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Milk dairy products contain the most saturated fat and thus should be limited in the diet. 2. With few exceptions, limit total fat intake to less than 35% of calories. For those whose fat intakes have exceeded the recommended amount, fat calories should be replaced with ones from complex carbohydrates, with an emphasis on whole grains, vegetables, fruits, and legumes beans and peas ; . As much as possible, avoid calories from products that contain a lot of refined carbohydrates, such as sugar and white flour. 3. Get half your total fat intake from monounsaturated fats. These fats are particularly plentiful in olive oil, canola oil, almonds, walnuts, and avocados. Because these sources are also concentrated sources of total fat calories, they must be eaten in moderation to maintain a diet containing no more than 35% of calories from fat and to avoid weight gain. 4. Get less than 300 mg of dietary cholesterol per day, and less than 200 mg if you have elevated levels of LDL cholesterol. Although saturated fat raises blood cholesterol levels more than dietary cholesterol, experts still recommend limiting dietary cholesterol. 5. Eat fatty fish at least twice a week. The omega-3 fatty acids in fatty fish appear to have some protective effects, and fish are a good source of protein and are low in saturated fat. Salmon, sardines, and albacore tuna are all good choices. 6. Limit trans fats as much as possible. Check food labels. The Food and Drug Administration FDA ; now requires manufacturers to list the amount of trans fats on food labels; the amount is listed below the amount of saturated fat, for example, maxide.
This Bulletin is intended to offer advice and guidance to both users and manufacturers of devices and reprocessing equipment. It draws together existing advice, with particular reference to disinfectant contact times. Personnel with responsibility for decontamination and infection control may base their processing procedures on this information. The Bulletin reviews the use of established disinfectants and processing equipment and provides information on some of the new or emerging technologies available for the decontamination of endoscopes. It provides information on all stages of the reprocessing of endoscopes from the initial cleaning to storage following reprocessing. The Bulletin also looks at the health and safety aspects of reprocessing endoscopes and highlights some of the problems that may occur.
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Starting January 1, 2006. People in the QMB, SLMB, and QI-1 programs will automatically be enrolled in the VIVA MEDICARE Plus Part D plan starting June 1, 2006. People in any of these Medicaid programs will automatically qualify for government assistance. No application will be necessary. The VIVA MEDICARE Plus Part D Benefit Medicare Advantage plans like VIVA MEDICARE Plus must offer a Part D benefit that is at least as good overall as the standard Medicare Part D benefit described above. The Medicare Advantage plan can cover more for some types of drugs for example, generics ; and less for other types of drugs for example, high-cost brand name drugs ; but the overall expected value of the benefit has to be the same or more than the standard Medicare Part D benefit. VIVA MEDICARE Plus will file its proposed Part D benefit with the government on June 6, 2005 and we expect final approval by September 15, 2005. Once the benefit is approved, we will provide information to all our members telling them about the VIVA MEDICARE Plus Part D benefit including what will be covered, what part they will have to pay out-of-pocket and what the monthly premium will be. The choice will then be theirs.
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PROCEDURE: You are to have an examination of your lower gastrointestinal tract colon ; . After intravenous sedation to make the examination more comfortable, a flexible tube colonoscope ; will be inserted into your rectum and passed up through your colon. Your colon will be examined in detail. Additional procedures may be performed, including taking samples of tissue biopsies ; , removing polyps, and injecting or cauterizing bleeding sites. In certain situations, such as if you have an artificial heart valve, antibiotics may be given. RISKS: Colonoscopy is a very safe procedure when done by a specially trained physician. However, there are some risks associated with the procedure and with the sedation used. The risks associated with the procedure range from minor problems to significant medical problems. Minor problems may include bloating, abdominal cramps, or reaction to the medications used for sedation, such as inflammation of the vein at the IV site, temporary slowing of the heart rate or breathing, or fall in blood pressure. Occasionally, pain relief is incomplete. Significant complications occur rarely. Perforation is a potentially serious problem resulting from a tear in the wall of the colon. If this occurs, it is generally treated with hospitalization and antibiotics or surgery. If a polyp is removed, the risk of perforation increases, and bleeding may also occur. With bleeding, blood transfusions as well as other treatments may be needed to stop the bleeding. Rarely, significant bleeding can occur after a biopsy. Other very rare complications can occur, including death. The colonoscope will usually be passed through the entire colon to the point where it meets the small intestine. However, at times, only a more limited examination will be done depending on clinical circumstances. Although colonoscopy is a very sensitive and accurate examination, it is possible that an abnormality that is present will not be detected. ALTERNATIVES: Alternatives to colonoscopy include x-ray studies and surgery. Colonoscopy may provide information that cannot be obtained by x-ray and offers the possibility of immediate treatment such as removal of polyps. Surgery to remove polyps carries a considerably higher risk.
