NEW: Cholera Treatment Workshop: Case Study Questions in Spanish

1. ¿Cuáles son las señales de deshidratación que se presentan, si hubiera alguna?

2. ¿Cuál es el grado de deshidratación?: ninguno, moderado o grave

3. Describa su plan de tratamiento para las primeras cuatro horas.

4. ¿Qué haría si este niño comenzara a vomitar?

5. ¿Qué evidencia buscaría de que este niño está bien hidratado?

6. ¿Cuándo alimentaría a este niño?  ¿Qué le daría?

7. ¿Qué antibiótico utilizaría?  ¿Cuándo lo administraría?

8. ¿Qué haría una vez que el niño esté bien hidratado?

9. ¿Cómo haría un diagnóstico de cólera en este niño?

1. ¿Cuáles son las señales de deshidratación que se presentan, si hubiera alguna?

2. ¿Cuál es el grado de deshidratación?: ninguno, moderado o grave

3. Describa su plan de tratamiento para las primeras cuatro horas.

4. ¿Qué evidencia buscaría de que este hombre está bien hidratado?

5. ¿Cuándo interrumpiría la terapia intravenosa?

6. ¿Qué antibiótico utilizaría?  ¿Cuándo lo administraría?

7. ¿Cuáles son las complicaciones a tener en cuenta en pacientes de este tipo?

View the original article here

NEW: Cholera Treatment Workshop: Case Study (Questions) in English and French

1. What signs of dehydration are present, if any?

2. What is the degree of dehydration: none, some, or severe?

3. Outline your treatment plan for the first four hours.

4. What would you do if this child started vomiting?

5. What evidence would you look for that this child was adequately hydrated?

6. When would you feed this child? What would you give?

7. What antibiotic would you use? When would you give it?

8. What would you do once the child has adequate hydration?

9. How would you make a diagnosis of cholera in this child?

1. What signs of dehydration are present, if any?

2. What is the degree of dehydration: none, some, or severe?

3. Outline your treatment plan for the first four hours.

4. What evidence would you look for that this man was adequately hydrated?

5. When would you stop IV therapy?

6. What antibiotic would you use? When would you give it?

7. What complications do you need to watch for in patients like this?

View the original article here

UPDATE: Frequently Asked Questions About the Haiti Cholera Outbreak

Beginning in mid-May, the Haitian Ministry of Health surveillance and reports from PAHO and other partners indicated an upsurge in cholera cases and deaths in some parts of Haiti. These cases have been primarily seen in the Departments of South-East, Grand-Anse, South and West. As of May 29, 2011, there have been 321,066 cases and 5,337 deaths and the cumulative case fatality rate is 1.6%.

The prevention steps are the same now as they have been since the original outbreak of cholera in Haiti in fall 2010: Drink and use safe water. Wash your hands often with soap and safe water. If no soap is available, scrub hands often with ash or sand and rinse with safe water. Use latrines or bury feces. Do not defecate in any body of water. Cook food well, keep it covered, eat it hot, and peel fruits and vegetables. Clean up safely—in the kitchen and in places where the family bathes and washes clothes. For more information see: Five Basic Cholera Prevention Messages

The outbreak of cholera was confirmed in Haiti on October 21, 2010.

Although we can’t be certain, experience from the Peru outbreak in the early 1990s and from other countries in Latin America suggests that we should expect to identify additional cases for many months to several years.

No, the current outbreak is not a result of the January 2010 earthquake. Outbreaks of epidemic cholera have not been documented in Haiti before or anywhere in the Caribbean since the mid-nineteenth century. For a cholera outbreak to occur, two conditions have to be met: (1) there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms; and (2) cholera must be present in the population. While it is unclear how cholera was introduced to Haiti, both of these conditions now exist.

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe.

Cholera infection is often mild or without symptoms, but can sometimes be severe.  In severe cases, the infected person may experience profuse watery diarrhea, vomiting, and leg cramps, which can cause rapid loss of body fluids and lead to dehydration and shock.  Without treatment, death can occur within hours.

