[其他]English lesson 12

(English lesson 12)



I have collected all the compositions!


Still remember I told you this:

After you memorise the compositions, you will be able to understand English TV news, English newspapers, English magazines, and English novels. Because all the content of the reading materials are only regarding :

war and peace,
sports,
pollution,
AIDS,
drugs,
road accident,
computer,
internet,..
these hot topics. (You may find for yourself the topics I haven’t mentioned)
So after you memorise them, you would be able to understand what the media says.

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I have collected all the compositions from the encyclopedias or from the web sites. If the compositions are taken from the web sites, I will write down the address of the web site. If there isn’t any address of the web site, they are the compositions I have taken from the encyclopedias. I hope you would at least read the compositions.

If you can’t memorise the whole composition, you can go and learn the words you don’t know only. That can also help you to achieve the goal of lesson 9 (improving your vocabulary, speaking fluent English and being able to understand English news, English reading materials) But of course, it is not as good as the method memorising the composition. Because whenever you talk about the topic, you tend to use the words that you memorise. If you learn the words only, you forget them quickly.

But I am also lazy. I learn the words only. You can learn from me if you want.

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Index


POLLUTION
ROAD SAFETY
COMPUTER APPLICATIONS
AIDS
TERRORISM

THE VALUE OF SPORTS AND GAMES
INTERNET
DRUGS
MDMA (ECSTASY)
THE NATURE OF WAR AND PEACE
SARS

POLLUTION


Pollution is the fouling of the environment – land, water and air --- by waste, smoke, chemicals and other harmful substances. The most serious pollution occurs where there are large cities and many factories.

Smoke from factory chimneys and exhaust gases from motor vehicles pollute the air. Chemicals in the air combine with moisture to make acids, which eat away stone and brick, and so damage buildings. Carbon monoxide gas and substances called hydrocarbons given out by the engines of cars, lorries and buses can damage people’s health.

Pollution is not a new problem. In the middle of the 20th century most towns were dirty, water supplies were foul and diseases spread quickly. Much has been done to improve sanitation and public health. But since the Industrial Revolution, the problems of waste disposal have become more complicated. Every industrial country faces the problem of waste. As factories produce new goods for people to buy, old ones are thrown out with the household rubbish. Burning this refuse pollutes the air, dumping it in rivers and seas pollutes the waster, and rubbish tips are unpleasant and take up much-needed space. Getting rid of plastics is particularly difficult. After some time wood and paper decay through the action of bacteria. But plastics never decay. The more we throw away, the more litter is produced. So scientists are trying to make plastics which will break down naturally into harmless substances. Industrial waste, such as poisonous chemicals or radioactive matter, often has to be buried deep underground to prevent contamination.

Because industry needs a constant supply of raw materials, the ideal solution to the problem of waste is to make use of rubbish as a raw material by re-using or ‘re-cycling’ it. For example, cars can be reduced to scrap by giant shredders and the valuable metal used again.

The world’s oceans have been used as ‘dustbins’, with millions of tons of rubbish being dumped into the seas every year, harming marine life. If too much untreated sewage is poured into seas, lakes and rivers from sewers, the water can no longer dilute it, all the oxygen is used up, and the fish die. The bacteria which normally break down the sewage into harmless substances also die; only harmful bacteria which do not need air remain, and these cause disease.

Pollution is also caused by the fertilizers and insecticides used by farmers. The chemicals in fertilizers may be washed from the soil into rivers. They can build up in water supplies, and they can also make algae grow so fast that they use up all the oxygen, choke the river and kill all life in it. Poisons used to kill insect pests kill useful creatures too. Plants sprayed with poisonous chemicals are eaten by animals, which take the poison into their bodies. In turn these animals are eaten by predators, such as hawks and falcons. So much poison builds up in the birds’ bodies, that they lay eggs with thin shells, which crack before hatching. So they quickly become scarce.

There are many different pollutants (substances which cause pollution) in the modern world. Scientists are trying to find ways to avoid using them or to counteract their harmful effects so as to restore the ‘balance of nature’ which man has upset.

ROAD SAFETY


The need to use the roads skillfully becomes greater as time goes by. Every year several hundreds of thousands of new vehicles come on to the roads. In Great Britain alone nearly 7,500 people are killed every year and more than 340,000 injured, mainly because road users are careless or have insufficient knowledge about how to use the roads properly . Yet if everyone followed the Highway Code most of these accidents would not happen. The Highway Code tells people about road laws and what they should do as they travel on the roads. It can be bought through any newsagent.

The Highway Code tells you how to ‘speak’ the language of the road; that is, how to signal to other people and how to understand their signals to you, how to understand road signs and the different kinds of white and yellow lines whch are painted on roads to make them more safe to use. This ‘language’ is mostly a silent one --- it consists mainly of seeing and understanding --- but it is vital to learn it thoroughly. Nowadays people travel about far more than they used to so it has become necessary to have road signs that are understood in most countries. Road signs in Britain are mostly the same, or similar, to those in Europe. Thus we can understand what road signs mean in France, Germany and other countries, just as European visitors can understand ours.

The government, with the help or organisations like RoSPA (the Royal Society for the Prevention of Accidents) tries to persuade drivers and riders, as well as walkers, to take greater care and to learn how to be more skilful in using the roads. This is done by means of television and radio programmes, as well as films and filmstrips, booklets and special courses of instruction. Children can receive free training under the National Cycling Proficiency Training Scheme, and if they pass the national test, they are awarded a certificate and a badge. Training courses and the test are held near their homes, mostly in schools. Children who want to take safety officer or the police for details of the scheme. Most of the children who take these courses are between 9 and 13 years old, but there are special lessons for children of 7 and 8, as well as advanced courses for older children who have already gained their national certificate. These schemes have led to a steady reduction in accidents to child cyclists, although there are more children riding cycles each year.



Preventing Accidents

How can road accidents be prevented? We all start to use the roads by walking along them. During this time we develop attitudes to road behaviour, and we begin to understand. We learn how to wait at kerbs before dashing across roads, to look around for fast moving traffic and to judge when it is safe to cross. Younger children cannot do these things easily, so they must be helped by their parents or by older children.

As pedestrians we learn how to use pedestrian crossings. Sometimes we have to wait traffic is stopped and not run on to a crossing hoping that drivers will be able to stop their vehicles in time to avoid hitting us. At some crossings pedestrians can press a button which operates a light signal which tells them when it is safe to cross the road. Usually this signal is like a green traffic light but sometimes it may be a little green man. Cross the road by the shortest route and as quickly as possible. Always find a safe place to cross, especially if there are no crossings for you to use. Choose places where traffic is not too dense and where you can see vehicles clearly. And never dash into the road from between parked cars!

Cyclists are legally drivers of vehicles with the same right to use the roads as other vehicles. They must also observe the laws in the same way. They must obey road signs and signals, ride with proper care, use lights at night , not ride on footpaths reserved for pedestrians, and generally conduct themselves with the skill and courtesy of responsible citizens. Every cyclist should study the Highway Code and should observe the first requirements of road users on wheels. These are to keep vehicles in good condition and pay particular attention to light, brakers, steering, and tyres. Bicycles should be the correct size for their riders. This means that the rider should be able to sit astride the saddle, hands comfortably on the handlebar, with the balls of the feet on the ground. These are the first essentials of proper control. For young cyclists the best thing to do is to be trained in the National Cycling Proficiency Scheme and learn from experts. This provides an excellent basis for future road experience and will stand them in good stead when the time comes to drive faster and more lethal motor vehicles.

Many dogs are killed unnecessarily on the roads every year, mostly because they have not been properly trained. In some towns road safety officers organise special dog-training classes where owners can learn how to teach and control their pets. Until a young dog has learned to obey you and stop at kerbs at your command, it is best kept on a lead when taken out for exercise. Teach it to walk beside you and not pull hard on its lead, and to stop and sit when you stop. Begin teaching your dog the essential things it should understand as soon as possible.

COMPUTER APPLICATIONS



Wherever there is need for the rapid processing of large quantities of information or for the performance of routine, highly repetitive tasks, there is need for a computer. Until the last 1970’s, because of cost, computers were largely the reserve of large business organisations, government agencies, and scientific and technical laboratories. Today, although a computer may be used for almost any information-processing task, there are many fields where computer development lags behind practical applications.


Education

In education, some trends seem clear. Because of the expanding importance of computers in the economic growth of society, people must know how to interact with a computer. It is less clear what people should learn about computers. Should it be to learn to write programs or to learn the details of computer operation? Most people will likely have to know as much about operating computers as they know about operating an automobile. Because, like automobiles, computers will be everywhere.

Computers are becoming increasingly useful tools of education. For some applications, such as routine instruction, they can be superb adjuncts to the teacher. They are ideally suited to self-paced instruction where the course objectives and content are well defined. Examples are situations where certain thought processes must be learned, where a body of facts must be assimilated, and where certain mechanical procedures must be mastered ---- from the operation of a complex machine to the giving of an anesthetic. Properly programmed computers can be superior to the average teacher for tasks such as these. For economic reasons, computers will probably be used extensively in industrial and military training before they are used in the classroom.

Computers are not good at teaching in ‘fuzzy’ situations, that is, where tasks cannot be defined in simple terms. Until fifth-generation computers become a reality, computers will be confined to the routine aspects of teaching.

In the universities, computers have long been the key tools for numerous forms of research. Many of the fundamental advances in computer science have come from university laboratories. However, careers in computer science have become so lucrative that students are going into government or industry rather than continuing their graduate education: As a result, the source of teachers for future computer scientists is drying up. This trend must be reversed to protect the future of the U.S. computer industry.

Business

Computers began their business careers in the banking and insurance industries, where massive amounts of data have to be processed daily. In the late 1950’s the banking industry adopted magnetic coding of checks; this made computer processing of checks possible. Computers were made available to tellers in banks and other financial institutions and later began to replace tellers as the use of ATMs (automated teller machines) expanded. The credit card and the debit card are used for automatic, instantaneous banking transactions via computer. The concept of ‘bank anywhere, anytime’  depends on the computer-based expansion of EFT (electronic funds transfer) technology. Banking from home computers or data terminals is the next logical step.

By the late 1960’s computer-processed data had become a fact of life in business. Computers are used for almost all aspects of business administration: bookkeeping, accounting, inventory control, forecasting, and record keeping; these capabilities are also available to small businesses. In the field of office automation, computers, interconnected by telecommunications, are applied to such tasks as the handling of electronic mail and text and document processing. With an office or desktop microcomputer, one can compose a memo, do calculations, draw graphs, check spelling, and automatically transmit the results by electronic mail.


