Ultrasonography is an blood and form urine with removal of nitrogenous important screening test in pregnant patients with substances urea and ammonium compounds treatment dynamics florham park buy epivir-hbv with mastercard, as 3 treatment lead poisoning purchase epivir-hbv visa,4 acute flank pain and in acute renal failure treatment 4th metatarsal stress fracture order epivir-hbv 100mg on line. They also get rid of excess water and salts to keep the constant There are many diseases that impair the reosmotic concentration of blood medicine 8 - love shadow discount epivir-hbv 150mg line. In obstructive uropaphologic and functional assessment of the urinary thy there is obstruction to the drainage of urine at system symptoms lung cancer quality epivir-hbv 100 mg. Other imaging techniques like ultrasonogrenal treatment emergent adverse event order epivir-hbv with a mastercard, ureteric or urinary bladder level world medicine order genuine epivir-hbv line. While in men over after injecting a water soluble medications that interact with grapefruit purchase epivir-hbv 100 mg with amex, radio-opaque con60 years, benign prostatic hyperplasia and carcitrast and pelvi-calyceal system (pyelogram) in the noma prostate are the common causes. Abdomistructive uropathy and when acute obstructive urnal /pelvic and retroperitoneal tumors, neurologiGomal Journal of Medical Sciences January-June 2010, Vol. Ultrasonographic findings of pyonephrosis is low amplitude echoes of debris in hydronephfrom abdominal pain, lump in the flank, dysurea, rotic kidney & its absence excludes pyonephrohematuria or retention of urine. Diseases Excretory function Number Diseases Excretory function Number of affected kidney (Percentof affected kidney (Percentage) age) Bilateral renal 15 Non-excretory 37 (18. Urol Clin North Am 1997; 24: 545nephrogram, then faint pyelogram and lastly fair 69. State of the art: imagnephrogram appears in late films which is persising of renal infections. The nonnor in the delayed films while in completely norfunctioning kidney in renal tuberculosis. Int Urol mal excretory renal function, nephrogram appears Nephrol 1976; 8: 189-95. The clini5-10 minutes, urogram in 15 minutes and cystocal study of genitourinary tuberculosis in east gram in 20-25 minutes. Stojadinovic M, Micic S, Milovanovic lence of stones in the kidneys and ureters are more D. Ultrasonographic and computed tomography in this region with increased number of non-excrefindings in renal suppurations: performance intory kidneys. Yilmaz S, Sindel T, Arslan G, Ozkaynak C, and post-traumatic cases, the excretory urograKaraali K, Kabaalioglu A, et al. Use of Magnetic Resonance urography versus conventional urography to study the urinary system. Obstructive uropathy as the etiology of reDera X-Ray Clinic, Faqirni Gate nal failure in ovarian hyperstimulation D. Administration for Community Living, Department of Health and Human Services, Washington, D. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. Cover photograph by Timothy Greenfield-Sanders the material contained in this book is presented for the purpose of educating and informing readers about paralysis and its effects. Nothing contained herein should be construed as medical diagnosis or treatment advice. This information should not be used in place of the advice of a physician or other qualified healthcare provider. We hope you fnd its content educational, practical and in some cases, life-changing. Special thanks to my colleagues, Reeve Foundation staf members Rebecca Sultzbaugh, Donna Valente, Christopher Bontempo and Bea Torre as well as Patricia Correa, Beth Eisenbud and Kathy McArthur of the Information Specialist team, all of whom contributed to the editing, proofreading and bulletproofng of this revision. Very special thanks to Bernadette Mauro for her thorough editing skills and fact-checking. Sincere appreciation to Leslie McCullough for writing our profles of individuals living with paralysis as well as to Brenda Patoine who updated Chapter 6. Many organizations in the disability community provided resources as we reach for the highest standards of verisimilitude. The Paralysis Resource Guide is dedicated to the memories of Christopher Reeve and Dana Morosini Reeve. Our goal is to help you find what you need to stay as healthy, as active and as independent as possible. Our founders, Christopher and Dana, understood how frightening it is to suddenly become paralyzed. Being active one day and immobile the next thrusts you into an entirely new existence. We have strong ties with many national organizations to make sure you get the most relevant and reliable information. We have resources available on travel and recreation, specialized assistive equipment and automobiles, and key information to help navigate the healthcare and insurance systems. You will find numerous listings in this book devoted to accessibility, health promotion, advocacy, research, and more. If you prefer to speak to a trained Information Specialist, please contact us by phone (toll-free 1-800-539-7309) or email (infospecialist@ChristopherReeve. Finally, and perhaps most importantly, we want you to know that paralysis is not a hopeless condition. Scientists are making steady progress in deciphering the complexities of diseases and injuries to the brain and spinal cord; we are convinced that they will succeed in developing treatments for acute and chronic paralysis. The goals of this book and of the Christopher & Dana Reeve Foundation Paralysis Resource Center are to improve the lives of millions of people living with paralysis. We offer information you can trust in order to make the best choices for a fulfilling and active life. The Reeve Foundation has over the years invested millions of dollars to support research to restore function in the damaged spinal cord. While we expect the long-term payoff of treatments and cures, we understand the day-to-day challenges of living with paralysis. We also advocate for the rights of people with disabilities; we want you to be armed with the information and knowledge you need to face the world of paralysis with the fierce determination and courage of our namesakes. But we all know there is much work ahead of us; we have yet to reach our goal of mobility, full participation and independence for all citizens. Our staff is dedicated to providing a roadmap to navigate the inevitable chaos of paralysis. The Paralysis Resource Center, formed through a cooperative agreement with the Centers for Disease Control and Prevention in 2002, offers information (in English, Spanish and other languages on demand) directly by telephone from our team of Information Specialists (toll-free 1-800539-7309), by e-mail (infospecialist@ChristopherReeve. Information Specialist Services: Our seasoned specialists, several of whom live with spinal cord injury, answer questions regarding paralysis by providing reliable information and referral to local, state, and national resources. Through interpreter services, our team can provide free information in over 150 languages. The Quality of Life program awards grants to a wide range of nonprofit organizations that offer accessible playgrounds, wheelchair sports, therapeutic riding, emergency services