Bird Flu, Swine Flu, Vaccines

[RedFox]

Was it FluMist they where referring too? _http://pediatrics.about.com/cs/immunizations/a/new_flu_vaccine.htm this appears to have been developed for the normal flu vaccine in 2007.

I did some searching on dealing with breathing in toxic substances, but there didn't appear to be much of anything on this.
However I do remember Laura mentioning something that could be breathed in to help in flu cases anyway
http://www.cassiopaea.org/forum/index.php?topic=12260.msg94277#msg94277

Also fwiw perhaps you should breath out during/after the spray (without drawing attention to yourself)......that would give a good chance of not allowing it too deeply into the lungs etc

Washing your nose/sinuses out with a neti pot (with something to calm the immune system in perhaps?) could also be used afterwards. _http://en.wikipedia.org/wiki/Neti_pot

I would be interested to know how quickly something can be absorbed by the nasal membrane. The only thing I've found so far is how quickly it can be absorbed and get to the brain....

_http://www.stop-smoking-updates.com/quitsmoking/nicotine-replacement-therapy/nicotine-substitute-products/nicotine-nasal-spray-mist-to-satisfy-cravings-quickly.htm

Of the several nicotine replacement therapies available, the nicotine nasal spray is the strongest and meant for heavy smokers who find it hard to quit smoking using other methods. Nicotine nasal sprays, as the name suggests, deliver a fast-acting nicotine spray into the nose which is absorbed into the bloodstream and transported to the brain in as little as 10 minutes. These sprays are the closest it can get to cigarettes.

Perhaps then you'd have less than 10 minutes to act to remove it (sneezing perhaps)? Alternatively work out a way to coat your nasal membrane/airways with something before hand?

*edit*
Having said all that....

_http://news.yahoo.com/s/ap/20090817/ap_on_he_me/us_swine_flu_schools

"Are you going to do it at a time when the parents can be present, if they want?" Greene said. "I've heard the kids are more panicky when their parents are around than when they're not."

Knox County, Tenn., has always used FluMist, the nasal spray flu vaccine, to eliminate that concern, and will again this year in school vaccinations against regular flu. But most of the swine flu vaccine supply will be in shot form, and program director Jennifer Johnson hasn't decided whether to offer that in schools, too. She said one possibility is to inoculate kids at elementary schools after-hours, so parents could hold scared youngsters and then be vaccinated themselves.

The nasal spray is popular. Last year, FluMist maker MedImmune said it sent about 450,000 doses of the nasal spray vaccine to 140 school vaccination programs. The company expects FluMist vaccinations against regular winter flu to nearly double in schools this year.

 

[go2]

Perhaps then you'd have less than 10 minutes to act to remove it (sneezing perhaps)? Alternatively work out a way to coat your nasal membrane/airways with something before hand?

I have used garlic infused olive oil for sinus infection for decades. I also use olive oil to coat the mucus membrane of the nasal passages before I take long flights, as the air dries my sinuses. I administer the olive oil infusion by laying back and putting a dropper full of the infusion in each nostril. Then I slowly rotate my head to allow the olive oil to coat the sinus cavity. This will burn for about a minute. I don't know if this would prevent the assimilation of a flu mist vaccine.

 

[Andrew]

Was it FluMist they where referring too? _http://pediatrics.about.com/cs/immunizations/a/new_flu_vaccine.htm this appears to have been developed for the normal flu vaccine in 2007.

I can't say for certain whether that was it or not. It was a quick blip of a commercial and I just remember it talking about vaccination being administered through the nose might be more effective then standardized injections. But it may have been the flu mist that was being referred to although it did specifically say for the swine-flu. But I'm not completely sure.

I did some searching on dealing with breathing in toxic substances, but there didn't appear to be much of anything on this.
However I do remember Laura mentioning something that could be breathed in to help in flu cases anyway
http://www.cassiopaea.org/forum/index.php?topic=12260.msg94277#msg94277

Also fwiw perhaps you should breath out during/after the spray (without drawing attention to yourself)......that would give a good chance of not allowing it too deeply into the lungs etc

Washing your nose/sinuses out with a neti pot (with something to calm the immune system in perhaps?) could also be used afterwards. _http://en.wikipedia.org/wiki/Neti_pot
-
-
_http://www.stop-smoking-updates.com/quitsmoking/nicotine-replacement-therapy/nicotine-substitute-products/nicotine-nasal-spray-mist-to-satisfy-cravings-
quickly.htm

Of the several nicotine replacement therapies available, the nicotine nasal spray is the strongest and meant for heavy smokers who find it hard to quit smoking using other methods. Nicotine nasal sprays, as the name suggests, deliver a fast-acting nicotine spray into the nose which is absorbed into the bloodstream and transported to the brain in as little as 10 minutes. These sprays are the closest it can get to cigarettes.

Perhaps then you'd have less than 10 minutes to act to remove it (sneezing perhaps)? Alternatively work out a way to coat your nasal membrane/airways with something before hand?

Thanks for the info. I'll have to look more into this.

I would be interested to know how quickly something can be absorbed by the nasal membrane. The only thing I've found so far is how quickly it can be absorbed and get to the brain....

Ya same here. Especially if their saying that it could be more effective this way. But we already know what they mean when they say "more effective".

 

[RedFox]

Perhaps then you'd have less than 10 minutes to act to remove it (sneezing perhaps)? Alternatively work out a way to coat your nasal membrane/airways with something before hand?

I have used garlic infused olive oil for sinus infection for decades. I also use olive oil to coat the mucus membrane of the nasal passages before I take long flights, as the air dries my sinuses. I administer the olive oil infusion by laying back and putting a dropper full of the infusion in each nostril. Then I slowly rotate my head to allow the olive oil to coat the sinus cavity. This will burn for about a minute. I don't know if this would prevent the assimilation of a flu mist vaccine.

Interesting....well I would assume anything that coats the mucus membrane and stays there would slow/halt the absorption of anything introduced after it. Perhaps it would even help with washing it out? My idea was some sort of solution containing activated charcoal (to absorb the 'vaccine') that could be flushed out afterwards.
But this is speculation. Given there are no signs so far they are going for sprays it may be worth leaving it for now.

