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The initial investment/implementation was expected to be in the range of $100 medications restless leg syndrome cheap 400 mg indinavir otc,000 - $150 medicine journal indinavir 400mg line,000 starting with Water Distribution medicine bg order indinavir 400 mg line, Fleet Services kapous treatment buy indinavir cheap, and Wastewater Collections. That cost included the software licensing/maintenance cost of what was expected at the time to be a new software application, as well as initial implementation of the new application. Staff has negotiated a low-cost update/transition to a newer software application with modest (3-5%) annual subscription increases and the ability to expand usage as originally planned. If it does, staff will return to Council towards the end of the contract term to either request continuing authorization or seek approval to solicit for a new system as discussed in February 2020 with Council. The evaluation consisted of research, vendor demonstrations, interviews of other governmental entities, etc. The team ultimately recommended Cartegraph to Council as the recommended application. The initial expenditure/contract was expected to be in the range of $100,000 $150,000. However, when/as additional departments/divisions across the city implement, the costs were noted to increase (additional licenses/maintenance plus one-time implementation). The goal of these applications working together (integrated) is to better track, serve, and address citizen requests. Capital Facilities and Utilities Goal 4: Conservation of the natural environment and sustainable use of limited, renewable, and non-renewable resources protects and enhances the natural environment of Walla Walla. Capital Facilities and Utilities Goal 5: the sound fiscal management of government services and facilities promotes a transparent and collaborative relationship between government and residents. Authorize the upgrade as outlined including the additional City Manager authority for one-time expenses and increases in the annual subscription costs. Direct staff to go through a formal request for proposal process as discussed in February 2020. Run the current program to full failure and replace it when it is no longer working. Section 2: the contract to supply updated enterprise asset management software and to perform related services and provide additional related work is hereby awarded to Cartegraph, and the City Manager of the City of Walla Walla, and designees of the City Manager, are hereby authorized, empowered and directed to purchase software, services, and work from Cartegraph, and execute such purchase orders, contracts, agreements, licenses, and other documents that may be required; provided that sufficient appropriations therefor have been made by the Walla Walla City Council. Section 4: the City Manager of the City of Walla Walla is also hereby authorized and empowered to execute amendments, modifications, and change orders to the purchase orders, contracts, agreements, and other documents authorized by section 2 herein, which do not materially alter such contracts, agreements, and purchase orders, and also do not increase the financial obligations beyond amounts authorized by sections 2 and 3 herein. Section 5: the City Clerk of the City of Walla Walla is hereby authorized and directed to attest the purchase orders, contracts, agreements, amendments, modifications, change orders, and other documents authorized herein, and to attach to each duplicate thereof a copy of this resolution. The project location was selected based on community outreach and citizen concerns. On March 18, 2021, two bids were received, however only one bid was opened due to the second being delivered after the closing time and deemed non-responsive. The project is also consistent with the Council adopted 2021-2026 Capital Facilities Plan (Ordinance 2020-45) Contracts of $20,000 or more require Council authorization. Section 2: the City Manager of the City of Walla Walla is hereby authorized and empowered to execute amendments, modifications, and change orders to the agreement approved by section 1 herein on behalf of the City of Walla Walla, provided that sufficient appropriations have been made by the Walla Walla City Council, and provided further the aggregate value of all amendments, modifications, and change orders may not -1- exceed twenty thousand dollars ($20,000. Section 3: the City Clerk of the City of Walla Walla is hereby authorized and directed to attest the agreement approved by section 1 herein, any amendments, modifications or change orders authorized by section 2 herein, and to attach to each duplicate thereof a copy of this resolution. All Contracts: Not Applicable Federally funded contracts only: Not Applicable Construction contracts only: Not Applicable Brief Summary of Requested Action: Awards the bid for emergency supply of large aggregate materials used for public works emergency activities. Including an additional $100,000 of City Manager purchasing authority within the resolution to allow for additional large aggregate material purchases in the event additional material is needed in an emergency. An increase in the amount would be executed by change order as authorized by the City Manager under the additional authority; and 2. Including authorization to purchase large aggregate materials from the second low bidder, Koncrete Industries, Inc. Large aggregate consists of multiple rock products in multiple sizes used for rebuilding roadways or replacing washed away earth next to waterways. This award will provide the City with a vendor, reducing the response time in a public works emergency event. A call for bids was advertised in the Walla Walla Union-Bulletin on March 4, 2021.

