Order 50 mg minocycline free shipping

Plaintiffs Have Standing to Challenge the Accession and Retention Directives For the foregoing reasons, Plaintiffs have established two injuries in fact with respect to the Accession and Retention Directives. The hands-on component will feature equipment, testing methods, sensors, clinical applications, test protocols and patient set up. Generally with the metabolic clinic annually, but will be determined prior to discharge from hospital following transplant 3. We are all carriers of Mycoplasma which may have spread from various bugs including mosquitoes. The public health impact of kidney disease is significantly high with about 20 million Americans having chronic kidney disease with a gross mortality rate for patients on dialysis being ~ 50-70 %. Possible mechanisms for disruption of hormone homeostasis include direct effects on gonadal steroid synthesis or altered hormone metabolism. In chronic effusions or during inflammatory processes, mesothelial cells proliferate and become very large. Risk of bias was low for 28 percent of the trials, unclear for 61 percent, and high for 11 percent. Necrosis was characterized by neurons with irregularly smudged, basophilic, shrunken, and wrinkled chromatin or eosinophilic amorphous cytoplasm. Unfortunately in many cases, public health impacts cannot always be predicted because vog releases and resulting areas of impact cannot always be predicted accurately. Treatment: Septra (Co-trimoxazole (800 mg of sulfamethoxazole and 160 mg of trimethoprim) given twice daily for 24 months to prevents relapses in patients. We have developed a method for analyzing microarray dose-response data that is flexible, while still capable of capturing the complexity of the responses. The type of errors most commonly reported across studies involved visual scanning and checking behaviours prior to lane changing and pulling out into traffic as well as unspecified difficulties negotiating T-intersections, traffic light intersections, and roundabouts [48, 50, 51]. This methodology is therefore useful in evaluating the overall neurotoxicity of pesticide mixtures. Nerves, have an outer covering called Myelin, which is like a roll of paper wrapped around the axon (axon is inner portion of the nerve). In Gratz, the plaintiff merely stated an intention to apply as a transfer student- surely it was possible that academic failures at his current institution, or other hardships, would have prevented him from applying. No differences between Tg2576 and wild-type were noted in spatial task acquisition. Hattori, "Videomanometry of the pelvic organs: a comparison of the normal lower urinary and gastrointestinal tracts," International Journal of Urology, vol. The health effects of tungsten are of concern to both the public and military personnel. Brazil has rampant Aids while Argentina does not, it depends which country bought how many vials of the vaccine. It is courteous and respectful to consider social norms and mandatory to adhere to military standards of conduct. Hypoxic insult to the lung initiates a cascade of events that ultimately results in tissue damage. Calendula is derived from the whole calendula plant and used much like herbal preparations are to promote the healing of minor Cuts and scrapes, cool Sunburns, and relieve skin irritations. Remember to only use natural foods wile you fast and plenty of water with sea salt. Age, Race and Sex Dose adjustment on the basis of age, race, and sex is not necessary. Accordingly, the Mattis Implementation Plan effectively translates into a ban on transgender persons in the military. Exposure to isocyanates has been associated with occupational airway diseases, including asthma. Allopathic medicine cures of Asthma In adults a 2 weeks course with oral doxycycline (100 mg twice daily), azithromycin (1000 mg once weekly). How often is it difficult for you to understand or communicate with your health care provider due to language problems? The effect of this is to continue the July 2016 medical guidance tmtil the Secretary promulgates final policy implementing the direction from the Commander In C hief of the Ar:ned Forces. Our findings suggest that low-level light therapy may attenuate the effects of diabetes on renal function and stimulate antioxidant protective pathways in the diabetic rat model. However, the mechanisms underlying the increased susceptibility of the aging kidney to injury remain poorly defined.

