X
|
STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
|
Michael Belden MD
This includes fully considering the karst geology erectile dysfunction icd safe viagra jelly 100 mg, impacts on property value how is erectile dysfunction causes viagra jelly 100mg on-line, water availability and cumulative impacts impotence may be caused from quizlet discount viagra jelly 100mg visa. This decision is ultimately made by Minnesota Pollution Control Agency Commissioner John Linc Stine erectile dysfunction treatment kerala discount viagra jelly 100mg free shipping. This site is located in a karst area that is rich with sinkholes, springs and creeks. The current comment period coincided with crop planting, Memorial Day weekend and end-of-school activities. Citizens need more time and an informational meeting to fully understand what is being proposed. The Fillmore County District Court agreed with this in a December 2000 ruling about locating a large feedlot and manure lagoon in Forestville Township. The public well at the Newburg Methodist Church, located next to a proposed manure application field for the proposed project, has nitrates exceeding the state standard. Judith Webster 13030 241st ave Harmony Minnesota 55939 89 From: Ron Welper <rwelper@gmail. We regularly visit relatives who live a couple of miles from the proposed site and the Scheie Church located nearby. The risk to the water quality from the planned manure application to surrounding farmland projected to be produced by this operation is immense. The amount planned for each year is so great we do not believe there is any suitable application that will not prevent runoff and contamination of the local water table. The amount of water also planned to be used in the operation also poses a risk to wells of people living near the site. What happens to these people if the water table level is reduced to the point they can no longer draw water from their own well? Winds will spread them far and wide permeating the air with foul odors preventing local people from enjoying any outdoor activity. The quality of life they now experience will be decreased to the point where some will no longer wish to live there but will be unable to sell as their property values will also be affected from this operation. Once again we urge you to reject this request and ask that a full Environmental Impact Statement be conducted. We object strongly to this plan because of the negative impacts to our air, our water, our property values and our general quality of life. We strongly object to the spread of manure from the proposed facility on agricultural fields in the township. Our residence and our church will be inundated by the smell and the particulates unavoidably released into the air as the manure is spread. We are very concerned about the areas of significant biodiversity which will be impacted by any spills or leakages which make their way into the water. The plans proposed for this farrowing facility do not take into account unexpectedly heavy rainstorms which will increase the leakage and outright flow of manure into the surrounding karst formations, wells, waterways, and tributaries to the trout streams. The public water sources for our local churches (Scheie Lutheran, Garness Trinity Lutheran, and Newburg United Methodist) are in danger from the waste products from this proposed facility. Each home and house of worship has its own well, all of which draw from the water source endangered by the raising and composting of hogs. We have no doubt this facility would be a significant detriment to the local community and our quality of life. Peterson, I write to voice my objections on accepting a large swine feedlot operation into Fillmore County, where I live. This is an enormous operation and I have concerns about the environmental impact, particularly on water resources. Going ahead with this enormous factory will bring harmful destruction to the environment in our beautiful county, which in turn will lower our property values. Not only is there a high risk of groundwater pollution, our magnificent trout stream will be negatively impacted. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. This area is underlain with karst topography which is highly susceptible to groundwater contamination. Already many wells in the area around Newburg test high for nitrates, a symptom of contamination from surface runoff from agricultural operations caused both by inappropriate and over application of fertilizers, especially animal manures. If the existing small operations have not been able to apply fertilizers in this area without damaging the groundwater, one of this magnitude will definitely not. A couple of potentially serious concerns are the understatement of calculated Animal Units, the number and location of sink holes, and the location of nearby wells. There are grade A trout