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Biological Hazard: Designer Pathogens Gone Wild


Long-Dreaded Superbug Found in Human and Animal in U.S.

Germination A Blog by Maryn McKenna
Thursday, 26 May 2016

The antibiotic resistance factor MCR, which protects bacteria against the final remaining drugs of last resort, has been found in the United States for the first time—in a person, and separately, in a stored sample taken from a slaughtered pig.

Department of Defense researchers disclosed Thursday in a report placed online by the journal Antimicrobial Agents and Chemotherapy that a 49-year-old woman who sought medical care at a military-associated clinic in Pennsylvania last month, with what seemed to be a urinary tract infection, was carrying a strain of E. coli that possessed resistance to a wide range of drugs. That turned out to be because the organism carried 15 different genes conferring antibiotic resistance, clustered on two “mobile elements” that can move easily among bacteria. One element included the new, dreaded gene mcr-1.

The discovery “heralds the emergence of truly pan-drug resistant bacteria,” the DOD personnel, Patrick McGann, PhD of the Walter Reed Army Institute of Research and Kurt Schaecher, PhD of the Walter Reed National Military Medical Center, along with eight colleagues, write in the journal report.

Dr. Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases at the Centers for Disease Control and Prevention, said the CDC has begun working with the researchers and the Pennsylvania Department of Health to understand how the woman came to be carrying the highly resistant  bacterium. (Later Thursday, Pennsylvania Governor Tom Wolf confirmed the case, and the CDC joint investigation, in a statement.) The DOD researchers who described her case, who did not immediately respond to a request for comment, provided no other information on her case, except to say that she had not traveled in the previous five months, suggesting she did not pick up the bacterium outside the U.S.

“It is extremely concerning; this is potentially a sentinel event,” Bell said in a phone interview. “There is a lot that needs to be done in terms of contact tracing and field investigation, to have a sense of who else might have been exposed or might be carrying this resistant bacterium.”

Bell disclosed that the U.S. Department of Agriculture will shortly announce the first identification of MCR in the United States in an animal. It was found in a stored sample of pig intestine that was collected as part of the National Antimicrobial Resistance Monitoring System, a shared project of the CDC, USDA and Food and Drug Administration that looks for resistant foodborne bacteria in people, animals and meat.

“We have been intentionally looking for this since MCR was first announced,” she said.

The Department of Health and Human Services subsequently confirmed the pig finding in a blog post Thursday afternoon.

The existence of MCR was reported for the first time just last November, in a report by British and Chinese researchers who said they had found the gene in people, animals and meat in several areas of China. Subsequently it has been found in people, animals or meat in at least 20 countries across the world.

MCR is so troubling because it confers protection against colistin, the last remaining antibiotic that works against a broad family of bacteria that have already acquired resistance to all the other antibiotics used against them. Colistin has worked up to this point because it is a toxic drug from the early days of the antibiotic era, seldom prescribed because of its side effects; because it was used so infrequently, bacteria had not adapted to it. But because it is effective, if harsh, agriculture adopted it instead, using it widely and legally for prevention of diseases in food animals. By the time medicine discovered it needed the drug back, resistance to colistin was already moving from agriculture into the human world.

Colistin is not actually used in animals in the United States, though it has been approved for use by the FDA. That makes the arrival of colistin resistance a mystery that will have to be plumbed through genetic sequencing.

Advocates who track antibiotic resistance, especially in agriculture, reacted to the news of US colistin resistance with the gravity it deserves.

“This shows that we are right on the verge of getting into the territory of routine bacterial infections being untreatable,” Steven Roach, the food safety program director at the Food Animal Concerns Trust, said by phone. “It underscores the failure of both the federal government and Congress, and the industry, to get a grasp of the problem. We can’t continue to drag our feet on taking needed action.”

The Pennsylvania woman’s diagnosis occurred thanks to a system set up within the DOD after MCR was discovered. Since last fall, any E. coli that was already resistant to a family of drugs known as ESBLs (extended-spectrum beta-lactams), as hers was, has been sent up the chain to Walter Reed, to be scrutinized for colistin resistance. That kind of systematic checking for antibiotic resistance, known as active surveillance, is rare in the United States. Most civilian surveillance systems are patchy; they focus only on foodborne illnesses, or rely on physicians or labs to report diagnoses, or draw from a few state health departments with already well-funded labs.

