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Litter consists of trash and household toxic substances that are improperly disposed of on land or in water. Whether the litter is intentional or unintentional, large or small, it can drastically affect the environment for years to come. Before carelessly tossing another item out the window or looking the other way when someone else does, consider the impact you can make on the environment by recycling, reusing and disposing of waste properly.

Marine Litter

Litter that is tossed into the ocean can travel long distances with the currents and winds. Not only does this litter directly affect marine life and birds, but it also washes onto beaches, is caught in fishing nets, damages boat motors, is an eyesore and smells bad. Plastic bags and plastic wrap can asphyxiate marine animals and fish, and birds can easily entangle themselves in plastic six-pack rings and strings. Animals also get sick or die from swallowing trash, such as cigarettes and silicon packets. Metal scraps and broken glass can cut the flesh of birds and other animals.

Land Litter

Land litter is not hard to spot and comes in all types -- cigarette butts, plastic bags, old tires, fast food wrappers and plastic and glass bottles. According to the Pennsylvania Department of Transportation, seven major sources contribute to land litter: home trash cans, business trash collection areas, loading docks, construction and demolition sites, uncovered trucks, motorists and pedestrians. Litter isn't just unsightly: It can cause vehicle accidents and injuries, smother plants, start fires and harm or kill animals. It also attracts rats and harmful bacteria.

Contaminated Groundwater

Litter, chemical runoff, illegal dumping and tobacco products can seep into groundwater and affect the water quality of people, especially people who rely on wells for their drinking water. Humans, animals and plants all need unpolluted water to survive. Litter can also clog storm-water drains and cause flooding. Food scraps and other organic items that are disposed of improperly can increase algal blooms in water, which reduces the amount of available oxygen for other aquatic life, such as fish.

Monetary Cost

It costs residents and local, state and federal governments millions of dollars to pick up litter, reverse the effects of littering and prevent litter. The monetary cost for these efforts could be drastically reduced and used for other environmental projects if people would dispose of garbage properly, recycle and reuse. For instance, the Virginia Department of Transportation spends more than $6 million every year cleaning up roadway trash, and that doesn't include the time and energy that Adopt-a-Highway volunteers contribute. Millions spent like this could be allocated instead to environmental education programs such as New York's Environmental Education and Grow to Learn NYC, hazardous waste and cleanup programs like the Environment Protection Agency's Superfund program or grant programs such as the Community Action for a Renewed Environment.

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How Does Littering Affect the Environment?

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How Does Littering Affect the Environment?. Litter consists of trash and household toxic substances that are improperly disposed of on land or in water. Whether the litter is intentional or unintentional, large or small, it can drastically affect the environment for years to come. Before carelessly tossing another ...

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Butterfly watching, though unlikely to match the widespread popularity of bird watching, has gained significant favor in recent years. Butterflies are colorful, diverse, abundant, and active during the day in warm months, making them an ideal pursuit for wildlife watchers (Figure 1). In fact, wildlife watching as a whole, given impetus by the increased awareness of regional and ecological diversity, has become one of this country's fastest-growing outdoor recreational activities.
Butterflies and caterpillars (the larval stage in the butterfly life cycle) provide food for birds and other organisms, pollinate flowers, and are easy to attract to a garden or backyard landscape. Butterflies are found throughout North Carolina and will flourish within a well-designed landscape of native plants in both rural and urban areas. Planting a variety of both nectar plants for adults and host plants for caterpillars in a sunny location will ensure many hours of viewing pleasure as butterflies visit your garden.

North Carolina's diverse natural landscape includes coastal dunes, pocosins, sandhill savannahs, piedmont forests, wetlands, and mountain ranges. These different vegetation communities provide a home for more than 175 butterfly species. Some species are found statewide, while others are restricted to a specific habitat type or region. Scientists classify species into a series of genera and families, based upon similar genetics or similar physical characteristics. Here is a sampling of the butterflies you are likely to encounter in North Carolina:
Family Papilionidae (swallowtails)
Pipevine Swallowtail (Battus philenor)
Zebra Swallowtail(Eurytides marcellus)
Black Swallowtail(Papilio polyxenes)
Eastern Tiger Swallowtail(Papilio glaucus)
Spicebush Swallowtail (Papilio troilus)
Palamedes Swallowtail ( Papilio palamedes)
Family Pieridae (sulphurs, whites, and yellows)
Cabbage White (Pieris rapae)
Clouded Sulphur(Colias philodice)
Orange Sulphur (Colias eurytheme)
Cloudless Sulphur(Phoebis sennae)
Sleepy Orange ( Eurema nicippe)
Family Lycaenidae (gossamer-wings)
Gray Hairstreak (Strymon melinus)
Red-Banded Hairstreak (Calycopis cecrops)
Eastern Tailed-Blue (Everes comyntas)
Summer Azure(Celastrina neglecta)
Family Nymphalidae (brushfoot butterflies)
American Snout (Libytheana carinenta)
Variegated Fritillary ( Euptoieta claudia)
Great Spangled Fritillary(Speyeria cybele)
Pearl Crescent (Phyciodes tharos)
Question Mark (Polygonia interrogationis)
Eastern Comma(Polygonia comma)
Mourning Cloak (Nymphalis antiopa)
American Lady ( Vanessa virginiensis)
Red Admiral(Vanessa atalanta)
Common Buckeye (Junonia coenia)
Red-Spotted Purple(Limenitis arthemis astyanax)
Viceroy(Limenitis archippus)
Monarch(Danaus plexippus)
Family Hesperiidae (skippers)
Silver-Spotted Skipper (Epargyreus clarus)
Long-Tailed Skipper ( Urbanus proteus)
Southern Cloudywing(Thorybes bathyllus)
Juvenal's Duskywing ( Erynnis juvenalis)
Horace's Duskywing ( Erynnis horatius)
Least Skipper (Ancyloxypha numitor)
Fiery Skipper ( Hylephila phyleus)
Sachem ( Atalopedes campestris)
Clouded Skipper(Lerema accius)

Butterflies and moths are unique because they change from a caterpillar to a winged adult through a process called metamorphosis ( Figure 7). A typical butterfly's life begins as an egg, generally laid on the leaf of a host plant. A host plant is a plant that caterpillars like to eat. Eggs soon hatch into caterpillars, which act as eating machines to devour leaves of the host plant. Caterpillars often have very specific food requirements that restrict them to just one or a few plant species ( Figure 8, top). After a few weeks, the caterpillar molts into a mummy-like stage with a hard protective casing, called a pupa or chrysalis. While in the chrysalis, the caterpillar transforms into an adult. At the end of about 2 weeks, the adult emerges from the chrysalis, spreads and dries its wings, and begins searching for food and a mate ( Figure 8, bottom). Following successful mating, the female begins her search for a host plant on which to deposit her eggs, and the life cycle begins again.