after natural disasters, and much more. Military and Veterans: this Reeve Foundation initiative addresses the needs of service members, whether they are paralyzed through combat-related, servicerelated, or non-service related events. We help with navigating the military and veterans systems and also with the transition back to the community. The online community enables people to connect and share solutions with others living with paralysis. The Reeve community is active, friendly and helpful, and features an expert team of contributors; the blog Life After Paralysis articulates self-reliance, resourcefulness and optimism. Motor neurons are nerve cells located in the brain, brainstem, and spinal cord that serve as control units and communication links between the nervous system and the voluntary muscles of the body. The loss of these cells causes the muscles under their control to weaken and waste away, leading to paralysis. People who opt for permanent use of a feeding tube and a ventilator after failure of swallowing and respiratory muscles can generally be kept alive for many more years. For reasons unknown, men are about one-and-a-half times more likely to have the disease than women. Riluzole is believed to minimize damage to motor neurons due to the release of the neurotransmitter glutamate. Riluzole does not reverse the damage already done to motor neurons however, and people taking the drug must be monitored for liver damage and other possible side effects. A company called Neuralstem has enrolled several dozen patients in a clinical trial testing neural stem cells; there have been no safely issues and some indication that the cells are beneficial. Arimoclomol appears to accelerate the regeneration of previously damaged nerves in animals. Early phase clinical trials have shown the drug to be safe in humans; more tests are ongoing for dose and treatment. The compounds given together appear to delay cell death, prevent nerve cell loss, and reduce inflammation. Low-impact aerobic exercise such as walking, swimming, and stationary bicycling can strengthen unaffected muscles, prevent deconditioning, improve cardiovascular health, and help patients fight fatigue and depression. Range-of-motion and stretching exercises can help prevent painful spasticity and muscle contractures (shortening of muscles, limits joint movement). Occupational therapists can suggest devices such as ramps, braces, walkers, and wheelchairs that help people conserve energy and remain mobile, while making it easier to perform activities of daily living. Indicators of deteriorating respiratory status can include difficulty breathing, especially when lying down or after meals; lethargy; drowsiness; confusion; anxiety; irritability; loss of appetite; fatigue; morning headaches; and depression. When muscles are no longer able to maintain oxygen and carbon dioxide levels, these devices may be required full-time. People are advised to make sure their fluid intake is sufficient to keep the secretions thin; some take an over-the-counter cough medicine containing the expectorant guaifenesin, a mucus thinner. It causes a tightening of muscles and a stiffening of the arms, legs, back, abdomen, or neck. Fasciculation (muscle twitching) is common, too, though these are not painful so much as annoying. Although assistive technology offers many solutions, it may be underutilized because people lack information about their options. Assistive devices range from simple call buttons and sensitive switches to small communication boards that speak pre-recorded words and messages. If a person can move nearly any body part, there is potential for some basic communication. Numerous communication devices are on the market and can be found in many home health dealers or Internet shopping sites. See pages 256-262 for more information on hands-free control of cursors for communication, entertainment, and even work. The larger the lesion, the greater the amount of pressure there is on surrounding brain or spinal cord structures. They occur in males and females of all racial or ethnic backgrounds at roughly equal rates. Other neurological symptoms may include muscle weakness or paralysis in one part of the body or loss of coordination (ataxia). A thin tube is inserted in a leg artery, threaded toward the brain, and then injected with a dye. Paralysis Resource Guide | 6 1 Arteriovenous malformations can put veins under great pressure since there are no capillaries to slow blood flow. While the risk of hemorrhage is small, the risk increases over time; treatment is usually recommended. A third treatment option is endovascular embolization, which is similar to an angiogram. A catheter is inserted into a leg artery and threaded through the body toward the affected arteries. Symptoms may include a limp or paralyzed arm and loss of muscle control or sensation in the arm, hand, or wrist. Some brachial plexus injuries may heal without treatment; many babies improve or recover by three to four months of age. Treatment for these injuries includes occupational or physical therapy and, in some cases, surgery. For avulsion (tears) and rupture injuries there is no potential for recovery unless surgical reconnection is made in a timely manner. For neuroma (scarring) and neuropraxia (stretching) injuries, the potential for recovery is encouraging; most people with neuropraxia injuries recover. Injury to the brain, whether the result of severe trauma to the skull or a closed injury in which there is no fracture or penetration, can disrupt some or all of these functions. The highest incidence is among persons 15 to 24 years of age and 75 years and older. Alcohol is associated with half of all brain injuries, either in the person causing the injury or in the injured person. People with spinal cord injury often have accompanying brain injury; this is especially true for higher cervical injuries, close to the brain. Enclosed within the bony framework of the skull, the brain is a gelatinous material that floats in cerebrospinal fluid, which acts as a shock absorber in rapid head movements. Injury to the brain can be caused by a fracture or penetration of the skull (such as a vehicle accident, fall, or gunshot wound), a disease process (including neurotoxins, infection, tumors, or metabolic abnormalities), or a closed head injury such as shaken baby syndrome or rapid acceleration/deceleration of the head. With trauma, brain damage may occur at the time of impact or may develop later due to swelling (cerebral edema) and bleeding into the brain (intracerebral hemorrhage) or bleeding around the brain (epidural or subdural hemorrhage). If the head is hit with sufficient force, the brain turns and twists on its axis (the brainstem), interrupting normal nerve pathways and causing a loss of consciousness. If this unconsciousness persists over a long period of time, the injured person is considered to be in a coma, a disruption of nerve messages going from the brainstem to the cortex. A bullet wound to the head, for example, might destroy a large area of the brain but the result may be minor if the area is not a critical one. Closed head injuries often result in more damage and extensive neurologic deficits, including