Discussion Although data from the ER- negative male 1 ; , the aromatase deficient males 24 ; and crosssectional observational studies 610 ; demonstrate that E plays a role in the acquisition and maintenance of BMD, whether E also effects bone loss in men is P value is for comparison across groups by ANOVA. OC, osteocalcin; 25- OH ; D, 25-hydroxyvitamin D. unclear. However, our study clearly establishes that E regulates these men P 0.002 and 0.013 for E and T, respective- both bone formation and resorption in normal elderly ly ; . As with the resorption markers, E and T appeared to men in a direction that would oppose bone loss. By have additive effects on serum osteocalcin levels Figure directly manipulating T and E levels and assessing the 3, top panel ; , but again, the interaction term in the changes in bone turnover markers, these data thus proANOVA model was not significant P 0.963 ; . vide unequivocal proof of the key role that E plays in Similar to the findings with osteocalcin, serum PINP skeletal metabolism in men. levels fell significantly 22% ; in Group A T, E ; , and While we found that E was the dominant sex steroid did not change in Group D + T, + Figure 3, bottom regulating bone resorption in elderly men, T may make panel ; . Also similar to osteocalcin, PINP levels did not change in Group B T, + E ; , but in contrast to the osteocalcin data, serum PINP levels did decrease significantly 16% ; in Group C + T, E ; Using the ANOVA model, we found a significant E effect P 0.0001 ; , but no T effect P 0.452 ; on PINP levels. Serum BSAP did not change significantly over the three-week time period in the group made hypogonadal Group A ; , or in Groups B T, + E ; and D + T, + changes of 0.2 2.9%, 4.9 and 1.9 1.7%, respectively [mean SEM] ; , although there was a slight decrease in Group C + T, E ; 6.5 2.2%, P 0.02 versus base line ; . Table 4 shows the changes in serum calcium, phosphorus, and PTH levels over the three-week study period in the various groups. There was a small, but statistically significant, increase in serum calcium levels in Groups A T, E ; and C + T, E ; , likely reflecting increased calcium flux from the skeleton as a result of the increase in bone resorption in these groups, whereas serum calcium levels did not change in the E-treated groups Groups B and D ; . By the ANOVA model, there was a significant E effect, but no T effect, on changes in serum calcium levels. Serum albumincorrected calcium showed identical changes data not shown ; . The increase in serum calcium levels, in turn, led to a signifFigure 3 icant decrease in serum PTH levels in the subjects in Changes in serum osteocalcin top panel ; and PINP bottom panel ; Group A T, E ; , and a trend for a decrease in the sub- levels in the four groups between the base-line and final visits. AP jects in Group C + T, E ; The decrease in serum PTH 0.005 and BP 0.001 for change from base line. The overall effect of levels was accompanied by an increase in serum phos- E and T on the bone markers was analyzed using the two-factor phorus levels in Group A T, E ; and, to a lesser extent, ANOVA model described in Methods and eulexin.
