International Conferences


Colorectal cancer
Notice that none of these peoples real true wealth is ever recorded. One week later, the woman who provided the alibi vanishes. However, earlier pain management did not affect the total length of hospitalization for patients admitted to the inpatient services. World Bank Research Observer. Other microRNAs, with likely comparable numbers of target genes, are even more frequently epigenetically altered in colonic field defects and in the colon cancers that arise from them. Dietary fiber helps reduce the chance of gastrointestinal problems such as constipation and diarrhea by increasing the weight and size of stool and softening it. The purpose of the Illuminati is to divide the goyim all non-Jews through political, economic, social, and religious means.

2.3 Hatching Egg Transfer

Sample size calculation in cross-sectional studies

The underlying causes could also be categorized as those related to the child's food security, health including protection from infections and appropriate treatment of illness and care, including maternal and family practices such as those related to frequency of feeding, breastfeeding and weaning. Prematurity or low birth weight may predispose the child to the development of nutritional marasmus. Failure of breastfeeding because of death of the mother, separation from the mother or lack of or insufficient breastmilk may be causes in poor societies where breastfeeding is often the only feasible way for mothers to feed their babies adequately.

An underlying cause of PEM is any influence that prevents mothers from breastfeeding their newborn infants when they live in households where proper bottle-feeding may be difficult or hazardous. Therefore promotion of infant formula and insufficient support of breastfeeding by the medical profession and health services may be factors in the aetiology of marasmus. Prolonged exclusive breastfeeding without the introduction of other foods after six months of age may also contribute to growth faltering, PEM and eventually nutritional marasmus.

The view that kwashiorkor is the result of protein deficiency and nutritional marasmus the result of energy deficiency is an oversimplification, as the causes of both conditions are complex. Both endogenous and exogenous causes are likely to influence whether a child develops nutritional marasmus, kwashiorkor or the intermediate form known as marasmic kwashiorkor.

In a child who consumes much less food than required for his or her energy needs, energy is mobilized from both body fat and muscle. Gluconeogenesis in the liver is enhanced, and there is loss of subcutaneous fat and wasting of muscles. It has been suggested that under these circumstances, especially when protein intake is very low relative to carbohydrate intake with the situation perhaps aggravated by nitrogen losses from infections , various metabolic changes take place which contribute to the development of oedema.

More sodium and more water are retained, and much of the water collects outside the cardiovascular system in the tissues, which results in pitting oedema. The actual role of infection has not been adequately explained, but certain infections cause major increases in urinary nitrogen, which derives from amino acids in muscle tissue.

There is not yet broad agreement on the actual cause of the oedema that is the hallmark of kwashiorkor. Most researchers agree that potassium deficiency and sodium retention are important in the pathogenesis of oedema. Some evidence supports the classical argument that oedematous malnutrition is a sign of inadequate protein intake.

For example, oedema, fatty liver and a kwashiorkor-like condition can be induced in pigs and baboons on a protein-deficient diet. Epidemiological evidence also shows higher rates of kwashiorkor in Uganda, where the staple diet is plantain, which is very low in protein, than in neighbouring areas where the staple food is a cereal. Recently two new theories have been advanced to explain the cause of kwashiorkor. The first is that kwashiorkor is due to aflatoxin poisoning.

The second is that free radicals are important in the pathogenesis of kwashiorkor; it has been hypothesized that most of the clinical features of kwashiorkor could be caused by an excess free radical stress. This new, relatively untested theory also suggests, however, that kwashiorkor, even if produced by free radicals, is likely to occur only in children who have inadequate food intake and are subjected to infection. Thus even if this theory were to be proved correct, it would merely explain a mechanism for the pathogenesis of kwashiorkor.

It would not change the fact that improving diet and reducing infection lead to significant reduction in both kwashiorkor and nutritional marasmus. Neither the aflatoxin nor the free radical theory has been proved experimentally, nor is there adequate convincing research to uphold the view of individual dysadaptation as the cause of severe PEM.

Surprisingly, no studies have been able to give conclusive proof of either similarities or differences in dietary consumption between children who develop kwashiorkor with oedema and those who show clinical signs of nutritional marasmus without any oedema. In severe PEM there is usually biochemical evidence, and often clinical evidence, of micronutrient deficiencies, which is not surprising in a child or adult who consumes a grossly inadequate diet.

However, there is little indication that any one micronutrient deficiency is the main cause of PEM or is by itself responsible for the oedema of kwashiorkor. Irrespective of which theory of aetiology may be proved correct, improving the quantity of food consumed, taking steps to ensure that diets are nutritionally well balanced and controlling infection all help to prevent PEM.

The condition of PEM is often likened to an iceberg, of which 20 percent is visible above the water and about 80 percent submerged. The severe forms of PEM - kwashiorkor, nutritional marasmus and marasmic kwashiorkor - constitute the top, exposed part of the iceberg: Mild and moderate PEM are diagnosed mainly on the basis of anthropometry, especially using measurements of weight and height and sometimes other measurements such as arm circumference or skinfold thickness.

As shown by the iceberg diagram Figure 5 , the prevalence of highly visible, serious PEM kwashiorkor, marasmic kwashiorkor and nutritional marasmus is usually between about 1 and 5 percent, except in famine areas. In contrast, moderate and mild malnutrition in many countries of sub-Saharan Africa and South Asia add up to 30 to 70 percent. In these areas often only 15 to 50 percent of young children between six months and 60 months of age do not have evidence of PEM. The diagram illustrates that both energy deficiency and protein deficiency play a part, but that energy deficiency is more important.

It suggests that protein deficiency plays a greater part in kwashiorkor and energy deficiency in nutritional marasmus. The percentage of children classified as having severe, moderate and mild PEM depends on how these terms are defined. The two severe forms of malnutrition, kwashiorkor and nutritional marasmus, have very different appearances and clinical features as described below.

It is generally agreed that the hallmark of kwashiorkor is pitting oedema, and the overriding feature of nutritional marasmus is severe underweight. Children who have both oedema and severe underweight are diagnosed as having marasmic kwashiorkor. The so-called Wellcome classification of severe forms of PEM has been widely used for over 20 years see Table It has the advantage of simplicity because it is based on only two measures, namely the percentage of standard weight for age and the presence or absence of oedema.

The category "undernourished" includes children who have moderate or moderately severe PEM but no oedema and whose weight is above 60 percent of the standard. Today a cut-off point using standard deviations SD is considered more appropriate than percentage of standard, but not many children would be reclassified. In the s and s the degree of malnutrition was almost always based on the child's percentage of standard weight for age.

In Latin America and elsewhere the Gomez classification was very widely used Table In the early s a number of nutrition workers began to suggest that judging the degree of malnutrition only on the basis of weight for age had many disadvantages. A method was suggested that distinguished three categories of mild to moderate PEM based on weight and height measurements of children.

Subsequently these categories came to be known as follows: Percentage of standard weight for age. Bengoa of WHO suggested that all children with oedema be placed in Grade This became known as the Bengoa modification.

This classification makes a distinction between current and past influences on nutritional status. It helps the examiner assess the likelihood that supplementary feeding will markedly improve the nutritional status of the child, and it gives the clinician some clue as to the history of the malnutrition in the patient.

It also has advantages for nutritional surveys and surveillance. In general, stunting is more prevalent than wasting worldwide. In country reports published based on weight for age alone, "underweight" is commonly used to denote weight below 2 SD of the NCHS standards in children up to five years of age.

In a normal distribution it is expected that 2 to 3 percent of children will fall below the -2 SD cut-off point. Prevalence above that level suggests that there is a nutritional problem in the population assessed. If measurements are also taken of length or height, then the children can be further divided into those who are wasted, stunted, or wasted and stunted. Policy-makers and health workers need to decide which growth standards to use as a yardstick for judging malnutrition and for surveys, monitoring and surveillance.

The international growth standards have been found to be applicable for developing countries, as evidence shows that the growth of privileged children in developing countries does not differ importantly from these standards, and that the poorer growth seen among the underprivileged results from social factors, including the malnutrition-infection complex, rather than from ethnic or geographic differences.

The functional significance of mild or moderate PEM is still not fully known. Studies from several countries show that the risk of mortality increases rather steadily with worsening nutritional status as indicated by anthropometric measures. Recent investigations in Guatemala indicated that teenagers who had manifested poor growth when examined in early childhood were smaller in stature, did less well at school, had poorer physical fitness and had lower scores on psychological development tests than children from the same villages who grew better as young children.