Butterflies and moths are insects in the order Lepidoptera, meaning "scaly-winged." A person who studies these creatures is called a "lepidopterist."

Moths may have whip-like, fern-like, or fuzzy antennae with no knobs at their ends. Butterfly antennae are smooth, thin, and whip-like with a terminal knob.

Butterfly wings are covered with thousands of tiny overlapping scales arranged like shingles on a roof. A butterfly can fly even if these scales are removed.

Colors such as blue, green, violet, gold, and silver on butterfly wings are not caused by pigment, but rather by light reflecting off the wing scales.

Depending upon the species, adult butterflies can live from 1 week to 9 months.

Butterflies (and other insects) have an exoskeleton, or structural support on the outside of their bodies, to protect them and keep in fluids so they don't dry out.

Butterflies and caterpillars breathe through "spiracles," which are tiny openings along the sides of their bodies.

Butterflies can smell with their antennae.

Butterflies have compound eyes that allow them to see the colors red, green, and yellow. Their eyes do not rotate to follow a predator's movement; rather, they detect movement as the object moves from one facet of the eye to the next.

Butterflies use special nerve cells called chemoreceptors on the pads of their feet to "taste" food and identify leaves of their caterpillar's host plant before they lay their eggs.

In some butterfly species, females and males look different. Their colors may vary slightly, and females generally are larger than males. But size cannot be used to distinguish between the sexes because individuals of any single species may vary in how big they are, depending on the amount and quality of food they ate as caterpillars.

Most butterflies lay their eggs on a specific type of plant, called their host plant, which their caterpillars later feed on (Figure 9). Exceptions include Harvester caterpillars, which eat woolly aphids, and a few other caterpillars that eat rotting leaves rather than living plant foliage.

Adult butterflies may feed on nectar from flowers, but some prefer rotten fruit or tree sap. They suck the liquid food through a straw-like "tongue" called a proboscis, which curls up under the head like a watchspring when not in use.

Male butterflies often congregate at "puddling" areas, which include mud puddles, moist soil along stream banks, and animal scat (Figure 10). There they ingest salts important in sperm production.

Different species of butterflies have characteristic behaviors. For example, some perch on leaves, guarding an area and flying out to investigate all intruders. Others appear to constantly patrol certain areas and rarely perch.

Butterflies bask in the sun to warm their bodies before they fly (Figure 11). Their wings act as solar collectors.

Butterflies are most active during the warmest parts of the day, but in temperatures of over 100°F, they may become overheated and seek shade.

Most species of butterflies survive the winter by hibernating as caterpillars, pupae, or adults. A few spend the winter as eggs. Fewer still migrate to warmer climates.

Those species that spend the winter as adults tuck themselves behind loose bark or in tree cavities. They emerge in search of sap or rotten fruit on warm, sunny days.

Eggs, caterpillars, and adult butterflies have many predators. To avoid them, females lay eggs in concealed locations on the host plant, and caterpillars often look inconspicuous. To scare away predators, some caterpillars have large eye-spots that resemble a snake's head. Other caterpillars have protective spines, release obnoxious scents, or just plain taste bad.

Native plants generally are defined as those that occurred in North America before European settlement. Non-native, or exotic, plants are those that are not native. Plants native to your area grow well because they are specifically adapted to the climate, soils, temperature, and precipitation. Native plants are those to which regional butterflies have adapted, and therefore, they are ideal for butterfly gardening and for larger restoration projects ( Figure 12).
Why focus on native plants for butterfly habitat?

These plants require relatively little maintenance, watering, or care because they are adapted to a particular area.

Native plants will attract butterflies native to the region. Caterpillars are very picky eaters and will eat only very specific host plants; native plants provide these specific food sources.

Some non-native plants grow with excessive vigor and compete for space with native plants. Because some non-natives could "escape" from your garden and threaten nearby wild habitat, they should be specifically avoided (see Landscaping for Wildlife with Native Plants, AG-636-03)

Most ornamental plants are bred for color and bloom size, not for nectar production. While these cultivars may be attractive to us, many provide little benefit to wildlife.

An effective butterfly habitat provides everything a butterfly needs to complete its life cycle.

Provide a good diversity of host plants to attract a variety of butterflies and their caterpillars (see Table 1). Caterpillars are voracious but picky eaters, and many feed only on a particular species of plant.

Choose a variety of nectar plants that will provide food throughout the growing seasons, as different species of butterfly are active from early spring through late fall (see Table 2) (Figure 13).

Choose flowers with blooms of different sizes and depths (Figure 14). Smaller butterflies, such as hairstreaks and skippers, have shorter proboscises and are unable to reach the nectar in larger blooms. Larger butterflies, such as swallowtails, favor larger blooms.

Consider the moisture and light requirements of plants before introducing them to your butterfly habitat. Choose only the plants most appropriate for your area.

Visit butterfly gardens at local nature centers or botanical gardens and observe which flowering plants attract butterflies.

Do not get discouraged if a particular plant does not attract butterflies as anticipated. Experiment and find out which plants work in your butterfly habitat (Figure 15).

Peelings and cores of fruit (peeled, overly ripe bananas work well) can be discarded in partially shaded nooks in the garden where they will attract butterflies that eat rotting fruit.

Plan your butterfly habitat before buying and putting in any plants ( Figure 16). Decide how much space you want to dedicate to your butterfly habitat.

Map the area in its current condition, then create a map for your projected habitat, making sure to provide for all the basic butterfly needs (sun, shelter, larval host plants, and adult nectar plants).

Your butterfly habitat will function best in a sunny location. Most butterflies are active only in the sun, and many butterfly larval and nectar plants require sunny spots.

