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Irene E. Aga, MD

Assistant Professor
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of Texas Health Science Center at Houston
Houston, Texas

It was developed as a tool to encourage common understanding among caregivers muscle relaxant id ponstel 250mg generic, teachers spasms of the larynx buy ponstel 250mg online, families spasms everywhere purchase 500mg ponstel, and healthcare professionals about infectious diseases and to aid with efforts for reducing illnesses muscle relaxant medications back pain buy generic ponstel, injuries and other health problems in childcare settings spasms constipation ponstel 500 mg amex. This guide explains the health history of immunizations muscle relaxant neuromuscular junction ponstel 500mg visa, ways to prevent and control the spread of communicable diseases, symptoms of common infections seen in childcare settings, how infections are spread, when to seek medical care, inclusion/exclusion criteria, fact sheets, and sample letters to give to parents. As families enter the workforce, they must rely on childcare centers to provide a safe, healthy and caring environment for their child. These children are very susceptible to contagious diseases because they have not been exposed to many infections. A variety of infections have been documented in children attending childcare, sometimes with spread to caregivers and to others at home. In addition, wherever there are children in diapers, the spread of diarrheal diseases may readily occur as the result of poor or inadequate handwashing, diaper changing and environmental sanitation measures. In general, sending home (excluding) mildly ill children is not an effective way to control the spread of most germs. All of these factors make infections in childcare settings common and fast spreading. This manual contains disease fact sheets specifically meant for childcare settings. These fact sheets may be distributed to parents and staff; fact sheets will help staff determine when children should be sent home or readmitted to your facility. Any child who has not had a well baby or well child examination recently (within the past 6 months) should be examined within 30 days of entering your childcare facility. You should assure that all children admitted to your facility are up to date on their vaccinations. Children attending childcare especially need all of the recommended vaccinations to protect themselves, the other children, the childcare provider, and their families. Several diseases that can cause serious problems for children and adults can be prevented by vaccination. These diseases are chickenpox, diphtheria, Haemophilus influenzae certain types of meningitis, hepatitis A and B, influenza, measles, mumps, pneumococcal disease, polio, rubella (German measles or 3-day measles), tetanus, and whooping cough (pertussis). Many of these diseases are becoming less common because most people have been vaccinated against them. However, cases still occur and children in childcare are at increased risk for many of these diseases because of the many hours they spend in close contact with other children. Children who are not up to date on their vaccinations should be taken out of childcare (excluded) until they have begun the series of shots needed. Each child in your care should have an Immunization certificate on file at the facility. Each child shall also have a current health appraisal on file signed by a licensed healthcare provider. This health appraisal should include a description of any disability or impairment that may affect adaptation to childcare. Date: Printed Name: Telephone: 8 Childcare Manual Health History & Immunization Policy for Childcare ProvidersHealth History & Immunization Policy for Childcare Providers Children, especially those in groups, are more likely to get infectious diseases than are adults. As a childcare provider, you will be exposed to infectious diseases more frequently than will someone who has less contact with children. To protect yourself and the children in your care, you need to know what immunizations you received as a child and whether you had certain childhood diseases. If you are not sure, your healthcare provider can test your blood to determine if you are immune to some of these diseases and can vaccinate you against those to which you are not immune. Childcare providers shall also have a health appraisals signed by a licensed healthcare provider on file at the facility. Providers are considered immune to rubella if they have received at least one does of rubella vaccine on or after their first birthday. A blood test indicating immunity to rubella or one dose of rubella vaccine is required. Tetanus, Diphtheria & Pertussis Childcare providers should have a record of receiving a series of 3 doses of Tetanus, Diphtheria and Pertussis containing vaccine (usually given in childhood) and a booster of tetanus given within the past 10 years. Those who have not received the Tdap vaccine (available only since 2005) should receive a single dose. Polio Childcare providers, especially those working with children who are not toilet-trained, should have a record of a primary series of 3 doses (usually given in childhood) and a supplemental fourth dose given at least 6 months after the third dose of the primary series. Providers who have had the disease (confirmed by a healthcare provider) are considered immune. Hepatitis B Childcare providers who may have contact with blood or body fluids or who work with developmentally disabled or aggressive children should be vaccinated against Hepatitis B with one series of 3 doses of vaccine. Children receiving influenza vaccination for the first time should receive 2 vaccinations during the first year. However, the risks of serious disease from not vaccinating are far greater than the risks of serious reaction to the vaccination. You may also contact the National Vaccine Injury Compensation Program at1-800-338-2382 for additional information. By immunizing on time (by age 2), you can protect your child from disease and also protect others at school or daycare. A record should be started at birth when your child receives his/her first vaccination and updated each time your child receives the next scheduled vaccination. This information will help you if you move to a new area or change healthcare providers, or when your child is enrolled in daycare or starts school. Remember to bring this record with you every time your child has a healthcare visit. Further information regarding vaccines and immunizations