These results suggest long-term consequences of PEM in early childhood. The attempt to control the extent and severity of PEM using many different strategies and actions is at the heart of nutritional programmes and policies in most developing countries. The reduction and eventual prevention of mild or moderate malnutrition will automatically reduce severe malnutrition. Thus, although it may be tempting particularly for doctors and other health workers to put major emphasis on the control of nutritional marasmus and kwashiorkor, resources are often better spent on controlling mild and moderate PEM, which will in turn reduce severe PEM.

Kwashiorkor is one of the serious forms of PEM. It is seen most frequently in children one to three years of age, but it may occur at any age. It is found in children who have a diet that is usually insufficient in energy and protein and often in other nutrients.

Often the food provided to the child is mainly carbohydrate; it may be very bulky, and it may not be provided very frequently. Kwashiorkor is often associated with, or even precipitated by, infectious diseases. Diarrhoea, respiratory infections, measles, whooping cough, intestinal parasites and other infections are common underlying causes of PEM and may precipitate children into either kwashiorkor or nutritional marasmus.

These infections often result in loss of appetite, which is important as a cause of serious PEM. Infections, especially those resulting in fever, lead to an increased loss of nitrogen from the body which can only be replaced by protein in the diet. Kwashiorkor is relatively easy to diagnose based on the child's history, the symptoms reported and the clinical signs observed Figure 6.

Laboratory tests are not essential but do throw more light on each case. All cases of kwashiorkor have oedema to some degree, poor growth, wasting of muscles and fatty infiltration of the liver. Other signs include mental changes, abnormal hair, a typical dermatosis, anaemia, diarrhoea and often evidence of other micronutrient deficiencies. The accumulation of fluid in the tissues causes swelling; in kwashiorkor this condition is always present to some degree.

It usually starts with a slight swelling of the feet and often spreads up the legs. Later, the hands and face may also swell. To diagnose the presence of oedema the medical attendant presses with a finger or thumb above the ankle. If oedema is present the pit formed takes a few seconds to return to the level of the surrounding skin.

Growth failure always occurs. If the child's precise age is known, the child will be found to be shorter than normal and, except in cases of gross oedema, lighter in weight than normal usually 60 to 80 percent of standard or below 2 SD. These signs may be obscured by oedema or ignorance of the child's age. Wasting of muscles is also typical but may not be evident because of oedema. The child's arms and legs are thin because of muscle wasting.

Fatty infiltration of the liver. This condition is always found in post-mortem examination of kwashiorkor cases. It may cause palpable enlargement of the liver hepatomegaly. Mental changes are common but not invariably noticed. The child is usually apathetic about his or her surroundings and irritable when moved or disturbed.

The child prefers to remain in one position and is nearly always miserable and unsmiling. Appetite is nearly always poor. The hair of a normal Asian, African or Latin American child is usually dark black and coarse in texture and has a healthy sheen that reflects light. In kwashiorkor, the hair becomes silkier and thinner. African hair loses its tight curl. At the same time it lacks lustre, is dull and lifeless and may change in colour to brown or reddish brown.

Sometimes small tufts can be easily and almost painlessly plucked out. On examination under a microscope, plucked hair exhibits root changes and a narrower diameter than normal hair. The tensile strength of the hair is also reduced. In Latin America bands of discoloured hair are reported as a sign of kwashiorkor.

These reddish-brown stripes have been termed the "flag sign" or "signa bandera". Dermatosis develops in some but not all cases of kwashiorkor. It tends to occur first in areas of friction or of pressure such as the groin, behind the knees and at the elbow. Darkly pigmented patches appear, which may peel off or desquamate. The similarity of these patches to old sun-baked, blistered paint has given rise to the term "flaky-paint dermatosis".

Underneath the flaking skin are atrophic depigmented areas which may resemble a healing burn. Most cases have some degree of anaemia because of lack of the protein required to synthesize blood cells. Anaemia may be complicated by iron deficiency, malaria, hookworm, etc. Stools are frequently loose and contain undigested particles of food.

The cheeks may appear to be swollen with either fatty tissue or fluid, giving the characteristic appearance known as "moonface".

Signs of other deficiencies. In kwashiorkor some subcutaneous fat is usually palpable, and the amount gives an indication of the degree of energy deficiency. Mouth and lip changes characteristic of vitamin B deficiency are common. Xerosis or xerophthalmia resulting from vitamin A deficiency may be seen. Deficiencies of zinc and other micronutrients may occur. Oedema is also a feature of nephrosis, which may therefore be confused with kwashiorkor.

In nephrosis, however, the urine contains much albumin as well as casts and cells. In kwashiorkor, there is usually only a trace of albumin. If flaky-paint dermatosis or other signs of kwashiorkor are present, the diagnosis is established. Ascites is frequently seen in nephrosis, but only rarely in kwashiorkor.

In most developing countries kwashiorkor is a much more common cause of oedema than nephrosis. Oedema may result from this cause alone. In young children kwashiorkor is often also present. In pure hookworm anaemia there are no skin changes other than pallor.

In all cases the stools should be examined. Pellagra is rare in young children. The skin lesions are sometimes similar to those of kwashiorkor, but in pellagra they tend to be on areas exposed to sunlight not the groin, for example. There may frequently be diarrhoea and weight loss, but no oedema or hair changes. In most countries marasmus, the other severe form of PEM, is now much more prevalent than kwashiorkor. In marasmus the main deficiency is one of food in general, and therefore also of energy.

It may occur at any age, most commonly up to about three and a half years, but in contrast to kwashiorkor it is more common during the first year of life. Nutritional marasmus is in fact a form of starvation, and the possible underlying causes are numerous.

For whatever reason, the child does not get adequate supplies of breastmilk or of any alternative food. Perhaps the most important precipitating causes of marasmus are infectious and parasitic diseases of childhood. These include measles, whooping cough, diarrhoea, malaria and other parasitic diseases. Chronic infections such as tuberculosis may also lead to marasmus.

Other common causes of marasmus are premature birth, mental deficiency and digestive upsets such as malabsorption or vomiting. A very common cause is early cessation of breastfeeding. The important features of kwashiorkor and nutritional marasmus are compared in Table The following are the main signs of marasmus.

In all cases the child fails to grow properly. If the age is known, the weight will be found to be extremely low by normal standards below 60 percent or -3 SD of the standard. In severe cases the loss of flesh is obvious: The child appears to be skin and bones. An advanced case of the disease is unmistakable, and once seen is never forgotten. The muscles are always extremely wasted. There is little if any subcutaneous fat left. The skin hangs in wrinkles, especially around the buttocks and thighs.

When the skin is taken between forefinger and thumb, the usual layer of adipose tissue is found to be absent. Children with marasmus are quite often not disinterested like those with kwashiorkor.

Instead the deep sunken eyes have a rather wide-awake appearance. Similarly, the child may be less miserable and less irritable. The child often has a good appetite. In fact, like any starving being, the child may be ravenous. Children with marasmus often violently suck their hands or clothing or anything else available.

Sometimes they make sucking noises. Stools may be loose, but this is not a constant feature of the disease. Diarrhoea of an infective nature, as mentioned above, may commonly have been a precipitating factor. There may be pressure sores, but these are usually over bony prominences, not in areas of friction. In contrast to kwashiorkor, there is no oedema and no flaky-paint dermatosis in marasmus.

Changes similar to those in kwashiorkor can occur. There is more frequently a change of texture than of colour. Although not a feature of the disease itself, dehydration is a frequent accompaniment of the disease; it results from severe diarrhoea and sometimes vomiting.

Children with features of both nutritional marasmus and kwashiorkor are diagnosed as having marasmic kwashiorkor. In the Wellcome classification see above this diagnosis is given for a child with severe malnutrition who is found to have both oedema and a weight for age below 60 percent of that expected for his or her age.

Children with marasmic kwashiorkor have all the features of nutritional marasmus including severe wasting, lack of subcutaneous fat and poor growth, and in addition to oedema, which is always present, they may also have any of the features of kwashiorkor described above.

There may be skin changes including flaky-paint dermatosis, hair changes, mental changes and hepatomegaly. Many of these children have diarrhoea.

Laboratory tests have a limited usefulness for the diagnosis or evaluation of PEM. Some biochemical estimations are used, and give different results for children with kwashiorkor and nutritional marasmus than for normal children or those with moderate PEM.

In kwashiorkor there is a reduction in total serum proteins, and especially in the albumin fraction. In nutritional marasmus the reduction is usually much less marked. Often, because of infections, the globulin fraction in the serum is normal or even raised.

Serum albumin drops to low or very low levels usually only in clinically evident kwashiorkor. Serum albumin levels are not useful in predicting imminent kwashiorkor development in moderate PEM cases. It is often true that the more severe the kwashiorkor, the lower the serum albumin, but serum albumin levels are not useful in evaluating less severe PEM. It has also been suggested that serum albumin levels below 2. Serum albumin determinations are relatively easy and cheap to perform, and unlike the other biochemical tests mentioned below, they can be done in modest laboratories in many developing countries.