partial to complete paralysis; cognitive, behavioral, and memory problems; and persistent vegetative state. However, once brain tissue is dead or destroyed, there is no evidence that new brain cells form. The process of recovery usually continues even without new cells, perhaps as other parts of the brain take over the function of the destroyed tissue. A concussion is a type of closed head injury; while most people fully recover from a concussion, there is evidence that accumulated injury to the brain, even moderate injury, causes long-term effects. Brain injury can have serious and lifelong effects on physical and mental functioning, including loss of consciousness, altered memory and/or personality, and partial or complete paralysis. Common behavioral problems include verbal and physical aggression, agitation, learning difficulties, poor self-awareness, altered sexual functioning, impulsivity, and social disinhibition. However, many problems may persist, including those related to movement, memory, attention, complex thinking, speech and language, and behavioral changes; survivors often cope with depression, anxiety, loss of self-esteem, altered personality, and, in some cases, a lack of self-awareness of their deficits. Rehab may include cognitive exercises to improve attention, memory, and executive skills. These programs are structured, systematic, goal-directed, and individualized; they involve learning, practice, and social contact. Sometimes memory books and electronic paging systems are used to improve particular functions and to compensate for deficits. Psychotherapy, an important component of a comprehensive rehabilitation program, treats depression and loss of Paralysis Resource Guide | 10 1 self-esteem.
Measurement this window allows the duration of the measurement to be defined medicine 20th century purchase epivir-hbv with mastercard, and to make multiple measurements of the same sample treatment 2015 purchase epivir-hbv uk. The Aggregation Index is used to quantify the presence of particles such as dust or aggregates within the sample treatment zinc poisoning epivir-hbv 100mg overnight delivery. The Aggregation Index parameter can be added to the Record view using the Workspace selection windows: Size parameters medicine bobblehead fallout 4 buy epivir-hbv now. Highlighting both the forward and backward measurements and selecting Expert advice will also display the Aggregation Index value treatment of lyme disease buy generic epivir-hbv 100 mg. Measurement duration the Measurement duration setting affects the accuracy and repeatability of the results medicine 10 day 2 times a day chart order epivir-hbv without prescription. With Automatic selected medicine rheumatoid arthritis purchase epivir-hbv 100mg with amex, the software automatically determines the most appropriate measurement duration 4 medications at target generic epivir-hbv 150mg mastercard. Automatic measurements will be divided into a number of runs of at least 10 seconds in length. Using Manual the time may be reduced for the measurement of a latex standard, or increased to improve the repeatability of the measurement of particularly polydisperse samples. Manual run durations can be set between 1 and 600 seconds, and the number of runs from 1 to 600. Longer measurement durations will increase the quality of data obtained and will generally give better results, as those runs that contain the poorest data will be rejected, with the remaining good runs used in the final measurement calculation. Note If repeat measurements with the Manual setting still show differences in the distribution with an increased measurement time then the sample preparation method should be reconsidered, as large particles may be disrupting the measurement. Measurements this option allows a sample to be measured more than once; to investigate the effect on particle size over time, or to prove repeatability. Add a delay between measurements in the Delay between measurements text box if required. Display the following instructionsbefore this area is useful to give details that will allow measurements to be made correctly and consistently;. Display the following instructionsafter With this check box selected post-measurement instructions can be displayed. Measurement position Positioning method Typically the measurement position that is automatically determined by the software will be appropriate for most sample measurements. In certain circumstances it may be beneficial to fix the position to reduce the total measurement time, or establish a precise cell position for subsequent measurements of the same sample. By changing the cuvette position the effect of performing a measurement at different positions within the cell can be investigated. Automatic attenuation selection this can be used to enable the count rates of two samples to be compared, or to speed up the optimization stage prior to a measurement being performed. If No is selected, a parameter appears that allows setting of the attenuator position. Size ranges and measurement thresholds can be applied to the analysis to filter spurious peaks out prior to the analysis being performed. Three Analysis Models are available General Purpose, Multiple Narrow Modes and Protein analysis. Analysis Models fi General Purpose Select this model if the characteristics of the sample to be measured are unknown. Configure button the Configure button window enables various attributes of the analysis model to be altered. These include the Name, the measured size Display range, the Analysis mode and the measurement thresholds. If it is known that all particles within the sample will fall within a certain size range, then the size Display range can be set to ignore data or artifacts at each end of the distribution. The transformations to volume and number will then ignore the data outside the set limits. Similarly lower and upper thresholds can be applied to eliminate undesired populations that are below a defined percentage of the particle population. Change the Name and Description fields in the Analysis details to reflect the new Analysis settings. Previously saved analysis models can be used, viewed and altered by pressing the Load button. Data Processing Reports the Reports window enables various reports to be selected and then printed automatically once the measurement has finished. One to enable a report to be printed after each measurement is completed and the other to print out a report after all measurements have been completed. Any reports created using Report Designer will automatically be added to this list. Data Processing Export the Export window enables the measurement results to be exported to third party software packages such as Excel or Wordpad. With the Export results check box selected measurement parameters can be defined and exported on completion of the measurement. Select the required Export template from the list; this will display the export windows described in Advanced features chapter. The parameters will be exported as a text file to the specified output filename and saved. Append to file will add the exported results to the existing file while Overwrite file will replace any previous measurement results so only the last measurement