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Working together, we can make tobacco-related disease and death a thing of the past. A strategy for controlling the marketing of tobacco products: a regulated market model. Transforming the tobacco market: why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate. Broken Promises to Our Children: A State-by-State Look at the 1998 1For Tobacco Settlement 20 Years Later, 2018; < States & Localities that Have Restricted the Sale of Flavored Tobacco Products, January 22, 2019; <. Patterns in first and daily cigarette initiation among youth and young adults from 2002 to 2015. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014; <. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. Ending tobacco-caused mortality and morbidity: the case for performance standards for tobacco products. In and across bureaucracy: structural and administrative issues for the tobacco endgame. The tobacco control vaccine: a population-based framework for preventing tobacco-related disease and death. Increasing smoking cessation in the United States: expanding the availability of over-the-counter medication. Update: characteristics of patients in a national outbreak of e-cigarette, or vaping, product use-associated lung injuries-United States, October 2019. Department of Health and Human 662 Chapter 8 Smoking Cessation Services, National Institutes of Health, National Cancer Institute, 2017. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Racial/Ethnic Minority Groups-African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998. Print corrective statements- exhibit 3: newspaper exemplars, October 2, 2017; <. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes, n.

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Sterilization can be accomplished by heat, ethylene oxide gas, hydrogen peroxide gas, plasma, ozone, and radiation (in industry). From an operational standpoint, a sterilization procedure cannot be categorically defined. Rather, the procedure is defined as a process, after which the probability of a microorganism surviving on an item subjected to treatment is less than one in one million (10-6). It eliminates nearly all recognized pathogenic microorganisms but not necessarily all microbial forms. Disinfection does not ensure an "overkill' and therefore lacks the margin of safety achieved by sterilization procedures. The effectiveness of a disinfection procedure is controlled significantly by a number of factors, each one of which may have a pronounced effect on the end result. Among these are: the nature and number of contaminating microorganisms (especially the presence of bacterial spores); the amount of organic matter present. Disinfection is a procedure that reduces the level of microbial contamination, but there is a broad range of activity that extends from sterility at one extreme to a minimal reduction in the number of microbial contaminants at the other. By definition, chemical disinfection and in particular, high-level disinfection differs from chemical sterilization by its lack of sporicidal power. This is an over simplification of the actual situation because a few chemical germicides used as disinfectants do, in fact, kill large numbers of spores even though high concentrations and several hours of exposure may be required. Non-sporicidal disinfectants may differ in their capacity to accomplish disinfection or decontamination. Some germicides rapidly kill only the ordinary vegetative forms of bacteria such as staphylococci and streptococci, some forms of fungi, and lipid-containing viruses, whereas others are effective against such relatively resistant organisms as Mycobacterium tuberculosis var. Appendix B: Decontamination and Disinfection 327 Spaulding Classification In 1972, Dr. This system, as it applies to device surfaces, is divided into three general categories based on the theoretical risk of infection if the surfaces are contaminated at time of use. From the laboratory perspective, these categories are: critical-instruments or devices that are exposed to normally sterile areas of the body require sterilization; semi-critical-instruments or devices that touch mucous membranes may be either sterilized or disinfected; non-critical-instruments or devices that touch skin or come into contact with persons only indirectly can be either cleaned and then disinfected with an intermediate-level disinfectant, sanitized with a low-level disinfectant, or simply cleaned with soap and water. Such disinfectants are capable of sterilization when the contact time is relatively long. As high-level disinfectants, they are used for relatively short periods of time. They are formulated for use on medical devices, but not on environmental surfaces such as laboratory benches or floors. In this arena, decontamination may entail disinfection of work surfaces, decontamination of equipment so it is safe to handle, or may require sterilization. Regardless of the method, the purpose of decontamination is to protect the laboratory worker, the environment, and anyone who enters the laboratory or handles laboratory products away from the laboratory.

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Current technology cannot completely prevent fungal contamination of field crops before harvest. Research is underway in many laboratories with the objective of controlling preharvest contamination through genetic manipulations, use of irrigated plots, the application of various chemicals, and other innovative measures. Some progress has been made in this research, but no commercial, large-scale controls have been adopted. Aflatoxin conversion by dairy cattle consuming naturally contaminated whole cottonseed. Molar absorptivities of aflatoxins B 1, B 2, G 1, and G 2 in acetonitrile, methanol, and toluene-acetonitrile (9 1): collaborative study. Thin-layer chromatography of mycotoxins and comparison with other chromatographic methods. Multifunctional column coupled with liquid chromatography for determination of aflatoxins B 1, B 2, G 1 and G 2 in corn, almonds, Brazil nuts, peanuts and pistachio nuts: collaborative study. Immunoaffinity column coupled with solution fluorometry or liquid chromatography post-column derivatization for determination of aflatoxins in corn, peanuts and peanut butter: collaborative study. Determination of aflatoxin in cattle feed by liquid chromatography and post-column derivatization with electrochemically generated bromine. Post-column excitation of aflatoxins using cyclodextrins in liquid chromatography for food analysis. Immunoaffinity column cleanup with liquid chromatography for the determination of aflatoxin M 1: collaborative study. Surveillance of stored grain from the 1997 harvest in the United Kingdom for ochratoxin A. Effects of processing and detoxification treatments on ochratoxin A: introduction. A survey of data on the incidence and levels of ochratoxin A in food and animal feed worldwide. Determination of ochratoxin A at the ppt level in human blood, serum milk and some foodstuffs by high-performance liquid chromatography with enhanced fluorescence detection and immunoaffinity column cleanup methodology and Swiss data. Molecular and epidemiological approaches to the etiology of urinary tract tumors in an area with Balkan endemic nephropathy. Determination of ochratoxin A in wine by means of immunoaffinity column clean-up and high performance liquid chromatography. Screening of the occurrence of ochratoxin A in green coffee beans of different origins and types. Epidemiology of wheat head blight and maize ear rot caused by Fusarium graminearum. Worldwide contamination of cereals by the Fusarium mycotoxins nivalenol, deoxynivalenol, and zearalenone.

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Cultures are still recommended in any investigation of a foodborne outbreak, because strains of group C, G, or other species are not detected by the rapid antigen test and because intact live isolates may be required for further specific identification. A list of the more important virulence factors, extracellular enzymes, and other products along with their functions is provided in Table 8. Group C and G streptococci also elaborate their own versions of these products, with the exception of the pyrogenic exotoxins. Also aiding the organisms is the C5a peptidase, which inhibits the chemotactic activity of complement. Several other components, including immunoglobulin-binding proteins, interfere with host defenses by interacting with antibodies or complement. M18 strains are almost entirely dependent on capsule expression for protection against phagocytosis. The hemolysins streptolysin O and streptolysin S are cytotoxic, capable of killing phagocytes, and they may also be responsible for some secondary inflammation. Fibronectin-binding protein is one of several factors that promote adherence, along with other proteins and lipoteichoic acids on the cell surface (1,30). The hyaluronidase is thought to facilitate the spread of infection within the tissues by breaking down basement membrane matrix. Streptokinases are plasminogen converting factors, some of which may play a role in the renal damage leading to acute glomerulonephritis. A streptokinase from group C is also used therapeutically to dissolve clots in certain cases of acute thrombosis or empyema. These "superantigens" induce lymphocyte blastogenesis, suppress antibody synthesis, potentiate endotoxic shock, and promote the febrile response (30,128). Although its genome has been sequenced and many of its pathogenic features have been studied at the genetic level, investigators are only beginning to understand the complex interactions of the bacterium and its host environment and the factors that influence development of disease. Other mobile elements include plasmids and transposons, mainly associated with resistance to erythromycin, aminoglycosides, tetracycline, and chloramphenicol. The major virulence gene are located in a cluster called the vir regulon, which contains the emm genes coding for M and M-like proteins. There are several evolutionarily related families of Copyright 2003 by Marcel Dekker, Inc. Over 100 different types of M proteins have been identified by serological and molecular (emm gene) classification. T agglutinins are surface proteins of unknown biological function that are associated with certain M types but are not themselves virulence factors.

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Streptococcus pyogenes strains containing emm12 and emm55 possess a novel gene coding for distantly related sic protein. Human immune response to streptococcal inhibitor of complement, a serotype M1 group A Streptococcus extracellular protein involved in epidemics. Antibodies to streptococcal inhibitor of complement function and M peptides in a poststreptococcal glomerulonephritis endemic region of Australia. Antibodies against four proteins from a Streptococcus pyogenes serotype M1 strain and levels of circulating mannan-binding lectin in acute poststreptococcal glomerulonephritis. Effect in penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis. Susceptibility of group A beta-hemolytic streptococci to thirteen antibiotics: examination of 301 strains isolated in the United States between 1994 and 1997. Antibiotic resistance: relationship to persistence of group A streptococci in the upper respiratory tract. Characterization of antimicrobial resistance in Streptococcus pyogenes isolates from the San Francisco Bay area of northern California. Multivalent group A streptococcal vaccine designed to optimize the immunogenicity of six tandem M protein fragments. Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pharyngitis. Significance of quantitative salivary cultures for group A and non-group A and non-group A beta-hemolytic streptococci in patients with pharyngitis and in their family contacts. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome-a comparative observational study. Darenberg J, Ihendyane N, Sjolin J, Aufwerber E, Haidl S, Follin P, Andersson J, Norrby-Teglund A. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research. Twelve to seventeen-year follow-up of patients with poststreptococcal acute glomerulonephritis in Trinidad. Studies of the continuing susceptibility of group A streptococcal strains to penicillin during eight de- 468. Antimicrobial susceptibility patterns and genomic diversity in strains of Streptococcus pyogenes isolated in 1978-1997 in different Brazilian cities. Protekt 1999-2000: a multicentre study of the antimicrobial susceptibility of respiratory tract pathogens in Japan.