Place taller plants and shrubs behind smaller plants and ground covers to maximize visibility and enjoyment of your design (Figure 17).

Concentrate flowering plants with similar blooming periods to allow butterflies easy access to seasonally abundant nectar sources without excessive movement and increased exposure to predators (see Table 2) (Figure 18).

Many nectar and larval host plants grow tall. Taller plants and shrubs provide butterflies with shelter from wind and rain.

Remember that many of your plants will grow larger and multiply each year as they mature. Be sure to leave room for each plant to grow and expand.

Do not dig plants from the wild unless you are part of an organized plant rescue. Select nursery-grown native species or cultivate your own from nursery-bred native seeds. By using nursery stock from a reputable dealer, you will help preserve your local environment and the native plant population.

Make "puddling" (ingestion of salts from watery or damp ground) easy for male butterflies by designing water puddles and wet, sandy areas into the habitat and by allowing animal feces to remain in the landscape.

Provide a few large flat rocks for butterflies to perch on while basking in the sun.

You can provide shelter for the butterflies in your habitat by leaving snags (standing dead trees) or a brush pile. There is little evidence to suggest that butterflies actually use butterfly houses.

Maintenance

Throughout the growing season, leave the dead flower heads and dead foliage on your plants or you may accidentally remove eggs or pupating butterflies.

If neatness is in your blood, consider allocating a few plants as butterfly host plants. Leave those plants alone, but remove and relocate caterpillars from individual plants, if you like.

Wildlife habitat, whether for birds or butterflies, is best left untidy. As native grasses and wildflowers grow, bloom, and set seed, they may grow fast, tall, and a bit scraggly. Nature is not always perfectly ordered, and the most effective butterfly gardens will follow in nature's footsteps.

To keep your garden looking and performing its best requires research, planning, and annual maintenance. Although you'll probably discover that many butterflies quickly find your new plantings, expect to wait several years before your butterfly garden becomes fully established and, therefore, fully appreciated by the butterflies.

Alnus serrulata
Alder

Harvester (carnivorous larvae eat woolly aphids commonly found on alder)

* Trees that can be pruned and kept at shrub size by cutting them to the ground every 2-3 years. In this way, people with small yards can increase tree species diversity.
** Rarely uses this host plant in North Carolina.

Encourage your neighbors and local school officials, businesses, or parks officials to put in butterfly plantings of their own so you all can create a network of butterfly gardens throughout your community.

Gardening with native plant species can increase critical habitat for both larvae and adult butterflies.

Minimize the use of pesticides. Chemicals that kill insect pests also kill butterflies and beneficial insects. Pesticides can be toxic to birds, too, and runoff can contaminate streams and water systems.

Butterfly-releases at weddings or other occasions have become popular, but are not recommended for a number of reasons. These butterflies can spread diseases to the native butterfly population. They may interbreed with the native population, causing genetic problems or interfering with natural migration patterns. They also generally die quickly because they are released during an inappropriate season or are not equipped to handle the particular environment where they are released.

CarolinaLeps is a listserve-style email forum for butterfly enthusiasts to discuss all aspects of butterfly life in the Carolinas, including butterfly finding, butterfly identification, trip reports, butterfly counts, butterfly behavior, backyard butterflying, butterfly gardening, butterfly photography, and butterfly club information. To subscribe, send the message text "subscribe carolinaleps" (without the quotation marks) to sympa@duke.edu. Leave the subject line blank, and do not write anything else in your message text. You will receive an automated confirmation, which includes a file of information. For more details, visit CarolinaLeps.

Ajilvsgi, G. 1990. Butterfly Gardening for the South. Dallas, Texas: Taylor Publishing Co.

Barnes, T. G. 1999. Gardening for the Birds. Lexington: The University Press of Kentucky.

Brock, J. P., and K. Kaufman. 2003. Butterflies of North America. Singapore: Hillstar Editions L.C.

Glassberg, J. 1999. Butterflies Through Binoculars, The East. New York: Oxford University Press.

Glassberg, J. 2012. A Swift Guide to Butterflies of North America. Sunstreak Books.

Opler, P. A., and R. T. Peterson. 1992. Field Guide to Eastern Butterflies (Peterson Field Guides). New York: Houghton Mifflin Co.

Pyle, R. M., and S. A Hughes. 1992. Handbook for Butterfly Watchers. New York: Houghton Mifflin Co.

Wasowski, S., and A. Wasowski. 1994. Gardening with Native Plants of the South. Dallas, Texas: Taylor Publishing Co.

For more information, click the resources below or request the following Working With Wildlife (WWW) and Urban Wildlife (AG) publications from your local Cooperative Extension Center.

Funding for creation of this publication was provided in part through an Urban and Community Forestry Grant from the North Carolina Division of Forest Resources, Department of Environment and Natural Resources, in cooperation with the USDA Forest Service, Southern Region.

N.C. Cooperative Extension prohibits discrimination and harassment regardless of age, color, disability, family and marital status, gender identity, national origin, political beliefs, race, religion, sex (including pregnancy), sexual orientation and veteran status.

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Butterflies in Your Backyard | NC State Extension Publications

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Butterfly watching, though unlikely to match the widespread popularity of bird watching, has gained significant favor in recent years. Butterflies are colorful, diverse, abundant, and active during the day in warm months, making them an ideal pursuit for wildlife watchers (Figure 1).

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Centers for Disease Control and Prevention

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Personal protective equipment (PPE) is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from potentially infectious patients and materials, toxic medications, and other potentially dangerous substances used in healthcare delivery.

PPE shortages are currently posing a tremendous challenge to the US healthcare system because of the COVID-19 pandemic. Healthcare facilities are having difficulty accessing the needed PPE and are having to identify alternate ways to provide patient care.

CDC's optimization strategies for PPE offer options for use when PPE supplies are stressed, running low, or absent. Contingency strategies can help stretch PPE supplies when shortages are anticipated, for example if facilities have sufficient supplies now but are likely to run out soon. Crisis strategies can be considered during severe PPE shortages and should be used with the contingency options to help stretch available supplies for the most critical needs. As PPE availability returns to normal, healthcare facilities should promptly resume standard practices.