I've started trying to find some stuff on possible nano-tech that may well be added to vaccines. So far I've come across an article from 2007 that may be of note.
Bold added
_http://www.in-pharmatechnologist.com/Materials-Formulation/New-vaccine-technology-holds-double-promise

New vaccine technology holds double promise
By Kirsty Barnes, 05-Mar-2007

Related topics: Materials & Formulation, Ingredients, excipients and raw materials

A new nanotechnology-based vaccine delivery method could allow the development of single-dose vaccines as well as new vaccines in disease areas of unmet need.

Research presented at last week's ASM Biodefense and Emerging Disease Research Meeting revealed that a biodegradable polymer in a microsphere formulation could be used to develop time-released vaccines, thus reducing the need for vaccine booster shots, as well as stimulate an immune response that traditional vaccines do not.

"Current vaccines are good at producing antibodies that block entry into the cell. In the case of some diseases, such as malaria or tuberculosis, antibody vaccines just aren't effective," said Jenny Wilson-Welder, a lead researcher on the study conducted at Iowa State University.

The polymer, called polyandydride, is already being used as a delivery system for a brain cancer drug designed to inhibit tumor growth but this is the first time its application in vaccines has been shown.

"It's like an everlasting gobstopper or a bar of soap. It wears away slowly over time, delivering its payload," says Wilson-Welder.

Initially intended to find a controlled-release drug delivery mechanism that would eliminate the need for booster vaccinations, the study found that polyanhydride microspheres not only achieved this, but also enhanced a type of immune response known as cellular-mediated immunity (CMI).

CMI allows the immune system to identify, target and kill cells that have already become infected, something antibodies can not do.

According to Wilson-Welder, these research findings could lead to the development of single-dose vaccines for diseases that currently require booster innoculations in order to be most effective, such as tetanus, whooping cough and chicken pox.

"The slow release mechanism of the polymers means that vaccines that currently require multiple doses might only need a single dose in the future," she said.

In addition, the finding that vaccine adjuvants can elicit a CMI provides hope for vaccines against intracellular diseases that there are currently no effective vaccines for, like malaria, tuberculosis and even AIDS, said Wilson-Welder.

"If we understand how an adjuvant activates the dendritic cells, we can start tailoring our vaccines to induce a better cellular response. If we can tailor the immune response, it holds greater promise for vaccines that we do not currently have."

A nano-path for 'extending' limited vaccine supplies
Bold added
_http://www.popsci.com/scitech/article/2009-07/nanopatch-administers-targeted-vaccine-dose

After yesterday's announcements by the World Health Organization, calling swine flu "unstoppable" and noting that there might not be enough vaccine produced by the time flu season rolls around, the debate began over what to do with the small amount of H1N1 vaccine that will be produced this year.

Well, if you're Australian scientist Mark Kendall, you answer that question by designing a vaccine system that provides the same protection as a regular shot, but only uses a fraction of the vaccine.

Kendall and his team at Australian Institute for Bioengineering and Nanotechnology in Brisbane are working on a small patch that would stretch what little vaccine will be ready by flu season across a much larger segment of the population.

The patch is smaller than a fingertip. One side is covered in small spikes coated in dried vaccine. Unlike the normal flu vaccine shot, which punches deep into tissue before the immune system eventually finds, identifies, and responds to the virus, the patch barely penetrates the skin at all.

That seems likely to work well: because the skin forms the body's first line of defense against the infectious outside world, a dense layer of immune cells resides just below the surface. Rather than bypassing those cells, as a regular shot does, the patch targets them directly. By injecting the vaccine into those immune cells, the patch can provoke the same immune response as a shot with significantly less vaccine.

The patch isn't ready quite yet, but the Australian National Health and Medical Research Council has fast-tracked the program, in the hope that Kendall and his team can win the race against the coming flu season.

nano-particles cross the blood brain barrier (not virus/vaccine related, but worth noting perhaps)
_http://www.nanotech-now.com/news.cgi?story_id=34128

Abstract:
Brain cancer is among the deadliest of cancers. It's also one of the hardest to treat. Imaging results are often imprecise because brain cancers are extremely invasive. Surgeons must saw through the skull and safely remove as much of the tumor as they can. Then doctors use radiation or chemotherapy to destroy cancerous cells in the surrounding tissue.
Nanoparticles cross blood-brain barrier to enable 'brain tumor painting'
Seattle, WA | Posted on August 4th, 2009

Researchers at the University of Washington have been able to illuminate brain tumors by injecting fluorescent nanoparticles into the bloodstream that safely cross the blood-brain barrier -- an almost impenetrable barrier that protects the brain from infection. The nanoparticles remained in mouse tumors for up to five days and did not show any evidence of damaging the blood-brain barrier, according to results published this week in the journal Cancer Research.

Results showed the nanoparticles improved the contrast in both MRI and optical imaging, which is used during surgery.

"Brain cancers are very invasive, different from the other cancers. They will invade the surrounding tissue and there is no clear boundary between the tumor tissue and the normal brain tissue," said lead author Miqin Zhang, a UW professor of materials science and engineering.

Being unable to distinguish a boundary complicates the surgery. Severe cognitive problems are a common side effect.

"If we can inject these nanoparticles with infrared dye, they will increase the contrast between the tumor tissue and the normal tissue," Zhang said. "So during the surgery, the surgeons can see the boundary more precisely.

"We call it 'brain tumor illumination or brain tumor painting,'" she said. "The tumor will light up."

Nano-imaging could also help with early cancer detection, Zhang said. Current imaging techniques have a maximum resolution of 1 millimeter (1/25 of an inch). Nanoparticles could improve the resolution by a factor of 10 or more, allowing detection of smaller tumors and earlier treatment.

Until now, no nanoparticle used for imaging has been able to cross the blood-brain barrier and specifically bind to brain-tumor cells. With current techniques doctors inject dyes into the body and use drugs to temporarily open the blood-brain barrier, risking infection of the brain.

The UW team surmounted this challenge by building a nanoparticle that remains small in wet conditions. The particle was about 33 nanometers in diameter when wet, about a third the size of similar particles used in other parts of the body.

Crossing the blood-brain barrier depends on the size of the particle, its lipid, or fat, content, and the electric charge on the particle. Zhang and colleagues built a particle that can pass through the barrier and reach tumors. To specifically target tumor cells they used chlorotoxin, a small peptide isolated from scorpion venom that many groups, including Zhang's, are exploring for its tumor-targeting abilities. On the nanoparticle's surface Zhang placed a small fluorescent molecule for optical imaging, and binding sites that could be used for attaching other molecules.

