Mark Corson

By J. Ashton. University of Delaware. 2018.

Waterborne Diseases ©6/1/2018 507 (866) 557-1746 The graph shown on the last page depicts the chlorine residual as a function of increasing chlorine dosage with descriptions of each zone given below (Drawing by Erik Johnston cheap emsam 5mg mastercard, adapted from Reynolds and Richards order 5mg emsam with mastercard, 1996) purchase emsam 5 mg on line. Waterborne Diseases ©6/1/2018 508 (866) 557-1746 Water Treatment In water treatment, pre-chlorination is utilized mainly in situations where the inflow is taken from a surface water source such as a river, lake, or reservoir. Chlorine is usually added in the rapid mixing chamber and effectively prevents the majority of algal growth. Algae is a problem in water treatment plants because it builds up on the filter media and increases the head which means that the filters need to be backwashed more frequently. In addition, the algal growth on the filter media causes taste and odor problems in the treated water. Post Chlorination Post chlorination is almost always done in water treatment, but can be replaced with chlorine dioxide or chloramines. In this stage chlorine is fed to the drinking water stream which is then sent to the chlorine contact basin to allow the chlorine a long enough detention time to kill all viruses, bacteria, and protozoa that were not removed and rendered inactive in the prior stages of treatment. Drinking water requires a large addition of chlorine because there must be a residual amount of chlorine in the water that will carry through the system until it reaches the tap of the user. After post chlorination, the water is retained in a clear well prior to distribution. Since there are 86,400 seconds in each day (60 sec/min x 60 min/hour x 24 hour/day) and 454 grams in each pound of element, 14. One coulomb is the amount of charge accumulated in one second by a current of one ampere. Electricity is actually a flow of charged particles, such as electrons, protons, or ions. The charge on one of these particles is a whole-number multiple of the charge e on a single electron, and one coulomb represents a charge of approximately 6. The coulomb is named for a French physicist, Charles-Augustin de Coulomb (1736-1806), who was the first to measure accurately the forces exerted between electric charges. Considering typical current efficiencies of 95 percent, the actual electrochemical reaction requires roughly 15 amperes of direct current to produce one pound of chlorine gas during a 24-hour period: 14. The chlorine mixes with the ejector water to form hypochlorous acid and/or hypochlorite ion depending on the water pH. With so many varied and valuable uses, chlorine chemistry is truly an indispensable asset to modern life. Waterborne Diseases ©6/1/2018 511 (866) 557-1746 Chlorine Generator Process The chlorine generator is as simple as a battery. There are no moving parts; however, the chlorine generator does require operation and maintenance. Cell: The cell includes the anode and cathode compartments that are hydraulically isolated by an ion selective membrane located between the two cell compartments. The anode compartment contains the anode (electrode), salt, saltwater electrolyte, and chlorine. Chlorine gas generated from the anode compartment is swept under vacuum by the Venturi ejector into the water supply. The cathode compartment contains the cathode (electrode), sodium hydroxide (caustic soda) electrolyte, and hydrogen. Waterborne Diseases ©6/1/2018 512 (866) 557-1746 The hydrogen produced from the cathode compartment is vented to the outside atmosphere. The two cell compartments are joined together by a union pipe fitting that also holds the ion selective membrane between the union flanges. Please note that the use of a union pipe fitting in the cell configuration is patented and subject to royalty fees. Power Controller The power controller is simply a common dimmer switch (used to dim lights) that the power supply is plugged into to adjust the voltage input to the power supply. Like dimming your lights, the power controller will "dim" your chlorine production to the desired chlorine level. Pressurized Water Supply The water passes through a Venturi creating a vacuum that is applied to the anode compartment of the cell. The Venturi ejector also includes a flow switch connected to a relay that operates the Power Controller. This safety feature ensures that flow is going through the Venturi ejector before chlorine is generated. The discharge from the vacuum ejectors is highly chlorinated water in the form of hypochlorous acid and/or hypochlorite ion. Process Installation Provided the plumbing for the system is complete (existing vacuum ejector, or simply using a garden hose connected to the