chapter 13 essays

chapter 13 essays Ralphs tears of pain and sorrow trickled down his roughed up face, the suns beating rays warmed his body. As Ralph looked up and wiped the tears from his face, he parted his golden hair so he could see the naval officer. In a whimpering voice Ralph said Its been such a long time since weve seen a grown up. Whats your name Sir? Why you can call me Bigsby young lad stated the tall officer With glooming eyes the rest of the boys nodded their heads with agreement. With tears still flowing down his face, Ralph began to hysterically laugh and smile while saying Its over... Its finally over! The naval officer turns around and looks at him with an expression of dull confusion. Whats over? The storm said Ralph in a murmuring voice. Ralph looks around and sees that Jack and Roger are missing. For a moment he thought he saw the trees in the back rustling. Ralph yelled at the top of his lungs. Sam! Eric! While searching over the other boys heads, looking for a sudden movement. As the two boys pop their heads out simultaneously, Ralph grins in delight. The two boys walk closer and closer to Ralph and the naval officer. With every step they take they feel the wet sand sticking between their bare feet. As they stood beside him he felt alive again. Where are Roger and Jack? Uh...uhh... up on Castle rock, by themselves. Sam said softly In the background the boys started to drop their spears and wipe their bodies free of the clay. Than the officers started to rally up the boys so they could take them to the ship to get cleaned up. While the flames still engulfed the Jungle the boys stood still, they started to remember home, their friends, their choir group, and their family. Lets go get them, before they end up on this island b...

A Study of Fauvism

A Study of Fauvism Fauvism For artists, the twentieth century began five years late. Late it might have been, but when it got going, it was decades ahead of its time. In 1905 nothing was as modern as modern art. It was to remain that way throughout the century. There are many people who still fail to understand the art introduced in 1905, over seventy years ago. That first modern art appeared in an exhibition in Paris in 1905. Among the participating artists was one of the centurys most famous, Hentri Matisse. Along with Matisses art were works by Maurice de Vlaminck, Andre Derain, and Georges Rouault. Today the works of these artists hang in museums, but in 1905 they werent yet famous. To the public they were infamous. Their paintings were so shocking that one newspaper critic called them the work of Fauves a French word meaning wild beasts. The name stuck so that all the artists who exhibited in that 1905 show were ever after called Fauves and their paintings were dubbed Fauve art. The name Fauve was given to the art of Matisse, Vlaminck, and their colleagues, even though they didnt work with a common principle. And, as years passed, their personal art changed. Paintings done by some at the end of their careers little resembled those done at the beginning. Still, the name. Fauve continued to be used. These were the pioneering artists of the twentieth century and their art, Fauve painting, was the pioneering movement of our century. Theory The fauve artists had no single or unifying principle of art. Perhaps that was necessary for the centurys pioneering movement. Their one basic theory was experimentation. Thats what shocked the 1905 French Public. Their art was so experimental that it resembled nothing gallery visitors had ever seen before. Fauve art doesnt seem so radical today. Thats because their interest in experimentation became the guiding principle of almost all twentieth century art movements. Experimentation in art has meant discovering new types of visual expression. It can be the general theory guiding all the art projects you try in this book. It was originally a fauve principle. However, if most twentieth-century art movements have been guided by experimentation, those experiments have been controlled by further theories. The leading Fauve theoretician was Henri Matisse. His colleagues followed many of his ideas, and his thoughts about art inspired many twentieth-century art developments. To gain an understanding of Fauve art, you can do no better then examine the art and ideas of Matisse. Nor can you find any better guide for developing your own art. Here is what Matisse once said about his art. Expression is what Im seeking most of all however, expression