streams in the area that bring in tourist dollars and enrich the quality of life of people who choose to live here. The springs that are the headwaters of one is located on the west side of Newburg, within a few hundred feet of manure application area #10 and downhill from it. The hills around here are steep with less likelihood for storm water to soak into the soil and be filtered. Contamination of surface waters is inevitable with this volume of manure to be disposed of whether it is applied by injection or on the surface. This is a low-income area and the degrading of property values due to odor pollution from the hog building, the manure containment facility and, most assuredly, the copious amounts of manure being applied to the countryside will further depress the finances of property owners adjacent to and for quite a ways downwind from these locations. The attractiveness of the area to such prospective residents will be seriously reduced if their air quality is compromised for most of the year. Although this is ultimately an economic impact it is the result of a measureable and predictable environmental impact. Inability to enjoy the out-of-doors without a stench is a very real concern for home buyers and existing property owners such as myself. There may be locations with the geology, hydrology, and population density are such that an operation such as is planned may not present a problem to the environment and proposed neighbors. For instance with thick loess soils, relatively flat topography, and farm residences miles apart. This, however, is a very fragile system with thin soils, fractured bedrock, steep slopes, and small parcels inhabited by nearby neighbors. I would appreciate receiving a copy of whatever report or summary is created from the public comments received. The sustainability and vitality of my rural community depends on clean air and water. Alexander to walk the site and verify sinkholes; the landowner, Al Hein, originally agreed but then canceled. In addition, pumping 8-9 million gallons of water from the local aquifer to water the thousands of swine and handle their manure is a concern for all area farmers and land owners that have private wells. Fillmore County already has 15 percent of its wells exceeding the nitrate standard. We need to preserve the unique quality of this part of Minnesota for tourism, the arts, and outdoor recreation -industries central to the shared prosperity of our greater region and my community of Lanesboro in particular. There is not going to be an option for a do-over if this facility causes problems. Why risk catastrophic damage to the commons - the quality of our water, air and land - so that a few people can simply make money selling shit? There is no social or environmental benefit from a colossal corporate farm with 4,980 hogs creating 7. Does the disgustingly greedy and reckless self-interest of Al Hein, Dan Dykstra, Brad Herman, and the Waukon Feed Ranch outweigh the common good of the other 20,000 people living in Fillmore County and the tens of thousands more that will live here in the decades to come? Additionally, I urgently request an extension of the public comment period on this proposal, to a date several weeks after the public informational meeting is conducted. But this proposal represents a leap in potential volumes of manure and intensity of odors and air pollution about which citizens need to be educated.
Physical examination shows an elevated cutaneous papule with bloody purulent exudate erectile dysfunction young age causes buy viagra jelly 100mg without a prescription. The rash disappears erectile dysfunction treatment vacuum device order viagra jelly 100 mg otc, but 1 year later erectile dysfunction gel treatment purchase 100mg viagra jelly amex, the patient develops arthralgias and right facial nerve palsy erectile dysfunction treatment tablets generic 100mg viagra jelly visa. Postmortem examination demonstrates bilateral adrenal hemorrhages (shown on right). Her urine appears dark on visual inspection, and a urine dipstick is positive for hemoglobin. An X-ray film of the chest shows multiple areas of consolidation, with a large cavity in the right upper lobe. Examination of the lungs at autopsy discloses multiple, sharply delineated, gray foci with hemorrhagic borders. Which of the following mechanisms of disease best accounts for these pathologic findings? Physical examination shows marked pallor, respiratory distress, nasal flaring, and intercostal retractions. There are enlarged cells with prominent, dark-blue nuclear inclusions (shown in the image). His past medical history is significant for a splenectomy following a motor vehicle accident 3 years ago. Physical examination shows puffiness around the eyes and pitting edema of the lower extremities. Blood analysis discloses reduced serum levels of C3 and an elevated titer of