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We believe this constitutes a 'fair use' of any such copyrighted material as provided for in section of the US Copyright Law. In accordance with Title 17 U. In Pseudomonas now Burkholderia cepacia in people with CF was first reported in North America and thereafter reports of this new pathogen, with the potential to spread between patients and cause serious illness, occurred with increasing frequency both from North America Isles et al, above; Thomassen et al, above and later from the UK Simmonds et al, below.
At first some clinicians were slow to accept that cross infection with B. Holiday camps for people with CF — so popular in N. America and so appreciated by some patients from the UK - were a source of cross infection and eventually abandoned Pegues et al, below. This was the start of the era of cross-infection control, which was to radically alter the whole attitude to infection, cross-infection and social contact in CF Centres and in the community.
Also there was increasing evidence of cross-infection with Pseudomonas aeruginosa. The concept of cross-infection between people with CF with organisms other than B. As a result of these developments it is was recommended that people with CF should be segregated according to their microbiological status and those with B.
Does Pseudomonas cross infection occur between cystic fibrosis patients? Over a month period respiratory Pseudomonas aeruginosa isolated from CF patients were typed by serology and pyocin production to determine whether cross-infection was occurring. Although one strain appeared in four unrelated patients, none of these patients had been in contact with each other and the strains were considered to have been acquired from the environment.
However, it is relevant that each of six pairs of siblings with CF shared the same strain, but the pairs of strains were distinct from each other. These results suggested to the authors that the general environment was the most important source of Pseudomonas strains for CF patients and that for cross-infection to occur prolonged intimate contact was required — such as living in the same household.
This was an early study on the possibility of cross infection which at the time was considered to be reassuring. However subsequently, with the advent of more sensitive genetic testing, cross infection was shown to be relatively common in CF centres and clinics, although in there were relatively few such large groups of patients with CF in the UK.
Pseudomonas cepacia infection in cystic fibrosis: J Pediatr ; The carriage of P. Patients infected with P. Prevention of acquisition and effective treatment of P. This paper from Toronto describes the devastating effect of the introduction of B. This organism was to have a profound permanent effect on the treatment and social life of people with CF and their families.
From there was a general introduction of infection control measures in CF Centres in the UK; also there was an end to the North American CF holiday camps which were shown to be an important source of acquisition of the B. In Leeds we had three patients who developed serious B. In we published the first UK paper on B. An epidemic spread of multiresistant Pseudomonas aeruginosa in a cystic fibrosis centre.
J Antimicrob Chemother ; Most of the epidemic could be attributed to a specific nosocomial strain by means of O-grouping and phage- typing. This strain was present in the centre at a low frequency in and developed resistance during repeated courses of chemotherapy. The epidemic was stopped by isolating the patients with the resistant strains. The extensive use of the third generation cephalosporins in the clinic was probably responsible for inducing and selecting for the resistant strains.
Clustering of patients in the centre facilitated the spread. First-line use of older beta-lactam antibiotics, close bacteriological monitoring and prompt isolation of patients with resistant strains was implemented. The Danish CF centre was unusual in giving regular 3-monthly courses of IV antibiotics to all their patients who were chronically infected with Pseudomonas aeruginosa Pedersen et al, below. It is interesting that in the Liverpool paediatric CF clinic the routine use of ceftazidime monotherapy was associated with the development of a resistant Pseudomonas aeruginosa with epidemic spread amongst the patients there Cheng et al, below.
Management of Pseudomonas aeruginosa lung infection in Danish cystic fibrosis patients. Acta Paediatr Scand ; The annual mortality rate of cystic fibrosis patients with chronic P. From patients who acquired chronic P. The patients were followed for patient-years; seven died and the year survival rate after onset of P. Although precipitating antibodies against P. An unwelcome consequence was an increase in cross-infection between patients associated with more frequent hospitalisation and an increased incidence of new P.
Arch Dis Child ; America of this organism appeared in the late Seventies Lararya-Cuassay et al, above , this report from Leeds was the first to report Burkholderia cepacia in the UK — previously known as Pseudomonas cepacia. We were impressed by the very serious consequences of this infection in some patients. We could not identify any source of cross infection in the Leeds CF centre at that stage nor was there an inappropriate use of antibiotics.