Buy minocycline 50mg on line

Prolotherapy: A technique in which dextrose injection is given in the painful tissue around a joint to help improve joint motion and overcome joint disease. Rather, according to the Circuit, "Adarand rests on the common-sense notion that when a contractor depends for its livelihood on competing for government contracts, and when the government has committed itself to doling out those contracts on a race-conscious basis, it stands to reason that the contractor will soon be competing on an uneven playing field. Analysis of the gene expression data indicated that all chemicals induced a dose-dependent increase in the number of active responses with a strong correlation to the corresponding stimulation indices. Dextrose (D50) should only be administered to a patient with a confirmed blood glucose level less that 60 mg / dl. Airman Bristol is uncertain if she needs to report the procedure to her chain of command. Based on poor strength evidence there is no evidence that any one triptan has a particular advantage or disadvantage over others in any subgroups based on age, gender, race, use of prophylactic treatment, or association with menstruation. Azathioprine (Imuran) is a broad spectrum immunosuppressive agent and has a steroid sparing action, provides long-term immunosuppression with relatively few side effects the dose is 2. Celiac disease can present with similar symptoms and needs to be ruled for treatment look under the gastrointestinal chapter. These results suggest that arsanilic acid may impact on germinal cells at embryo development stage and affects more on myeloid, muscle and neuroblast cells after maturation. Here, the severity of motor symptoms was positively correlated with the degree of olfactory dysfunction which might indicate patients with a latent basal ganglia dysfunction. Neither C-pneumoniae nor H-pylori antibody status was related to response in treatment. Creatine is a substrate that assists in muscle contraction, helping to maximize physical performance and reduce exercise fatigue. Other erythroid precursor stages are typically absent (erythroid aplasia), although in immunosuppressed patients, erythroid hyperplasia may be seen with viral inclusions present in all stages of erythroid differentiation. These include: · a history of chest surgery, includir,g but not limited to the surgical removal of the breasts,20 and genital surgery, including but not limited to the surgical removal of the testicles;2 1 See. This study found that the percentage of correct predictions for the drugs was 38% when considering all known human metabolites, while correct predictions based on major metabolites was significantly higher at 62%. Age and/or gender could either be specified or randomly chosen from a full population distribution (gender ratio depends on age). Basic tools to collect information from a child and the importance of checking extraocular movements in pediatrics will be discussed. These patients tend to have traits of both obsessive-compulsive and impulse control disorders [18]. Do not delay oxygen administration in patients experiencing severe respiratory distress. Discussion: A crosses the blood-brain barrier and induces peripheral and central muscarinic effects. These findings have important implications for understanding the potential health effects of nanoparticle exposure. Determined endpoints were compared to physical-chemical properties (total polar surface area, calculated partition coefficients (cLogD, cLogP), basic pKa and molecular weight). Prolactin-producing pituitary tumors often cause gynecomastia and erectile dysfunction in male patients. Symptoms: the patient usually presents with back pain and then rapidly develops weakness. At 4hr, a marked systemic inflammatory response was evidenced by increased inflammatory serum proteins. In the workplace, high levels of chronic inhalation exposure to inorganic Mn have been associated with a Parkinsonian-type syndrome known as manganism which may or may not be reversible with cessation of exposure. Then the immune system mounts an attack on the organism, but in people with weak immune systems, this attack also damages their own body. Predisposing factors include prolonged operation, neutropenia, high level immunosuppression, choledochojejunostomy and prolonged exposure to broad antibiotic coverage b.