will be available. Sample Material the Zetasizer software requires certain information about the physical properties of the dispersant used. By selecting the Sample Material window and pressing the button, the Materials properties manager is displayed where these properties can be defined. Sample Solvent the Zetasizer software requires certain information about the physical properties of the dispersant that is used in the sample that is to be measured. By selecting the Sample Solvent window and pressing the button, the Solvents properties manager is displayed where these properties can be defined. By selecting the Sample Standard window and pressing the button, the Standards properties manager is displayed where these properties can be defined. The standard properties can be added, modified and deleted in the same way as detailed for the Solvent Manager above. Sample General Options Molecular weight by Static Light Scattering Input here the differential refractive index increment (dn/dc) of the solvent. This is the change in refractive index as a function of the change in concentration. Note this will require a refractometer capable of measuring to an accuracy of six decimal places. Measurement the Measurement window allows the duration of the measurement to be set, and multiple measurements of the same sample to be made. With Manual selected the measurement will use the user defined settings Shape correction model this option allows selection of the shape correction model used for the measurement. With knowledge of the sample structure it is possible to improve the result of the measurement by adding the value that most closely corresponds to the probable sample shape; i. The measurement process takes a sequence of count rate measurements, one every 20 milliseconds, for the run length specified. This automatic default will normally be 10 seconds though this may increase for lower scattering samples to help increase the accuracy. Performing only one run may not always be sufficient to achieve a good measurement of the intensity. This is because the sample scattering will normally show some systematic variations, as well as an expected random variation about a mean value. If any variations are detected that are greater than the set values, then the measurement will be repeated until a result below the thresholds is achieved. Adjusting the Variation factors will enable a percentage of these systematic variations to be ignored during the measurement process, therefore allowing a quicker measurement to be performed. The default variation factors are: fi Ratio of systematic to statistical deviation the systematic deviation should be < 0. Measurement Duration the Measurement Duration setting can affect the accuracy and repeatability of the size results. Partial Results If it is likely that a measurement will not produce a correlation function that can be analysed, then the data collected can still be saved by selecting the Allow results to be saved containing correlation data only check box within the Partial results area. This means that the measurement will continue, with no error warning, to the next measurement. Sample Material the Zetasizer software requires certain information about the physical properties of the dispersant to be used in the sample that is to be measured. By selecting the Sample Material window and pressing the button, the Material properties manager is displayed where these properties can be defined. Sample Dispersant the Zetasizer software requires certain information about the physical properties of the dispersant that is used in the sample that is to be measured. By selecting the Sample Dispersant window and pressing the button, the Dispersants manager is displayed where these properties can be defined. Sample viscosity options this area is useful for customising the viscosity parameters. Measurement this window allows the duration of the measurement to be set, and to make multiple measurements of the same sample. With Automatic selected, the software will automatically determine the measurement duration. This will be suitable for the majority of samples and can simply be left as the default. The Minimum run and Maximum run entry boxes can be used to define the run duration limits of the automatic measurement. The measurement will then complete even though the displayed run total has not been achieved. With Manual selected the measurement will use the user defined Number of runs: setting. The time may be reduced for the measurement of a latex standard, or increased to improve the repeatability of the measurement of particularly polydisperse samples. All the individual runs are accumulated and then averaged to give a final zeta potential result. Naturally the more runs selected the longer the duration of the complete measurement. However if the sample has a high conductivity, measuring for too long can affect the sample and the electrodes. Measurement Advanced In the Measurement Advanced window there are two functions: Measurement settings and voltage. Measurement settings Fixing the attenuator setting can be used to enable the count rates of two samples to be compared, or to speed up the optimization stage prior to a measurement being performed. Either set the Automatic attenuation selection parameter to Yes to use automatic settings, or No to display an extra parameter line that will allow setting of the attenuator position. Voltage the cell voltage is the voltage applied to the cell electrodes during a measurement. Data Processing If the characteristics of the sample to be measured are known, this window will allow an appropriate analysis model to be applied and so optimise the measurement calculation. Size ranges and measurement thresholds can be applied to the analysis to filter spurious peaks prior to the analysis being performed. This should be used for most measurements, especially if the sample to be measured is unknown; otherwise two additional analysis models are available General Purpose and Monomodal; or a custom analysis model can be applied (Load analysis settings. Each Analysis Model can be altered using the Configure button Please see the Help file for more information. In this mode the software will determine the most suitable type of measurement scheme to perform after measuring the sample conductivity; this is useful if the sample to be measured is unknown. In Auto mode the result will reveal details about the number of modes and the shape of the zeta potential distribution. If the conductivity exceeds 5ms/cm Auto mode will automatically select either a General purpose of Monomodal analysis see analysis models below. If the sample is thought to consist of a multi-modal distribution then 20 to 30 measurement runs should be performed. General Purpose Use this analysis model to obtain a distribution regardless of conductivity Monomodal the monomodal model only gives the mean zeta potential value required. In this case only five to ten runs maybe required to obtained an accurate measurement. This mode is recommended for time, pH and temperature trend measurements as well for samples known to have a conductivity greater than 5milliSiemens/cm. This enables a previously saved analysis model to be loaded