Treatment of chemical warfare casualties /

Includes index.

Technical escort information on chemical agents and decontaminating procedures.

"January 1971."

Demilitarization procedures for FSC 4230, decontaminating and impregnating equipment; FSC 4410, industrial boilers; FSC 6810, chemicals; FSC 6850, miscellaneous.

"September 1976."

A Comparative Analysis of Two Slug Test Methods in Puget Lowland Glacio-Fluvial Sediments near Coupeville, WA

Two different slug test field methods are conducted in wells completed in a Puget Lowland aquifer and are examined for systematic error resulting from water column displacement techniques. Slug tests using the standard slug rod and the pneumatic method were repeated on the same wells and hydraulic conductivity estimates were calculated according to Bouwer & Rice and Hvorslev before using a non-parametric statistical test for analysis. Practical considerations of performing the tests in real life settings are also considered in the method comparison. Statistical analysis indicates that the slug rod method results in up to 90% larger hydraulic conductivity values than the pneumatic method, with at least a 95% certainty that the error is method related. This confirms the existence of a slug-rod bias in a real world scenario which has previously been demonstrated by others in synthetic aquifers. In addition to more accurate values, the pneumatic method requires less field labor, less decontamination, and provides the ability to control the magnitudes of the initial displacement, making it the superior slug test procedure.

The population pharmacokinetics of citalopram after deliberate self-poisoning: A Bayesian approach

Defining the pharmacokinetics of drugs in overdose is complicated. Deliberate self-poisoning is generally impulsive and associated with poor accuracy in dose history. In addition, early blood samples are rarely collected to characterize the whole plasma-concentration time profile and the effect of decontamination on the pharmacokinetics is uncertain. The aim of this study was to explore a fully Bayesian methodology for population pharmacokinetic analysis of data that arose from deliberate self-poisoning with citalopram. Prior information on the pharmacokinetic parameters was elicited from 14 published studies on citalopram when taken in therapeutic doses. The data set included concentration-time data from 53 patients studied after 63 citalopram overdose events (dose range: 20-1700 mg). Activated charcoal was administered between 0.5 and 4 h after 17 overdose events. The clinical investigator graded the veracity of the patients' dosing history on a 5-point ordinal scale. Inclusion of informative priors stabilised the pharmacokinetic model and the population mean values could be estimated well. There were no indications of non-linear clearance after excessive doses. The final model included an estimated uncertainty of the dose amount which in a simulation study was shown to not affect the model's ability to characterise the effects of activated charcoal. The effect of activated charcoal on clearance and bioavailability was pronounced and resulted in a 72% increase and 22% decrease, respectively. These findings suggest charcoal administration is potentially beneficial after citalopram overdose. The methodology explored seems promising for exploring the dose-exposure relationship in the toxicological settings.

Antibiotic resistance in the intensive care unit: A primer in bacteriology

The clinical use of potent, well-tolerated, broad-spectrum antibiotics has been paralleled by the development of resistance in bacteria, and the prevalence of highly resistant bacteria in some intensive care units is despairingly commonplace. The intensive care community faces the realistic prospect of untreatable nosocomial infections and should be searching for new approaches to diagnose and manage resistant bacteria. In this review, we discuss some of the relevant underlying biology, with a particular focus on genetic transfer vehicles and the relationship of selection pressure to their movements. It is an attempt to demystify the relevant language and concepts for the anaesthetist and intensivist, to explain some of the reasons for the emergence of resistance in bacteria, and to provide a contextual basis for discussion of management approaches such as selective decontamination and antibiotic cycling.