doesnt mean the passion which a human face reflects. The total composition of my painting is expressive. My arrangement of figures or objects, the empty spaces surrounding them, their proportions, everything has its roll to play. Except for Georges Roualt, most Fauve painters followed Matisse and sought expression with the total painting, the total subject. This isnt a simple goal. Its one achieved only after much time and thought. Studying the work of Matisse can help you understand Fauve expression in art. Matisse expressed himself with line. He did this by simplifying the line in his work. This meant eliminating unnecessary lines and using only the most important. These were, of course, the lines that created the shape of his subjects, not the lines that defined details. He wasnt interested in linear details. In short, he simplified his drawing. But simplified drawing doesnt mean you will automatically produce expressive lines in your art. Simplification can mean producing nothing more than a simple but disjointed sketch. More is required. Matisse and his Fauve friends did it by creating rhythmic lines. His lines swing easily, curve and twist like a melody. Matisse created such expressive lines in painting like The Dance. The joy of dance requires lines with lovely rhythm. He eliminated details. In the essential lines that remained, he created graceful bends and flowing curves, lines swinging with the delight of dancing. The Fauves also expressed themselves in color. They understood that color was essential to painting. They didnt feel color should be dominated by subject matter. This means their use of color wasnt dictated by realism. Instead, color could stand on its own. Fauve artists intensified their colors, using bright flesh colors, pinks oranges, and reds for faces. They created shadows of bright colors. In one famous painting, Matisse painted a green stripe down the face of his wifes portrait. He used green because it was the strongest color contrast to the reddish tone of the painting. In such painting, you notice the color before you notice the subject. Such a bold use of color doesnt mean you can color without thinking. In fact, you must be even more careful with color in such a case. A realistic artist who uses color poorly can claim his inadequate colors only copy the poor coloring of his subject. However, Fauve artists couldnt do this. Their bold coloring was of their own choice so they had to be especially sensitive to the use of color they used in their art. Thats why color is such an important ingredient in Fauve art. When you create art in the spirit of Fauve painters, you too will be very conscious of your use of color. You will also be conscious of your use of line. When thinking like a Fauve artist, youll experiment. Like Matisse, youll seek expression in your art in the way you use line and color. Youre line will be simplified and your color diverse from realism. Yet your lines will have beauty and expression because youll give them rhythm and grace. Your colors will be beautiful, because youll treat them intelligently and with sensitivity. Thats how the Fauve artist worked when producing some of the greatest paintings of 20th century art.

Compare the video in the youtube about the fieldwork for boy scouts Assignment

Compare the video in the youtube about the fieldwork for boy scouts and girl scouts - Assignment Example To avoid the heat of the sun, the comedy skit was performed at night. As a couple of Boy Scouts were doing the skit, the other group members were playing the role of the audiences. While the Boy Scout speaker was telling the story, another guy was purposely acting whatever was being spoken about the storyline. For example, every time the speaker had mentioned the phrase â€Å"falling rocks†, the other guy would intentionally fall down the mattress in a prone position. video is about a group of Boy Scouts engaged in a skit that requires a group of 11 Boy Scouts to sing and dance in front of the audiences. In this particular video, the Boy Scouts were singing the song â€Å"If I were not a Boy Scout, I’ll tell you what I would be†Ã¢â‚¬ ¦ (Mccullarsj1). Basically, each of the Boy Scout who were performing a skit had their own line to say. As the song progresses, the Boy Scouts grouped in pairs who had said what they would be if they were not a Boy Scout would all at the same time shout what they think they would be in life. The third video involves a group of eight (8) Girls Scouts who were