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Two other vector-borne diseases of public health importance in Ethiopia are the subject of this study session purchase sinemet 125 mg line symptoms miscarriage. They are caused by different bacteria proven sinemet 125mg symptoms 5 weeks into pregnancy, but are transmitted by the same vector the human body louse (plural, lice). The diseases are louse-borne relapsing fever and louse- borne typhus, which are classied as febrile illnesses because the symptoms always include high fever. In this study session, you will learn about the causes, modes of transmission, symptoms and methods of prevention of these diseases. This will help you to identify patients and quickly refer them to the nearest health centre or hospital for specialist treatment. You are also expected to report any cases of these louse-borne diseases to the District Health Ofce, so that coordinated action can be taken to prevent an epidemic from spreading in your community. Learning Outcomes for Study Session 36 When you have studied this session, you should be able to: 36. The human body louse (species name, Pediculus humanus humanus) is commonly found in the clothes, bedding and on the bodies of people living in overcrowded and insanitary conditions, where there is poor personal hygiene. When body lice are found, for example in clothes, the articles are said to be louse-infested. The bites cause an allergic reaction in the person s skin, which becomes inamed and itches, causing the person to scratch the area. Lice are transmitted from person to person during close contact and when sharing bedding in which eggs have been laid. It is one of the epidemic-prone diseases that can cause small, or large-scale epidemics anywhere in Ethiopia, with an estimated 10,000 cases annually. The bacteria multiply in the gut of the louse, but the infection is not transmitted to new hosts when the louse bites a healthy person. Instead, humans acquire the infection when they scratch their bites and accidentally crush a louse, releasing its infected body uids onto their skin. The bacteria enter through breaks in the skin, typically caused by scratching the itchy louse bites. After entering into the skin, the bacteria multiply in the person s blood and they can also be found in the liver, lymph glands, spleen and brain. The symptoms continue for three to nine days, while the immune system of the patient makes antibodies that attach to the bacteria and clear them from the blood, and the patient appears to recover. The numbers of bacteria gradually increase, and four to seven days after recovering from the rst episode of fever, the patient relapses, i. Almost all the organs are involved and there will be pain in the abdomen and an enlarged liver and spleen, in addition to the other symptoms. Without treatment with special antibiotics, 30% to 70% of cases can die from complications such as pneumonia and infection in the brain, leading to coma (a state of deep unconsciousness) and death. Precautions should be taken by you and by health workers in the hospital or health centre, to avoid close contact with a patient with relapsing fever, to prevent acquiring the infection. Louse-borne typhus (also known as epidemic typhus, jail fever or tessibo beshita in Amharic) is similar in many ways to relapsing fever. They are extremely small bacteria called Rickettsia prowazekii (named after two doctors who died of typhus when they were researching into the disease). Louse-borne typhus has caused major epidemics over many centuries, resulting in millions of deaths during war, famine and mass displacement. The Rickettsia bacteria acquired during a blood meal from an infected person multiply in the gut of the louse and pass out of its body in the louse s faeces, which are deposited on the person s skin. The louse bites are itchy and when the person scratches them, the louse faeces are rubbed into breaks in the skin. This is how the typhus bacteria are transmitted to healthy people when an infected louse gets into their clothes or bedding. After an incubation period of about one to two weeks the symptoms begin suddenly, with severe headache and fever rising rapidly to 38. They also experience very severe muscle pain, sensitivity to light, lethargy and falling blood pressure. Refer patients suspected of having typhus to the nearest health centre or hospital, where they will be treated by doctors with special antibiotics. Typhus is an epidemic-prone disease, so search actively for other people locally with a similar illness and report all suspected cases to the District Health Ofce. In addition to the above actions, you should also educate your community about how to prevent these louse-borne diseases. As we said earlier, these diseases are associated with overcrowding and insanitary conditions in other words, they are associated with poverty. They are best prevented by addressing the underlying socioeconomic circumstances that promote louse infestation: overcrowding, poverty, homelessness and population displacement. However, you should also educate people in your community to take the following preventive actions:. Change clothes and bedding at frequent intervals to reduce the number of body lice. Treat louse-infested clothes and bedding with chemicals to kill the lice and their eggs (this is called delousing). In infested situations like those in refugee camps, clothes and bedding should be deloused by trained personnel with appropriate insecticides, such as 0. Treating clothing with liquid permethrin can provide long-term protection against louse infestation. Note that close contact with patients should be avoided and delousing of the patient s clothes and bedding should be done immediately, to prevent transmission of infected body lice from the patient to healthy people including the health workers who are caring for them. If there is an outbreak of relapsing fever or typhus, the spread of infection can be controlled by active case nding and effective treatment of infected persons and their close contacts with the correct antibiotics. Early treatment controls the spread of infection by reducing the reservoir of bacteria in the local population.