Future research will evaluate this nanoparticle's potential for treating tumors, Zhang said. She and colleagues already showed that chlorotoxin combined with nanoparticles dramatically slows tumors' spread. They will see whether that ability could extend to brain cancer, the most common solid tumor to affect children.

Merely improving imaging, however, would improve patient outcomes.

"Precise imaging of brain tumors is phenomenally important. We know that patient survival for brain tumors is directly related to the amount of tumor that you can resect," said co-author Richard Ellenbogen, professor and chair of neurological surgery at the UW School of Medicine. "This is the next generation of cancer imaging," he said. "The last generation was CT, this generation was MRI, and this is the next generation of advances."

Other co-authors are Omid Veiseh, Conroy Sun, Chen Fang, Narayan Bhattarai, Jonathan Gunn of the UW's department of materials science and engineering; Forrest Kievit and Kim Du of UW bioengineering; Donghoon Lee of UW radiology; Barbara Pullar of the Fred Hutchinson Cancer Research Center; and Jim Olson of the Fred Hutchinson Cancer Research Center and Seattle Children's Hospital.

The research was funded by the National Institutes of Health, the Jordyn Dukelow Memorial Fund and the Seattle Children's Hospital Brain Tumor Research Endowment.

Nanotech Particles Affect Brain Development In Mice
_http://www.sciencedaily.com/releases/2009/07/090728201737.htm

ScienceDaily (July 30, 2009) — Maternal exposure to nanoparticles of titanium dioxide (TiO2) affects the expression of genes related to the central nervous system in developing mice. Researchers found that mice whose mothers were injected with the nanoparticles while pregnant showed alteration in gene expression related to neurological dysfunction.
Ken Takeda led a team of researchers from the Tokyo University of Science, Japan, who carried out the tests. He said, "Nanotechnology and the production of novel man-made nanoparticles are increasing worldwide. Titanium dioxide in its nanoparticle form has a high level of photocatalytic activity, and can be used for air and water purification and self-cleaning surfaces. Our findings, however, add to the current concern that this specific nanomaterial may have the potential to affect human health".

For this study, the researchers injected pregnant mice with Ti02 nanoparticles. The brains were obtained from male fetuses/pups on the 16th day of gestation and at several points after birth. Comparing these brains to those of control animals, the researchers were able to demonstrate changes in expression of hundreds of genes. According to Takeda, "Diseases associated with these genes include those we normally consider to develop in childhood, such as autistic disorder, epilepsy and learning disorders, and also others that arise mainly in adulthood or old age, such as Alzheimer's disease, schizophrenia and Parkinson's disease."

Nanotechnology deals with engineering at the molecular scale. Materials reduced to nanoparticles behave in ways dissimilar to those we're used to - altering their reactivity, surface area to volume and any number of other properties. While larger TiO2 particles are commonly used in paints and sunblocks, nanoparticles of TiO2 are specially created for new applications in coatings and self-cleaning surfaces and their effects on living tissue are only beginning to be understood. It should be noted that this gene expression data cannot be interpreted as a direct health effect. In addition, the nanoparticles were deliberately injected at a high dose, so the relevance to real-life exposure may be limited.

tamiflu ingredients
_http://medguides.medicines.org.uk/document.aspx?name=Tamiflu&use=Swine%20flu&section=ingredients

Tamiflu contains:

* black iron oxide (E172)
* croscarmellose sodium
* FD and C blue 2 (indigo carmine, E132)
* gelatin
* oseltamivir phosphate
* povidone
* pregelatinised maize starch
* red iron oxide (E172)
* shellac
* sodium stearyl fumarate
* talc
* titanium dioxide (E171)
* yellow iron oxide (E172)

Slightly off topic (feel free to move elswhere), but related to this nanotech thread
EPA Nanomaterial Case Studies: Nanoscale Titanium Dioxide in Water Treatment and Topical Sunscreen
_http://www.azonano.com/news.asp?NewsID=13005

EPA is announcing a 45-day public comment period for the draft document, Nanomaterial Case Studies: Nanoscale Titanium Dioxide in Water Treatment and Topical Sunscreen (External Review Draft), as announced in the July 31, 2009 Federal Register Notice. The deadline for comments is September 14, 2009.

This draft document presents two case studies of nanoscale titanium dioxide (nano-TiO2) used (1) to remove arsenic from drinking water and (2) as an active ingredient in topical sunscreen. The draft case studies are organized around a comprehensive environmental assessment approach that combines a product life cycle framework with the risk assessment paradigm. The document does not draw conclusions about potential risks. Rather, the case studies are intended to help identify what needs to be known in order to conduct a comprehensive environmental assessment of the potential risks related to nano-TiO2. This draft document is part of a process that will inform the development of EPA’s research strategy to support nanomaterial risk assessments.

Engineered nanoscale materials (nanomaterials) have been described in part as having at least one dimension on the order of approximately 1 to 100 nanometers (nm) and unique or novel properties that arise from their small size. This draft document is a starting point to determine what is known and what needs to be known about selected nanomaterials as part of a process to identify and prioritize research to inform future assessments of the potential ecological and health implications of these materials. Two specific applications of nanoscale titanium dioxide (nano-TiO2) are considered: as an agent for removing arsenic from drinking water and as an active ingredient in topical sunscreen. These “case studies” do not represent completed or even preliminary assessments, nor are they intended to serve as a basis for risk management decisions in the near term on these specific uses of nano-TiO2. Instead, the intent is to use this document in developing the scientific and technical information needed for future assessment efforts.

The case studies are organized around the comprehensive environmental assessment (CEA) approach, which combines a product life-cycle framework with the risk assessment paradigm. Risk assessment relates exposure and effects information for a substance or stressor; CEA expands on this paradigm by including life-cycle stages and considering both direct and indirect ramifications of the substance or stressor. Each chapter includes a list of questions that reflect information gaps in that portion of the document. Some of these information gaps or research needs are specific to the respective uses of nano-TiO2 either as a water treatment agent or as an ingredient in topical sunscreen. Other research needs may apply more broadly to nano-TiO2 irrespective of its application, and still other needs may apply even more widely to nanomaterials in general.

Readers are encouraged to consider the questions listed throughout the document and offer specific comments on how individual questions, or research needs, might be better expressed. If additional questions should be included or if information is already available to address some of the questions posed here, readers are also encouraged to provide such comments as well. These and other comments should be submitted as explained below under Additional Information.