Key Concepts

HCP and facilities-along with their healthcare coalitions, local and state health departments, and local and state partners-will have to work together to develop strategies that identify and extend PPE supplies, so that recommended PPE will be available when needed most. When using PPE optimization strategies, training on PPE use, including proper donning and doffing procedures, must be provided to HCP before they carry out patient care activities.

All U.S. healthcare facilities should begin using PPE contingency strategies now.

Maximize use of engineering controls, such as barriers and maintained ventilation systems, and administrative controls, such as altering work practices to minimize patient contacts.

Cancel elective and non-urgent procedures/appointments.

Reserve PPE for HCP and replace PPE normally used for source control with other barrier precautions such as tissues.

Use re-usable PPE that can be reprocessed.

Use PPE beyond the manufacturer-designated shelf life for training.

Consider allowing HCP to extend use of respirators, facemasks, and eye protection, beyond a single patient contact.

U.S. healthcare facilities experiencing PPE shortages may need to consider crisis capacity strategies, which must be carefully planned before implementation. The effectiveness of crisis strategies is uncertain and they may pose a risk for transmission between HCP and patients.

Consider using intact PPE that is beyond the manufacturer-designated shelf life for patient care activities.

Carefully prioritize PPE use for selected care activities. This could include reserving sterile gowns and gloves for urgent sterile patient procedures, such as surgery, and reserving respirators for aerosol-generating procedures and patient care with airborne transmitted disease risks, like tuberculosis, measles, and varicella.

If no commercial PPE is available, carefully consider if alternative approaches will reduce the risk of HCP exposure and are safe for patient care.

As PPE becomes available, healthcare facilities should promptly resume standard practices.

Guidance

Emergency Use Authorization (EUA) of Respiratory Protective Devices

On February 4, 2020, the HHS Secretary declared that circumstances exist to justify the authorization of emergency use of additional respiratory protective devices in healthcare settings during the COVID-19 outbreak. The FDA is providing frequent updates for manufacturers, facilities, and local/state jurisdictions about Emergency Use Authorizations (EUA) for respirators and other types of personal protective equipment. The FDA has issued EUAs to authorize all NIOSH approved particulate-filtering air purifying respirators (APRs)external icon to be used in healthcare settings, including all NIOSH approved filtering facepiece respirators, elastomeric APRs, powered air purifying respirators, expired NIOSH-approved filtering facepiece respirators, and respirators that have been decontaminated pursuant to the terms and conditions of an authorized decontamination system. The authorized decontamination systems are listed on the FDA EUA website. In addition, non-NIOSH-approved disposable filtering facepiece respirators within the context of the posted EUAexternal icon are permitted for use as well.

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Personal protective equipment (PPE) is used every day by healthcare personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from potentially infectious patients and materials, toxic medications, and other potentially dangerous substances used in healthcare delivery.

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Q: Is there a shortage of gowns? Surgical masks?

A: The FDA is aware that as the COVID-19 outbreak continues to expand globally, the supply chain for these devices will continue to be stressed if demand exceeds available supplies. We have received information from healthcare organizations that some distributors may have placed certain types of personal protective equipment (PPE) on allocation, basing the quantity available to the healthcare organization on previous usage, not projected use. Increased use may exceed the available supply of PPE, resulting in shortages at some healthcare organizations.

The FDA recommends conservation strategies for use by healthcare organizations and personnel-categorized for a range of clinical needs and supply levels-intended to assist healthcare organizations in determining conservation procedures during this time period. The FDA's recommendations are intended to augment, and not intended to replace, specific controls and procedures developed by health care organizations, the Centers for Disease Control and Prevention (CDC), or CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) to aid in infection prevention and control.

Q: Can respirators approved under standards used in other countries, such as KN95, be used in the U.S. during the COVID-19 pandemic?

A: Yes, under an emergency use authorization. The U.S. Food and Drug Administration (FDA) is working diligently to mitigate any potential shortages in the supply chain and taking action to assure health care personnel on the front lines have sufficient supplies of respiratory protective devices. The FDA concluded, based on the totality of scientific evidence available, that certain imported respirators that are not National Institute for Occupational Safety and Health (NIOSH)-approved are appropriate to protect the public health or safety.

Importing Non-NIOSH-approved N95 Respirators

On March 24, 2020, the FDA issued an Emergency Use Authorization (EUA) for importing non-NIOSH-approved N95 respirators. Under this EUA, among other criteria, the FDA accepted standards from Australia, Brazil, Europe, Japan, Korea, and Mexico who have similar standards to NIOSH. The FDA did not list KN95 respirators in this EUA because of concerns about fraudulent products listed as KN95s.

On June 6, 2020, the FDA reissued the two EUAs covering imported respirators by tightening criteria in the Non-NIOSH-Approved Disposable Filtering Facepiece Respirators Manufactured in China as well as in the Imported, Non-NIOSH-Approved Disposable Filtering Facepiece Respirators to not only include new language related to decontamination as noted above, but also to revise the Scope of Authorization with respect to which jurisdictions are included in the criteria for eligibility in both EUAs, among other revisions.

Non-NIOSH-approved N95 respirators made in China

On April 3, 2020, in response to continued respirator shortages, the FDA issued a new EUA for non-NIOSH-approved N95 respirators made in China, which makes KN95 respirators eligible for authorization if certain criteria are met, including evidence demonstrating that the respirator meets certain standards.

On May 7, 2020, the FDA revised and reissued the April 3, 2020 EUA based in part on concerns raised about the performance of certain respirators authorized under the third criterion of the April 3, 2020 EUA. For example, data from NIOSH testing on some respirators that were listed in Appendix A showed that some respirators failed to meet the expected filtration performance efficiency.

On June 6, 2020, the FDA reissued the Non-NIOSH-Approved Disposable Filtering Facepiece Respirators Manufactured in China by revising the Scope of Authorization such that authorized respirators listed in Appendix A will no longer be authorized if decontaminated. The FDA also reissued multiple decontamination system EUAs, such that, among other things, they are no longer authorized to decontaminate respirators manufactured in China, where applicable.

The FDA also issued guidance outlining a policy to help expand the availability of general use face masks during this pandemic. Face masks may also be authorized for use as source control (for example, not as PPE) under the Face Mask umbrella EUA if certain criteria are met.