doing a skit on â€Å"If I weren’t a counselor† (Robbert Bobbert). This particular skit was performed during day time at St. Albans. Throughout the skit, the Girl Scout performers were singing and dancing as they share to the audiences what they think they would be in case they were not a counselor. In this particular video, the Girl Scout audiences were very attentive to the group performers. Each Girl Scout performing the skit had their own line to say with regards to what they would like to be if they were not a cousellor. As the song progresses, the Girl Scouts who had said what they want to be if they were not a Counsellor would all at the same time shout what they think they would be in life. The fourth video is all about a three (3) Girl Scouts who were singing the

Personal Statement Example | Topics and Well Written Essays - 500 words - 36

Personal Statement Example I have now decided to follow my heart and complete my medical program from the University so that I can continue to serve the people who would benefit from my professional expertise. Apart from the objective of ensuring good education for my children, I am a self-driven person who would like to reach the highest level of professional excellence, both in terms of gaining knowledge and attaining high status in society as a medical professional. I would also like to contribute constructively to the society which has been so helpful in my years of adjustment within a new culturally different environment when I had moved from Armenia to America. My American friends and neighbours and my friends from Armenia have always encouraged me to remain optimist. After 14 years of running a restaurant successfully, I now realize that my medical experience needs to be applied for the wider welfare of the society which has given me so much. Thus, I believe that the American degree in medicine would equip with necessary knowledge and skills so that I can re-start my practice as a dentist in America. Throughout my career as a medical professional, I have been proactively involved in the well-being of my patients as well as with the students of medical programs and community groups. I have extensively participated in the medical seminars and conferences which have greatly benefitted students and young medical professionals. I have been invited as guest speakers in many of the conferences organized at the Medical University of Yerevan, Armenia which has also recognized my contribution by awarding me the certificate of ADA (Armenian Dental Association). I have also held educational and clinical seminars for medical students where they got hands-on experience in the clinical setting. The various activities that involved medical fraternity and the

The relation of quality management and risk management -or- the future Thesis Proposal

The relation of quality management and risk management -or- the future of quality management with risk management - Thesis Proposal Example Widdop et al (2007, p.2) observes that integrating the two approaches to management requires communication. There is a gap in the existing literature of the lack of a framework of enhancing the integration of quality management with risk management and this is the focus of this study. Developing this integrative framework will make it easy for organizations to manoeuvre these important approaches to management. According to Williams et al (2006, p.68) risk management intersects with quality management at the point at which it seeks to ensure the effectiveness, efficiency and economy of a business strategy or process. Quality management is the design and execution of products and services with the objective of meeting and preferably exceeding customers’ expectations without the wastage of available resources (Williams et al 2006, p.68). Risk management identifies, prioritizes, addresses, and eliminates potential sources of failure of the services and products to meet their set objectives. In this context, risk management is a pre-emptive, proactive, predictive, and preventive endeavour. After studying a number of companies, Williams et al (2006, p.69) found that reducing risk deltas reduces objective gaps and variation hence increasing process quality. Kuhn and Youngberg (2002, p.159) asserted quality is one of the important issues in risk-based approach to management alongside health, safety and environment. After examining five organizations, Kuhn and Youngberg (2002, p.159) found that continuous improvement, stakeholder satisfaction, adherence to standards and checks and balances, optimizing the quality of every investor’s dollar and prevention are quality principles and practices that seamlessly fit into risk management. Kuhn and Youngberg (2002, p.160) observe that the Six Sigma is an exemplar case of how to integrate quality management with risk management. For example, he notes that Six Sigma’s DMAIC (Define, Measure, Analyze, Improve,