A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates the food and/or water.  The disease can rapidly spread in areas with inadequate treatment of sewage and drinking water, such as Haiti.  However, at this time the origin of this outbreak is unknown and CDC hopes to learn more in the course of its response to this outbreak.

Person-to-person transmission is extremely rare, even to healthcare workers during epidemics. Drinking water and food contaminated with Vibrio cholerae from the feces of an infected person is the most common source of cholera infections.

Cholera can be treated by immediately replacing fluids and salts lost through diarrhea using oral rehydration solution. This solution is used throughout the world to treat diarrhea. Antibiotics may also be used to shorten the course and diminish the severity of the illness. However, they are not as important as receiving oral or intravenous rehydration therapy.

Cholera is found naturally in the environment in many areas around the world and can move from place to place via contaminated water or food, or infected people.

Cholera can be prevented by both visitors and residents of Haiti by following the Five Basic Cholera Prevention Messages:

Drink and use safe water* Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use Use safe water to brush your teeth, wash and prepare food, and to make ice Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse *Piped water sources, drinks sold in cups or bags, or ice may not be safe and should be boiled or treated with chlorine.

To be sure water is safe to drink and use: Boil it or treat it with a chlorine product or household bleach If boiling, bring your water to a complete boil for at least 1 minute To treat your water with chlorine, use one of the locally available treatment products and follow the instructions If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking Always store your treated water in a clean, covered container Wash your hands often with soap and safe water* Before you eat or prepare food Before feeding your children After using the latrine or toilet After cleaning your child’s bottom After taking care of someone ill with diarrhea * If no soap is available, scrub hands often with ash or sand and rinse with safe water. Use latrines or bury your feces (poop); do not defecate in any body of water Use latrines or other sanitation systems, like chemical toilets, to dispose of feces Wash hands with soap and safe water after defecating Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water What if I don’t have a latrine or chemical toilet? Defecate at least 30 meters away from any body of water and then bury your feces Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. Do not put plastic bags in chemical toilets Dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables* Boil it, Cook it, Peel it, or Leave it Be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through *Avoid raw foods other than fruits and vegetables you have peeled yourself. Clean up safely—in the kitchen and in places where the family bathes and washes clothes Wash yourself, your children, diapers, and clothes, 30 meters away from drinking water sources

In the United States, cholera was prevalent in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems.  However, U.S. travelers to areas with epidemic cholera (for example, parts of Africa, Asia, or Latin America) may be exposed to the cholera bacterium.  Additionally, travelers may bring contaminated seafood back to the United States, which can result in foodborne outbreaks of cholera.

At this time, CDC does not recommend cholera vaccines for travelers since their risk of contracting the disease is extremely low. For cholera vaccine to be effective, people need two doses, and it takes time for vaccinated people to become immune. Multiple weeks can elapse before they are protected following vaccination. Since most people travel for a short period of time, the vaccine is not recommended. Basic hygiene precautions should always be taken.

Information can be accessed on CDC’s Travelers’ Health Website as well as the CDC Cholera Website.

CDC, in collaboration with the US government led by USAID, is assisting the government of Haiti, PAHO and several other international health agencies in responding to the cholera outbreak. There are several laboratory tests in progress in CDC labs, including a variety of molecular tests, which will help determine the genetic connections between the bacterial isolates from the Haiti outbreak and other strains around the world. CDC will continue to gather information about outbreak strains for comparison to other known cholera strains. However, the most important goals right now are to save lives and reduce the spread of disease  in Haiti.

View the original article here

NEW: Frequently Asked Questions Haiti Cholera

Beginning in mid-May, the Haitian Ministry of Health surveillance and reports from PAHO and other partners indicated an upsurge in cholera cases and deaths in some parts of Haiti. These cases have been primarily seen in the Departments of South-East, Grand-Anse, South and West. As of May 29, 2011, there have been 321,066 cases and 5,337 deaths and the cumulative case fatality rate is 1.6%.