Government

Government is a major user of computers. In the United States the federal government, the largest employer in the country, is also the largest user of computers. About half the federal computers are in the Department of Defense. Federal, state, and local authorities use computers much as does business; many other applications, however, are specific to government work.


Space and defense

The space program, including the lunar landings, the planetary probes, communications satellites, and the space shuttle, would not have been possible without computers. Computers are needed for designing, building, launching, tracking, and, in some cases, recovering a spacecraft. Missiles are computer-guided. Many forms of ‘smart’ weapons have microcomputers as ‘brains’. Computer-based command and control communications systems support NASA’s space-tracking operations. Similar systems support military operations worldwide.


Weather Prediction

One of the earliest uses of computers was in weather prediction. Today, computers run the communications network that brings data to the National Weather Service, check observations for errors, plot weather maps, use data from satellites to plot maps of cloud cover, perform the extensive calculations involved in predicting the weather using mathematical models of the atmosphere, and plot the forecast maps and disseminate the results to airports, Weather Service offices, and the news media.


Federal bureau of Investigation (FBI)

The FBI runs a National Crime Information Center, the heart of which is a computer system in which records of wanted individuals, stolen motor vehicles and other goods, stolen securities, and so on are stored. This information can be accessed within seconds by various federal, state, and city law-enforcement agencies. Thus, a highway police officer can quickly check whether an out-of-state vehicle has been stolen. Many states have similar systems.


Internal Revenue Service

Computers are used to check the arithmetic of income tax returns, to check whether itemized deductions are ‘reasonable’, to check whether items such as dividends reported by the taxpayer tally with the reports submitted by the paying company, and to prepare refund checks or demands for additional payment from the taxpayer. Large businesses file their tax returns on computer tapes rather than on paper.


Census

It takes several years to analyze the results of a population census using computers. (The firs major use of punched cards by the federal government was for the 1890 census, and the first commercially available computer was used for the 1950 census). Completed census questionnaires are now read automatically onto microfilm and then onto magnetic tapes. These tapes are processed by computer to produce summary tapes from which printed reports can be prepared photographically. Summary tapes are also sold to researchers who make specialized analyses using their own computers.


Home

Computers began entering the home in large numbers in the late 1970’s. By mid-1983 there were an estimated 2 million computers in U.S. homes. Many home computers are used mainly for entertainment but have great potential for education, household management, and household control. A key feature in the entertainment and educational aspect of the personal computer is interactivity; the user is a participant rather than a passive observer. There are thousands of different programs (software) available for use with home computers. As the cost of secondary storage decreases, the information available to the owner of a personal computer will be almost without limit. An assortment of inexpensive services available via telephone will further increase the variety and number of uses of home computes. Remote working, or ‘telecommuting’--
that is, doing a job at home rather than going to an office --- is increasing. There is also a trend toward ‘smart’ appliances of various types. Besides microwave ovens, some of which talk to the user, there are environmental controls, programmable recorders and radios, home security systems, and smart telephones, all run by microprocessor.

http://health.yahoo.com/health/dc/000594/0.html



AIDS


DEFINITION

AIDS stands for "Acquired Immune Deficiency Syndrome." AIDS is caused by the Human Immunodeficiency Virus (HIV). AIDS is the final and most serious stage of HIV disease, in which the signs and symptoms of severe immune deficiency have developed.

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ALTERNATIVE NAMES

Acquired immune deficiency syndrome

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CAUSES, INCIDENTS, AND RISK FACTORS


AIDS is the fifth leading cause of death among persons between ages 25 and 44 in the United States. About 47 million people worldwide have been infected with HIV since the start of the epidemic.

The Human Immunodeficiency Virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening illnesses and cancers. Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with fully functional immune systems can cause fatal illnesses in people with AIDS.

HIV has been found in saliva, tears, nervous system tissue, blood, semen (including pre-seminal fluid, or "pre-cum"), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk have been proven to transmit infection to others.

Transmission of the virus occurs:


1.through sexual contact -- including oral, vaginal, and anal sex
2.through blood -- via blood transfusions or needle sharing
3.from mother to child -- apregnant woman can passively transmit the virus to her fetus, or a nursing mother can transmit it to her baby


Other transmission methods are rare and include accidental needle injury, artificial insemination through donated semen, and througha donated organ.

HIV infection is NOT spread by casual contact such as hugging and touching, by touching dishes, doorknobs,or toilet seats, during participation in sports, or by mosquitoes. It is NOT transmitted to a person who donates blood or organs. However, it can be transmitted to the person receiving blood or organs from an infected donor. This is why blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

Those at highest risk include homosexual or bisexual men engaging in unprotected sex, intravenous drug users who share needles, the sexual partners of those who participate in high-risk activities, infants born to mothers with HIV, and persons who received blood transfusions or clotting products between 1977 and 1985 (prior to standard screening for the virus in the blood).

AIDS begins with HIV infection. People who become infected with HIV may have no symptoms for up to ten years, but they can still transmit the infection to others. Meanwhile, their immune system gradually weakens until they are diagnosed with AIDS. Acute HIV infection progresses over time to asymptomatic HIV infection and then to early symptomatic HIV infection and later, to AIDS (very advanced HIV infection):

HIV Infection (acute HIV infection) -->early asymptomatic HIV infection -->early symptomatic HIV infection -->AIDS

Most individuals infected with HIV will progress to AIDS if not treated.
However, there is a very small subset of patients who develop AIDS very
slowly or never at all. These patients are called non-progressors.

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PREVENTION

Prevention of AIDS requires foresight and self-discipline. The requirements often seem personally restrictive but they are effective and can save your life.


1. Do not have sexual intercourse with:

People known or suspected to be infected with AIDS
Multiple partners
A person who has multiple partners
People who use IV drugs


2. Do not use intravenous drugs. If IV drugs are used, do not share needles or syringes. Avoid exposure to blood from injuries or nosebleeds where the HIV status of the bleeding individual is unknown. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.

3. Anyone who tests positive for HIV may pass the disease on to others and should not donate blood, plasma, body organs, or sperm. From a legal, ethical, and moral standpoint, they should warn any prospective sexual partner of their HIV positive status. They should not exchange body fluids during sexual activity and must use whatever preventative measures (such as a latex condom) will afford the partner the most protection.

4. HIV positive women should be counseled before becoming pregnant about the risk tounborn childrenand medical advances which may help prevent the fetus from becoming infected.

5. Mothers who are HIV positive should not breast feed.

6. "Safe sex" practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

7. HIV-positive patients who are taking anti-retroviral medications are less likely to transmit the virus. For example, pregnant women who are on treatment at the time of delivery transmit HIV to the infant about 5% of the time.

The U.S. blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood. Currently, the risk of infection with HIV in the United States through receiving a blood transfusion or blood products is extremely low and has become progressively lower, even in geographic areas with high HIV prevalence.

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SYMPTOMS

The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These infections are termed "opportunistic infections."

Patients with AIDS have had their immune system destroyed by HIV and are susceptible to such opportunistic infections. The general symptoms are fevers, sweats, chills, weakness, and weight loss. See the signs and tests section below for a list of the common AIDS-defining opportunistic infections and the major symptoms associated with them.

Note: Initial infection may produce no symptoms. Some people with HIV infection remain without symptoms for years between the time of exposure and development of AIDS.

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SIGNS AND TESTS


Not all patients infected with HIV have AIDS. The patients who have tested positive for the HIV antibody test slowly develop AIDS as HIV destroys their immune systems.

In order for a patient who is infected with HIV to have AIDS, their immune system must be severely damaged. The severity of the immune system damage is measured by an absolute CD4 lymphocyte count. The CD4 lymphocyte is an important cell in the blood stream that helps protect from several infections and cancers. If a person infected with HIV has a CD4 count less than 200, they are said to have AIDS.

The following is a list of "AIDS-defining" infections and cancers that people with AIDS acquire as their CD4 count decreases. Many other illnesses and corresponding symptoms may develop in addition to those listed here.


CD4 count below 350/ml

*Herpes Simple Virus — causes ulcers in your mouth and/or genitals
*Tuberculosis — infection by the tuberculosis bacteria that predominately affects the lungs
*Oral and/or vaginal thrush — yeast infection of the mouth or genitals
*Herpes zoster — ulcers over a discrete patch of skin caused by this virus
*Non-Hodgkins Lymphoma — cancer of the lymph glands


CD4 count below 200/ml

*Pneumocystis carinii pneumonia
*Candida esophagitis — painful yeast infection of the esophagus


CD4 count below 100/ml

*Cryptococcal meningitis — infection of the brain by this fungus
*AIDS Dementia — worsening and slowing of mental function caused by HIV
*Toxoplasmosis encephalitis — infection of the brain by this parasite
*Progressive multifocal leukoencephalopathy — a viral disease of the brain caused by a virus (called the JC virus) that caused quick decline in cognitive and motor functions
*Wasting Syndrome — extreme weight loss and anorexia caused by HIV


CD4 count below 50/ml

*Mycobacterium — a blood infection by a bacterium related to tuberculosis
*Cytomegalovirus infection — a viral infection that can affect almost any organ system, especially the eyes


In addition to the CD4 lymphocyte count, T (thymus derived) lymphocyte count, chest x-rays, pap smears, and other tests are useful in managing HIV disease.

TERRORISM




Definition of terrorism


Short legal definition proposed by A. P. Schmid to United Nations Crime Branch (1992):
Act of Terrorism = Peacetime Equivalent of War Crime


Academic Consensus Definition:


"Terrorism is an anxiety-inspiring method of repeated violent action, employed by (semi-) clandestine individual, group or state actors, for idiosyncratic, criminal or political reasons, whereby - in contrast to assassination - the direct targets of violence are not the main targets. The immediate human victims of violence are generally chosen randomly (targets of opportunity) or selectively (representative or symbolic targets) from a target population, and serve as message generators. Threat- and violence-based communication processes between terrorist (organization), (imperilled) victims, and main targets are used to manipulate the main target (audience(s)), turning it into a target of terror, a target of demands, or a target of attention, depending on whether intimidation, coercion, or propaganda is primarily sought" (Schmid, 1988).


Introduction
Wars are fought. But we do not call the combatants of either side terrorists, though they also kill.

A group of individuals commit acts of violence against the state or some other country. It wishes to get some political benefit, like freedom for that group, or release from prison of companions. Members of such groups are called terrorists. Terrorists, of course, would hotly deny they are terrorists. They claim they are freedom fighters, fighting for a just cause.