However, in retrospect, we suspected that at least two of our patients had acquired the infection at CF holiday camps in N. America some months before the organism appeared in their respiratory cultures. A further report of 13 infected patients three of whom died from the paediatric CF centre in Manchester in the UK also failed to show evidence of cross infection and the authors suggested that further studies were required before segregation of patients should be recommended Gladman G et al, Arch Dis Child ; Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis Lancet ; In this very important paper he reported the definite transfer of B.
An analysis of isolates from patients attending regional CF clinics in Edinburgh and Manchester between and showed that the main cause of increased isolations of P. Epidemiological evidence indicated that social contact was important in spread of the epidemic strain within and between clinics.
Guidelines to limit the acquisition of B. Following this important paper the UK CF Trust advisory group of clinicians and microbiologists advised that strict segregation of B. The widespread introduction of segregation from this time led to a steady reduction in the incidence of new B.
Johns Hopkins Med J ; J Antimicrob Chemother ; 12 Suppl A: Prevention of acquisition and effective treatment of B. In we published from Leeds the first UK paper on B. Epidemic of Pseudomonas cepacia in an adult cystic fibrosis Unit: Evidence of person-to-person transmission. J Clin Microbiol ; Prevalence rose from 1. In only two of the six patients referred to the Birmingham CF centre had P. Two genomic fingerprinting techniques were used to see if this had arisen from epidemic spread of a single strain.
This had indeed occurred and 92 The authors suggested that careful surveillance of the prevalence of antibiotic resistance in CF centres should be instituted with measures to prevent cross-infection. This lesson had already been learned in Copenhagen in the early Eighties Pedersen et al, above and in the past a number of writers had already cautioned against the use of monotherapy. Most CF centres at the time already followed the recommendation to use two antibiotics when treating exacerbations of Pseudomonas infection.
However, prior to this outbreak, intravenous ceftazidime monotherapy had been routine in the Liverpool CF clinic. This was a very important paper which highlighted the risk of cross infection with Pseudomonas aeruginosa in CF clinics now clearly identified by genomic finger printing techniques.
It is cause for concern that, even after experience such as reported here, there is still discussion as to the use of one or two antibiotics for the treatment of exacerbations — even to the extent of a Cochrane review which failed to give firm advice to use two antibiotics!! Ephick HE, Tan A. Single versus combination intravenous antibiotic therapy for people with cystic fibrosis.
Cochrane Database of Systematic Reviews. Comment - Avoidance of cross infection became an increasingly important part of management as it became apparent that, not only could B. The need to segregate patients according to their microbiological status had a major effect on the social lives of people with CF and their families and also on clinic routines in the CF centres. Infection control in cystic fibrosis: Am J Infect Contr ; The great detail in this report is a reflection of the increasing realization that cross infection was a common and potentially harmful occurrence in CF centres.
Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol ; The study is based on 22 of these patients. Prior to attending camp, 17 out of the 22 patients harboured Pseudomonas aeruginosa in their sputum, but 5 patients did not.
After returning from camp, all 22 patients harboured P. The typing results showed that the 5 CF patients who were free of P. The authors concluded that separate holiday camps based on the infection status of the patients with cystic fibrosis are necessary to avoid cross-infection of patients not infected with P. This is one of the more conclusive reports of people with CF contracting new P. The report was important for at this time there were still experienced and respected CF physicians who questioned the importance of segregation according to microbiological status Geddes DM.
Of isolates and isolation: Pseudomonas aeruginosa in adults with cystic fibrosis. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P. Here it was shown to have infected patients already chronically infected with another strain of Pseudomonas.
Travel-associated Burkholderia pseudomallei infection Melioidosis in a patient with cystic fibrosis: Clin Infect Dis ; In August , her pulmonary function rapidly declined, with productive cough and intermittent fever. The chest x-ray films revealed diffuse, small, patchy opacities in the upper lobes. Burkholderia pseudomallei BP were isolated from specimens of the patient's sputum and were identified by means of 16S rDNA sequencing.