Cutaneous Tuberculosis Disease: Challenges of Treatment

Cutaneous Tuberculosis Disease: Challenges of Treatment CHAPTER -1 CUTANEOUS TUBERCULOSIS INTRODUCTION: In this innovative world while progress in medicine has helped up to deal with many diseases Tuberculosis and Cutaneous Tuberculosis is still a challenge for doctors. A resurgence of Cutaneous Tuberculosis in areas of high HIV incidence, drug resistant present in patients with pulmonary tuberculosis and in immunosupressed patients are the main challenges for clinicians. (6) Cutaneous TB is caused by Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccinations and the Tuberculids whose pathogenesis is poorly understood. Cutaneous TB is very variable in its clinical presentation, significance prognosis. Factors which effect on variability are: The pathogenesity of the organism involved. The Previous treatment given. The Immune status of the patients which can be related to the presence of Acquired Immunodeficiency Syndrome (AIDS) or Immunosuppressive therapy. The Port of infection. Any Local factors like, the recent Trauma, the lymphatic drainage, the vascularity of area and the proximity to lymph nodes). PREVALANCE: Thirty years ago it was assumed world wide that tuberculosis would be eradicated in the developed countries, as its incidence increased only on by average 6 % in the United States and 10% in Europe between the years 1953 and 1985. However, in 1983 tuberculosis was declared a global emergency by the world Health Organization because of a sharp increase in incidence. (9) Among infectious diseases, Tuberculosis is an important cause of death. Tuberculosis was responsible for 6% of deaths worldwide. Global prevalence of TB currently is greater than 32%. More than 50% of new patient occurrences were in 5 Asian countries, i.e. India (largest worldwide patient load), China, Indonesia, Bangladesh, and Pakistan(ref ?) The current global burden of Tuberculosis is mind boggling. In 1997, the incidence of new Tuberculosis patients approached 8 million in addition to more than 16 million patients already diagnosed. Around 2 million people died of Tuberculosis in 1997 with a global fatality rate of 23%, fatality rates exceed 50% in some African countries in which there is a high HIV incidence. Approximately 8% of tuberculosis patients are HIV infected. (2) Prevalence of tuberculosis infection in 1985, 1995 and 2005 (10) Prevalence of tuberculosis has increased between 1985 and 2005.According to the World Health Organization case reports statistics, in 1985 there were around 3 million patients of tuberculosis of all types with the highest no of cases in Asia and Africa. In Asia the highest numbers of cases were in India, Pakistan, China, Philippines, Bangladesh, Afghanistan and Vietnam. In Africa the highest number of case were in Ethiopia, Nigeria, South Africa, Congo, Morocco and Tanzania. (10) During the last two decades the number of cases increased all over the world. In 1995 the total number of cases increased to 4.6 million and in 2005 to 7.5 million worldwide. In Asia in 2005 the highest numbers of cases were in India, China Pakistan. In Africa in 2005 the highest numbers of cases were in South Africa, Ethiopia Congo. (10) There is an increasing rate of tuberculosis in the developing countries is approximately 500/100,000/y. Great alarm has been the progressive increase in numbers of strains of tuberculosis that are resistant to antibiotics. Since 1984, that incidence of extra pulmonary tuberculosis has increased at even faster rate than that of pulmonary tuberculosis and is considered to be a diagnostic criterion in the case definition for AIDS. Because immunocompromised individual are at increased risk of extra pulmonary tuberculosis, so dermatologist are renewing their historic role in the diagnosis of cutaneous lesions of tuberculosis. (11) EPIDEMIOLOGY: Epidemiological analysis is used to detect the changing trends in the incidence and prevalence of mycobacterial disease in the community. The main objectives of these methods are to determine the natural behavior of disease and factors which affect his behavior and to calculate future trend if possible to help in the design of any control measures and to assess the usefulness of these measure.