Terrorists believe in violence. They kill, and they kill even the innocent. They do so by stealth, cunning. They plant bombs in government buildings. They may hijack a plane. They abduct important people and ask for ransom. By such violence they hope the public would compel the government to give in to their demands.



Types of terrorism


There are three major kinds of terrorism:
(a) Bioterrorism
(b) Suicide terrorism
(c) Nuclear terrorism


(a) 'Bioterrorism'
This is terrorism that involves bacteria or disease. Terrorists can and will use the weapons such as biological agents or chemical agents on unsuspecting innocent people. For example, the "anthrax-in-the-mail" scare in the USA.

The major biological agents are Anthrax, Botulism, Plague, Smallpox, Tularemia, V.H.F. Major chemical agents are Sulfur Mustard, Vx, Chlorine, Sarin, H. Cyanide.


(b) ‘Suicide terrorism’
A suicide attack is an “operational method in which the very act of the attack is dependent upon the death of the perpetrator.” The terrorist is fully aware that if he does not kill himself, the planned attack will not be implemented. The attack is carried out by activating explosives worn or carried by the terrorist in the form of a portable explosive charge, or planted in a vehicle he is driving.

It is important to correctly define a suicide attack, for there are different types of attacks, which may be mistakenly considered as belonging to this special category:

On many occasions, the perpetrator of an attack sets out with the knowledge that there is a good chance of being killed in the course of an attack (for example in trying to force a bus over a cliff). In spite of the imminent danger to the terrorist’s life, as long as there is a possibility of the attack being carried out without him being forced to kill himself during the course of it, this should not considered to be “ a suicide attack.”

Sometimes the terrorist makes concrete preparations for the possibility of death as a result of the attack (preparing a will, carrying out purification ceremonies, etc.). However, these preparations in themselves do not turn the attack into a suicide attack.

In some attacks, the terrorists are equipped with arms or explosives for blowing themselves up should the attack go wrong, (For example if the attack fails, or security forces break into a building where terrorists are holding hostages). The existence of such arms or explosives—and even the decision use them—does not constitute adequate grounds for the attack to be defined as a suicide attack.

As mentioned above, in a true suicide attack, the terrorist knows full well that the attack will not be executed if he is not killed in the process.

Suicide attacks are attractive to terrorist organizations, as they offer them a variety of advantages:

(1) Suicide attacks result in many casualties and cause extensive damage.

(2) Suicide attacks attract wide media coverage. A suicide attack is a newsworthy event for the media as it indicates a display of great determination and inclination for self-sacrifice on the part of the terrorists.

(3) Although a suicide attack is a very primitive and simple attack, the use of suicide tactics guarantees that the attack will be carried out at the most appropriate time and place with regard to the circumstances at the target location. This guarantees the maximum number of casualties (in contrast to the use of technical means such as a time bomb or even a remote controlled explosive charge). In this regard the suicide bomber is no more than a sophisticated bomb—a carrier that brings the explosive device to the right location and detonates it at the right time.

(4) In a suicide attack, as soon as the terrorist has set off on his mission his success is virtually guaranteed. It is extremely difficult to counter suicide attacks once the terrorist is on his way to the target; even if the security forces do succeed in stopping him before he reaches the intended target, he can still activate the charge and cause damage. (Thus the need for accurate intelligence concerning the plans of the terrorist organizations is crucial).

(5) Planning and executing the escape route after a terror attack has occurred is usually one of the most complicated and problematic stages of any terrorist attack. Suicide attacks require no escape plan.

Since the perpetrator is killed during the course of the suicide attack, there is no fear of him being caught afterwards, being interrogated by the security forces and passing on information liable to endanger other activists.



(c) ‘Nuclear terrorism’

The most accessible nuclear device for any terrorist would be a radiological dispersion bomb. This so-called 'dirty bomb' would consist of waste by-products from nuclear reactors wrapped in conventional explosives, which upon detonation would spew deadly radioactive particles into the environment. This is an expedient weapon, in that radioactive waste material is relatively easy to obtain. Radioactive waste is widely found throughout the world, and in general is not as well guarded as actual nuclear weapons.


Diversion of Nuclear Material or Weapons

The threat from radiological dispersion dims in comparison to the possibility that terrorists could build or obtain an actual atomic bomb. An explosion of even low yield could kill hundreds of thousands of people. A relatively small bomb, say 15-kilotons, detonated in Manhattan could immediately kill upwards of 100,000 inhabitants, followed by a comparable number of deaths in the lingering aftermath.

Fortunately, bomb-grade nuclear fissile material (highly enriched uranium or plutonium) is relatively heavily guarded in most, if not all, nuclear weapon states.

Nonetheless, the possibility of diversion remains. Massive quantities of fissile material exist around the world. Sophisticated terrorists could fairly readily design and fabricate a workable atomic bomb once they manage to acquire the precious deadly ingredients (the Hiroshima bomb which used a simple gun-barrel design is the prime example).


911

One of the most shocking acts of terrorism was on September 11, 2001. Nineteen terrorists hijacked four commercial airplanes. They crashed two of the planes into the twin towers of the World Trade Center in New York City, and one into the Pentagon in Washington, D.C. A fourth plane crashed in Pennsylvania. As a result, thousands of innocent individuals from more than 80 nations lost their lives.


Conclusion
The government must not think of only army action to put down terrorism. It must consider what wise measures and what beneficial measures can win terrorists over. It must also consider the source of the reason terrorists will attack the country concerned.

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The sites I referred when I organised the composition of Terrorism:


definition of terrorism
http://www.undcp.org/terrorism_definitions.html


types of terrorism
http://dir.yahoo.com/Society_and ... of_Crime/Terrorism/


bioterrorism
http://bioterrorism.straws.com/
http://www.pbs.org/wgbh/nova/bioterror/
http://www.pbs.org/wgbh/nova/bioterror/agents.html


suicide terrorism
http://www.ict.org.il/articles/articledet.cfm?articleid=128


nuclear terrorism
http://www.tmia.com/sabter.html
http://www.cdi.org/terrorism/nuclear.cfm


911
http://www.whitehouse.gov/response/faq-what.html

THE VALUE OF SPORTS AND GAMES

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SPORTS AND GAMES


Sports and games are given much encouragement all over the world. This has been so from ancient times. The Greeks attached great importance to athletics. The Olympic Games of today had their origins in ancient Greece. Today, based on the pattern of the Olympics, we have regional athletic meets, such as the Asian Games, held annually or biennially in different parts of the world.

These games are intended for young men and women; for sports and games keep men and women physically fit and healthy. Why? A nation that is full of weaklings; of both genders, will be ruined. So, every nation encourages sports and games from the very beginning of a child’s education in schools and even kindergartens.

Apart from toning muscles and developing a good physique, sports and games also help build up a person’s stamina and endurance. Coordination of the limbs and reflexes are developed and sharpened. The defence of a country depends largely on the physical and mental fitness of its defence personnel. That is why all defence-related branches of a country attach a lot of significance to sports and games and encourages its members to participate in sports and games.

There are psychological benefits, too. They promote the development of spirit, courage and determination, to fight and struggle for success against all odds. And, they inculcate a sense of fair play and discipline, obedience and a sense of duty, team-spirit and cooperation, and above all sportsmanship.

Sportsmanship means many things: a mental attitude to behave in a gentlemanly manner on all occasions; a scrupulous observance of rules and regulations; a proper regard for and understanding of the concept of leadership; and the spirit to accept success and failure with an equal measure of cheerfulness.

It was the Duke of Wellington who remarked: “The Battle of Waterloo was won on the fields of Eton.” This statement emphasises the importance of the qualities that sports and games inculcate in us. No doubt sports and games entertain and thrill us, but more valuable are the qualities that we develop because of our participation in sports. Our future attitudes and outlook on life, our ability to face the vicissitudes of life, all depend on these qualities.

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SHOULD DANGEROUS SPORTS BE BANNED?


In recent times, Malaysians have scaled Mount Everest, trekked to the North Pole, and sailed round the world. They can join groups that go skydiving, kayaking and rock climbing. These are new activities in Malaysia and the majority of the population would not dream of joining the daring minority because these sports are considered to be too dangerous. The question is: are they dangerous enough to be banned? These sports are not dangerous enough to be banned, and they definitely promote better health and are character building.

Many sporting activities are considered to be so dangerous that they are called extreme and hazardous. Many would consider hiking to be much safer than rock-climbing but the fact is, hikers often lose their way in unfamiliar territory because they are careless about their preparation, erroneously believing that they are not putting their lives in danger by going on a ‘simple hike’. Rock climbers, on the other hand, are very much aware of the risk they take and the possible danger they may face. Consequently, they take the time to ensure that their equipment is checked and up to standard. Skydivers have to be well-rested and free from alcohol when they go up for their jump, but motorists think nothing of driving after a few drinks, making our roads death traps. It would therefore not be fair to ban such sports as rock climbing or white-water rafting.

In addition, these sports take participant out into the outdoors. One must be outdoors in order to enjoy the magnificence of the world’s highest peaks; white-water rafting involves shooting through torrents in the wild. Even climbing up less daunting peaks than Mount Everest makes physical demands on the climber. She/he must deal with freezing temperatures; the body’s muscles must support every foothold to avoid a potentially fatal fall. In white-water rafting, the body must be able to respond to the demands of swift currents. You need to have quick reflexes and be able to think on your feet.

Finally, these “dangerous” sports help their participants to develop character. They teach responsibility, for a hiker who forgets to bring along a compass is headed for trouble. They also teach independence and self-reliance: a sky diver must remember to open the parachute at the minimum safety height. Sports such as these test one’s endurance. They help you to overcome great obstacles, which in turn builds self-confidence and gives you a sense of accomplishment. It is indeed a satisfying feeling to know that you have struggled and won.

People who participate in the dangerous sports need to be very well prepared for the hazards that are inherent in these activities. The preparation includes physical, psychological and technical training. Once they are ready to participate in the sports, they will enjoy good heath and character development – as well as the thrill and the pleasure of pitting their skills and intelligence against impossible odds.

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THE ABSENCE OF SPORTING SPIRIT AND ITS CONSEQUENCES


The world from the dawn of civilization has been enjoying sports. One of the pastimes of the rulers was to arrange for periodical sports. It may be hunting, chariot race, horse riding, wrestling and boxing. Organized sports were popular in Greece, especially Olympia from which modern Olympic games have derived their names. Sports were for fun and frolics. In the middle ages sports were very popular in European countries. Sports are supposed to develop many good qualities. There may be healthy competition and rivalry and never enmity or bitterness. It is and should be for the sports’ sake and not for winning the laurels. This is the real sporting spirit. There are rules and regulations in play and games. The sporting spirit implies the following of rules whether one wins or loses. The outcome or the result is not the important thing but how the game is played.