Levels of two other serum proteins, pre-albumin and serum transferrin, are also of use and not too difficult to determine. Levels of both are reduced in kwashiorkor and may be useful in judging its severity. However, serum transferrin levels are also influenced by iron status, which reduces their usefulness as an indicator of kwashiorkor. Levels of retinol binding protein RBP , which is the carrier protein for retinol, also tend to be reduced in kwashiorkor and to a lesser degree in nutritional marasmus.

However, other diseases, such as liver disease, vitamin A and zinc deficiencies and hyperthyroidism, may also influence RBP levels. Other biochemical tests that have been used or recommended for diagnosing or evaluating PEM have limited usefulness. These include tests for: These tests are not specific, and most cannot be performed in ordinary hospital laboratories.

All children with severe kwashiorkor, nutritional marasmus or marasmic kwashiorkor should, if possible, be admitted to hospital with the mother. The child should be given a thorough clinical examination, including careful examination for any infection and a special search for respiratory infection such as pneumonia or tuberculosis.

Stool, urine and blood tests for haemoglobin and malaria parasites should be performed. The child should be weighed and measured. Often hospital treatment is not possible. In that case the best possible medical treatment available at a health centre, dispensary or other medical facility is necessary. If the child is still being breastfed, breastfeeding should continue.

Treatment is often based on dried skimmed milk DSM powder. The child should receive ml of this mixture per kilogram of body weight per day, given in six feeds at approximately four-hour intervals. Each feed is made by adding five teaspoonfuls of DSM powder to ml of water. Attention to providing all micronutrients is important.

The milk mixture should be fed to the child with a feeding cup or a spoon. If cupor spoon-feeding is difficult - which is possible if the child does not have sufficient appetite and is unable to cooperate or if the child is seriously ill the same mixture is best given through an intragastric tube.

The tube should be made of polyethylene; it should be about 50 cm long and should have an internal diameter of 1 mm. It is passed through one nostril into the stomach. The protruding end should be secured to the cheek either with sticky tape or zinc oxide plaster. The tube can safely be left in position for five days. The milk mixture is best given as a continuous drip, as for a transfusion. Alternatively, the mixture can be administered intermittently using a large syringe and a needle that fits the tube.

The milk mixture is then given in feeds at four-hour intervals. Before and after each feed, 5 ml of warm, previously boiled water should be injected through the lumen of the tube to prevent blockage. There are better mixtures than plain DSM. They can all be administered in exactly the same way by spoon, feeding cup or intragastric tube. Most of these mixtures contain a vegetable oil e. The vegetable oil increases the energy content and energy density of the mixture and appears to be tolerated better than the fat of full cream milk.

Casein increases the cost of the mixture, but as it often serves to reduce the length of the hospital stay, the money is well spent. A stock of the dry SCOM mixture can be stored for up to one month in a sealed tin. To make a feeding, the desired quantity of the mixture is placed in a measuring jug, and water is added to the correct level.

Stirring or, better still, whisking will ensure an even mixture. As with the plain DSM mixture, ml of liquid SCOM mixture should be given per kilogram of body weight per day; a 5-kg child should receive ml per day in six ml feeds, each made by adding five teaspoonfuls of SCOM mixture to ml of boiled water. A ml portion of made-up liquid feed provides about 28 kcal, 1 g protein and 12 mg potassium.

Children with kwashiorkor or nutritional marasmus who have severe diarrhoea or diarrhoea with vomiting may be dehydrated. Intravenous feeding is not necessary unless the vomiting is severe or the child refuses to take fluids orally.

Rehydration should be achieved using standard oral rehydration solution ORS , as is described for the treatment of diarrhoea see Chapter For severely malnourished children, unusually dilute ORS often provides some therapeutic advantage. Thus if standard ORS packets are used which are normally added to 1 litre of boiled water, in a serious case a packet might be added to 1.

Even in tropical areas temperatures at night often drop markedly in hospital wards and elsewhere. The seriously malnourished child has difficulty maintaining his or her temperature and may easily develop a lower than normal body temperature, termed hypothermia. Untreated hypothermia is a common cause of death in malnourished children. At home the child may have been kept warm sleeping in bed with the mother, or the windows of the house may have been kept closed.

In the hospital ward the child may sleep alone, and the staff may keep the windows open. He or she must be kept in warm clothes and must be kept covered with warm bedding, and there must be an effort to ensure that the room is adequately warm.

Sometimes hot-water bottles in the bed are used. The child's temperature should be checked frequently. Although it is useful to establish standard procedures for treating kwashiorkor and nutritional marasmus in any hospital or other health unit, each case should nevertheless be treated on its own merits. No two children have identical needs. Infections are so common in severely malnourished children that antibiotics are often routinely recommended. Benzyl-penicillin by intramuscular injection, 1 million units per day in divided doses for five days, is often used.

Ampicillin, mg in tablet form four times a day by mouth, or amoxycillin, mg three times a day by mouth, can also be given. Gentamycin and chloramphenicol are alternative options but are less often used. In areas where malaria is present an antimalarial is desirable, e. In severe cases and when vomiting is present, chloroquine should be given by injection. If anaemia is very severe it should be treated by blood transfusion, which should be followed by ferrous sulphate mixture or tablets given three times daily.

If a stool examination reveals the presence of hookworm, roundworm or other intestinal parasites, then an appropriate anthelmintic drug such as albendazole should be given after the general condition of the child has improved. Severely malnourished children not infrequently have tuberculosis and should be examined for it. If the disease is found to be present, specific treatment is needed. On the above regime, a child with serious kwashiorkor would usually begin to lose oedema during the first three to seven days, with consequent loss in weight.

During this period, the diarrhoea should ease or cease, the child should become more cheerful and alert, and skin lesions should begin to clear. When the diarrhoea has stopped, the oedema has disappeared and the appetite has returned, it is desirable to stop tube-feeding if this method has been used.

A bottle and teat should not be used. If anaemia is still present, the child should now start a course of iron by mouth, and half a tablet mg of chloroquine should be given weekly. Children with severe nutritional marasmus may consume very high amounts of energy, and weight gain may be quite rapid. However, the length of time needed in hospital or for full recovery may be longer than for children with kwashiorkor. In both conditions, as recovery continues, usually during the second week in hospital, the patient gains weight.

While feeding of milk is continued, a mixed diet should gradually be introduced, aimed at providing the energy, protein, minerals and vitamins needed by the child. If the disease is not to recur, it is important that the mother or guardian participate in the feeding at this stage.

She must be told what the child is being fed and why. Her cooperation with and follow-up of this regime is much more likely if the hospital diet of the child is based mainly on products that are used at home and that are likely to be available to the family. This is not feasible in every case in a large hospital, but the diet should at least be based on locally available foods. Thus in a maize-eating area, for example, the child would now receive maize gruel with DSM added.

For an older child, crushed groundnuts can be added twice a day, or, if preferred by custom, roasted groundnuts can be eaten. A few teaspoonfuls of ripe papaya, mango, orange or other fruit can be given. At one or two meals per day, a small portion of the green vegetable and the beans, fish or meat that the mother eats can be fed to the child, after having been well chopped.

If eggs are available and custom allows their consumption, an egg can be boiled or scrambled for the child; the mother can watch as it is prepared. Alternatively, a raw egg can be broken into some simmering gruel. Protein-rich foods of animal origin are often relatively expensive. They are not essential; a good mixture of cereals, legumes and vegetables serves just as well. If suitable vitamin-containing foods are not available, then a vitamin mixture should be given, because the DSM and SCOM mixtures are not rich in vitamins.

The above maize-based diet is just an example. If the diet of the area is based on rice or wheat, these can be used instead of maize. If the staple food is plantain or cassava, then protein-rich supplements are important. After discharge, or if a moderate case of kwashiorkor has been treated at home and not in the hospital, the child should be followed if possible in the out-patient department or a clinic.

It is much better if such cases can visit separately from other patients i. A relaxed atmosphere is desirable, and the medical attendant should have time to explain matters to the mother and to see that she understands what is expected of her. It is useless just to hand over a bag of milk powder or other supplement, or simply to weigh the child but not provide simple guidance. Hardly anyone donates to me any longer.

I have been putting out much more money in the last 6 months than what has been coming in. This is why I must now cut back on the Videos since they cost much money to produce. With all due respect, clearly, you need some more sources than what you provided us here about David Rockefeller. And the Bilderbergers are not exclusively Jewish. Prince Bernhard of the Netherlands, who was also instrumental in creating the Bilderberg group, was a member of the Nazi Party until , three years prior to his marrying the Dutch Queen Juliana, and had also worked for the German industrial giant, I.

