To Learn..To Treat..To Cure..Feel Of God

Thursday, 8 December 2011

A SQL profile repository, can maintain repository items in item caches
Strongly recommended that you do not use locked caching for the user item in the profile repository
The user items in both the ProfileAdapterRepository and the InternalProfileRepository are configured to use simple cache mode
Caching is disabled for the Password property in both repositories

Standard User Profile Repository Definition

Profile Repository Administration Interfaces

Three interfaces to view/edit profile repository items:

1) The ATG Dynamo Server Admin interface (http://hostname:port/dyn/admin/nucleus)
2) The Personalization > Users options in the ATG Business Control Center
3) The Profile Repository window in the ACC

Internal and External user profiles

ATG maintains separate profile repositories for external and internal users.

External user profiles represent anyone who visits your externally-facing Web site. For commerce sites, external users are typically customers.The default external user profile repository is /atg/userprofiling/ProfileAdapterRepository, which is defined by the userProfile.xml file located in <ATG9dir>\DPS\config\profile.jar.
Internal user profiles represent people within your organization who use ATG applications such as the ATG Business Control Center or ATG Service to create and manage site content.Internal profiles are stored in the /atg/userprofiling/InternalProfileRepository, defined by the internalUserProfile.xml file in <ATG9dir>\DPS\InternalUsers\config\config.jar.

ATG Personalization Programming

Profile Repository

ATG applications use profile repositories to manage user profiles.
A standard profile repository is a SQL repository component of class atg.adapter.gsa.GSARepository.
Each user profile is represented by an item in the profile repository, and the attributes that make up the profile are stored as properties of the repository item. A profile repository definition is a list of all the profile properties that you want to track for users. For example, you can define a profile repository to track the first name, last name, and address for site members.
The standard profile repository definition is located in the configuration path at /atg/userprofiling/userProfile.xml.

ATG - Create a Website of your own

Art Technology Group (ATG) was an independent Internet technology company specializing in eCommerce software and on-demand optimization applications until its acquisition by Oracle on January 5, 2011. ATG continues to be based in Cambridge, Massachusetts and operates under its own name as a subsidiary of Oracle.

When to suspect:

Patents presenting with Fever (body temperature of 38o Celsius or high) with one of the following symptoms:

Muscle ache, cough, abnormal breathing (unusual breathing difficulty) or suspected pneumonia by the physician, or influenza

in addition to

History of direct contact with infected / dead birds in past 7 days or

Occurrence of unusual death of birds in the community within the past 14 days; or

Contact with a pneumonia patient or another patient suspected of avian influenza

Case definition of probable case: symptoms of suspected case and
Preliminary test shows infection of influenza group A, but cannot yet be confirmed whether it is from human or birds or

Respiratory failure or

Death

Case definition of Confirmed cases: A suspected or probable case with at least one of the following:

• Positive viral culture for influenza A/H5

• Positive RT PCR for influenza A/H5

• Positive IFA for influenza A/H5

• A 4 fold rise in influenza A/H5 specific antibody titers.

Management guideline for all suspected cases of avian flu:

Obtain NP swabs from all the patients (see annexure 1)

Assess severity of illness: Look for presence of following:

Respiratory distress as indicated by: increased respiratory rates, chest indrawing, dehydration, hypotension, altered sensorium or oxygen saturation of less than 93% in room air. If any of these are present patient should be admitted to ward in designated area and manage on following principles

1. Isolate cases

Monitor vital signs every 1-2 hours
Maintain air way breathing and circulation (ABC)
Maintain hydration, electrolyte balance, and nutrition
Provide oxygen and assisted ventilation when indicated
Manage fever with paracetamol
Give antiviral Oseltamivir (For doses see annexure 2)
Broad spectrum antibiotics for treatment of secondary pulmonary infection
Avoid giving nebulized medications: chances of spread

Management of non severe cases

If patient is stable: (absence of above clinical features): take NP aspirate from all the patients and isolate them in the designated area identified for them and Start on Oseltamivir

Obtain lab results and see clinical course. If lab tests negative: discontinue Oseltamivir and provide supportive care, shift them to regular wards if hospitalization indicated otherwise send them home

If lab test is positive: Transfer to designated in patient area and continue supportive care and oseltamivir

Discharge policy

Adult patients: Infection control precautions for 7 days after resolution of fever

Children: Infection control measures for 21 days after onset of illness.

