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When did the opioid epidemic begin?

The opioid epidemic can be looked at in three waves, the first starting in the early 90’s. This was when the over use of the all powerful pad for scripts was overused by the powerful Doctor, who saw patients looking for a way to alleviate pain, whether that pain be physical or emotional/mental. The Doctor was less likely to question anyone claiming that physical pain would mean physical limitations and deemed narcotic pain medicine an effective way to help out. From personal experience, I can recall having to call on the help of an oral surgeon, there were not to many around. Upon my first appointment, a mere consult, I was provide a script for 90 Percocet. After tooth was extracted I received another script for 90 Percocet and upon follow up exam yet another 90! That is 270 pills, that is three times the amount prescribed to my ailing father after a stage 4 lung cancer diagnoses! By 1999, 86% of patients were using opioids for non -cancer related pain. The pharmaceutical companies also began promoting the use of these highly addictive little pills as being at low risk for addiction.The second part of the epidemic began in 2010 when there was a rapid increase in the number of heroin overdoses across the country. This is in part due to the earlier efforts to decrease the over writing of prescription opioids. This also is the time period where the oxycontin 80 mg pill that had a street value of 65 $ and up, was revamped. They now made this pill, fool proof so to speak and virtually impossible to crush up and snort or inject. This had desperate individuals looking for a way to get the “medicine” that they had become addicted to, thus heroin sales blew up. It was much more affordable and also much more potent. It wasn’t long before people of all age, gender and socioeconomic groups began over-dosing and dying. This is when we would see a 286% rise in overdose by heroin fatalities between 2002 - 2013.The third wave came in 2013 where we can put fentanyl, a man made drug with a potency 50–100 times stronger than heroin, to blame. It is noteworthy to mention that this is not diverted medical fentanyl but illicitly manufactured fentanyl used to replace or adulterate heroin and other drugs alike. In just one year (2016) there were well over 66,000 heroin or opioid related deaths with 20,000 of them involving fentanyl or its meaner, uglier brother car-fentanyl. This wave of the three part series is still claiming the lives of over 192 people a day that is the equivalent of a 747 crashing and killing all passengers, a day! This drug has a pattern of claiming lives of white men in their late 20’s early to 30’s. But truly is wreaking havoc across the country, parents are loosing their children, children are being orphaned, loosing not one but both parents. Siblings, like my self are loosing their brothers and sisters. The only way to combat this epidemic is to share your knowledge, carry Narcan, teach our youth early on and provide treatment for those seeking help.My brother and I were in my car on January 26, 2016, talking about this drug. I asked him what it felt like and why he was so compelled to continue using even though he was aware that it could cost him his life. He told me that it was “the best feeling in the world” He said this with a heavy heart, with shame, guilt and remorse…he said this three days before he died.Rest in Peace John Page I love you always and forever. I wish I could have told you that you truly were my hero. xoFind Answers to all Your QuestionsHOPEIS HERE.GET HELP800.327.5050CARA ActOn July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) into law as Public Law 114-198. One of CARA’s important provisions expands access to substance use treatment services and overdose reversal medications—including the full spectrum of services from prevention to medication-assisted treatment (MAT) and recovery support—by extending the privilege of prescribing buprenorphine in office-based settings to qualifying nurse practitioners (NPs) and physician assistants (PAs) until Oct. 1, 2021.Proposed Learning ObjectivesCARA requires that NPs and PAs complete 24 hours of training to be eligible for a prescribing waiver. SAMHSA has created a list of recommended learning objectives for the trainings. While we cannot require that the organizations listed in the CARA Act use these learning objectives, we are sharing them with the stakeholders. Access the Proposed Learning Objectives for the NP and PA Waiver Training – 2017 (PDF | 196 KB).Sign Up for CoursesNPs and PAs are required to obtain no fewer than 24 hours of initial training addressing each of the topics in 21 USC 823(g)(2)(G)(ii)(IV) provided by one of the following organizations: The American Society of Addiction Medicine, American Academy of Addiction Psychiatry, American Medical Association, American Osteopathic Association, American Nurses Credentialing Center, American Psychiatric Association, American Association of Nurse Practitioners, American Academy of Physician Assistants, or any other organization that the Secretary of Health and Human Services determines is appropriate.NPs and PAs may take both the eight-hour DATA-waiver course for treatment of opioid use disorder, designed by national experts, that physicians currently take, and the additional 16 hours course offered for free by SAMHSA through the Providers Clinical Support System(link is external).NPs and PAs who have completed the required training and seek to become DATA-waiver for up to 30 patients will be able to apply to do so beginning in early 2017. For more information on the upcoming launch of the application and SAMHSA-sponsored training opportunities, sign up(link is external) for the Buprenorphine Waiver Management email list.. 

