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Finally medicine x xtreme pastillas generic topiramate 100 mg, consider how the laboratory would manage after a fire and implement plans for facilitating continuity of operations medications list discount topiramate amex. Having purchasing records readily available can make a difference in how long it takes for insurance claims to be processed medicine university buy topiramate amex. The laboratory did not have a sprinkler system symptoms 6 weeks pregnant discount topiramate 200mg without a prescription, which would have reduced the magnitude of the damage. However, the laboratory had planned for such an occurrence and the immediate availability of purchasing records facilitated the insurance claim. The laboratory manager had backup plans and had a temporary but fully functional laboratory operating in 3 days. It took more than a year to renovate the burned laboratory but the services were disrupted for less than 1 week. However, because the plans are rarely implemented, it is even more important to have drills and/ or exercises that allow laboratory personnel to simulate their response. Prudent practice coordinates the testing of the system with a drill that exercises the appropriate response. By sounding the alarm and expecting everyone to evacuate, one can uncover problems with the planning. Drills and exercises may be full scale, where individuals are expected to carry out the responsibilities and procedures; tabletop exercises, where individuals discuss their response but do not physically respond; or a combination of both. Prudent practice establishes good communication with these responders before they are expected to respond to an emergency. You can facilitate this by · inviting responders to the facility for a tour of the areas of most concern; · providing information about areas of higher risk for a fire, spill, or other emergency; · providing maps and other tools to help them navigate the facility and familiarize themselves with the location of laboratory buildings or special facilities; · informing emergency responders and local hospitals of the use of chemicals that present unusual hazards; and · having chemical inventories accessible remotely through a password-protected system or file, which allows emergency responders to have an idea of what could be in the laboratory or building before they enter. It may be necessary to use existing laboratories or furnish a temporary laboratory in order to continue operations. Prudent Practices in the Laboratory: Handling and Management of Chemical Hazards, Updated Version 4 Evaluating Hazards and Assessing Risks in the Laboratory 4. Prudent Practices in the Laboratory: Handling and Management of Chemical Hazards, Updated Version 46 4. This chapter provides a practical guide for the trained laboratory personnel engaged in these activities. B introduces the sources of information for data on toxic, flammable, reactive, and explosive chemical substances. C discusses the toxic effects of laboratory chemicals by first presenting the basic principles that form the foundation for evaluating hazards for toxic substances. The remainder of this section describes how trained laboratory personnel can use this understanding and the sources of information to assess the risks associated with potential hazards of chemical substances and then to select the appropriate level of laboratory practice as discussed in Chapter 4. E present guidelines for evaluating hazards associated with the use of flammable, reactive, and explosive substances and physical hazards, respectively. Finally, nanomaterials, biohazards, and radioactivity hazards are discussed briefly in sections 4. The primary responsibility for proper hazard evaluations and risk assessments lies with the person performing the experiment. The actual evaluations and assessments may be performed by trained laboratory personnel, but these should be checked and authorized by the supervisor. The supervisor is also responsible for ensuring that everyone involved in an experiment and those nearby understand the evaluations and assessments. For example, depending on the level of training and experience, the immediate laboratory supervisor may be involved in the experimental work itself. As part of a culture of safety, all of these groups work cooperatively to create a safe environment and to ensure that hazards are appropriately identified and assessed prior to beginning work. Many laboratories require documentation of specific hazards and controls for a proposed experiment. Be aware that some laboratories have been asked by local emergency personnel to print paper copies in the event of an emergency. As the first step in risk assessment, trained laboratory personnel should examine any plan for a proposed experiment and identify the chemicals with toxicological properties they are not familiar with from previous experience. Phone numbers are provided so that, if necessary, users can contact the supplier to obtain additional information on hazards and emergency procedures.