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The patient may either be positioned lying down (usually the case) or rarely be sitting down (if procedure is performed under fluoroscopy or ultrasound) cheap sinemet 300mg with visa medicine clip art. The patient is given proper breathing instructions and asked to hold the breath for a few seconds while the needle is inserted safe sinemet 125 mg treatment 10. The positioning of the needle may require multiple images to be taken to help guide the needle into the appropriate location. Once the lesion is reached, the radiologist aspirates samples from the lesion(s) and a cytopathologist technician prepares a microscopic slide of the sample in order to examine the material under microscope. If the sample seen under microscopy is not considered adequate to make a diagnosis, additional tissue can be collected. After the procedure, pressure is applied to the injection site to control any local bleeding. The injection site is covered by sterile dressing and the patient is monitored usually in the radiology observation area for a few hours. Patients are made aware that they should report to the emergency room if they experience increased shortness of breath, sharp chest pain, rapid pulse or excessive hemoptysis (coughing blood). Slight streaks of blood mixed with cough are not uncommon after the procedure and should not be a cause for alarm. Benefts Reliable and relatively safe (in experienced hands), quicker and less invasive way of differentiating a benign (treated non surgically) from malignant lung lesion or nodule (treated by surgery, chemotherapy or radiation). Rarely, the air leak may be severe enough to require a chest tube insertion and hospital admission for several days. Warning signs include shortness of breath, cough, sharp chest and shoulder pain increased on breathing. This possibility must be carefully considered when the diagnosis appears to be non-cancerous. The oxygenated blood is then returned by the pulmonary veins into the left atrium of the heart. The main pulmonary artery starts as a trunk approximately two inches long and slightly over one inch wide that arises from the right ventricle outflow tract. It then branches into right and left pulmonary arteries, which further divide to supply the corresponding lung. In fire fighters, probably the most common cause for a blood clot is leg trauma with subsequent prolonged inactivity (casting and or bed rest). Another vascular disease is pulmonary hypertension which is a more insidious disease of the pulmonary arteries, which occurs as a consequence of several chronic lung conditions including interstitial lung diseases and severe emphysema. It results in poor exercise tolerance and may lead to a progressive, fatal course. Pulmonary Angiography The classic test for imaging pulmonary arteries is pulmonary angiography. It involves injection of iodinated dye into the circulation with subsequent direct x-ray visualization (fluoroscopy) of the lungs. Conventional (Catheter) Pulmonary Angiography Conventional pulmonary angiography is invasive because a catheter is introduced into the right heart through one of the thigh veins. The scanning is optimally timed such that the contrast is within the pulmonary arteries at the time that the image is acquired. The scanning time is usually about five seconds and the entire time within the scanner is approximately five minutes. The size of the vessels can be accurately measured to see if these are dilated, which can be a sign of pulmonary hypertension. The test uses radioactive materials in relatively low doses, which are inhaled and injected into the human body. While passing through the human body, these radioactive materials emit certain rays such as gamma rays which can be detected by special cameras (gamma cameras) to create a computer generated image of that part of the body. These two phases evaluate how well air and blood are able to circulate through the bronchial airways and the pulmonary circulation, respectively. Impaired uptake of these inhaled radiotracers due to airway obstruction or pneumonia leads to image voids from the corresponding lung on the ventilation scan. The perfusion phase of the scan involves injection of a radionuclide tracer (usually radioactive technetium tagged to macro aggregated albumin) into one of the arm veins. Blood clots within pulmonary arteries result in impaired circulation of the radionuclide in that lung or part of the lung without hampering ventilation or airflow. This is reflected in the perfusion scan classically as wedge-shaped area(s) of decreased uptake of radio tracer in that part of lung which has a normal ventilation image and is described as a mismatched defect. Ultrasonography of the veins of the thigh and calves (Venous Doppler) can be performed to detect blood clot in these veins. When faced with a solitary pulmonary nodule, the physician and the patient usually have one of three choices: 1. The proper choice depends on radiographic appearance, assessment of probabilities based on epidemiology, assessment of surgical risk, and patient preferences. Surgical resection of an early solitary malignant lesion still represents the best chance for cure. On the other hand, unnecessary resection of benign nodules exposes patients to the morbidity and mortality of a surgical procedure. The aim of this chapter is to review what we know about the solitary pulmonary nodule in order to formulate a systematic approach to thinking about this common and often controversial problem. The goal will be to arrive at a solution that will facilitate prompt identification of malignant lesions so that they can be brought to surgery while avoiding surgery in patients with benign nodules. Finally, we will review the risk factors that are of particular relevance to fire fighters and related personnel with respect to solitary pulmonary nodules. Previously there was controversy as to what constituted the upper size limit for defining a solitary pulmonary nodule. However, it is now recognized that lesions larger than three centimeters are almost always malignant, so current convention is that solitary pulmonary nodules must be three centimeters or less in diameter.