“This shows how much we need comprehensive surveillance, so that things are not discovered by accident,” Bell said. The CDC recently received additional funding under the Obama Administration’s national strategy for antibiotic resistance that will allow it to begin to set up regional lab networks. “We’ll be able to identify things systematically, identify clusters and begin contact investigations quickly,” she said.

“The first known case of MCR-1 in a U.S. patient underscores the urgent need for better surveillance and stewardship programs to combat antibiotic resistance,” agreed Dr. David Hyun, an infectious-disease specialist who is a senior officer in a long-running antibiotic resistance project at the Pew Charitable Trusts.

If there is any good news in the announcements of MCR’s appearance in the United States, it is that it has not, as yet, combined with other resistance genes into a completely untreatable organism. Bacteria acquire resistance genes like gamblers amassing a hand of cards, but the way the “cards” arrive is not step-wise—bad resistance, and then worse resistance, and then the worst—but randomly. What that means, in this case, is that the Pennsylvania E. coli possesses ESBL resistance (bad) and colistin resistance (worst)—but it remains susceptible to other intervening categories of drugs. (The stored pig sample has a yet different resistance pattern, colistin plus what is known as ASSuT, for the drug families represented by ampicillin, streptomycin, sulfas and tetracycline.)

But the random roulette of bacterial genetic recombination makes it more likely that an untreatable combination—of, for instance, colistin resistance plus carbapenem resistance, which the CDC has previously called “nightmare bacteria”—might occur. In fact, it already has occurred in patients in China, where MCR was first identified.

“We’re one step closer to carbapenem-resistant and colistin-resistant E. coli  bumping into each other in someone’s gut,” Lance Price, a molecular biologist and the director of the Antibiotic Resistance Action Center at George Washington University, said by phone. “It doesn’t matter in which direction the transfer takes place—if the carbapenem-resistant strain picks up colistin resistance, or if the colistin-resistant strain picks up carbapenem resistance. It’s double jeopardy.”

Once bacteria begin to collect resistance to multiple families of antibiotics, the speed and direction of their spread becomes hard to predict, because using any of the antibiotics to which they are resistant allows them to increase in number. (Not because the drugs affect the resistant bugs—they don’t—but because they kill susceptible organisms nearby, freeing up additional living space and food.) That makes it crucial to create surveillance systems that can identify them early.

The Department of Defense system that detected the Pennsylvania organism is a model for how surveillance ought to be carried out, Price said: “We need active surveillance for multi-drug resistant or high-priority resistant organisms, in animals and people, throughout the U.S.”

Previous coverage on Phenomena:

Feb. 1, 2016: Last-Ditch Antibiotic Resistance: What is the Role of Food?

Jan. 7, 2016: Last-Ditch Resistance: More Countries, More Dire Results

Jan. 6, 2016: Last-Ditch Drug Resistance: China and Europe Respond

Dec. 20, 2015: Last-Ditch Drug Resistance: An Early Warning And Chance to Act

Dec. 18, 2015: Resistance to a Last-Ditch Antibiotic: Invisible Spread

Dec. 15, 2015: More Countries Are Seeing a Last-Ditch Antibiotic Failing

Dec. 3, 2015: Apocalypse Pig Redux: Last-Resort Resistance in Europe

Nov. 21, 2015: Apocalyse Pig: The Last Antibiotic Begins to Fail

Source: National Geographic


See Also

26 May 2016: The U.S. Military HIV Research Program (MHRP). First discovery in United States of colistin resistance in a human E. coli infection.” 

11 Dec 2015: Scientists find mcr-1 gene in food and human isolates

18 Dec 2015: More MCR-1 findings lead to calls to ban ag use of colistin

Obama’s new home, what does it matter?


Obama’s Fancy New Mansion Is Located 1,000 Feet From The Islamic Center Of Washington DC

 Short walk, truth, or conspiracy theory? Well now you know…

The mammoth, multi-million-dollar mansion where resident Barack Obama and his family will reportedly live after the first family exits the White House is located 1,096 feet from the Islamic Center of Washington — one of the largest mosques in the Western Hemisphere.

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The Islamic Center is a tremendous resource for the District’s Muslim community. “It provides Qur’an and Islamic Literature and distribution of such publications that would create awareness and knowledge of Islamic Truth,” according to the center’s website.