The FDA has adjusted its import screening to further expedite imports of legitimate products and is continually monitoring its import systems to prevent and mitigate any potential issues. The FDA established a special email inbox, COVID19FDAIMPORTINQUIRIES@fda.hhs.gov, for industry representatives to quickly communicate with the agency and address questions or concerns. The FDA is ready and available to engage with importers to minimize disruptions during the importing process.

Q: How can manufacturers of personal protective equipment (PPE) who may be considering increasing availability of these products to the US market engage with the FDA?

A: The FDA recognizes that the need by healthcare providers and personnel for personal protective equipment (PPE) such as surgical masks and surgical and isolation gowns, may outpace the supply during the Coronavirus Disease 2019 (COVID-19) outbreak.

The FDA is collaborating with manufacturers of personal protective equipment (PPE) to help facilitate mitigation strategies related to the COVID-19 outbreak. The FDA's door is open, and we are available to collaborate with stakeholders.

To help alleviate supply pressures, the FDA may consider expedited review of manufacturing site changes or premarket submissions-manufacturers of PPE (particularly surgical masks and surgical or isolation gowns) may contact FDA regarding plans to increase availability of these products to the U.S. market.

For reference, the applicable product codes discussed in these FAQs are:

Surgical masks (FXX)

Surgical mask with antimicrobial/antiviral agent (OUK)

Pediatric/child facemask (OXZ)

Surgical gowns (FYA)

Isolation gowns and surgical apparel accessories (FYC, LYU, OEA)

Surgical suits (FXO)

To facilitate a rapid response to your email, please see an example of information that FDA would find helpful to have initially below:

Subject of the email: "Product Codes XXX, Shortage Mitigation Options for FDA Engagement," where XXX represents the product code(s).
Body of the email:

Describe the affected product or products which may include the brand name, model number, 510(k) number, etc.

Describe the proposed mitigation approach.

Identify what you are interested in discussing with FDA, such as:

Expedited review of a premarket submission, or

Expedited review of a manufacturing site change if you are a class III device manufacturer, or

Information about importing certain products.

Q: Which gowns are FDA-cleared? Which surgical masks are FDA-cleared?

A: To identify FDA-cleared products, search the 510(k) Premarket Notification database using the product codes for gowns (FYA, FYB, FYC) and surgical masks (FXX, OUK, OXZ).

Q: Do gowns and surgical mask provide protection from coronavirus?

A: Gowns and surgical masks are intended to provide broad barrier protection. Please see current guidelines from the Centers for Disease Control and Prevention (CDC) on recommended use of PPE during the COVID-19 outbreak. At this time, FDA has not cleared, approved, or authorized any gowns or surgical masks for specific protection or prevention against the virus that causes COVID-19.

Q: Can we use expired gowns and surgical masks? Do they offer the protection needed?

A: These products were designed to serve as protective barriers and thus FDA believes they may still offer some protection even when they are used beyond the manufacturer's designated shelf life or expiration date. The user should visibly inspect the product prior to use and if there are concerns (such as degraded materials or visible tears) the product should be discarded. As a conventional capacity strategy, expired products may be used for training and demonstration purposes where barrier protection is not needed.

Q: Can I reuse a cloth gown?

A: Yes. Cloth gowns that will not be used in a sterile field, such as surgery, can be reused if they are laundered in enzymatic detergent or per the hospital's SOP.

Q: How can I know in advance that manufacturers will have a shortage of masks and gowns so I can prepare?

A: If you are a part of a group purchasing organization (GPO), you may want to contact the GPO staff to determine what communication they receive from their suppliers; otherwise, you can contact manufacturers directly.

Q: My health care organization already has a plan for protection against COVID-19, which includes other types of protective equipment (such as Powered Air Purifying Respirators (PAPRS) or Controlled Air Purifying Respirators (CAPRS)) and other strategies. Are we required to follow the FDA's recommendations listed in the letter to health care providers?

A: The letter to health care providers is intended to aid in the management of gowns and surgical masks. The FDA's recommendations in the letter should supplement a health care organization's policy.

Q:. How do I know what the manufacturer-designated shelf life is?

A: The manufacturer-designated shelf life may be found in the product labeling and if not, you can contact the manufacturer directly.

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FAQs on Shortages of Surgical Masks and Gowns During COVID-19

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A: The FDA is aware that as the COVID-19 outbreak continues to expand globally, the supply chain for these devices will continue to be stressed if demand exceeds available supplies. We have received information from healthcare organizations that some distributors may have placed certain types of personal protective equipment (PPE) on allocation, basing the quantity available to the healthcare organization on previous usage, not projected use.

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Although butterflies appreciate large stands of nectar-rich flowers, a container garden full of annuals can offer all the elements of butterfly-friendly garden design. In particular, butterflies appreciate shelter from the elements, and a group of containers on your balcony or patio may provide a respite from the windswept conditions in open landscapes. Add a clay saucer drinking station, and you may soon be honored with some of the more than 700 species of butterflies that inhabit North America.

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Bring Butterflies to the Container Garden

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Although butterflies appreciate large stands of nectar-rich flowers, a container garden full of annuals can offer all the elements of butterfly-friendly garden design. In particular, butterflies appreciate shelter from the elements, and a group of containers on your balcony or patio may provide a respite from the windswept conditions in open landscapes.

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Wake Relief has more than 100 volunteers dedicated to alleviating hunger in Wake County. Our volunteers are the staff on Tucker Street, delivery teams who pick up food at ALDI and bring to Wake Relief in a rented U-Haul, teams who transfer food from truck to shelf.

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Wake Relief has more than 100 volunteers dedicated to alleviating hunger in Wake County. Our volunteers are the staff on Tucker Street, delivery teams who pick up food at ALDI and bring to Wake Relief in a rented U-Haul, teams who transfer food from truck to shelf.

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Survival of America's Rarest Wolf at Stake

As few as 18 wild red wolves (Canis rufus)-the world's only wild population of red wolves-live in a five county area on the Albemarle Peninsula of eastern North Carolina. According to population estimates by the U.S. Fish and Wildlife Service, the wild population of red wolves has declined by more than 70 percent from what it was five years ago when an estimated 100 red wolves lived within the same area.