can be found at. Infection is the term used to describe a situation in which the germ causes disease. In childcare settings the surfaces of floors, activity and food tables, diaper changing tables, doorknobs, restrooms, toys, and fabric objects can have many germs on them if they are not properly cleaned and sanitized. Direct head to head contact, sharing hats or hairbrushes, or storing articles of clothing in close proximity can result in transmission of head lice. Close proximity to respiratory secretions can spread a variety of respiratory germs. Infection Spread by the Fecal-Oral RouteInfection Spread by the Fecal-Oral Route Children in diapers present a high risk for the spread of gastrointestinal infections through contamination of hands or surfaces with fecal matter (stool). Germs can spread by the fecal-oral route if the infected person does not wash hands after changing a diaper, using the restroom or before food preparation or when people eat food contaminated with disease-causing germs from fecal matter. Germs that spread via the fecal-oral route include campylobacter, cryptosporidium, E. Coli O157, giardia, hepatitis A, salmonella, shigella and a variety of gastrointestinal viruses. Teaching children to cover their mouths and noses with a tissue or the inside of their elbow when they cough or sneeze helps to limit the spread of these germs. It is best to use a disposable tissue to cover a cough or sneeze then wash hands before touching anything else. Hand sanitizers should be readily available for use when immediate washing with soap and water is not possible. Infection Spread through Blood, Urine, and SalivaInfection Spread through Blood, Urine, and Saliva Contact with blood and body fluids of another person usually requires more intimate exposure than typically occurs in childcare settings. Some infections are spread through contact with contaminated blood through a cut that lets germs into the body. Following standard precautions to remove blood from the environment safely prevents transmission of bloodborne germs. Infected children can possibly transmit theses infections through biting if there is blood mixed with their saliva. Saliva and urine often contain viruses long after a child has recovered from an illness. Good handwashing and standard precautions will help prevent the spread of these viruses. Thorough cleaning is one of the most important steps in reducing the number of germs and the spread of disease. Surfaces most likely contaminated are those children are routinely in contact with. These include toys that children put in their mouths, crib rails, food preparation areas, and diaper-changing areas. Routine cleaning with soap and water is the most useful method for removing germs from surfaces in the childcare setting. Good mechanical cleaning (scrubbing with soap and water) physically reduces the numbers of germs from the surface, just as handwashing reduces the numbers of germs from the hands. Removing germs in the childcare setting is especially important for soiled surfaces, which cannot be treated with chemical disinfectants, such as some upholstery fabrics. However, some items and surfaces should be disinfected after cleaning with soap and rinsing with clear water. Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs. Disinfection usually requires soaking or drenching the item for several minutes to give the chemical time to kill the remaining germs. Recipe for: Bleach Disinfecting Solution Weaker Bleach Disinfecting Solution (For use in bathrooms, diapering areas, etc. Therefore, bleach solution should be mixed fresh each day to make sure it is effective. Keep the bleach solution you mix each day in a cool place out of direct sunlight and out of the reach of children. The bleach and water solution or chlorine containing scouring powders or other commercial bathroom surface cleaners/disinfectants can be used in these areas. Surfaces that infants and young toddlers are likely to touch or mouth should be washed with soap and water and disinfected at least once daily and also whenever visibly soiled. After the surface has been drenched or soaked with the disinfectant for at least 10 minutes, surfaces likely to be mouthed should be thoroughly wiped with a fresh towel moistened with tap water. Washing Potty Chairs and ToiletsWashing Potty Chairs and Toilets Potty chairs are difficult to keep clean and out of reach of children. Small size flushable toilets or modified toilet seats and step aids are preferable. If potty chairs are used for toilet training, you should use potty chairs only in the bathroom area and out of reach of toilets or other potty chairs. You may empty solid stool into the toilet being careful not to splash or touch toilet water with your hands. Explain to parents that washing or rinsing soiled diapers and clothing increases the risk of exposure to germs that cause disease. Although receiving soiled clothes is not pleasant, remind parents that this policy protects the health of all children and providers. Each item of sleep equipment, including cribs, cots, mattresses, blankets, sheets, etc. Linens from beds of older children should be laundered at least weekly and whenever soiled. Washing and Disinfecting ToysWashing and Disinfecting Toys Whenever possible, infants and toddlers should not share toys. Consistent use of toys that children (particularly infants and toddlers) put in their mouths should be washed and disinfected between uses by individual children. If you cannot wash a toy, it probably is not appropriate for an infant or toddler. When an infant or toddler finishes playing with a toy, you should retrieve it from the play area and put it in a bin reserved for dirty toys. Toys can be washed later, at a more convenient time; then transferred to a bin for clean toys and safely reused by other children. Toys and equipment used by older children and not put into their mouths should be cleaned at least weekly and when visibly soiled. A soap and water wash followed by clear water rinsing and air-drying should be adequate. Cleaning up Body FluidsCleaning up Body Fluids Spills of body fluids, including blood, feces, vomit, urine, nasal and eye discharges, and saliva should be cleaned up immediately.

Cistus incanus (Labdanum). Ponstel.

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Bronchitis, diarrhea, edema, hernia, leprosy, hardening of the spleen, expelling mucus from the chest, use as a stimulant, emptying and cleansing the bowel, stopping or preventing bleeding, and other uses.
What is Labdanum?
Dosing considerations for Labdanum.