Protein contamination of the laryngeal mask airway and its relationship to re-use

The Laryngeal Mask Airway is a reusable device for maintaining the patency of a patient's airway during general anaesthesia. The device can be reused after it has been cleaned and sterilized. Protein contamination of medical instruments is a concern and has been found to occur despite standard sterilization techniques. The reason for the concern relates to the possibility of the transmission of prions and the risk of developing a neurodegenerative disorder such as Creutzveldt-Jacob disease. The purpose of this study was to quantify the amount of protein contamination that occurs, and to relate this to the number of times the Laryngeal Mask Airway has been used. Fifty previously used Classic Laryngeal Masks were collected after routine sterilization and packaging. The devices were immersed in protein detecting stain and then visual inspection performed to assess the degree and distribution of the staining. The researcher was blinded to the number of times the Laryngeal Mask Airway had been used. Linear regression analysis of the degrees of staining of the airway revealed that protein contamination occurs after the first use of the device and this increases with each subsequent use. This finding highlights the concern that the currently used cleaning and sterilization methods do not prevent the accumulation of proteinaceous material on Laryngeal Mask Airways. Consideration should be given to the search for more efficient cleaning and sterilization techniques or the use of disposable devices.

Infection risk associated with a closed luer access device

The potential for microbial contamination associated with a recently developed needleless closed luer access device (CLAD) (Q-Syte™ Becton Dickinson, Sandy, UT, USA) was evaluated in vitro. Compression seals of 50 multiply activated Q-Syte devices were inoculated with Staphylococcus epidermidis NCTC 9865 in 25% (v/v) human blood and then disinfected with 70% (v/v) isopropyl alcohol followed by flushing with 0.9% (w/v) sterile saline. Forty-eight of 50 (96%) saline flushes passed through devices that had been activated up to a maximum of 70 times remained sterile. A further 25 Q-Syte CLADs that had undergone multiple activations were challenged with prefilled 0.9% (w/v) sterile saline syringes, the external luer tips of which had been inoculated with S. epidermidis NCTC 9865 prior to accessing the devices. None of the devices that had been accessed up to 70 times allowed passage of micro-organisms, despite challenge micro-organisms being detected on both the syringe tip after activation and the compression seals before decontamination. These findings suggest that the Q-Syte CLAD may be activated up to 70 times with no increased risk of microbial contamination within the fluid pathway. The device may also offer protection from the external surface of syringe tips contaminated with micro-organisms. © 2005 Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Government preparedness:using simulation to prepare for a terrorist attack

The heightened threat of terrorism has caused governments worldwide to plan for responding to large-scale catastrophic incidents. In England the New Dimension Programme supplies equipment, procedures and training to the Fire and Rescue Service to ensure the country's preparedness to respond to a range of major critical incidents. The Fire and Rescue Service is involved partly by virtue of being able to very quickly mobilize a large skilled workforce and specialist equipment. This paper discusses the use of discrete event simulation modeling to understand how a fire and rescue service might position its resources before an incident takes place, to best respond to a combination of different incidents at different locations if they happen. Two models are built for this purpose. The first model deals with mass decontamination of a population following a release of a hazardous substance—aiming to study resource requirements (vehicles, equipment and manpower) necessary to meet performance targets. The second model deals with the allocation of resources across regions—aiming to study cover level and response times, analyzing different allocations of resources, both centralized and decentralized. Contributions to theory and practice in other contexts (e.g. the aftermath of natural disasters such as earthquakes) are outlined.

Lower Bounds on the Directed Sweepwidth of Planar Shapes

We investigate a recently introduced width measure of planar shapes called sweepwidth and prove a lower bound theorem on the sweepwidth.

