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Finally, the use of a cleanup stack continued to be useful because there were several classes that did not adequately clean up properly upon destruction These objects required the developer to explicitly call a cleanup method generally Close, Release, or Destroy The EUserHL Core Idioms Library also includes a set of classes to assist the developer with proper resource management in these cases This includes the LCleanedupXXX and LManagedXXX classes The LCleanedupXXX group of classes, found in Table 7-1, is designed for use with local function variables, and the LManagedXXX group of classes, found in Table 7-2, is designed for use with class member variables These classes implement what can be viewed as a set of smart pointers The developer no longer has to worry about pushing and popping objects from the cleanup stack, deleting memory before a reference goes out of scope, or calling a resource cleanup function This is all performed appropriately when one of the

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tients Symptoms of botulism can be categorized as neurologic, gastrointestinal, or miscellaneous Dysphagia, xerostomia, diplopia, and dysarthria beginning acutely and progressing over the course of 12 36 hours are characteristic Anxiety is a common symptom The time course is dependent, in part, on the amount of toxin consumed A careful history may allow documentation of upper cranial nerve involvement prior to the development of more rostral swallowing and speaking dif culties In foodborne botulism, gastrointestinal symptoms of nausea, occasional vomiting, and initial diarrhea followed by constipation may occur just prior to or coincident with the neurologic symptoms Associated complaints of abdominal cramps, undue fatigue, and dizziness may also be described during the disease s evolution Subsequently, dependent on the degree of intoxication, patients develop progressive weakness affecting rst the upper and then the lower extremities The patient may begin to notice shortness of breath prior to extremity involvement Occasional asymmetries may be appreciated It has been speculated that the cranial muscles are affected prior to the limb muscles due to higher temperatures of the face compared to limbs There is a distinct lack of sensory complaints, although an occasional patient may describe an alteration in sensation affecting either face or limbs Cranial nerve evaluation in botulism typically reveals ptosis, a diminished gag re ex, dysphagia, dysarthria, facial paralysis, tongue weakness, and occasionally nystagmus Deep tendon re exes may be normal or diminished initially, with progression to complete loss in severely affected individuals The forced vital capacity is reduced in most cases, with ventilator support eventually being required in 32 81% of patients237,238 The duration of required mechanical ventilation is dependent on the severity of the illness and serotype of the infecting organism, with a mean of 58 days for type A and 26 days for type B botulism237,238 Careful patient examination can reveal disturbances of autonomic function affecting both the sympathetic and parasympathetic systems Speci cally, there can be loss of vagal cardiac in uence, ileus, hypothermia, and urinary retention Hypotension without tachycardia may be present, and a lack of vasomotor responses to postural change may be observed Pupils are often poorly reactive to light In wound botulism, the patient s symptoms are quite similar to the foodborne form of botulism with a few modi cations The patient may or may not relate to a history of a traumatic event, particularly individuals who use elicit, parenteral drugs Botulism should enter the differential diagnosis of weak patients who are intravenous (IV) drug abusers Gastrointestinal complaints are less common than foodborne botulism Wound botulism is more likely to affect an individual as opposed to a group as might be anticipated in foodborne disease.

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