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It is important to note that in addition to excluding those who may have quit for 1 day during the past year, this measure does not include pastyear quit attempts of less than 1 day. Participants were asked, "Overall, on a scale from 1 to 10, where 1 is not at all interested and 10 is extremely interested, how interested are you in quitting smoking? This question was asked of current cigarette smokers who used another tobacco product or who used two or more tobacco products. Tobacco counseling refers to any information provided that related to tobacco use in any form, including cigarettes, cigars, snuff, and chewing tobacco, and on exposure to tobacco Patterns of Smoking Cessation Among U. Adults, Young Adults, and Youth 119 A Report of the Surgeon General in the form of secondhand smoke, smoking cessation, and prevention of tobacco use, as well as referrals to other healthcare providers for smoking cessation programs. Receipt of advice to quit was defined as having been given advice from a medical doctor, dentist, or other health professional to quit smoking or to quit using other kinds of tobacco among current cigarette smokers and former smokers who quit during the past year. A separate measure, being advised not to use tobacco, was defined using current cigarette smokers (smoked cigarettes during the 30 days preceding the survey) as being advised by a doctor, dentist, or nurse during the past 12 months not to use tobacco that is smoked or put in the mouth. Counseling is defined as having used one-on-one counseling; a stop-smoking clinic, class, or support group; and/or a telephone helpline or quitline during the past year, among current smokers who tried to quit in the past year and among former smokers who quit in the past 2 years. Current smokers were also asked if they did any of the following the last time they tried to quit: tried to quit by switching to (a) smokeless tobacco, such as chewing tobacco, snuff, or snus; (b) regular cigars, cigarillos, little filtered cigars, or any pipes filled with tobacco, and (c) electronic or e-cigarettes. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. The association of survey setting and mode with self-reported health risk behaviors among high school students. Methodologic changes in the Behavioral Risk Factor Surveillance System in 2011 and potential effects on prevalence estimates. The accuracy of self-reported smoking: a systematic review of the relationship between 1For self-reported and cotinine-assessed smoking status. Prevalence of youth substance use: the impact of methodological differences between two national surveys. An assessment of the effect of data collection setting on the prevalence of health risk behaviors among adolescents. Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project. Determinants of social desirability bias in sensitive surveys: a literature review. Adults, Young Adults, and Youth 121 A Report of the Surgeon General Ryan H, Trosclair A, Gfroerer J. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. The biologic mechanisms underlying nicotine addiction continue to be a subject of great research interest, and several promising pharmacotherapeutic targets have emerged. This section describes the preclinical basis for understanding nicotine addiction and the ways that this knowledge could be used to enhance smoking cessation.

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Evaluation 105 static proteinuria must be excluded by a first morning urine protein measurement if the initial finding of proteinuria was obtained on a random specimen during the day. Otherwise, for ease and consistency of collection, a random urine specimen for protein or albumin to creatinine ratio is acceptable if a first-morning urine specimen is not available. Table 60 compares the advantages and disadvantages of the various modalities of collecting urine for evaluating kidney function. The differences among these protocols balance ease of collection of samples with the need to collect urine to reflect kidney function over the course of the day or overnight. Rationale for Measurement Methods Screening for proteinuria with urine dipsticks is acceptable. Confirmation of proteinuria should be performed using quantitative measurements (R, O). Standard urine dipsticks detect total protein above a concentration of 10 to 20 mg/dL. Evaluation 107 bound by negatively charged serum proteins, including albumin and most globulins. The standard urine dipstick is insensitive for low concentrations of albumin that may occur in patients with microalbuminuria. In addition, the standard dipstick is also insensitive to positively charged serum proteins, such as some immunoglobulin light chains. Albumin-specific dipsticks detect albumin above a concentration of 3 to 4 mg/dL and are useful for detection of microalbuminuria. Screening with a dipstick for proteinuria or albuminuria is often a satisfactory first approach to evaluation of kidney disease; however, clinicians need to be cognizant of causes of false positive and more importantly false negative results (Table 61), and in both instances repeat analyses of urine with quantitative total protein or albumin and creatinine analyses are strongly advised when a result may be inconsistent with the clinical evaluation. Special care should be taken to avoid false negative results which may delay implementation of treatment early in the course of kidney disease. Monitoring proteinuria in patients with chronic kidney disease should be performed using quantitative measurements (O). Increasing proteinuria is associated with a higher risk of loss of kidney function. Decreasing proteinuria, either spontaneously or after treatment, is associated with a lower risk of loss of kidney function. Quantitative measurements provide a more accurate assessment of changes in proteinuria. In patients with diabetes mellitus, there has been nearly a uniform adoption of albumin as the ``criterion standard' in evaluating kidney damage. Thus, for this disease the same standards have been adopted for adults and children.

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