ejector); it should not take longer than 30 minutes to an hour to have your chlorine generator completely operational. The installation includes the following steps:  Remove components from the box, check contents for any missing or broken parts  Soak the membrane in warm water  Install the membrane on the cell flange  Add salt and water to the anode compartment  Add water and dry sodium hydroxide (i. Draino) to the cathode compartment  Connect water supply to Venturi ejector  Connect the vacuum tubing from the anode compartment to the Venturi ejector  Clamp red (positive) power clamp from power supply to anode  Clamp black (negative) power clamp from power supply to cathode  Turn on power supply switch  Plug power supply into power controller  Plug power controller into power circuit  Operate Venturi ejector and energize power circuit, adjust power controller to desired chlorine level. Waterborne Diseases ©6/1/2018 513 (866) 557-1746 System Operation The system operation includes the control of the system, addition of salt and water to the anode compartment, periodic dilution of the sodium hydroxide in the cathode compartment, and occasional cleaning of the cell membrane. The simplest way is to plug the power controller into a power outlet that is only energized at times when the generator is needed for chlorine production. This on/off operation procedure can be accomplished by installing a power control relay on the power outlet circuit. Nearly all municipal well installations include this type of circuit typically used for a hypochlorination pump. The power controller includes a flow switch that ensures operation of the chlorine generator only when there is flow through the Venturi ejector. Having the pool filter and water supply fill line on the vacuum ejector will allow the chlorine generator to operate at any moment when water is moving into the pool.

Organ Manifestations At autopsy emsam 5mg line, organs with high blood flow safe 5mg emsam, including lungs order emsam 5 mg free shipping, spleen, liver, bone marrow, kidneys, and adrenals, are frequently affected. Respiratory symptoms (cough, dyspnea, pleuritic chest pain) are present in 30% to 70% of patients. Commonly reported symptoms include abdominal pain (diffuse or localizing to the right upper quadrant), nausea, vomiting, and diarrhea. Liver function tests are frequently abnormal and typically suggest a cholestatic pattern. Frank jaundice, ascites, cholecystitis (31), and pancreatitis (32) are rare, but elevations of alkaline phosphatase and transaminases were reported in 83% and 42% of patients in one series (33). The most typical skin lesions, termed “tuberculosis cutis miliaris disseminata” or “tuberculosis cutis acuta generalisata”, are described as small papules or vesiculopapules (37). Rarely lichenoid, macular, purpuric lesions, indurated ulcerating plaques, and subcutaneous abscesses have been reported (35,37). Adrenal gland involvement has been found in as many as 42% of autopsy-based case series (38). Even in autopsy series, cardiovascular involvement, with the exception of pericarditis, is distinctly rare. The problem is to consider the diagnosis in time and to initiate diagnostic work up and therapeutic interventions without delay, as the host is generally not able to control M. A typically normocytic, normochromic anemia is seen in approximately 50% of the patients. Most patients have a normal white blood cell count, but leukopenia and leukocytosis 424 Albrecht occur in an approximately equal minority of patients. Pancytopenia due to bone marrow infiltration or a hemophagocytic syndrome has been described. Hyponatremia, the most common biochemical abnormality, often indicates inappropriate antidiuretic hormone secretion. Hypercalcemia and polyclonal hypergamma- globulinemia have been reported in several cases. Bronchoalveolar lavage tends to reveal absolute and relative lymphocytosis, but mostly due to conflicting results no other useful markers have been identified. Miliary Tuberculosis in Critical Care 425 the onset of clinical symptoms (24,33,45,46). The initial nodular interstitial spread occurs without significant alveolar involvement. In order to be large enough to be appreciated on a plain chest radiograph, however, some spread to the adjacent alveoli will have to have occurred (47). Furthermore, while many studies report extraordinary high rates of classic radiologic findings; this usually is a self-fulfilling prophecy as the radiologic findings were often used as an inclusion criterion as well. Asymmetrical nodular pattern, coalescing nodules, mottled appearance, snowstorm appear- ance, ground-glass appearance, and air-space consolidation have been described (3). Conversely, other conditions that typically present with larger nodules such as