antistreptolysin O antibodies. A 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. An autopsy shows necrotizing bronchitis and diffuse, hemorrhagic necrotizing pneumonia. Her parents report that her rash began in the form of pink papules behind the ears and spread around her body. Sputum cultures are negative, and the patient does not respond to antibiotic therapy. Histologic examination of the lungs at autopsy shows giant cells with up to 100 nuclei (shown in the image). The patient reports that a number of similar cases have occurred recently in the building where he works. An X-ray film of the chest shows an ill-defined area of consolidation at the periphery of the right middle lobe and mediastinal lymphadenopathy. Lymph node biopsy in this patient would most likely show which of the following pathologic findings? Physical examination reveals periorbital edema and a mucopurulent postnasal discharge. The vessel in the center of the field is occluded by a septic thrombus (shown in the image). These clinicopathologic features are typical of which of the following pulmonary diseases? An X-ray film of the chest shows bilateral, diffuse, A 3-year-old boy is brought to the emergency room by his parents with a high fever, sore throat, hoarse voice, and acute respiratory distress. On physical examination, the child is observed to be leaning forward with a hyperextended neck. Infectious and Parasitic Diseases the epiglottis appears swollen and erythematous. Physical examination of his oral cavity demonstrates a whitish membrane covering much of his tongue and palate. Endoscopic examination reveals the same whitish membrane covering his esophageal mucosa. Physical examination shows marked pallor of the skin and mucous membranes and arthralgias of the lower limbs. The brain at autopsy reveals large areas of subependymal necrosis with calcification (shown in the image, see arrows). Which of the following pathogens is the most likely cause of death in this neonate? Which of the following is chiefly responsible for the barking cough and inspiratory stridor seen in this patient? Cerebrospinal fluid shows numerous neutrophils, decreased glucose, and increased protein. Physical examination shows bilateral swelling of the parotid glands and a purpuric, maculopapular rash that spares the palms, face, and soles. Biopsy of lesional skin discloses intracellular microorganisms up to 1 m in length within capillary endothelial cells. Which of the following mechanisms of disease is chiefly responsible for the development of gastrointestinal symptoms in this patient? A lung biopsy reveals necrotizing inflammation and vascular thrombi with branching fungal hyphae. Histologic examination of the lesion reveals chocolate-colored, odorless debris, surrounded by a shaggy fibrin lining, scant inflammatory reaction, and organisms attached to adjacent cells. Physical examination shows the stigmata of intravenous drug abuse, as well as splenomegaly and pleuritis. A silver stain of a biopsy from a skin lesion (shown in the image) reveals organisms clustered in large macrophages. A 42-year-old man presents with a 1-week history of myalgia, low-grade fever, and swelling of the left calf. Examination of a muscle biopsy in this patient would most likely reveal an infiltrate of which of the following cell types? Which of the following is the most likely cause of lymphadenopathy in this patient? Which of the following pathogens is the most likely cause of anemia in this patient? Which of the following parasites is the most likely cause of urinary symptoms in this patient? In addressing her concerns, you might consider that the virus is harbored in a latent form in which of the following anatomic locations? An X-ray film of the chest shows patchy consolidation of the right lower lobe, with evidence of interstitial involvement. An X-ray film of the chest shows nodular pulmonary infiltrates and thin-walled cavities. A mucicarmine stain of a lung biopsy discloses budding yeast surrounded by a mucin-rich capsule. If this patient has yellow fever, pathologic changes would most likely be observed in which of the following organs? A bone marrow biopsy (silver stain) displays macrophages filled with proliferating organisms. At birth, the neonate shows signs of profound anemia and generalized edema (hydrops fetalis). Three days later, the patient presents with sudden onset of severe pain at the site of injury. Physical examination shows darkening of the surrounding skin, hemorrhage, and cutaneous necrosis. The wound shows a thick serosanguinous discharge with gas bubbles and a fragrant odor. Physical examination shows mild abdominal distension and evidence of malabsorption. Secondary syphilis represents systemic dissemination and proliferation of the spirochete, Treponema pallidum.
Generic viagra jelly 100 mg visa. 1963 TV Concert: 'It's The Beatles' Live.