The diagnosis of melioidosis was serologically confirmed. Continuous therapy with ceftazidime and co-trimoxazole and maintenance with co-trimoxazole, doxycycline, and chloramphenicol resulted in eradication of Burkholderia pseudomallei.
This infection appears to be a particular risk for the increasing number of adults with CF travelling aboard to places such as Thailand as they seem to be prone to melioidosis. Subsequently further cases were reported. Burkholderia pseudomallei is an important cause of pneumonia and septicaemia in Thailand particularly in the rainy season when it may contaminate the water supply.
There are now almost 70 cases of the infection causing serious illness reported in people with cystic fibrosis. So going on holiday to Thailand represents a definite risk for a person with CF particularly in the rainy season. Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic. Cross-infection by a new multiresistant P.
The authors recommended CF centres should undertake microbiological surveillance of their patients. A subsequent report from Manchester showed that patients infected with this strain of Pseudomonas required more intensive treatment Jones AM et al. John Govan of Edinburgh, that was influential in the eventual introduction of widespread microbiological surveillance of CF centres in the UK. A similar clinical situation with a transmissible P.
The papers from Manchester were influential in the introduction of a more rigorous policy of segregation according to microbiological status in most UK CF centres. Suggestions for prevention and infection control". However, some clinicians accepted the report with some degree of reluctance for example one senior respected physician wrote in the Lancet- "There is a real risk of stigmatisation by sputum bacteriology, enhanced anxiety about what may be a relatively benign organism many adults with CF remain well despite positive cultures of Pseudomonas aeruginosa for decades and fear of attending a CF centre or any school or social event where another person with CF may be met.
There are risks in doing too little but it may be worse to do too much". Also one London paediatrician wrote - "This segregation means there will be loss of continuity of care as well as flexibility for the families choosing which days they come to see us". Another of his paediatric colleagues described those of us at the UK CF Trust responsible for recommending patient segregation as "an unruly bunch of zealots" Fortunately only a minority of clinicians held these views!!
Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: The purpose of this study was to determine if there are genomovar-specific disparities in transmission and disease severity. Patient-to-patient spread was observed with B.
Genomovar III strains replaced B. Genomovar III strains were also associated with a poor clinical course and high mortality. Infection control practices should be designed with knowledge about B.
An important paper regarding the management of people with CF who are infected with organisms in the B. Occurrence of Burkholderia cepacia in foods and waters: J Food Protect ; Two hundred forty-eight retail "ready-to-eat" foodstuffs in eight food categories and waters categorized into nine types were analyzed for the presence of the Burkholderia cepacia complex of organisms.
Of these, 14 of 26 Consumption of raw unpasteurized milk may therefore act as a potential source of infection with this organism, which is of particular concern for patients with cystic fibrosis, where colonization and infection with this B. In addition to the associated risk of infection from fecal pathogens, patients with cystic fibrosis should therefore avoid the consumption of raw unpasteurized milk to minimize the risk of becoming infected with this organism.
Of considerable practical importance as unpasteurised milk is still available in some countries. Distribution of raw milk is illegal in Scotland while it is legal in England, Wales, and Northern Ireland, the only registered producers are in England. About producers sell raw, or "green top" milk direct to consumers, either at the farm, at a farmers' market, or through a delivery service.
The bottle must display the warning "this product has not been heat-treated and may contain organisms harmful to health", and the dairy must conform to higher hygiene standards than dairies producing only pasteurised milk.
As it is only legal to supply unpasteurised milk direct to consumers, it is illegal to be sold on the High Street, via shops or supermarkets. Raw milk is available in the USA but illegal in Canada. Occurrence of Burkholderia cepacia in the hospital environment. Irish J Med Sci ; To determine the prevalence of Burkholderia cepacia from the environment in a regional adult cystic fibrosis CF care centre.
In addition, the organism was not detected in toilet bowls, even in the B. With regard to positive environments for B. All positive samples originated in the B.