Indeed purchase sinemet 300 mg mastercard treatment resistant anxiety, amino acid sequences document homologies among these group I members (74) cheap sinemet 125mg with mastercard treatment for hemorrhoids. Other studied group I members include Poa p 1 (Kentucky bluegrass), Cyn d 1 (Bermuda), Dac g 1 (orchard), and Sor h 1 (Johnson). The group I allergens are of major importance in that by skin testing and histamine release, 90% to 95% of grass pollen allergic patients react on testing ( 75). Profilin, a compound involved in actin polymerization, has been described as a component of several tree pollens ( 77). Despite 84% identity, the predicted secondary structures suggest they may not be cross-reactive ( 78). Only about 20% of grass pollen sensitive patients appear to be skin test reactive to these allergens. Analysis of the cloned Kentucky bluegrass allergen, Poa p 9, has suggested the existence of a family of related genes. Among the group V allergens, the most work has been done with the timothy grass allergens Phl p 5a and Phl p 5b. Other group V allergens have been isolated from a number of temperate grasses, including Dactylis glomerata (orchard grass). The Dac g 5b allergen also has been cloned and coded for a fusion protein that was recognized by IgE antibodies in six of eight samples of atopic sera tested. This suggests that Dac g 5b may be a major allergen, but it has not been completely characterized ( 82). The most recent major grass pollen to be identified, Lol p 11, appears to be a member of a novel allergen family (83). No sequence homology with known grass pollen allergens was found, but it does have 32% homology with soybean trypsin inhibitor ( 83). This allergen reacted with IgE from over 65% of grass-pollen positive sera tested. Lol p 11 appears to share some sequences with allergens from olive pollen, as well as tomato pollen. A strategy to take advantage of the extensive cross-reactivity between species using recombinant allergens has been studied. A mixture of Phl p 1, Phl p 2, Phl p 5, and Bet v 2 (birch profilin) accounted for 59% of grass-specific IgE ( 85). The Lol p extracts reacted with 80% of the IgE, whereas the recombinant Phl p reacted with 57% of the IgE (86). This transgenic ryegrass pollen maintained its fertility, but had a significant decrease in its IgE binding capacity compared with normal pollen. This creates the possibility of genetic engineering of less allergenic grasses ( 87). Tree Pollen Antigens There seems to be a higher degree of specificity to skin testing with individual tree pollen extracts compared with grass pollens because pollens of individual tree species may contain unique allergens. Despite this observation, several amino acid homologies and antigenic cross-reactivities have been noted. A major birch-pollen allergen, Bet v 1, has been isolated by a combination chromatographic technique. Monoclonal antibodies directed against this allergen have simplified the purification process ( 88). There is considerable (80%) amino acid homology between Bet v 1 and other group I tree allergens ( 2). Bet v 1 is the birch tree allergen that cross-reacts with a low-molecular-weight apple allergen, a discovery that helps to explain the association between birch sensitivity and oral apple sensitivity ( 90). Further investigations by the same workers extend this cross-reactivity to include pear, celery, carrot, and potato allergens. Most of the 20 patients tested had birch-specific serum IgE (anti Bet v 1 and anti Bet v 2) that cross-reacted to these fruits and vegetables. Bet v 2 has been cloned and identified as profilin, a compound responsible for actin polymerization in eukaryotes. There is approximately 33% amino acid homology between the human and birch profilin molecules ( 77). Bet v 3 and Bet v 4 have both been cloned and further described as calcium binding molecules ( 91,92). Recombinant Bet v 5 appears to have sequence homology with isoflavone reductase, but the biochemical function remains unknown ( 93). It reacts with IgE from 20% of birch allergic patients and has been identified as a cyclophilin ( 94). A major allergen has been isolated from the Japanese cedar, which contributes the most important group of pollens causing allergy in Japan. This allergen, designated Cry j 1, was initially separated by a combination of chromatographic techniques. Four subfractions were found to be antigenically and allergenically identical (95). There is some amino acid homology between Cry j 1 and Amb a 1 and 2, but the significance of this is unclear. Allergens from mountain cedar (Juniperus ashei) are important in the United States. The major allergen, Jun a 1, has a 96% homology with Cry j 1 and with Japanese cypress (Chamaecyparis obtusa) (97). In 1726, Sir John Floyer noted asthma in patients who had just visited a wine cellar; in 1873, Blackley suggested that Chaetomium and Penicillium were associated with asthma attacks; and in 1924, van Leeuwen noted the relationship of climate to asthma and found a correlation between the appearance of fungal spores in the atmosphere and attacks of asthma ( 99). Over the next 10 years, case reports appeared attributing the source of fungal allergies to the home or to occupational settings.

