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By F. Rocko. Waynesburg College. 2019.

Protein require- ments of man: Comparative nitrogen balance response within the submaintenance-to-maintenance range of intakes of wheat and beef proteins order protonix paypal. Evaluation of the protein quality of an isolated soy protein in young men: Relative nitrogen requirements and effect of methionine supplementation discount protonix 20mg line. Agurs-Collins’ primary research interests include the role of nutrition in cancer and diabetes buy protonix 20mg low cost, nutrition and aging, and disease prevention in minority popula- tions. Agurs-Collins was the president of the District of Columbia Metropolitan Area Dietetic Associa- tion in 1998–1999. She is a member of the Mayoral-appointed Board of Dietetics and Nutrition of the District of Columbia Government, where she developed licensing rules, regulations, and the state nutrition exami- nation. Agurs-Collins was the 1999–2000 recipient of the American Association for Cancer Research, Historically Black Colleges and Universities Faculty Award in Cancer Research and the 1999–2000 Outstanding Dieti- tian of the Year Award, District of Columbia Metropolitan Area Dietetic Association. At the University, he is also codirector of the Program in Food Safety, Nutritional and Regulatory Affairs. Her research interests focus on the associations among nutrition, physical activity, and bone health in women and she has authored over 75 publications. Barr served as vice president of the Canadian Dietetic Association (now Dietitians of Canada) and is a fellow of both the Dietitians of Canada and the American College of Sports Medicine. She is currently a member of the Scientific Advisory Board of the Osteoporosis Society of Canada and the Medical Advisory Board of the Milk Processors Education Program. He also was a research scientist and scientific manager at Health Canada, where he worked in the areas of biochemistry, pharmacology, nutrition toxicology, and toxicology of food-borne and environmental contaminants. He has published over 60 papers and book chapters in the fields of bio- chemistry, toxicology, and risk assessment methodology. His research is intended to elaborate the path- ways and controls of lactic acid formation and removal during and after exercise and to study the integration of carbohydrates, lipids, and amino and fatty acids into the carbon flux sustaining exercise. To study these problems in detail, isotope tracer, biochemical, and molecular techniques have been developed and are used extensively. Additionally, the effects of acute and chronic bouts of exercise, gender, hypoxia, and perturbations in oxygen transport on energy fluxes and associated cellular organelles, membranes, and enzyme systems are under investigation. Brooks is responsible for articulating the “Crossover Concept” describing the bal- ance of carbohydrate and lipid used during physical exercise, as well as for discovery of the “Cell-Cell” and “Intracellular Lactate Shuttles” that describe the pivotal role of lactate in intermediary metabolism. Department of Agriculture/Agricultural Research Center Children’s Nutri- tion Research Center, Department of Pediatrics, Baylor College of Medi- cine, Houston, Texas. Her memberships include the American Society of Clinical Nutrition (Budgetary Committee, 1998–present), the International Society for Research on Human Milk and Lactation (Executive Committee, 1996–present and Secretary/Treasurer, 1990–1992), the Society for Inter- national Nutrition Research (Executive Committee, 1996–present), and the International Dietary Energy Consultancy Group Steering Committee (1994–present). Her areas of expertise are energy requirements of infants, children, and women during pregnancy and lactation. He is currently president of the Society for International Nutrition Research and a member of the American Society of Nutritional Sciences, the American Society for Clinical Nutrition, the North American Society for the Study of Obesity, and the North American Society of Pediatric Gastroenterology and Nutrition. He is a member of the editorial board of the American Journal of Clinical Nutrition and the editor of the Encyclopedia of Human Nutrition. Environ- mental Protection Agency and the National Pork Producers Council and is an affiliate for the Law and Economics Consulting Group. Carriquiry is the current president of the International Society for Bayesian Analysis and is an elected member of the International Statistical Institute. Carriquiry’s research interests include nutrition and dietary assess- ment, Bayesian methods and applications, mixed models and variance com- ponent estimation, environmental statistics, stochastic volatility, and linear and nonlinear filtering. She is a past president of the American Dietetic Association and of the California Dietetic Association. She has more than a 20-year history of clinical research at Stanford University where her research centered on the nutritional needs of adults and the elderly. Her special research interest is in the nutritional management of diabetes and dyslipidemias, particularly in the role of dietary carbohydrates. Her substantive expertise is in the areas of food assistance and nutrition policy and child health policy and programs. She has conducted several studies of the school nutrition programs, the Food Stamp Program, and the Special Supplemental Nutrition program for Women, Infants and Children. Devaney also serves on the advisory board for the Maternal and Child Health Nutrition Leadership Training Program and was a visiting professor at the University of California at Los Angeles, where she taught classes on food and nutrition assistance policy. His current research interests are the effects of different fiber sources on nutrient digestibility, and gastrointestinal tract health in humans and companion animals. Faustman’s research is to identify biochemical mechanisms of develop- mental toxicity and to develop new methods for the evaluation of health risks from environmental agents. Her research in risk assessment includes an effort to combine results derived from laboratory experiments to develop mechanistically-based toxikinetic and toxicodynamic models of developmental toxicity. His research expertise relates to the regulation of energy and macronutrient balances, and on the roles of dietary fat, carbohydrate balance, and exercise on body weight regulation and obesity. Flatt serves on the Nestlé Foundation for the Study of Nutritional Problems in the World. Fried joined the faculty at Rockefeller University as an assistant professor in the Laboratory of Human Metabo- lism and Behavior in 1986, before moving to Rutgers in 1990. She has been the director of the Graduate Program in Nutritional Sciences at Rutgers since 1996. Fried’s research concerns the regulation of adipose tissue metabolism, with a focus on the mechanisms underlying depot dif- ferences in human adipocyte metabolism. Her research program utilizes in vitro and in vivo methods to undercover the nutritional and hormonal mechanisms regulating the production of leptin and other cytokines by human adipose tissue from lean and obese subjects. Fried currently serves on the editorial boards of the Journal of Nutrition, Obesity Research, and the Biochemical Journal. She has served on a number of national scien- tific advisory panels and is currently a member of the Nutrition Study Section of the National Institutes of Health. Fried is a member of the American Society for Nutritional Sciences, the American Society for Clinical Nutrition, the American Physiological Society, and the North American Association for the Study of Obesity. She was a post-doctoral fellow in endocrinology and metabolism at Emory University and in lipid biochemistry at the Medical College of Pennsylvania. He served 13 years in the Department of Nutrition of the London School of Hygiene and Tropical Medicine, followed by 10 years at the Rowett Research Insti- tute in Aberdeen, Scotland. His research has concentrated on the nutri- tional control of protein and amino acid metabolism in health and disease, especially on studies in humans employing stable isotope tracers, leading to 140 original scientific articles.