 

[JEEP]

9/4/09 Columbus Dispatch front page (_http://www.dispatch.com/live/content/local_news/stories/2009/09/04/FLUDEATH.ART_ART_09-04-09_A1_F9EVFQB.html?sid=101):

Swine flu kills new mom; baby is OK
Pregnant women urged to get vaccine after first H1N1 death in county
Friday, September 4, 2009 3:06 AM
By Misti Crane
THE COLUMBUS DISPATCH

A 20-year-old Columbus woman who became ill with swine flu while pregnant died yesterday after delivering a healthy baby a week ago.

Kelsey Young, a Westland High School graduate, worked at Port Columbus and had eagerly prepared for months for the baby's arrival, said her stepfather, Tom Quinn. Young knew she was having a daughter and named her Ava Renee.

"Kelsey was beautiful, and she really enjoyed life and she was excited about having this baby," Quinn said last night from the Far West Side home where Kelsey lived with her stepfather and mother, Catherine Quinn.

"She left behind a little godsend in Ava," Mr. Quinn said.

Ava was delivered by Caesarean section on Aug. 27 at 32 weeks gestation in hopes that both she and Young would survive, Quinn said. Young had been at Doctors Hospital for several days before that in intensive care and was suffering from pneumonia and a high fever.

Ava was born healthy and strong and is in Nationwide Children's Hospital so that she can be in isolation, said Quinn. She does not have the H1N1 virus, hospital spokeswoman Pam Barber said. Young rebounded somewhat after Ava's birth, but then her health began to deteriorate again, Quinn said. OhioHealth spokesman Mark Hopkins said doctors and nurses did everything they could to save the lives of both mother and baby.

"They are just saddened beyond explanation that they couldn't save (Young's) life," Hopkins said.

Young's death at Doctors Hospital is the first in Franklin County attributed to the H1N1 virus and the third death attributed to swine flu in Ohio.

It prompted health officials to urge pregnant women to seek out seasonal flu vaccine immediately and swine-flu vaccine as soon as it becomes available. They said these women need to take special care with hygiene, including frequent hand-washing.

Pregnant women have been particularly vulnerable to the new strain of flu, and federal health leaders already have said they will be among those at the front of the line when a vaccine is approved and distributed. Vaccines currently are being evaluated and are expected in mid- to late October.

Seasonal flu vaccine is not yet widely available in doctors' offices, but retail clinics have started providing it. Pregnant women should seek out the vaccine wherever they can get it, said Columbus Public Health spokesman Jose Rodriguez.

In midsummer, officials at the federal Centers for Disease Control and Prevention reported that 6 percent of swine-flu hospitalizations involved pregnant women. A CDC spokesman said updated numbers weren't available yesterday. At any given time, pregnant women make up about 1 percent of the population.

Dr. Mysheika LeMaile-Williams, the city's medical director, said pregnant women experiencing flu symptoms -- including fever, chills and sweats, cough, sore throat and headache -- should talk to their doctors. Prompt use of antiviral drugs can help prevent severe illness, said Health Commissioner Dr. Teresa Long.

Neither would say whether Young had any underlying health conditions other than her pregnancy that might have contributed to the severity of her illness.

Long said pregnant women might want to think about staying away from crowded areas that could put them at increased risk of exposure to the flu. Dr. Wayne Trout, who practices at Stoneridge Obstetrics and Gynecology in Dublin, said he hasn't gone so far as to recommend that pregnant women avoid crowded spaces. He has been focused primarily on recommending that they practice good hygiene, avoid sick people and get vaccinated when it becomes available.

"Most of these women that have died of H1N1 have been healthy, so there's no one who shouldn't get the vaccine," he said.

An online comment to the above article:

H1N1 is a cruel virus. It takes the healthy young adults by turning their own immune systems against them. It will be a winter of many funerals as this horrible disease spreads across the land. I spoke with a person who lived through the 1918 flu epidemic, and they had to stack the bodies outside the hospital during the winter until the ground thawed so they could bury them. Almost everyone lost a family member, and she told of empty houses where the entire family died.

Article adjacent to continuation of the above article (_http://dispatch.com/live/content/national_world/stories/2009/09/04/Swine_flu_LAT.ART_ART_09-04-09_A4_QQEVHBH.html?sid=101):

H1N1 deadlier in adolescents, CDC discovers
Unlike seasonal flu, most of child fatalities so far in 5-18 age group
Friday, September 4, 2009 2:56 AM
By Thomas H. Maugh II
LOS ANGELES TIMES

Adolescents are at a higher risk of dying of pandemic H1N1 influenza virus than younger children, a situation that is the opposite of that encountered with seasonal flu, health authorities said yesterday.

And those with underlying health problems, such as cerebral palsy, muscular dystrophy and neurodevelopmental disorders, are at the highest risk and should be among the first to be vaccinated against the virus, according to a report in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

The government's warning takes on added urgency as schools begin to reopen and increases in infections from the virus, commonly known as swine flu, become apparent. Swine-flu outbreaks are sporadic throughout the country, especially in the Southeast.

"The most likely explanation is that schools started earlier there," said Dr. Thomas R. Frieden, CDC director.

In a separate report, the American College Health Association said there were 1,640 swine flu cases during the week of Aug. 22-28 at the 165 universities reporting to it. There was only one hospitalization and no deaths.

From the time of the outbreak of the pandemic in April until Aug. 8, 36 U.S. children and adolescents died with swine-flu infections out of 477 deaths in the country linked to the virus. Seven deaths were of children younger than 5.

In a normal flu season, at least half of the deaths in children occur in those younger than 5. With swine flu, more than 80 percent of the child fatalities occurred in youths ages 5 to 18. In a typical flu season, 50 to 100 children die of it. The swine-flu deaths occurred after the normal flu outbreak was over.

Of the 36 children who died, 24 had high-risk medical conditions such as cerebral palsy or long-standing respiratory or cardiac conditions. Many of those who did not have such a medical condition had a bacterial infection, such as bacterial pneumonia, according to the CDC report.

Health authorities have gotten some good news from preliminary trials of vaccines in China and Britain. Swiss drugmaker Novartis said that preliminary results from its trial of one vaccine in Britain show that 80 percent immunity is achieved with only one dose of vaccine and that 90 percent is achieved with two.

The Novartis vaccine cannot be used in the United States, however, because it contains an adjuvant that boosts the immune response to the flu antigens. Flu vaccines containing adjuvants have not been licensed in the U.S.