What does a positive Q fever skin test look like?

This is something new to me and had to look it up on Google but thank you for sharing. Interesting new (or old) disease.About usContact usLog InRegisterHomeCOVID-19Health professionalsConsumersPublicationsProgramsResourcesPartner with usSearchHomeMedicine FinderQ-VaxAAConsumer medicine informationQ-VaxCoxiella burnetii vaccineShareBRAND INFORMATIONBrand nameQ-VaxActive ingredientCoxiella burnetii vaccineScheduleS4Consumer medicine information (CMI) leafletPlease read this leaflet carefully before you start using Q-Vax.Download CMI (PDF)Download Large Text CMI (PDF)What is in this leaflet?This leaflet answers some common questions about Q-VAX®. It does not contain all the available information. It does not take the place of talking to your doctor or other health professional.Keep this leaflet. You may want to read it again.All medicines, including vaccines, have risks and benefits. Your doctor considers the risks of you having Q-VAX® Fever Vaccine and the benefits they expect it will have for you.If you have any concerns about this vaccine, ask your doctor or other health professional.What Q-VAX® is used forQ-VAX® Q fever Vaccine is given by injection under the skin, usually in the upper arm. It is used to help protect people against the infection "Q fever.”Q fever is caused by bacteria (called Coxiella burnetii) which can be caught by humans from animals that carry the infection. These bacteria can cause illness in humans, sometimes mild, sometimes severe.Vaccination with Q-VAX® is recommended for people working with cattle, sheep or goats, or products from these animals, for exampleabattoir workers, and visitorsveterinary personnelstockyard workersfarmersshearersanimal transporterslaboratory workers handling potentially infected veterinary samples or visiting abattoirspeople who cull and process kangaroos.The risk of becoming infected with Q fever is highest in the first few years of exposure. Workers who are at risk of contracting Q fever should be immunised as soon as possible after they commence work.How Q-VAX® worksQ-VAX® works by causing your body to produce its own protection against the Coxiella burnetiibacteria that cause Q fever. After you are vaccinated with Q-VAX® your immune system is able to destroy the Q fever organism if you come into contact with it. This prevents you from getting Q fever. However, your body does take several weeks after vaccination to fully develop this protection against Q fever.Protection by vaccination requires one dose of Q-VAX® Vaccine. Protection lasts for many years.You must not be given Q-VAX® Vaccine more than once.As with all vaccines, 100% protection cannot be guaranteed.However, most people will be protected against Q fever.The risk of having a severe unwanted reaction from Q-VAX® is small. The risks from NOT being vaccinated against Q fever may be serious.Before you are given Q-VAX®Before you are given Q-VAX® Vaccine, your doctor will give you a skin test and a blood test to check if you are already immune to Q feverWhen you must NOT be given Q-VAX® VaccineDo not have Q-Vax® Vaccine if:you have previously been vaccinated with Q-VAX®you have had Q feveryou have been exposed to the bacteria and you have had a Q fever-like illnessyou have not had the required Q Fever skin test AND blood testthe skin test OR the blood test show your doctor that you already have immunity against Q fever.Note: Do not have Q-VAX® Vaccine unless both your skin test AND blood test are negative.Tests required before having Q-VAX®skin testandblood test.The Q-VAX® Skin test is a small injection (0.1mL) in your forearm. The forearm must then be checked by your health professional seven days after the test injection. If the skin test is positive, a small lump will be present.For the blood test, your blood sample is examined in a specialised laboratory. The test results are sent to your doctor.Positive skin and/or blood tests show that you are already protected against Q fever. (The illness Q fever may be mild and difficult to diagnose. You may have had Q fever without realising it.)If either or both of the skin and blood tests are positive, it