The prevention steps are the same now as they have been since the original outbreak of cholera in Haiti in fall 2010: Drink and use safe water. Wash your hands often with soap and safe water. If no soap is available, scrub hands often with ash or sand and rinse with safe water. Use latrines or bury feces. Do not defecate in any body of water. Cook food well, keep it covered, eat it hot, and peel fruits and vegetables. Clean up safely—in the kitchen and in places where the family bathes and washes clothes. For more information see: Five Basic Cholera Prevention Messages

The outbreak of cholera was confirmed in Haiti on October 21, 2010.

Although we can’t be certain, experience from the Peru outbreak in the early 1990s and from other countries in Latin America suggests that we should expect to identify additional cases for many months to several years.

No, the current outbreak is not a result of the January 2010 earthquake. Outbreaks of epidemic cholera have not been documented in Haiti before or anywhere in the Caribbean since the mid-nineteenth century. For a cholera outbreak to occur, two conditions have to be met: (1) there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms; and (2) cholera must be present in the population. While it is unclear how cholera was introduced to Haiti, both of these conditions now exist.

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe.

Cholera infection is often mild or without symptoms, but can sometimes be severe.  In severe cases, the infected person may experience profuse watery diarrhea, vomiting, and leg cramps, which can cause rapid loss of body fluids and lead to dehydration and shock.  Without treatment, death can occur within hours.

A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates the food and/or water.  The disease can rapidly spread in areas with inadequate treatment of sewage and drinking water, such as Haiti.  However, at this time the origin of this outbreak is unknown and CDC hopes to learn more in the course of its response to this outbreak.

Person-to-person transmission is extremely rare, even to healthcare workers during epidemics. Drinking water and food contaminated with Vibrio cholerae from the feces of an infected person is the most common source of cholera infections.

Cholera can be treated by immediately replacing fluids and salts lost through diarrhea using oral rehydration solution. This solution is used throughout the world to treat diarrhea. Antibiotics may also be used to shorten the course and diminish the severity of the illness. However, they are not as important as receiving oral or intravenous rehydration therapy.

Cholera is found naturally in the environment in many areas around the world and can move from place to place via contaminated water or food, or infected people.

Cholera can be prevented by both visitors and residents of Haiti by following the Five Basic Cholera Prevention Messages:

Drink and use safe water* Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use Use safe water to brush your teeth, wash and prepare food, and to make ice Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse *Piped water sources, drinks sold in cups or bags, or ice may not be safe and should be boiled or treated with chlorine.

To be sure water is safe to drink and use: Boil it or treat it with a chlorine product or household bleach If boiling, bring your water to a complete boil for at least 1 minute To treat your water with chlorine, use one of the locally available treatment products and follow the instructions If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking Always store your treated water in a clean, covered container Wash your hands often with soap and safe water* Before you eat or prepare food Before feeding your children After using the latrine or toilet After cleaning your child’s bottom After taking care of someone ill with diarrhea * If no soap is available, scrub hands often with ash or sand and rinse with safe water. Use latrines or bury your feces (poop); do not defecate in any body of water Use latrines or other sanitation systems, like chemical toilets, to dispose of feces Wash hands with soap and safe water after defecating Clean latrines and surfaces contaminated with feces using a solution of 1 part household bleach to 9 parts water What if I don’t have a latrine or chemical toilet? Defecate at least 30 meters away from any body of water and then bury your feces Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. Do not put plastic bags in chemical toilets Dig new latrines or temporary pit toilets at least a half-meter deep and at least 30 meters away from any body of water Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables* Boil it, Cook it, Peel it, or Leave it Be sure to cook shellfish (like crabs and crayfish) until they are very hot all the way through *Avoid raw foods other than fruits and vegetables you have peeled yourself. Clean up safely—in the kitchen and in places where the family bathes and washes clothes Wash yourself, your children, diapers, and clothes, 30 meters away from drinking water sources

In the United States, cholera was prevalent in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems.  However, U.S. travelers to areas with epidemic cholera (for example, parts of Africa, Asia, or Latin America) may be exposed to the cholera bacterium.  Additionally, travelers may bring contaminated seafood back to the United States, which can result in foodborne outbreaks of cholera.