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Allergens most commonly associated with atopic disorders are inhalants or foods cheap sinemet 110 mg on line medicine xifaxan, reflecting the most common entry sites into the body cheap sinemet 110mg line symptoms quit drinking. Drugs, biologic products, insect venoms, and certain chemicals also may induce an immediate-type reaction. The allergenic molecules generally are water soluble and can be easily leached from the airborne particles. They react with IgE antibodies attached to mast cells, initiating a series of pathologic steps that result in allergic symptoms. This chapter is confined to the exploration of these naturally occurring inhalant substances; other kinds of allergens are discussed elsewhere in this text. The chemical nature of certain allergens has been studied intensively, although the precise composition of many other allergens remains undefined ( 1). For others, the physiochemical characteristics or the amino acid sequence is known. Still other allergens are known only as complex mixtures of proteins and polypeptides with varying amounts of carbohydrate. Details of the chemistry of known allergens are described under their appropriate headings ( 2). The methods of purifying and characterizing allergens include biochemical, immunologic, and biologic techniques. The methods of purification involve various column fractionation techniques, newer immunologic techniques such as the purification of allergens by monoclonal antibodies, and the techniques of molecular biology for synthesizing various proteins. All of these purification techniques rely on sensitive and specific assay techniques for the allergen. Aeroallergens are named using nomenclature established by an International Union of Immunologic Societies subcommittee: the first three letters of the genus, followed by the first letter of the species and an Arabic numeral ( 3). Commonly encountered allergens For a particle to be clinically significant as an aeroallergen, it must be buoyant, present in significant numbers, and allergenic. Fungal spores are ubiquitous, highly allergenic, and may be more numerous than pollen grains in the air, even during the height of the pollen season. The above allergens are emphasized because they are the ones most commonly encountered, and they are considered responsible for most of the morbidity among atopic patients. Others may be associated with occupational exposures, as is the case in veterinarians who work with certain animals (e. Some sources of airborne allergens are narrowly confined geographically, such as the mayfly and the caddis fly, whose scales and body parts are a cause of respiratory allergy in the eastern Great Lakes area in the late summer. In addition, endemic asthma has been reported in the vicinity of factories where cottonseed and castor beans are processed. Airborne pollens are in the range of 20 to 60 m in diameter; mold spores usually vary between 3 and 30 m in diameter or longest dimension; house dust mite particles are 1 to 10 m. Protective mechanisms in the nasal mucosa and upper tracheobronchial passages remove most of the larger particles, so only those 3 m or smaller reach the alveoli of the lungs. Hence, the conjunctivae and upper respiratory passages receive the largest dose of airborne allergens. These are considerations in the pathogenesis of allergic rhinitis, bronchial asthma, and hypersensitivity pneumonitis as well as the irritant effects of chemical and particulate atmospheric pollutants. The development of asthma after pollen exposure is enigmatic because pollen grains are deposited in the upper airways as a result of their large particle size. Experimental evidence suggests that rhinitis, but not asthma, is caused by inhalation of whole pollen in amounts encountered naturally ( 4). Asthma caused by bronchoprovocation with solutions of pollen extracts is easily achieved in the laboratory, however. Pollen asthma may be caused by the inhalation of pollen debris that is small enough to access the bronchial tree. Extracts of materials collected on an 8- m filter that excludes ragweed pollen grains induced positive skin test results in ragweed-sensitive subjects. Using an immunochemical method of identifying atmospheric allergens, Amb a 1 was found to exist in ambient air in the absence of ragweed pollen grains ( 6). Positive bronchoprovocation was induced with pollen grains that had been fragmented in a ball mill, but was not induced by inhalation of whole ragweed pollen grains ( 7). Exposure of grass pollen grains to water creates rupture into smaller, respirable size starch granules with intact group V allergens ( 8), possibly explaining the phenomenon of thunderstorm asthma during grass pollen seasons (9,10). However, despite the generally accepted limitations previously mentioned, examination of tracheobronchial aspirates and surgical lung specimens has revealed large numbers of whole pollen grains in the lower respiratory tract ( 11). Another consideration is the rapidity with which various allergens are leached out of the whole pollen grains. The mucous blanket of the respiratory tract has been estimated to transport pollens into the gastrointestinal tract in less than 10 minutes. The allergens of grass pollens and ragweed Amb a 5 are extracted rapidly from the pollen grains in aqueous solutions and can be absorbed through the respiratory mucosa before the pollen grains are swallowed. Ragweed Amb a 1, however, is extracted slowly, and only a small percentage of the total extractable Amb a 1 is released from the pollen grain in this time frame ( 12). This observation has not been reconciled with the presumed importance of Amb a 1 in clinical allergy, but absorption may be more rapid in the more alkaline mucus found in allergic rhinitis ( 13). The enzymatic activity of Der p 1 helps the allergen to penetrate through the respiratory mucosa and helps to promote an IgE response as described in detail later in this chapter. A similar study performed on fungal proteases also suggests the importance of enzymatic activity in the development of an allergic response ( 14). Sampling Methods for Airborne Allergens Increasing attention is being focused on the daily levels of airborne allergens detected in a particular locale. Patients commonly seek out daily reports of ragweed or Alternaria levels, frequently reported in newspapers and on television, to correlate and predict their allergy symptoms. The clinician must be acquainted with the various sampling techniques used to accurately assess the validity and accuracy of the readings reported.