is important that you DO NOT HAVE THE Q-VAX®VACCINATION. If you are already immune to Q fever, Q-VAX® vaccination may cause a severe reaction.Do not have Q-VAX® if you have or previously had an allergy to:eggsany of the ingredients listed at the end of this leaflet.Symptoms of an allergic reaction may includeshortness of breath, wheezing or difficulty breathingswelling of the face, lips, tongue or other parts of the bodyskin rash, itching or hives.Q-VAX® is not recommended for use in children.There is no information on the use of Q-VAX® in people who have poor immunity or are on treatment that lowers immunity.Do not have Q-VAX® after the expiry date (EXPIRY) printed on the pack.Do not have Q-VAX® if the packaging is torn or shows signs of tampering.If you are not sure whether you should have Q-VAX®, talk to your doctor.Tell your doctor if you have ever reacted to any vaccination with any of the following:severe allergic reactiondifficulty breathingswelling of the throatfainting or collapsefits or convulsionshigh temperature (greater than 38.5 degrees C)severe skin reaction at the injection site, including severe bruising.Tell your doctor if you have allergies to:any other medicinesany other substances, such as foods, preservatives or dyes.Tell your doctor if you have worked with farm animals or been in contact with animal carcasses.Tell your doctor if you are pregnant or intend to become pregnant. There is no information on the use of Q-VAX® in pregnancy. It is recommended that vaccination is deferred. Your doctor will discuss the possible risks and benefits with you.Tell your doctor if you are breast-feeding. There is no information on the use of Q-VAX® during breastfeeding.Your doctor will discuss the possible risks and benefits of having Q-VAX®.Taking other medicinesTell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.How Q-VAX® is givenRemember: you should not be given Q-VAX® Vaccine unless your skin test and blood test are both negative.Q-VAX® vaccination is given by injection by a trained health professional. It is injected just underneath the skin, usually in your upper arm.How much is givenQ-VAX® Vaccine is pre-filled in a single-use syringe. This contains one 0.5mL dose.Overdose is unlikely as your doctor gives you the vaccination.One vaccination only is given.You should NOT be given a booster dose of Q-VAX® Vaccine.A second dose may cause a severe reaction.Follow the advice (see below) about keeping a record of this vaccination.If you have any concerns, ask your doctor.After having Q-VAX®Things you must doYou must be given Q-VAX® by a trained health professional, where there are facilities to manage any allergic reaction.Allergy to Q-VAX® is uncommon, but allergy to any vaccine may occur.Keep an updated record of all your vaccinations.Ask the doctor to give you a written record of the injection stating the date, dose and batch number of the vaccine.If you develop any medical problems after being given Q-VAX®, tell your doctor.Q-VAX® is unlikely to affect your ability to drive or operate machinery.Side effectsTell your doctor as soon as possible if you do not feel well after receiving Q-VAX®.All medicines, including vaccines, can have side effects. Q-VAX® vaccination may cause unwanted side effects in some people. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.Ask your doctor to answer any questions you may have.Tell your doctor if you notice any of the following and they worry you:reactions around the injection site such as redness, itchiness, pain or discomfort, warmth, burning or stinging, swelling or the formation of hard lumps or scars (up to 6 months after vaccination)headachesfeveraching musclesfatiguegenerally feeling unwellnauseavomitingdiarrhoeaincreased sweating.These side effects are usually mild.Serious side effects are rare.Tell your doctor immediately if you notice any of the following:infection or an abscess at the injection sitepainful, swollen jointssudden extreme tiredness or weaknessswollen glandsfeeling faint.These may be serious side effects. You may need urgent medical attention.Other side effects not listed above may occur in some patients. Tell your doctor if you