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EFFICACY AND SAFETY OF EMPIRIC CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY IN SUBJECTS WITH OBSTRUCTIVE SLEEP APNEA Robert P. Skomro, MD, FRCP, FCCP * ; Leane King, BSc; Joseph Mink, BSc, RPSGT. University of Saskatchewan, Saskatoon, SK, Canada PURPOSE: Obstructive Sleep Apnea OSA ; is typically diagnosed on Polysomnography PSG ; , however the access to PSG is limited. This prompts physicians to utilize other diagnostic methods and may lead to the prescription of Continuous Postive Airway Pressure CPAP ; therapy without PSG. The purpose of this study was to review: 1. efficacy and safety of empiric CPAP; 2. physicians' diagnostic accuracy in cases of suspected OSA; 3. accuracy of empiric CPAP pressure as compared to the CPAP pressure established after a split-night PSG. METHODS: Retrospective chart review of patients who were prescribed empiric CPAP . Subjects' characteristics age, sex, BMI ; , Epworth Sleepiness Score before and after CPAP were obtained and compliance data were downloaded. CPAP pressures prescribed after PSG were compared with the empirically set pressures. RESULTS: Eighty-nine patients 67 male; 52.2 - 11.7 years; BMI : 35.3 - 7.9; Epworth 13.8 - 5.7 ; were prescribed empiric CPAP mean pressure of 9.5 -1.6 cm H2O ; . The average duration of CPAP therapy prior to PSG was 254 days. In 26 29% ; cases portable oximetry was used prior to CPAP prescription. Seventy-nine patients 89% ; had OSA mean AHI: 43.5 - 30.2 ; . The optimal CPAP pressure, as determined on a split-night PSG, was 9.9 - 1.9 cm H2O and was not significantly different from the empiric CPAP pressure p 0.12 ; , however, 33 patients were undertreated empiric CPAP pressure optimal CPAP pressure ; .There was significant improvement in subjective somnolence in the entire group ESS: 13.8 - 5.7, after CPAP: 8.7 - 4.0, p 0.001 ; . The mean CPAP compliance was 5.0 - 2.3 hrs night N 67 ; . There were no adverse effects from empiric CPAP therapy. CONCLUSIONS: 1. Pulmonologists can accurately predict presence of moderate and severe OSA, 2. Empiric CPAP therapy is safe and, for instance, hydrodiurjl 25.
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2. Cash Flow used for Investing Activities In 2004, cash outflow due to investing activities was $3.2 billion. A total of $1 billion was spent on acquisitions, while investments in property, plant & equipment amounted to $1.3 billion. The net payments for acquiring marketable securities was $0.8 billion and other investments accounted for $0.1 billion. In 2003, our cash outflow due to investing activities was $1.3 billion. $0.4 billion was spent to increase the strategic investment in Roche and for the acquisition of Idenix. Our investment in property, plant and equipment totaled $1.3 billion. The net proceeds from sales of marketable securities was $0.4 billion. In 2002, our net cash outflow from investing activities was $2.9 billion. Thereof $2.7 billion was spent to increase the strategic investment in Roche and for the acquisition of Lek and sustiva.
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Chlamydia rates among Toronto youth continue to rise according to Toronto Public Health TPH ; surveillance data. Chlamydia is the most commonly reported communicable disease in Toronto and comprises 50% of all STI reports. Young women and men aged 15 to 24 low-income neighbourhoods account for an extremely disproportionate number of cases. But the rise of this infection is not unique to Toronto. United States, Australia, New Zealand and Great Britain have all launched public health initiatives to increase awareness, testing and treatment of chlamydia with the aim of reducing infection rates. In order to effectively combat the increasing rate of chlamydia, proactive testing needs to be increased among physicians in family practices in the high needs neighbourhoods and across the City in general. if left untreated -- infertility and death in the extreme--many cases of chlamydia are going undetected. In fact, our research suggests that the growing prevalence of chlamydia is driven, in part, by the out-of-sight, out-of-mind nature of the infection. Research with physicians and youth indicates that a majority of respondents are not aware that chlamydia is rising. Only 17% of the physicians have seen an increase in the number of 15 to year old female patients visiting for chlamydia-related issues in the past 12 months, and yet chlamydia cases increased 62% in five years, and are dramatically higher in low income neighbourhoods. "Since there is a lack of awareness as to the scope of the problem there is little motivation to change behaviour, practise safer sex, seek testing, and for physicians to adhere to more proactive testing, " stated Dr. Gerstein. Although three quarters of physicians test for chlamydia when they know youth are sexually active, three in 10 physicians do not recommend testing to all sexually active female patients and generally wait for a patient to bring up sexual health concerns before initiating testing. "Compounding this problem is that and vaseretic.
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FIGURE 2 A, Age-adjusted CD4 T-cell count during 240 weeks of follow-up on HAART. Follow-up of all patients during treatment with NFV-containing regimen. Inset, A comparison is shown between children with undetectable pVL and children whose therapy failed. No difference over time was found between the groups. Interaction term time virologic success ; , P .9. Bars indicate standard errors of the mean SEM ; . B, Age-adjusted CD8 T-cell count during 240 weeks of follow-up on HAART. Follow-up of all patients during treatment with NFV-containing regimen. Inset, A comparison is shown between children with undetectable pVL and children whose therapy failed. No difference over time was found between the groups. Interaction term time virologic success ; , P .9. Bars indicate SEM!
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Figure 8: Patient's regular drugs prescription 2 ; .The entries in the 6am row for vancomycin are the plasma concentrations of the drug in mg per litre.
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