A real sportsman takes things easy. Take for instance, an angler sitting by the river side from morning till evening, casting his line into the water. He may not always be lucky to have a catch. Still he whistles back home happy in the evening when the night sets in. It is not the catch that is the point but the angler’s attitude. He cannot grow angry and break the fishing rod. Then he has lost the fun. So too in any game the winner or the loser, much more so the latter must be able to take things easy. A real sportsman does not lose his head when he wins nor is he bowled over when he loses.

The crux of the problem is whether a sportsman plays the game; in other words if he strictly follows the rules of the game and never adopts foul means to get a win. But unfortunately this point is missing. In certain modern sports, games like horse racing, they dope the horses. The Olympic games where one expects the ideas to prevail seems to be no exception. There are instances of doping and impersonation and hence vigorous tests are given and the competitors are checked seriously.

When the sporting spirit is absent or missing, naturally very unpleasant consequences can ensue. Very ugly scenes are more often the rule in football matches. Referees are manhandled and the crowd become partisan. Cricket was a king of games where such behaviour was unheard of. But of late, even in cricket unpleasant things do happen; when a player is signalled out by the umpire, he loses his temper and grimaces at the umpire and so on and makes a show of his unpleasantness. Bowlers are being very often warned. All these result from lack of sporting spirit.

A good sportsman knows his game rather than the rules of the game and follows them willingly. In whatever position he is placed he plays his part. He cooperates with all the members of the team and works always for the good of the team of which he forms a part. He develops espirit de corps and in and outside the field he shows this sporting spirit. He never plays foul though there are few who turn mercenary and wreck the fortune of their team for the sake of money or other considerations.

This sportsman’s spirit may be developed in ordinary life. In whatever walk of life one finds himself he must be able to do his duty. Material gains apart, he must be able to deliver the goods. He must be reliable and a good companion to his comrades. He is faithful and obedient to his superiors. He goes about his duty without gossiping and scandal mongering. Then people call him a good sportsman. Such people are scarce but they are assets wherever they are found.

If people do know the value of the sporting spirit why then the rarity or the absence of it? Simply it is because of selfishness. For personal glory or ownership or name, one grows selfish. The selfishness gets started in early childhood. Jealousy and rivalry and sometimes even lack of security lead to selfishness. Very often children do not want to part with their play things or share them with others. When this selfishness grows into life, there will be absence of sporting spirit. Such people keep themselves in isolation and they never mix freely with others. Temperamentally they are non-companionable and they are never happy nor add to the happiness of others. So we see that this sporting spirit must be developed even when they are children. Here comes the Cubs, Girl Guides and Boy Scouts movement which develop in their incumbents all the good qualities of a sportsman.

INTERNET


How is the word Internet spelt?
Internet should be spelled with a capital I. If you spell it as internet with a small I, then you are using the term to mean ‘between netsworks’.

What is Internet?
The Internet is also commonly known as Cyberspace, Information superhighway, Infobahn or just The Net.

The Internet, also known as The Net, is a worldwide network of computers. The Internet is built up of thousands of interconnected computer networks. (A computer network is simply a bunch of computers connected in some fashion.) In other words, the Internet is a network of networks. The Internet is therefore, the largest computer network of the world.

The Internet is a gigantic pool of resources, services and information, accessible to users across national borders and boundaries. Connections between networks allow any user from any component network to access information residing on any server over the Internet.

Internet History
Internet originated from a military project called ARPANET (Advanced Research Projects Administration). It was funded by the US Department of Defense. The ARPANET was set up to link the Department of Defense (DoD) to the military research institutions (which included several large universities). It started small, but grew so rapidly that it became too unwieldy to manage. At the same time, military security also became a concern to the DoD. The project’s primary aim was to develop a computer network that will allow any computer in the network to automatically send messages to another computer using a different link, should the current link be broken (Meaning if the current link was broken or became unavailable).

To cope with the management and security issue, it was decided that the network be split into two networks – MILNET (consisting only the military sites) and ARPANET (making up the rest). Although they were separate networks, they still remained connected using a protocol ( a set of rules) called the Internet Protocol (IP). The Internet Protocol proved to be a great success that it soon became the basis for communication between computers in a network.

As more organisations around the world joined the ARPANET, its name had to be changed to reflect it s composition. It was called the Internet.


Internet Services
Internet provides several services:


Electronic mail (e-mail)
This is probably the most widely used Internet service. E-mail allows Internet users to communicate (send and receive mail) with other users anywhere in the network instantly and inexpensively (often for free). The mail can be multimedia (text, picture, sound or video). It allows you to send mail to multiple users at the same time. Most of the time, they are announcements or circulars in this case. It is similar to MailMerge facility in wordprocessing. You can also send carbon copies.


The Worldwide Web (Web or WWW)
In simpler terms, the Web is an Internet-based computer network that allows users on one computer to access information stored on another through the worldwide network.

Using a browser software (Internet Explorer, Netscape, or Mosaic), the users can browse and retrieve information (in the form of documents) stored at any of the thousands of web sites (Meaning web servers) around the world. The documents in the web can be in the form of hypertext or hypermedia.

Hypertext is a series of text chunks connected by links which offer the reader different pathways.

Hypermedia is similar to hypertext but includes media other than text. A hypermedia document could include text and graphics, or sound and animation.


Usenet News
This service allows users to engage in discussions with other users on a wide variety of topics ranging from astronomy to zoology. There are at least eight major categories of topics or news groups, each of which in turn is organised in a tree structure representing various sub-topics (within a major topic). The number of top-level categories depends on the particular news server that you are accessing. Some may have more categories than others.


Information Retrieval
This service allows you to search and retrieve information resources (software, picture, sound, and video clips). There are mountains of useful information on the Internet. It will be difficult to locate the information that you want without some help. There are servers specially dedicated for this purpose.


Internet Relay Chat
This service allows users to ‘chat’ (by typing text at the terminal) with other users in real-time. It allows a small group of people to join a channel (roughly equivalent to a topic) and talk to one another. There are servers, called IRC servers, dedicated for this purpose.

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DRUGS


Nowadays people often use the word ‘drug’ to refer to pills or mixtures taken to relieve pain or to make people sleep. However, in a more correct sense the word means any substance or mixture of substances used as a medicine, and the use of such substances is a very old and important art.

In ancient times drugs were nearly always connected in people’s minds with magic or religion. This can be seen by considering some of the things many unfortunate patients in Egypt and Babylon were given to swallow --- none of which can possibly have helped to cure their illnesses. Sometimes the patient ate raw meat or drank mixtures of nitre (mineral salts), beer, milk and blood, boiled and swallowed hot. Perhaps the drug might be bile from the liver of fishes or, what sounds even worse, a concoction made from the bones, fat and skins of bats, vultures, lizards and crocodiles.

The first doctors were the wise men of old --- the priests, the teachers and the philosophers --- and the first step forward in the treatment of diseases came about through these men’s knowledge of the healing power of plants. The medicine man picked his herbs and used each by itself. He gave way after many centuries to the apothecary, or chemist, who made his drugs carefully after weighing the different substances. He would then prepare powders by grinding them with a pestle and mortar or roll pills by hand, and made up many other mixtures. The apothecary in turn has given way to factories. The industry responsible for the manufacture of drugs is called the pharmaceutical industry and large international firms produce great quantities of drugs. All new drugs are tested by giving them to animals to make sure that they are safe.


The discovery of Drugs

Most of the old remedies were prepared from plants, and through many of these herbal remedies were useless, some of the ingredients of the mixtures had valuable properties.

The coca plant, considered magical in old Peru, was said to give the Indians wonderful powers of endurance when they chewed its leaves. The leaves contain cocaine, a substance which deadens pain, and which was one of the first local anaesthetic used by dentists. Morphine, which is used to kill severe pain, originally came from poppy seeds. Digitalis, which is used in many kinds of heart disease, was made from the foxglove. Quinine used to be made from the bark of the cinchona tree, which is found in Peru and in the Amazon region, and was used in the treatment of malaria. From castor beans, which grow in nearly all hot countries, comes castor oil, a powerful laxative (a drug that loosens the bowels). More recently drugs used in the treatment of certain kinds of cancer have been found in the periwinkle.

Some drugs have been prepared by extraction from organs of animals. Extracts of thyroid (a gland in the neck) were used in some thyroid diseases. Insulin, which is used in the treatment of diabetes, is made from the pancreas of cows or pigs.

The sulphonamide group of drugs, which were the first really effective drugs to be used against infections, were developed from the dye industry (such as pneumonia) are now generally treated with antibiotics, many of which are still prepared by extraction from moulds. The first antibiotics, discovered by Sir Alexander Fleming, was penicillin, and the first patients were treated in 1941.

Other drugs are extracted from minerals. They include mercury (used in ointments), iodine (an antiseptic) and bromides (which are sedatives --- drugs which have a soothing effect).

Most of the drugs which used to be extracted from plants, animals and minerals are now made in factories, since chemists have discovered their precise composition and structure. Among the most common synthetic (artificial) drugs is aspirin, which was developed in connection with the coal tar industry, as was novocaine.


Modern Drugs


The treatment in disease by drugs is very important in medicine and a wide variety of drugs is now available. There are drugs which are active on almost all the organs of the body. There are drugs that help patients to sleep (hypnotics), which include the barbiturates, and others which take away pain (analgesics). Antibiotics are used in the treatment of infections, while hormones (substances produced by the body to regulate and control a variety of functions) can be given to patients in whom they are lacking such as in diabetes or thyroid cases.

Some drugs are used in the treatment of mental illness and the calming drugs known as tranquilizers are in great demand.

Although many of these drugs are extremely valuable in the treatment of disease, their side effects may sometimes be dangerous. For this reason they may be prescribed only by doctors, who know something about their properties.


Drug Addiction

Some drugs have powerful effects on the mind, causing either dreamy or highly excitable states which some people find pleasurable. This is true of a number of drugs – many of them originally extracted from plants --- such as heroin, morphine, cocaine and cannabis. Drugs of the cannabis group come from varieties of the hemp plant, and include hashish, marijuana and bhang. Other drugs such as LSD (lysergic acid diethylamide) are made in a laboratory by chemical synthesis.