and used for the data processing. These include the Name, the measured Zeta Display range, the Analysis model and the measurement thresholds. Note If any of the settings have been altered, the analysis model will be automatically saved under the name given in the Name entry box, or as Customised analysis settings if no name has been given. The Scattered light intensity and Hydrodynamic diameter can be plotted as a trend, and, with the addition of optional external input windows, information from external measuring sources, such as a refractive index detector, can be monitored and displayed. Start Temperature Input the temperature that the first measurement is to be made at. The instrument will initially cool, or heat, to this temperature before starting the measurement. Return to Start temperature If this check box is selected, once the Aggregation point has been determined the measurement will return to the original starting temperature defined above. Temperature Interval / Number of steps the measurement can be configured to change either in specific measurement intervals. Aggregation measurements only Check for Aggregation If the protein denaturation point is required, select the Aggregation point check box. Stop when Aggregation found If this check box is selected the measurement will stop once the Aggregation point has been determined. The additional features are: fi At Each step gives the option to control the Equilibration time and Number of measurements performed. Consider an application where a manufacturer is producing the same type of sample in different factories. It will be important that the measurement protocol is consistent between factories. The database is used for the calculation of Complex solvents; generally necessary when performing measurements involving proteins. The calculations operate using the assumption that changes in the base solvent properties will be additive. The window above shows the Solvent builder for a Complex solvent when selected for either a size dispersant or molecular weight solvent. For a zeta potential dispersant, a Dielectric increment is added to the window, with Dielectric constant replacing Refractive index in the summary area. Building a Complex solvent To generate a Complex solvent, a few sample parameters have to be entered into the builder window. The refractive index and viscosity increments will be added to the table, with the total solvent viscosity and refractive index, or dielectric constant, calculated and displayed in the Summary area. To modify a dispersant, once created, select the dispersant from the list and press the Modify. The builder will only be displayed if the solvent was originally created using the builder and not the standard Dispersant properties window Zetasizer Nano Page 9-3 Chapter 9 Advanced features Complex solvents have this icon displayed before the solvent or dispersant name in the Solvents or Dispersants Manager windows. A dispersant, or solvent, can be deleted by selecting the dispersant from the list and pressing the Delete. Note that it is not possible to modify or delete any dispersants or solvents that were specified by Malvern. This is useful for performing different measurement types consecutively without any user interaction; a playlist can be created, the Start button pressed, and the measurement will continue, performing size and zeta potential measurements in sequence with appropriate pauses, or macros. Zetasizer Nano Page 9-5 Chapter 9 Advanced features Note, that when first opened, the table on the left will normally be blank. Pastes the copied or cut action(s) to the end of the playlist Use this button to remove actions from a playlist. The list can be arranged in order as required by dragging and dropping an action at the desired point. An instruction for the parameter is displayed at the bottom of the Properties tab. When the playlist is played using the button, the Measurement display is displayed; the actions being performed can be viewed by selecting the Log sheet tab, whilst the playlist can be viewed by selecting the Player tab. All other functions are of the Measurement display are as previously described in the manual. Note It is important to ensure that the measurement cells selected in an action are compatible for all other actions in the playlist. The description or details of the selected Macro will explain what should be entered here.
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Protein-Energy Requirement Studies in Developing Countries: Results of International Research. Effects of ingested steak and infused leucine on forelimb metabolism in man and the fate of the carbon skeletons and amino groups of branched-chain amino acids. The 24-h pattern and rate of leucine oxidation, with particular reference to tracer estimates of leucine requirements in healthy adults. Validation of the tracer-balance concept with reference to leucine: 24-h intravenous tracer studies with L-[1-13C]leucine and [15N-15N]urea. Changes in total body composition during normal and diabetic pregnancy: Relation to oxygen consumption. Correlations between brain tryptophan and plasma neutral amino acid levels following food consumption in rats. Rat embryo development on human sera is related to numbers of previous spontaneous abortions and nutritional factors. Aspartate-induced neuronal necrosis in infant mice: Protective effect of carbohydrate and insulin. Resting metabolic rate and body composition of healthy Swedish women during pregnancy. Impact of supplemental lysine or tryptophan on pregnancy course and outcome in rats. Human protein requirements: the effect of variations in energy intake within the maintenance range. Protein-energy requirements of prepubertal school-age boys determined by using the nitrogen-balance response to a mixed-protein diet. Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet. Net postprandial utilization of [15N]-labeled milk protein nitrogen is influenced by diet composition in humans. Oral L-histidine fails to reduce taste and smell acuity but induces anorexia and urinary zinc excretion. Effect of oral alanine on blood beta-hydroxybutyrate and plasma glucose, insulin, free fatty acids, and growth hormone in normal and diabetic subjects. Human protein requirements: Assessment of the adequacy of the current Recommended Dietary Allowance for dietary protein in elderly men and women. Rate and amount of weight gain during adolescent pregnancy: Associations with maternal weight-for-height and birth weight. Cerebellar dysfunction, mental changes, anorexia, and taste and smell dysfunction. The effect of a histidineexcess diet on cholesterol synthesis and degradation in rats. Dimethylglycine and chemically related amines tested for mutagenicity under potential nitrosation conditions. L-Glutamine supplementation in home total parenteral nutrition patients: Stability, safety, and effects on intestinal absorption. Sweat losses by and nitrogen balance of preadolescent girls consuming three levels of dietary protein. Blood and tissue branched-chain amino and -keto acid concentrations: Effect of diet, starvation, and disease. Long-term toxicity/carcinogenicity study of L-histidine monohydrochloride in F344 rats. ProteinEnergy Requirement Studies in Developing Countries: Results of International Research. Protein requirements of Filipino children 20 to 29 months old consuming local diets. Hormonal and dietary regulation of lysosomal cysteine proteinases in liver under gluconeogenesis conditions. Effects of dietary protein content and glucagon administration on tyrosine metabolism and tyrosine toxicity in the rat. A study of growth hormone release in man after oral administration of amino acids. Indices of protein metabolism in term infants fed either human milk or formulas with reduced protein concentration and various whey/casein ratios. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. A morphological study of the acute toxicity of L-cysteine on the retina of young rats. Susceptibility of the cysteine-rich N-terminal and C-terminal ends of rat intestinal mucin Muc 2 to proteolytic cleavage. The proportionality of glutaminase content to growth rate and morphology of rat neoplasms. Oral and intravenous tracer protocols of the indicator amino acid oxidation method provide the same estimate of the lysine requirement in healthy men. Lysine requirements of healthy adult Indian subjects receiving long-term feeding, measured with a 24-h indicator amino acid oxidation and balance technique. Threonine requirements of healthy Indian adults, measured by a 24-h indicator amino acid oxidation and balance technique. Effect of an oral tryptophan/carbohydrate load on tryptophan, large neutral amino acid, and serotonin and 5-hydroxyindoleacetic acid levels in monkey brain. Is increased dietary protein necessary or beneficial for individuals with a physically active lifestylefi Long-term oral branched-chain amino acid treatment in chronic hepatic encephalopathy. Nutritional value of [15N]-soy protein isolate assessed from ileal digestibility and postprandial protein utilization in humans. The effects of excess amino acids on maintenance of pregnancy and fetal growth in rats. The effects of oral administration of salts of aspartic acid on the metabolic response to prolonged exhausting exercise in man. Prolonged meat diets with a study of the metabolism of nitrogen, calcium and phosphorus. Plasma tyrosine in normal humans: Effects of oral tyrosine and protein-containing meals. Dietary protein requirements and body protein metabolism in endurance-trained men. Incorporation of urea and ammonia nitrogen into ileal and fecal microbial proteins and plasma free amino acids in normal men and ileostomates. The nutritional value of plant-based diets in relation to human amino acid and protein requirements. Lysine prophylaxis in recurrent herpes simplex labialis: A double-blind, controlled crossover study. Visual disturbances, serum glycine levels and transurethral resection of the prostate. The contribution of phenylalanine to tyrosine in vivo: Studies in the post-absorptive and phenylalanine-loaded rat. Effect of excess levels of individual amino acids on growth of rats fed casein diets. Amino acid requirements of children: Minimal needs of lysine and methionine based on nitrogen balance method. The metabolism of 14C-labelled essential amino acids given by intragastric or intravenous infusion to rats on normal and proteinfree diets.
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However this does not mean that every result obtained from a suite of samples of treated S/S material must individually meet this criterion medicine 20th century purchase generic epivir-hbv, in order to meet the treatment goal medicine joint pain order epivir-hbv once a day. Variability this small is likely to be exceeded given all the possible factors affecting the test result medicine 831 generic epivir-hbv 100 mg free shipping, and would not necessarily indicate remedy failure symptoms type 1 diabetes buy epivir-hbv online from canada. Hence micro non-homogeneity symptoms of colon cancer purchase epivir-hbv 150 mg without prescription, unimportant in the large monolith treatment centers for depression generic epivir-hbv 150mg with visa, impacted the laboratory result treatment 0 rapid linear progression buy generic epivir-hbv 150 mg on-line. An example of what is considered normal variation in physical properties is illustrated in Table 6 symptoms tonsillitis order genuine epivir-hbv online. More information about the successful remediation of this site contaminated with creosote, pentachlorophenol and dioxins is available in Bates (2002). Acceptable ranges for variation from target values are often stated in remediation contracts. Development of acceptable, but pragmatic, ranges for variations should be developed during design with input from the key stakeholders in the project. Performance specifications are often written to include a value to be achieved after 28 days of curing, or longer. However, it is desirable to conduct early testing so as to recognise impending failure. One of the best methods is to compare the values being obtained during the early stages of remediation against those achieved during the bench or pilot-scale treatability study. For example, the strength of performance samples at 7 days of age can be directly compared with the 7 day data recorded by the treatability samples. Once a significant database has been built using performance samples from the remediation, then this replaces reliance on the treatability database as the template for comparison. The best approach is to place substantial emphasis on construction quality control and on early detection of any treatment problems. With some remedial technologies, it is possible to re-treat material that is considered to have failed. However for S/S, re-treatment is often not viable, especially if leaching was one of the performance criteria, because S/S processes usually employ cement or other alkaline reagents and these binders will have irreversibly changed the properties of the soils, especially with respect to pH. As the solubility of many metals (and some organics) are pH dependent, retreatment, with the addition of more alkaline reagents, may cause the soil to exhibit increasing leaching of, for example, amphoteric metals like Pb and As. If however there are no concerns with leaching criteria, and the failure is one of strength or permeability, it may be possible to re-treat the material. However, even in these cases, the re-treatment formula likely will need to be changed from the original formula and designed to treat the cause of failure. This may require a new benchscale treatability study and a consequent delay in completing the remedial action. As mentioned, factors inducing erroneous data include sample cracking, poor compaction, and the inclusion of debris. Thus, an investigation of the laboratory test procedures used, the quality of samples tested, record keeping, and calculations used, especially dilution factors applied during leachate analysis, is necessary. Then one may have the laboratory undertake repeat testing, using reserve replicate samples that have been kept for such eventualities. For example, if the permeability specification is that the average of all treated material -6 -8 should be fi 1 x 10 cm/sec (fi 1 x 10 m/sec) and that no single sample exceed 1 x -5 -7 -5 -7 10 cm/sec (1 x 10 m/sec), then a