If discharged earlier: child should not attend school and parents should be educated to observe infection control measures at home.

Precautions for health care workers handling cases of avian flu

Wear personal protective equipments

A. Protective clothings:

1. Overall plus an impermeable apron or surgical gown with long cuffed sleeves plus impermeable apron

2. Heavy duty rubber work gloves that may be disinfected

3. Standard well fitted surgical masks should be used if N 95 respiratory masks are not available.

4. Goggles

5. Rubber or polyurethane boots or protective foot cover

B .Chemoprophylaxis:

For close contacts: Oseltamivir 75 mg daily for 7 days

Persons at risk: Oseltamivir 75 mg daily for the entire epidemic

C. Monitoring of close contacts and health care workers exposed: observe for fever of >38 Celsius, watery diarrhoea, pain abdomen, headache, cough, rhinorrhoea, sore throat, shortness of breath and CNS manifestations. Check for them daily till 14 days of last exposure

Annexure 1
Collection and transport of samples
Samples from upper respiratory tract include
Nsopharyngeal aspirate
Nasal wash
Throat swab
From lower respiratory tract samples include :
Transtracheal aspirate
Bronchoalveolar lavage
Lung biopsy
Post-mortem lung or tracheal tissue
Specimens for the laboratory diagnosis of avian influenza A should be collected in the following order of priority:
· nasopharyngeal aspirate/swab
· acute serum
· convalescent serum.
The sample collection should be done with all the necessary biosafety precautions including use of gowns, gloves and masks
The samples should be kept on ice and transported to virology laboratory as soon as possible

Annexure II

Antiviral drugs and their doses

Oseltamivir: is the only drug effective against H5N1 virus Doses are:

• Adults: 75 mg twice a day for adults,

• Children weighing < 15 Kg: 30 mg twice a day

15-23 Kgs: 45 mg twice a day
23-40 kgs: 60 mg twice a day

> 40 kg: 75 mg twice a day

Adverse effects of oseltamivir

Nausea and vomiting: transient and occur in the beginning and are self limiting

Abdominal pain, epistaxis, conjuctivitis

Should be used in pregnancy with caution

Contraindications: Hypersensitivity to drug

Algorithm for management of Avian flu patients

Suspect case of Avian flu

(Patents presenting with Fever (body temperature of 38o Celsius or high) with one of the following symptoms: Muscle ache, cough, abnormal breathing (unusual breathing difficulty) or suspected pneumonia by the physician, or influenza in addition to History of direct contact with infected / dead birds in past 7 days or Occurrence of unusual death of birds in the community within the past 14 days; or Contact with a pneumonia patient or another patient suspected of avian influenza)

Obtain NP aspirates and send to lab

Asses severity of illness
(Look for presence of following Respiratory distress as indicated by: increased respiratory rates, chest indrawing, dehydration, hypotension, altered sensorium or oxygen saturation of less than 93% in room air)

Any one of the above present None of the above present

Admit in designated area and treat as follows

Isolate cases

Monitor vital signs every 1-2 hours
Maintain air way breathing and circulation (ABC)
Maintain hydration, electrolyte balance, and nutrition
Provide oxygen and assisted ventilation when indicated
Manage fever with paracetamol
Give antiviral Oseltamivir (For doses see annexure 2)
Broad spectrum antibiotics for treatment of secondary pulmonary infection
Avoid giving nebulized medications: chances of spread

Keep the patient in designated out patient area, start oseltamivir and collect lab report reportresults

Transfer to general ward and manage according to

Send home with supportive care

Can I reach this goal?

Can I resist temptation?