The habit of drug-taking is dangerous and the possession of some drugs is illegal. Some drugs can cause abnormal and dangerous hallucinations. Others lead to drug addiction. This means that the addict cannot live without the drug he is taking and may become seriously ill when deprived of it. Drug addicts often die young because of the damaging side effects of both the drugs and the methods of taking them by injection. There are now many medical centres which specialize in the treatment of drug addicts. Doctors aim to withdraw the drug so that the patient can once again lead a normal life. This is particularly important because drug addicts often live together in very bad conditions and frequently resort to crime in order to obtain their supplies of drugs. The police in many countries try to stop people smuggling drugs from the countries where they are produced.

http://www.usdoj.gov/dea/concern/mdma/mdmaindex.htm


MDMA (ECSTASY)


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MDMA (ECSTASY)
MDMA (3, 4-Methylenedioxymethamphetamine) is a Schedule I synthetic, psychoactive drug possessing stimulant and hallucinogenic properties. MDMA possesses chemical variations of the stimulant amphetamine or methamphetamine and a hallucinogen, most often mescaline. Commonly referred to as Ecstasy or XTC, MDMA was first synthesized in 1912 by a German company possibly to be used as an appetite suppressant. Chemically, it is an analogue of MDA, a drug that was popular in the 1960s. In the late 1970s, MDMA was used to facilitate psychotherapy by a small group of therapists in the United States. Illicit use of the drug did not become popular until the late 1980s and early 1990s. MDMA is frequently used in combination with other drugs. However, it is rarely consumed with alcohol, as alcohol is believed to diminish its effects. It is most often distributed at late-night parties called "raves," nightclubs, and rock concerts. As the rave and club scene expands to metropolitan and suburban areas across the country, MDMA use and distribution are increasing as well.


MDMA is taken orally, usually in tablet or capsule form, and its effects last approximately four to six hours. Users of the drug say that it produces profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation. MDMA is also said to suppress the need to eat, drink, or sleep, enabling users to endure two- to three-day parties. Consequently, MDMA use sometimes results in severe dehydration or exhaustion. While it is not as addictive as heroin or cocaine, MDMA can cause other adverse effects including nausea, hallucinations, chills, sweating, increases in body temperature, tremors, involuntary teeth clenching, muscle cramping, and blurred vision. MDMA users also report after-effects of anxiety, paranoia, and depression. An MDMA overdose is characterized by high blood pressure, faintness, panic attacks, and, in more severe cases, loss of consciousness, seizures, and a drastic rise in body temperature. MDMA overdoses can be fatal, as they may result in heart failure or extreme heat stroke.


The effects of long-term MDMA use are just beginning to undergo scientific analysis. In 1998, the National Institute of Mental Health conducted a study of a small group of habitual MDMA users who were abstaining from use. The study revealed that the abstinent users suffered damage to the neurons in the brain that transmit serotonin, an important biochemical involved in a variety of critical functions including learning, sleep, and integration of emotion. The results of the study indicate that recreational MDMA users may be at risk of developing permanent brain damage that may manifest itself in depression, anxiety, memory loss, and other neuropsychotic disorders.


Clandestine laboratories operating throughout Western Europe, primarily the Netherlands and Belgium, manufacture significant quantities of the drug in tablet, capsule, or powder form. Although the vast majority of MDMA consumed domestically is produced in Europe, a limited number of MDMA labs operate in the United States. In addition, in recent years, Israeli organized crime syndicates, some composed of Russian emigres associated with Russian organized crime syndicates, have forged relationships with Western European traffickers and gained control over a significant share of the European market. The Israeli syndicates are currently the primary source to U.S. distribution groups.


Overseas MDMA trafficking organizations smuggle the drug in shipments of 10,000 or more tablets via express mail services, couriers aboard commercial airline flights, or, more recently, through air freight shipments from several major European cities to cities in the United States. The drug is sold in bulk quantity at the mid-wholesale level in the United States for approximately eight dollars per dosage unit. The retail price of MDMA sold in clubs in the United States remains steady at twenty to thirty dollars per dosage unit. MDMA traffickers consistently use brand names and logos as marketing tools and to distinguish their product from that of competitors. The logos are produced to coincide with holidays or special events. Among the more popular logos are butterflies, lightning bolts, and four-leaf clovers.


While MDMA abuse currently is not as widespread as that of many other drugs, it nonetheless increased significantly--500 percent--over a five-year period. Drug Abuse Warning Network (DAWN) estimates reveal that nationwide hospital emergency room mentions for MDMA rose dramatically from 70 in 1993 to 2,850 in 1999. Seizures of MDMA have also increased drastically. Over a six-year period, seizures of MDMA tablets submitted to DEA laboratories have risen from a total of 196 in 1993 to 143,600 in 1998. Seizures from January through May 1999 total over 216,300 MDMA tablets; the 1999 figure will most likely double the 1998 figure.

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"ECSTASY" DAMAGES THE BRAIN AND IMPAIRS MEMORY IN HUMANS


By Robert Mathias
NIDA NOTES Staff Writer




ANIDA-supported study has provided the first direct evidence that chronic use of MDMA, popularly known as "ecstasy," causes brain damage in people. Using advanced brain imaging techniques, the study found that MDMA harms neurons that release serotonin, a brain chemical thought to play an important role in regulating memory and other functions. In a related study, researchers found that heavy MDMA users have memory problems that persist for at least two weeks after they have stopped using the drug. Both studies suggest that the extent of damage is directly correlated with the amount of MDMA use.


"The message from these studies is that MDMA does change the brain and it looks like there are functional consequences to these changes," says Dr. Joseph Frascella of NIDA's Division of Treatment Research and Development. That message is particularly significant for young people who participate in large, all-night dance parties known as "raves," which are popular in many cities around the Nation. NIDA's epidemiologic studies indicate that MDMA (3,4-methylenedioxymethamphetamine) use has escalated in recent years among college students and young adults who attend these social gatherings.


In the brain imaging study, researchers used positron emission tomography (PET) to take brain scans of 14 MDMA users who had not used any psychoactive drug, including MDMA, for at least three weeks. Brain images also were taken of 15 people who had never used MDMA. Both groups were similar in age and level of education and had comparable numbers of men and women.


In people who had used MDMA, the PET images showed significant reductions in the number of serotonin transporters, the sites on neuron surfaces that reabsorb serotonin from the space between cells after it has completed its work. The lasting reduction of serotonin transporters occurred throughout the brain, and people who had used MDMA more often lost more serotonin transporters than those who had used the drug less.


Previous PET studies with baboons also produced images indicating MDMA had induced long-term reductions in the number of serotonin transporters. Examinations of brain tissue from the animals provided further confirmation that the decrease in serotonin transporters seen in the PET images corresponded to actual loss of serotonin nerve endings containing transporters in the baboons' brains. "Based on what we found with our animal studies, we maintain that the changes revealed by PET imaging are probably related to damage of serotonin nerve endings in humans who had used MDMA," says Dr. George Ricaurte of The Johns Hopkins Medical Institutions in Baltimore. Dr. Ricaurte is the principal investigator for both studies, which are part of a clinical research project that is assessing the long-term effects of MDMA.


"The real question in all imaging studies is what these changes mean when it comes to functional consequences," says NIDA's Dr. Frascella. To help answer that question, a team of researchers, which included scientists from Johns Hopkins and the National Institute of Mental Health who had worked on the imaging study, attempted to assess the effects of chronic MDMA use on memory. In this study, researchers administered several standardized memory tests to 24 MDMA users who had not used the drug for at least two weeks and 24 people who had never used the drug. Both groups were matched for age, gender, education, and vocabulary scores.


The study found that, compared to the nonusers, heavy MDMA users had significant impairments in visual and verbal memory. As had been found in the brain imaging study, MDMA's harmful effects were dose related, the more MDMA people used, the greater difficulty they had in recalling what they had seen and heard during testing.


The memory impairments found in MDMA users are among the first functional consequences of MDMA-induced damage of serotonin neurons to emerge. Recent studies conducted in the United Kingdom also have reported memory problems in MDMA users assessed within a few days of their last drug use. "Our study extends the MDMA-induced memory impairment to at least two weeks since last drug use and thus shows that MDMA's effects on memory cannot be attributed to withdrawal or residual drug effects," says Dr. Karen Bolla of Johns Hopkins, who helped conduct the study.


The Johns Hopkins/NIMH researchers also were able to link poorer memory performance by MDMA users to loss of brain serotonin function by measuring the levels of a serotonin metabolite in study participants' spinal fluid. These measurements showed that MDMA users had lower levels of the metabolite than people who had not used the drug; that the more MDMA they reported using, the lower the level of the metabolite; and, that the people with the lowest levels of the metabolite had the poorest memory performance. Taken together, these findings support the conclusion that MDMA induced brain serotonin neurotoxicity may account for the persistent memory impairment found in MDMA users, according to Dr Bolla.


Research on the functional consequences of MDMA-induced damage of serotonin-producing neurons in humans is at an early stage, and the scientists who conducted the studies cannot say definitively that the harm to brain serotonin neurons shown in the imaging study accounts for the memory impairments found among chronic users of the drug. However, "that's the concern, and it's certainly the most obvious basis for the memory problems that some MDMA users have developed," Dr. Ricaurte says.


Findings from another Johns Hopkins/NIMH study now suggest that MDMA use may lead to impairments in other cognitive functions besides memory, such as the ability to reason verbally or sustain attention. Researchers are continuing to examine the effects of chronic MDMA use on memory and other functions in which serotonin has been implicated, such as mood, impulse control, and sleep cycles.


How long MDMA-induced brain damage persists and the long-term consequences of that damage are other questions researchers are trying to answer. Animal studies, which first documented the neurotoxic effects of the drug, suggest that the loss of serotonin neurons in humans may last for many years and possibly be permanent. "We now know that brain damage is still present in monkeys seven years after discontinuing the drug," Dr. Ricaurte says. "We don't know just yet if we're dealing with such a long-lasting effect in people."




Sources


Bolla, KI; McCann, U.D.; and Ricaurte, G.A. Memory impairment in abstinent MDMA ("ecstasy") users. Neurology 51:1532-1537,1998.

Hatzidimitriou, G.; McCann, U.D.; and Ricuarte, G.A. Altered serotonin innervation patterns in the forebrain of monkeys treated with MDMA seven years previously: Factors influencing abnormal recovery journal of Neuroscience 191(12):5096-5107,1999.

McCann, U.D.; Mertl, M.; Eligulashvili, V; and Ricaurte, G.A. Cognitive performance in W 3,4-methylenedioxymethainphetamine (MDMA, "ecstasy") users: a controlled study. Psychopharmacology 143:417-425,1999.

McCann, U.D.; Szabo, Z.; Scheffel, U.; Dannals, R.F; and Ricaurte, G.A. Positron emission tomographic evidence of toxic effect of MDMA ("ecstasy") on brain serotonin neurons in human beings. Lancet 352 (9138):1433-37,1998.