And this from last Wednesday (_http://nl.newsbank.com/nl-search/we/Archives?p_action=doc&p_docid=12A7AA1974467240&p_docnum=1&s_dlid=DL0109090510284104789&s_ecproduct=SUB-FREE&s_ecprodtype=INSTANT&s_trackval=&s_siteloc=&s_referrer=&s_subterm=Subscription%20until%3A%2012%2F14%2F2015%2011%3A59%20PM&s_subexpires=12%2F14%2F2015%2011%3A59%20PM&s_username=colnp&s_accountid=AC0107113013072912054&s_upgradeable=no):

Quick emergence of swine flu puts colleges on alert

By Suzanne Hoholik
THE COLUMBUS DISPATCH

Published: Wednesday, September 2, 2009
Edition: Home Final
Section: News
Page: 01A

Universities and public-school districts spent the summer preparing for swine flu. For some colleges, however, the virus popped up sooner than expected.

Four Ohio schools -- Miami, Xavier, Cedarville and Cincinnati -- have cluster cases of the flu, according to state health officials.

"We knew we were going to see it, but to have it happen so quickly surprised us a little bit," said Debora del Valle, spokeswoman for Xavier.

The Cincinnati school has 110 suspected flu cases and canceled large events through Labor Day.

No cases have been reported by Ohio public-school districts.

Yesterday, President Barack Obama urged Americans to prepare for a potentially deadly outbreak of swine flu and to take steps to prevent infection. A vaccine is being developed and likely will be available by October. He said the government will "strongly recommend" that people get it. Ohio Department of Health officials have stopped testing individual cases to confirm swine flu unless the person meets specific criteria. So university officials assume that all suspected cases, most of which have been mild, are swine flu.

All are following guidelines from the federal Centers for Disease Control and Prevention.

Posters have been placed on campuses to remind students to wash their hands, cough into their arms and stay away from classes if they're sick. Some schools have placed hand sanitizer at dorm entrances and classroom buildings.

Some colleges have created isolation areas for ill students who can't go home.

The lower level of the alumni center at Xavier is being used as a recovery area for as many as 45 infected students. There are cots, locker rooms with showers and Internet access. Food is delivered.

Cedarville University in Greene County has about 60 flu cases. Students are told they can go home, stay in their dorm rooms or use empty apartments as isolation areas, said spokesman John Davis.

Ohio University in Athens, which starts classes next week, has designated 25 medical rooms in dorms for as many as 50 students, said David Hopka, assistant vice president of safety and risk management.

If those fill up, officials plan to use one floor of a dorm -- about 34 rooms -- to house additional sick students.

At Miami in Oxford, 69 flu cases have been reported, said Claire Wagner, university spokeswoman. Ill students are told to stay in their rooms and wear masks when their roommates deliver meals.

There are two flu cases at Cincinnati, which starts Sept. 23. Students are being told to stay home if they have flu symptoms.

"If you're showing symptoms, you don't belong here. That's how it spreads," said Greg Hand, university spokesman.

Instructors at the universities have been told to adjust their absence policies. In some cases, the names of sick students are passed on to instructors.

Parents sending their children to college should talk with them about good hygiene and make sure they recognize flu symptoms, said Debbie Coleman, Columbus' assistant health commissioner.

She suggests packing hand sanitizer, a thermometer, cough syrup and fever reducer in the student's belongings.

Columbus City Schools students took home letters yesterday reminding parents how to stop the spread of flu and to have a plan if their child is sick and needs to stay home.

"Our goal is to keep the healthy kids in school and the sick at home," Coleman said.

Information from the Associated Press was included in this story.

Very disturbing! I was especially surprised by the college student illness - I would have thought after a summer in the sun that they would have enough vitamin D to ward off this flu. Also, pregnant women usually are on prenatal vitamins in addition to eating healthfully (in the conventional sense). How is this being perpetrated? Already established toxic build up? Underlying health conditions of those fallen ill?

However it's coming about, you can see the disaster unfolding - women and children first!!!

 

[Third_Density_Resident]

Very disturbing! I was especially surprised by the college student illness - I would have thought after a summer in the sun that they would have enough vitamin D to ward off this flu.

More than Vitamin D is needed to ward off flu, don't forget. And that's why it's so important, RIGHT NOW, for everyone to DETOX!!!

Also, pregnant women usually are on prenatal vitamins in addition to eating healthfully (in the conventional sense). How is this being perpetrated? Already established toxic build up? Underlying health conditions of those fallen ill?

"Eating healthfully (in the conventional sense)" -- well right there you have a problem. The "conventional sense" with respect to diet, like so many other conventional practices that we've lived by over the years and decades, is precisely why there's a global epidemic of disease and malnutrition. The already established toxic build-up that you mentioned is definitely a part of why apparently healthy people are getting sick and dying of this Swine Flu. But also there are very likely to be underlying health issues that are deliberately kept hidden to instil more fear into the public about this flu, thereby causing more people to line up and get the vaccine.

 

[Avi]

Hi E,

Well I have taken even longer to reply! :( Sorry.

I am not on my laptop currently, where I have a few files relating to the Georgia Guidestones, so cannot post just yet all that I wanted to on this.

But in a nutshell I wanted to add the following:

First, to your point about all the other points being dependent upon the "Maintain humanity under 500 million"

Yes, it would appear that without that first point the others have no context. Or as you say the sequence of inscription carries importance.

At this point I do not know and hence have been researching and collecting information, visited them a handful of times, etc.

I will say that though it is a bit premature just yet, the evidence does not look too good! In other words based upon finding out more about WHO has been involved in the project I am left with a creepy feeling. Yet...

What if they ARE meant to help humanity? What would that look like?

Well it COULD mean that there was a group of people who had foresight into impending disaster and wanted to erect these stones as a monument to the people left after the "cataclysm". Who might such people be? Well they could be "spiritual" types, and one of the most interesting bits discovered is that a prominent TS member was involved in translation.

However, what I find really interesting (and this is what I do not have on this computer so will post again later) are the references one finds when searching online for "500 million" - for they range from "spiritual writings" to "sustainable development" groups - but in each case actually reference this exact number. Where did it come from?