sample reporting 2 x 10 cm/sec (2 x 10 m/sec) is outside the specifications and a failure. If, however, it is located on the edge of the monolith, it may be more significant. Thus position may weigh into the decision regarding whether to take an action, considering that it may be necessary to rip out a lot of good treated material to reach a piece that is slightly off-spec. The off-spec material could be removed and retreated, but note earlier discussion regarding potential difficulty in retreating. With either of these options, it may be necessary to remove and manage a significant amount of treated material that does meet specifications, to gain access to the target material. In this case, an alternative option is to leave the material where it is, but take a compensating action. If the treated but failed material is readily accessible then one should examine the S/S material before beginning expensive or difficult removal and/or retreatment options. Sometimes the bulk treated material may prove to be within specification, and it was the performance samples that were not representative. The S/S-treated material was accessible and field inspection revealed that some of the material was out of specification, leading to removal and retreatment. However it was also found that a significant portion appeared well cemented and within specification. This material was tested in place using a field cone penetrometer to measure penetration resistance as a surrogate for compressive strength (Figure 6. Although unconfined compressive strength in the laboratory and penetration resistance/compressive strength in-place in the field, are not directly comparable, the in-place strength results were sufficiently impressive, that it was agreed that this material did not require removal and retreatment. Likewise if the performance sample failure had been of a leaching nature, samples from the actual field placed material could have been obtained and tested. Performance samples indicated that the top parts of a small number of columns (out of the hundreds treated) did not meet requirements for strength. Since the tops of these columns were accessible, it was decided to excavate the suspect columns until obviously well cemented competent material was encountered, then retreat and replace the poor quality material (Figure 6. If performance samples do indicate a failure, the use of reserve samples to verify the result, augmented by field investigation of the affected material, is encouraged. It has also been tried in order to conduct evaluations of in-place treated material several years after the remediation. However, this approach can introduce significant bias in the results obtained, and is not recommend, except in special circumstances. The physical aspect of cutting a core can introduce micro-fractures that increase and may invalidate permeability testing results. Furthermore, if during the coring water is used as a lubricant and coolant, then the core will be pre-leached before recovery. If coring is dry, then substantial heat is generated which adversely affects the core properties. This is partly due to the fact that S/S soils generally are weakly cemented materials with typically 2 to 10 % of the strength of structural concrete. To date the majority of available guidance emphasises the technical aspects of S/S technology and appropriateness for use at a given site and waste/contaminant types. The process of developing and implementing performance specifications for S/S begins with setting site remedial goals. The remedial goals are intended to address the impacted media, risk pathways and exposure endpoints. The role of S/S is site-specific, ranging from a sole technology (single treatment option) to a component of an overall remedial strategy/treatment train. Examples of the way S/S has been utilised include: fi Ex-situ S/S combined with a composite surface cap and a perimeter slurry wall as a source control to limit mass flux of a mixed-contaminant site. Some of these sites used S/S as the sole remedy to manage impacted soil and groundwater, while others included additional components, such as covers. By way of example, at sites where the source material is accessible for treatment, S/S can be the primary remedial remedy. Here, a source term defined from leaching tests coupled with a groundwater transport model can verify that the (groundwater-related) remedial goals can be achieved by S/S alone. At other sites where the contaminated material is not completely accessible, S/S may be used as a containment system, whilst recognising that some groundwater treatment may be necessary. In this scenario, a groundwater model and a detailed leaching evaluation may not be necessary, as the impacted groundwater will be managed by other technologies. However, when using S/S in a treatment train, it is important to consider compatibility between different technologies. For example, if the raising of groundwater pH may result from S/S, the effect of this change on downgradient treatment design. Examples of material performance goals include: fi A bearing capacity to support overlying soil cover, structures, or equipment fi Chemical treatment of contaminants to achieve lower soluble species and limit mass flux to groundwater. The material performance goals will be used to identify the material performance specifications which will include the performance parameters to be evaluated, the performance tests to be conducted, and a preliminary set of performance criteria. As various mix designs are developed and evaluated and the performance tests (and other material property tests as desired) are performed, it may not always be possible to achieve the performance criteria. The cost and availability of reagents is often taken into account during the choice of mix designs selected for testing to assure that the formulas tested are economically viable for full-scale treatment. Failure of economically viable formulations to fully achieve the desired property does not have to mean that the treatability testing has failed, or that S/S will not work for the site, rather this may be a point in the treatability testing where the material performance goals and how S/S fits into the overall remedial strategy are re-evaluated. The material performance specifications developed in conjunction with the treatability testing will ensure that the S/S mix design achieves the material performance goals. However, the testing of cured specimens must recognise that under some circumstances extended curing times beyond 28 days are appropriate, especially where contaminated sediments and other contaminated materials require treatment. The concept of testing materials at 28 days of cure time comes from the concrete industry where it has important construction considerations, but during S/S, this time limit does not fully account for development of desirable properties. Under some circumstances, therefore, the performance evaluation should take many months. Under these (or changed) circumstances, the tests to be used may differ from the material performance specifications developed during the treatability testing. By way of example, the evaluation of the strength development during the treatability