Purchase minocycline 50 mg line

The application of nanotechnology to food packaging and as food or color additives has generated questions on the safety of nanomaterials in biological systems. Furthermore, the Department also finds lhat exempting such persons from well-established mental health, physica! Metallic nickel particles showed only a very slight activation of caspase-3, -6 and -9. When relevant, military practice has long adhered to this s1raightfonvard and logical demarcation. Because its toxicological effects are still unclear, we attempted to verify what are the specific toxic effects of HgS. Methods of natural healing An important method of natural healing is through diet. The combined activity of the lepidopteranactive proteins was consistent with dose additivity and there was no interaction between the lepidopteran and rootworm-active traits. Alternately, it may appear to contain numerous large fat 54 the College of American Pathologists 2019 Hematology, Clinical Microscopy, and Body Fluids Glossary Bone Marrow Cell Identification vacuoles, separated by delicate, light blue or pink cytoplasm. Preliminary results at a 10M dose for 24 hours reveal permeation to basolateral side of 3. The current results are particularly noteworthy given the largely comparable cognitive functioning of the two groups and despite the relatively low demands of the simulated driving task which utilized a conservative speed limit (50 km/hr), straight road, simple visual environment and use of a single driving event that differed only in terms of the cue and response requirement. For each given tumor type, statistical analysis was performed if the incidence in at least one dosed group was increased by at least two occurrences over the control group. Remember, everyone is responsible for fostering the best possible command climate within your unit. Macrophage Containing Neutrophil(s) (Neutrophage) the neutrophage is a macrophage containing one or more phagocytosed neutrophils. Radioactive iodine: the iodine damages thyroid cells to shrink the thyroid gland, to reduce hormone levels. Plaintiffs have established that they will be injured by these directives, due both to the inherent inequality they impose, and the risk of discharge and denial of accession that they engender. Women suffer frequent urinary tract infections, have menstrual periods, they also have pregnancy and stress, these factors trigger more autoimmune diseases in women. The human health concerns associated with radiological incidents, whether accidental or intentional, are well documented. It is not uncommon for patients with schizophrenia to experience illness exacerbations over a 1-year period, and it is also possible that many of these patients were not fully adherent to the study medication. TiCl4 is highly corrosive, hydrolyzing upon contact with moisture releasing heat, hydrochloric acid, and orthotitanic acids, thereby causing direct tissue damage in the lung. The cataplectic attacks are triggered by laughter; embarrassment, anger, athletic exertion or sexual intercourse. On approach to each traffic signal, participants either encountered no warning cue or one of two Warning Cues informing them about the phase of the upcoming traffic signal: Red or Green. The skin is indeed a biologically active barrier driving the exposure to compounds and their possible metabolites. The conservative statistical approach employed for this analysis lends credence to the results and uses general linear modeling to minimize the potential confounds of demographic variation (age and sex) and unrelated experimental manipulations (such as medication status). The comparison of rat and human data proposes congruence as well as differences in how liver slices from different species respond to these compounds. In the present study, we have re-examined this problem using isolated rabbit renal proximal tubules. A self-administered parental questionnaire was used to collect information on potential confounds, including parental socioeconomic status, education, occupation, and marriage status. Clay is a natural source of nutrients; we need to use the clay coming out of mines as it is safe. Exposure to environmental toxicants has been implicated as one of the causative factors of infertility in mammals. Until recently, methodological limitations have prevented comprehensive examination of many of the fundamental biological phenomena underlying both toxicological responses and risk assessment assumptions at or below the low end of traditionally-defined toxicity dose-response curves.

Purchase 50mg minocycline amex

Thus, although the technology to modify crops genetically has many advantages over more conventional approaches, there is some concern that introduction of a novel protein into the food supply could result in unintentional introduction of a new food allergen and could pose a risk to susceptible individuals. The primary end point was the proportion of patients who were headache pain-free 2 hours after patch activation. Mercury and silver absorbed from the amalgam can easily be removed by taking cilantro 100 mg daily for a month. Other important antibody markers include antihyaluronidase, antideoxyribonuclease-B, and antistreptokinase antibodies may be present. Notably, sweet taste receptors have been found in the intestine as well as in taste buds on the tongue. Particles such as metal nano-colloids (silver), metal oxide nanoparticles (aluminum oxide), and carbon-based nanostructures (C60). The prevalence of food allergy is increasing, providing greater incentive to understand the process and an urgent need for better safety assessment tools. The myelin sheath is the fatty covering, which acts as an insulator, on nerve fibers in the brain. Pelvic Inflammatory Disease · Be tactful when questioning the patient to prevent embarrassment. Hattori, "Orthostatic hypotension in a case with multiple sclerosis," Clinical Autonomic Research, vol. In one set of experiments, the antifungal activity of these two compounds was tested using strains of both S. The cells are typically small, but show some variability in size, ranging from 10 to 20 m. If there is a history of recent maternal narcotic use, consider Naloxone (Narcan) 0. Adenovirus: Incidence is as high as 10% in pediatric liver transplant recipients and 50% in intestinal transplant patients. Summary of Labeling Recommendation the Office of Clinical Pharmacology recommends the following labeling concepts be included in the final package insert: · Lumateperone should be taken with food. Patienst usually go to a dermatologist when in fact all autoimmune cases should be seen by a infectious disease specialist. The ToxCast Pathway Database will be used to organize this extensive dataset, to perform network analyses, and to visualize putative modes of action that are activated by particular chemicals. Oxidative damage was not detected but significant increases in caspase-3 activity were observed at 0. Tobacco smoke contains a mixture of over 4700 chemical components, many of which are toxic. Kuno, "Therapeutic effects of dopamine D1/D2 receptor agonists on detrusor hyperreflexia in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned parkinsonian cynomolgus monkeys," Journal of Pharmacology and Experimental Therapeutics, vol. This study aimed at comparing pyrethroid exposure between an urban and rural population of the Province of Quebec, Canada. Even that most enduring of documents, the Constitution of the United States, may be amended from time to time. Although, patients reported comparable tolerability against trospium chloride (77 %) and tolterodine (80 %), only 23 % of patients using oxybutynin considered the drug as tolerable. This includes transgender Service members who entered into military service after Jar. We cannot explain this discrepancy, but we hypothesize that it may be due to the differences in patient mean age between the 2 studies. Several sources of water samples were selected to provide representative ranges of naturally occurring levels of arsenic, tungsten and polonium-210. We will look at data and discuss the results and their implication for daily practice. We have begun investigating the effects of chromium in bowhead whales and comparing these effects with those seen in humans. The extent of neurodegeneration seen with 24-hour exposure is indeed greater than that seen after a 9-hour exposure. A tiny sample of the liver tissue, examined under a microscope, helps diagnose autoimmune hepatitis and tells how serious it is.