At this time, CDC does not recommend cholera vaccines for travelers since their risk of contracting the disease is extremely low. For cholera vaccine to be effective, people need two doses, and it takes time for vaccinated people to become immune. Multiple weeks can elapse before they are protected following vaccination. Since most people travel for a short period of time, the vaccine is not recommended. Basic hygiene precautions should always be taken.

Information can be accessed on CDC’s Travelers’ Health Website as well as the CDC Cholera Website.

CDC, in collaboration with the US government led by USAID, is assisting the government of Haiti, PAHO and several other international health agencies in responding to the cholera outbreak. There are several laboratory tests in progress in CDC labs, including a variety of molecular tests, which will help determine the genetic connections between the bacterial isolates from the Haiti outbreak and other strains around the world. CDC will continue to gather information about outbreak strains for comparison to other known cholera strains. However, the most important goals right now are to save lives and reduce the spread of disease  in Haiti.

View the original article here

The Checkup: More questions about cell phone safety

Are cell phones safe? That question has gotten a lot of attention, but so far, as my colleague pointed out on Monday, there has been no convincing evidence that those ubiquitous devices actually cause health problems. However, a new federal study may stir things up further, even though the bottom line again is that it raises more questions than it answers.

For the study, Nora Volkow of the National Institutes of Health and colleagues conducted PET scans on the brains of 47 subjects throughout 2009, as they randomly held phones up to their left or right ears for 50 minutes at a time, sometimes on but muted and other times off.

The researchers found that the activity of the entire brain did not differ between when the phone was on or off. But activity in the brain region closest to the antenna, known as the orbitofrontal cortex and temporal pole, was significantly higher -- about 7 percent more active -- when the phone was on, compared to when it was off.

"The increases were significantly correlated with the estimated electromagnetic field amplitudes, both for absolute metabolism and normalized metabolism," the authors write. "These results provide evidence that the human brain is sensitive to the effects of RF-EMFs from acute cell phone exposures."

They add, however, that "these results provide no information as to their relevance regarding potential carcinogenic effects (or lack of such effects) from chronic cell phone use. Further studies are needed to assess if these effects could have potential long-term harmful consequences."

In an editorial accompanying the study, Henry Lai of the University of Washington and Lennart Hardell of University Hospital in Orebro, Sweden, said the meaning of the findings remains far from clear but "warrant further investigation."

"An important question is whether glucose metabolism in the brain would be chronically increased from regular use of a wireless phone with higher radiofrequency energy than those used in the current study. Potential acute and chronic health effects need to be clarified. Much has to be done to further investigate and understand these effects," they wrote.

The findings may indicate that other changes in brain function occur from exposure to radiofrequency emissions, they said.

"If so, this might have effects on other organs, leading to unwanted physiological responses. Further studies on biomarkers of functional brain changes from exposure to radiofrequency radiation are definitely warranted," they wrote.

View the original article here

Physical chemistry could answer many questions on fracking

The process of hydraulic fracturing involves drilling a vertical and horizontal well, which can allow the exploration of wide shale formations (up to 6,000 acres) with only a small surface pad (6 acres). Points A, B, C identify the locations for future research opportunities. Credit: Arun Yethiraj and Alberto Striolo, et al. ©2013 American Chemical Society

(Phys.org) —By some estimates, continued growth in hydraulic fracturing (or "fracking"/"fraccing") could put the US on the path to self-sufficiency in energy over the next few decades. Yet despite the potential economic benefits, fracking has also generated controversy due to the unknown long-term consequences of all the drilling, pumping, fracturing, and extracting processes involved. Now, two scientists have identified several important scientific challenges encountered in fracking that can be addressed with physical chemistry, which could lead to improved fracking techniques.

