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A substantial fraction of the mysteries associated with crack extension might be eliminated if the description of fracture experiments could include some reasonable estimate of the stress conditions near the leading edge of a crack particularly at points of onset of rapid fracture and at points of fracture arrest. It is pointed out that for somewhat brittle tensile fractures in situations such that a generalized plane-stress or a plane-strain analysis is appropriate, the influence of the test configuration, loads, and crack length upon the stresses near an end of the crack may be expressed in terms of two parameters. One of these is an adjustable uniform stress parallel to the direction of a crack extension. It is shown that the other parameter, called the stress-intensity factor, is proportional to the square root of the force tending to cause crack extension. Both factors have a clear interpretation and field of usefulness in investigations of brittle-fracture mechanics.
The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions.
This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.IntroductionParameters of the Report
In the full guidelines, Part I, Background Information: Environmental Infection Control in Health-Care Facilities, provides a comprehensive review of the relevant scientific literature. Attention is given to engineering and infection-control concerns during construction, demolition, renovation, and repair of health-care facilities. Use of an infection-control risk assessment is strongly supported before the start of these or any other activities expected to generate dust or water aerosols. Also reviewed in Part I are infection-control measures used to recover from catastrophic events (e.g., flooding, sewage spills, loss of electricity and ventilation, or disruption of water supply) and the limited effects of environmental surfaces, laundry, plants, animals, medical wastes, cloth furnishings, and carpeting on disease transmission in health-care facilities. Part III and Part IV of the full guidelines provide references (for the complete guideline) and appendices, respectively.
Part II (this report) contains recommendations for environmental infection control in health-care facilities, describing control measures for preventing infections associated with air, water, or other elements of the environment. These recommendations represent the views of different divisions within CDC's National Center for Infectious Diseases and the Healthcare Infection Control Practices Advisory Committee (HICPAC), a 12-member group that advises CDC on concerns related to the surveillance, prevention, and control of health-care--associated infections, primarily in U.S. health-care facilities. In 1999, HICPAC's infection-control focus was expanded from acute-care hospitals to all venues where health care is provided (e.g., outpatient surgical centers, urgent care centers, clinics, outpatient dialysis centers, physicians' offices, and skilled nursing facilities). The topics addressed in this report are applicable to the majority of health-care facilities in the United States. This report is intended for use primarily by infection-control practitioners, epidemiologists, employee health and safety personnel, engineers, facility managers, information systems professionals, administrators, environmental service professionals, and architects. Key recommendations include
Wherever possible, the recommendations in this report are based on data from well-designed scientific studies. However, certain of these studies were conducted by using narrowly defined patient populations or specific health-care settings (e.g., hospitals versus long-term care facilities), making generalization of findings potentially problematic. Construction standards for hospitals or other health-care facilities may not apply to residential home-care units. Similarly, infection-control measures indicated for immunosuppressed patient care are usually not necessary in those facilities where such patients are not present.
Also, in the absence of scientific confirmation, certain infection-control recommendations that cannot be rigorously evaluated are based on strong theoretic rationale and suggestive evidence. Finally, certain recommendations are derived from existing federal regulations. Performance Measurements
Contributors to this report reviewed primarily English-language manuscripts identified from reference searches using the National Library of Medicine's MEDLINE, bibliographies of published articles, and infection-control textbooks. All the recommendations may not reflect the opinions of all reviewers. This report updates the following published guidelines and recommendations:
Tablan OC, Anderson LJ, Arden NH, et al., Hospital Infection Control Practices Advisory Committee. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994;15:587--627. Updates and expands environmental infection-control information for aspergillosis and Legionnaires disease; online version incorporates Appendices B, C, and D addressing environmental control and detection of Legionella spp.
CDC. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(No. RR12). Supplements environmental infection-control information from the section, Hospitals with Endemic VRE or Continued VRE Transmission.
As in previous CDC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretic rationale, applicability, and possible economic effect. The recommendations are evidence-based wherever possible. However, certain recommendations are derived from empiric infection-control or engineering principles, theoretic rationale, or from experience gained from events that cannot be readily studied (e.g., floods).
(iii) falsely assuming the title of, or falsely representing any person to be, a manufacturer, wholesaler, pharmacist, physician, doctor of osteopathic medicine licensed to practice medicine, dentist, podiatrist, veterinarian, or other authorized person for the purpose of obtaining a controlled substance.
(a) A person convicted under the provisions of subdivision 2, clause (1), who has not been previously convicted of a violation of this chapter or a similar offense in another jurisdiction, is guilty of a gross misdemeanor if: (1) the amount of the controlled substance possessed, other than heroin, is less than 0.25 grams or one dosage unit or less if the controlled substance was possessed in dosage units; or (2) the controlled substance possessed is heroin and the amount possessed is less than 0.05 grams.
National Roadside Vegetation Management Association www.nrvma.orgNorth Carolina Department Of Transportation, Vegetation Management _chief_eng/roadside/vegetation/maintenance/ Washington State Department of Transportation, Integrated Vegetation Management IX. AppendicesA. Clear Zone Description The concept of clear zone is an approach to minimize the number and severity of crashes involving vehicles running off the road. Simply stated, it is a traversable area that starts at the edge of the traffic lane and extends laterally a sufficient distance to allow a driver to stop or return to the road before encountering a hazard or overturning. The traversable area would be considered safe, if there were no fixed objects, unless they are breakaway, and if the roadside geometry (either the fore slope, back slope, or ditch) was flat enough that a vehicle could safely traverse the area without tipping and rolling over. Roadside safety features include breakaway sign and light posts, and traversable drainage structures. Curbs are not considered a roadside safety feature since they can be easily mounted by errant vehicles; hence, their presence does not alter how clear zone is measured. A safe traversable slope can be either a recoverable slope or a non-recoverable slope with a clear run-out area at the bottom. A recoverable slope is a slope on which a motorist may, to a greater or lesser extent, retain or regain control of a vehicle and recover or stop. Slopes 1:4 (Vertical:Horizontal) or flatter are generally considered recoverable. A non-recoverable, traversable slope is a slope which is considered traversable but on which an errant vehicle will continue to the bottom. Embankment slopes from 1:3 and 1:4 may be considered traversable but non-recoverable if they are smooth and free of fixed objects. A clear run-out area is the flatter area at the toe of a non-recoverable slope available for safe use by an errant vehicle. Slopes steeper than 1:3 are not considered traversable and should not be found in the clear zone. 2b1af7f3a8