Buy generic minocycline 50mg on-line

Yet despite widespread use, few reproductive toxicity studies are available for this drug, particularly at human relevant doses. Toxic effects of drugs with high protein binding (>90%) were generally impaired by adding plasma proteins to the cell culture systems. Then you lay down in bed with your head turned down toward the right side and sit up, then lay down with your head on the left side and sit up. An additional 13 trials were previously reported in the Summary Review as published since the search dates of the included systematic reviews for a total of 24 new trials (eight head-to-head studies and 16 placebo-controlled trials). Only patients able to provide informed consent were selected for the study and demented patients were excluded. Main results We included 12 studies using sumatriptan 85 mg or 50 mg plus naproxen 500 mg to treat attacks of mild, moderate, or severe pain intensity: 3663 participants received combination treatment, 3682 placebo, 964 sumatriptan, and 982 naproxen. Exploratory factor analysis revealed the presence of 5 factors, explaining 70% of variance. Farmer and I may well have a different take on the contributions that have been made over time by the World Bank and other international financial institutions. Data integration is the process of combining data residing at different sources and providing the user with a unified view of these data. Ongoing trace element analysis will provide data to correlate source components with changes in cardiac endpoints. Magnesium is deficient in patients who eat white flour, only 16% of magnesium is left in white flour when compared to whole wheat. Broadly, the term "transgender person" refers to individuals whose internal sense of being male or female (gender identity) is different from the sex they were assigned at birth. In warm antibody hemolytic anemia, the self-generated antibodies (autoantibodies) attach themselves and cause the destruction of the red blood cells, at temperatures above normal body temperature. Urine concentrations of the chemical or metabolite were used to determine exposure from the application. Three male and 3 female beagle dogs were infused with sterile physiological saline at a rate of 15 ml/kg/day for six weeks. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. Since E2F/Rb protein complexes localize to highly repetitive pericentromeric regions we sought to determine if L1 epigenetic regulation is E2F/Rb-mediated. Xylitol is a 5-carbon sugar that lowers airway surface liquid salt concentration potentially enhancing innate immunity and reducing airway infections. The morphologic features of a blast cell do not permit determination of the cell lineage, (ie, myeloblasts versus lymphoblast (see lymphoblast entry). Recurrent miscarriage syndrome and infertility caused by blood coagulation protein or platelet defects. Recent reports show dystonia, chorea encephalopathy, and dystonic choreoathetosis occurring as squeal of streptococcal infections. A reduction of 25% tissue viability relative to the negative controls was used to define irritancy within our model. The patient can then be treated with doxycycline 100mg twice a day and prednisone resulting in complete recovery. However, the precise mechanisms that underlie these associations are not well-understood, and further exploration of pollution effects on hypothesized pathogenic pathways is indicated. The allergic rats exhibited an altered breathing pattern (apnoeas), and a slightly increased breathing frequency during challenge, allergic laryngitis and increased granulomatous inflammation in the lungs. Scenario 12: Urinalysis A transgender Service member is randomly selected to undergo a urinalysis test at their new command. Chondrocyte (Cartilage Cell) Rarely, chondrocytes are seen on cytospin preparations of cerebrospinal fluid, likely obtained as the needle nicks the vertebral cartilage during lumbar puncture. Exposure to spouses and children not present during the application were low, but did vary by the measured exposure in the applicator. Furthermore, identification of the most sensitive endpoint may be chemical dependent so that neurotoxicity may be most evident on a per animal basis by evaluating many endpoints. Community Platforms for Public Health Interventions Melissa Sherry, Abdul Ghaffar, and David Bishai 267 15. The most common are proximal muscle weakness, difficulty speaking (dysphonia) or difficulty eating (dysphagia).