(8) Even though 1 of 3 individuals on this planet is infected with tubercle bacillus, the incidence of Cutaneous TB appears low. In areas such as India or China where TB prevalence is high, cutaneous manifestations of TB (overt infection or Tuberculids) are found in less than 0.1% of persons seen in dermatology clinics. The frequency of patients with Cutaneous Tuberculosis seen between 1980 and 1993 in a hospital dermatology clinic in Madrid was 16 per 10,304 which was 0.14%. In a ten year retrospective survey of patients seen in governmental dermatology clinics in Hong Kong between 1983 and 1992, the detected incidence of Cutaneous Tuberculosis among patients was 179 per 267,089 which was 0.07%. Among patients with Cutaneous Tuberculosis only15% had classic Cutaneous Tuberculosis and 85% had tuberculids. In that classical cutaneous tuberculosis approximately 5% had lupus vulgaris, 5% had Tuberculosis Verrucosa cutis and 5% had scrofuloderma. (2) In a tertiary-care hospital in northern India, 0.1% of dermatology patients seen between 1975 and 1995 had Cutaneous Tuberculosis. Lupus vulgaris was the most common manifestation around 55%, followed by scrofuloderma 27%, TB Verrucosa cutis 6%, tuberculous gumma 5%, and tuberculids occurred in 7%. (2) FREQUENCY: USA: In the United States, tuberculosis cases decreased from 84,304 cases in 1953, when national reporting was first began, to 22,201 in 1985.   This represented fairly steady decline of about 5.8% per year. However, the turn down in tuberculosis cases stopped in between 1985 and 1992. In 1992 the annual number of cases increased by 20% to 26,673 cases. (12) The increases were concentrated geographically in several states, with over 90% of the 14,871 cases in California, Florida, New Jersey, New York, and Texas and demographically tuberculosis occurred in racial and ethnic minorities, in people aged 25 to 44, males and in those born abroad. Especially troubling, and indicative of increasing transmission of new infections, was a 36% increase in tuberculosis among children 4 years old or younger. Tuberculosis appears to be on the decline again in the United States as numbers with only 14,871 cases in 2003. (12) Reported tuberculosis cases in United States, 1982-2002 (12) The percentage of Tuberculosis patients who were born abroad individuals was 42%. People born in Mexico, the Philippines, and Vietnam account for one half of born abroad Tuberculosis patients in the United States. The Tuberculosis rate among born abroad people was 4 to 6 times higher than for US-born peoples. Minimum estimates of the proportion of TB patients with coincident HIV infection were approximately 10-15%. Among people aged 25-44 years, this proportion increased to 20-30%. (12) The fundamental origin of this new Tuberculosis epidemic in troubled states reflects a minimum of four major factors including (1) the involvement of Tuberculosis with the HIV epidemic, (2) the increased migration from countries where Tuberculosis is common, (3) the spread of Tuberculosis in congested settings (health-care facilities, prisons, homeless shelters), and (4) the worsening of the basic health-care infrastructure. (2) Molecular typing of Mycobacterium tuberculosis isolates in the United States in a restriction fragment-length polymorphism study suggests more than one third of new patient incidence results from people-to-people transmission, and the remainder result from reactivation of latent infection. Approximately 1 of 13 Mycobacterium tuberculosis isolates currently shows a form of drug resistance. (2) The modern introduction of biological agents that block tumor necrosis factor-alpha in the treatment of rheumatoid arthritis, psoriasis, and several other autoimmune disorders has additional raised about the necessity of the identification of patients with latent Tuberculosis. At present, several hundred cases of Tuberculosis have been reported in patients who receive these tumor necrosis factor-alpha antagonists. (2) HISTORY: Tuberculosis has an ancestry which can be traced to the earliest history of mankind. It was recognized as a contagious disease by the time of Hippocrates and Aristotle in 350 BC. Signs of skeletal Tuberculosis were identified in Europe since Neolithic times and in ancient Egypt around 3700 BC in mummified bodies. Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC. (5) During1600s and 1800s tuberculosis was known ass the Great White Plague in Europe.   Other names for Tuberculosis were Phthisis which was from Greek term phthinein, meaning to waste away, scrofula which were used for swellings of the lymph nodes of the neck and consumption which were used as progressive wasting away of the body.(2) In 1826 Laennec first reported cutaneous tuberculosis which he called PROSECTOR WART. Following Laennec, Rokitansky and Virchow described the histological features in detail comparing them to those of visceral tuberculosis. (6) The Incidence of TB increased with population density and urban development so that by the Industrial Revolution in Europe in 1750, it was responsible for more than 25% of adult deaths. Indeed, in the early 20th century, TB was the leading cause of death in the United States. In 1882, a German biologist ROBERT KOCH presented his discovery of the organism that caused TB. NEIL FINSEN won the Nobel Prize in Medicine in 1903 for introducing UV light into the treatment of skin TB. (2) With the help of better living conditions and the introduction of the antibiotic streptomycin on 20th November 1944, the number of reported TB patients in the United States steadily declined around 126,000 TB patients in 1944, 84,000 in 1953, 22,000 in 1984, and 14,000 in 2004.(2) MODE OF TRANSMISSION: Tuberculosis is an airborne contagious disease that occurs after inhalation of infectious droplets expelled from patients with laryngeal or pulmonary Tuberculosis during coughing, sneezing, or speaking. Each cough can generate more than 3000 infectious droplets. Droplets are so small around 1 to 5 micro meter, that they remain airborne for hours. (2) The likelihood that disease transmission will occur depends upon the infectiousness of the tuberculous patient, the environment in which exposure takes place, and the duration of exposure. Roughly 20% of people in the infected household contact develop infection. Micro epidemics have occurred in closed environments such as transcontinental flights and submarines. Tuberculin sensitivity develops 2 to 10 weeks after infection and usually is lifetime. (2) Because Tuberculosis induces a powerful immune response, individuals with positive tuberculin reactions are at a considerably lower risk of acquiring new tuberculous infection. In HIV-infected individuals, active Tuberculosis is more likely to occur from reactivation of existing disease than from superinfection with a new mycobacterial strain. (2) Without treatment, an estimated 10% lifetimes possibility exists of developing active disease after tuberculous infection, 5% occurs within the first 2 years and 5% thereafter. An Increased risk of acquiring active disease occurs during HIV infection, Intravenous drug abuse, diabetes mellitus, silicosis, immunosuppressive therapy, cancer of the head and neck, hematological malignancies, end-stage renal disease, intestinal bypass surgery or gastrectomy, chronic malabsorption syndromes and low body weight. Infants younger than two years are associated with increased risk. (2) 1) DIRECT INHALATION: The most common mode of entry via portal in to the lungs usually resulting from the Inhalation of airborne droplets containing a few bacilli, expectorated by individuals with â€Å"open† pulmonary disease.(8) 2) INDIRECT INHALATION: A) Ingestion: Less often bacilli may be swallowed and lodge in to the tonsil or in the wall of the intestine. These infections are chiefly related to the consumption of contaminated milk products. (8) 3) INOCULATION: Cutaneous tuberculosis manifestations depend upon the method of cutaneous inoculations, which may be exogenous that is from an out side source, may occur by autoinoculation, or may be by endogenous .Direct exogenous inoculation in an individual not previously infected with tuberculosis causes primary tuberculosis infection, will led to the tuberculous ‘chancre or to tuberculosis Verrucosa cutis depending upon the immune status of the patient. Another example of exogenous transmission is lupus vulgaris at the site of BCG vaccination. (9) Endogenous transmission can occur by continuous extension of tuberculous process underlying the skin as in scrofuloderma, by the way of lymphatic as in lupus vulgaris and by hematogenous spread as in acute miliary tuberculosis or lupus vulgaris. (9) Infrequent mode of transmission is direct implantation in to the skin through cuts and abrasions. These troubles usually in persons, working with infected material or cultures of tubercle bacilli. These skin lesions were called as â€Å"Prosector warts† (8) CLASSIFFICATION OF CUTANEOUS TUBERCUCLOSIS: Cutaneous tuberculosis clinical manifestations comprise a considerable number of skin changes, usually sub classified in to more or less distinct disease forms. Classification depends on morphology more recently mode of transmission or the immunological state of host, but none of them satisfies completely. 