Lancet leishmaniasis in the endemic area of Porteirinha Municipality purchase 110mg sinemet with mastercard medications dialyzed out, 1999; 353: 1541 generic 300 mg sinemet otc symptoms 6dpo. Travelling waves in Diversity and species composition of sand ies (Diptera: the occurrence of dengue haemorrhagic fever in Thailand. Lutzomyia longipalpis in Clorinda, haemorrhagic fever, and its emergence in the Americas. Formosa province, an area of potential visceral leishmaniasis World Health Stat Q 1997; 50: 161 69. Trypanosoma cruzi, the etiologic agent of Chagas bodies in urban Lagos, southwestern Nigeria. J Vector Borne Dis disease: status in the blood supply in endemic and nonendemic 2007; 44: 241 44. Am J Trop Med Hyg 2005; the heterogeneity of malaria incidence in children in Kampala, 73: 523 33. Dengue prevention and 35 years of prophylaxis of viral hepatitis: a global perspective. The importance of social intervention in Britain s Vaccine 2000; 18 (suppl 1): S57 60. Department of Health annual report action to address inequities: the experience of the Cape Town Equity 1005/2006. Jones Associate Professor - Livestock The University of Arkansas does not endorse any products or services named or pictured in this slide show. University of Arkansas, United States Department of Agriculture and County Governments Cooperating. Herd Health Plan Needed to maintain the overall health of the herd Key to success of the plan is the prevention of problems before they start Vital Signs of Beef Cattle Temp. Symptoms of Blackleg First sign is one or more animals suddenly die Before death symptoms are: Lameness Swollen muscles Severe depression High fever (in early stages) Animal may be unable to stand Preventing Blackleg Vaccination Calves are vaccinated when young (typically in the spring at branding or shortly after calving) and again at weaning (fall) Dead animals should be burned or buried Treating Blackleg Massive doses of antibiotics Treatment is only effective if diagnosed early Prevention is more effective and less costly. Calf Enteritis (Scours) Disease complex (group of diseases) Most common in fall, winter and spring Afflicts young calves-calves over 2 months of age are seldom affected Symptoms of Scours Vary Acute form Calf is in a state of shock Nose, ears and legs are cold Diarrhea Sudden death Chronic form Symptoms for several days Weight loss Death after several days if not treated Preventing Scours Sanitation is the most important factor! How Pinkeye Spreads Insects Direct Contact with infected animals Dust Tail switching Controlling Pinkeye Control flies and insects to prevent pinkeye Vaccinations are available to control Moraxella bovis, the bacteria that is considered to be the main cause of pinkeye Treating Pinkeye Animals should be isolated in a dark place Antibiotics and sulfa drugs are applied to the eye Medicine should be applied 2 X s/day Why??? Treatment of Shipping Fever Antibiotics Sulfa drugs Treatment must begin as soon as symptoms are noticed Treatment after an animal has developed pneumonia is of little value. Trichomoniasis A venereal disease caused by a protozoan, Trichomona fetus The organism infects the genital tract of the bull and is transmitted to the cow during breeding Clean bulls can also be infected by breeding dirty cows The disease can also be transmitted through infected semen, even when artificial insemination is used. Symptoms Abortion in early gestation Low fertility Irregular heat periods Uterine infection Cows may have discharge from their genital tract Bulls may not show any symptoms of the disease but still be capable of transmitting it to the cow during breeding The organism is identified by microscopic examination of material from an aborted fetus, the prepuital cavity of the bull or vaginal discharge from the cow Prevention No treatment or vaccination for trich Infected bulls should be slaughtered Use only clean bulls on clean cows Test bulls to ensure they are free of the disease Use semen from clean bulls Campylobacteriosis (Vibriosis) Reproductive disease Both intestinal and venereal Leading cause of infertility and abortion in the cattle industry Campylobacteriosis Intestinal form has little harmful effect Venereal form is more serious If the organism infects the uterus there will be some abortion in the herd Number of cows infected is usually small Cows do not