The Islamic Center in our nation’s capital also provides help for families in need, holds wedding ceremonies, organizes language courses, offers counseling and makes available ample research material related to Islam.

The Islamic Center features prayer five times daily. Jumaa Prayer, a traditional, congregational prayer held each Friday, occurs at 1:30 p.m.

Natural Hazard – Wild Snake Attack: Bangkok, Thailand (Was it a Ball Python?)


Thai man attacked by snake that slithered up through his toilet

BANGKOK – A Thai man is recovering from a bloody encounter with a 10-foot python that slithered through the plumbing of his home and latched its jaws onto his penis as he was using a squat toilet.

(Headline Excerpt)

Published May 26, 2016
Associated Press via Fox News

No comment on the intimate intrusion available from PETA or Obama’s homosexual agenda advocates.

Meanwhile, A radical new approach to generating human organs is to grow them inside animals.

Chemosabeism and other stories


Tonto (whose name means “fool” in Spanish).

Meanwhile back at the Colosseum….

Forked tongue speaks: How?

“Burning down the house”: Prohibitive economic realities …


File:Ivanpah Solar Power Facility.

Ivanpah Solar Power Facility. California Mojave Desert, 27 September 2013 Ivanpah’s eastern tower online. Note the sunlight glare on either side of the boiler. Image: Craig Dietrich, Wikipedia Creative Commons

Solar Energy’s Real Problem

Ivanpah, the world’s largest solar power plant located in California’s Mojave Desert, caught fire last Thursday, causing damage to one of the plant’s three towers.  This latest engineering setback is the least of the plant’s woes.  Prohibitive economic realities are the true problem.

Earlier this year, the California Public Utilities Commission (CPUC) decided to postpone its continued support of the struggling facility, which was touted as the future of solar power when it opened in 2014.  But after receiving $1.6 billion in loan guarantees from the Department of Energy (DOE) and $535 million from the U.S. Treasury Department, the facility’s promising future is turning out to be a multi-billion-dollar waste of money.

Ivanpah is unable to meet its intended electricity generation of 940,000 megawatt-hours per year, despite its designation as the largest concentrated solar plant in the world.  Pacific Gas & Electric (PG&E) received only 45 percent of the electricity it expected from Ivanpah in 2014 and 68 percent in 2015.

Output is so low, in fact, that it fails to meet Ivanpah’s power purchase agreement, which requires a set amount of electricity production for a certain price.

Ivanpah’s managers found that the facility needs to produce much more steam than initially thought to run efficiently, which requires substantially more natural gas than originally planned to supplement the concentrated solar each morning.  Weather predictions underestimated the amount of cloud cover the area receives, which prevents the facility from consistently producing high levels of electricity.

Compounding this reality, the price of solar photovoltaic panels has dropped precipitously, making concentrated solar more costly and less efficient in comparison to new solar technologies.  Ivanpah is a concentrated solar power (CSP) facility, using mirrors to concentrate sunlight and power a steam turbine to create electricity.  Solar photovoltaic panels, in contrast, convert sunlight into electricity directly.  Although CSP was once thought to be the future of solar power, technology improvements have made photovoltaics cheaper and more efficient.

Despite these realities, PG&E has given Ivanpah an extra six months to meet the required electricity production.  If Ivanpah can’t produce enough power by July 31, the $2.2-billion facility will shut down.

The reasons why are simple.  Ivanpah has been selling electricity for, on average, anywhere from $135 to $200 per megawatt-hour of electricity.  Existing coal-fired power plants produce electricity for $88 per megawatt-hour, after accounting for social and environmental costs, and even solar photovoltaic was being sold for $57 per megawatt-hour in 2015.  Despite the CPUC continuing to force PG&E to pay an expensive premium for electricity, Ivanpah simply cannot deliver.

Ivanpah is not the first taxpayer-funded renewable to fail.  In 2009, Solyndra, a solar panel manufacturer, received a $535-million loan guarantee from the Department of Energy.  The Obama administration encouraged the DOE to expedite the decision-making process so Vice President Biden could announce the program as a political success sooner.  At the same time, Chinese solar panels became cheaper, and natural gas prices plummeted, making Solyndra a lousy investment.  The DOE convinced Solyndra to delay layoffs until after the 2010 midterm elections as a political move.  In August 2011, Solyndra declared bankruptcy.