1)INOCCULATION TUBERCUCLOSIS (Exogenous Source) Tuberculosis chancre Warty tuberculosis(Verruca cutis) Lupus vulgaris(some) 2) SECONDARY TUBERCULOSIS (Endogenous source) A) Contiguous spread Scrofuloderma B) Auto-inoculation Orifical tuberculosis 3)HAEMATOGENOUS TUBERCULOSIS Acute miliary tuberculosis Lupus vulgaris(some) Tuberculous gumma 4)ERUPTIVE TUBERCUCLOSIS (Tuberculids) A) Micropapular Lichen scrofulosorum B) Papular Papular/Papulonecrrotic TB C) Nodular Erythema induratum(Bazin) Nodular Tuberculids (CLASSIFICATION OF TUBERCULOSIS, MODIFIED FROM beyt et al) (4) CHAPTER-2 CLASSIFICATION OF MYCOBACTERIA: Tuberculosis is an infectious disease which is caused by the Mycobacterium species. Mycobacteria are acid fast, non-sporulating, non-motile weakly gram positive organisms. TEM micrograph of Mycobacterium tuberculosis Table 3: Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Scientific classification by Lehmann Neumann. (3) In 1950s Runyon classified the atypical mycobacteria according to their ability to form pigment, their rate of growth colony characteristics. This classification also includes obligate human pathogens and facultative human pathogens. (1) Today more then 60 species of mycobacteria are identified. Around 41 of these were included in the approved lists of bacterial names in 1980. (9) 30 species of mycobacterium are known that can cause disease in humans. The most common causative organism includes: Mycobacterium tuberculosis Mycobacterium Leprae. Atypical mycobacteria. The species which produce disease in tuberculosis primary complex include: Mycobacterium tuberculosis. Mycobacterium Bovis. Mycobacterium Africanum. Sometimes Bacillus Calmette Guerin (BCG) may also cause disease. (1) MEDICAL CLASSIFICATION: For the purpose of diagnosis treatment mycobacteria can be classified in several major groups. Mycobacterium tuberculosis complex, which can cause tuberculosis by the pathogens Mycobacterium tuberculosis, M Bovis, M Africanum M microti. Mycobacterium Leprae, which causes Hansens disease. Nontuberculous mycobacteria are the mycobacteria which can cause pulmonary disease, lymphadenitis, and skin disease disseminated disease. SLOW GROWING MYCOBACTERIA RUNYON GROUP 1)Obligate human pathogens M. tuberculosis-bovis group including bacillus Calmette-Guerin(BCG) M Africanum (not included in runyon classification 2)Facultative Human pathogens M. kansasii I M. marinum I M. simiae I M. scrofulaceum II M. szulgai II M. gordanae II M. avium-intracellualr complex III M. haemophilum III M. Ulcerans III M. xenopi III 3) Nonpathogens M. flavescen II M. terrae complex III M. trivale III M. gastri III RAPIDLY GROWING MYCOBACTERIA 1))Facultative Human pathogens M. fortuitum I V M. chelonae I V M. abscessus I V 2) Nonpathogens M. smegmatis I V M. phlei I V M. vaccae I V others STAINING CHARACTERISTICS OF MYCOBACTERIA: Mycobacteria are aerobic, facultative, intracellular non-spore forming and non-motile curved rods measuring 0.2- 0.5 by 2-4 um. Mycolic acid rich long chain glycol lipids and phospholipoglycans, a mycocides present in the cell wall of mycobacteria protect them. (2) Mycobacteria do not gram stain readily but their most valuable staining characteristic is Acid Fastness. This ability retains carbol fuchin dye after washing with acid or alcohol occurs because of the high content of cell wall mycolic acids, fatty acids other lipids. Other staining methods used include Dietrele, auramine-Rhodamine and phenolic acridine orange stains. Nocardia rhodococcus, legionella dadei, isospora cryptosporidium also share acid fastness. (1) The Ziehl-Neelson acid-fast stain, while highly specific for mycobacteria, is relatively insensitive, and recognition requires at least 10,000 bacilli per mL; most clinical laboratories currently use a more sensitive auramine-rhodamine fluorescent stain (auramine O). Routine culture uses a nonselective egg medium called Lowenstein-Jensen or Middlebrook 7H10 and often requires more than 3-4 