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METHYLENEDIOXYMETHAMPHETAMINE (MDMA, XTC, X, ECSTASY, ADAM)




Introduction


3,4-Methylenedioxymethamphetamine (MDMA) is a popular drug of abuse. Its subjective effects have contributed to its popularity as a "party drug" among adolescents and young adults who frequent "rave" or "techno" parties. There is no accepted medical use for MDMA in the U.S. The majority of the drug is being smuggled into the U.S. but it is also produced in illicit laboratories domestically. MDMA produces significant long-term neurochemical changes after a single administration and selective and permanent brain damage during repetitive use. Recent reports estimate that over 2 million tablets are smuggled into the U.S. each week. Current estimates suggest that within the Newark, New York, and Jersey Shore corridor over 750,000 dosage units are being consumed each week.




Licit Uses


MDMA has no approved medical use in the U.S. MDMA was discovered in Germany in 1913 and patented by a pharmaceutical company in 1914. It was intended as a weight-loss (anorectic) drug, but because of its side-effects MDMA was never marketed. MDMA was re-discovered in the mid 1960s, began to be reported in growing numbers in the scientific literature but remained outside of the control mechanisms for many more years. During the 1970s there was an interest by some psychiatrists in using MDMA as a therapeutic agent because it was reported to reduce the inhibition of their patients to speak openly during therapy sessions. The subjective effects of MDMA in humans include a heightened sense of awareness as well as a feeling of increased empathy or emotional closeness to others. The production of MDMA in clandestine laboratories, its increasing abuse among young people and evidence of adverse health effects, including brain damage, led to the emergency scheduling of MDMA into C1 of the CSA in 1985.




Chemistry/Pharmacology


MDMA is 3,4 methylenedioxymethamphetamine, a ring substituted derivative of phenethylamine, which is a close structural analog of amphetamine, methamphetamine and 3,4 methylenedioxyethylamphetamine (MDE: Eve). MDMA has both stimulant and hallucinogenic effects in humans. MDMA has analgesic and central stimulating effects; it produces hyperthermia, memory loss, cognitive impairment, and long-term neurochemical and brain cell damage. Pharmacologically, MDMA is an indirect monoaminergic agonist producing a heightened sense of awareness. MDMA also induces a state characterized as "excessive talking" (loquacity), which was once believed to be helpful in psychotherapy. In the 1970s, MDMA was documented to produce permanent damage to serotonin pathways in the brains of rats and monkeys. Short-term high dose use of MDMA has produced incidences of an amphetamine-like psychosis and, in some cases, severe hyperthermia which was unresponsive to medical intervention leading to death. In the mid 1990s it was clearly demonstrated that similar neurotoxicity was produced in humans self-ingesting MDMA as a recreational drug. The results of extensive laboratory testing of humans with a history of MDMA use has shown cognitive and memory loss which have been attributed to a unique interaction between serotonin and midbrain dopamine systems resulting in the progressive degeneration of nerve terminals.



Illicit Uses


MDMA is used as a drug of abuse for its combination of stimulant and hallucinogenic effects. There is no accepted medical use for MDMA in the U.S.



User Population


Similar to gamma-hydroxy-butyrate (GHB), MDMA is abused by young adults who frequent the "rave" or "techno" parties which have become popular in large urban communities. While these urban rave clubs may be the usual venue for the acquisition of MDMA, many suburban communities are experiencing an increased use of MDMA within smaller party environments. It has become increasingly available through high school drug networks through purchases made in rave clubs. MDMA is usually taken orally in doses ranging from 50 to 150 mg. Doses of MDMA are often "piggy-backed" on each other in a series over just a few hours leading to severe over-heating and cardiac emergencies which require medical intervention.


Illicit Distribution

All seized MDMA is produced from clandestine or foreign manufacturing facilities. The Netherlands, Israel, and Belgium traffic large quantities of the drug throughout Europe and England. The packaging and pill characteristics of MDMA are as varied as the sources of the product.




Control Status

The control action on MDMA was prepared in 1984. After formal hearings it was emergency controlled on July 1, 1985. Permanent control into CI of the CSA was completed in 1986. After a protracted appeal process the final permanent control into C1 of the CSA occurred in 1988.

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THE NATURE OF WAR AND PEACE


The simplest and common view of war is that it is a state of armed conflict between nations. Peace, then, is a state or period when there is no armed conflict. According to this view, the United States went to war from April, 1917, to November, 1918. Then the United States was at peace until December, 1941, when it entered the Second World War.

If this view of war and peace is correct, we should have been at peace since V-J Day in 1945, save for the ‘police action’ in Korea. But few people would assert that the past sixteen years have been a time of peace. The common idea of war and peace simply does not apply to the present period. Indeed, we characterise this time as one of ‘cold’ war, as opposed to the ‘hot’ war of actual fighting.

Our view of war, then, must be broadened to include both armed conflict and battles of diplomacy, economic aid, and propaganda. War is war, whether it is ‘hot’ or ‘cold’. The struggle for power and prestige among the nations goes on all the time. Only the means vary, and whether these be armed force or diplomatic pressure or other nonviolent means depends on the occasion.

It follows, then, that peace is not merely a negative thing --- the absence of armed conflict. What real, positive peace among the nations would be we may see by considering the state of affairs in local, state, and national communities. In our civil society, peace and order, not war, are the normal state of things. The whole meaning and purpose of civil society is peace and order. Civil government creates civil peace. Individuals who violate the law are disturbers of the peace and are dealt with accordingly.

The great thinkers of the past are helpful to us in three ways in considering the question of war and peace. They show us that the wider definition of war is the correct one. They indicate the connection between civil peace and civil government. And they point to how this insight may be applied to the world of nations.

Thucydides is as aware as we are that a peace treaty is usually only an armistice in a war that is continuously going on. Hobbes sees that ‘war consists not in battle only or in the act of fighting’ but in the will to fight, the attitude of hostility between nations. And in our own century Veblen sees that ‘the state of war is the natural relation of one power to another.’ The term ‘cold war’ may be new, but the state of affairs to which it refers is quite ancient.

More important for us in the present crisis are the insights the great books give us into the connection between peace and law. Locke observes that there are only two ways of settling disputes between men – law or force – and where there is no law, force is the ultimate arbiter. The way of law is the way of peace.

Kant aplies this analysis to the international scene, which he sees as a lawless state of anarchy where the right of the stronger prevails. He calls upon the nations to emerge from this state of savagery and to enter into a federation of nations where law and peace would prevail. Dante, centuries earlier, proposes a single world government to provide enduring peace for the whole of mankind.

The common point which all these thinkers make is that peace is a state of affairs in which men are willing to settle disputes by discussion instead of force. Civil peace prevails at present within all legally constituted societies. A state of war – sometimes ‘hot,’ sometimes ‘cold,’ --- prevails among the nations.

Whether a state of real peace can be secured on a worldwide scale is a subject of controversy. Some believe that a world peace requires a world government. Others want to proceed by other means. But there is common agreement that peace is not the mere absence of fighting, but a positive order in which the will to settle disputes peaceably prevails.

Contrary to a lot of loose talk, it is peace and not war that is proper to human nature. Cicero and many other thinkers rightly point out that fighting and snarling are the way brute beasts, while taking things over and listening to reason are the proper way for men. Peace is required not only for our material survival but also for a really human existence.

http://www.cdc.gov/ncidod/sars/basics.htm

BASIC INFORMATION ABOUT SARS
April 16, 2003, 12:30 PM ET


A new disease called SARS

The Centers for Disease Control and Prevention (CDC) is investigating a new disease called severe acute respiratory syndrome (SARS) that has recently been reported in Asia, North America, and Europe. As of April 13, about 190 cases of SARS had been reported in the United States. This fact sheet provides basic information about the disease and what is being done to combat its spread.


What are the symptoms and signs of SARS?
The illness usually begins with a fever (measured temperature greater than 100.4癋 [>38.0癈]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also experience mild respiratory symptoms at the outset.

After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10 percent to 20 percent of cases, patients will require mechanical ventilation. For more information, see the MMWR dispatch.

How SARS spreads

The primary way that SARS appears to spread is by close person-to-person contact. Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or by other ways that are currently not known.


How long is a person with SARS infectious to others?
Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.


Who is at risk for SARS

Cases of SARS continue to be reported mainly among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health-care workers who did not use infection control procedures while taking care of a SARS patient. In the United States, there is no indication of community spread at this time. The Centers for Disease Control and Prevention (CDC) continues to monitor this situation very closely.


Is there a test for SARS?
No "test" is available yet for SARS. However, the Centers for Disease Control and Prevention (CDC), in collaboration with World Health Organization (WHO) and other laboratories, has developed 2 research tests that appear to be very promising in detecting antibodies to the new coronavirus. The Centers for Disease Control and Prevention (CDC) is working to refine and share this testing capability as soon as possible with laboratories across the United States and internationally.


What medical treatment is recommended for patients with SARS?
The Centers for Disease Control and Prevention (CDC) currently recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia of unknown cause.

Is there any reason to think SARS is or is not related to terrorism?
Information currently available about SARS indicates that people who appear to be most at risk are either health-care workers taking care of sick people or family members or household contacts of those who are infected with SARS. That pattern of transmission is what would typically be expected in a contagious respiratory or flu-like illness.


Travel and Quarantine

What should I do if I have recently traveled to a country where cases of SARS have been reported?
You should monitor your own health for 10 days following your return. If you become ill with a fever of more than 100.4°F [ >38.0 ° C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health-care provider. To help your health-care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.



THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) RECOMMENDATIONS

The Centers for Disease Control and Prevention (CDC) has issued recommendations and guidelines for people who may be affected by this outbreak.

For individuals considering travel to affected parts of Asia:
The Centers for Disease Control and Prevention (CDC) advises that people planning elective or nonessential travel to mainland China and Hong Kong, Singapore, and Hanoi, Vietnam may wish to postpone their trips until further notice.

For individuals who think they might have SARS:
People with symptoms of SARS (fever greater than 100.4°F [ >38.0 ° C] accompanied by a cough and/or difficulty breathing) should consult a health-care provider. To help the health-care provider make a diagnosis, tell them about any recent travel to places where SARS has been reported or whether there was contact with someone who had these symptoms


WHAT THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) IS DOING ABOUT SARS

The Centers for Disease Control and Prevention (CDC) is working closely with the World Health Organization (WHO) and other partners in a global effort to address the SARS outbreak. For its part, CDC has taken the following actions:

(1) Activated its Emergency Operations Center to provide round-the-clock coordination and response.