Consequently, these two positive sites should therefore be treated as high risk, where organisms may be potentially transmitted from environment to patient. Dr John Moore is Clinical Microbiologist at the Belfast City Hospital and very active in research and clinical work including many practically useful papers on cystic fibrosis relating to the environment and infection prevention and control. This present study confirming that B.
Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic. Am J Resp Crit Care ; However, after detecting a genotypically identical strain of P.
This study demonstrates extensive spread of a single, clonal strain of P. Whether such a strain is also more virulent than sporadic isolates remains to be determined however the fatal outcome for 5 of these children suggests this was almost certainly the case. As transmissible strains could emerge elsewhere, the authors suggested that other CF clinics may also need to consider molecular methods of surveillance for cross-infection.
This is a really tragic story and further evidence of the potential and at times very real dangers of spread of highly transmissible strains of P. The fact the 5 children died attests to this strain's virulence and this type of highly transmissible infection also leads to a requirement for more treatment Jones AM et al. This is another study recommending to others that molecular methods should be used when studying cross infection in CF centres.
It is interesting and of some concern that around this time in some major CF centres, there were still clinicians who doubted the need for segregation even though the first major epidemic had been described as long ago as from Liverpool Cheng et al, above.
Spread of an epidemic Pseudomonas aeruginosa strain from a patient with cystic fibrosis CF to non-CF relatives. However, transmission of these strains by social contact to healthy non-CF individuals has not been described.
A case is presented where an adult CF patient colonised by an epidemic P. This the first report of this occurring. Increased treatment requirements of patients with cystic fibrosis who harbour a highly transmissible strain of Pseudomonas aeruginosa.
It was apparent that the patients who harbour the highly transmissible P. The authors suggest that these findings support the need for microbiological surveillance for highly transmissible P. Pseudomonas cross-infection from cystic fibrosis patients to non-cystic fibrosis patients: Spread of a highly transmissible P. The spread of infection to non-CF patients from CF patients is a definite risk in hospital wards, particularly if there are immunocompromised patients mixing with CF patients who have chronic P.
I have observed this on a paediatric ward on one occasion in the years before cross infection with P. Epidemic spread of Pandoraea apista, a new pathogen causing severe lung disease in cystic fibrosis patients. It is most likely that this strain of P.
All patients developed chronic infection with high levels of antibodies, and 4 patients had a downhill course of lung disease. In this instance cohort isolation prevented further spread of P. Such reports from large CF centres such as Copenhagen are useful for clinicians who subsequently encounter such organisms. Infection control recommendations for patients with cystic fibrosis: The result is a very detailed paper full of information and nearly references!
Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients. Since this strain is common in many CF units, strain identification in all CF centres is essential. This can only be carried out using genomic typing methods. The long term effects of the epidemic strain originally described by Cheng et al in in the Liverpool paediatric CF unit Cheng K, et al. Prevalence of Pseudomonas aeruginosa in households of patients with cystic fibrosis.
Internat J Hyg Envir Health ; PA was detected in 73 PA was detected most frequently in drains of showers Toilet seats and dish-clothes did not show PA in any household. The frequency and intensity of cleaning measures did not impact the detection rate of PA. Results of the present study for the first time determine the rate of contamination with PA in households of patients with CF.
Future studies would determine the risk of transmission of PA from households locations to people with CF. As staff in CF centres became aware of and took measures to prevent patient to patient spread of infection in hospitals, it became apparent that many new Pseudomonas infections were acquired from the environment outside the hospitals. Here the home is shown to be a rich source of these organisms.
Suggestions for Prevention and Infection Control. Cystic Fibrosis Trust, September Full text available on www. Cystic Fibrosis infection Control Group. Cystic Fibrosis Trust, November Identification and characterization of transmissible Pseudomonas aeruginosa strains in cystic fibrosis patients in England and Wales. J Med Microbiol ; However, two recent UK reports of highly transmissible strains of PA in patients in regional centres in Liverpool Cheng et al, above and Manchester Jones et al, above raised questions as to the extent of the problem.
These reports prompted the UK CF Trust to fund this nationwide survey to establish the distribution of PA genotypes among these patients. In total, isolates were received from 31 centres range 1 to A panel of strains of the common genotypes including representatives of reported transmissible strains was assembled and further characterized by fluorescent amplified fragment length polymorphism FAFLP genotyping.