Farben, the maker of Zyklon B, the gas used in concentration camps. The Germanic dynasty of Saxe-Coburg-Gotha http: And no, they are not just figure heads of state. This is a big fat lie. Is the constitutional monarch of sixteen independent sovereign states known as the Commonwealth realms:. Notice that none of these mostly Northwestern European countries have been seriously affected by the financial crisis, and notice that most of these countries live off of American military might, so they have enough money to pay for their cradle-to-the-grave nanny states.

Notice that none of these peoples real true wealth is ever recorded. What lies in store for Greece, Portugal, Spain, Ireland, Italy, and, in short order, the United States, is the wholesale sell-off of public property to private corporations at bargain basement prices.

Total corporate control over every facet of life equals extreme fascism. What is occurring in Greece is a bellwether for what will befall other nations in Europe, as well as the United States, if the bankers get their way. And in Greece, the people know how generations of investments by the taxpayers are being turned over to vampire capitalists who have the full backing of the International Monetary Fund, European Commission, and the European Central Bank.

The European and global bankers have demanded that the Greek government sell off entirely or assume a minority stake in a number of state enterprises and utilities. For example, this year global capitalists are slated to acquire 84 percent of OTE, the Greek telecommunications provider. In addition, private bankers will assume 66 percent ownership of the Greek Postal Savings Bank; 51 percent of the National Lottery; 60 percent of the Salonika Water Authority; 68 percent of DEPA, the natural gas utility; and 25 percent ownership of the ports of Piraeus and Salonika.

Next year, the capitalist grab for public property increases in intensity with Athens International Airport coming under 79 percent private ownership. The Greek Communist Party has vowed to fight against the acquisition of public property by the private sector. In fact, it is the Communist parties of Europe that have been the most vocal against the power grab by the bankers but their opposition to the privatization moves receives very little attention by the corporate-controlled media.

Massive sell-off lists of public property are now being drawn up by the governments of Portugal, Spain, Italy, and Ireland. One Libyan government official this reporter spoke to in Tripoli, during an intensive NATO bombing assault, opined that the same fate is in store for the Libyan Socialist Jamahiriyah.

With the highest standard of living in Africa, Libyans could witness the U. There was also the case of Marshal of the Soviet Union Kulik, demoted to major-general by Stalin, who had then sent him to prison and announced that he was dead. After Stalin, Kulik was released from prison and restored to his rank of lieutenant-general.

He was promised promotion to Marshal if he could organise the design and production of the first Soviet intercontinental ballistic missile. He succeeded and in he again became a Marshal of the Soviet Union, although no explanation of his return from the dead was ever made public. Here we have a man that official was declared dead.

And he is alive. Just how many others who we was told they was dead and live? Nobody ever talks about German prisoners of war, that were taken off probably to Siberia during WW2. Needless to say, I am sure they all died in a bad way. But that is ok. They were evil Germans and they were white. Somehow civilization flourished for thousands of years with neither one of these absolutist approaches to public goods medieval Holy Land pilgrimages, for example, might have been impossible without the ecosystem of private toll roads created in response.

Much as I resent paying Jew taxes for participating in the financial system, I resent even more these facile suggestions Heeb straw-man arguments that I have only two choices: I try to stay fresh, brother!

Feel free to make any puns you like, I always enjoy a round or two of wordplay. Does he do it? A bright note, however: Brother Nathanael is the only person I have yet found on the Internet who is telling the full and entire truth. He is the man with the inside scoop. The answer is NO! Look at the history of Sephardic Jews just in slavery: Look up their name in the Jewish historian Malcolm H. Do you see the names: There is one little fragment of Scripture which is tremendous but it has a terrible statement in it:.

That first, earthly Israel is not now in blessing, nor in life, nor is it in the Divine vocation. It is where the Lord Jesus said it would be if it rejected Him - in outer darkness, where there would be weeping and wailing and gnashing of teeth, and for these many centuries the Wailing Wall in Jerusalem has fulfilled that prophecy!

Though you obviously posted them for a different purpose, your recent links seem quite relevant to our earlier discussion. When asked who the men were, Doctor Dodd refused to name them. Lucifer is very much alive. You know what all those terms: Guess we have a wee bit of double standard going on in US, huh? It seems that China Arnold right was having a fight with her boyfriend and decided to get back at him by jamming her own 28 day-old tot, Paris, into the microwave, pressing the power button for about 30 seconds and cooking the baby girl from the inside out.

She died the next day in the hospital. They never report on crime blacks do because the PC media mavens want to keep White people oblivious to the very real black horror show going on in all White nations, as well as keeping us from racial awareness and solidarity.

Stupid White people thought by electing Obama who is really just as much White or Jewish, as black , might shut up the big-mouthed, militant Negroes and we might see them act a little more civilized. Like fat, effing, chance. In fact, Negroes all over the country are going criminally bonkers — taking part in flash mob robberies and racially-motivated gang attacks on innocent White people in the street in broad daylight everywhere. Whites are being brutally victimized all over because of their race.

One example recently, an elderly White woman, Marthie Grobler, was found dead, stabbed and tortured to death, apparently for hours, by multiple blacks who broke into her home. This kind of thing happens all the time over there.

They have it all planned out. In fact, being a multicultural liberal, is about the most foolish and destructive thing you can be, both for your own kind, as well as for the blacks. They have been working steadily to keep us Whites screwed-up in the head while they use America like a bitch.

Absolutely nothing will ever change, in fact, it will keep getting worse and worse until us Whites come together as a race to put a stop to it. Not only will it help our race out, but blacks too. Yep, think it through. No longer will they think they can get away with murder and mayhem. Think of spoiled little children who need a strong, but wise hand.

If us White people will just stop with accusing each other of racism hear that Oxy? All you got to do is talk to everyone you know. No need to shave your head and rush out and join the Nazi party. How appropriate to this article! God Bless You and Thank You! To the successor of St. So as a birthday present to you, Mr. The light will shine, and in due time, the people will be ready to follow its path.

Was this excitement about free electricity all just wishful thinking that science eventually disproved? Spectacular new energy technologies were developed right along with other breakthroughs. Since then, multiple methods for producing vast amounts of energy at extremely low cost have been developed. None of these technologies have made it to the open consumer market, however. New energy technology is here.

It has been here for decades. Communications technology and the Internet have torn the veil of secrecy off of this remarkable fact. People all over the world are starting to build new energy devices. New energy technology will change everything about the way we live, work and relate to each other.

It obsoletes greed and fear for survival. But like all exercises of spiritual faith, we must first manifest generosity and trust in our own lives. They are all the workers of Satan. The Jacob Rader Marcus Center of the American Jewish Archives is proud to make the latest edition of this classic text available online.

First American Jewish Families: This publication is an historical document in its own right, and it is not our intention to alter it in any way. Students of American Jewish genealogy are encouraged to use this text as a basis for their research. Jews and Muslims Clash; http: And that is exactly what the Jews did to Russia.

To conquer the world you must have guns. Every single male Russian was drafted when he turned 18 years. Because the Jews killed all retards. If you were born with only one arm in the Jew-run Soviet, you were killed by the Jews. So the Jews just killed anyone that was unfit for the military and this is why every single 18 year old male was drafted, because all the unfit was killed when they was born.

And do you know what the Jews did to them? The Jews killed all of them on the spot. The generals fare worse. They are plagued, endlessly, by uncertainty.

In one day, in February , Khrushchev sacked generals from the Soviet Army. No Soviet general, and for that matter no Soviet officer or soldier -— no single member of this enormous organisation — has any guarantee that he will be allowed to retain his privileges, his rank or even his life. They may drive him out, like an old dog, at any moment: Can they really enjoy living like this? Why are they silent? An excursion guide once showed me an area in a large Western city which he said was entirely controlled by the Mafia.

Prostitutes, drug-peddlers, shoeblacks, shopkeepers, owners of restaurants, cafes and hotels — all of them controlled, and protected by the Mafia.

Once we had emerged, unscathed, from this unhappy district, in our large tourist bus, and felt that we were back in safety,. I put these same questions to our apprehensive guide. Everyone living there had grown up in freedom and democracy; behind them lay centuries of freedom of speech, of the press and of assembly. Yet, despite these centuries-old traditions, the inhabitants were silent. They had a free press on their side, the population of the entire country, running into many millions, the police, political parties, parliament, the government itself.

And yet they said nothing. They made no protest. The society from which I fled is not simply a spacious well-lit prison, providing free medical care and full employment.