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Over-the-counter antibiotic access is substrates from monosaccharides to polysaccharides widespread in Nigeria and nosocomial diarrhoea (Ezeji et al spasms from spinal cord injuries purchase ponstel 250 mg with amex. Clostridium Difficile C difficile has been reported as a pathogen of animals spasms from overdosing discount 500mg ponstel fast delivery, affecting dogs spasms sternum order ponstel 500 mg line, cats spasms all over body buy online ponstel, horses and pigs (Weese et Clostridium difficile is the most common cause of al muscle relaxant food generic 250 mg ponstel with amex. Another study in the worldwide and substantially burdens health care Netherlands showed high C spasms with broken ribs generic ponstel 500 mg online. Investigations of these and other outbreaks were present in horse and poultry samples. Outbreaks have also been associated with other patients in 2009/2010, encompassing 0. Whereas outbreaks in North piglets has yet to be conclusively elucidated (Hopman et American and European hospitals have led to increased al. All rights reserved Volume 7, Number 2 83 in the United States of America (Songer et al. Seven types of botulinum toxins 2010) with a zero prevalence in passerine birds in are known (A through G), of which types A, B, E, and F Europe (Bandelj et al. Botulism is characterized by rapidly progressive colonize the entire environment to create havoc to cranial neuropathy and symmetric descending flaccid public health. Possible routes other than meat consumption the organism is the causative agent of muscular (direct and indirect contact) with animals, have been gangrene syndrome with clinical features that overlap speculated (Weese, 2010). It is increasingly recognized with those of other clostridial diseases and that aerial dissemination of bacterial elements can be the acute/hyperacute syndromes seen with other diseases main route of zoonotic transmission (Kuske, 2006; such as anthrax (Fasanella et al. Blackleg in ruminants has been reviewed (Useh et Traditional microbiological methods are unable to al. Soft tissues are usually affected in the pathology ill (Merchant and Barner, 1964), gangrenous myositis of the disease with an accompanying necrotizing (Williams and Andrews, 1992), clostridial myositis of infection (Gnerlich et al. In Nigeria, Jakari, Vom and histotoxic diseases in both humans and animals K76 strains have been incriminated as the aetiologic (McClane, 2007; Amimoto et al. These strains are also responsible for the environment come in contact with the host, where disease in both the natural and accidental hosts spores undergo germination followed by outgrowth, cell (Radostits et al. These neurotoxins are the biofuel producing clostridia are very important considered the most toxic substances known (Lamanna, as they are nonpathogenic and produce biogenic fuels 1959) and have been designated as category A for industrial use (Kopke et al. It can be used as a precursor in the caused by potent neurotoxins produced by the gram manufacture of a range of chemical products, including positive, anaerobic, spore-forming bacterium C. All rights reserved Volume 7, Number 2 global market of around 32 million tons per annum, clostridia (Mao et al. Apart from the usefulness valued at approximately $43 billion in sales (Xiu and of non-pathogenic clostridia in biofuel production, it is Zeng, 2008). Three (3) acetogenic members of the believed that their spores could serve as vehicles for Clostridium genus (C. Botulinum toxin in bacteria in fermentation systems that depend on sugars bioterrorism has been reviewed (Bossi et al. Aerosols of botulinum toxin could be used as a Homologues of the genes involved in the requisite biological weapon (Franz et al. The Aum while a broader expression study of Wood-Ljungdahl Shinrikyo cult in Japan attempted unsuccessfully to pathway genes has been shown to provide a release an airborne form of botulinum toxin in Tokyo on transcription-level view of one of the oldest existing three separate occasions in the early 1990s (Arnon et al. It is likely that several countries have developed form to develop new stains of clostridial organisms with and stockpiled botulinum toxin weapons (Arnon et al. This positive, strictly anaerobic bacillus that forms a is re-invigorated by the high and ever rising cost of subterminal spore. These spores can be found in soil crude and the desire for alternative energy sources to cut samples and marine sediments throughout the world. The shortage of Botulinum toxin does not penetrate intact skin (Arnon et gasoline, even in some oil producing countries, has al. Toxins act by binding to the presynaptic stimulated governments of countries like China to re nerve terminal at the neuromuscular junction and at awaken their biofuel programme (Dong et al. Human botulism is saccharoperbutylacetonicum are known for producing almost always caused by toxin types A, B, E and, in rare biofuels (Jones and Kreis, 1995). Types C and D are associated with disease in of these bacteria through gene knockout/ down systems birds and mammals. Type G is not associated with any have been developed through homologues disease in humans or animals. It has been estimated that, recombination methods based on replicable/ non weight for weight, these toxins are the most toxic replicable vectors (Harris et al. All rights reserved Volume 7, Number 2 85 A, B, E, and rarely F responsible for human earthquakes and other mass casualty conditions (Stevens intoxication. Currently, tetanus occurs in about deadliest of the seven toxins with potency 1,000,000 people annually worldwide, and most patients approximately one million times greater than cobra are newly born in developing countries located in toxin, and one hundred billion times greater than tropical areas. If the soldier was not killed perfringens are robust and heat stable, but unlike B. During World War I, medical wounds and the subsequent establishment of gas treatments had improved. In this period, the incidence of gas gangrene is notoriously difficult, because the of gas gangrene was as high as 10% of wounded infection becomes established in tissues that are soldiers (MacLennan, 1962). Evidence that the toxins produced by an estimated 100,000 German soldiers during this