But the pushing point is replace that with the thought and Ask

Why

Can’t I reach this goal?

Can’t I resist temptation?

Can’t I move towards my destiny?

That’s the Glucocortz way!!Let’s move and find a better place!!

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Thursday, 8 December 2011

Wednesday, 7 December 2011

When to suspect:

Patents presenting with Fever (body temperature of 38o Celsius or high) with one of the following symptoms:

Muscle ache, cough, abnormal breathing (unusual breathing difficulty) or suspected pneumonia by the physician, or influenza

in addition to

History of direct contact with infected / dead birds in past 7 days or

Occurrence of unusual death of birds in the community within the past 14 days; or

Contact with a pneumonia patient or another patient suspected of avian influenza

Case definition of probable case: symptoms of suspected case and

Preliminary test shows infection of influenza group A, but cannot yet be confirmed whether it is from human or birds or

Respiratory failure or

Death

Case definition of Confirmed cases: A suspected or probable case with at least one of the following:

• Positive viral culture for influenza A/H5

• Positive RT PCR for influenza A/H5

• Positive IFA for influenza A/H5

• A 4 fold rise in influenza A/H5 specific antibody titers.

Management guideline for all suspected cases of avian flu:

Obtain NP swabs from all the patients (see annexure 1)

Assess severity of illness: Look for presence of following:

Respiratory distress as indicated by: increased respiratory rates, chest indrawing, dehydration, hypotension, altered sensorium or oxygen saturation of less than 93% in room air. If any of these are present patient should be admitted to ward in designated area and manage on following principles

1. Isolate cases

Monitor vital signs every 1-2 hours

Maintain air way breathing and circulation (ABC)

Maintain hydration, electrolyte balance, and nutrition

Provide oxygen and assisted ventilation when indicated

Manage fever with paracetamol

Give antiviral Oseltamivir (For doses see annexure 2)

Broad spectrum antibiotics for treatment of secondary pulmonary infection

Avoid giving nebulized medications: chances of spread

Management of non severe cases

If patient is stable: (absence of above clinical features): take NP aspirate from all the patients and isolate them in the designated area identified for them and Start on Oseltamivir

Obtain lab results and see clinical course. If lab tests negative: discontinue Oseltamivir and provide supportive care, shift them to regular wards if hospitalization indicated otherwise send them home

If lab test is positive: Transfer to designated in patient area and continue supportive care and oseltamivir

Discharge policy

Adult patients: Infection control precautions for 7 days after resolution of fever

Children: Infection control measures for 21 days after onset of illness.

If discharged earlier: child should not attend school and parents should be educated to observe infection control measures at home.

Precautions for health care workers handling cases of avian flu

Wear personal protective equipments

A. Protective clothings:

1. Overall plus an impermeable apron or surgical gown with long cuffed sleeves plus impermeable apron

2. Heavy duty rubber work gloves that may be disinfected

3. Standard well fitted surgical masks should be used if N 95 respiratory masks are not available.

4. Goggles

5. Rubber or polyurethane boots or protective foot cover

B .Chemoprophylaxis:

For close contacts: Oseltamivir 75 mg daily for 7 days

Persons at risk: Oseltamivir 75 mg daily for the entire epidemic

C. Monitoring of close contacts and health care workers exposed: observe for fever of >38 Celsius, watery diarrhoea, pain abdomen, headache, cough, rhinorrhoea, sore throat, shortness of breath and CNS manifestations. Check for them daily till 14 days of last exposure

Annexure 1

Collection and transport of samples

Samples from upper respiratory tract include

Nsopharyngeal aspirate

Nasal wash

Throat swab

From lower respiratory tract samples include :

Transtracheal aspirate

Bronchoalveolar lavage

Lung biopsy

Post-mortem lung or tracheal tissue

Specimens for the laboratory diagnosis of avian influenza A should be collected in the following order of priority:

· nasopharyngeal aspirate/swab

· acute serum

· convalescent serum.

The sample collection should be done with all the necessary biosafety precautions including use of gowns, gloves and masks