The government is the ruling body of the JEW Mafia: Press, television, the judges, the prosecutors—these are not influenced by the JEW Mafia—they are the Mafia. Smart tourist buses pass through our unhappy capital. The drivers and guides belong to the Mafia. I spent thirty years of my life on my knees. Then I got up and ran. Well, there is something which surprises me, too. The aim of all this activity is, quite simply, to bring you to your knees.

Tomorrow it will be too late. As the whole world now lives in more enlightened times, should there be any sort of reparations? And in what form? The Jewish near monopoly of this industry was particularly evident during the days of the Roman Empire, at that time it was mainly White Slaves, but it included other social groups too. This article about the Jewish role in the White Slave Trade has a very interesting twist connecting it with Auschwitz.

This trade was probably the origin and not religion, bigotry, hate, ignorance etc of European anti-Semitism. The video I provided the link here yesterday has been replaced by something else, cover-up already? Oxy really needs psychiatric help! I hope he gets it! Alex Jones works for the Jews, is married to a descendant of Jews, who is proud to be such, and needs them to promote his computer writings and videos.

He gives out so much disinformation about Hitler, the Germans, and Nazis; and Michael Collins Piper has announced that he will soon do a podbean explaining the Jones phenomenon. Basically these criminals consolidated their financial power by manipulating 19th century war news. Fast forward to the turn of the 20th century, they controlled every major media format until Thomas Edison invented new ones, then they tried to steal the technology from him!

Fake Civil Rights do we see any in Gaza? Pornography and child pornography. Like Henry Ford said in the early s: And for the English people to read your opinions to become more aware, perhaps more courageous to admit..? You know why I say that. There was this British lady, man it was like talking to a wall. I told her that the garbage from WWII about the lampshades made from Jew skin, and soap from their bones was just a hoax, a prop the Allies used to get the world angry with the Germans.

Even the Holocaust people now admit it was hoax, that it never happened. She went on and on calling me a Naz i you know, the usually stupid Goyim screaming technique: Sound familiar Ox, Henny? Her skull must of been made from Zionist concrete? She was religious also. How many Zionist Jews you know of?

Or that own media in England? I even posted this brilliant John Tyndall piece, because I thought they figured Americans are anti-Semitic? I just got to read it now, been so busy. You know how you spoke of all porn-ers are Jew boyz? This soft porn rag in St. Louis officially went over the cliff. Celebrating the contributions the poofsters have made to society. I know Christianity preaches tolerance but I should would like to break out the terrible swift sword and send some of this garbage to the netherworld.

This months dive in to the gutter: To them, it was life. Yeah, well let them pack around the government cheese truck like in New Orleans and watch as they get a bullet in the head like in New Orleans too. A head shot to at least be humane about it. Then no tears, no remorse, back to business of avoiding being rounded up and put in the camps.

Do you understand how your heating or AC system works in your house? You can by Zyklon-B at your local shop. Just ask for a bugspray. A bugspray on can is a simplyfied version of the extremely complicated bugspray Zyklon-B. And the reason why there was no gas-chamber in Germany is that every single person who was allowed entry into Germany was deloused in the workcamps in Poland. Zyklon-B only kills bugs and lice. Do you get it?

Can you handle the truth? The truth is that the jews holohoax is just one more timless eternal lying jew scum bullshit.

The holohoax never happend. And the deaths that did occur are mostly the fault of the Allies that bombed the supply trains. The Bolsheviks got a nice bus ride to Palestine and 40 acres and a Olive Grove, or got all expenses paid boat ride to AmeriKwa and handed the keys to whatever Goy business that they wanted to own. One that will no doubt include guarantees to ensure a continued drugs trade. Encyclopedia Of The Palestinians Publisher: The first edition of Encyclopedia Of The Palestinians appeared in and there have been vast changes in the region since, prompting the need for this substantively revised edition, which offers new entries about these recent developments.

Articles have all been updated, photos of important leaders and events added, and fifty key documents included. Encyclopedia Of The Palestinians provides depth and detail on Palestine history and issues, making it a recommended pick for general-interest college-level history holdings, as well. What time is it? The only time they got itchy was when I started talking about the holohoax and providing links concerning that bogus event. Yup, that about sums it up. This has been the only time that this has ever happened to me, in 3 years on zerohedge.

Looks like that site got hacked. The title is overwritten with Holocaust Denial by a Holocaust Denier Ewww, sticks and stones may break my bones…. The other thing is when January and February rolls around, then The History Channel is on a Black civil rights marathon: Is it just coincidence?

Both civil rights movements in South Africa and the USA were instigated by World Communist Jewry, yet none ever seemed interested in the Palestinians rising up against their capitalist oppressors? Yes, the Jew holohoax BS is jew porn. Everything the lying Jew scum accuse all us non-Jews to have done to the Jews - the Jews have done to us non-Jews.

Those fighter pilots are responsible for most dead in the work-camps. When the Jews tried to take over Russia in , what did the Jews scream? And this is why America let in the Jews in the first place. My Mother stands with Me. There will be fighting everywhere. There will be famine and polluted water in many places. Flood waters will increase in many places. You will think that the heavens and the earth have rebelled against you. This improved version of Zyklon-B kills the lice and the lice egg.

Zyklon-B did NOT kill the lice egg and that is why everybody got a haircut in the German-run work-camps.

Six million Jews died from Zyklon-B? That is Jew BS. Just show me one person who was killed by the bugspray Zyklon-B. Not one single Jew can prove that you can die from the bugspray Zyklon-B. Now - make that six million. How do you feel about the made up religions like Mormons? Joseph Smith and the Golden Plates that mysteriously went missing when the curious wanted to see them parallels to the holyhoax?

Notice how the Jew Boy and the Mormon at Southpark never attack Mormons, and how the little vile fat kid is always the one to call the Jew a Jew and insult him but the insults stop there no real attack on Jews. Of course I got the usual stories, like ….

Then I asked them. Well what did he see? Lamp shades made out of human skin? Soap made out of human fat? Give me a break already. I told them, Eisenhower and Churchill both, after the war authored huge volumes on the war and not a word in either of these massive tomes was there uttered one word about the holohoax. They had Jews in the SS too. Some of them retired and moved to Israel.

Not a word is discussed about this. The Red Cross, after some discussion with German authorities, was allowed to visit the camps and to bring care packages. The total number of people who died in the camps and the reasons they died are in the Red Cross records of the times.

On Trinity Broadcasting Network on last Friday, there was a program on that made my ears perk up. I saw some Jewish Rabbis at the speaker podium of some black church in Texas, talking to the congregation about what must be done to combat hate and bullying etc in our schools. Sounds like they took a page out of the ADL playbook. Explain it to me. Well now they replace the can with a plastic bottle: People are getting wise to them and their little puppets like Oxy and their usual name calling, to embarrass you from telling the truth.

I said this before on here, is it just coincidence the Rothschilds financed pedophile Joseph Smith who had many Talmudic tendencies?

I had one trying to influence my stepson one time to join the Mormons. The Jews are great for wanting you to respect all these other religions, and yet they have zero for Catholicism and openly MOCK it in Hollywood, and on Talmudivision, and in the Talmud Times.

They consider themselves to be Allies with the Jews because they consider themselves to be part of the ten lost tribes. What is funny about it, is that Jews go along with this charade because it serves their purposes. The Mormons are the only religious group in the United States that ever declared war on the United States. Some of the founding members and associates and aids of Joseph Smith were Kabbalistic Jews, to wit, the reason why Mormonism has so many Kabbalistic and Masonic leanings.

The children gather wood, and the fathers kindle the fire, and the women knead their dough, to make cakes to the queen of heaven, and to pour out drink offerings unto other gods, that they may provoke me to anger. The Jew will help along any Shabbath Goy imbecile, as long as it serves one of their hidden purposes or agendas. Bill, it is the same with the Blacks. As soon as those two Yids left that Black church, they were probably laughing about how gullible and naive these schwartzas are.

No, their kids, like the two Yids, go to school to learn, to be future doctors, lawyers, engineers, corporate CEOs, scientists, computer programmers and computer engineers what our White Christian culture use to produce, until the Zionist bastardized us. Take a look at some of the Ivy League and other top schools enrollments: The times I have had to listen to them in person, it was all I could do to prevent myself from just repeatedly smashing them in the mouth until there was nothing left but a puddle of goo.

They are bar none the most offensive, insulting, vulgar and disgusting of people. Typical because to them were just garbage and it matters not whether we were offended or felt misrepresented.

No more comments on this matter as I have stated the Orthodox teaching on this issue succinctly and concisely. So tell me Milton, are you a confirmed Orthodox Priest and if you are, under who did you study and who gave you that confirmation? Jews have used Christians arguing their different dogma, and spiritual ideas, for years, against them! You tell me that? Brother Nathanael, thank you for your public defense of the Blessed Virgin — I assure you, heaven will notice.