(2) Committed more than 300 medical experts and support staff to work on the SARS response.

(3) Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.

(4) Provided ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.

(5) Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.

(6) Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.

____________________________________________________________


Isolation and Quarantine
April 3, 2003, 6:30 PM EST


To contain the spread of a contagious illness, public health authorities rely on many strategies. Two of these strategies are isolation and quarantine. Both are common practices in public health and both aim to control exposure to infected or potentially infected individuals. Both may be undertaken voluntarily or compelled by public health authorities. The two strategies differ in that isolation applies to people who are known to have an illness and quarantine applies to those who have been exposed to an illness but who may or may not become infected.

Isolation: For People Who Are Ill

Isolation of people who have a specific illness separates them from healthy people and restricts their movement to stop the spread of that illness. Isolation allows for the focused delivery of specialized health care to people who are ill, and it protects healthy people from getting sick. People in isolation may be cared for in their homes, in hospitals, or at designated health care facilities. Isolation is a standard procedure used in hospitals today for patients with tuberculosis (TB) and certain other infectious diseases. In most cases, isolation is voluntary; however, many levels of government (federal, state, and local) have basic authority to compel isolation of sick people to protect the public.

Quarantine: For People Who Have Been Exposed But Are Not Ill

Quarantine, in contrast, applies to people who have been exposed and may be infected but are not yet ill. Separating exposed people and restricting their movements is intended to stop the spread of that illness. Quarantine is medically very effective in protecting the public from disease.

States generally have authority to declare and enforce quarantine within their borders. This authority varies widely from state to state, depending on the laws of each state. The Centers for Disease Control and Prevention (CDC), through its Division of Global Migration and Quarantine, also is empowered to detain, medically examine, or conditionally release individuals suspected of carrying certain communicable diseases. This authority derives from section 361 of the Public Health Service Act (42 U.S.C. 264), as amended.

SARS and Isolation

SARS patients in the United States are being isolated until they are no longer infectious. This practice allows patients to receive appropriate care, and it contains the potential spread of the illness. Those who are more severely ill are being cared for in hospitals. Those whose illness is mild are being cared for at home. Individuals being cared for at home have been asked to avoid contact with other people and to remain at home until 10 days after their symptoms have resolved.

____________________________________________________________

Interim Guidance on Infection Control Precautions for Patients with Suspected Severe Acute Respiratory Syndrome (SARS) and Close Contacts in Households


Patients with SARS pose a risk of transmission to close household contacts and health care personnel in close contact. The duration of time before or after onset of symptoms during which a patient with SARS can transmit the disease to others is unknown. The following infection control measures are recommended for patients with suspected SARS in households or residential settings. These recommendations are based on the experience in the United States to date and may be revised as more information becomes available.

(1) SARS patients should limit interactions outside the home and should not go to work, school, out-of-home child care, or other public areas until 10 days after the resolution of fever, provided respiratory symptoms are absent or improving. During this time, infection control precautions should be used, as described below, to minimize the potential for transmission.
(2) All members of a household with a SARS patient should carefully follow recommendations for hand hygiene (e.g., frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
(3) Use of disposable gloves should be considered for any direct contact with body fluids of a SARS patient. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.
(4) Each patient with SARS should be advised to cover his or her mouth and nose with a facial tissue when coughing or sneezing. If possible, a SARS patient should wear a surgical mask during close contact with uninfected persons to prevent spread of infectious droplets. When a SARS patient is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient.
(5) Sharing of eating utensils, towels, and bedding between SARS patients and others should be avoided, although such items can be used by others after routine cleaning (e.g., washing with soap and hot water). Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity.
(6) Household waste soiled with body fluids of SARS patients, including facial tissues and surgical masks, may be discarded as normal waste.
(7) Household members and other close contacts of SARS patients should be actively monitored by the local health department for illness.
(8) Household members or other close contacts of SARS patients should be vigilant for the development of fever or respiratory symptoms and, if these develop, should seek healthcare evaluation. In advance of evaluation, healthcare providers should be informed that the individual is a close contact of a SARS patient. Household members or other close contacts with symptoms of SARS should follow the same precautions recommended for SARS patients.
(9) At this time, in the absence of fever or respiratory symptoms, household members or other close contacts of SARS patients need not limit their activities outside the home.


____________________________________________________________

FREQUENTLY ASKED QUESTIONS
April 16, 2003, 12:00 PM ET


Is the use of ribavirin (or other antiviral drugs) effective in the treatment of patients with SARS?
At present, the most efficacious treatment regimen, if any, is unknown. In several locations, therapy has included antivirals such as oseltamivir or ribavirin. Steroids also have been given orally or intravenously to patients in combination with ribavirin and other antimicrobials. In the absence of controlled clinical trials, however, the efficacy of these regimens remains unknown. Early information from laboratory experiments suggests that ribavirin does not inhibit virus growth or cell-to-cell spread of one isolate of the new coronavirus that was tested. Additional laboratory testing of ribavirin and other antiviral drugs is being done to see if an effective treatment can be found.


Cause of SARS

What is the cause of SARS?
Scientists at the Centers for Disease Control and Prevention (CDC) and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. This new coronavirus is the leading hypothesis for the cause of SARS, however, other viruses are still under investigation as potential causes.

What are coronaviruses?
Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under a microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals. Coronaviruses can survive in the environment for as long as three hours.

What evidence is there to suggest that coronaviruses may be linked with SARS?
The Centers for Disease Control and Prevention (CDC) scientists isolated a virus from the tissues of two SARS patients and then used several laboratory methods to characterize it. Examination by electron microscopy revealed that the virus has the distinctive shape and appearance of coronaviruses, and genetic analysis suggests that this new virus does belong to the family of coronaviruses but differs from previously identified family members. Tests of serum specimens from people with SARS showed that they appeared to have been recently infected with this virus. Other tests demonstrated that this previously unrecognized coronavirus was present in a variety of clinical specimens (including specimens obtained by nose and throat swab) from other SARS patients with direct or indirect links to the outbreak. These results and other findings reported from laboratories participating in the World Health Organization (WHO) network provide growing evidence in support of the hypothesis that this new coronavirus is the cause of SARS. Additional studies of the link between this coronavirus and SARS are under way.

If coronaviruses usually cause mild illness in humans, how could this new coronavirus be responsible for a potentially life-threatening disease such as SARS?
There is not enough information about the new virus to determine the full range of illness that it might cause. Coronaviruses have occasionally been linked to pneumonia in humans, especially people with weakened immune systems. The viruses also can cause severe disease in animals, including cats, dogs, pigs, mice, and birds.

Has new information about coronavirus changed the recommendations for medical treatment for patients with SARS?
The possibility that coronavirus is the cause of SARS has not changed treatment recommendations. The new coronavirus is being tested against various antiviral drugs to see if an effective treatment can be found.


What about reports from other laboratories suggesting that the cause of SARS may be a paramyxovirus?
Researchers from several laboratories participating in the WHO network have reported the identification of a paramyxovirus in clinical specimens from SARS patients. These laboratories are still investigating the possibility that a paramyxovirus is a cause of SARS.


The Outbreak

What is the Centers for Disease Control and Prevention (CDC) doing to combat this health threat?
The Centers for Disease Control and Prevention (CDC) is working closely with WHO and other partners as part of a global collaboration to address the SARS outbreak. For its part in this international effort, CDC has taken the following actions:

(1) Activated its Emergency Operations Center to provide round-the-clock coordination and response.

(2) Committed more than 300 infectious disease experts and support staff to work on the SARS response.

(3) Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.

(4) Provided ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.

(5) Issued multiple notices providing guidance on ways to minimize the risk for SARS in health-care facilities, in the household, when traveling, and in other settings.

(6) Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.

(7) Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.

As always, the Centers for Disease Control and Prevention (CDC) is committed to communicating regularly and effectively with public health professionals, elected leaders, clinicians, and the general public.



Travel and Quarantine

What are CDC's quarantine officials doing to prevent and control the spread of SARS?
CDC's quarantine inspectors or their designees are distributing health alert cards to air passengers returning in airplanes either directly or indirectly to the United States from China, Singapore, and Vietnam. The notices inform travelers about SARS and its symptoms and asks them to monitor their health for 10 days and to see a doctor if they get a fever with a cough or have difficulty breathing. The Centers for Disease Control and Prevention (CDC) distributes approximately 18,000 health alert notices each day to air travelers returning from the affected regions at 23 ports of entry. Inspectors also are boarding airplanes if a traveler has been reported with symptoms matching the case definition of SARS.

WHO has recommended procedures for pre-departure screening of airline passengers from some countries for respiratory illnesses or other symptoms of SARS.

What information about SARS is being provided to people traveling on ships?
SARS information contained on CDC's health alert cards is being provided by the major shipping associations and the International Council of Cruise Lines to people traveling on cargo ships and cruise ships at U.S. ports. Inspectors also are boarding ships if a passenger or crew member has been reported with symptoms matching the case definition of SARS.

What does a quarantine inspector do?
Quarantine inspectors serve as important guardians of health at borders and ports of entry into the United States. They routinely respond to illness in arriving passengers and ensure that the appropriate medical action is taken.

What is considered routine health inspections of airplanes or ships versus what is happening now?
Routine health inspections consist of working with airline, cargo ship, and cruise ship companies to protect passengers and crew from certain infectious diseases. Quarantine inspectors meet arriving aircraft and ships reporting ill passengers and/or crew (as defined in the foreign quarantine regulations [pdf]) and assist them in getting appropriate medical treatment.

What is the risk to individuals who may have shared a plane or boat trip with a suspected SARS patient?
Cases of SARS continue to be reported primarily among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health-care workers who did not use infection control procedures while attending to a SARS patient. SARS also has occurred among air travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.

The Centers for Disease Control and Prevention (CDC) is requesting locating information from travelers who are on flights with people suspected of having SARS. CDC, with the help of state and local health authorities, is attempting to follow-up with these travelers for 14 days to make sure no one develops symptoms consistent with SARS.

Who actually notifies quarantine officials of potential SARS cases? Is it the crew of the airplane or ship? The passengers?
Under foreign quarantine regulations, the master of a ship or captain of an airplane coming into the United States from a foreign port is required by law to report certain illnesses among passengers. The illness must be reported to the nearest quarantine official. If possible, the crew of the airplane or ship will try to relocate the ill passenger or crew member away from others. If the passenger is only passing through a port of entry on his/her way to another destination, port health authorities may refer the passenger to a local health authority for assessment and care.