Order minocycline 50mg with visa

There were no trials available comparing rectal aminosalicylic acid to other therapies such as rectal steroids. Taken together, these studies provide evidence that Reb A is not teratogenic or genotoxic at the doses tested. Potentially, these alternative approaches (which currently provide essential repeat-dose phototoxicity data) could substitute for the standard hairless mouse photocarcinogenesis bioassay. Over time, the accumulation of precipitated material could adversely affect lysosomal function leading to cellular dysfunction (Lenz, Braendli-Baiocco et al. It is recommended that some cotton wool be placed in the affected ear to reduce noise. Removal: · · · If helmet must be removed due to unusual circumstances, at least 4 people are needed. Manganese (Mn) is needed for normal physiological functions, but high amounts are toxic and cause Manganism, which is similar to Parkinsons disease. Type-2 alkene exposure is pervasive and occurs through occupation, dietary contamination, industrial pollution, automobile exhaust and cigarette smoking. Regular fluid intake increases the motility of the stomach and intestines, washing the bacteria away. At 80 ppm-hrs the predicted bone marrow dose showed no appreciable impacts of exposure rate on major metabolites, but a paradoxical trend of disproportionately higher benzene fraction and a lower fraction of hydroquinone, catechol, and benzenetriol was observed at the highest peak exposures. Current near visual acuity of any degree that does not correct to 20/40 in the better eye. Chapter 21 Skin & Hair Autoimmune Diseases Autoimmune Urticaria: Urticaria is usually considered idiopathic in reality the chronic form is autoimmune. Controversy remains regarding the safety of consuming seafood, particularly during pregnancy. As a one-day dose titration, patients in the risperidone group received risperidone 2 mg on Day 1, and 4 mg daily thereafter. Up to 10 mice/group were subjected to Wk 24 necropsy and histopathologic examination. This internal cueing deficit is also present on tasks that primarily demand cognition rather than motor performance, with impairment observed in the ability to use advance information to internally cue responses on Stroop colour naming and cognitive set-shifting tasks [23, 24]. If patient develops a temperature of or greater than 38°C, the transplant team is to be notified and will order: i. Exposures to sepiolite particles produced evidence of multinucleated giant cells in airspaces and patchy evidence of minimal septal tissue thickening, suggesting the development of lung fibrosis. Existing standards of conduct shall continue to apply to all Service Members with the continued expectation of treating each other with dignity, respect, and professionalism. Morphine may mask pain, so conduct a complete assessment prior to administration 5. To the contrary, the record at this stage of the case shows that the reasons offered for categorically excluding transgender individuals were not supported and were in fact contradicted by the only military judgment available at the time. The overnight fast prior to necropsy or blood collection is a routine procedure in many toxicology studies. The term muddy brown cast is used for a specific variant of granular cast with a dark brown or red-brown muddy color and a granular interior. In conclusion, retrorsine is a mechanism-based inactivator of P450 3A4, but monocrotaline failed to show such inhibition, even it is metabolically activated. These genes (and/or pathways) could potentially be used to predict airway responses to other isocyanates and possibly other low molecular weight chemicals. This study focused on a possible alternative method of using ascorbic acid supplementation in the treatment of lead poisoning. Thus, prekeratocytes and keratocytes are usually found together in the same blood smears and should raise the question of a microangiopathic process. The carcinogenicity testing of biopharmaceuticals may not always be possible by conventional means due to factors such as species specificity and immunogenicty. Cools, "The human basal ganglia modulate frontal-posterior connectivity during attention shifting," Journal of Neuroscience, vol. Targeted revocations of rights are a factor that has been present in a number of cases finding equal protection violations. Chemicals that produce tumors are typically described as either genotoxic or non-genotoxic.