On November 4, 2018, the Southern Environmental Law Center, on behalf of conservation groups, secured a court order declaring that the agency violated the law in gutting protections for the endangered wild red wolves in recent years. The court also made permanent a previous September 29, 2016, order stopping the Service from capturing and killing, and authorizing private landowners to capture and kill wild red wolves not posing a threat to human safety or property.

Conservation groups brought the federal court action over the USFWS's decision to allow red wolves that were not causing any problems to be shot and killed by private landowners, at the same time as it rolled back conservation measures that had helped red wolves grow from four pairs released in 1987, to over 100 animals in eastern North Carolina from 2002-2014. Since those management changes were made, the red wolf population has plummeted over the past four years.

In addition to the changes enacted in 2015, the USFWS proposed a rule on June 27, 2018, that would restrict wild red wolves to one National Wildlife Refuge and a bombing range in eastern North Carolina, while allowing the immediate killing of any wolves that live on or wander onto non-federal lands in what previously had been a designated five-county Red Wolf Recovery Area. The USFWS proposal would reduce the recovery area by almost 90 percent. The Service has halted progress on this proposed rule since the November 4, 2018 court order.

Nonetheless, the wild red wolf population remains in jeopardy as the U.S. Fish and Wildlife Service has failed to resume previously-successful conservation measures, including releasing captive-born red wolves into the wild population and managing coyotes in the recovery area.
The Return of Red Wolves
North Carolina is home to the only wild population of red wolves in the world. Red wolves bred in captivity were successfully reintroduced on a North Carolina peninsula within their native range in the late 1980's after red wolves were declared extinct in the wild. Once common throughout the American Southeast, intensive predator control programs and loss of habitat decimated wild red wolf populations.
Listen to the red wolf chorus
Previous Court Action
In July 2013, the N.C. Wildlife Resources Commission authorized coyote hunting both during the day and at night with artificial spotlights within the area designated for red wolf recovery.

The law center notified the NCWRC that it was in violation of the federal Endangered Species Act by allowing hunting of coyotes within the Red Wolf Recovery Area and the groups would file a federal enforcement action unless the commission took steps to protect the wolves. Subsequently, the parties agreed to a settlement to address shootings of wild red wolves, including banning coyote hunting by spotlight at night within the Red Wolf Recovery Area and requiring for the first time permitting and reporting for coyote hunting during the day within the five-county area. Since the settlement, the North Carolina Wildlife Resources Commission passed a resolution calling for red wolves to be declared extinct in the wild and demanding USFWS to remove red wolves from the wild.

Coyote Control
To prevent wild red wolves interbreeding with coyotes, the U.S. Fish and Wildlife in the past sterilized coyotes that held territories within and near red wolf habitat. Shooting sterilized coyotes undoes effective coyote population control efforts and further jeopardizes the native wild red wolf population.

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World's Only Wild Red Wolves in Jeopardy

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As few as 18 wild red wolves (Canis rufus)-the world's only wild population of red wolves-live in a five county area on the Albemarle Peninsula of eastern North Carolina. According to population estimates by the U.S.

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We live in an age where we can communicate with distant friends and family members with a few clicks of a mouse or taps on a smart phone screen. Despite advances in communications technology and the increasing connectedness it brings, research indicates that, as a society, we are lonelier than we have ever been. A 2018 survey conducted by Cigna showed that nearly half (46 percent) of 20,000 U.S. adults report that they feel alone sometimes or always. Perhaps no other age group feels the keen sting of loneliness more than the elderly.

Understanding Loneliness in Seniors

Aging brings many changes that can contribute to a more solitary life. One of the biggest issues for seniors is that their social circles begin to shrink as the years go by. On one hand, retiring grants older adults more free time for hobbies and relaxation, but it also puts an end to meaningful interactions with colleagues on a regular basis. Friends, significant others and family members may move away or pass away. Even those who still live close by may be difficult to meet with in person due to changes in mobility. This is especially true once a senior stops driving for safety reasons. Age-related conditions, such as hearing loss and eye diseases, can also make it so difficult to communicate that it doesn't seem worth the effort anymore.

Embarrassment can be a factor as well. Many older adults living with chronic medical conditions not only face logistical challenges when it comes to leaving the house, but they may also feel insecure about these "obvious" signs of aging. Incontinence is a common concern that can complicate an elder's social life, while the use of durable medical equipment like mobility aids and oxygen therapy systems can affect their self-confidence.

It is trying enough for a senior to maintain healthy relationships despite these challenges. When one's entire peer group is experiencing any combination of these factors, it can be difficult (if not impossible) to get together or keep in touch with friends on a regular basis. Sadly, many seniors experience a decline in the quantity and quality of their relationships as they age, whether it is self-imposed or due to forces outside of their control.

Families Struggle to Support "Forgotten Seniors"

Even when an older adult is being taken care of by family caregivers, T. Byram Karasu, MD, distinguished professor emeritus at the Albert Einstein College of Medicine's department of psychiatry and behavioral sciences, says that there is often little attention paid to deep, engaging communication between a senior and the rest of their family. The changes listed above certainly play a role, but caregivers are usually so worn out from juggling their day-to-day responsibilities that they have little time or energy left for singlehandedly meeting all a senior's emotional and social needs.

Bobbie Smith, a professional caregiver for Home Instead Senior Care with more than six decades of elder care experience under her belt, echoes this sentiment but believes the structure of families is also an underlying issue. She says that a modern trend is the breakdown of extended family relationships like those between grandparents and grandchildren. This has caused many elderly people to feel as though they have been "pushed to the side" and forgotten about. Family units that have spread across the country find it particularly difficult to make time for visits and even regular communication by phone and mail.

The Effects of Loneliness on the Elderly

Feeling that one lacks fulfilling personal relationships doesn't just affect one's mental and emotional health. In fact, it can also take a toll on one's physical health. A 2018 meta-analysis of 35 research articles that measured loneliness and mortality confirmed that feeling lonely is a risk factor for all-cause mortality for both men and women.

Another study conducted by researchers from the University of California, San Francisco (UCSF) found that adults 60 years old and older who reported feeling lonely were at higher risk for functional decline in addition to the increased risk of death. This decline manifested specifically in participants' abilities to perform activities of daily living (ADLs)-the five basic tasks (bathing, dressing, transferring, toileting and eating) that are necessary for truly independent living. In other words, unchecked loneliness has the potential to jeopardize an elder's ability to live independently and to accelerate their need for assistance from a family caregiver or another source of long-term care.

