By P. Hamlar. Urbana University. 2018.
Selling coca leaf rather than keeping processing chemicals and equipment on the farm may be part of a risk-aversion strategy employed by farmers buy super p-force 160 mg low price. First effective super p-force 160 mg, coca leaf is processed or traded in Colombia as fresh coca leaf order super p-force 160mg with amex, immediately after the harvest super p-force 160 mg with mastercard, whereas in Peru and the Plurinational State of Bolivia super p-force 160mg on-line, farmers dry the fresh coca leaf before selling, by spreading the leaves on the ground and exposing them to air. The result is coca leaf with a much reduced moisture, which makes transport easier and allows storage of the leaves. The second reason is that the moisture content of both fresh and sun-dried coca leaf varies considerably, depending on the biological properties of the leaf as well as environmental factors such as the humidity of the air. A fresh coca leaf harvested in the early morning, for example, will have a different moisture content than leaves from the same bush plucked at noon. Coca leaves sun-dried after a heavy rainfall at a low altitude will have a different moisture content than leaves sun-dried in the dry season at a high altitude. While differences may not matter much to farmers selling coca leaves, it matters from a scientific point of view, when comparing coca leaf production in different countries and estimating how much cocaine can potentially be extracted from the leaves. In other words, scientists are interested in how much dry plant matter is in the leaves, and which proportion of that dry matter consists of cocaine alkaloids. The water content of the leaves is not of interest in that context and has to be taken out of the calculation. A kilogram of fresh coca leaves would typically lose over half of its weight through sun-drying. When drying in a laboratory oven to remove all moisture from the leaves, sun-dried coca leaves would still lose another third of their weight. In other words, a kilogram of fresh coca leaves weighs only about 300 grams after leaving the drying chamber, which is the weight of dry plant matter. Thus, when comparing coca leaf production, the weight in oven-dried coca leaf equivalent is the most appropriate. However, currently, not enough information on the moisture content of coca leaf in different regions of coca culti- vating countries is available. Therefore, a direct comparison between fresh coca leaf in Colombia and sun-dried coca leaf in the Plurinational State of Bolivia and Peru by converting all figures into oven-dry equivalents is therefore not possible. There are indications of some cross-border trafficking of cocaine base for further processing in other countries in 319 8,691 408 the region: Argentina (36 laboratories), Ecuador (10) and the Bolivarian Republic of Venezuela (26) all reported destruction of cocaine producing facilities. Traffickers use secondary extraction laboratories to revert that process and recover the cocaine. Most of the clandestine installations detected in Spain in 2008 and 2009 were involved in secondary extraction (24 in 2008 and 11 in 2009). Greece also reported detection of clandestine installations involved in cocaine processing. One installa- tion handled only cocaine and four more were also handling heroin (reported under ‘heroin’). More information on the detection of clandestine sec- ondary extraction installations and repackaging and adulteration sites from other countries would be useful to understand potential changes in trafficking strategies. Since 2006, seizures have shifted towards the years that some 90% of the cocaine consumed in North source area of South America away from the consumer America comes from Colombia,1 supplemented by some markets of North America and West and Central Europe, cocaine from Peru and limited amounts from the reflecting better international cooperation and exchange Plurinational State of Bolivia. The traf- 2009) and by more than one half in West and Central ficking of cocaine into the United States is nowadays Europe (from 121 mt in 2006 to 55 mt in 2009). Seizures outside The origin of cocaine consumed in Europe seems to be the Americas and Europe accounted for just 0. Caribbean, 8, 1% North America, 132, 18% Central America, 91, 12% Europe, 57, 8% Africa, 1. The influ- cocaine seized in Europe over the 2008-2010 period, ence of the Mexican drug cartels, which dominate Peru for 7% and the Plurinational State of Bolivia for cocaine sales to the United States, seems to be limited 5% (based on information from 13 European countries). Although precise purity adjustments at the level Guinea and Nigeria) and Europe (notably Spain, the of individual countries are not feasible with the current Netherlands and Portugal). In order to account for all cocaine seizures in volume terms in Europe over the the time lag incurred between cultivation and traffick- 2008-2010 period, Peru for 6% and the Plurinational ing, one may consider the average production in the State of Bolivia for 2%. If cocaine that could be traced preceding two years (2007 and 2008) as a proxy for back to the Bolivarian Republic of Venezuela, Ecuador global supply.