notice anything that is making you feel unwell.Do not be unduly alarmed by the list of possible side effects. You may not experience any of them.Storing Q-VAX®Q-VAX® is usually stored in the doctor's surgery or clinic. However, if you need to store Q-VAX®:Keep it where children cannot reach itKeep Q-VAX® in the original pack until it is time for it to be givenKeep it in the refrigerator between 2 degrees C and 8 degrees C and protect it from light. Do not freeze Q-VAX®.Product descriptionWhat it looks likeQ-VAX® Q fever Vaccine is supplied in a pre-filled glass syringe containing 0.5 mL of a slightly cloudy colourless liquid.Each Q-Vax® Vaccine syringe is supplied in a moulded plastic blister with peel-off paper cover.Do not use if the blister is damaged or missing.Q-VAX® Skin Test is supplied in a glass vial containing 0.5 mL of a clear colourless liquid.The Q-Vax® Skin Test vial has a removable plastic cap covering the top of the vial. Do not use if the removable plastic cap is damaged or missing.IngredientsActive ingredient:Q-VAX® Q fever vaccineEach 0.5mL dose of vaccine contains no less than 25 micrograms of killed Coxiella burnetiiorganisms.Q-VAX® Skin TestEach diluted 0.1 mL dose contains 16.7 nanograms of killed Coxiella burnetii organisms.Other ingredients:sodium chloridemonobasic sodium phosphatedibasic sodium phosphatethiomersal.water for injectionsQ-VAX® may also contain traces offormalinegg proteinssucrose.Q-VAX® does NOT contain:lactoseglutentartrazineany other azo dyes orlatex.Ask your doctor or other health professional if you are unsure about anything or want more information about Q-VAX®.Name and Address of SponsorQ-VAX® is sponsored by:Seqirus Pty LtdABN 26 160 735 03563 Poplar Road, ParkvilleVictoria 3052AUSTRALIARegistration numbersQ-VAX® Q fever VaccineAUST R 100517Q-VAX® Skin TestAUST R 100518Q-VAX® is a registered trademark of Seqirus UK Limited or its affiliates.Date of preparation27 June 2019Published by MIMS November 2019BRAND INFORMATIONBrand nameQ-VaxActive ingredientCoxiella burnetii vaccineScheduleS41 Name of MedicineInactivated Coxiella burnetii as active ingredient.6.7 Physicochemical PropertiesNot applicable.2 Qualitative and Quantitative CompositionQ-Vax is a purified suspension of formalin-inactivated, Coxiella burnetii prepared from the Phase I Henzerling strain of the organism grown in the yolk sacs of embryonated eggs. Trace amounts of ovalbumin (< 1 microgram) may also be present.Q-Vax Vaccine contains ≥ 25 microgram of antigen in 0.5 mL of aqueous solution.Q-Vax Skin Test contains ≥ 2.5 microgram of antigen per 0.5 mL of aqueous solution. Prior to administration, Q-Vax Skin Test is diluted with Sodium Chloride injection to ensure that 16.7 ng (nanograms) of antigen is delivered per 0.1 mL intradermal dose. (See Section 4.2 Dose and Method of Administration).Each 0.5 mL Q-Vax Vaccine also contains sodium chloride 4.1 mg, monobasic sodium phosphate dihydrate 120 microgram, dibasic sodium phosphate dodecahydrate 245 microgram thiomersal as preservative 50 microgram and water for injections to 0.5 mL.Each 0.1 mL Q-Vax Skin Test dose after dilution also contains sodium chloride 0.9 mg, monobasic sodium phosphate dihydrate 0.8 microgram, dibasic sodium phosphate dodecahydrate 1.6 microgram, thiomersal as preservative 333 nanogram and water for injections to 0.1 mL.3 Pharmaceutical FormQ-Vax Q-Fever Vaccine is a clear to slightly opaque, colourless suspension for subcutaneous injection.Q-Vax Skin test is a clear to slightly opaque, colourless suspension for dilution prior to intradermal injection.5 Pharmacological Properties5.1 Pharmacodynamic PropertiesMechanism of action.Q fever is caused by Coxiella burnetii, an obligate, intracellular, Gram-negative coccobacillus. The C. burnetii is shed in the products of conception, and on the neonate of the infected animal. It may also be present in the udder and milk of infected animals and is passed on within their faeces and urine. Infection is transmitted to humans primarily by inhalation of infected airborne particles or dust during the handling or processing of these materials or by close proximity to infected animals and their