Loneliness is thought to act on the body in a way that is similar to chronic stress. According to research funded by the National Institute on Aging (NIA), it raises the levels of stress hormones like cortisol, which impairs immune responses and contributes to inflammation. Prolonged loneliness is hard on the body and can leave seniors vulnerable to mental health issues like anxiety and depression and chronic conditions like heart disease and obesity. Another study published in JAMA Psychiatry even found an association between feelings of social detachment and the development of brain biomarkers common in preclinical Alzheimer's disease.

Ways to Alleviate Loneliness in the Elderly

Smith feels that there are many steps that can be taken to rectify this situation. "It's so easy to combat loneliness in the elderly, but we have to be willing to get up and make it happen," she explains. If your loved one is feeling socially isolated or lonely, use some of the tips below to help them feel more connected and supported.

Listen and observe.
"We often don't listen enough to the people we love," laments Tina Tessina, PhD, psychotherapist and author of The Ten Smartest Decisions a Woman Can Make After Forty. According to Tessina, "Saying 'tell me more' is a gift you can give from your heart." Encouraging someone you care about to express themselves can help you discover what they're thinking and feeling and what interests and passions lie dormant, just waiting to be rekindled.
"You've got to really dig deep and find out what their interests were before and get them to try to awaken those forgotten activities," Smith says. Keep in mind that once-loved activities may no longer interest them or fit their abilities. Do your best to help them discover ways to adapt these hobbies or find new pastimes altogether.

Develop a strategy for minimizing isolation.
Once you know what your loved one enjoys doing, you can use this information to develop a personalized plan for eradicating loneliness. For example, Smith was caring for an angry 91-year-old man who was reluctant to communicate when she discovered that he had a passion for singing and photography. One day while walking down the hall with him, she began to belt out a few bars of Bing Crosby's Let Me Call You Sweetheart. The man responded by singing right along with her and grudgingly admitting, "You're OK." Today, he sings for his community and is a member of a club for retired photographers that Smith helped him contact. Sometimes our elders just need a creative push to step outside their comfort zone and seek out the meaningful interactions they yearn for.

Let them teach you.
Smith encourages caregivers to connect with loved ones by allowing them to pass along some hard-earned knowledge. "I learn something new every day because I am being taught by the best," Smith admits. The key is to let the senior's passions and experiences guide the lesson plan. For example, if your mother loves to embroider, ask her to teach you how to do it. This not only has the potential to be a great bonding experience, but it can also help restore a bit of balance to the child-parent dynamic that may have been lost once caregiving began.

Bridge the generation gap.
According to Smith, caregivers can play a vital role in fostering relationships between elders and their youngest relatives. Grandkids often perceive their grandparents as either weird or boring, when they should consider their elders sources of valuable wisdom and fun. Try to devise ways of helping multiple generations of your family spend time together, whether in person, by phone or via mail.
Dr. Karasu also points out that seniors have the potential to contribute a lot to their families if they are allowed to remain engaged. He says this is doubly important, considering research has shown that an unengaged elderly adult will experience cognitive decline at a much faster rate than a senior who is mentally stimulated by interactions with other people.

It's the thought that counts.
Another piece of advice from the pros is to urge other family members to reach out to an elderly loved one. It doesn't have to be a grand, time-consuming gesture. Something as simple as sending a card, sharing a favorite meal, or calling for 30 minutes once a week can go a long way to making a senior feel loved and connected to the rest of the family.

Consider senior living.
For some seniors, no amount of effort encourages them to come out of their shell. It may take a large change to get them to renew their interest in people and activities. While moving to a senior living community might seem like a viable solution for a lonely elder, it isn't always that straightforward.
The success of such a transition depends on the individual person and the fit of the facility. It also takes time and effort for a loved one to adapt to and grow comfortable with their new living arrangement and neighbors. In fact, it may appear to backfire at first. "When seniors move to nursing homes or assisted living communities, it can be a totally disorienting experience," Dr. Karasu points out. Family members and staff should provide gentle encouragement to help new residents acclimate, meet new people and participate in activities and events. One of the best parts of senior living (aside from receiving necessary care) is that opportunities for socialization and fulfillment are available right outside a resident's door.

Sources: 2018 Cigna U.S. Loneliness Index ( https://www.cigna.com/assets/docs/newsroom/loneliness-survey-2018-full-report.pdf); Association of loneliness with all-cause mortality: A meta-analysis ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754055/); Loneliness in older persons: a predictor of functional decline and death ( https://www.ncbi.nlm.nih.gov/pubmed/22710744); Social isolation, loneliness in older people pose health risks ( https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks); Association of Higher Cortical Amyloid Burden With Loneliness in Cognitively Normal Older Adults ( https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2575729)

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Combatting the Epidemic of Loneliness in Seniors

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We live in an age where we can communicate with distant friends and family members with a few clicks of a mouse or taps on a smart phone screen. Despite advances in communications technology and the increasing connectedness it brings, research indicates that, as a society, we are lonelier than we have ever been.

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Endangered and Threatened species of North Carolina

The Endangered Species Act of 1973 (ESA) protects species of plants and animals that are in danger of extinction. The purpose of the ESA is to protect and recover imperiled species and the ecosystems upon which they depend. The ESA is administered by the U.S. Fish and Wildlife Service (USFWS) and the Commerce Department's National Marine Fisheries Service (NMFS), part of the National Oceanic and Atmospheric Administration. The USFWS has primary responsibility for terrestrial and freshwater organisms, while the responsibilities of NMFS are mainly marine wildlife such as whales and sea turtles.

The ESA allows the USFWS and the NMFS to list species of plants and animals as threatened or endangered. "Endangered" means a species is in danger of extinction throughout all or a significant portion of its range. "Threatened" means a species is likely to become endangered within the foreseeable future. In addition, candidate species are species for which the agencies have enough information to warrant proposing them for listing, but are precluded from doing so by higher listing priorities. For additional information about the ESA, please see Endangered Species Act Basics.