Consider closing intake or switching to other sources if raw water quality deteriorates order 160mg super p-force mastercard. Well head casing incomplete or borehole unsealed causing intrusion of surface Secure and maintain well head to prevent contamination discount super p-force 160mg on line. Well head not secured against livestock access causing microbial Protect well-head with appropriate cover buy super p-force 160mg without prescription. Water Treatment Manual: Disinfection Hazard Control contamination Infiltration gallery influenced by surface water causing microbial contamination Monitor source water 160 mg super p-force with visa. Land drains causing preferential pathway for pollution of shallow well source Re-route land drains buy super p-force 160mg online. Catchment: Surface Water or Groundwater Supply Hazard Control Vandalism – deliberate contamination of source and unauthorised access Appropriate security and alarm system for site. Raw Water Intake Hazard Control Direct surface water abstraction causing variability in water quality Change abstraction point to minimise variability in raw water. Intake not secured against livestock access causing microbial contamination Install and maintain fencing in the vicinity of the intake. Lake source intake point vulnerable to variation due to streams/ stratification/ Change abstraction point to minimise variability in raw water. Raw Water Storage Hazard Control Susceptible to flooding / contamination Consider flood defences. Unauthorised access resulting in deliberate contamination Appropriate security and alarm system for site. Lockable covers on all Water Treatment Manual: Disinfection access points to water supply. Wildlife access to raw water tank causing contamination Erect fencing or cover to prevent wildlife access. Sludge build up in raw water tank causing contamination Regular inspection and maintenance programme. Leaking impounding reservoir causing ingress of contamination Regular inspection and maintenance programme. Raw Water Line Hazard Control Pipe corroded or not watertight causing intrusion of Surface Water Regular inspection and maintenance programme. Raw water serving consumers without disinfection or other treatment Ensure asset records are kept up to date and authorised connections refer to these records. Treatment plant operating above design capacity Ensure treatment plant is operating within acceptable limits. Plant data can be used to verify this By-passing of any stage of treatment Appropriate alarms to notify when individual processes are bypassed. Frequent and significant flow variations through the works Consider intermediate storage to smooth out flow variations. Verify with plant data Coagulation/Flocculation/Clarification Stage Hazard Control Chemicals delivered to incorrect storage vessel Ensure chemical deliveries are overseen by competent treatment works personnel. Floc carry over due to inappropriate/inadequate dosing regime Regular dose optimisation. Floc carry over due to overloading of the plant/ surge flows Operate process within design parameters. Floc carry over due to poor adjustment/maintenance/design of lamella plates Regular inspection and maintenance programme Floc carry over due to poor maintenance or flooding of settlement channels Regular inspection and maintenance programme. Consider covering settlement channels if flooding a serious risk Floc carry over due to variations in raw water characteristics Regular inspection and dose optimisation Floc carry over due to effects of weather condition Regular inspection and maintenance programme. Floc carry over due to inadequate cleaning of clarifiers Regular inspection and maintenance programme Water Treatment Manual: Disinfection Hazard Control Floc carryover due to poor settlement/ unstable sludge blanket Regular inspection. Floc carryover due to sludge float/ scraper not operating properly Regular inspection and maintenance programme Floc carryover due to sludge concentrators not operating properly Regular inspection and maintenance programme Floc carryover due to sludge bleeds not operating properly Regular inspection and maintenance programme Floc carryover due to insufficient sludge draw off Regular inspection and maintenance programme Chemicals used after expiration date – ineffective chemicals Ensure chemicals are stored appropriately and used within expiry date Inadequate storage areas for chemical stocks, risk of running out of treatment Ensure storage is adequate for required chemical stockpile. Consider moving dosing point Inadequate cleaning regime in mixing tank Regular inspection and maintenance programme Algal or plant growth in clarifiers causing poor water quality and clogged filters Regular inspection and maintenance programme Poor structural integrity of clarifiers causing contamination due to ingress Regular inspection and maintenance programme Sludge recycled to head of works Ensure sludge quality and quantity suitable for reuse. Inadequate particle removal due to blocked filters Run filters within design and operating limits. Assess by measurement of head loss, flow rate and turbidity Inadequate particle removal due to inadequate filter media depth Check appropriate media depth for design of filter. Water Treatment Manual: Disinfection Hazard Control Inadequate particle removal due to inadequate filter media type Check appropriate media type for design of filter. Regular inadequate cycle length, uneven scour, pump failure, loss of filter media) inspection of filters and maintenance of backwash equipment. Inadequate particle removal due to poor filter maintenance (cracks, boils etc) Regular inspection and maintenance programme.