C. In addition, the incidence of gas gangrene was whose economic importance includes the ability to higher in European theaters than in desert operations, cause disease (pathogenic strains), industrial uses and likely because the fertile valleys of Europe were heavily therapeutic potentials. Uniforms too were found to be contaminated Clostridial infections cut across animal and human with enteric clostridia and C. Gas gangrene continues to be literature for hundreds of years largely because of their problematic in both military theaters and the civilian fulminant nature, distinctive clinical presentations and sectors, always associated with traumatic injuries. All rights reserved Volume 7, Number 2 gas gangrene has increased in civilian populations in caused by the highly toxigenic strains involves recent years and necrotizing infections associated with neutralization of the toxins. It is generally advocated that the associated with pregnant females undergoing normal administration of crystalline penicillins intravenously vaginal delivery, caesarian sections or medical should precede the long-acting preparations that should abortions. The best preventive and control membranous colitis, is currently one of the most strategy is vaccination. Natural Products as Potential Therapeutic risk for hospitalized patients and result in significant Agents Against Clostridial Infections costs to health care systems. The economic the active substances present in many medicinal plants losses of ruminants to the disease have yet to be could be used as therapeutic alternatives against quantified in most countries, but in Nigeria, losses of clostridial infections (Woodford and Livermore, 2009). In United States most medicinal plants with potentials to ameliorate of America, Latin America, India and other parts of Asia clostridial infections have yet to be defined, there are and Europe, the economic losses of ruminants to strong indications that the results of most in vitro studies blackleg have yet to be estimated, but it has been that seem to point to some beneficial actions of these reported that the disease causes major economic losses plants is worth further investigations after all. Table 1 in cattle and minor losses in sheep (Cottral, 1978; shows a list of medicinal plants from different parts of Ramarao and Rao, 1990; Troxel et al. Management, Prevention and Control of C, D and E) based on the type of enterotoxins it Infections by Pathogenic Clostridia produces. Delta-toxin is one of the five haemolysins released by Clostridium perfringens which play a most Resistance of pathogenic clostridial organisms to important role in gas gangrene and gastroenteritis. The therapeutic antimicrobials has been reported and is native structure of the delta-toxin is not yet reported in increasingly becoming an issue of concern to public the structural databases (Skariyachan et al. The resistance perfringens has been shown to develop multiple drug means that alternative therapeutic protocols will have to resistance, indicating that the treatment for this be developed in the future to treat resistant strains. Drugs rational design of improved therapeutics requires the like metronidazole, (oral administration), vancomycin crystal structure for the toxin. However, the structure for and several stand-alone therapies or as adjunct agents the toxin is not yet available in its native form. Alternative treatments include the use recent study, some authors modeled the toxin structure of rifaximin (Johnson et al. Treatment of clostridial infections future design and development of novel compounds against the delta-toxin produced by C. List of some natural products with ethnopharmacological potentials against clostridial infections Natural product possible clostridial target Reference Combretum fragrans C. Green tea catechins Coprisin, an antibacterial peptide has been isolated also reduced the heat-resistance characteristics of C. Some other unpublished data (cited by clinical significance of treatment with a coprisin analogue Friedman, 2007) also suggest that concentrated green tea (a disulfide dimer of the nine peptides) on inflammation extracts inhibit sporulation and growth of C. These inflammation, established by administration of antibiotics observations suggest that the use of polyphenols or other followed by C. All rights reserved Volume 7, Number 2 significantly ameliorated decreases in body weight, Experiments carried out on phrenic nerve-diaphragm improved survival rate, decreased mucosal damage and preparations of rats showed that the neuromuscular pro-inflammatory cytokine production. For example, they were both Bifidobacterium spp, which are known to inhibit the concentration and temperature dependent; and the colonization of the gut by C. The staining levels were similar to related to the nerve activity and concentration of Ca2+. Thus, these results indicate that sensitivity of the transmitter release machinery. The latest encyclopedia of Chinese traditional release at central synapses as it did at the neuromuscular medicine lists over 5500 natural sources (82. During the facilitatory phase, both the However, Chinese traditional medicine is unacceptable to transmitter release (either spontaneous or evoked), and the Western society partly because the bases of Chinese Ca2+ sensitivity of transmitter release machinery were traditional medicine like the yin-yang theory and five enhanced (Shi et al. However, analysis of their differences digestive tract-parasiticide and agricultural insecticide. Many herbal possesses special biological actions and perhaps remedies have been reported to ameliorate blackleg, considerable pharmacological values in scientific caused by C. Tea polyphenols: selective growth inhibitors of physiological activity of the enzyme. Growth-inhibitory effects of Galla Rhois-derived tannins on Moreover, some of the synthetic inhibitors become less intestinal bacteria. This makes recourse to plants as source of Clostridium perfringens cells elicits protection against neuraminidase inhibitors an appealing alternative, because Clostridium tetani in mouse model: identification of cross their active compounds are synthesized in direct response reactive proteins using proteomic methodologies. These authors concluded that the active positive Clostridium