Taxpayers paid a half-billion dollars to Solyndra and never saw the promised benefits.  Both Solyndra and Ivanpah were free to make risky investments without risk of failure because the companies funding came through the political system rather than through the competitive market.

Proponents of such loan guarantee programs argue that although a few companies fail, the majority have not and are actually turning a profit for the federal government.  But the DOE often awards loans for financially unsound political reasons, with Solyndra and Ivanpah being prime examples.

If the government is making a profit off these loan programs, the private sector will fill the investment gap left by a government exit.  At least 28 utility-scale photovoltaic projects have been funded by private investors since 2011, while the DOE approved loans for just five projects.  The private sector offers loans to the most promising renewable investments, rather than throwing money at risky but politically enticing roads to nowhere.

Renewable energies undoubtedly have a future in the United States.  As the cost of extracting and using fossil fuels rises and costs for renewables decrease following technology improvements, developing renewable energies will become more cost-effective.  Until then, forcing investment in renewables comes at a huge cost to taxpayers with little reward.

[Byline Ryan Yonk, Ph.D., an assistant professor of research at Utah State University, is vice president and executive director of research at Strata.  Devin Stein student research associate at Strata.]

Source: American Thinker

Talking Heads “Burning Down the House”

Solar Energy’s other Real Problem – Cronyism and the darkness of night.

Bureaucratic entropy – Are NYC values reflective of a third-world America, or are they not?


New York City has seen the highest population growth since the year 2010—a 3.86-percent increase, to 8.4 million residents, according to the census bureau. Staten Island grew at the slowest rate—0.97 percent.

New York City’s suburbs were the next fastest-growing region, the census bureau reported, growing by around 1.23 percent to nearly 5.2 million residents. —Population 2016

The OWS Rap Sheet (So Far)

Remember this ‘fundamental change’? The OWS Rap Sheet (So Far)

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New York City is about to become a lot more disgusting

New York Post
May 26, 2016

(Excerpt)

Scofflaws of New York, rejoice — the City Council has cleared the way for you to litter, loiter and pee in the street to your heart’s content.

New legislation dubbed the “Criminal Justice Reform Act” was passed by lawmakers Wednesday, giving miscreants a get-out-of-jail-free card by eliminating the criminal penalties on a raft of quality-of-life crimes.

The disgusting and disturbing acts that the council voted to decriminalize include drinking alcohol out of a paper bag, lurking in parks after hours, urinating in the street and making enough of a racket to violate the noise code.

Under the legislation, which Mayor Bill de Blasio is expected to sign, offenders will face only civil summonses instead of criminal citations.

The main part of the “reform” act sponsored by Council Speaker Melissa Mark-Viverito deals with reducing the penalty for public urination and other quality-of-life offenses. It passed by a 40-9 vote in the liberal-leaning council.

(Full article at link)

[Byline Michael Gartland]

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FOLLOW THE STORY

New York City is about to become a lot more disgusting

City Council finalizes bills easing penalty for peeing in the street

Common sense from the commish: Bratton’s wise words on guns and drug-dealing bodegas

The dangerous push against policing is the top threat to black lives

Speeding drivers helped city rake in $957M in fines last year

Bill de Blasio must be living in an alternate reality

SEE ALL 54 STORIES

Or visit there, then if you manage to survive it, decide for yourself.
Beware also, the infectious liberal manifest destiny of  Chicago and Detroit as it’s shadow moves across the continent.

Or perhaps it could just be some migration phenomena, or something that is characteristic of things that tend to occur at or slightly above the 38th Parallel North.


Environmental Health Hazard – Agrochemical Contamination (Fatal): Colombia, S.A.


UNDIAGNOSED ILLNESS – COLOMBIA: (CUNDINAMARCA) FATAL, FUNGICIDE SUSPECTED, REQUEST FOR INFORMATION
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Published Date: 2016-05-25 05:31:18
Subject: PRO/EDR> Undiagnosed illness – Colombia: (CU) fatal, fungicide suspected, RFI
Archive Number: 20160525.4241004

Date: Mon 23 May 2015
Source: Fresh Plaza, La Razón report [edited]

The fire department of Cundinamarca stated that the irresponsible use of a fungicide on a potato crop, in the village of San Rafael, in the municipality of La Calera [Cundinamarca], near Bogotá, had left a tragic toll of one dead and 19 people intoxicated on Wednesday night [18 May 2016].