One other side note, there is inscribed at the site that a "time capsule" exists in the vicinity and I have heard of/read elsewhere time capsules being placed on each of the 7 continents, one per continent, though I cannot with any authority confirm (a) that there IS a time capsule present or (b) that the stories concerning time capsules are true. Even IF it is true the story goes that the time-capsules have been sealed with "advanced technology" and cannot be opened by ordinary means.

I heard this before becoming interested in alien and UFO material so I do not know if the slant would be "alien" technology or perhaps something else altogether, AGAIN, considering IF this is true.

One thing we know though is that Carter came to office in 1976/1977 and these were commissioned in 1977/1978 AND that Carter Administration was apparently involved in the "depopulation" policies written.

In the end though it is the "monument of authority" which leads me to currently believe that the origins are of a definite STS nature, though that in itself does not necessarily prove anything, but more to the point that they were probably designed as part of the "program" with the intent to REDUCE (not MAINTAIN) humanity to 500 million.

I guess it is the wishful thinking or naivete on my part that wants to attribute traits of "goodwill"



There truly are some strange anomalies however, most critically are the apparent typo's. Either some clue that may lead to discovery of something, or perhaps just "clues" of the wild goose chase sort?

All in all, certainly an enigma.

Sincerely,

Avi

Hi LEOURSA,

sorry, I only noticed your post now. Completely missed it.

[quote author=LEOURSA]
The messages themselves are pretty sane, for instance, "avoid petty laws and useless officials" - sounds good!

The reference to 500 million in this article on the sott page made me think of the Georgia Guidestones again.

Have you ever considered the possibility that the sequence of the inscriptions maybe carries some importance. Even though the rest of the inscriptions are quite "sane", that the people behind the guidestones only considered it possible once the population doesn't exceed 500 million. So basically, from a sequential point of view, they meant the 2nd, 3rd, 4th etc. inscriptions can be achieved once the 1st inscription is achieved.

Just a thought. Sorry for my late response.


[/quote]

 

[Erna]

Very interesting.

a prominent TS member was involved in translation.

What does 'TS' stand for?

there is inscribed at the site that a "time capsule" exists in the vicinity

I didn't know this bit. Have you been to the guidestones? Because very often, these websites add stuff to make it more sensational.

 

[Avi]

Hi E,

sorry for assuming all would know TS. It stands for Theosophical Society.

Francis Merchant, who was involved in writing The Labours of Hercules: An Astrological Interpretation
(I find this book to be very good) with Bailey and "The Tibetan" was involved in the linguistic requirements for the Guidestones.

Based on the information collected I had plans for a documentary,.

Examining the 12 languages, 4 directions, constellations overhead even maps of Ancient Athens, interviewing people involved that are still alive today, etc, but for various reasons these plans have been delayed.

So, yes, I have visited the Georgia Guidestones.

In my opinion there is not a single website out there that does a good job of looking into this mystery. Take for example that NONE of them to-date even so far as MENTION that there are typos inscribed in the granite? Why and how could that be?

The intent behind the inscriptions may indeed prove to be nefarious but I would rather that decision/perception come about based upon insight, not prejudice, which is what most of the websites concerning the Guidestones seem to suggest.

With kind regards,

Avi


PS - for those interested here are some photos i took on one of my visits:

_http://www.flickr.com/photos/leoursa/sets/72157614824426003/

Very interesting.

a prominent TS member was involved in translation.

What does 'TS' stand for?

there is inscribed at the site that a "time capsule" exists in the vicinity

I didn't know this bit. Have you been to the guidestones? Because very often, these websites add stuff to make it more sensational.

 

[Cyre2067]

I got an email this morning from a friend who's a conservative republican/fundie xtian, he's a nice person all around so we maintain email contact and share perspectives on different bits here and there. He sent me this bit which I found pretty scary:

H1N1 Roadblocks Planned


_http://www.thetruthseeker.co.uk/article.asp?ID=11334
H1N1 Roadblocks Planned
Received September 1, 2009

After reading former Kansas State Trooper Greg Evenson's article The Death of Liberty- The Final Scene Unfolds I called him to discuss what he is saying. He's telling us that he's been contacted by active duty State trooper friends from several states who are all telling him of plans to erect roadblocks at key places along interstate highways to force all cars to go single file up to barricades where you will be given a "choice": be vaccinated on the spot and fitted with a stainless steel wrist bracelet containing an RFID chip with your medical history showing you've received the vaccine, or be put on a bus and taken to a FEMA Quarantine Camp.

If you don't receive the vaccine and RFID bracelet, you will be blocked from entering your place of business, supermarkets, you'll be blocked from flying, police are being set up to be the new SS, and many aren't liking it at all. All should rebel against this.

GET THIS MESSAGE TO YOUR COUNTY SHERIFF, ALL LOCAL POLICE, EVERONE IN THE MILITARY THAT YOU KNOW- OUR REPUBLIC IS UNDER ATTACK BY THIS TROJAN HORSE- THIS BIOWEAPON CALLED THE "SWINE FLU VACCINE" NO ONE SHOULD TAKE IT

Sheriff's should realize they have the legal right to block vaccine clinics from being set up inside their counties. They have the right to do whatever they think is necessary to uphold the Constitution inside their counties, but most don't realize they have this right. They should read Sheriff Mack's book The County Sheriff- America's Last Hope _www.sheriffmack.com

Sheriffs, police, and military should all be directed to this information as well as everything else in this alert. They must be encouraged to join the Oathkeepers. Please show your sheriff this You Tube which explains the mission of the Oathkeepers which is to encourage military, sheriffs and police to not obey any illegal orders including orders to set up roadblocks to force this vaccine on us, orders to force us into FEMA camps, orders to engage in warrantless searches of our homes, orders to surround our towns and cities turning them into concentration camps.

PLEASE JOIN ME AS A MEMBER OF THE OATHKEEPERS AND URGE YOUR LOCAL SHERIFF, POLICE, MILITARY PEOPLE TO JOIN BEFORE ITS TOO LATE- OUR REPUBLIC IS DANGLING BY A THREAD:

Costs nothing to join, join for free via your state chapter. You don't have to use your real name or photo to join. You can remain anonymous and still network via this group and its essential that you do and get others to quickly because we're running out of time to turn this around. The intention of the world's ruling elite is to use this weaponized vaccine and weaponized flu to kill millions of us and they've got the coffins stockpiled for our corpses. If you don't want to end up in one of these coffins, you need to roll up your sleeves and proactively make an effort to alert everyone around you to this threat.