difficile-associated diarrhoea in a Canadian principles of these medicinal plants should be further tertiary-care hospital. The distribution of Clostridium management of clostridial infections, although laced with difficile in the environment of South Wales. A novel importance, with regards to the pathogenic, industrial and toxin homologous to large clostridial cytotoxins found in culture potential therapeutic uses of members of this genus. Botulinum toxin as a biological herbs, which have proved to be useful and potential weapon. Clostridium difficile in ready to eat salads, Cornell University, Ithaca, New York, where the Scotland. Bonn, Germany for generous financial support via Continuous two stage acetone-butanol ethanol fermentation with clostridial research grants at various times. Bioproduction of Staphylococcus aureus, bacterial pneumonia, Clostridium butanol from biomass: from genes to bioreactors. Bennett J, Macia J, Traverso H, Banoagha S, Malooly C and Fasanella A, Galante D, Garofolo G and Jones M H. Antimicrobial properties of stem bark extracts from Phyllanthus muellerianus (Kuntze) Excell. Franz D R, Jahrling P B, Friedlander A M, McClain D J, Hoover Cato E P, George W L and Finegold S M. Clinical recognition and management of patients exposed to biological warfare agents. Gadhi C A, Weber M, Mory F, Benharref A, Lion V, Jana V and Management of gas gangrene in Wenchuan earthquake victims. Molecular characterization and antimicrobial induced change of dopamine level detected by microdialysis in vivo at rat striatum. Cornell University Press, Garey K W, Salazar M, Shah D, Rodrigue R and DuPont H L. Rifamycin antibiotics for treatment of Clostridium difficile associated diarrhoea. Date K, Fagan R, Crossland S, Maceachern D, Pyper B, Bokanyi R, Houze Y, Andress E and Tauxe R. Three outbreaks of Garofolo G, Galante D, Serrecchia L, Buonavoglia D and Fasanella A. Technological advancements for the detection of and protection Emergence of Clostridium difficile infection due to a new against biological and chemical warfare agents. Clostridium chauvoei and Clostridium septicum in clostridial Appl Microbiol Biotechnol. Origins and relationships of Harvey R B, Norman K N, Andrews K, Hume M E, Scanlan C industrial solvent-producing clostridial strains. Aerial dissemination of Clostridium Hlady W G, Bennette J V, Samadi A R, Begum J, Hafez A, difficile on a pig farm and its environment. Anaerobe difficile in swine thought to have Clostridium difficile infections Laboratory Manual. Koene M G J, Mevius D J, Wagenaar A, Harmanus C, Hensgens Isolation and characterization of a defensin-like peptide M P M, Meetsma A M, Putirulan F F, van Bergen M A P and (corprisin) from the dung beetle Corpris tripartitus. Survey of ethnoveterinary practices in Kuehne S A, Heap J T, Cooksley C M, Cartman S T and Minton Nigeria. Strain Engineering: Methods and Protocols, James ethnoveterinary practices in Nigeria, sponsored by International A. Toxinotype V Clostridium difficile in Clostridium difficile-associated disease in North America and humans and food animals. All rights reserved Volume 7, Number 2 Kyne L, Hamel M B, Polavaram R and Kelly C P.

A zone of colour above quad spasms after acl surgery buy 500 mg ponstel with amex, or within muscle relaxant tea purchase ponstel, the section used to provide operating instructions may be used to identify the type of extinguisher muscle relaxant lyrics ponstel 250mg mastercard. Fire precautions A range of precautions are based on the principles summarized earlier muscle relaxant alcoholism discount ponstel 250 mg without prescription. However muscle relaxant commercial generic ponstel 250mg on line, general precautions spasms to the right of belly button discount ponstel uk, applicable to the majority of work situations, are listed in Table 6. Escape/access Escape doors and routes must be kept free of obstructions Access for emergency services must be maintained Fire equipment Fire alarm and fire-fighting equipment must be regularly inspected, maintained and tested Portable extinguishers to have designated locations/be of correct type. Practice is necessary Flues Passages for services or other ducts must be adequately fire-stopped to prevent their acting as flues for fire/smoke transmission Sprinklers Maintain sprinkler systems Institute alterations if building is modified, use changes etc. T S u b s t a n c e S p e c i f i c V a p o u r F l a s h I g n i t i o n F l a m m a b l e B o i l i n g M e l t i n g S o l u b i l i t y V a p o u r g r a v i t y d e n s i t y p o i n t t e m p. Whilst in some cases the heat of reaction is absorbed into the products and the reaction cools (endothermic reactions), most reactions evolve energy as heat (exothermic reactions), and sometimes as light and sound. When the heat liberated or absorbed cannot be accommodated by the surrounding environment hazards are presented which can result in material damage. This can arise because either the amount of energy (thermodynamics) or the rate of energy release due to the speed of reaction (reaction kinetics) is excessive. The aim therefore is to establish the thermal stability of the system and then to control the extent and rate of heat release so as to minimize risk from energetic hazards. Thousands of reactive hazards have been documented by Bretherick (see Bibliography). The present chapter provides an insight into the hazards and the basic precautions to control the risk. Reactive chemical hazards may arise from the inherent properties of the chemicals handled, used or disposed of and/or from their admixture or processing. A hazard may arise with a chemical because of its tendency to decompose spontaneously or to react violently on contact with other common chemicals, as illustrated in Figure 7. The case of pyrophoric chemicals is summarized in Chapter 6; some dangerous reactions of compressed gases are mentioned in Chapter 9; other cases are summarized here. However, extreme caution is necessary with mixed chemical systems since many which are thermodynamically unstable exhibit considerable kinetic stability. The kinetic barrier to stability may be overcome if traces of catalyst are present, and result in a violent reaction. The most common catalysts derive from metals, or their compounds, and the unpredictable behaviour of