weeks to grow because of the 22-hour doubling time of mycobacterium tuberculosis. Radiometric broth culture, BACTEC radiometric system of clinical specimens significantly reduces time 10 to 14 d for mycobacterial recovery. DNA probes specific for mycobacterial ribosomal RNA categorize species of clinically significant isolates after recovery. In tissue, polymerase chain reaction (PCR) amplification techniques can be used to detect Mycobactereria tuberculosis-specific DNA sequences and thus, small numbers of mycobacteria in clinical specimens. (2) The cell wall of mycobacteria consist of: (3) Outer lipids Mycolic acid Polysaccharides(arabinoglactan) Peptideglycan Plasma membrane. Lipoarrabinomannan(LAM) Phosphatidylinositol mannoside. Cell wall skeleton. PATHOGENESIS: The most common site for Tuberculosis disease is lungs and 85% of TB patients present with pulmonary symptoms. The most common sites of extrapulmonary disease are mediastinal, retroperitoneal, and cervical lymph nodes, vertebral bodes, adrenals, meninges, and the GI tract. Pathology of these lesions is similar to those in the lung. Extrapulmonary TB can occur as part of a primary or late generalized infection or as a reactivation site that may, coexist with pulmonary reactivation. (2) Mycobacterium tuberculosis is an obligate pathogen. It is a slender aerobic rod, characterized by high lipid content. This lipid is responsible for resistance to phagocytosis. Identification of organism is easy in tuberculous chancre, scrofuloderma, orificial lesions and the miliary variant. This may be difficult to find or absent in lupus vulgaris, gummata and warty tuberculosis. The organism is highly resistant to drying to drying and therefore can retain infectivity by inoculation or contamination of minor wounds. (19) The reaction of the bacterium depends on: the size of inoculum. the virulence of organism. <

Digital Subscriber Line (DSL) :: essays research papers

Digital Subscriber Line (DSL) Digital Subscriber Line new technology that takes advantage of standard copper telephone line to provide secure, reliable, high-speed Internet access. DSL refers to the family of digital subscriber line technologies, such as ADSL, HDSL, and RADSL. Connection speed for DSL ranges from 1.44 Mbps to 512 Kbps downstream and around 128 Kbps upstream. Unlike traditional connections DSL such as analog modems and IDSN, DSL deliver continuous â€Å"always on† access. That means multimedia-rich websites, e-mail, and other online applications are available anytime. DSL makes it possible for you to remain online even while you’re talking on the telephone-without jeopardizing the quality of either connection. DSL is available in a spectrum of speeds. Some are best home use, while others are designed to accommodate rigorous business demands. Whether for business or the home, DSL, offers unsurpassed price/performance value compared to other online options. There are the five facts tha t one should know about DSL. It is remarkably fast. With DSL service, you can benefit from Internet speeds that are up to 12 minutes faster than a typical ISDN connection and 50 times faster than traditional 28.8 Kbps modems. This means that in the 12 seconds it takes to read this information, you could have downloaded a 2 megabyte presentation file or web photograph. It would take 10 more minutes (600 more seconds!) to download the same with a traditional 28.8 Kbps. It’s highly reliable. One can depend on DSL because its proven technology takes full advantage of the existing telecommunications infrastructure. It’s inherently secure. DSL network provides a dedicated Internet connection via private telephone wires, you can bypass dial-up intruders or shared network hackers. Unlike traditional dial-upp modems or cable modems. DSL protects your valuable data with the most secure connection available. It’s surprising affordable. DSL is widely recognized as the most cost-effective connectivity solution for small buisness. DSL delivers industrial- strength like speed to multiple users at only 25% of typical TI costs. There is no better price option available. DSL is also an exceptional value for home users. At about $2 a day for services that meets the needs of most people. The connection is always on. It’s ready to run every minute of the day. There’s no more logging on and off. No more busy signals or disconnects. This gives you the freedom to focus on what you want to accomplish on line rather than focusing on trying to get connected.