products.Administration of inactivated Coxiella burnetii in Q-Vax vaccine stimulates production of an immune response in the vaccinated individual. The immune response provides protection against clinical illness in a high proportion of vaccinated individuals, but may not be effective in some individuals.Early antibody response to the vaccine is predominantly with the IgM subclass; IgG antibodies appear later. Although the seroconversion rate is low (50-80%) and antibody levels are transient, cell mediated immunity develops. Clinical trials have demonstrated a high degree of efficacy (see Section 5.1 Pharmacodynamic Properties, Clinical trials). As Q fever is often asymptomatic or misdiagnosed due to its non-specific nature, many abattoir workers develop immunity to Q fever without an obvious illness.The duration of protective immunity following immunisation is unknown, but is believed to be in excess of five years.Revaccination must never be undertaken due to the possibility of severe hypersensitivity reactions (see Section 4.3 Contraindications).Clinical trials.A randomised, blind, controlled study comparing Q-Vax and influenza vaccine for the prevention of Q fever amongst 200 workers in three Queensland abattoirs was undertaken, using sequential analysis for determining the efficacy of Q-Vax. A statistically significant difference in the incidence of symptomatic Q fever was noted 15 months after commencement of vaccination, with 7 cases in those given the control vaccine and no cases in those given Q-Vax. At 15 months, 24% of those who had not been vaccinated and had not developed symptomatic infection had serological evidence of exposure to Q fever, indicating subclinical infection.A retrospective cohort study in three South Australian abattoirs was undertaken to compare the incidence of Q fever in vaccinated and unvaccinated subjects between 1985 and 1990. There were two cases of Q fever amongst 2555 vaccinated employees compared with 55 cases in 1365 unvaccinated subjects. Both cases of Q fever in the vaccinated group occurred within two weeks of receiving the vaccine. For workers who were vaccinated, the mean duration of employment following vaccination was 1.9 years; 203 workers were employed for all five years of the study. Protection against clinical infection over this period was demonstrated.Although the dose in each of these studies was nominally 30 microgram, one batch which contained only 20 microgram in each dose was shown to be as effective. However, as with all vaccines, 100% effectiveness for generation of protective immunity against Q fever cannot be guaranteed (see Section 4.4 Special Warnings and Precautions for Use).5.2 Pharmacokinetic PropertiesNot applicable.5.3 Preclinical Safety DataGenotoxicity.No data available.Carcinogenicity.No data available.4 Clinical Particulars4.1 Therapeutic IndicationsQ-Vax Vaccine is indicated for the immunisation of susceptible adults at identifiable risk of infection with Q fever.Abattoir workers (and those closely associated with the meat industry), farmers, veterinarians, stockyard workers, shearers, animal transporters and many others exposed to cattle, sheep or goats or their products should be considered for vaccination.Note also that Q fever has occurred among persons culling and processing kangaroos and that laboratory personnel handling potentially infected veterinary specimens, or visiting abattoirs, are at risk.Q-Vax Skin Test is indicated for the prescreening of potential vaccine recipients for prior sensitisation to Q fever antigens.It is essential to test for sensitisation to Q fever antigens using Q-Vax Skin Test in every individual prior to immunisation (see Section 4.4 Special Warnings and Precautions for Use).4.3 ContraindicationsQ-Vax should not be administered to:Persons who have a history of Q fever.Persons who have been previously vaccinated with Q fever vaccine.Persons who have a history of likely exposure followed by an illness strongly suggestive of Q fever.Persons with positive serology for Q fever antibody or a positive Q fever skin test.Persons with known hypersensitivity to egg proteins or any component of the medicinal product.4.4 