many reactions arises from the unwitting presence of impurities. Hence any system must be treated with care which (a) is thermodynamically unstable or (b) may contain a catalyst, or impurities which could serve as a catalyst. With flammable gas generation the heat of reaction may cause ignition, depending upon the compound in question, as illustrated by the list of hydrides in Table 7. Toxic hazards from mixtures Undesirable emissions of toxic gases may occur as a result of mixing relatively common chemicals. Chemicals which are incompatible in this way must be brought into contact only under strictly controlled conditions. An appraisal is needed of all chemicals which may be present, even if unintentionally. Column 1 Column 2 Acetic acid Chromic acid, nitric acid, hydroxyl-containing compounds, ethylene glycol, perchloric acid, peroxides, or permanganates Acetone Concentrated nitric and sulphuric acid mixtures Acetylene Chlorine, bromine, copper, silver, fluorine or mercury Alkali and alkaline earth metals, Carbon dioxide, carbon tetrachloride, or other chlorinated. This is also encountered when concentrated sulphuric acid is diluted (refer to Table 7. Oxidizing agents Oxidizing agents, although not normally spontaneously flammable, often represent a source of oxygen that can support combustion. Hence an oxidizing agent will invariably accelerate the rate of burning of a combustible material. Hazards arising from the oxidation of organic compounds are greater when the reactants are volatile, or present as a dust or an aerosol. The use of perchloric acid or perchlorates has resulted in numerous explosions; their use should be avoided when possible (refer to Table 7. Explosive chemicals Explosions involving flammable gases, vapours and dusts are discussed in Chapter 6. In addition, certain chemicals may explode as a result of violent self-reaction or decomposition when subjected to mechanical shock, friction, heat, light or catalytic contaminants. They include acetylides and acetylenic compounds, particular nitrogen compounds. With pyrotechnics the hazard is related to the violence with which the chemical burns. Propellant hazards are akin to those for pyrotechnics except that confinement can lead to detonation. Precautions Expert advice is required before handling any of these materials, many of which are governed by legislation regulating. Disposal of explosive waste and the repair or dismantling of contaminated plant need extreme care. Collection of the waste should be in well labelled, distinctive, specially designed containers. Repair work should be the subject of a permit-to-work system (Chapter 13); it should be assumed that explosives may have penetrated threads, joints and other crevices and bolts, flanges etc. The chance of accidental initiation is related to the energy imparted to the substance and the sensitivity of the compound. Consider fire protection, detection and suppression requirements (Chapter 6), and means of escape, alarms, etc. Where appropriate, keep samples dilute or damp and avoid formation of large crystals when practicable. Where relevant, store in dark and under chilled conditions, except where this causes pure material to separate from stabilizer. Consider need for high/low temperature alarms for refrigerated storage; these should be inspected and tested regularly. Consider need for mitigatory measures (fire, blast, fragment-resistant barricades/screens), electrical and electrostatic safeguards, personal protection, disposal etc. Depending upon scale, explosion proof electrics and static elimination may be required. Equipment for such products requires special design and a knowledge is required of activators, decomposition rates and temperatures. General principles for storage the general principles for storage of chemicals, which follow from previous summaries, are listed in Table 7. Hazards arising in chemicals processing Some factors contributing to chemical process hazards are summarized in Chapter 6: the roles of individual chemicals can be assessed from the preceding part of this chapter. Negligible/low High What is the potential What is the potential for harm to operators Continuous reactors generally offer the advantage of low materials inventory and reduced variation of operating parameters. Recycle of reactants, products or of diluent is often used with continuous reactors, possibly in conjunction with an external heat exchanger. Adequate heat removal facilities are generally important when controlling the progress of exothermic chemical reactions. Common causes of thermal runaway in reactors or storage tanks are shown in Figure 7. A runaway reaction is most likely to occur if all the reactants are initially mixed together with any catalyst in a batch reactor where heat is supplied to start the reaction. Stores should be specially designed, constructed of non-combustible material, and located away from other hazards. Other combustible material such as fabric, paper, organic solvents should not be stored there. Generally the substances in this class are unstable when heated or exposed to light; they should be stored cool and in the dark. However, for liquids with added stabilizer cooling may cause separation of the material from the stabilizer. Similarly, precipitation of a potentially explosive compound from a diluent may occur on cooling. Material should be purchased in several small containers rather than one large container and always stored in original containers. Use Use must be restricted to experienced workers, aware of the hazards and the necessary precautions. For the above scales, eye protection should be worn and work should be undertaken in a standard fume-cupboard behind a well-anchored polycarbonate screen. It is advisable to wear a protective apron and hand protection; whether leather gauntlets or tongs should be used will be dictated by circumstances. Such measures are recommended but it should be ensured that they do not precipitate a hazard as a result of loss of tactile sensitivity. Splashes in eyes or on skin should be washed away immediately with copious quantities of water. To minimize risk of static electricity, laboratory coats of natural fibre rather than synthetic fabrics are preferred. It is important to neutralize any spillage on the coat immediately, since delay could