become sterile and bulls are not affected. Ringworm A contagious skin disease that can be spread to other animals and humans Symptoms Round, scaly patches of skin that lack hair May appear on any part of the body The affected area clears up but moves to another part of the body Sanitation helps control ringworm Isolate infected animals Treat ringworm with iodine tincture or quaternary ammonium compounds Ringworm Nutritional Health Problems (X) Bloat Occurs when rapid fermentation in the rumen causes to much gas to be produced The rumen swells and the animal can not get rid of the gas Bloat The major cause of bloat is eating to much green legume too fast Ways to prevent bloat Prevent animals from eating to much legume Feed grain, dry roughage or silage before turning animals onto legume pastures Free access to water should be provided at all times Bloat Treatments Stomach tubes Walking the animal on rough ground and forcing it to burp Forcing the animal to drink mineral oil or poloxalene (trade name Bloat Guard) Inserting a trocar and cannula into the rumen through the side This should only be considered after other methods have failed. Enterotoxaemia (Overeating Disease) Usually affects cattle on high-concentrate rations Symptoms Lameness Bloody diarrhea Bloat The animal may die in 1-24 hours Vaccinating calves 2 weeks before putting them on high concentrate rations helps prevent overeating disease Treatments Removing concentrates from the diet Feeding roughage Vaccinating Animals may gradually be put back on the high concentrate ration after vaccination. Summary cont Insecticides are used to control insects flies, lice, mites and ticks are the most common. It outlines practical approaches to combat threats to respiratory health, and proven strategies to significantly Respiratory diseases improve the care that respiratory professionals provide for individuals afflicted with these diseases worldwide. The report also calls for improvements in healthcare policies, in the world systems and care delivery, as well as providing direction for future research. A man smokes a cigarette outside his home in an urban village in Jakarta, Indonesia. As part of the Universal Immunisation Programme, a public health worker administers a vaccine in a primary health center in a village in south India. All material (with the exception of the images credited above) is copyright to Forum of International Respiratory Societies and may not be reproduced in any way, including electronically, without the express permission of Forum of International Respiratory Societies. But when our lung health is impaired, nothing else but our breathing really matters. Tat is the painful reality for those sufering from lung disease, which afects people of all ages in every corner of the world. Treats to our lung health are everywhere, and they start at an early age, when we are most vulnerable. Fortunately, many of these threats are avoidable and their consequences treatable. Te purpose of this document is to inform, raise awareness and assist those who advocate for protecting and improving respiratory health. It tells of the magnitude of respiratory diseases and the threats to lung health across the globe. It is not intended to be a comprehensive textbook, but instead is a guide emphasising the diseases of greatest and immediate concern. It outlines practical approaches to combat threats to respiratory health, and proven strategies to signifcantly improve the care we provide for individuals aficted with respiratory diseases worldwide. Te document calls for improvements in healthcare policies, systems and care delivery, as well as providing direction for future research. In brief, it outlines ways to make a positive diference in the respiratory health of the world. We would like to thank everyone involved in the development of this work, especially Don Enarson and his colleagues who comprised the Writing Committee. We would also like to express our sincere appreciation to Dean Schraufnagel for his careful and expert review. We intend to update this document regularly, and seek feedback and suggestions for ways to improve it. On behalf of those sufering from respiratory disease and those who are at risk of respiratory disease in the future, we ask for your help in making a diference and a positive impact on the respiratory health of the world.