When I briefly spatted with Fr Joseph I was just saying I thought he was arguing theology on a level that none of us really wanted to argue about. But admittedly many find me very harsh. Catholic Goys at that. You and I both know you have to be rough with the Goys or else they backslide and back talk. Like your troubles with Oxy. How many times have you seen me posting U. Rather, it is religious and theological. It is either God or atheism. Who are you going to believe?

I have heard other say, the visions at Fatima were of Satanic origin, that is their belief, it is not mine. As a Catholic, we were raised with the utmost respect for Mary. You people on here, that claim we pray mostly to her, in place of Christ or God, are watching, and listening to too much John Hagee?

He did have a lot of great quotes and is a wealth information that I enjoy. In two years, I have had only 3 or 4 negative responses to me, Oxy, Stanley, America the Beautiful, Henrik, and few others here and there that threw cheap shots at me, then never posted again. I truly love this country and its people. I have met many friends there and occasionally go back for a holiday. I would hate to see the Bilderberg do with Switzerland what they did with Iceland and with all the banks, bringing the country almost to bankruptcy.

You know they like to use it as a diversion because their faiths are illegitimate bastards of Christianity. I remember seeing something somewhere, about some old Hungarian guy who wanted to meet him and talk to him about his experiences in the camps.

But he refused to meet with him. That is because the Hungarian guy said that he never saw him there and thought he never was in any camp. Simon Wiesenthal had to finally admit before a Frankfurt district court that he was actually never in Auschwitz. He was a liar and a collaborator, both he and his father and yet they said this man was some kind of hero.

This is the way Jews are. This aspect of collaborating in order to save their own skins, or profit from the situation, or improve their lot, under the circumstances, has gone on many, many times down through history. Another example would be what went on in Spain when the Moors invaded in The Christian leadership took off, leaving the poor people to fend for themselves.

When the Moor armies approached, any Jews in the towns, opened the doors and let them in. Jews collaborated with the Muslims on many occasions.

Matter of fact, according to Professor Shlomo Sand, there were many Jewish converts to Islam in the ranks of the Moorish armies which invaded Spain and this is how Jewry got its foot in the door, in Spain. Truth is not a popular subject and if old Jesse was really after it, he would never so much as darken the hallowed hallways of any jewish infested televsion network.

I notice dear old Alexander Bullhorn Jones has a link on the Drudgereport now. Some years ago the Jews started Freemason. Why did the Jews do that? To control the non-Jews elite. By doing so every single non-Jew possible future leaders was scrutinized by the Jews from birth.

Some years ago, in the mid s the Jews started every single Union in the whole world. So the Jews could scrutinize every single non-Jew possible leader from the m asses, the rank and file. The Moral Hazard of Modern Banking: How Banks Create and Destroy Money http: How the media covers Bilderberg meetings; http: The Russian roots of Nazism: This is anti-white propaganda.

Just look at the names who gave him entry to the jew run Soviet. Regardless if the Rothchilds are indeed Ashkenazi Jews or not, this verse is very fitting when describing the history of the Rothschild family.

For theirs is a history of treachery, deceit, manipulation, amassing of vast riches and murder. Hate of dogma, and hate of dogmatism, will be one of the forces that will push many to accept the religion of the Antichrist, which will be religious, but will appear to be non-dogmatic. And it has brought forward a mindless Atheism, which is nothing but pure Satanism, even if people do not realize this. And the reason for this?

They are happy to ignore previously validated dogma, and instate new dogma, without even realizing it. One needs to be very careful when saying that dogma is not needed or it must not be mentioned.

This attitude is a guaranteed way to eventually even hate Jesus Christ our God. Why do we accept it? There is no logical answer, at least not a universal one for all humans of all status, except the fact that it seems to direct our lives towards a better place for the ones who accept Him as the Light, the Way and the Truth. Do NOT fear correct dogma.

Refute incorrect dogma, however, because it is the root of many evils. You have been conditioned to avoid true dogma and at the same time accept what are incorrect dogmas as fact. That, is one of the core weapons used against us by the Satanic Jews. Thus, be VERY careful, train your mind, and be vigilant.

Most organized thinking and therefore the results of it, is ultimately based on dogma. Philosophical and theological thinking is also based on dogmas. Dogma can be wrong and right. Correct dogma, directs one towards a right world view or a wrong one. If one claims that dogma is not needed, then they are being dogmatic, by definition.

There is no other way around it. And by extension, most of us, have been conditioned to not to try and find out what true Christianity is supposed to be like and how we are supposed to glorify Him. The west has avoided correct dogma so much, that it thinks nothing of instating new, incorrect dogma. They have forgotten the correct role of the Mother of God Mary and the role of the Church. Thus, not only is correct dogma and thinking about dogma something not to avoid, but it is something everyone has a divine responsibility to sort out for them selves and with each other.

To avoid talking about dogma, which is one of the basic foundations of Christianity, is thus an ultimate censorship. And consequently, whomever willingly avoids talking about it, is committing the ultimate act of submittal. Dogma is useful when wanting to control others. That is why religion often uses it. The world is not that simple. Not questioning religious authority is a common dogma of all religions. But what if that authority has authoritarian objectives?

Then one should question that authority and cast it out. Tom turkeys and turkey hens must be handled in such a way as to prevent injury and minimize stress throughout all aspects of the semen collection and artificial insemination processes.

Broody hens are those that cease laying, preferring to incubate the eggs instead. Preventing and managing broodiness to keep hens laying is an important part of turkey breeder production.

Signs of broodiness may include increased nesting time, decline in egg production, protection of the nest, increased vocalizations, reduced feed intake, and reluctance to move Factors that promote broodiness include early sexual maturity, hot weather, lack of uniform lighting or low light intensity, leaving eggs in the nests too long, pens with corners or secluded areas, and not forcing hens out of the nests at egg collection The challenge is to prevent broodiness without disturbing the hens to the point that they stop laying.

Good nesting habits are typically established during the first three weeks of lay. Proper handling and storage of hatching eggs is important to promote healthy embryo development and to minimize embryo mortality. Hatching eggs must be handled and stored in ways that promote healthy embryos. Feather pecking can be a problem in turkey flocks and breeder flocks, especially if it evolves into cannibalism.

The underlying cause of this behaviour is poorly understood. Enrichment can play an important role in preventing and mitigating injurious feather pecking and cannibalism Action must be taken to manage bird behaviour at the onset of an outbreak of feather pecking or cannibalism.

Caponizing is the procedure of removing the testicles of roosters to influence their growth and resulting meat quality. It is therefore an invasive, painful process. This procedure is not typically performed in Canada. To prevent outbreaks of feather pecking, breeder chicks and poults are often beak treated in hatcheries and occasionally trimmed as adults, if needed.

Roosters must not be caponized unless under veterinary supervision, using pain control. Initial beak trimming must not be performed on broiler breeders that are older than 10 days of age, unless required to control an outbreak of cannibalism.

Equipment must be properly maintained and adjusted prior to performing any beak treatments. Controlled moulting induced through feed and water deprivation is not practiced in Canada and is not recognized as a good production practice. However, in the event of a situation that endangers the survival of a strain or line, threatens the supply of hatching eggs, and consequently where the life of a breeder flock must be extended, controlled moulting may be undertaken on healthy birds under the supervision of a poultry veterinarian.

Methods other than extended feed and water deprivation are available for controlled moulting. Controlled moulting can be accomplished primarily with lighting programs and diet formulation. Controlled moulting practices must be performed under veterinary supervision.

Only healthy birds must be selected for moulting. Poultry transportation is a shared responsibility between all stakeholders. This Code focuses on the aspects of the transportation process that take place on-farm and are thus under the control of the producer. Information regarding transportation of poultry beyond the farm gate is covered in the Recommended Code of Practice for the Care and Handling of Farm Animals: Additional provisions pertinent to transportation of hatching eggs, chicks, and poults are dealt with in the Hatchery section of this Code.

It is recognized that by its very nature, the transportation process which includes catching, loading, transporting, and lairage includes stress and risk of injury Every effort should be made to only load birds that have the capacity to withstand the expected duration of the transport process.

Incapacity may be due to injury, fatigue, poor health, distress, or any other cause. The welfare of the birds must be the first consideration. It is acknowledged that poultry producers often deal with large numbers of birds, which makes inspection of individual birds difficult. During cool and cold conditions, appropriate procedures are needed if birds are wet to prevent hypothermia during transport e.