The change from the cervical to those of the cranial is very marked from the third cervical upward medications peripheral neuropathy purchase genuine indinavir on line, including the axis treatment hyperkalemia generic indinavir 400mg with mastercard, atlas medications hyponatremia cheap indinavir 400mg, the ring which forms the foramen magnum and the bones which constitute the vault of the skull medicine youth lyrics indinavir 400mg free shipping. The development of the bones of the face is intimately related to the transformation of the curves of the visceral. The clefts are analagous to the openings between the arches of the spinal vertebrae. The processes of the cranial laminae articulate with those of the facial bones and eventually fuse. Harelip is usually complicated with a cleft palate, a malformation of the superior maxillary bone due to a lack of fusion. The olfactory and optic nerves, tho classed as cranial, are metamorphosed parts of the brain. All other cranial nerves are segmentally arranged in a manner similar to the spinal nerves. The brain and the cranial nerves are protected by the neural arches the bones forming the cranium. The primitive cranium is membranous, which, in turn, is partly converted into the bones of the cranium, while the remainder represents the dura mater of the adult, an inner lining for the skull, the periosteum of the cranial bones and a tough protective envelope to the brain. The dura mater is closely adherent over the whole of the base of the skull, where it is prolonged thru the foramina, becoming continuous with the pericranium (periosteum of the skull) and blends with the fibrous sheaths of the nerves and vessels which pass out of and into the cranium. Over the vault, its attachments are chiefly in the region of the sutures where its outer fibrous layer separates to form the venous sinuses. Elsewhere, it is comparatively loose, so that extravasation from rupture of the meningeal vessels or purulent accumulations may collect between the dura mater and the bone causing compression of the brain. Such pressure, if occurring immediately after an injury, is probably due to a depressed fragment of bone; if some time after, it is likely to be an effusion of blood or pus. The inner table may be fractured and the fragments may press on the brain with no solution of continuity externally perceptible. In a morphological sense, the primitive cranium is the dura mater; the nerves are extra-cranial after leaving this membranous covering. It is interesting to note that no two skulls are alike in shape or size, even the parts or openings which are paired may differ greatly. Excessive heat (fever) causes the diploe to enlarge, while a temperature lower than normal will lessen the cancellous portion and condense and increase its weight. The condensing and thinning of the cranial bones may be physiologic or pathologic. The veins of the diploe are of comparatively large size, but their walls are very thin and imperfect. They form irregular communicating apertures, which terminate in four or five main descending channels, some going outward thru the external table and others inward thru the internal. In old age the cancerous portion is reduced in proportion to the decrease of animal heat. Physiologically, the decrease in animal heat, the cancerous diploe and the blood circulation, should diminish gradually in old age. A displacement of the 12th dorsal vertebra; the second center place, caused an impingement upon the 12th pair of nerves, which resulted in the above pathological conditions. Bones which are eburnated-ivory-like in quality, shiny, dense and hard-have been subjected to intense heat. In this aged skull of a young person the sutures are obliterated and there is no trace, whatever, of the diploe. The bony framework, up to and including the atlas, had normal heat, while the entire skull was supplied with less than the usual amount. These changes, occurring in a person of the age of a century or more, would be physiological, but, at the age of 27, are pathological. Excessive heat-too much functionating-softens bones causing them to become friable and the processes more or less deficient, as shown by a skull of reddish cast. Periostitis, osteitis, caries and necrosis occur in the bones of the skull as elsewhere. For relief the Chiropractor will locate and adjust as in other portions of the body.

The nerve-trunk is composed of two roots; the posterior is composed of root-filaments which are of the peripheral origin of spinal cord medications with pseudoephedrine discount indinavir express. The teachers of the above school and all others are branches from the one taught by me treatment centers for alcoholism cheap 400 mg indinavir with amex, or cuts from those branches medications lexapro purchase indinavir 400mg on-line. The original Chiropractor has been transported from his primary soil to Portland medications causing hyponatremia cheap indinavir amex, Ore. Is not "The Palmer School" in a similar position as "The Palmer-Gregory School" and "The Gorby and Hinkley School," over all of which I once presided Each school was fortunate in having the Founder as its acknowledged head for a time. Palmer Chiropractic College of Portland is now the Fountain Head of Chiropractic and no others are. I can vouch for the statement that he has been vitally connected with the science for the last ten years, for he was relieved of consumption about that long ago by the writer. This lecturer of great ability stated in one of his discourses: "We understand that the salivary glands and the testes and the ovaries are the same kind of organs-they are ramified heavily or richly from the kidney nerves. So that, even in a case of mumps it is a pretty good idea, before you let it alone, to find that you are in thorough adjustment. Doctor, your explanation does not explain the situation, does not elucidate the metastatic parotiditis, the change of the disease from the parotid gland to the mammae, testes or ovaries. I do not understand that the above glands "are ramified heavily or richly from the kidney nerves. It is in the province of this Adjuster to adjust any misstatements made under the head of Chiropractic. Inflammation is but excessive heat, caused by an impingement upon calorific nerves. This impingement excites the functions of these fibers, thereby increasing heat function. The student of anatomy will understand that the parotid glands, mammae, testes and ovaries are glands connected by the lymphatic thoracic duct which extends from the neck to the lumbar region. The parotid gland is connected with the spinal nerves through the carotid plexus, which is a branch of the superior cervical ganglion of the great sympathetic. Thus Chiropractors analyze the condition, trace the line of communication back to the cause and from cause to effect. Poisons act on sensory nerves; they in turn draw vertebrae out of alignment, impinging upon nerves and creating an excess of heat-named inflammation. There is a rise in the bodily temperature in consequence of this local excess of heat which we name fever. An overstimulation of nerves by pressure causes enlargement of those filaments, more especially at their peripheral endings; thus we have parotitis. This inflammatory condition may pass to the mammae and down the thoracic duct to the testes or ovaries. Deep origin, nucleus of cells in brain or cord to which the fibers of a nerve penetrate. Superficial origin, point on the surface of the brain or cord where a nerve emerges. Origin superficial, of a nerve; the point at which it emerges from the brain or cord. Superficial origin, the point at which a cranial nerve emerges from the surface of the brain. Deep origin, Ental origin, the true beginning of the brain-fibers of a nerve within the substance of the brain. While passing an office, I noticed on a window, Chiropractic among several methods of treating the sick. She informed me that they had several different methods; that they picked the best of each; that Osteopaths used the fingers and the Chiropractors the thumbs when treating. From it, and her explanations, I learned that disease was caused by the vertebrae compressing the cartilage, making it thinner and the holes which pinched the nerves smaller. When satisfied that I had learned enough for one lesson, I introduced myself by giving her my card and hand, and informed her that she knew nothing about Chiropractic. Blank an hour to give a treatment; that he sometimes used his thumbs, fingers and fists.