Estudo da eficiência eletroquímica para tratamento de chorume gerado em aterro sanitário brasileiro

This work was performing effluent degradation studies by electrochemical treatment. The electrochemical oxidation (EO) hydroquinone (H2Q) was carried out in acid medium, using PbO2 electrode by galvanostatic electrolysis, applying current densities of 10 and 30 mA/cm2 . The concentration of H2Q was monitored by differential pulse voltammetry (DPV). The experimental results showed that the galvanostatic electrolysis process performance significantly depends on the applied current density, achieving removal efficiencies of 100% and 80 % and 10 applying 30 mA/cm2 , respectively. Furthermore, the electroanalytical technique was effective in H2Q be used as a detection method. In order to test the efficiency of PbO2 electrode, the electrochemical treatment was conducted in an actual effluent, leachate from a landfill. The liquid waste leachate (600ml effluent) was treated in a batch electrochemical cell, with or without addition of NaCl by applying 7 mA/cm2 . The efficiency of EO was assessed against the removal of thermo-tolerant coliforms, total organic carbon (TOC), total phosphorus and metals (copper, cobalt, chromium, iron and nickel). These results showed that efficient removal of coliforms was obtained (100%), and was further decrease the concentration of heavy metals by the cathode processes. However, results were not satisfactory TOC, achieving low total removal of dissolved organic load. Because it is considered an effluent complex were developed other tests with this effluent to monitor a larger number of decontamination parameters (Turbidity, Total Solids, Color, Conductivity, Total Organic Carbon (TOC) and metals (barium, chromium, lithium, manganese and Zinc), comparing the efficiency of this type of electrochemical treatment (EO or electrocoagulation) using a flow cell. In this assay was compared to electro streaming. In the case of the OE, Ti/IrO2-TaO5 was used as the anode, however, the electrocoagulation process, aluminum electrodes were used; applying current densities of 10, 20 and 30 mA/cm2 in the presence and absence of NaCl as an electrolyte. The results showed that EO using Ti/IrO2–TaO5 was anode as efficient when Cl- was present in the effluent. In contrast, the electrocoagulation flow reduces the dissolved organic matter in the effluent, under certain experimental conditions.

Aplicação de tratamentos eletroquímicos integrados para remediação de solos e águas contaminadas com petróleo e pesticidas

Electrochemical technologies have been proposed as a promising alternative for the treatment of effluents and contaminated soils. Therefore, the objective of this work was to study the treatment of contaminated soils and wastewaters using electrochemical technologies. Thus, the study regarding the scale-up of the electrochemical system with continuous flow treatment of wastewater of the petrochemical industry was investigated using platinum electrodes supported on titanium (Ti / Pt), and boron-doped diamond (BDD). The results clearly showed that under the operating conditions studied and electrocatalytic materials employed, the better removal efficiency was achieved with BDD electrode reducing the chemical oxygen demand (COD) from 2746 mg L-1 to 200 mg L-1 in 5 h consuming 56.2 kWh m-3 . The decontamination of soils and effluents by petrochemical products was evaluated by studying the effects of electrokinetic remediation for removal of total petroleum hydrocarbons (HTP) from contaminated soil with diesel. The efficiency of this process was dependent on the electrolyte used Na2SO4 (96.46%), citric acid (81.36%) and NaOH (68.03%) for 15 days. Furthermore, the effluent after treatment of the soil was treated by electrochemical oxidation, achieving a good elimination of the organic polluting load dissolved. Depending on the physical behavior of wastewater contaminated with oil (emulsified state); atrazine emulsified effluents were investigated. The main characteristics of the effluent produced during the washing of contaminated soil were studied, being dependent on the surfactant dosage used; which determined its electrolytic treatment with BDD. The electrochemical oxidation of emulsified effluent of atrazine was efficient, but the key to the treatment is reducing the size of micelles.

Resposta clínica periodontal e controle glicêmico em pacientes com e sem diabetes tipo II portadores de periodontite crônica ao tratamento periodontal “full mouth desinfection”