In preparation for transport, the flock must be evaluated for fitness and those birds that are deemed unfit for transport must be euthanized, separated, or transported with special provisions for veterinary assessment or treatment only. Wet birds must not be loaded in cold weather if there is a risk that birds will become chilled. The welfare of birds can be adversely affected by delays. Stakeholders should adjust loading, departure, and transit times or routes to avoid potential delays.

Environmental conditions can significantly affect the comfort and welfare of birds during loading and transit. Handling procedures, loading densities, and time of loading may need to be adjusted accordingly.

The flock and environmental conditions, as well as the expected journey duration, must be taken into consideration when loading birds for transport. Feed is typically withdrawn from birds ahead of transport to ensure that their digestive tracts are empty, to reduce the risk of contamination of carcasses during slaughter.

Withdrawal times are usually determined by the processor. However, total withdrawal times should not be so excessive as to negatively affect bird welfare i.

When planning feed removal on-farm, it is important to consider several factors that impact bird welfare, such as amount of time required to empty the gut prior to processing, amount of time required for catching and loading, distance to plant and expected duration of travel, expected lairage, and expected processing time. Pre-transport feed withdrawal must be managed to minimize the time that birds are off feed.

A daily inspection and culling program is an important part of flock management. It will reduce culling prior to and after loading and improve the efficiency of the catching and loading processes. Despite pre-transport culling, there will likely be some birds that are deemed unfit for transport or non-saleable during catching and loading.

Birds that are not loaded for transport and not euthanized must continue to be cared for in accordance with relevant sections of this Code e. Careful handling of birds during catching, loading, and unloading will reduce fear and minimize injuries to birds.

Heavy turkeys may have difficulty walking long distances. Turkeys that are reluctant to walk are not necessarily lame, and may simply need to rest. Producer or a competent designee must be readily available to provide assistance throughout the catching and loading process. All catching and loading equipment must be operated by competent personnel.

The catching area must promote safe and humane handling and catching e. Birds must be in an upright position after being loaded into containers. Birds must be loaded in containers in such a way that permits all of them to rest on the floor at the same time when evenly distributed, while preventing excessive movement within the container.

Parts of birds must not protrude from containers in any way that can cause injury or impede movement. Conveyors used for loading containers of live birds must prevent tilting of containers that causes birds to pile up. Proper building design and accessibility to transport vehicles greatly improves the humane handling of poultry. This includes interior and exterior design, and maintenance of buildings, yards, and loading areas to facilitate loading and unloading of poultry at all times of the year and in all weather conditions.

When building new barns or renovating existing barns or yards, the way in which birds are moved into and out of barns must be taken into consideration with a view to facilitating safe and humane transfer of birds to and from the transport vehicles e.

Openings through which birds are passed must be large enough to ensure that birds can be transferred in a way that minimizes injury. Driveways and yards must be maintained to facilitate unobstructed, safe, and easy access by transport vehicles. To alleviate pain and suffering when there is no reasonable prospect for recovery, euthanasia of birds is necessary.

Having a euthanasia decision-making process and providing training in euthanasia techniques can help ensure that necessary euthanasia is carried out in a timely manner. Protocols that include irreversible stunning of birds prior to the final kill step may assist in effective euthanasia. Hatcheries euthanize chicks and poults that are injured, malformed, or suffering, and those otherwise unsaleable.

Some unhatched eggs will contain live embryos that may need to be euthanized. Unhatched embryos that have passed the halfway point of incubation are sufficiently developed to be sensible to pain 4. An acceptable method for euthanizing chicks and poults must be used.

Refer to Appendix B - Methods of Euthanasia. Eggs with the possibility of live embryos that have been culled must be euthanized. It is important that everyone who works with birds be trained to recognize normal behaviour as well as signs of pain, injury, illness, and distress that indicate that euthanasia may be necessary.

Developing a euthanasia decision protocol can provide guidance for personnel in making consistent decisions on when birds need to be euthanized. Sick or injured birds and birds that exhibit obvious signs of pain must be promptly treated or euthanized by competent personnel. Birds that are isolated for observation must be monitored at least twice daily and reassessed for continued recovery, or euthanized. The successful application of any euthanasia method depends on many factors, including the competence and commitment of the personnel carrying out the procedure Personnel who are tasked with euthanizing birds need to be trained and monitored periodically to ensure continued competence.

Personnel need to understand the importance of timely and effective euthanasia in reducing animal suffering. Not all personnel working with birds are suited to euthanizing birds or have the required physical strength or abilities.

This may impact the efficacy of the euthanasia method. Operator fatigue may impact animal welfare Attitudes towards euthanasia should be monitored to ensure that personnel are comfortable with the methods being used.

All individuals who perform euthanasia must be competent in the euthanasia methods and protocols used on-farm. Many factors must be taken into account when selecting a method of euthanasia. Regardless of the method chosen, the determinant of success is whether the method can be consistently applied and the bird loses consciousness rapidly, with minimal pain and distress.

An appropriate method for euthanizing birds, as contained in Appendix B - Methods of Euthanasia , must be used. Prior to being euthanized, birds must be handled in a manner that minimizes pain and suffering. All equipment used for euthanasia must be well maintained, used correctly, and not overloaded, so that it operates effectively and efficiently. Death may not occur immediately but is the result of eventual respiratory and cardiac failure, which can take several minutes It is therefore essential that birds be swiftly rendered insensible and remain so until death.

For this reason, euthanasia methods that affect the brain first are preferred Immediate application of the same or an alternate approved euthanasia method is required when signs of sensibility are observed.

Signs of sensibility include:. Absence of these signs indicates that the bird is insensible. Death is confirmed by cessation of breathing and heartbeat. It is not necessary to assess for sensibility or confirm death when maceration or decapitation is used due to the proven consistency of these methods.

Birds must be inspected for signs of sensibility after the euthanasia method has been applied. If signs of sensibility are observed after the application of a euthanasia method, a second application of the euthanasia method or an alternate method must be immediately administered.

Death must be confirmed before leaving birds and disposing of carcasses. Mass depopulation refers to killing entire flocks or large numbers of birds. Typically, mass depopulation on-farm is an infrequent practice; however, in some cases, large numbers of birds are required to be depopulated on-farm in an emergency such as a disease outbreak or natural disaster. In addition, unexpected events e. In some cases, government representatives may be involved in the decision-making and depopulation processes.

Depopulating an entire flock or group of birds may employ euthanasia techniques, but not all methods used for mass depopulation meet the criteria for euthanasia Despite this, the methods employed for depopulating large numbers of birds need to be as humane as possible given the situation.

A plan for depopulating entire flocks or large numbers of birds provides guidance in the event of a disease outbreak or other unexpected disaster. Plans will need to be reviewed regularly and updated as needed as new and better methods are developed and approved.

The depopulation plan should include adapted from Those individuals who are involved with depopulating large numbers of birds, particularly when the birds are healthy, can suffer from emotional stress Moreover, individuals may encounter physical fatigue, especially when physical methods are used. Both types of stress can have a negative impact on bird welfare during the depopulation event. If not using a method listed in Appendix B - Methods of Euthanasia , methods for depopulating large groups of birds on-farm must be undertaken in consultation with a veterinarian.

Individuals who are involved in mass depopulation must be competent in the methods used. All equipment used for depopulating birds must be maintained in good working order. Food Safety Enhancement Program Manual. European Food Safety Authority. Structural and Functional Development. Effects on Embryo and Poult Viability.

Review of Scientific Research on Priority Issues. National Farm Animal Care Council. British Poultry Science Applied Animal Behaviour Science Federation of Animal Science Societies, pp. Saskatchewan Ministry of Agriculture. Asian-Australasian Journal of Animal Sciences Hybrid Breeder Management Guide. World's Poultry Science Journal Research in Veterinary Science American Veterinary Medical Association. Canadian Veterinary Journal The following chart lists acceptable methods of euthanasia of individual birds 1 for use on-farm and at hatcheries, as well as methods that are only considered acceptable with the noted conditions.

The chart is based on the information that was available at the time of publishing. For any method to be considered acceptable, it must result in rapid loss of sensibility and the bird must not return to sensibility prior to death. Therefore, when physical methods are used, those methods that result in immediate, severe, and irreversible damage to the brain are preferred Effectiveness of all euthanasia methods may be compromised by operator fatigue when euthanizing large numbers of birds.

Individuals who euthanize birds must be competent in the appropriate methods, and in some cases a high level of technical skill is required. Some euthanasia methods may result in operator injury if used improperly.

The impact must be of sufficient force and accurately placed in order to result in immediate insensibility and death in a single blow. Alternative methods should be considered e. Birds may become sensible if gas concentration is not sufficiently high and if oxygen levels are not low enough.

