control strategies that do not explicitly account for inter-regional dispersal can still be successful over the short-term, even if long-term management requires an explicit understanding of regional dispersal pathways. Finally, the strong differences in recruitment and growth patterns caused by substrate differences may allow the categorization of sites by recruitment risk. This large-scale invasion threatens to disrupt many important ecosystem services such as habitat for oysters and migratory birds, nutrient cycling, and storm water runoff control (Sayce 1988). A consortium of local residents, state agencies and the Federal government is currently attempting to manage the invasion with the ultimate goal of eradicating S. There have been few attempts to comprehensively manage such a large plant invasion. Property ownership, funding allocations, and the idiosyncratic interests of stakeholders usually force management to occur on an ad hoc and project-specific basis. However, given the large extent of many invasions there is a growing appreciation for the need to manage invasive plants at explicitly landscape scales (With 2002).

Instead of discussing these medical conditions allergy forecast yonkers ny purchase 5mg clarinex amex, the Implementation Report compares cross-sex hormone therapy for gender dysphoria with other medical conditions that are plainly not comparable allergy shots rapid desensitization 5mg clarinex otc. With medically appropriate care allergy treatment nasal spray order clarinex 5 mg free shipping, it is possible for transgender service members to resolve the clinically significant gender dysphoria without any residual symptoms or impairment allergy bomb generic clarinex 5mg otc. Comparisons made to schizophrenia and bipolar disorder in the Implementation Report are inappropriate, as these two conditions constitute serious mental illnesses for which treatments are often ineffective and for which the notion of "cure" is nonsensical. In any case, the military recently adopted universal deployment standards that already mandate the discharge of service members who are nondeployable "for more than 12 consecutive months, for any reason. The military has generally applicable standards for determining whether a service member may continue to serve despite periods of limited non-deployability. A determination of non-deployability must be based on the status of the individual and not on arbitrary, non-evidence based determinations. Although the Implementation Report states that one commander predicted that transgender service members beginning a course of hormone therapy will be non-deployable for as long as two-and-a-half years, the Implementation Report does not cite any data to support that assertion. There is no medical basis for the Implementation Reports suggestion that cross-sex hormone therapy could render a transgender service member non-deployable for a full twelve months. There is also no basis to presume that surgical care for gender dysphoria will render transgender service members non-deployable for extended periods of time. Moreover, transgender service members can schedule medical procedures to ensure that they do not interfere with deployment. This approach is routinely done for other medically necessary procedures, such as orthopedic surgeries that allow for flexibility in the timing of the surgery. There is no medical basis to conclude that all, or even most, service members undergoing treatment for gender dysphoria are categorically unfit to serve. Carson, have been retained by counsel for Plaintiffs as an expert in connection with the above-captioned litigation. My professional background and qualifications are set forth in my previous declaration dated August 28, 2017. In that capacity, and at the direction of the Secretary of Defense, I led a group of senior personnel drawn from all of the armed services to develop, over many months of information collection and analysis, a Department-wide policy regarding service by transgender people (the "Open Service Policy"). The purpose of this supplemental declaration is to respond to the "Department of Defense Report and Recommendations of Military Service By Transgender Persons," which I refer to in this declaration as the "Implementation Report. I have knowledge of the matters stated in this declaration and have collected and cite to relevant literature concerning the issues that arise in this litigation. As discussed in my previous declaration, on July 28, 2015, then-Secretary of Defense Ashton B. That mandate did not mean, as the Implementation Report insinuates, that "standards were adjusted or relaxed to accommodate service by transgender persons. Rather, instead of simply assuming that the medical needs of transgender service members were inconsistent with generally applicable standards for fitness or deployability, we conducted an evidence-based assessment to determine whether those prior assumptions were actually true. We began our work based on reports from commanders that there were already transgender individuals serving in the field and performing their duties well, so the task before us was not merely an abstract exercise to establish a policy on military service by transgender persons. Rather, the question was whether there was any reason these existing service members should be deemed unfit for service and involuntarily separated due to their transgender status. We were receiving questions from the field about whether these individuals could continue serving, and we needed to develop a consistent policy rather than leaving the issue to ad hoc determinations by commanders. Among other things, the Implementation Report ignores the significant contributions being made by transgender service members. The Implementation Report is atypical of military assessments of policy because it does not account for the service level impacts where its conclusions may result in discharge of thousands of people currently in service. The Implementation Report is also atypical of military assessment of policy because it does not consider the impacts of a reversal in policy with regard to the need to retrain command and troops. Nor does it account for the impacts a reversal of policy would have on non-transgender service members who may question whether other historically disadvantaged groups could be targeted for similar discriminatory treatment.