alveolar hemorrhage, lymphangitic cancers, or inhalational diseases can appear as early small nodules. Approximately 5% of patients have additional findings that may provide additional clues to the diagnosis. Subtle miliary lesions are best appreciated in slightly underpenetrated films, but in many cases visualization requires a high index of suspicion and review with an experienced chest radiologist. Numerous small (1–3 mm) nodules, distributed throughout both lungs, are easily visualized. A recent review, however, came to the conclusion that “in the published reports, no systematic pattern of diagnostic approach could be identified and invasive diagnostic sampling appeared to be arbitrary and individualized, especially in the pediatric series” (3). While it is indeed difficult to generate evidence-based recommendations for testing, recent studies have helped establish several important testing paradigms (24,33). However, the probability of a positive smear increased with the number of sites sampled. Thus, when present, samples of sputum, gastric aspirate, urine, pleural fluid, pericardial fluid, and ascites should all be rapidly examined for the presence of acid-fast bacilli. Fluorochrome dye–based stains may be more sensitive than conventional Ziehl–Nielsen staining (52). It should be noted that neither of these traditional stains allows for distinction between tuberculous and nontuberculous mycobacteria, but direct probes have been developed that allow for species detection in smear-positive samples (53). Cultures tend to be more sensitive, but the turnaround time of several weeks significantly diminishes their usefulness in the critical care setting. However, even if the results may not be available in time before treatment decisions have to be made, it is extremely important to procure tissue/fluids as positive cultures are prerequisite for later drug-susceptibility testing. All specimens should be inoculated into an automated radiometric detection system, preferably using lysis centrifugation techniques, which is both more rapid and more sensitive than standard techniques using solid medium for the isolation of M. These tests produce results within two to seven hours after sputum processing and are therefore of interest in critically ill patients. False-positive or false-negative results occur more frequently when technician proficiency is suboptimal. While sensitivity and specificity are somewhat depen- dent on pretest probability, all available tests perform better in smear-positive samples than in smear-negative patients. Molecular rapid tests have generally replaced adenosine deaminase and interferon- gamma-based tests that have mostly been evaluated in resource-limited settings with high pretest probabilities. In the two modern case series, granulomas were demonstrated in up to 100% of liver biopsies, 82% of bone marrow biopsies, and 72% of transbronchial biopsies (24,33). If biopsies were guided by clinical or laboratory abnormalities specific to Miliary Tuberculosis in Critical Care 427 the organ system being sampled, the yield was generally higher. Specific target amplification can be performed on fresh and even processed samples.

Vector An organism (or living creature) that carries disease-causing microorganisms from one host to another buy emsam 5mg. Vehicle transmission An indirect method of disease transmission where the disease- causing organism is carried by food buy discount emsam 5mg on line, water or some other object cheap emsam 5 mg mastercard. Virus A group of microbes that are incapable of reproducing on their own and must invade a host cell in order to use its genetic machinery for reproduction. Viruses are smaller than bacteria, and are responsible for the most common human diseases, the common cold and the "flu" (influenza). Advisory Committee on Immunization Practices and the American Academy of Family Physicians. January 2007 A-71 International Association Infectious Diseases of Fire Fighters Appendices U. The composition and the terms of reference of the Working group would be as follows: Subgroup I: Communicable Diseases 1. To review the achievement of ongoing major communicable disease control programmes their target and suggests corrective measures to improve their th implementation in the 12 Plan. To suggest introduction of new programmes/ continuation of existing programmes for control of communicable diseases and modifications required, if th any, in the 12 Five Year Plan on the basis of 1& 2 above along with detailed budget for each programme. To review the current system of monitoring and evaluation of the existing communicable disease control programmes and suggest measures to make the system more effective V. To review the functioning Integrated Disease Surveillance Programme