Acrolein can be oxidized in the liver by alcohol dehydrogenase to acrylic acid or by liver or lung microsomal cytochrome P450s to form the epoxide glycialdehyde 72210 treatment effective topiramate 100 mg, which is hydrolyzed in turn to form glyceraldehyde symptoms 7dp3dt generic 100 mg topiramate free shipping. Early studies suggested that 3-hydroxypropyl mercapturic acid in urine might be useful as a biomarker for acrolein medicine lake california order topiramate 200 mg with visa, but it did not correlate well with exposure (Alarcon 1976) symptoms zollinger ellison syndrome topiramate 200mg with mastercard. The major toxicologic properties of the compound are that it is extremely irritating and that it binds irreversibly to the tissues of the respiratory tract when inhaled. In obligate nose breathers, the nose was a sensitive target organ because of the reactive nature of the compound. In all species studied, neutrophilic infiltration and focal squamous-cell hyperplasia and metaplasia were observed in the upper respiratory tract. Repeated exposure of dogs to 4 mg/m3 for 24 hours/day for 90 days resulted in confluent bronchopneumonia. Guinea pigs and rats showed focal liver necrosis after similar exposures to 2 mg/m 3. In rats and rabbits exposed to acrolein for 13 weeks at 1 to 11 mg/m3, tracheal inflammation, mucousgland hyperplasia, epithelial metaplasia, bronchiolitis, accumulations of alveolar macrophages, and focal interstitial pneumonitis (at high doses only) were observed (Feron et al. More recent studies have focused on the molecular interactions of acrolein with tissues (Kehrer and Biswal 2000). At low doses, as would be expected in tissues after inhalation exposure, acrolein inhibited cell proliferation without causing cell death and might have enhanced apoptosis induced by other toxins. Kehrer and Biswal suggested that the acrolein-mediated decrease in cell proliferation was caused by changes in expression of growth- or stress-related genes or transcription factors secondary to the depletion of glutathione known to be caused by acrolein. No reproductive toxicity was seen in rats or rabbits treated with acrolein by gavage. In another study, Nath and colleagues (1998) noted that acrolein was present in cigarette smoke at 100 to 1000 µg/cigarette (depending on the brand) and in automobile exhaust, and that acrolein could also be a product of endogenous lipid peroxidation. Cohen and colleagues (1992) reported that acrolein induced bladder cancer in rats when 2 mg/kg body weight of acrolein was injected intraperitoneally twice a week for 6 weeks, followed by 41 Mobile-Source Air Toxics: A Critical Review of the Literature administration of uracil as 3% of the diet for 20 weeks (18 of 30 rats, compared with 8 of 30 rats exposed to control solvent). An identical 6-week acrolein protocol followed by a control diet produced no tumors. A 26-week acrolein exposure protocol had to be stopped at 21 weeks because of severe toxicity. In a study at the National Center for Toxicological Research, 150 or 75 nmol acrolein was injected intraperitoneally twice into neonatal B6C3F1 mice. These results showed that neonatal mice were relatively insensitive to acrolein (Von Tungeln et al. Acrolein is highly reactive with sulfhydryl groups (cysteine, histidine, and lysine) and is endogenously produced during lipid peroxidation. Studies of firefighters exposed to wood smoke in prescribed burns in the western U. However, the presence of acrolein in smoke was correlated with that of other compounds, making it impossible to distinguish the effects of the acrolein (Slaughter et al. Thioredoxin also contains thiol groups and was reduced in A549 cells after exposure to acrolein (Yang et al. These effects occur through the mitochondrial pathway by liberating cytochrome c, activating the initiator caspase-9, activating the effector caspase-7, and inhibiting the enzymatic activity of caspase-3 (Tanel and Averill-Bates 2005). Acrolein induces a dose-dependent increase in reactive oxygen species from brain mitochondria and decreases glutathione content (Luo and Shi 2005). It can induce mitochondrial stress in brain mitochondria or spinal-cord tissue (Shi et al. Acrolein exposure can lead to time- and dose-dependent reactive oxidant species generation and lipid peroxidation in spinal-cord tissue. All of these studies involved in vitro exposures; their relevance to human in vivo exposures is not known. A search of the literature and published regulations for North America, Asia, Australia, and Europe did not reveal any exposure standards for acrolein. The available data did suggest, however, that personal mean and peak exposures for adults and children were similar and were lower than 15 µg/m3 and that mean personal exposures were two or more times higher than measured ambient or indoor concentrations. The limited data for urban roadside and urban in-vehicle acrolein concentrations suggested that exposures in these environments were considerably lower, both as mean and peak concentrations, than for other outdoor areas, residences, schools, or personal exposures. Measurements from tunnel studies indicated concentrations that were surprisingly low (< 0. Differences in sampling and sample analysis might affect the absolute concentrations reported in the various studies, but it was beyond the scope of this report to assess sampling and sample analysis.