Special Warnings and Precautions for UsePrior to immunisation, all potential vaccinees must have a serum antibody estimation and a skin test reported; administration of Q-Vax to those who are already sensitised to Q fever antigens can cause serious hypersensitivity reactions.As with other injectable vaccines, including Q-Vax Skin Test solution, appropriate medical treatment and supervision should always be available in case of anaphylactic reactions. Adrenaline should always be readily available whenever the injection is given.Q-Vax should never be administered intravenously.There is no information available on the efficacy and safety of Q-Vax in immunodeficient or immunosuppressed individuals.Those who have a confirmed positive antibody test or a positive skin reaction must not be given Q-Vax (see Prevaccination testing).If the skin test is negative or equivocal and antibodies are present at low titres (reported as a borderline laboratory test result), it cannot be concluded that the subject has adequate protective immunity against Q fever. The low level presence of antibodies may be nonspecific or due to technical factors of the assay. The risk/ benefit decision of being vaccinated or not should be individually assessed and discussed with the subject, in order to decide whether potential adverse events following vaccination outweigh the potential risk to that subject from Q fever infection and its associated complications.It should be noted that a very small number of people may have had Q fever in the past and yet show no response to serological or skin testing. Such persons may have severe reactions to Q-Vax. For this reason, subjects should be carefully questioned regarding the possibility of previous exposure to Q fever and the duration of such exposure.Workers who are at risk of contracting Q fever should be immunised prior to commencement of work or as soon as possible after they commence work as the risk of infection is highest in the first few years.Vaccination during the incubation period of Q fever does not prevent the onset of the disease.Despite the significant efficacy of Q-Vax in clinical trials, cases of Q fever following vaccination have been reported (see Section 5.1 Pharmacodynamic Properties, Clinical trials).Prevaccination testing.Serology.People who are being considered for Q fever vaccination must have serum antibody testing. Subjects in whom antibodies are unequivocally positive should not be given Q-Vax (see Section 4.4 Special Warnings and Precautions for Use).Skin test.Preparation.Skin Test solution should be prepared by diluting 0.5 mL of the Q-Vax Skin Test in 14.5 mL of sodium chloride injection (to a final volume of 15 mL). The diluted Q-Vax Skin Test should be freshly prepared, stored at 4°C and used within six hours.Administration.The dose administered for skin testing is 0.1 mL of the diluted Q-Vax Skin Test. This should be injected intradermally into the volar surface of the mid-forearm.A positive reaction is indicated by any induration at the site of injection read seven days after the test dose. Any person with a positive reaction must not be vaccinated.Use in the elderly.No data available.Paediatric use.No data available.Effects on laboratory tests.No data available.4.5 Interactions with Other Medicines and Other Forms of InteractionsNo data available.4.6 Fertility, Pregnancy and LactationEffects on fertility.No data available.(Category B2)Safety of use in pregnancy has not been established. Deferral of vaccination is recommended.No data available.4.8 Adverse Effects (Undesirable Effects)Vaccination of already immune subjects may result in severe local or general reactions, with the possibility of local abscess formation.Clinical trial data.In a clinical trial in South Australia the following adverse events were recorded amongst 464 persons who received Q-Vax. See Table 1.There was a single case report of abscess formation at the injection site.Postmarketing data.A range of adverse reactions has been reported with clinical use of Q-Vax. The reactions are summarised below and categorised by frequency according to the following definitions. Very common: ≥ 1/10; common: < 