There is a bidirectional association between periodontal disease (PD) and diabetes mellitus, in which diabetes favors the development of PD and PD, if left untreated, can worsen the metabolic control of diabetes. Thus, periodontal disease should be treated to restore periodontal health and reduce the complications of diabetes. Therefore, the objective is assess the effect of full mouth periodontal therapy decontamination (Full Mouth Desinfection - FMD) in diabetic type II patients with chronic periodontitis during 12 months. Thirty-one patients in group one (G1) and 12 in group two (G2) were followed at baseline, 03, 06 09 and 12 months. There following clinical parameters were accessed: probing on bleeding (BOP), visible plaque index (PI), probing depth (PD), clinical attachment level (CAL) and gingival recession (GR). For diabetic patients, there were also made laboratory tests to evaluate blood parameters: fasting glucose and glycated hemoglobin. The results had been analyzed in two ways: all sites in the mouth and another with diseased sites. The Mann-Whitney, Friedman and Wilcoxon tests were used with 5% significance. Intergroup analysis of all sites it is clear that there was no significant difference over time concerning PD, BOP, PI, CAL and RG. However, when evaluating the diseased sites, we observed significant difference for CAL and PD, with higher values in G1. The intragroup analysis for all sites showed a statistically significant reduction at PD, PI and BOP in both groups. Intragroup analysis of periodontal affected sites showed a statistically significant reduction in PD, BOP and CAL in both groups. There was also a statistically significant increase in RG values. There was no significant change concerning glycated hemoglobin and fasting glucose in the G1. Therefore, it can be concluded that there were improvements in periodontal parameters over the 12 months of research, but without changes in glycemic levels of diabetic patients. Thus, periodontal therapy proved effective in maintaining oral health.

Desinfeção aplicada aos cones de guta-percha

Introdução: Ao longo do tempo o Tratamento Endodôntico Não Cirúrgico tem sido das áreas da Medicina Dentária que mais tem evoluído. Todos os passos do tratamento têm sido revistos de forma a aumentar a taxa de sucesso. O controlo microbiológico é crucial para que o tratamento seja um sucesso a curto, médio e longo prazo. A assepsia deve ser mantida em todas as fases deste tratamento para que este seja um sucesso. Objetivo: Ao longo do meu percurso académico pude concluir que a fase da descontaminação dos cones, aquando a obturação (fase final do Tratamento Endodôntico Não Cirúrgico) era desvalorizada, o que me levou a efetuar uma revisão bibliográfica de modo a poder melhorar os meus conhecimentos e técnica. Material e Métodos: Para a elaboração deste trabalho foi realizada uma pesquisa bibliográfica recorrendo aos seguintes motores de busca: B-on, PubMed, Scielo e ScienceDirect, com as seguintes palavras-chave: “decontamination in endodontics”;” disinfection in endodontics”; “root canal irrigants”; “endodontics microbiology”; “Candida albicans“; “Enterococcus faecalis”; “sodium hypochlorite ”; “alcohol”; “contamination during Obturation”; “clorohexidine”; “filling materials endodontics”; “termoplastic gutta-percha”; “obturation material”; “Mineral Trioxide Aggregate”; “resilon”; “resin cement”; “resin material for root canal obturation”; “resin sealer”; “root canal”; “root canal sealing”; “root canal filling materials”; “condensation in endodontics”; “lateral condensation”; “gutta-percha”; “microlekeage”; “system B”; “fluid filtration model”;“dye penetration”. Como critério de inclusão estabeleceu-se que os artigos deveriam ser em Português, Inglês ou Espanhol e publicados entre 1995 e 2015. Dos resultados apresentados foram utilizados 110 artigos, pesquisados entre Maio de 2015 e 20 de Outubro de 2015. Foram ainda consultados livros de referência nestes mesmos locais. Conclusão: a presença de bactérias e os seus subprodutos no sistema tridimensional de canais está diretamente implicado com o insucesso do Tratamento Endodôntico. A descontaminação dos cones de guta-percha, é, portanto, um processo importante no Tratamento Endodôntico pois impede que os cones sejam colocados nos canais radiculares, estando contaminados por microorganismos que inviabilizam o tratamento efetuado. A submersão dos cones durante um minuto em clorohexidina a 2% ou hipoclorito a 5,25% está indicado e comprovado como um processo eficiente de desinfeção dos cones.