This may be difficult to achieve in an on-farm setting. Requires specialized equipment pressure-reducing regulator, CO 2 cylinder or tank and a closed chamber to contain gas.

Dangerous to operators and potentially explosive at high concentrations; therefore, producers are encouraged to find an alternative to CO gassing. This method is restricted to smaller birds e. Performed correctly, cervical dislocation results in the luxation dislocation — never crushing — of the cervical vertebrae. Cervical dislocation is difficult to perform correctly in large birds, and therefore may not result in immediate loss of sensibility.

It is recommended that larger birds be rendered insensible prior to applying cervical dislocation. Must use properly maintained, proven effective, purpose-designed equipment that results in instantaneous and complete maceration. Effective application may be compromised if operator is fatigued or large numbers of birds are to be euthanized.

Alternative methods should be considered due to difficulty in checking for insensibility with very young chicks and poults. Basic guidelines for feed and water access for broiler chickens. Based on free-choice feed availability. Always monitor uniformity of bird access to feed and water and adjust as necessary. Assumes that both sides of the trough are available to the birds. If not, then double the space allocation per bird c. Perimeter space for round feeders and waterers can be calculated by multiplying linear trough space by 0.

Basic guidelines for feed and water access for turkeys. If not, then double the space allocation per bird b. This protocol 39 presents to the producer a course of action during the suspicion of an infectious disease. This plan is an excellent example of procedure, but other protocols regarding quarantine and infectious disease do exist.

It is recommended that all producers are familiar with local or industry-accepted procedures. Upon the suspicion of an infectious disease in a poultry flock, the following set of guidelines should be followed by the producer.

The intention of this protocol is to limit the spread of disease between barns and, most importantly, the spread of disease off-farm. The CFIA has developed disease response plans and strategies for these diseases upon their identification in domestic flocks. The national immediately notifiable diseases are infectious laryngotracheitis ILT , avian cholera pasteurellosis , chlamydiosis psittacosis, ornithosis , duck hepatitis, avian encephalomyelitis, egg drop syndrome avian adenovirus , goose parvovirus infection Derzsy's disease , and turkey rhinotracheitis avian pneumovirus, swollen head syndrome.

The CFIA must be notified if these diseases occur; however, limited action is taken, and only with respect to certification of meat product for export to certain countries. Specific provinces have a list of provincially notifiable diseases that are of significant economic concern, and there may be specific action response plans to the occurrence at the industry level or mandated by the provincial government. The most common ones are infectious laryngotracheitis ILT and mycoplasma in breeder birds and turkeys.

All other diseases are "unregulated" and are a private issue between you and your veterinarian. Your confidentiality will be respected, but your cooperation in informing your industry service representatives of a potential infectious disease problem is encouraged and appreciated.

The Following list provides examples of potential signs of pain or distress in individual birds that warrant further evaluation:. Reprinted with permission from the Poultry Industry Council www. Code Development Committee Members. Their hard work and support throughout the process was invaluable.

Thanks also to Brooke Aitken and Clover Bench, research writer and peer review coordinator for the Scientific Committee. The committee appreciates the valuable input from the public comment period and all those who provided comments and advice throughout the process. Refer to the cited Code section for further context about the Requirements.

Additional requirements for broiler breeders. Additional requirements for broiler chickens. Additional requirements for turkeys. Additional requirements for broiler chickens, turkeys and turkey breeders. Disclaimer Information contained in this publication is subject to periodic review in light of changing practices, government requirements and regulations.

Introduction Codes of Practice strive to promote acceptable standards of care for animals in such a way that achieves a workable balance between the welfare needs of animals and the capabilities of producers. Glossary The following terms and definitions refer only to how the terms are used in this document. Treatment or removal of a portion of the beak. A chicken or turkey of any age, size, weight, or sex. A mature male or female chicken or turkey used for breeding.

A chicken that is raised for meat production. The act of one bird consuming the flesh of another bird. A sexually mature male chicken. A male turkey used for breeding or meat production. A female turkey used for breeding or meat production. Refer to Appendix A - Sample Bird Welfare Policy develop and follow a facility maintenance program identify supervisors or managers that personnel can approach with poultry welfare questions or concerns. Live chicks and poults must be removed from hatch residue.

Break-out of unhatched eggs must take place within the day of hatch. Take steps to identify and remedy significant deviations from expected rates do not drop chicks and poults from heights exceeding 15 cm 5. Tip trays to remove chicks, poults, and hatch residue in such a way that the chicks and poults do not pile or become trapped. Boxes containing chicks or poults must not be thrown or dropped. Chicks and poults must be able to stand erect during transport.

A human ear thermometer is a good tool for this application if travelling in a non-climate-controlled vehicle, consider both the outside temperature and the duration of transport when determining the optimum density of chicks or poults in boxes.

In hot weather or when transporting chicks or poults over long distances, reduce the packing density provide no less than The maximum group size for a single compartment should be adjusted according to the equipment specifications adjust vehicle temperature prior to loading chicks and poults to prevent them from becoming overheated or chilled monitor and adjust ventilation, temperature, and spacing of boxes so that chicks and poults are able to maintain their normal core body temperature minimize the change in environment if, during transportation, boxes are to be transferred between vehicles use clean boxes.

Keep vehicles used to transport chicks or poults clean, and disinfected or sanitized, and in good working order to ensure that chicks and poults arrive at their destination in good condition check chicks and poults at random to ensure that they appear, behave, and sound normal prior to departure deliver chicks and poults as soon as possible after hatching deliver all chicks and poults destined for any given barn floor at the same time to avoid challenges associated with meeting different age-related needs provide gel pucks or alternative sources of hydration to chicks and poults when the duration between hatch and placement is expected to exceed 24 hours.

Signs that indicate that temperature is too high include: Conversely, signs that indicate a temperature is too low include: Ventilation and Air Quality Ventilation plays a key role in maintaining a comfortable and healthy environment for birds. Take steps to avoid ammonia concentrations exceeding 10 ppm.

Action to control ammonia levels includes the following: Higher relative humidity will negatively affect litter quality and may increase the chance of heat stress in birds at high temperatures.

Refer to Table 3. Fresh bedding must be provided for chicks and poults at placement. Pay special attention to litter around feeders and waterers, which is often wetter than elsewhere in the barn and may need corrective action balance moisture levels in litter to avoid excessive dust too dry or caking too wet inspect bedding used in barns for visible mould or other contaminants monitor and manage the incidence and severity of hock burns, breast blisters, and foot pad lesions. These are signs of poor litter quality.

Additional Requirements for Turkeys Stocking densities for turkeys must not normally exceed limits contained in Column a in Table 3. Some of the factors affecting nest use in breeders include but are not limited to: The range area must be kept free of debris that may shelter pests. This may also help to reduce the risk of disease 17 provide popholes for broiler chickens and turkeys at a minimum rate of 1 pophole for each 15 meters of linear space provide windbreaks in open fields where there is a likelihood of strong winds protect outdoor birds from animals that may prey on the birds or cause fear use electric fencing outside enclosures and fine netting over enclosures to reduce the risk of predation.

Additional Requirements for Broiler Chickens, Turkeys, and Turkey Breeders Broiler chickens and turkeys must have access to feed and water in sufficient quantities at all times in normal circumstances, up until the time of catching. Make dietary changes gradually and according to the recommendations of a nutritionist or other qualified specialist test water for water treatment chemicals e.

Scatter grit, oyster shells, or grains in the litter 3. A Flock Health Plan may include: Biosecurity protocols can include: If it is necessary to enter more than one building, personnel should move from the youngest to the oldest birds, and from the healthiest to the least healthy birds 22 avoiding contact with poultry stock from other premises wherever possible, particularly on premises where strict sanitary measures e.

A pest control plan can include: When inspecting the flock, personnel should look for: Dead birds must be removed and disposed of daily.

If parasites are detected, administer corrective treatment as soon as possible conduct inspections in a manner that does not startle the birds consult other advisors e. If the initial treatment protocol fails, then reassess treatment options seek veterinary advice , or euthanize keep records to evaluate the success of treatment regimens for sick or injured birds.

Emergency contact information must be readily available. Additional Requirements for Hatcheries An alarm or monitoring system must be used to alert hatchery personnel of failures of critical systems such as heat or electricity. This practice is particularly important when the light intensity or noise is greater outside the barn than inside release chickens by setting them down on their feet or from low heights that enable them to land normally, feet first.

Avoid releasing in such a way that requires flying carry heavy turkeys by both legs and one wing, and release gently on the floor on their breasts gently set small turkeys down on their feet or their breasts. Evaluation criteria could include: The fluff will not be matted, there will be no signs of dehydration, and the navel will be healed.

The Lancet