Captain Alvaro Farfán said 5 people had been taken to a local clinic because they had a high degree of intoxication and that one of them had died. A few hours later, the number of intoxicated people increased and the medical personnel started to experience symptoms of intoxication, so the medical facility had to be evacuated to avoid a mass poisoning and the patients were referred to other clinics in Bogotá.

The director of the Regulatory Center of Emergencies of Cundinamarca, Carlos Arturo Maria Julio said in an interview with Caracol Radio that the emergency had been generated by the misuse of the fungicide, which had not been handled following the appropriate protective measures. Authorities are uncertain as to what fungicide was used. They suspect that it was ME-8 [tetraconazole].

communicated by:
ProMED-mail
<promed@promedmail.org>

[Maps of Colombia can be seen at http://www.ezilon.com/maps/images/southamerica/map-of-Colmbia.gif and http://healthmap.org/promed/p/53351. – Sr.Tech.Ed.MJ

The article does not tell us precisely what symptoms the affected individuals were experiencing. I assume that these people must have been within the drift of the fungicide, as the article does not mention ingestion of the potatoes.

If the fungicide was tetraconazole it is regarded as low toxicity (category III or IV) but it is classified as likely to be carcinogenic to humans, based on the occurrence of liver tumors in male and female mice. Tetraconazole is harmful if swallowed or absorbed through skin, or inhaled, and causes moderate eye irritation. However, most of the toxicities with this chemical are not as acute as this article leads us to believe.

Data indicate tetraconazole is an eye irritant but not a dermal irritant or sensitizer, so the rapidness of the death and the other illnesses reported are not indicative of exposure to tetraconazole, even with high concentration of this chemical. As emergency personnel were also affected it seems more likely this may have been a pesticide such as an organophosphate off-gassing from the clothing, resulting in secondary exposure.

Several other articles report that those using the fungicide spray were mixing dithane (mancozeb), curaxil M8 (m8 cymoxanil mancozeb), curzate (cymoxanil), and pegal (agricultural adjuvant) and that the mixture was being used without any type of protection. This resulted in contamination of the environment and led to the illness.

Mancozeb (trade name Dithane) is relatively non toxic (category IV) fungicide. It is essentially not toxic by dermal absorption and by inhalation. It is a mild irritant to the skin and may be weak sensitizer. It is commonly found in combination with , another fungicide.

Zineb is an ethylene bisdithiocarbamate (EBDCs) fungicide for crops, slightly to moderately toxic when ingested. Following a single large dose of zineb, rats and mice exhibited incoordination, hyperactivity followed by inactivity, loss of muscle tone, and loss of hair.

In spray or dust forms, the EBDCs are moderately irritating to the skin and to respiratory mucous membranes. Poisoning from this class of chemicals includes itching, scratchy throat, sneezing, coughing, inflammation of the nose or throat, and bronchitis. Early symptoms from exposure of humans to inhalation of zineb include tiredness, dizziness, and weakness. More severe symptoms include headache, nausea, fatigue, slurred speech, convulsions, and unconsciousness. There is no evidence of neurotoxicity, that is nerve tissue destruction or behavioral change, from the EBDCs. However, EBDCs are partially chemically broken down, or metabolized, to carbon disulfide, a neurotoxin capable of damaging nerve tissue. EBDC residues in or on foods convert readily to ETU during commercial processing or home cooking.

Zineb is a skin and eye irritant and a dermal sensitizer. Cross sensitization with maneb and mancozeb may occur. Mucous membrane irritation has also been reported in humans. Absorption of large amounts of zineb through the skin can lead to the same acute symptoms caused by inhalation exposure.

The product curzate M8 or curaxil M8, is a formulation of 8 per cent cymoxanil and 64 per cent mancozeb. Cymoxanil is an acetamide compound used as both a curative and preventative foliar fungicide. Cymoxanil has low acute toxicity, both by dermal and inhalation exposure. It is not a skin sensitizer and is category III fungicide

All in all it appears these people were spraying with several trade name chemicals that had mostly the same active ingredient. Zineb seems to have the potential to cause the problems, or some of the problems mentioned in this article. More information and more clinical features are needed. If a definitive answer is found we would appreciate an update.