1/10 and ≥ 1/100; uncommon: < 1/100 and ≥ 1/1,000; rare: < 1/1,000 and ≥ 1/10,000 and very rare: < 1/10,000.Blood and lymphatic system disorders.Very rare: lymphadenopathy.Nervous system disorders.Common: headache. Very rare: dizziness.Gastrointestinal disorders.Uncommon: nausea, vomiting and diarrhoea.Skin and subcutaneous tissue disorders.Common: delayed skin reaction (presenting up to 6 months after vaccination) at injection site (either vaccination and/or skin test site). Uncommon: hyperhidrosis.Musculoskeletal and connective tissue disorders.Uncommon: myalgia. Very rare: arthralgia.General disorders and administration site conditions.Very common: injection site inflammation (e.g. erythema, pain, warmth and swelling). Uncommon: injection site induration and/or oedema, pyrexia, malaise, fatigue. Rare: injection site abscess formation, granuloma. Very rare: chills, chronic fatigue syndrome.Reporting suspected adverse effects.Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.4.2 Dose and Method of AdministrationQ-Vax Vaccine.Q-Vax Vaccine should not be administered until the results of serology and skin testing are known (see Section 4.4 Special Warnings and Precautions for Use). Q-Vax should be given only to those who have no demonstrable evidence of sensitisation to Q fever antigens.The dose of Q-Vax Vaccine is 0.5 mL given by subcutaneous (not intramuscular) injection. The container should be gently shaken before use.The vaccine should never be administered intravenously.No information is available on paediatric use.Revaccination must never be undertaken due to the possibility of severe hypersensitivity reactions.Q-Vax Skin Test.Preparation.Skin Test solution should be prepared by diluting 0.5 mL of the Q-Vax Skin Test in 14.5 mL of sodium chloride injection (to a final volume of 15 mL). The diluted Q-Vax Skin Test should be freshly prepared, stored at 4°C and used within six hours.Administration.The dose administered for skin testing is 0.1 mL of the diluted Q-Vax Skin Test. This should be injected intradermally into the volar surface of the mid-forearm.4.7 Effects on Ability to Drive and Use MachinesThe effect of this medicine on person's ability to drive and use machines were not assessed as part of its registration.4.9 OverdoseFor information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).7 Medicine Schedule (Poisons Standard)S4.6 Pharmaceutical Particulars6.1 List of ExcipientsSee Section 2 Qualitative and Quantitative Composition.6.2 IncompatibilitiesIncompatibilities were either not assessed or not identified as part of the registration of this medicine.6.3 Shelf LifeIn Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.6.4 Special Precautions for StorageQ-Vax Vaccine and Q-Vax Skin Test should be protected from light and stored at 2°- 8°C. Refrigerate. Do not freeze.6.5 Nature and Contents of ContainerAUST R 100517.Q-Vax Vaccine is available as a pre-filled syringe containing ≥ 25 microgram of antigen, in 0.5 mL solution.The syringe and all associated syringe components do not contain natural rubber latex. The Q-Vax Vaccine syringe is supplied in a moulded plastic blister with peel-off paper cover. Do not use if the blister pack encasing the syringe is damaged or missing.AUST R 100518.Q-Vax Skin Test is available as a pre-filled vial containing ≥ 2.5 microgram of antigen, in 0.5 mL solution. Q-Vax Skin Test must be diluted prior to use in pre-vaccination screening (see Section 4.2 Dose and Method of Administration). The vial and all associated components do not contain natural rubber latex. The Q-Vax Skin Test vial is packaged with a plastic tear away cap covering the vial septum. Do not use if the tear away cap on the vial is damaged or missing.6.6 Special Precautions for DisposalIn Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.Summary Table of ChangesPAGE SECTIONSBRAND INFORMATIONWhat is in this leaflet?What Q-VAX® is used forBefore you are given Q-VAX®How Q-VAX® is givenAfter having Q-VAX®Keep an updated record of all your vaccinations.Side effectsStoring Q-VAX®Product descriptionDate published: 27 June 2019Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy.FooterGo to