For patients who will be treated operatively for an acute Achilles tendon rupture cheap super p-force 160 mg mastercard, we are unable to recommend for or against preoperative immobilization or restricted weight bearing cheap 160 mg super p-force. Open cheap super p-force 160 mg with mastercard, limited open and percutaneous techniques are options for treating patients with acute Achilles tendon rupture buy super p-force 160mg. We cannot recommend for or against the use of allograft generic 160 mg super p-force otc, autograft, xenograft, synthetic tissue, or biologic adjuncts in all acute Achilles tendon ruptures that are treated operatively. We cannot recommend for or against the use of antithrombotic treatment for patients with acute Achilles tendon ruptures. We suggest early (≤ 2 weeks) post-operative protected weight bearing for patients with acute Achilles tendon rupture who have been treated operatively Strength of Recommendation: Moderate Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. We suggest the use of a protective device that allows mobilization by 2- 4 weeks post operatively. Strength of Recommendation: Moderate Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. A Moderate recommendation means that the benefits exceed the potential harm (or that the potential harm clearly exceeds the benefits in the case of a negative recommendation), but the strength of the supporting evidence is not as strong. We are unable to recommend for or against post-operative physiotherapy for patients with acute Achilles tendon rupture Strength of Recommendation: Inconclusive Description: Evidence from a single low quality study or conflicting findings that do not allow a recommendation for or against the intervention. In all patients with acute Achilles tendon rupture, irrespective of treatment type, we are unable to recommend a specific time at which patients can return to activities of daily living. In patients who participate in sports it is an option to return them to sports within 3-6 months after operative treatment for acute Achilles tendon rupture. In patients with acute Achilles tendon rupture treated non-operatively, we are unable to recommend a specific time at which patients can return to athletic activity. In addition to providing practice recommendations, this guideline also highlights gaps in the literature and areas that require future research. This guideline is intended to be used by all appropriately trained surgeons and all qualified physicians diagnosing and treating Achilles tendon ruptures. It is also intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations. To assist in this, this clinical practice guideline consists of a systematic review of the available literature regarding the treatment of Achilles tendon ruptures. The systematic review detailed herein was conducted between December 2008 and June 2009 and demonstrates where there is good evidence, where evidence is lacking, and what topics future research must target in order to improve the treatment of patients with acute Achilles tendon ruptures. Musculoskeletal care is provided in many different settings by many different providers. We created this guideline as an educational tool to guide qualified physicians through a series of treatment decisions in an effort to improve the quality and efficiency of care. This guideline should not be construed as including all proper methods of care or excluding methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment must be made in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. Typically, orthopaedic surgeons will have completed medical training, a qualified residency in orthopaedic surgery, and some may have completed additional sub-specialty training. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. Diagnosis and treatment for patients with acute Achilles tendon rupture are based on the assumption that decisions are predicated on 1 v1. Once the patient has been informed of available therapies and has discussed these options with his/her physician, an informed decision can be made. Clinician input based on experience with both conservative management and surgical skills increases the probability of identifying patients who will benefit from specific treatment options. Studies of European communities report comparable values ranging from 6 to 1-4 18 ruptures per 100,000 people. Time away from work may impact the 5 patient financially and limiting activity may impact the patient’s health. Some studies have shown 3 that ruptured Achilles tendons have occult degeneration. The injury often results in the patient’s inability to walk or perform their regular activities of daily living.