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Rosalind Moss cheap sinemet 300 mg otc symptoms zoloft, The Life After Death in Oceania and the Malay Archipelago (1925; Ann Arbor purchase 125 mg sinemet with visa medicine to stop period, Mich. Consult also the following works by James George Frazer: Man, God and Immortality (London: MacMillan, 1927); The Belief in Immortality and the Worship of the Dead, vol. Lindner, Hugo van Hqffinannstahls "Jederman" und seine Vorgnger, dissertation, Univ. See also Edelgard Dubruck, The Theme of Death in French Poetry of the Middle Ages and the Renaissance (Atlantic Highlands, N. Kurtz, The Dance of Death and the Macabre Spirit in European Literature (New York: Institute of French Studies, 1934). For the new death image of the rising middle classes of the late Middle Ages see Erna Hirsch, Tod und Jenseits im Spmittelalter: Zugleich tin Beitrag zur Kulturgeschichte des deutschen Brgertums, dissertation, Univ. Hellmut Rosenfeld, "Der Totentanz in Deutschland, Frankreich und Italien," Littrature Modeme 5 (1954): 62-80. Rosenfeld is the best introduction to the research and gives a detailed up-to-date bibliography. Clark, The Dance of Death in the Middle Ages and the Renaissance (Glasgow: Jackson, 1950). Elf, 1970): reproductions are very clear and are organized according to different themes. Consult the standard iconographies on Western Christian art: Karl Kunstle, Ikonographie der christlicher Kunst, 2 vols. Boase, Death in the Middle Ages: Mortality, Judgement and Remembrance (New York: McGraw-Hill, 1972). On the impact of time on the French death-image, see Richard Glasser, Time in French Life and Thought, trans. Klein, Die Bereitung zwn Sterben: Studim zu den evangelischen Sterbebchem des 16. For customs see Placidus Berger, "Religiser Brauchtum im Umkreis der Sterbelitur-gie in Deutschland," Zeitschrift fur Missionswissenschaft und Religionswissenschqft 5 (1948): 108-248. See also Manfred Bambeck, "Tod und Unsterblichkeit: Studien zum Lebensgefhl der franzsischen Renaissance nach dern Werke Ronsarde," ms. Eberhard Klass, Die Schilderung des Sterbens im mittelhochedeutscken Epos: Ein Beitrag zur mittelhochdeutschen Stilgeschichte, dissertation, Univ. Patch, The Other World According to Descriptions in Medieval Literature (Cambridge, Mass. Emir Rodriguez Monegal, "Death as a Key to Mexican Reality in the Works of Octavio Paz," mimeographed, Yale Univ. Albert Freybe, Das alte deutsche Leichmmahl in seiner Art und Entartung (Gtersloh: Bertelsmann, 1909), pp. Henri Rondet, "Extrme onction," in Dictionnaire de Sfriritualit (1960), 4:2189-2200. Leibowitz, "A Responsum of Maimonides Concerning the Termination of Life," Koroth (Jerusalem) 5 (September 1963): 1-2. Paul Fischer, Strafm und sichemde Massnahmen gegen Tote im germanischen und deutschen Recht (Dsseldorf: Nolte, 1936). Fehr, "Tod und Teufel im alten Recht," Zeitschrift der Savigny Stiftung fur Rechtsgeschichte 67 (1950): 50-75. Karl Knig, "Die Behandlung der Toten in Frankreich im spteren Mittelalter und zu Beginn der Neuzeit (1350-1550)," ms. Hans von Hentig, Der nekrotrope Mensch: Vom Totenglauben zur morbiden Totennhe (Stuttgart: Enke, 1964). He was only the master of his life to the extent that he was the master of his death. From the 17th century onward, one began to abdicate sole sovereignty over life, as well as over death. These matters came to be shared with the family which had previously been excluded from the serious decisions; all decisions had been made by the dying person, alone and with full knowledge of his impending death. John Koty, Die Behandlung der Alien and Kranken bet den Naturvlkem (Stuttgart: Hirschfeld, 1934). Will-Eich Peuckert, "Altenttung," in Handwrterbuch der Sage: Namens des Verbandes der Vereine fr Volkskunde (Gottingen: Vandenhoeck & Ruprecht, 1961). Infanticide remained important enough to influence population trends until the 9th century. Death remained a marginal problem in medical literature from the old Greeks until Giovanni Maria Lancisi (1654-1720) during the first decade of the eighteenth century. The same philosophers who were the minority which positively denied the survival of a soul also developed a secularized fear of hell which might threaten them if they were buried while only apparently dead. Philanthropists fighting for those in danger of apparent death founded societies dedicated to the succor of the drowning or burning, and tests were developed for making sure that they had died. Elizabeth Thomson, "The Role of the Physician in Human Societies of the 18th Century," Bulletin of the History of Medicine 37 (1963): 43-51. The hysteria about apparent death disappeared with the French Revolution as suddenly as it had appeared at the dawn of the century. Doctors began to be concerned with reanimation a century before they were employed in the hope of prolonging the life of the old, 42 Theodor W. Adorno, Minima Moralia: Refiexionm aus dan beschdigten Leben (Frankfurt am Main: Suhrkamp, 1970). Ebstein, "Die Lungenschwindsucht in der Weltliteratur," Zeitschrift fr Bcherfreunde 5 (1913). Shryock, The Development of Modem Medicine: An Interpretation of the Social and Scientific Factors Involved, 2nd ed.