Commodity chain (supply chain) A functionally integrated network of production allergy testing infants cheap 5mg clarinex otc, trade and service activities that covers all the stages in a supply chain allergy medicine psoriasis buy clarinex 5 mg with visa, from the transformation of raw materials allergy medicine drowsiness generic clarinex 5mg, through intermediate manufacturing stages allergy symptoms 7 months cheap clarinex 5 mg amex, to the delivery of a nished good to a market. The chain is conceptualized as a series of nodes, linked by various types of transactions, such as sales and intra rm transfers. Common carrier A transportation company engaged in the business of handling persons or freight for compensation and for all customers impartially. Commuter bus service Fixed route bus service, characterized by service predominantly in one direction during peak periods, limited stops, use of multi-ride tickets and routes of extended length, usually between the central business district and outlying suburbs. Commuter bus service may also include other service, characterized by a limited route structure, limited stops and a coordinated relationship to another mode of transportation. Commuter rail Railroad local and regional passenger train operations between a central city, its suburbs and/or another central city. It may be either locomotive-hauled or self-propelled, and is characterized by multi-trip tickets, speci c station-to-station fares, railroad employment practices, and usually only one or two stations in the central business district. Conference (liner) An association of ship owners operating in the same trade route who operate under collective conditions such as tariff rates and shared capacity. They provide international liner services for the carriage of cargo on a particular route or routes within speci ed geographical limits and which has an agreement or arrangement within the framework of which they operate under uniform or common freight rates and any other agreed conditions with respect to the provision of liner services. Congestion Occurs when transport demand exceeds transport supply in a speci c section of the transport system. Urban congestion mainly concerns two domains of circulation, private and public, often sharing the same infrastructures. Connecting carrier A carrier that has a direct physical connection with another or forming a connecting link between two or more carriers. Consolidated shipment A method of shipping whereby an agent (freight forwarder or consolidator) combines individual consignments from various shippers into one shipment made to a destination agent, for the bene t of preferential rates. Consolidation provides shippers access to better rates than would be otherwise attainable. Constant dollars Figures where the effect of change in the purchasing power of the dollar has been removed. Usually the data are expressed in terms of dollars of a selected year or the average of a set of years. Container A large standard size metal box into which cargo is packed for shipment aboard specially con gured transport modes such as oceangoing container ships. It is designed to be moved with common handling equipment enabling high speed intermodal transfers in economically large units between ships, rail cars, truck chassis and barges using a minimum of labor. The container, therefore, serves as the transfer unit rather than the cargo contained therein. Container ship A cargo vessel designed and constructed to transport, within speci cally designed cells, portable tanks and freight containers which are lifted on and off with their contents intact. Full container ships are equipped with permanent container cells with little or no space for other types of cargo. Partial container ships are considered multi-purpose container vessels, where one or more but not all compartments are tted with permanent container cells, and the remaining compartments are used for other types of cargo. This category also includes container/car carriers, container/rail car carriers and container/roll-on-roll-off vessels. Containerization Refers to the increasing and generalized use of the container as a means of freight transport. As a standard and versatile means, the container has greatly contributed to intermodal transportation of merchandise and its widespread use, therefore, is responsible for profound mutations in the transport sector. Through reduction of handling time, labor costs and packing costs, container transportation allows considerable increases in speed of rotation along a circuit and thus entails a better optimization of time and money. Conventional car A single platform at car designed to carry a trailer or container. Conventional cars are equipped with one or two stanchions, depending on length, for shipment of one or two trailers. Corridors are multi-scalar entities depending on what types of ow are being investigated.

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