All containers in use should be secured in position by chains or other methods as appropriate cheap 160 mg super p-force fast delivery. Gas containers should only be lifted with suitably rated and tested equipment and never by their protective hoods buy cheap super p-force 160 mg on-line. Where plastic connections are used buy generic super p-force 160mg on line, vacuum connections must not be over-tightened discount super p-force 160 mg visa. Pressure lines buy super p-force 160 mg without a prescription, where necessary, should be seamless carbon steel All pipe, valves, and fittings must be thoroughly cleaned of all oils and foreign matter (grease, pipe chips, dirt, etc. Failure to properly clean may result in undesirable chemical reactions and non-warrantable equipment failure. Vents from chlorine gas installations should be discharged to atmosphere in a suitable open location where the risk to personnel has been risk assessed. The termination point must be open, pointing downward and should covered with a fine mesh screening. Vent pipes from the system should be separately routed and should never be discharged via a manifold with other vented lines. Current material safety data sheets, warning signs and other proprietary chlorine wall charts should be visible for use by site personnel and visitors. In particular written operating procedures should be followed by operators that address the appropriate steps for evacuating and filling chlorine containers. Similarly, a site specific inspection and maintenance schedule should be created for all chlorine storage and handling equipment and associated safety equipment. Equipment and chlorine containers should be regularly monitored for leaks using ammonia leak detection kits. Leaks should be repaired using site specific emergency response procedures and involve more than one person. Chlorine detection instruments in storage and dosing areas should be interfaced into an alarm system with appropriate alarm set points for detection. Where chlorine gas installations are located in confined sites or in built up areas, close to the public, consideration should be given to perimeter chlorine monitoring or air scrubbing equipment. Automatic or remote shut-down capability allows the operator to control of the situation from a distance. A written site specific emergency plan should be prepared for each chlorine gas installation by Water Service Authorities. Plant managers and operators should be trained in any of the procedures that require their involvement. Responses to the plan should be documented and the plan should be regularly updated to take account of such responses. With this, a provision is made for rescuing the endangered worker immediately if his respiratory device fails or he becomes incapacitated for any reason. In case of an accidental exposure, move exposed personnel to a well-ventilated area and seek medical assistance. Chemical reactivity and incompatibility Sodium Hypochlorite, or bleach, is produced by adding elemental chlorine to sodium hydroxide and is a strong oxidant It a clear, slightly yellowish solution with a characteristic odor and a relative density of is 1. Sodium Hypochlorite is normally supplied as a 14% w/v solution Commercial product varies from 5% sodium hypochlorite (I. At higher concentrations (10-15%) sodium hypochlorite (with a pH of around 13) burns and is corrosive. Commercial solutions are less hazardous and easier to handle than elemental chlorine. The pH of sodium hypochlorite is high because sodium hydroxide is used in its manufacture to increase stability of the product. Mixing of hypochlorite with certain organic based cleaning compounds may also result in the emission of explosive gasses. Piping and material handling equipment containing stainless steel, aluminum, carbon steel or other metals such as copper, nickel and cobalt should also be avoided as they accelerate the rate of decomposition. The stability of stored sodium hypochlorite Sodium hypochlorite at higher concentrations becomes increasingly unstable and degrades to chlorate thereby affecting the storage life and decreasing concentrations with time.