If I'm on board an airplane or ship with someone suspected of having SARS, will I be allowed to continue to my destination?
The Centers for Disease Control and Prevention (CDC) does not currently recommend that the onward travel of healthy passengers be restricted in the event that a passenger or crew member suspected of having SARS is removed from the ship or airplane by port health authorities. All passengers and crew members may be advised by port health authorities to seek medical attention if they develop SARS symptoms.

What does a quarantine official do if a passenger is identified as meeting the case definition for suspected SARS?
Quarantine officials arrange for appropriate medical assistance to be available when the airplane lands or the ship docks, including medical isolation. Isolation is important not only for the sick passenger's comfort and care but also for the protection of members of the public. Isolation is recommended for travelers with suspected cases of SARS until appropriate medical treatment can be provided or until they are no longer infectious.

What does a quarantine official do if a passenger identified as meeting the case definition for suspected SARS refuses to be isolated?
Many levels of government (Federal, State, and local) have basic authority to compel isolation of sick persons to protect the public. In the event that it is necessary to compel isolation of a sick passenger, the Centers for Disease Control and Prevention (CDC) will work with appropriate State and local officials to ensure that the passenger does not infect others.


____________________________________________________________

Interim Guidance: Air Medical Transport for Severe Acute Respiratory Syndrome (SARS) Patients
March 26, 2003, 6:30 PM EST


Introduction

The current outbreak of Severe Acute Respiratory Syndrome (SARS) has included reports of cases in southeast Asia, North America and Europe, and required urgent air evacuation of patients with severe illness. This guidance is intended to assist air medical transport (AMT) service providers using specialized aircraft to transport SARS patients while ensuring the safety of patients and transport personnel. It should not be generalized to commercial passenger aircraft. These interim recommendations are based on standard infection control practices, AMT standards, and epidemiologic information from ongoing investigations of SARS, including experience from transport of two patients during this outbreak.

Currently recommended infection control measures for hospital patients with SARS include Standard Precautions (with eye protection to prevent droplet exposure), plus Contact and Airborne Precautions. Respiratory protection using respirators providing at least 95% filtering efficiency (e.g., N--95) with appropriate fit-testing is recommended.


I. Air Transport of SARS Patients, General Considerations

SARS patients should be transported on a dedicated AMT mission minimizing crew size. There should not be any patients or passengers who do not have SARS on board.
If possible, a single caregiver should be assigned to the SARS patient.
All SARS patient movement involving U.S. citizens should be coordinated with appropriate state and federal health authorities, including the Centers for Disease Control and Prevention (CDC) (24 hour response number: (770) 488-7100) and the Department of State, before movement begins. International movement of SARS patients may require special approvals by countries that will be over-flown, aircraft servicing locations, patient rest stop hospitals, and/or final destinations.


II. Airframe Selection and Cabin Airflow

AMT service providers should consult manufacturer(s) of their aircraft to identify cabin airflow characteristics, including: HEPA filtration and directional airflow capabilities, air outlet location, presence or absence of air mixing between cockpit and patient-care cabin during flight, and the time and aircraft configuration required to perform a post-mission airing-out of the aircraft.
Aircraft with forward-to-aft cabin airflow and a separate cockpit cabin are recommended for transport of SARS patients. The flight deck/cockpit crew in aircraft with forward-to-aft cabin airflow and separate patient-care compartment are not required to wear respirators unless they enter the patient-care compartment.
Aft-to-forward cabin airflow may create a significant risk of airborne transmission to both cabin and flight deck personnel. If an aircraft with aft-to-forward airflow must be used, all personnel on board must wear fit-tested N-95 respirators throughout the flight.
Aircraft that re-circulate cabin and flight deck air without HEPA filtration should not be selected for SARS patient transport.
Aircraft ventilation should remain on at all times during transport of SARS patients, including during ground delays.
Aircraft that provide separate upwind cabin space for crew members to perform necessary personal activities (eating, drinking, handling contact lenses, etc.) should be selected for flights likely to exceed 4 hours.


III. Patient Placement

The in-flight environment may preclude the creation of a true negative pressure room; however, some aircraft designs permit a downwind zone of relative airflow isolation. The airflow of each aircraft should form the basis for litter and seat assignments. In general:

SARS patients should be positioned as far downwind with regard to cabin airflow as possible.
If the AMT aircraft uses vertical litter tiers, SARS litter patients should be placed in the lowest position in the tier.
Ambulatory SARS patients should be seated next to the cabin sidewall.
If a non-SARS patient must be transported simultaneously with SARS patient(s), the non-SARS patient must wear an N-95 respirator during transport and should not be positioned downwind from, or within 3 feet of, the SARS patient.
If several SARS patients are transported, they may be moved as a group (cohorted) in an aircraft that provides appropriate airflow and filtration characteristics as described above.


IV. Infection Control

General:

Personnel should not wear leather or other "flight" gloves while providing patient care.
Eating, drinking, application of cosmetics, and handling of contact lenses should not be done in the immediate patient care area.
Handling or storage of medication or clinical specimens should not be done in areas where food or beverages are stored or prepared.
Protective equipment and procedures:
Disposable, non-sterile gloves must be worn for all patient contact.
Gloves are removed and discarded in designated trash bags after patient care is completed (e.g., between patients) or when soiled or damaged.
Hands must be washed or disinfected with waterless hand sanitizer after removal of gloves.
Disposable fluid-resistant gowns should be worn for all patient care activity.
Gowns are removed and discarded in designated trash bags after patient care is completed or when soiled or damaged.
Goggles or face-shields must be worn for all patient care within 6 feet of the patient. Corrective eyeglasses alone are not appropriate protection.
Fit-tested N-95 respirators are approved for in-flight use and should be worn by personnel in the patient-care cabin at all times.
Fit-tested N-95 respirators should be worn by cockpit/flight-deck crew if an aircraft cannot provide forward-to-aft airflow.
For cockpit crews, aircraft aviator tight-fitting face-pieces capable of delivering oxygen that has not mixed with cabin air may be used in lieu of a disposable N-95 respirator.
Respirators may not be removed to eat or drink. Personal activities that require removal of respirators should not be performed in the patient-care cabin.
The patient may wear a paper surgical mask to reduce droplet production, if tolerated.
Oxygen delivery with simple and non-rebreather facemasks may be used for patient oxygen support during flight.
Cardiopulmonary resuscitation (CPR) should only be performed using a resuscitation bag-valve mask equipped with HEPA filtration of expired air.


V. Mechanically Ventilated Patients

Mechanical ventilators for SARS patients must provide HEPA filtration of airflow exhaust.
AMT services should consult their ventilator equipment manufacturer to confirm appropriate filtration capability and the effect of filtration on positive pressure ventilation.


VI. Clinical Specimens

Standard precautions must be used when collecting and transporting clinical specimens.
Specimens should be stored only in designated coolers or refrigerators.
Clinical specimens should be labeled with appropriate patient information and placed in a clean zip-lock bag for storage and transport.


VII. Waste Disposal

Dry solid waste, e.g., used gloves, dressings, etc., should be collected in biohazard bags for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
Waste that is saturated with blood or body fluids should be collected in leak-proof biohazard bags or containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
Sharp items such as used needles or scalpel blades should be collected in puncture resistant sharps containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
Suctioned fluids and secretions should be stored in sealed containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility. Handling that might create splashes or aerosols during flight should be avoided.
Suction device exhaust should not be vented into the cabin without HEPA filtration. Portable suction devices should be fitted with in-line HEPA filters. Externally vented suction should not be used during ground operation.
Excretions (feces, urine) may be carefully poured down the aircraft toilet.



VIII. Cleaning and Disinfection

After transporting a SARS patient, all exits and doors should be opened and the interior of the aircraft should be aired out with the aircraft air conditioning running at maximum capacity for a specified time based on aircraft-specific engineering features. Personnel boarding the aircraft must wear N-95 respirators until this "airing out" is complete.
Cleaning should be postponed until airing out is complete.
Compressed air that might re-aerosolize infectious material should not be used for cleaning the aircraft.
Non-patient-care areas of the aircraft should be cleaned and maintained according to manufacturer's recommendations.
Cleaning personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning patient-care areas.
Patient-care areas (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces likely to be directly contaminated during care) should be cleaned using an EPA-registered hospital disinfectant in accordance with aircraft manufacturer's recommendations.
Spills of body fluids during transport should be cleaned by placing absorbent material over the spill and collecting the used cleaning material in a biohazard bag. The area of the spill should be cleaned using an EPA-registered hospital disinfectant. Ground service personnel should be notified of the spill location and initial clean-up performed.
Contaminated web seats or seat cushions should be placed in a biohazard bag and labeled with the location and type of contamination for later disposal or cleaning.
Contaminated reusable patient care equipment should be placed in biohazard bags and labeled for cleaning and disinfection at the AMT service medical equipment section.
Personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning reusable equipment.
Reusable equipment should be cleaned and disinfected according to manufacturer's instructions.


IX. Logistical Planning and Post-Mission Follow-Up

Sufficient infection control supplies should be on board to support the expected duration of the mission plus additional time should the aircraft experience maintenance delays or weather diversions.
Flight planning should identify emergency or unexpected diversion airfields, and coordinate with authorities in advance.
Upon mission termination, the AMT team should provide the following information to their medical director: mission number/date; address of the team/aircraft basing; duration of patient transport; names, contact information, and crew positions (including estimated duration of direct patient care provided) of mission personnel.
AMT services should designate individuals responsible for performing post-mission monitoring of mission personnel and reporting results to the AMT service medical director.
Mission personnel should be monitored (directly or by telephone) twice daily for 10 days for evidence of fever or respiratory illness.


X. Ground/In-Flight Emergency Procedures

AMT service providers should have a written plan addressing patient handling during in-flight and/or ground emergency situations. Activities such as donning life vests and litter-patient emergency egress may create special exposure risks. Use of N-95 respirators must be weighed against time constraints and on-board emergency conditions (e.g., smoke in the cabin, sudden cabin decompression). Gowns and latex gloves represent a fire/flash hazard and should not be worn during ground or in-flight emergency response situations.


Acknowledgements

This guidance was prepared in cooperation with and with contributions from:

United States Department of Defense
US Transportation Command (USTRANSCOM)
Headquarters Air Mobility Command (HQ AMC)
US Pacific Command (USPACOM)
Headquarters Pacific Air Forces (HQ PACAF)
US Army Medical Research Institute of Infectious Diseases (USAMRIID)

United States Department of State
Commission on Accreditation of Air Medical Transport Services (CAMTS)
Aerospace Medicine Association (AsMA)

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