McFarland states that about half of the cadavers examined show seepage of blood into the stomach treatment yeast in urine indinavir 400mg low price. Hemorrhage escaping from the mouth is medicine 60 cheap 400 mg indinavir with mastercard, usually treatment nail fungus purchase 400 mg indinavir with visa, termed "coffee-ground vomit medicine engineering purchase indinavir with paypal," as the blood is modified by gastric juice and arterialization. There are several diseases of the lungs, as tuberculosis pulmonalis, hyperemia, ulceration and gangrene, in which hemorrhage is one of the symptoms. If capillaries are eroded, the hemorrhage is slight, the sputum being merely stained with blood. McFarland states: "Hemorrhage from the lungs-hemoptysis-may occur from the oozing of blood from the eroded capillaries, usually situated in the walls of the cavities. It may occur from the direct erosion of a blood-vessel of considerable size, but is usually preceded by aneurysmal dilation resulting from weakening of the walls of the vessel. The hemorrhages are of all degrees of severity-sometimes only sufficient to tinge the expectoration slightly red, sometimes large enough to cause the death of the patient from loss of blood. When large hemorrhages are not fatal they are usually distinctly detrimental, in that the blood which escapes by way of the air-vessels is sucked back into the bronchioles and air-cells with each inspiratory effort, thus lessening the already diminished breathing space, increasing the amount of effete matter contained within the lungs. The escaped blood is partly infiltrated into the brain substance and perivascular spaces. These characteristic changes are necrotic and belong to the class of colliquation necrosis. McFarland says: Hemorrhage between bone and periosteum may cause superficial necrosis. Arthritis or inflammation of joints may create a slight hemorrhage and an accumulation of blood in the joint. Hemorrhage from the bowels, in small quantities, imparts a chocolate color to the stool. For vicarious menstruation, see Anomalies and Curiosities of Medicine by Gould and Pyle, a book of nearly 1,000 pages, containing the most information for the price of any book I ever read. Mechanical injuries-bones displaced by accidents or poisons-impinge upon nerves and create an excess of heat which softens the walls of blood-vessels, thereby causing hemorrhage. Palmer: I wish to ask a few questions which I think will be of interest to Chiropractors. How can a laterally-bent spinous process be differentiated from a lateral sub-luxation, where one cannot be guided by nerve-tracing on account of paralysis of sensation While a large share of diseases are febrile, known by the nerve being inflamed, enlarged and sensitive, there are cases in which the nerves have lost part of their firmness, tonicity and vibration. Nerves which are impinged upon become hypersensitive until they arrive at a temperature which will soften their tissue. When we refer to a luxated vertebra, we consider the position of the body, because its displacement to the left or right, may impinge upon, press against, the vertical, sympathetic chain, upon one or both sides. If to the left, it may impinge upon the vertical nerve trunk on that side, upon the opposite side, or upon both sides. The projecting vertebra on the left, or the two adjoining bodies, may press against the sensitive sympathetic trunks. By the displacement of a vertebra to either side, it of a necessity draws with it (because of its attachments), the vertical chain of ganglia. In doing so, the sympathetic trunk is pressed against by the bodies of the vertebrae above and below. If so, we cannot determine by palpation whether the nerve is impinged upon or not. Can we determine by an examination of the spinous process, judging by its position, whether the vertebra is displaced I most emphatically state that an examination of the spines will not determine the position of the vertebra. Take your vertebral column (every Chiropractor should have one), tip a vertebra, throw the spine upward, keeping the anterior of the body in line, and you will see that the spinous process (more especially those which are oblique) projects backward.

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