Y Recently purchase super p-force 160 mg with mastercard, it was demonstrated that repeat doses of corticosteroids are accompanied by a reduction in birth weight and an increase in the prevalence of small for gestational age infants cheap 160 mg super p-force overnight delivery. Y Several trials show that women exposure to less than 10% of Y Long clinical experience with antiphospholipid syndrome the maternal level cheap super p-force 160 mg online. Considerations for Drugs with Minimal or Unknown Teratogenic Effect (continued) Breast-Feeding Considerations Drug Maternal Considerations Fetal Considerations Dexamethasone Y Routinely used for the Y Crosses the human placenta Y Still unclear whether (Decadron) acceleration of fetal lung and is proven to enhance maternal treatment with maturity buy 160mg super p-force with mastercard; administration is perinatal outcome after this drug increases the standard of care for threatened preterm birth generic 160mg super p-force visa. Y Effective antiemetic after been treated successfully with general anesthesia for this drug:121 pregnancy termination. Effects of aspirin consumption during pregnancy on approaches in the field of theranostics are being devel- pregnancy outcomes: meta-analysis. Aspirin and reproductive physicians should look more critically at a drug’s classi- outcomes. Clinicians should become familiar with all of platelet vascular endothelial growth factor, angiopoietin-1, the aspects of the drugs they prescribe, in addition to the and p-selectin levels in hypertensive patients. Recurrent preg- with maternal–fetal medicine specialists and through nancy loss with antiphospholipid antibody: a systematic references and Web sites providing up-to-date informa- review of therapeutic trials. Anticoagulants for the treatment of recurrent pregnancy loss in women without antiphospholipid syndrome. Medications in pregnancy and treatment [published erratum appears in Obstet Gynecol lactation. Human Development Network of Maternal-Fetal Medicine Subcell Biochem 2007;42:3–27. Placental transfer of antibiotics administered to dose acetylsalicylic acid in prevention of pregnancy-induced the mother: a review. Int J Clin Pharmacol Ther 2006;44: hypertension and intrauterine growth retardation in women 57–63. Tooth changes caused by tetracycline in the and congenital anomalies: a meta-analysis. Use of antibiotic and analgesic ilis and nonimmune fetal hydrops in a penicillin-allergic drugs during lactation. J Am Dent human fetal liver: implications for pharmacogenetic investi- Assoc 1983;107:12, 14. Obstet Gynecol 1981;58 suppl: recommendations for antimicrobial prophylaxis among 57S–62S. Polachek H, Holcberg G, Sapir G, Tsadkin-Tamir M, Pola- Gynaecol Obstet 1995;50:41–6. Eur meta-analysis of ibuprofen versus indomethacin for closure of J Obstet Gynecol Reprod Biol 2005;122:61–5. The effectiveness of antenatal syphilis screening and second trimester of pregnancy. Giamarellou H, Kolokythas E, Petrikkos G, Gazis J, Aravanti- of adverse pregnancy outcomes. Prevention of early-onset neonatal during pregnancy: risks and safety of drug therapy [published group B streptococcal disease with selective intrapartum erratum appears in Drug Saf 1999;21:456]. Time course of the regression of dopa versus no drug treatment in the management of mild asymptomatic bacterial vaginosis in pregnancy with and pre-eclampsia. Is bacterial vaginosis a stronger risk and fetal middle cerebral artery blood flows in preeclamptic factor for preterm birth when it is diagnosed earlier in patients. Antibiotics for bacterial Anti-hypertensive therapy and the feto-placental circulation: vaginosis or Trichomonas vaginalis in pregnancy: a system- effects on umbilical artery resistance. Reduced incidence of preterm delivery with pertensive medication into human breast milk: a systematic metronidazole and erythromycin in women with bacterial review. A randomized, double-blind, hemodynamic evaluation of Network of Maternal-Fetal Medicine Units. N Engl J Med nifedipine and labetalol in preeclamptic hypertensive emer- 2000;342:534–40. Shennan A, Crawshaw S, Briley A, Hawken J, Seed P, Jones sion in the postpartum period with intravenous hydralazine or G, et al. A randomised controlled trial of metronidazole for labetalol: a randomized clinical trial. Hypertens Pregnancy the prevention of preterm birth in women positive for cervi- 2007;26:163–71. Placental transfer of metronidazole in the first Database of Systematic Reviews 2006, Issue 3. Fetal death following labetalol nidazole excretion in human milk and its effect on the administration in pre-eclampsia.
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