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Likhodii and colleagues suggested that there may be a direct anticonvulsant action of acetone medications that cause tinnitus generic topiramate 200mg with amex. These observations demonstrate that the ketogenic diet has broad anticonvulsant properties and possibly antiepileptogenic activity medications hyperkalemia buy 100 mg topiramate mastercard. A variety of other plausible hypotheses have been advanced to explain the beneficial actions of the ketogenic diet including antioxidant properties (31 treatment by lanshin topiramate 200 mg amex,32) medicine school discount topiramate 200mg fast delivery, altered purine metabolism due to enhanced energy reserves (33), action of neuropeptides (34), and alteration of mitochondrial uncoupling protein (35). Like many anticonvulsant drugs, it is highly likely that the ketogenic diet has multiple mechanisms of action that summate and account for its rather unique therapeutic properties. Further basic science experiments will help to elucidate other novel effects of the ketogenic diet. At the same time, a careful and systematic study of the clinical effects of the ketogenic diet in specific epilepsy syndromes with particular causes might provide useful clues regarding mechanisms of action (36). It is typical to see a transient hypoglycemia during the first few days, which does not require any treatment unless the child demonstrates symptoms. Treatment of asymptomatic hypoglycemia delays the metabolic adaptation of the child to the state of chronic ketosis. During the fast, the patient is offered water, sugar-free beverages, and unsweetened gelatin. This approach was compared to the traditional fasting implementation by Kim and colleagues. They found greater tolerability in the nonfasting group with no difference in time to ketosis or ultimate effectiveness of the diet at 3 months (38). In another study comparing fasting to nonfasting initiations, no difference was found in ultimate effectiveness of the diet, though the fasting group achieved ketosis more rapidly (39). If the child is fasted, then the urine usually reveals medium to large ketones after the 38-hour fast, and the diet is started. We never have children fast any longer than this, and a shorter period of fasting (24 hours) often suffices with infants and young children. Instead, the diet is begun at a reduced concentration on the first day of admission. It is computed to provide 75 to 100 kcal/kg body weight and 1 to 2 g of dietary protein/kg body weight per day. Caloric requirements are adjusted to minimize weight gain and to maximize ketonemia. If a 3:1 (fat-to-nonfat) ratio is insufficient to produce the required ketosis, then a ratio of 4:1 is used. Close observation is important, because children with certain underlying inborn errors of metabolism, particularly ones that interfere with the utilization of ketone bodies, could quickly decompensate (37). The hospitalization also provides the opportunity for family members to be instructed on the maintenance of the diet and the monitoring of blood -hydroxybutyrate concentrations. Urine ketones may be misleading and should not be monitored if blood measurements are available. The 3:1 ratio of the diet stipulates that 4 g of food must contain 3 g of fat and 1 g of nonfat. One gram of fat has the calorie equivalent of 9 calories, whereas 1 g of protein or carbohydrate has the calorie equivalent of approximately 4 calories. Four grams of food (arbitrarily referred to as 1 unit here) on a 3:1 diet is then equal to 31 calories: 1 g fat 9 calories 27 4 3 27 calories 1 4 calories 31 calories/unit 1 g protein and carbohydrate Total calories 4 calories To calculate the daily fat intake, one first divides the daily requirements of calories by this figure of 31 calories/unit, Chapter 69: the Ketogenic Diet 793 which generates the number of units required for the day: 1000 calories/day = 32. Thus far, the combination of 871 calories of fat and 80 calories of protein leaves only 49 calories (1000 951) not accounted for in the daily allowance. The carbohydrate intake is then calculated to supply the necessary remaining calories (49 calories), which in this case is approximately 12 g. A sudden stop of the diet or sudden administration of glucose may aggravate seizures and precipitate status epilepticus (41). Livingston advocated maintaining the diet at a ratio 4:1 for 2 years and, if successful, weaning down to a 3:1 diet for 6 months, followed by 6 months of a 2:1 diet (42). An example of this is pyruvate carboxylase deficiency, in which patients may present early in life with refractory myoclonic seizures (37). However, Kang and colleagues showed that the ketogenic diet may be used in selected circumstances, particularly in patients with respiratory chain defects (43).