facebook pageGo to linkedin pageGo to youtube pageAbout usOur servicesContact usMediaNewsCareersOrderTranslated infoAccessibilityCopyrightTerms of useWhistleblower policyPrivacy©2020 NPS MedicineWise. We acknowledge the provision of funding from the Australian Government Department of Health to develop and maintain this website.PO Box 1147 Strawberry Hills NSW 2012Level 7, 418A Elizabeth St, Surry Hills NSW 2010ABN: 61 082 034 393Our other initiatives:FeedbackWe are always looking for ways to improve our websiteProvide feedbackConsumers: Talk to a professional (Monday – Friday, 9 am – 5 pm AET)Medicines LineGet medicines information:1300 MEDICINE (1300 633 424)Calls triaged by healthdirect AustraliaAdverse Medicine Events LineReport a problem with medicines, medical devices or vaccines:1300 134 237Online via the Therapeutic Goods Administration

How is Grand Canyon National Park cared for, maintained and preserved?

Since 1919 the Grand Canyon National Park has been cared for, maintained and preserved by the National Park Service. The NPS is an agency of the US Government and is funded by Government appropriations.National Park ServiceWhat We DoSince 1916, the American people have entrusted the National Park Service with the care of their national parks. With the help of volunteers and park partners, we safeguard these more than 400 places and share their stories with more than 275 million visitors every year. But our work doesn't stop there.We are proud that tribes, local governments, nonprofit organizations, businesses, and individual citizens ask for our help in revitalizing their communities, preserving local history, celebrating local heritage, and creating close to home opportunities for kids and families to get outside, be active, and have fun.Taking care of the national parks and helping Americans take care of their communities is a job we love, and we need—and welcome—your help and support.Our MissionThe National Park Service preserves unimpaired the natural and cultural resources and values of the National Park System for the enjoyment, education, and inspiration of this and future generations. The Park Service cooperates with partners to extend the benefits of natural and cultural resource conservation and outdoor recreation throughout this country and the world.Our EmployeesMore than 20,000 strong, the uncommon men and women of the National Park Service share a common trait: a passion for caring for the nation's special places and sharing their stories.Employee DirectoryWork With UsVolunteerOur PartnersAwards & RecognitionOur Official EmblemThe National Park Service arrowhead was authorized as our official emblem in 1951. The components of the arrowhead may have been inspired by key attributes of the National Park System, with the sequoia tree and bison representing vegetation and wildlife, the mountains and water representing scenic and recreational values, and the arrowhead itself representing historical and archeological values. A history of the arrowhead and other elements of NPS visual design is available. The arrowhead is also the registered service mark of the agency (number 4706627), protected by the trademark laws of the United States. The NPS allows limited use of the NPS arrowhead when doing so contributes to our work.Learn how to request permission to use the arrowhead.How We Are OrganizedThe National Park Service is a bureau of the U.S. Department of the Interior and is led by a Director nominated by the President and confirmed by the U.S. Senate.The Director is supported by senior executives who manage national programs, policy, and budget in the Washington, DC, headquarters and seven regional directors responsible for national park management and program implementation.Organization of the National Park ServiceExplore how NPS organizations fit togetherDownload an organizational chart (106KB PDF)Contact information for the Washington office, regional offices, and parksLearn MoreFrequently Asked QuestionsNPS Overview (157KB PDF)NPS TimelineFormer NPS DirectorsPublic Use StatisticsPark PlanningThe National Parks: America's Best IdeaMaps

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