Portions of this comment were extracted from http://pmep.cce.cornell.edu/profiles/extoxnet/pyrethrins-ziram/zineb-ext.html.

References
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1. Agway, Inc. Material safety data sheet on zineb formulations. No date given. Chemical Division. Syracuse, NY; http://pmep.cce.cornell.edu/profiles/extoxnet/pyrethrins-ziram/zineb-ext.html.
2. Berg GL (ed.). Farm chemicals handbook. Willoughby, OH: Meister Publishing Co, 1986.
3. Pesticide Management and Education: An on-line pesticide information database in CENET, Cornell Cooperative Extension Network. Cornell University, Ithaca, NY.
4. Clayton GD, Clayton FE (eds.). Patty’s industrial hygiene and toxicology. rd edition. Vol. 2: Toxicology. NY: John Wiley and Sons, 1981.
5. Cornell University. 1988 New York State pesticide recommendations. 49th annual pest control conference. Nov. 9-11. Ithaca, NY: 1987.
6. Gosselin RE, et al. Clinical toxicology of commercial products. 5th edition. Baltimore, MD: Williams and Wilkins, 1984.
7. Hallenbeck WH, Cunningham-Burns KM. Pesticides and human health. NY: Springer-Verlag, 1985.
8. Hartley D, Kidd H (eds.). The agrochemicals handbook. Nottingham, England: Royal Society of Chemistry, 1983.
9. Hayes WJ. Pesticides studied in man. Baltimore, MD: Williams and Wilkins, 1982.
10. Morgan DP. Recognition and management of pesticide poisonings. 3rd edition. US Environmental Protection Agency. Washington, DC: US Government Printing Office, 1982.
11. Pimentel D. Ecological effects of pesticides on nontarget species. Executive Office of the President’s Office of Science and Technology. Washington, DC: US Government Printing Office, 1971.
12. Shepard TH. Catalog of teratogenic agents. 5th edition. Baltimore, MD: The Johns Hopkins University Press, 1986.
13. Thomson WT. Agricultural chemicals. Book IV. Fungicides. Fresno, CA: Thomson Publications, 1985.
14. Tucker R, Crabtree DG. Handbook of toxicity of pesticides to wildlife. USDA Fish and Wildlife Service. Bureau of Sport Fisheries and Wildlife, 1970.
15. Memorandum from EF Tinsworth, director, Special Review and Reregistration Division. Office of Pesticides and Toxic Substances. Data call-in for small-scale retrospective ground-water monitoring. US Environmental Protection Agency: 1988.
16. Memorandum from E Neil Pelletier. Status of EBDC fungicide registrations. Office of Pesticides and Toxic Substances. Science Support Branch. Benefits and Use Division (TS-768-C). Washington, DC. Photocopy (1987 (May 13)).
17. Pesticides fact book. (A-107/86-003). Washington, DC: Office of Public Affairs, 1986 (June).
18. User’s manual for the pesticide root zone model (PRZM). Release 1. Athens, GA: Environmental Research Laboratory, 1984 (Dec).
19. Wagner SL. Clinical toxicology of agricultural chemicals. Environmental Health Sciences Center. Oregon State University. NJ: Noyes Data Corporation, 1983.
20. Witt JM (ed.). Chemistry, biochemistry, and toxicology of pesticides. Proceedings of an extension service short course at Oregon State University. Eugene, OR: Pest Control Education Program, 1985.
21. Worthing CR (ed.). The pesticide manual: A world compendium. Croydon, England: The British Crop Protection Council, 1983.
22. Hayes WJ, Laws ER (eds.). Handbook of pesticide toxicology, Vol 3, classes of pesticides. NY: Academic Press Inc, 1990.
23. Meister RT (ed.). Farm chemicals handbook ’92. Willoughby, OH: Meister Publishing Company, 1992.
24. Howard PH (ed.). Handbook of environmental fate and exposure data for organic chemicals, Vol. III: pesticides. Chelsea, MI: Lewis Publishers, 1989.
25. Occupational Health Services, Inc. MSDS for Zineb. Secaucus, NJ: OHS Inc, 1991 (21 Feb).
– Mod.TG]

………………………………………….sb/tg/mj/sh

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