Discount minocycline 50mg online

Abnormal Plasma cell: Plasma cell neoplasms such as plasma cell myeloma (multiple myeloma) are B-cell neoplasms. The objective of this study was to test whether oxidative stress plays a role in the adverse effects caused by toluene exposure, and if so, if effects were age-dependent. One of two added oxygen atoms is derived from the oxidant, the other from water; molecular oxygen is not directly required. Deformities of the skull, face, or mandible of a degree that may reasonably be expected to prevent the individual from properly wearing a protective mask or military headgear. Usually, these disorders develop subacutely within weeks to months; thus, the temporal profile of tremor development is unique. Therefore, based on the weight of evidence, it is likely that aniline metabolites are responsible for the accumulation of pigmented material and play a significant role in causing the toxicities observed in the nonclinical studies. These ulcerations are recurrent and chronic with spontaneous remissions and relapses which may be seasonal during the winter and summer months. Ensures that the standards in Section 5 are implemented throughout the DoD Components. There are other examples in which an alcohol is oxidized to a carboxylic acid without escape of the intermediate aldehyde. Sub lingual treatment of B12 and oral treatment for B6 and folic acid daily for three weeks. The rank order of efficacy of pyrethroids in the Na+ influx assay was telfluthrin> deltamethrin> -cyhalothrin> -cyfluthrin> esfenvalerate> S-bioallethrin> fenpropathrin> cyperthrin> biofenthrin. Measurements of the agglomeration and sedimentation rate are therefore a required step toward identifying the mechanisms of toxicity. Vith a history or diagnosis of ge:1der dysphoria be accessed or retained, 1, Accession of Individuals Diagnosed wiLh Gender Dysphoria. The mechanisms best describing inhibition of H metabolism were uncompetitive inhibition for T (Ki=1. Cadmium sulphuratum: Facial paralysis (usually left-sided) that starts after exposure to wind, and is accompanied by chilliness or overwhelming weakness, suggests a need for this remedy. As in previous experiments, A23187 produced dose-dependent arteriolar dilations (1069% of maximum response). And, for the sake of efficiency, they shoul<l do so at the least possible cost to the taxpayer. All available models for the listed endpoints were used within the four software platforms. Patient should be evaluated to assure that deep tendon reflexes are present, respirations are at least 13 breaths per min, and urine output is at least 100 mL during the preceding 3 h. Therefore, for the purposes of proficiency testing, it is not required that they be differentiated (for a detailed guideline for the differentiation of segmented and band 36 the College of American Pathologists 2019 Hematology, Clinical Microscopy, and Body Fluids Glossary Bone Marrow Cell Identification neutrophils, see Glassy, 2018; for other reading related to the clinical utility of band counts, see Cornbleet, 2002). Isolated trout livers were perfused using methods designed to preserve tissue viability and function. Graduate school of comprehensive human sciences, University of Tsukuba, Tsukuba, Japan. In the second, and the very different example, the provider described a patient with early life onset of dystonia. Meet applicable Service standards of the preferred gender, including medical fitness, physical fitness, uniform and grooming, deployability, and retention standards. The time has come to prevent these diseases by takeing a better diet, avoiding the genetically modified foods, avoiding chemicals at home and expose your skin to the Sun. Orexin/hypocretin may promote wakefulness by upregulating monoaminergic neuronal populations [14]. Tests: Men with a history of infertility should be tested for antisperm-antibodies. Xenobiotics that can impinge on the regulation of skin homeostasis include dioxin, which likely exerts its tumor promoting activities, in part, via its ability to inhibit apoptosis and senescence. Cytokine production by the immune system contributes importantly to both health and disease. The resulting scientific progresses remain driven in an industry perspective by realism and the only objective of perpetuating the innovation and insuring the Consumer Safety in the regulatory context of the 7th amendment to the European Cosmetic Directive.

References:

• http://www.csun.edu/~cmalone/pdf360/Ch03-2chromo.pdf
• https://biomedres.us/pdfs/BJSTR.MS.ID.004194.pdf
• http://www.oregonmedicalresearch.com/wp-content/uploads/2017/Dupixent-part1.pdf
• https://www.mass.gov/files/documents/2017/10/11/application-mass-eye-and-ear.pdf