Residential Treatment Centers - Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time erectile dysfunction treatment testosterone purchase 100 mg viagra jelly free shipping. Children with serious emotional disturbances receive constant supervision and care impotence testicular cancer cheap viagra jelly 100 mg overnight delivery. Treatment may include individual erectile dysfunction with age buy viagra jelly 100 mg on line, group erectile dysfunction medicine in ayurveda order viagra jelly 100 mg mastercard, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Respite Care - A service that provides a break for parents who have a child with a serious emotional disturbance. This gives families relief from the strain of taking care of a child with a serious emotional disturbance. Some of these disorders are depression, attention-deficit/ hyperactivity, anxiety, conduct, and eating disorders. Service - A type of support or clinical intervention designed to address the specific mental health needs of a child and his or her family. A service could be received once or repeated over a course of time as determined by the child, family, and service provider. System of Care - A method of delivering mental health services that helps children and adolescents with mental health problems and their families get the full range of services in or near their homes and communities. Therapeutic Foster Care - A home where a child with a serious emotional disturbance lives with trained foster parents with access to other support services. These foster parents receive special support from organizations that provide crisis intervention, psychiatric, psychological, and social work services. Therapeutic Group Homes - Community-based, home-like settings that provide intensive treatment services to a small number of young people (usually 5 to 10 persons). Psychiatric services offered in this setting try to avoid hospital placement and to help the young person move toward a less restrictive living situation. Transitional Services - Services that help children leave the system that provides help for children and move into adulthood and the adult service system. Help includes mental health care, independent living services, supported housing, vocational services, and a range of other support services. Wraparound Services - A "full-service" approach to develo ing help that meets the mental health needs of p individual children and their families. Children and families may need a range of community support services to fully benefit from traditional mental health services such as family therapy and special education. See appropriate services, coordinated services, family-centered services, and system of care. Grounding is a set of simple strategies that can help you detach from emotional pain. It is basically a way to distract yourself by focusing on something other than the difficult emotions you are experiencing. You may also think of grounding as centering, distracting, creating a safe place, or healthy detachment. Although grounding does not solve the problem that is contributing to your unpleasant emotions, it does provide a temporary way to gain control over your feelings and prevent things from getting worse. Grounding anchors you, gives you a chance to calm down, and allows you to eventually return and address the problem that is triggering the unpleasant emotions to begin with. You may find that one of these types works better for you, or that each is helpful. Or read each letter backwards so that you focus on the letters and not the meaning of words. Grab tightly onto your chair as hard as you can; notice the sensations and the experience. Notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. Extend your fingers, arms, legs as far as you can; slowly and gently roll your head around. Eat something in a savoring way; fully experience the food; describe the sights, aromas, textures, flavors, and the experience in detail to yourself. Remember the words to an inspiring song, quotation, or poem that makes you feel better. Plan a safe treat for yourself, such as a piece of candy, a nice dinner, or a warm bath. Then, when you need to call upon this skill you will have it, know it, and use it well. Any method you make up may be worth much more than those you read here, because it is yours. Make up an index card or type in your phone a list of your best grounding methods. Teach family and friends about grounding, so that they can help guide you with it if you become overwhelmed. Now, list three of the strategies described above that you think will work best for you. Then practice these skills regularly, so in times of need you will know what to do and how to do it successfully. After practicing and/or applying these grounding strategies, what have you noticed? Are you able to calm yourself and focus on something other than the unpleasant emotions and situations? The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Despite this, the reported levels of interrater reliability for the scale appear to be acceptable. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder. Rate the patients by finding the answer which best describes the extent to which he/she has these conditions. Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair. Dudek, PhD Professor Brody School of Medicine East Carolina University Department of Anatomy and Cell Biology Greenville, North Carolina Acquisitions Editor: Crystal Taylor Product Manager: Sirkka E. Howes Marketing Manager: Jennifer Kuklinski Vendor Manager: Bridgett Dougherty Manufacturing Manager: Margie Orzech Design Coordinator: Terry Mallon Compositor: Aptara, Inc. Materials appearing in this book prepared by individuals as part of their official duties as U. This is particularly important when the recommended agent is a new or infrequently employed drug. It was his hard work and sacrifice that allowed me access to the finest educational institutions in the country (St. It was by hard work and sacrifice that he showed his love for his wife, Lottie; daughter, Christine; and grandchildren, Karolyn, Katie, and Jeannie. As you may know, I include my e-mail address in the prefaces of all my books and ask for feedback from my readers. I pay close attention to these suggestions, and most have been included in this edition. I have retained the clinical vignettes, which first appeared in the third edition. All these cases were written by Shawn McGill, a medical student at the Brody School of Medicine.