in terms of its effectiveness in strengthening surveillance for picking up early warning signals of outbreaks and institution of appropriate control measures in a timely manner, identify gaps and suggest measures to strengthen the surveillance system for th prevention and control of communicable diseases during the 12 Plan. To deliberate and give recommendations on any other matter relevant to prevention and control of communicable diseases. Jagdish Kaur, Chief Medical Officer, Ministry of Health & Family Welfare (O)23063120 Terms of Reference I. To review status of ongoing Central Sector/Centrally Sponsored Disease Control Programme for non-communicable diseases. To suggest introduction of new programmes/ continuation of existing programmes for control of non-communicable diseases and modifications th required, if any, in the 12 Five Year Plan on the basis of 1& 2 above along with detailed budget for each programme. This shall include initiating a Programme for any non-communicable disease of public health importance not yet covered under any Programme. To study and work out comparative effectiveness of interventions at different levels of health care such as health promotion, prevention, community based services, screening/ early diagnosis, treatment and rehabilitative care taking into account short term and long term needs for prevention and management of non- communicable diseases. Based on the assessment made as at 5 above, suggest proportionate expenditure on preventive, promotive, curative and rehabilitative health care for non-communicable diseases for maximizing impact of these interventions and optimizing resources available. To deliberate and give recommendations on any other matter relevant to prevention and control of non-communicable diseases. The Chairman may constitute various Specialists Group / Working Groups / Sub- groups/task forces etc. Working Group will keep in focus the Approach paper to the 12 Five Year Plan and monitorable goals, while making recommendations. The Working group would submit its draft report by 31 July, 2011 and final report st by 31 August, 2011. Prevention & Control of Neurological Disorders (Epilepsy, Autism, Dementia) 240 20. Since the majority of deaths are premature there is a substantial loss of lives during the productive years as compared to other countries. Heart diseases, stroke and diabetes are projected to increase cumulatively, and India stands to lose 237 billion dollars during the decade 2005-2015. Road traffic injuries are increasing precipitously, and are estimated to account for as much as 25% of all health care expenditures in developing nations. Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care. More than 20% of the population has at least one chronic disease and more than 10% have more than one. Chronic diseases are widespread in people who are younger than 45 years and in poorer populations. Whereas socioeconomic development tends to be associated with healthy behaviours, rapidly improving socioeconomic status in India is associated with a reduction of physical activity and increased rates of obesity and diabetes. The emerging pattern in India is therefore characterized by an initial uptake of harmful health behaviours in the early phase of socioeconomic development. Such behaviours include increased consumption of energy-dense foods and reduced physical activity and increased exposure to risk factors. Health-damaging behaviours such as smoking, drinking, consuming unhealthy diets (rich in salt, sugar and fats, and low in vegetables and fruits) are also found to be common among the low socioeconomic group. However, personal behaviours are not only a matter of personal choice, but may be driven by factors such as higher levels of urbanization, technological change, market integration and foreign direct investment. National Health Pogrammes for Cancer and Blindness were started as early as 1975 and 1976 respectively, followed by programme on Mental Health in 1982. Some of the programmes were within the framework of National Rural Health Mission. These programmes have given insights of problems and experiences in implementation that would be useful in upscaling and expanding programmes across the country. Broadly, across programmes, following experiences were observed and lessons learnt in th implementation of programmes, which need to be addressed during the 12 Plan: 1. Convergence and integration would be critical in implementation of large number of interventions which would require unified management structure at various levels. Integration of cross cutting components like health promotion, prevention, screening of population, training, referral services, emergency medical services, public awareness programme management, monitoring & evaluation etc.