I can't do it by myself. Since I've been telling you all about Oathkeepers, a small number of you have joined me as members and are helping me network within the organization. I need a lot more of you to follow suit. It costs nothing, but its very important. Some of you seem to think I am joking when I tell you all of this, or that I am exaggerating. Some of you have your heads planted deeply in the sand. I need you to come out of denial and take proactive steps to defend your life and the lives of your family, friends, and neighbors. This is not a drill. In my last alert I documented that the Army National Guard has placed ads for guards to man the FEMA camps.

Please urge more people to join IAHF. It costs nothing, and there is safety in numbers. People can join via _www.iahf.com In past alerts I've provided information on how to protect yourself from the weaponized flu and vaccine. See that in my archives.

Not exactly sure how I feel about it. I mean, are the pathocrats capable of doing it? Sure. Would they get away with it? Probably not. Not unless the Swine Flu actually had serious breakouts and started killing people who didn't receive the vaccine. If any of the deaths were from individuals who had received the vaccine it would totally invalidate their argument. Or if they tried to instigate these quite serious methods as is, there's just not justification for it.

Another oddity is that the source seems to be thetruthseeker.co.uk, and its tagged with an attempt to get the reader to join this Oathkeeper's group. While its a good idea in principle I got this weird vibe that it could be used to track uncooperative individuals in police and military establishments. A way to take them out early. Maybe I'm just being a bit too paranoid, but GLP is also carrying the story, which again makes me curious and confuzzled.

Oh and the original linked website is down, another oddity.

 

[anart]

duty State trooper friends from several states who are all telling him of plans to erect roadblocks at key places along interstate highways to force all cars to go single file up to barricades where you will be given a "choice": be vaccinated on the spot and fitted with a stainless steel wrist bracelet containing an RFID chip with your medical history showing you've received the vaccine, or be put on a bus and taken to a FEMA Quarantine Camp.

So, how exactly are they going to fit you with a stainless steel bracelet 'on the spot' with your entire medical history on it when you've just been pulled over randomly on the interstate? This sounds like pure fear mongering and like it fits perfectly on GLP, Rense, Jones, et al - so not really sure why you're confused about it. (and what's with the stainless steel detail, is that supposed to mean something?)

Is it possible? Anything is possible. Is it likely? How expensive would this be to implement? The vast majority of the US does not have computerized medical records (yet) to have instantly put on a rfid chip 'on the spot' at a roadblock... I mean - it's like a sci fi movie at this point. In the future, who knows, but this is fear mongering, pure and simple - at least that's how it seems to me - and I could always be wrong.

Not surprising that it came from a conservative/republican/fundie - they just love this fear monger stuff - it gets the base all riled up and easy to herd.

 

[mamadrama]

Fwiw, I recently wrote to the dean of my son's college about my swine flu vaccine concerns. He forwarded my letter to his health staff and this is their reply. If you have any ideas or suggestions for my response, please feel free to post them. In any case, I'll post my reply soon. Thanks!

I would also like to take this opportunity to share some concerns about the swine flu vaccine and prevention suggestions in the hopes that it will inform you further. If after reading this you yourself have some concerns, I hope that you will make information such as this available to those who are considering taking this experimental vaccine. Hopefully, you'll agree that everyone should have all the data available in order to make an informed choice in this matter.

It's crucial to understand that these vaccines are experimental, untested, toxic and extremely dangerous to the human immune system. They contain squalene-based adjuvants that cause a host of annoying to life-threatening autoimmune diseases. In the rush to market this vaccine, it has not been properly tested and the current reaction by government and public health officials has disturbing similarities to the 1976 swine flu vaccine catastrophe which also resulted in a massive swine flu vaccine campaign and resulted in claims totaling $1.3 billion filed by victims who suffered paralysis and Guillain-Barre Syndrome (GBS) from the experimental vaccine. The flu killed one person and the vaccine killed 25. Meanwhile, the deadly swine flu pandemic itself NEVER materialized!

And now it seems we are on the verge of repeating the same catastrophic mistake again. In a letter to British neurologists from the Health Protection Agency, the official body that oversees public health in the UK, they warn that the swine flu vaccine has been linked to the deadly nerve disease, Guillain-Barre Syndrome, which could be triggered by the vaccine. GBS attacks the lining of the nerves, causing paralysis and inability to breathe, and can be fatal.

Additionally, there is research published in the August 25 issue of the British Medical Journal reveals that more than half of doctors and nurses in public hospitals would refuse the H1N1 vaccine, due to concerns about side effects and doubts about its efficacy.

Also, the swine flu vaccine has aroused new cancer fears after a German health expert gave a shocking warning about its safety. Lung specialist Wolfgang Wodarg has said that there are many risks associated with the vaccine for the H1N1 virus. The nutrient solution for the vaccine consists of cancerous cells from animals, and some fear that the risk of cancer could be increased by injecting the cells.

So it is becoming increasingly clear that while the vaccine may be great for the pharmaceutical industry with immunity against lawsuits , it can cause worse side effects than the actual swine flu virus in its recipients.

Along those same lines, British researchers recently warned that the antiviral medication Tamiflu is "inappropriate for healthy adults" with flu like symptoms. "Recommending the use of antiviral drugs for the treatment of people presenting with [flu] symptoms is unlikely to be the most appropriate course of action," they concluded. The study, published in the Lancet Infectious Diseases, recommends that healthy people who get the swine flu should NOT be treated with antivirals like Tamiflu or Relenza, unless they suffer complications from the flu. Based on their findings, either drug will reduce your illness by about HALF A DAY and comes with possibly serious side effects.

So it is important that we are armed with the facts we need in order to make informed choices in regard to the flu vaccine. But whatever course is decided by the individual, to take the vaccine or to decline it, information is needed to lessen the chances of contracting the flu and/or minimizing its effects should one become infected. No doubt your health staff has is on top of this and have recommended many of the following suggestions but I'm including a few more for consideration.

Optimize Vitamin D levels. People with flu like symptoms that have not been on vitamin D you can take doses of 50,000 units a day for three days to treat the acute infection. Some researchers like Dr. Cannell, believe the dose could even be as high as 1,000 units per pound of body weight for three days.

However, most of Dr. Cannell's work was with seasonal and not pandemic flu. If your body has never been exposed to the antigens there is chance that the vitamin D might not work. Your best bet is to maintain healthy levels of vitamin D around 60 ng/ml.