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Hampton Inn

Great job, Repairs!

S. Young wants the Repair department to know that he appreciates the quick attention in taking care of the pool repair. He indicated we are always dependable and professional and he would not call anyone else.

Atlantic States Management

Praise from long-time owner

A long time owner at Mainsail told the property management that they were SUPER happy with how the fountain and Jacuzzi look!

Great Construction Staff

From Community Association Manager at Landmark 24, LLC

"I have been out at the property the last two days and I wanted to let you know that the guys working on the site have really been great. They were very helpful and accommodating..."

New Pool Owners

Very satisfied with Year Round Pool Company

"We have been very pleased with our new Year Round pool. When we were getting ready to install the pool originally, we sought several bids. Although Year Round Pool Company...."

Property Administrator, Vacation Time of Hilton Head Island, Inc.

Hats off!!

"I wanted you to know the fine work that was done by your company just recently at Twin Oaks Villas in Sea Pines...I will continue to recommend Year Round Pool Company as "The Pros!"

New Pool Owners

Great experience with new pool construction

"We wish to share with you how delighted we are with the installation of our pool...Your company's motto should be "We Do Care!"

Property Administrators, Inc. (PAI)

Words of endorsement from commercial pool client

"I have been working with Year Round Pool Company for over four years. I felt that Year Round has provided exemplary service for my communities. I would recommend this company to any management company or owner."

Year Round Pool Client

Repair Tech praised by Year Round Pool Client

Jimmy does great work, is very knowledgeable and very courteous.

Good job Jimmy!

Commercial Pool Client

Commercial Pool Client praises a Pool Cleaning Manager

Tim was awesome and a great help during the process!

Latest News

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