The health consultant should conduct program observations to correct hazards and risky practices erectile dysfunction doctors jacksonville fl buy viagra jelly 100mg online. The child care provider should erectile dysfunction caused by obesity cheap viagra jelly 100 mg mastercard, when registering each child erectile dysfunction doctor nj viagra jelly 100 mg sale, inform parents of exclusion and readmittance policies and of the requirement to share affecting the child or any member of the immediate household to facilitate prompt reporting of diseases and institution of control measures erectile dysfunction treatment fruits purchase viagra jelly 100mg line. The child care provider or program director, after tion of parents of children who attend the program about exposure of their child to a communicable disease. Local and/or state public health authorities should be contacted about cases of In settings where human milk is stored and delivered to infants, there should be a written policy to ensure administration of human milk to the designated infant. A monitoring program should be instituted with policies to deal with incidents when human milk inadvertently is fed to an infant other than the designated infant (see Human Milk Banks, p 131). Health care facilities have developed policies that could be adapted to the child care setting to address such incidents. These policies require documentation, counseling, observation of the affected status. Determining the likelihood that infection in one or more children will pose a risk for schoolmates depends on an understanding of several factors: (1) the mechanism of pathogen transmission; (2) the ease with which the organism is spread (contagion); and (3) the likelihood that classmates are immune because of immunization or previous infection. Decisions to intervene to prevent spread of infection the United States relies on child care and elementary and secondary school entry immunization requirements to achieve and sustain high levels of immunization coverage. All states require immunization of children at the time of entry into school, and many states require immunization of children throughout grade school, of older children in upper grades, and of young adults entering college. The most up-to-date information consent to immunization can be obtained from the immunization program manager of each state health department, from a number of local health departments, from General methods for control and prevention of spread of infection in the school setting include: Meticulous hand and environmental hygiene. Documentation of the immunization status of enrolled children should be reviewed at the time of enrollment and at regularly scheduled intervals thereafter, in accordance of protection against poliomyelitis, tetanus, pertussis, diphtheria, type b, measles, mumps, rubella, and varicella. Infected children should be excluded from school until they no longer are considered ters in Section 3). Unimmunized or underimmunized children place other appropriately immunized children at risk of contracting a vaccine-preventable disease. Antimicrobial prophylaxis administered to close contacts of children with infections coccal infection, pertussis). Decisions about postexposure prophylaxis after an in-school exposure are best made in conjunction with local public health authorities. Temporary school closings can be used in limited circumstances: (1) to prevent spread of infection; (2) when an infection is expected to affect a large number of susceptible students and available control measures are considered inadequate; or (3) when an infection is expected to have a high rate of morbidity or mortality. Schools should maintain a clean environment and enforce high standards of personal hygiene, provide appropriate education for school staff, and ensure that the school outbreak. Physicians involved with school health should be aware of current public health guidelines to prevent and control infectious diseases. Close collaboration between the school and physician also is encouraged, helping to ensure that the school receives appropriate guidance and is stocked with the necessary materials to deal with outbreaks and limit spread of infections. In all circumstances requiring intervention to prevent spread of infection within the school setting, the privacy of children who are infected should be protected. Diseases Preventable by Routine Childhood Immunization Children and adolescents who have been fully immunized according to the recommended childhood and adolescent immunization schedule (http:/ /redbook. Measles and varicella vaccines have been demonstrated to provide protection in some susceptible people if administered within 72 hours after exposure, and up to 5 days after exposure in the case of varicella vaccine. Measles or varicella immunization should be recommended immediately for all nonimmune people during a measles or varicella outbreak, respectively, except for people with a contraindication to immunization. Many people without evidence of immunity may not yet have been exposed; therefore, vaccinating at any stage of an outbreak can prevent disease. In regard to measles, vaccination efforts should also be considered at unaffected schools that may be at risk during an outcumstances should be allowed to return to school after immunization, although they will need to be observed for the onset of wild-type disease during the interval before induction of protective immunity is afforded from vaccination (typically 2-3 weeks). Although measles vaccination should be delayed in people with moderate to severe febrile illnesses until resolution of the acute phase of the illness, an outbreak is an exception to this rule. For people older of data regarding vaccine