result in the impregnated garment becoming a fire hazard. To prevent glass fragments from flying in the event of an explosion, use should be made of metal gauzes to screen reaction flasks etc. Whenever possible a stabilizer or diluent should be used and separation of the pure material should be avoided. In the event of fire, the area should be evacuated, the alarm raised and the fire brigade summoned. Only if it is clearly safe to do so should the fire be tackled with an appropriate extinguisher. Chemical engineering operations Many chemical engineering unit operations may be linked together in chemical processing. Melting with quiet burning is at one end of the spectrum; cracking, flashing-off or flaring are considered hazardous. Impact Impact sensitivity can be gauged by striking a few crystals of the compound on a metal last with the ball of a ball-pein hammer. Ignition, smoking, cracking or other sign of decomposition are considered hazardous. Hazard indicators Differential thermal include heats of decomposition in excess of 0. Observations such as decomposition with evolution of gases prior to ignition are regarded as potentially hazardous. Bomb calorimetry Use of oxygen and an inert gas enables the heat of combustion and the heat of decomposition to be evaluated respectively. The decomposition rapidly propagates through the entire mass for unstable diazo compounds; no such propagation is reported for stable versions. Heat transfer Convective heat exchange, natural or forced Radiant heat transfer. They are substances not classified as deflagrating or detonating explosives but exhibit violent decomposition when subject to heat. Material Trauzel lead Combustion properties block value (cm3/g) 1:8, Bis (dinitrophenoxy)4,5-dinitro anthraquinone 18.

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Stage theories or discontinuous development assume that Source developmental change often occurs in distinct stages that are qualitatively different from each other spasms 1983 cheap ponstel 250mg otc, and in a set muscle relaxant clonazepam order ponstel 250mg visa, universal sequence spasms jerking limbs buy generic ponstel online. At each stage of development muscle relaxant reversal drugs order ponstel, children and adults have different qualities and characteristics muscle relaxant 4211 v order ponstel 500 mg line. Others spasms crossword clue purchase 250mg ponstel, such as the behaviorists, Vygotsky, and information processing theorists, assume development is a more slow and gradual process known as continuous development. For instance, they would see the adult as not possessing new skills, but more advanced skills that were already present in some form in the child. Brain development and environmental experiences contribute to the acquisition of more developed skills. Active versus Passive: How much do you play a role in your own developmental path Are you at the whim of your genetic inheritance or the environment that surrounds you Some theorists see humans as playing a much more active role in their own development. Piaget, for instance believed that children actively explore their world and construct new ways of thinking to explain the things they experience. In contrast, many behaviorists view humans as being more passive in the developmental process. Some theorists argue that the personality traits of adults are rooted in the behavioral and emotional tendencies of the infant and young child. Others disagree, and believe that these initial tendencies are modified by social and cultural forces over time. Historical Theories on Development th Preformationist View: Well into the 18 century, children Figure 1. Preformationism, or the belief that a tiny, fully formed human is implanted in the sperm or egg at conception and then grows in size until birth, was the predominant early theory. Children were believed to possess all their sensory capabilities, emotions, and mental aptitude at birth, and as they developed these abilities unfolded on a predetermined schedule (Thomas, 1979). John Locke (1632-1704): Locke, a British philosopher, refuted the idea of innate knowledge and instead proposed that children are largely shaped by their social environments, especially their Source: A tiny person inside a sperm. He believed that through education a child learns socialization, or what is needed to be an appropriate member of society. Locke indicated that the environment exerts its effects through associations between thoughts and feelings, behavioral repetition, imitation, and rewards and punishments (Crain, 2005). Jean-Jacques Rousseau (1712-1778): Like Locke, Rousseau also believed that children were not just little adults. However, he did not believe they were blank slates, but instead developed according to a natural plan which unfolded in different stages (Crain, 2005). He did not believe in teaching them the correct way to think, but believed children should be allowed to think by themselves according to their own ways and an inner, biological timetable. This focus on biological maturation resulted in Rousseau being considered the father of developmental psychology. Arnold Gesell (1880-1961): Gesell spent 50 years at the Yale Clinic of Child Development, and with his colleagues he studied the neuromotor development of children. Further, he believed that development unfolded in fixed sequences, and he opposed efforts to teach children ahead of schedule as he believed they will engage in behaviors when their nervous systems had sufficiently matured. Freud emphasized the importance of early childhood experiences in shaping our personality and behavior. In our natural state, we are biological beings and are driven primarily by instincts. During childhood, however, we begin to become social beings as we learn how to manage our instincts and transform them into socially acceptable behaviors. His beliefs formed the psychodynamic perspective and his theories of psychosexual development and psychopathology Sigmund Freud from Wikimedia dominated the field of psychiatry until the growth of behaviorism in the 1950s. Freud suggested that much of what determines our actions were unknown to us, and as scientists we cannot measure these unconscious concepts. Erikson (1950) proposed a model of lifespan development that provides a useful guideline for