Avoid Sugar and Processed Foods. Sugar decreases the function of your immune system almost immediately, and as you likely know, a strong immune system is key to fighting off viruses and other illness. Remember that sugar is present in foods you may not suspect, like ketchup and fruit juice.

Get Enough Rest. Just like it becomes harder for you to get your daily tasks done if you're tired, if your body is overly fatigued it will be harder for it to fight the flu.

Have Effective Tools to Address Stress. We all face some stress every day, but if stress becomes overwhelming then your body will be less able to fight off the flu and other illness.

Exercise. When you exercise, you increase your circulation and your blood flow throughout your body. The components of your immune system are also better circulated, which means your immune system has a better chance of finding an illness before it spreads.

Take a good source of animal-based omega-3's. Increase your intake of healthy and essential fats like the omega-3 found in krill oil, which is crucial for maintaining health. It is also vitally important to avoid damaged omega-6 oils like trans fats as it will seriously damage your immune response.

Wash Your Hands. Washing your hands will decrease your likelihood of spreading a virus to your nose, mouth or to other people. Be sure you don't use antibacterial soap for this -- antibacterial soaps are completely unnecessary, and they cause far more harm than good. Instead, identify a simple chemical-free soap that you can switch your family to.

Use All Natural Antibiotics. Garlic works like a broad-spectrum antibiotic against bacteria, virus, and protozoa in your body. And unlike with antibiotics, no resistance can be built up so it is an absolutely safe product to use. However, if you are allergic or don't enjoy garlic it would be best to avoid as it will likely cause more harm than good.

Other all-natural antibiotics include olive leaf extract, oil of oregano, and high quality colloidal silver.

Avoid Hospitals and Vaccines In this particular case, I'd also recommend you stay away from hospitals unless you have an emergency, as hospitals are prime breeding grounds for infections of all kinds, and could be one of the likeliest places you could be exposed to this new bug.


Thank you for taking the time to read about my concerns. I hope it has been informative. Please feel free to contact me if you would like any further information.



With Kind Regards,

The Health Director's reply:

First let me begin by stating that we follow the guidelines/recommendations issued by the Centers for Disease Control & Prevention and the County Dept. of Health and the State Department of Health re: H1N1 and all areas re: diagnosis/treatment and vaccine. In addition we adhere to the standards of care as mandated for evidence-based practice in a medical and legal sense.



Let me begin by addressing some of the comments made:



1. Yes Tamiflu or other anti-viral medication is NOT recommended for otherwise healthy adults-we do have a few doses available for use by those who fit the criteria (see cdc.gov/h1n1flu)



2. Many of her recommendations are very appropriate, i.e. attention to hand washing/rest. I personally am not aware of the efficacy of "natural antibiotics" and would not use them in a situation of documented BACTERIAL infection-I would use the tried and tested pharmaceutical antibiotic



3. Yes it is recommended to avoid hospitals as the H1N1 is expected to be for the most part self-limiting as most influenzas but vigilance is need as the latest statistics from the CDC show nearly 8000 hospitalizations and 522 deaths in the US confirmed-in the event of serious illness a student will be sent to the Medical Center for care-our primary concern is always the safety of the student and everyone in the community



4. Regarding the safety of the forthcoming H1N1 vaccine I would quote Anthony Fauci, M.D. director of the National Institute of Allergy and Infectious Diseases, National Institutes of Health (August 21, 2009) "there have been no flags of safety concerns" based on early reports of clinical trials. Source: Jay Butler, director, H1N1Task Force, CDC



5. The initial H1N1 Vaccine does NOT contain thimersol and the initial vaccine supply does NOT contain adjuvants (substance added to increase immunologic response to an antigen-H1N1 virus but versions with adjuvants are being tested in case they are needed(source Journal of Infectious Disease 2009:200;321 and cdc.gov/flu/professionals/acip/index.htm (8-26-09)

a. The Swine flu vaccine from 30 years ago was linked to a small increased risk of Guillain-Barre Syndrome but increased risk is much less likely with the new vaccine as it is manufactured like the seasonal flu vaccine and in a different version than the old one

b. As with any vaccine the risk of any adverse reaction is possible which is why the CDC mandates that before any vaccine is administered the patient is mandated to read the Vaccine Immunization Statement (VIS) which addresses these issues

c. The latest report is that 1 dose (rather than 2) is expected to provide an effective antibody response

d. The County Dept.of Health has advised us that as soon as vaccine becomes available thought to be mid-October or sooner they will provide vaccine and personnel to administer to all students who desire it and those faculty & staff members who meet the criteria for administration. It is hoped that the 2nd round will provide enough doses for the entire college community



Lastly I would say that the basis of practice is always to provide accurate/scientific evidence so that a patient may make an informed decision re: any aspect of medical care. This of course would include the decision to receive or not receive a vaccine.



Dr. Krimins will be addressing the scope of H1N1 diagnosis/treatment etc. soon in an open forum for students community-date and time to be announced. Also the Health Center is part of the physicians link through the State Department of Health which provides up to the minute updates on practice guidelines and recommendations re: H1N1



In the meantime, we encourage any questions or concerns and will make every effort to provide accurate/scientific information. The CDC website is a very good source _www.cdc.gov/h1n1flu

 

[Vulcan59]

Hi Black Swan,

This health director has no choice but to quote official sources or else his/her job could be on the line. Since in his/her reply there seems to be a choice as to whether one should or should not receive the vaccine, it would be easier to just avoid getting the vaccine than to try and convince this person of alternative views on vaccination, OSIT.

In my case, my youngest came home with a vaccination form and I just signed and returned it stating that I will be visiting the family doctor to receive the vaccine. Needless to say I have not done it. Not sure how long before it becomes mandatory here but I'll be avoiding it as long as it's possible.

 

[pete02]

I see here in the states they're pushing flu shots all over. A sign on Walmart's front door now reads "get your flu shots here" :(
I too wonder how much longer it'll be before becoming mandatory.

EDIT: Had another thought and didn't want to add more posts just in case. Its only a thought and maybe just noise but anyway I was just thinking if people get inoculated with H1N1 vaccine and they release H5N1 when cold season hits, those people's immune system won't stand a chance and most will end up dead no?

 

[mamadrama]

Thanks for your feedback Vulcan59. I think you are right, there is very little point in my trying to educate the health director any further on the matter. However, hopefully I opened their eyes a little bit with my initial letter.

Regards.