Physical chemists Arun Yethiraj, a professor at the University of Wisconsin-Madison, and Alberto Striolo, an associate professor at the University of Oklahoma in Norman, have published an overview of how physical chemistry could lead to a better understanding of fracking in a guest commentary in The Journal of Physical Chemistry Letters.

Over the past several years, fracking has become more widespread in the US as a relatively cheap way to produce natural gas and oil. The basic process involves drilling into the ground, first vertically and then horizontally; lining this well with a metal casing that contains small holes; and then pumping water (with some additives) into the well at high pressure, which flows through the holes and causes the surrounding rock to crack open. Out of the open cracks in the rock, fluids such as natural gas, oil, and about 10% of the pumped water can flow back to the well and be collected at the surface.

While fracking is currently being used with commercial success, much is still unknown about the details of the process. In 2012, the US National Science Foundation funded a workshop on hydraulic shale fracturing that brought together scientists and engineers from a variety of backgrounds. In the new commentary, Yethiraj and Striolo draw upon the information from this workshop to address the fundamental scientific problems that arise in fracking, and briefly propose how they might be solved with tools from physical chemistry.

"We attempted to outline many physical chemistry questions, to engage the broad community," Striolo told Phys.org. "Every scientist can target a question of his/her personal interest. The impact on the development of the fracking technology, however, is likely to depend on a global systemic approach, where all aspects we pointed out, and others, are tackled together."

For instance, some of the big questions in fracking require a better understanding of the physical properties of fluids in shale, which could be addressed by methods that characterize the shale microstructure and nanostructure, as well as measurements that monitor changes in rock properties upon infiltration of fluids. And since only 10% of the water that was pumped into the well flows back out, where does the rest of it go? If the water is absorbed into the shale, how does it affect the rocks' response to mechanical movement? Experimental data, computer simulations, coarse-grained models, and theoretical studies could help answer these questions.

Other questions include how much natural gas is absorbed by the porous shale, how much natural gas (and other hydrocarbons) is present in source rocks, whether these can be produced, whether fracturing fluids can be designed to reduce the amount of salt and trace metals that are extracted along with the hydrocarbons, how proppants (additives used to "prop" open the fractures) change the flow properties of the hydrocarbons, how back-flow water is treated after it flows back to the surface, how to minimize natural gas and oil leaks at the surface to avoid contaminating aquifers, and many more.

"We believe that proper fundamental investigations and attention in the application of the hydraulic fracturing technology will be able to limit the environmental impact of hydraulic fracturing," Striolo said. "Although accidents can always happen, proper planning and attention to safety and environmental regulations will limit the likelihood of such events."

Essentially every stage of the fracking process poses fundamental questions, but Yethiraj and Striolo think that physical chemists, with collaboration from researchers in other fields, are capable of providing answers.

Both scientists are currently investigating questions that could impact fracking in the future. Yethiraj and his group are developing models for water and aqueous solutions and investigating the static and dynamic properties of water-soluble polymers. Striolo has been investigating the thermodynamic and transport properties of aqueous systems confined in narrow pores. He is also participating in an international initiative (Deep Carbon Observatory https://dco.gl.ciw.edu), whose goal is to better understand the Earth's carbon cycle. The results from these areas of research could help answer some of the questions highlighted in the commentary.

More information: Arun Yethiraj and Alberto Striolo. "Fracking: What Can Physical Chemistry Offer?" The Journal of Physical Chemistry Letters. DOI: 10.1021/jz4000141e

Journal reference: Journal of Physical Chemistry Letters

Copyright 2013 Phys.org
All rights reserved. This material may not be published, broadcast, rewritten or redistributed in whole or part without the express written permission of Phys.org.

View the original article here