Currently, 61 federally threatened and endangered species are known to occur in North Carolina. Fact sheets for each protected species are available by clicking on the name of the species below. Links to additional information about each species are located at the bottom of individual fact sheets.

The North Carolina Natural Heritage Program (NCNHP), as part of its mission to preserve the biological diversity of North Carolina, maintains an inventory of all known locations of rare taxa and serves as the state's data source of locality information of natural areas and rare and federally and state listed plant and animal species. Using NCNHP data, the USFWS has developed a County List of federally protected species by each North Carolina county.

Since most of our federally threatened and endangered plants are not readily identifiable throughout the year, surveys must be conducted during the time of year when the species are recognizable by their flowers and/or vegetative characters. Please see the Optimal Survey Windows for Plants document for additional information about conducting surveys for listed plant species.

Survey protocols for Red cockaded Woodpeckers can be found in the revised Recovery Plan.

Since freshwater mussels and fish require removal from the water and extensive handling, Endangered Species Recovery Permits are required to conduct surveys for these species. Please contact the Raleigh Field Office for additional information.

For additional information about the endangered species consultation process and instructions on preparing a biological assessment or biological evaluation, please see our Endangered Species Consultation page.

Listed species believed to or known to occur in North Carolina Source: Environmental Conservation Online System.

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The Endangered Species Act of 1973 (ESA) protects species of plants and animals that are in danger of extinction. The purpose of the ESA is to protect and recover imperiled species and the ecosystems upon which they depend. The ESA is administered by the U.S.

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RALEIGH, N.C. ( WNCN) - A group of health care workers stood outside the capitol with a message of their own - reopen responsibly - as hundreds of people marched in downtown Raleigh demanding Gov. Roy Cooper end that state's stay at home order.

Health care workers are calling for a staged rollback of social distancing practices after the state meets several criteria, saying reopening too soon could cause a surge in cases of COVID19.

"Opening up too much too soon could be counterproductive and actually make things more difficult for us," said Tina Gordon. She is the CEO of the North Carolina Nurses Association (NCNA), representing the state's 140,000 RNs.

NCNA supports a staged reduction in social distancing once the state achieves three goals: a drop in cases over a two week period, reliable access to testing and personal-protective equipment, and contact tracing.

Right now, Gordon said the state hasn't reached those targets. North Carolina health officials reported 34 coronavirus-related deaths on Tuesday, marking the deadliest day for the state since the beginning of the pandemic.

A total of 213 deaths are being attributed to COVID-19 aross 93 counties.

"The virus hasn't gone away. We don't have treatment that will make it go away. We don't have vaccines that will make it go away. We have to find ways to control it," Gordon said.

Gordon said nurses are still rationing PPEs in some parts of the state, which makes it unsafe for them to treat COVID-19 patients, but also test for the virus.

"There are nurses that don't have what they need to take care of patients. That's a problem. We don't want to do anything that risks an escalation in the number of cases until we have firm control on safety, testing, and trends," Gordon said.

Gordon said the NCNA is concerned about the economic impact and understands the frustration of business owners. She also said the stay-at-home order needs to stay in place for now.

"We are all on the same team right now," Gordon said. "In dealing with infectious disease, hours and days can change the outcome. If we can buckle down and get through a short time period to go, it really will be significantly beneficial to the people of this state in the long run."

The NCNA suggested guidelines for rolling back social distancing are similar to President Donald Trump's guidelines for "Opening Up America Again." Trump's plan is intended to help local officials reopen their economies in a three phases approach.

Before states or local governments can begin the first phase, they must have a downward trajectory of documented cases for two weeks, and then another two weeks of decrease in cases before moving to the following phases.

Trump's guidelines also include setting up efficient testing sites and trace contacts of COVID-19 positive cases.

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Health care workers offer message to ReOpen NC protesters: reopen responsibly

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RALEIGH, N.C. (WNCN) - A group of health care workers stood outside the capitol with a message of their own - reopen responsibly - as hundreds of people marched in downtown Raleigh demanding Gov. Roy Cooper end that state's stay at home order. Health care workers are calling for a staged rollback of social distancing [...]

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Use compassion and creativity to do acts of good from home.

For every kind act shared with #DoGoodFromHome,
Hasbro will donate a toy or game to organizations providing care to the children of COVID-19 essential
workers, up to 25,000 toys and games.

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Calling all kids and teens to take the Challenge!

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At least 47 people contracted COVID-19 at a Knightdale nursing home, one of 29 known outbreaks at long-term care facilities statewide.

Wake County officials reported four people at Wellington Rehabilitation and Healthcare had tested positive for the virus April 9. Over the weekend, the facility identified 43 new cases, including 18 patients that are currently not showing symptoms. Twenty-five of those who contracted the virus are staff members.

The first two patients to test positive for the virus are still in the hospital, according to a press release.

"We're working closely with the operators of the facility and advising them on the best ways to prevent the virus from spreading further," said Jose Cabanas, Wake County's EMS and medical director. "They're following our guidance and isolating the positive patients to a single wing of the building."

As of Monday, there have been 4,816 confirmed cases of the virus in North Carolina and 86 people have died.

Nursing homes have become a hotbed for the virus, with outbreaks identified at 29 across the state. Governor Roy Cooper issued an executive order last week tightening restrictions at long-term care facilities, including banning visitors and requiring staff members get screened for symptoms daily.

The county, meanwhile, has mandated the following:
Contact Raleigh news editor Leigh Tauss at ltauss@indyweek.com. DEAR READERS, WE NEED YOUR HELP NOW MORE THAN EVER. Support independent local journalism by joining the INDY Press Club today. Your contributions will keep our fearless watchdog reporting and essential arts and culture coverage viable in the Triangle, coronavirus be damned.

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Knightdale Nursing Home Outbreak Now at 47 Cases

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At least 47 people contracted COVID-19 at a Knightdale nursing home, one of 29 known outbreaks at long-term care facilities statewide. Wake County officials reported four people at Wellington Rehabilitation and Healthcare had tested positive for the virus April 9.

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Take a stand to save the Amazon rainforest. By taking a closer look.

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Take a stand to save the Amazon rainforest - by taking a closer look. SAS AI analyzes millions of images to identify signs of deforestation. But AI can't do it alone. With our crowdsource app, you can help us classify images and train AI models to detect deforestation faster.