The important findings were as follows: FAFLP analysis revealed some microheterogeneity among strains of the Liverpool genotype but all isolates of this genotype were positive by PCR for a strain-specific marker.
These data are mentioned in detail in view of their great importance for clinic routines and suggest that cross-infection with PA has occurred both within and widely between CF centres in England and Wales. The two most common genotypes accounted for more than one-fifth of patients' isolates examined and transmissible genotypes were found in all but three of the 31 CF centres studied. These results emphasize the need for continued surveillance of P.
Burkholderia cenocepacia and Burkholderia multivorans: Deaths from "cepacia syndrome" occurred in both BCC groups. There was no difference in survival between CF patients infected with B multivorans and P aeruginosa. There were no observed differences in changes in spirometry and BMI or treatment requirements between the BCC groups and respective controls. In CF, the genomovar status of BCC may influence both the likelihood of progression from initial to chronic infection and the overall survival of the patients.
This study from a large CF centre in Manchester confirms the more serious prognosis for patients infected with B. J Cyst Fibros ; 3: It is important to recognise that 'cepacia syndrome' is not restricted to those infected with genomovar type III strains and that rapid, irreversible clinical decline can occur many years after the first isolation of Burkholderia cepacia complex Bcc.
So a word of warning after the reassuring report from the Manchester CF centre Blackburn L et al, above reproting that B. Clinical outcome of Burkholderia cepacia complex infection in cystic fibrosis adults. The rate of BMI decline was significantly greater in patients infected with B. Infection with a single B. Clonal strains of Pseudomonas aeruginosa in paediatric and adult cystic fibrosis units.
Eur Respir J ; Sputum was collected prospectively from productive patients attending the regional paediatric and adult CF units in Brisbane, Australia. Spirometry, anthropometrics, hospitalisations and antibiotic sensitivity data were recorded. The first sputum samples first 50 patients at each clinic harboured isolates of P. A total of 39 patients shared a common strain pulsotype 2 , 20 patients shared a strain with at least one other patient and 41 patients harboured unique strains.
Eight patients shared a strain identical to a previously reported Australian transmissible strain pulsotype 1. Compared with the unique strain group, patients harbouring pulsotype 2 were younger and had poorer lung function. Treatment requirements were similar in these two groups, as were the rates of multi resistance. In contrast to previously described clonal strains, the dominant pulsotype was indistinguishable from non clonal strains with respect to both colonial morphology and multi resistance.
The clinical significance of clonal strains remains uncertain and requires longitudinal study. Yet another major clinic where a significant number of patients shared a particular strain with others. In its final semester of operation it had 95 students. In December the district voted to close altogether effective the beginning of Initially the Treasure Island Homeless Development Initiative fought to save the school, but after discipline and staffing issues occurred in , the group stopped its efforts.
Heather Knight of the San Francisco Chronicle wrote that year "Even people who had fought to save the school earlier this year now admit it's no longer worth saving. Looking north towards the Marin Headlands from the western shore. The bridge's new eastern span is best viewed from near the marina. From Wikipedia, the free encyclopedia. Redirected from Treasure Island, California.
Treasure Island is "5, feet long by 3, feet wide"  and has the Treasure Island Marina on the south near Yerba Buena Island bottom. Treasure Island is the northernmost area of San Francisco's District 6.
Naval Station Treasure Island. Bay Bridge and the Golden Gate". Retrieved October 22, The Secretary of War approved the request that its execution be undertaken by the Army Corps of Engineers. While a group of such specialists applied their talents to the reclamation of the 'Yerba Buena Shoals', the day-by-day details were efficiently cared for by Colonel Fred Butler, U. Retrieved November 5, Retrieved November 7, Geographic Names Information System. United States Geological Survey.
Retrieved October 25, California Department of Parks and Recreation. Retrieved October 26, United States Census Bureau. Retrieved December 16, The San Francisco News. Retrieved October 26, — via SFmuseum. Gay By the Bay: