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Within the general population, data were focused on cardiovascular risk factors and diabetic or prediabetic conditions as well as reproductive and developmental endpoints. These outcomes were selected either because of the availability of studies in a variety of settings with some indications of effects. Summary tables are included to support evaluation of the weight of evidence and facilitate comparison of the serum concentrations in the epidemiology studies to those in the animals studies summarized in section 3. The sample size in the highest category ranged from 11 to 15 in the three examination years. The workers (n = 53 males, 20­63 years of age) participated in the medical surveillance program yearly from 1978 to 2007. In 2007, 37 males were active workers and 16 males were retired or had transferred to other departments and were no longer being exposed. This analysis included 175 male employees with data from 2000 and at least one of the other survey dates. Finally, mean serum levels for the group sampled in 1995, 1997, and 2000 (n = 41) were 1. Information on lipid-lowering medications and alcohol intake by the participants was not available. Antwerp, Cottage Grove, Decatur combined; 50-65% participation rate n = 506 (men, not taking lipid-lowering medications) Mean age: 40 yrs Mean duration: not reported Linear regression, adjusted [Related reference: Olsen et al. For the workers, yearly serum estimates were modeled from work history information and job-specific concentrations. The population (n = 860) included persons aged 20­80 years with no missing covariate information who were not pregnant, breast-feeding, taking insulin or cholesterol medicine, or undergoing dialysis. Data for covariates predicting cholesterol and body weight including age, gender, race/ethnicity, socioeconomic status, saturated fat intake, exercise, alcohol consumption at 20 years of age, smoking, and parity were obtained from the questionnaires. This cross-sectional study included 663 males and 90 females aged 50­65 years who were enrolled in the Danish Diet, Cancer and Health cohort. This population-based sample included 2,700 participants aged 18­74 years (~50% male) in the Canadian Health Measures Survey. The interpretation of these general population results is limited, however, by the moderately strong correlations (Spearman r > 0. These studies are limited by the reliance on mortality (rather than incidence) data, which can result in a substantial degree of under ascertainment and misclassification. When measurements for all years were combined in longitudinal analyses (Olsen et al. The regression models did not adjust for alcohol consumption, a potential limitation. The most recent update of disease incidence in the workers identified 35 cases of nonhepatitis liver disease (with medical validation) (Steenland et al. Studies examining measures of kidney function are described in this section and summarized in Table 3-5. The most recent update of incidence of chronic kidney disease in the workers in the C8 West Virginia community identified 43 cases (with medical validation) (Steenland et al. Two other studies, described below, examined reported history of colds and gastroenteritis in children up to age 3 years (Granum et al. A prevaccination serum sample was collected at the time of vaccination and the postvaccination serum sample was collected 21 ± 3 days later. The effects of prenatal exposure to perfluorinated compounds on vaccination responses and clinical health outcomes in early childhood were investigated in a subcohort of the Norwegian Mother and Child Cohort Study (Granum et al. Antibody titers specific to measles, rubella, tetanus, and influenza were measured as these vaccines are part of the Norwegian Childhood Vaccination Program. In summary, three studies have reported decreases in response to one or more vaccines. Between 2009 and 2010, asthmatic children were recruited from two hospitals in Northern Taiwan, while the controls were part of a cohort population in seven public schools in Northern Taiwan. Serum was collected for measurement of 10 perfluorinated compounds, absolute eosinophil counts, total IgE, and eosinophilic cationic protein. Associations of perflourinated compound quartiles with concentrations of immunological markers and asthma outcomes were estimated using multivariable regression models.

Since they are waterborne they can easily be deposited on surfaces by well-known processes such as coating, spraying, saturation or wet end deposition. Active Ingredient Carrier Polymer Approach Antimicrobial Polymer Emulsions the traditional biocidal agents often are lost over time due to leaching or degradation of the film. Recently, driven by the European Biocides Directive, many of these traditional biocides are coming under greater scrutiny regarding their potential affect on the environment. There is also concern regarding the ability of microorganisms to easily adapt to the additives used and build resistance over time. The result is a growing need for alternative solutions that provide sustainable antimicrobial protection while minimizing many of the potential issues related to the use of conventional additives. There is new, recently developed antimicrobial technology that offers unique ways to mitigate the effects of microbes on products. Unlike conventional active ingredients, the technology relies on antimicrobial polymers that either have inherent antimicrobial characteristics, or incorporate a conventional antimicrobial additive encapsulated or embedded into a polymer. Since the active ingredient, or part of the molecule that is primarily responsible for the antimicrobial action, is attached to a polymer or uniformly embedded into the polymer at a nanoscopic level, these materials provide a more sustained and effective antimicrobial action over time. In addition to the antimicrobial action, these same materials can provide polymer-related attributes such as binding, adhesion, barrier and bonding properties that conventional antimicrobial additives cannot. Waterborne polymers are useful in applications where an additive is desirable, and would allow formulators to design sustainable solutions without many of the handling and durability issues related to the conventional additive approach. These technologies present real value to customers interested in providing the multifunctional benefits derived from a polymer that has inherent or embedded antimicrobial characteristics. The silver ions exchange with other ions (counter ions) that may be present in nutrients or moisture and in this manner are transported to areas that support microbial growth. The antimicrobial properties of the silver ion have been recognized for a long time. If applied to doorknobs or other surfaces where germs tend to accumulate, the new substance could help fight the spread of the flu. The "antimicrobial paint," which can be sprayed or brushed onto surfaces, consists of spiky polymers that poke holes in the membranes that surround influenza viruses. The researchers observed a more than 10,000-fold drop in the number of viruses on surfaces coated with the substance. The polymers are also effective against many types of bacteria, including human pathogens Escherichia coli and Staphylococcus aureus, deadly strains of which are often resistant to antibiotics. The new coating acts in a very different way from the many antibacterial products ­ such as soaps, sponges, cutting boards, pillows, mattresses and even toys ­ that are now on the market. Those products kill bacteria but not viruses and depend on a timed release of antibiotics, heavy metal ions or other biocides. With this type of polymeric architecture it is highly unlikely that bacteria will develop resistance because it would be difficult for bacteria to evolve a way to stop the polymer spikes from tearing holes in their membranes. Repeated testing thus far suggests that the microbes are not becoming resistant and the polymer coating is 99% effective. Once the polymer coating is applied to a surface, it should last about as long as a regular coat of paint. Silver Plus Benzisothiazoline the combination of silver or silver with benzisothiazoline gives a new and very effective preservative system. By using this combination, the amount of sensitizing benzisothiazoline can be significantly reduced and, if an excess of benzisothiazoline is used, the well-known photosensitivity of silver compounds is reduced. This combination is a highly effective and safe new preservative system for coatings. It can be incorporated into aqueous and polar organic solventborne coatings, powder coatings and injection-molded plastics. The dispersible powders are highly concentrated, silver-containing antimicrobial additives made with proprietary stabilizers, and deliverable as powders or pre-dissolved dispersions. The dispersed additives release silver ions when in contact with moisture, inhibiting the growth of microbes. The effectiveness of silver products is based on the slow and continuous leaching of superfine silver ions that interact with the metabolism of microorganisms.

Periodic additional excessive amounts of phencyclidine may produce toxic psychotic episodes or intense isolation and loss of body control which is very frightening to users and often stimulates fantasies of dying or remaining permanently dysphoric. Increased irritability and belligerence is a common finding in patients with chronic organic brain disorders (Fauman and Fauman 1977). Our study also suggests that many phencyclidine users have difficulty tolerating anxiety and depression or common stresses of daily life. The Prolonged Phencyclidine Psychosis Before we undertook this study, it was our impression that phencyclidine regularly caused prolonged psychotic reactions (Fauman et al. These reactions typically are present as bizarre behavior, with confusion and agitation: the patient may be mute and staring, 196 and unresponsive to painful stimuli. In some cases, the patient is also violent or aggressive, particularly when s/he feels threatened. These symptoms persist for several days to two weeks before beginning to remit, and may take an additional four weeks to clear. As an increasing number and range of reactions came to our attention from our emergency department and in consultation with other hospitals, most of which did not fit our description of the psychosis we had seen initially, it began to appear that the reactions were dose dependent. Most authors suggested that there was an idiosyncratic propensity in those people who developed psychoses. He felt that these patients represented a part of a continuum between normals and schizophrenics. It appears that the prolonged phencyclidine psychosis may be the most dramatic effect of the drug and the one most likely to come to medical attention. The Direction of Future Investigation and Treatment It should be realized that there are two distinct aspects of phencyclidine abuse. Equally important is the type of personality problem which leads 197 individuals to use drugs like phencyclidine. In addition, the serious effects of phencyclidine should continue to be publicized. Second, there should be more investigation and attempts at treatment of the underlying personality problem that leads to abuse of drugs like phencyclidine. Finally, there should be an active monitoring of the polydrug abuse population for early detection of new drugs with a potential for abuse. Hospital emergency departments should be alerted to these drugs, and methods of treatment for the side effects and over-dosage developed and quickly disseminated to treatment centers. This study was conducted in December 1977 - January 1978, at the Crossroads Youth Program, 7400 West 183rd Street, Tinley Park, Illinois 60477. Assistant Professor, Emergency Medicine and Department of Psychiatry University of Chicago Hospitals and Clinics 950 East 59th street Chicago, Illinois 60637 200 Chapter 10 Phenomenological Aspects of Phencyclidine Abuse Among Ethnic Groups in Hawaii Anthony J. The Hawaii Job Corps this discussion of phencyclidine is based on our experiences as Director of Mental Health Services and Director of Medical Services for the Hawaii Job Corps, a Federally-funded residential program to provide educational and vocational training for high school dropouts between the ages of 16 and 21. The Hawaii Job corps in Honolulu has about 220 enrollees (55 females, 165 males) who reside in four dormitories. They are followed in number by Guamanians, Samoans, Caucasians (mainly armed service dependents), Filipinos, and a few Korean and Vietnamese immigrants. When the drug is smoked, the user spreads the phencyclidine over marihuana, parsley, mint, or tea. The users we have spoken with stated that the "hit" time ranges from five to twenty minutes. Snorting results in a faster action, and, in the opinion of some individuals, it produces more side effects than smoking. This amount sells for around $10 to $15 in Honolulu and is enough for five users or "hits. However, based on the comments of the Job Corps users, we are inclined to conclude that the highest frequency of use is among preteen and teen Hawaiian youth ("locals"). Although the Caucasian youths use it, "T" does not seem to have much popularity among them. The high frequency of phencyclidine use among "locals" as opposed to other groups raises some important questions about the reason for this state of affairs.

Right ventricular hypertrophy indicates elevated right ventricular systolic pressure paralleling the pulmonary arterial pressure level. Biventricular enlargement/hypertrophy exists in patients with a large volume of pulmonary blood flow and pulmonary hypertension due to a large defect. Isolated right ventricular hypertrophy and right-axis deviation occur in patients with pulmonary hypertension related to increased pulmonary vascular resistance of any cause. The increased pulmonary vascular resistance limits pulmonary blood flow, and therefore a pattern of left ventricular hypertrophy is absent. The radiographic appearance of the heart varies according to the magnitude of the shunt and the level of pulmonary arterial pressure. Ranging from normal to markedly enlarged, the size varies directly with the magnitude of the shunt. The cardiac enlargement results from enlargement of both the left atrium and the left ventricle from the increased flow. The left atrium is a particularly valuable indicator of pulmonary blood flow because this chamber is easily assessed on a lateral projection. By itself the right ventricular hypertrophy does not contribute to cardiac enlargement. The lateral view shows left atrial enlargement, outlined by barium within the esophagus. Summary of clinical findings the primary finding of ventricular septal defect is a pansystolic murmur along the left sternal border. The secondary features of ventricular septal defect reflect the components of the equation P = R Ч Q. The pulmonary arterial pressure (P) is indicated by the loudness of the pulmonary component of the second heart sound and by the degree of right ventricular hypertrophy on the electrocardiogram. Pulmonary blood flow (Q) is indicated by a history of congestive cardiac failure, an apical diastolic murmur, left ventricular hypertrophy on the electrocardiogram, cardiomegaly, and left atrial enlargement on chest X-ray. Natural history An uncorrected large ventricular septal defect may follow one of three clinical courses. The initiating factors for the development of medial hypertrophy and later intimal proliferation are unknown, but they are probably related to the arterioles being subjected to high levels of pressure and, to a lesser extent, to elevated blood flow. The pulmonary arteriolar changes can develop in pulmonary arterioles of children as young as 1 year of age. The early changes of medial hypertrophy are generally reversible if the ventricular septal defect is closed, but the intimal changes are permanent. The pathologic changes of the pulmonary arterioles usually progress unless the course is interrupted by operation. Children with Down syndrome appear to develop irreversible (or, if reversible, a more reactive and problematic) elevation of pulmonary vascular resistance within the first 6 months of life. The result of these pulmonary arteriolar changes is progressive elevation of pulmonary vascular resistance (Figure 4. The pulmonary arterial pressure does not increase, but instead remains constant because the ventricles are in free communication. Eventually, the pulmonary vascular resistance may exceed systemic vascular resistance, at which time the shunt becomes right-to-left through the defect and cyanosis develops (Eisenmenger syndrome). Those features reflecting elevated pulmonary arterial pressure, right ventricular hypertrophy, and loudness of the pulmonary component remain constant, whereas those reflecting pulmonary blood flow change (Figure 4. The clinical findings reflecting the excessive flow through the left side of the heart gradually disappear. Congestive cardiac failure lessens, the diastolic murmur fades, the electrocardiogram no longer shows the left ventricular hypertrophy, and the cardiac size becomes smaller on a chest X-ray. The heart size eventually becomes normal when the total volume of blood flow is normal. For many patients with cardiac disease, the disappearance of congestive cardiac failure and the presence of a normal heart size are favorable; but in a large ventricular septal defect the changes are ominous. In certain patients with a large ventricular septal defect, infundibular stenosis develops and progressively narrows the right ventricular outflow tract. The stenotic area presents a major resistance to outflow to the lungs; the pulmonary vascular resistance is often normal (Figure 4.