The sash should be composed of a composite material of safety glass backed by polycarbonate treatments cheap topiramate 100 mg fast delivery, with the safety glass on the interior side of the sash symptoms zoning out generic 100 mg topiramate with visa. In addition medicine allergy buy topiramate 100 mg on line, all components of the hood medicine express purchase topiramate 200 mg, including the electrical supply, lighting, etc. Blocked or plugged air intakes and exhausts, as well as control system calibration and operation, alter the performance of the total ventilation system. Filters become loaded, belts loosen, bearings require lubrication, motors need attention, ducts corrode, and minor components fail. All ventilation systems should have a device that readily permits the user to monitor whether the total system and its essential components are functioning properly. Manometer, pressure gauges, and other devices that measure the static pressure in the air ducts are sometimes used to reduce the need to manually measure airflow. If the substance of interest has excellent warning properties and the consequence of overexposure is minimal, the system will need less stringent control than if the substance is highly toxic or has poor warning properties. Some laboratory ventilation systems have become so complex that prudent practice requires a special team of facilities staff dedicated to the maintenance of the system. Inspect and maintain facility-related environmental controls and safety systems, including chemical hoods and room pressure controls, fire and smoke alarms, and special alarms and monitors for gases, on a regular basis. Evaluate each laboratory periodically for the quality and quantity of its general ventilation and anytime a change is made, either to the general ventilation system for the building or to some aspect of local ventilation within the laboratory. The size of a room and its geometry, coupled with the velocity and volume of supply air, determine its air patterns. Airflow paths into and within a room can be determined by observing smoke patterns. Convenient sources of smoke for this purpose are the commercial smoke tubes available from local safety and laboratory supply companies. If the general laboratory ventilation is satisfactory, the movement of supply air from corridors and other diffusers into the laboratory and out through laboratory chemical hoods and other exhaust sources should be relatively uniform. There should be no areas where air remains static or areas that have unusually high airflow velocities. If stagnant areas are found, consult a ventilation engineer, and make appropriate changes to supply or exhaust sources to correct the deficiencies. The number of air changes per hour within a laboratory can be estimated by dividing the total volume of the laboratory (in cubic feet) by the rate at which exhaust air is removed (in cubic feet per minute) and multiplying the total by 60. The sum of these rates for all exhaust sources yields the total rate at which air is exhausted from the laboratory. The rate at which air is exhausted from the laboratory should equal the rate at which supply air is introduced into the room. Thus, decreasing the flow rate of supply air (perhaps to conserve energy) decreases the number of air changes per hour in the laboratory, the face velocities of the chemical hoods, and the capture velocities of all other local ventilation systems. These instruments are available from safety supply companies or laboratory supply houses. The proper calibration and use of these instruments and the evaluation of the data are a separate discipline. Consult an industrial hygienist or a ventilation engineer whenever serious ventilation the laboratory ventilation system is one of the most important aspects of laboratory safety and, at the same time, is likely to be the highest consumer of energy in the laboratory building. Managing all facets of the ventilation system is crucial to maximize safety and energy conservation. Green Building Council uses this model as a consideration in its certification system for rating laboratory buildings. Overall, there are four main aspects of a ventilation system management program: design criteria, training for laboratory personnel, system maintenance, and performance measurement. Laboratory personnel who insist on working at the edge of the laboratory chemical hood, raise the sash above its maximum operating height, defeat alarms, disable sash closures, do not move an elephant trunk close to the source, block baffles, use loose materials in the chemical hood and clog the ductwork, leave the sash open when not working at the chemical hood, fail to report that a filter needs to be changed reduce safety and sustainability efforts. Sometimes, these actions are due to lack of consideration; sometimes personnel may simply not understand the implications. All laboratory personnel should receive training that includes · · · · · · how to use the ventilation equipment, consequences of improper use, what to do in the event of system failure, what to do in the event of a power outage, special considerations or rules for the equipment, significance of signage and postings. Clockwise from top left: reminder to close the chemical hood sash, guide to checking the telltale ribbon taped to the sash of the chemical hood, reminder that a clean bench is not for hazardous chemicals, indicator showing the safe maximum sash height. Many laboratories, particularly academic research laboratories, experience high turnover rates. Good signage and postings complement training and act as constant reminders (Figure 9.