Multiple and diverse determinants of virulence are expected in the wide range of diseases caused safe emsam 5 mg, which include septicemia discount 5 mg emsam mastercard, urinary tract infections order emsam 5 mg on-line, pneumonia, chronic lung infections, endocarditis, dermatitis, and osteochondritis. The ultimate Pseudomonas infection may be seen as composed of three distinct stages: (1) bacterial attachment and colonization; (2) local invasion; (3) disseminated systemic disease. Particular bacterial determinants of virulence mediate each of these stages and are ultimately responsible for the characteristic syndromes that accompany the disease. Colonization Although colonization usually precedes infections by Pseudomonas aeruginosa, the exact source and mode of transmission of the pathogen are often unclear because of its ubiquitous presence in the environment. It is sometimes present as part of the normal flora of humans, although the prevalence of colonization of healthy individuals outside the hospital is relatively low (estimates range from 0 to 24 percent depending on the anatomical locale). The fimbriae of Pseudomonas will adhere to the epithelial cells of the upper respiratory tract and, by inference, to other epithelial cells as well. These adhesions appear to bind to specific galactose, mannose or sialic acid receptors on epithelial cells. Colonization of the respiratory tract by Pseudomonas requires fimbrial adherence and may be aided by production of a protease enzyme that degrades fibronectin in order to expose the underlying fimbrial receptors on the epithelial cell surface. Tissue injury may also play a role in colonization of the respiratory tract since P. This has been called opportunistic adherence, and it may be an important step in Pseudomonas keratitis and urinary tract infections, as well as infections of the respiratory tract. The receptor on tracheal epithelial cells for Pseudomonas pili is probably sialic acid (N-acetylneuraminic acid). Mucoid strains, which produce an exopolysaccharide (alginate) have an additional or alternative adhesion which attaches to the tracheobronchial mucin (N-acetylglucosamine). Besides pili and the mucoid polysaccharide, there are possibly two other cell surface adhesions utilized by Pseudomonas to colonize the respiratory epithelium or mucin. Also, it is likely that surface-bound exoenzyme S could serve as an adhesion for glycolipids on respiratory cells. Alginate slime forms the matrix of the Pseudomonas biofilm which anchors the cells to their environment and, in medical situations, it protects the bacteria from the host defenses such as lymphocytes, phagocytes, the ciliary action of the respiratory tract, antibodies and complement. Waterborne Diseases ©6/1/2018 190 (866) 557-1746 Shigellosis Shigella Section Shigella dysenteriae type 1(or bacillary dysentery) is the only cause of epidemic dysentery. This organism is generally found in the stool of infected individuals, as well as in contaminated water supplies. It is known to be able to survive on soiled linens for up to seven weeks, in water supplies for 5-11 days, and in kitchen waste for 1-4 days. The infections caused by this organism are generally seen in developing countries and areas of poor sanitation. Transmission occurs via direct or indirect contact with individuals who are infected by ingesting contaminated water, or food, as well as contact with fecal material. The Shigella germ is actually a family of bacteria that can cause diarrhea in humans. Shigella were discovered over 100 years ago by a Japanese scientist named Shiga, for whom they are named. There are several different kinds of Shigella bacteria: Shigella sonnei, also known as "Group D" Shigella, accounts for over two-thirds of the shigellosis in the United States. Waterborne Diseases ©6/1/2018 191 (866) 557-1746 A second type, Shigella flexneri, or "group B" Shigella, accounts for almost all of the rest. Other types of Shigella are rare in this country, though they continue to be important causes of disease in the developing world. One type found in the developing world, Shigella dysenteriae type 1, causes deadly epidemics there. Microbial Characteristics Shigella dysenteriae is a Gram (-), non-spore forming bacillus that survives as a facultative anaerobe. When testing for it in the laboratory, you can help identify it by the fact that it is non-motile, and lactose and lysine (-). This organism, unlike some enterics, does not produce gas when breaking down carbohydrates. This disease is most often associated with areas of overcrowding and poor sanitation (developing countries). Symptoms of dysentery due to this organism include mild to severe diarrhea, which is sometimes bloody or watery. Some people, however, also suffer from vomiting and cramping, and some show no symptoms at all. The symptoms of the disease will generally show between 12-96 hours (1-3 days) after becoming infected. During this incubation period, the organism will penetrate the mucosal epithelial cells of the intestine through use of an intestinal adherence factor. This penetration causes severe irritation which is responsible for the cramps and watery, bloody diarrhea. Micrograph of intra-epithelial membrane-enclosed Shigella (from Microbiology: Fundamentals and Applications by R. Many different kinds of diseases can cause diarrhea and bloody diarrhea, and the treatment depends on which germ is causing the diarrhea. Determining that Shigella is the cause of the illness depends on laboratory tests that identify Shigella in the stools of an infected person. Waterborne Diseases ©6/1/2018 192 (866) 557-1746 These tests are sometimes not performed unless the laboratory is instructed specifically to look for the organism.