thinking about the changes we experience throughout life. Erikson proposed that each period of life has a unique challenge or crisis that the person who reaches it must face, referred to as psychosocial crises. According to Erikson, successful development Erik Erikson involves dealing with and resolving the goals and demands of each of these psychosocial crises in a positive way. These crises are usually called stages, although that is not the term Erikson used. If a person does not resolve a stage successfully, it may hinder their ability to deal with later stages. His theory also focused on the social expectations that are found in certain cultures, but not in all. For instance, the idea that adolescence is a time of searching for identity might translate well in the middle class culture of the United States, but not as well in cultures where the transition into adulthood coincides with puberty through rites of passage and where adult roles offer fewer choices. Learning Theory: Also known as Behaviorism, is based on the premise that it is not possible to objectively study the mind, and therefore psychologists should limit their attention to the study of behavior itself. Skinner used the ideas of stimulus and response, along with the application of rewards or reinforcements, to train pigeons and other animals. In addition, he used the general principles of behaviorism to develop theories about how best to teach children and how to create societies that were peaceful and productive (Skinner, 1957, 1968, 1972). The behaviorists made substantial contributions to psychology by identifying the principles of learning. Although the behaviorists were incorrect in their beliefs that it was not possible to measure thoughts and feelings, their ideas provided new insights that helped further our understanding regarding the nature-nurture debate as well as the question of free will. The ideas of behaviorism are fundamental to psychology and have been developed to help us better understand the role of prior experiences in a variety of areas of psychology. His theory calls our attention to the ways in which many of our actions are not learned through conditioning, as suggested by Skinner. Especially when children do not know what else to do, they learn by modeling or copying the behavior of others. Bandura (1986) suggests that there is interplay between the environment and the individual. We are not just the product of our surroundings, rather we influence our surroundings. There is interplay between our personality and the way we interpret events and how they influence us. Perhaps they try to be the perfect parents with their firstborn, but by the time their last child comes along they have very different expectations, both of themselves and their child. Then the children were allowed in the room, where they found the doll and during their play they began to hit it. The children also demonstrated novel ways of being aggressive toward the doll that were not demonstrated by those children who did not see the aggressive model. Source Cognitive Theory: the cognitive theories focus on how our mental processes or cognitions change over time. Jean Piaget (1896-1980) was one of the most influential cognitive theorists in development. Piaget theorized that children progressed through four stages of cognitive development (see Table 1. Preoperational 2 to 7 years Children acquire the ability to internally Theory of mind; represent the world through language and rapid increase in mental imagery. They Conservation operational can increasingly perform operations on objects that are real. Formal 11 years to Adolescents can think systematically, can Abstract logic operational adulthood reason about abstract concepts, and can understand ethics and scientific reasoning. Piaget has been criticized for overemphasizing the role that physical maturation plays in cognitive development and in underestimating the role that culture and experience plays. Looking across cultures reveals considerable variation in what children are able to do at various ages. Research has shown considerable overlap among the four stages and that development is more continuous. Lev Vygotsky (1896-1934) was a Russian psychologist who wrote in the early 1900s, but whose work was not discovered by researchers in the United States until the 1960s and became more widely known in the 1980s (Crain, 2005). His sociocultural theory emphasizes the importance of culture and interaction in the development of cognitive abilities. Vygotsky differed with Piaget in that he believed that a person not only has a set of abilities, but also a set of potential abilities that can be realized if given the proper guidance from others. Vygotsky developed theories on teaching that have been adopted by educators today. Information Processing is not the work of a single theorist, but based on the ideas and research of several cognitive scientists studying how individuals perceive, analyze, manipulate, use, and remember information. This approach assumes that humans gradually improve in their processing skills; that is, cognitive development is continuous rather than stage-like. The more complex mental skills of adults are built from the primitive abilities of children. At the same time, interactions with the environment also aid in our development of more effective strategies for processing information. Urie Bronfenbrenner (1917-2005) developed the Ecological Systems Theory, which provides a framework for understanding and studying the many influences on human development (Bronfenbrenner, 1979). Bronfenbrenner recognized that human interaction is influenced by 21 larger social forces and that an understanding of these forces is essential for understanding an individual. The input of those is modified by the cognitive and biological state of the individual as well. This relates to the different generational time periods previously discussed, such as the baby boomers and millennials. Taking into consideration all the different influences makes it difficult to research and determine the impact of all the different variables (Dixon, 2003). Consequently, psychologists have not fully adopted this approach, although they recognize the importance of the ecology of the individual.

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