study will allow for shorter specimen-cure times in the field. Although the plot shows some variability in pilot-test data (compared to the bench testing), the data was used to make periodic adjustments to the quantity of reagents applied at the particular site in question. For the evaluation of leaching, it is often not practical to perform leaching tests to monitor construction progress and compliance with the performance specifications. In some cases, therefore, strength and permeability are used to demonstrate consistency with the data obtained from treatability testing, with the leaching evaluation being undertaken later. In other cases, batch leach test or a single-point test at a relatively short curing time. However, it is critical that shorter-duration performance tests also be evaluated during bench-scale testing (Section 8. The level of detail required is however, sitespecific and dependent on the regulatory setting. Following the detailed analysis and risk assessment of the site to be treated, the remedial action objectives can be formulated. Then one can identify what technologies should be considered (and how they should be used) and the remedial goals for the site can be determined (see Section 7. An important consideration at this stage is the assessment of site geology and hydrogeology, contaminant-related factors, and the limitations of remedial technology options to meet the remedial targets identified. Alternate remedial strategies for complex sites where restoration is technically impracticable or cost prohibitive, may include actions such as exposure control (through institutional controls), source control by removal, treatment, or containment, and where practicable, groundwater restoration by in-situ or ex-situ treatment or natural attenuation. S/S can be used as a stand-alone remedy or in combination with other remedial actions (see Section 7. In addition, the method of S/S implementation will have limitations that may be due to soil type. These parameters are derived from the material performance goals established for a site, and can be grouped as follows: 226 Table 7. Design fi Unit Weight fi Some physical characteristics such as cobbles and Investigation boulders, significant debris content, and very dense soils fi Debris content may eliminate in-situ S/S from consideration. Groundwater Investigation, fi pH fi Additives may be required to overcome interference Geochemistry Treatability fi Sulfate mechanisms. Study fi Other cement hydration interference parameters fi Ettringite (a form of calcium aluminum sulfate) formation due as needed to high sulfate concentration causing excessive swell. Grout rheology may need to be fi Contaminant concentrations and mass released modified to reduce mixing shear resistance. Water Table Depth Site Investigation fi Water Table depth and seasonal variability fi Amount of water available for cement hydration affects grout fi Vadose zone and/or saturated zone contaminant design. Hydrogeology Site Investigation fi Geologic strata including geometry of geologic fi Affects contaminant distribution and accumulation zones. Infrastructure Investigation, industrial, commercial, etc) fi Active infrastructure and/or buildings can limit accessibility Feasibility Study, fi Site access to impacted soils. Remedial Design fi Ability to impose institutional controls fi Buried remnant structures and utilities may require fi Site ownership demolition and removal prior to S/S. Remedial Design risk fi Severity of the risk fi Ability to implement engineering and/or land use controls fi Remedial action objectives Aquifer/Waterbody Site Investigation fi Regulatory classification of groundwater and fi Affects remedial goals, clean-up criteria, and determination Status surface waters of practicability to achieve clean-up criteria 230 fi Environmental performance. Strength: Strength is the ability of the treated material to withstand an applied load. For S/S materials, strength may be used to assess suitability for placement of ex-situ treated material in a defined disposal area. Portland cement), and water has occurred and has not been subject to significant interference by the waste constituents or other site-specific geochemical reactions. Strength can also be used as a surrogate measure of durability, considering that, in general, it would be expected that higher strength materials would be more resistant to deterioration over time. Hydraulic conductivity: Hydraulic conductivity provides a measure of how easily water can pass through a material. Leachability: Leachability is the materials ability to release a contaminant from a solid phase into a contacting liquid. The leachability of S/S materials can be influenced by contact with an eluent and the chemical reactions involving the S/S binders, and contaminant solubility. Leaching into groundwater is a principal pathway for contaminant release into the environment, and is the key target parameter addressed by S/S. Two categories of assessment testing that are considered in S/S (Cajun and Shi [2005]) are: fi Basic information or index tests, which measure fundamental material properties such as gradation, moisture content, dry density, plasticity, contaminant concentrations, etc. When chemical stabilization is the only desired treatment, curing and testing of physical properties such as strength and hydraulic conductivity may not be necessary. In either scenario, the S/S material should be able to support the loads that will be present after treatment, whether as overlying soil/cover, or future construction or structures. A minimum strength value should be selected based on the anticipated loads the treated material will encounter where it is created or placed and to demonstrate if it is 232 a desired property that the solidification reactions occurred. In some situations, post S/S construction may require driving piles through treated material, in which case a maximum strength may be desirable. Also in some cases a much lower strength may be acceptable based upon site-specific considerations. Typical hydraulic conductivities of -4 -8 -6 solidified soils range from 1x10 cm/sec to 1x10 cm/sec (1x10 m/sec to -10 1x10 m/sec), comparable to that of clay materials. For -5 -6 many sites, a hydraulic conductivity criteria of 1x10 cm/sec to 1x10 cm/sec -7 -8 (1x10 m/sec to 1x10 m/sec) is used. In Europe this is often site-specific: leachability and permeability are combined in a model, as the effects of both influence the mobility of the pollutant. Sometimes very low permeabilities (< -7 -9 10 cm/s or <10 m/s) are specified to compensate for the leaching potential of a pollutant. Leachability: Leachability tests are typically performed on solidified or stabilized materials to evaluate mass transfer from a solid to a liquid. Extraction-based or equilibrium tests evaluate the mass of material that can be leached under a specific set of test conditions. Mass transfer, or flux-based testing, evaluates the rate of leaching over time from a mass or surface area of treated materials. In Europe various leaching protocols exist, based on granular or crushed samples, or based on monolithic samples (diffusion testing).
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