performance in this age group and the increased risk of severe manifestations of hepatitis A with increasing age. People who receive mumps immunization should be provided with information on symptoms and signs of illness and be instructed to contact their medical provider should they become sick. As an additional prevention measure, it is imperative that any child diagnosed with mumps stay home from school for 5 days after onset of parotid gland swelling. Those with rubella should be excluded from school for 7 days after the onset of rash. Students and staff members with documented pertussis should be excluded from school and related activities until they have received at least 5 days of the recommended course of azithromycin; public health authorities should be contacted to assist with outbreak investigation and control. Symptomatic contacts should be tested and treated for pertussis; they also should also be excluded until they have completed 5 days of appropriate antimicrobial treatment. Children and staff members who refuse appropriate antimicrobial treatment should be excluded for 21 days after last contact with the infected person. Chemoprophylaxis should be given to all household contacts and to school contacts who are at risk of severe illness or adverse outcomes (eg, women in the third trimeswith such people. Unimmunized or underimmunized contacts should be immunized (see Pertussis, p 608). Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine should be substituted for a single dose of tetanus and diphtheria toxoids vaccine for children 7 years or older and adults (Td) in the primary catch-up series or as a booster dose if age appropriate (http:/ /redbook. Bacterial meningitis in school-aged children may be caused by Neisseria meningitidis. After discharge from the hospital, they pose no risk to classmates and may return to school. Prophylactic antimicrobial therapy is not recommended for school contacts in most circumstances. Close observation of contacts is recommended, and they should be evaluated promptly if a febrile illness develops. Students who have been exposed to oral secretions of an infected student, such as through kissing or sharing of food and drink, States contains antigens for serogroups A, C, Y, and W-135, should be considered in consultation with local public health authorities if evidence suggests an outbreak within a school attributable to one of the meningococcal serogroups contained in the vaccine. Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Certain high-risk groups 2 through 10 years of age and 19 through 55 years of age also should be provision of the serogroup B meningococcal vaccine currently licensed for use in Europe and Australia could be considered after consultation with public health authorities (see Infections Spread by the Respiratory Route Some pathogens that cause severe lower respiratory tract disease in infants and toddlers, such as respiratory syncytial virus and metapneumovirus, are of less concern in healthy school-aged children. Respiratory tract viruses, however, are associated with exacerbations of reactive airway disease and an increase in the incidence of otitis media and can cause respiratory etiquette hand hygiene and covering mouth and nose with tissue when coughing or sneezing (if no tissue is available, use the upper shoulder or elbow area rather than hands) should be taught and implemented in schools. Mycoplasma pneumoniae causes upper and lower respiratory tract infection in schoolaged children, and outbreaks of M pneumoniae infection occur in communities and schools. M pneumoniae therapy does not necessarily eradicate the organism or prevent spread. Thus, intervention Mycoplasma outbreaks in schools should be reported to the local health department. Students with pharyngitis caused by group A Streptococcus hours after initiation of antimicrobial therapy. Students who have negative results for group A Streptococcus on a rapid antigen test but who are awaiting results of culture and not receiving antimicrobial therapy may attend school during the culture incubation period unless the infection involves a child with poor hygiene and poor control of secretions. Symptomatic contacts of students with pharyngitis attributable to group A streptococcal infection should be evaluated and treated if streptococcal infection is demonstrated. Before adolescence, children with tuberculosis generally are not contagious, but students who are in close contact with an older child, teacher, or other adult with infectious tuberculosis should be evaluated for infection, including tuberculin skin testing or intertious tuberculosis almost always is the source of infection for young children. If an adult should be made to determine whether other students have been exposed to the same source and whether they warrant evaluation for infection. Parvovirus B19 infection poses no risk children and adults with sickle cell disease or other hemoglobinopathies. Pregnant women exposed to an infected child 5 to 10 days before rash onset should be referred to their physician for counseling and possible serologic testing. Infections Spread by Direct Contact Infection and infestation of skin, eyes, and hair can spread through direct contact with the infected area or through contact with contaminated hands or fomites, such as hair brushes, hats, and clothing. Clinical disease (lesions) may develop when these organisms are passed from a person with colonized or infected skin to another person. Although most skin infections attributable to S aureus and group A streptococcal organisms are minor and require only topical or oral antimicrobial therapy, person-to-person spread should be interrupted by appropriate treatment whenever skin infections are recognized.