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Clinical experience remains limited purchase protonix with paypal, and infusion of antimicrobial agents should also be a priority and more clinical studies are needed before recommending these may require additional vascular access ports (68 cheap protonix 40 mg without prescription, 69) buy protonix cheap. In the non-culture molecular methods as a replacement for standard presence of septic shock, each hour delay in achieving admin- blood culture methods (60, 61). We suggest the use of the 1,3 β-d-glucan assay (grade 2B), increase in mortality in a number of studies (15, 68, 70–72). Empiric use of an echinocandin is pre- represent unstudied variables that may impact achieving this ferred in most patients with severe illness, especially in those goal. Future trials should endeavor to provide an evidence base patients who have recently been treated with antifungal agents, in this regard. This should be the target goal when managing or if Candida glabrata infection is suspected from earlier cul- patients with septic shock, whether they are located within the ture data. The agents should guide drug selection until fungal susceptibility strong recommendation for administering antibiotics within 1 test results, if available, are performed. Risk factors for candi- hr of the diagnosis of severe sepsis and septic shock, although demia, such as immunosuppressed or neutropenic state, prior judged to be desirable, is not yet the standard of care as verifed intense antibiotic therapy, or colonization in multiple sites, by published practice data (15). If antimicrobial agents cannot be mixed and delivered promptly Because patients with severe sepsis or septic shock have little from the pharmacy, establishing a supply of premixed antibiotics margin for error in the choice of therapy, the initial selection for such urgent situations is an appropriate strategy for ensuring of antimicrobial therapy should be broad enough to cover all prompt administration. This risk must be taken into consideration prevalence patterns of bacterial pathogens and susceptibility in institutions that rely on premixed solutions for rapid availabil- data. In choosing the antimicrobial regimen, clinicians therapy (ie, therapy with activity against the pathogen that is should be aware that some antimicrobial agents have the advan- subsequently identifed as the causative agent) correlates with tage of bolus administration, while others require a lengthy infu- increased morbidity and mortality in patients with severe sep- sion. Thus, if vascular access is limited and many different agents sis or septic shock (68, 71, 79, 80). We recommend that initial empiric anti-infective therapy severe sepsis or septic shock warrant broad-spectrum therapy include one or more drugs that have activity against all until the causative organism and its antimicrobial susceptibili- likely pathogens (bacterial and/or fungal or viral) and that ties are defned. Although a global restriction of antibiotics is penetrate in adequate concentrations into the tissues pre- an important strategy to reduce the development of antimi- sumed to be the source of sepsis (grade 1B). The choice of empirical antimicrobial therapy ate strategy in the initial therapy for this patient population. Collaboration with antimicro- pital, and that previously have been documented to colonize bial stewardship programs, where they exist, is encouraged to or infect the patient. The most common pathogens that cause ensure appropriate choices and rapid availability of effective septic shock in hospitalized patients are Gram-positive bac- antimicrobials for treating septic patients. All patients should teria, followed by Gram-negative and mixed bacterial micro- receive a full loading dose of each agent. Candidiasis, toxic shock syndromes, and an array often have abnormal and vacillating renal or hepatic function, of uncommon pathogens should be considered in selected or may have abnormally high volumes of distribution due to patients. An especially wide range of potential pathogens exists aggressive fuid resuscitation, requiring dose adjustment. When choosing empirical therapy, ting for those drugs that can be measured promptly. Signifcant clinicians should be cognizant of the virulence and growing expertise is required to ensure that serum concentrations max- prevalence of oxacillin (methicillin)-resistant Staphylococcus imize effcacy and minimize toxicity (81, 82). The antimicrobial regimen should be reassessed daily for bapenem among Gram-negative bacilli in some communities potential de-escalation to prevent the development of resis- and healthcare settings. Within regions in which the prevalence tance, to reduce toxicity, and to reduce costs (grade 1B). Once the causative pathogen has been identifed, Clinicians should also consider whether candidemia is a the most appropriate antimicrobial agent that covers the pathogen likely pathogen when choosing initial therapy. On occasion, warranted, the selection of empirical antifungal therapy (eg, an continued use of specifc combinations of antimicrobials echinocandin, triazoles such as fuconazole, or a formulation might be indicated even after susceptibility testing is available 592 www. Decisions on defnitive antibiotic choices and for selected forms of endocarditis, where prolonged should be based on the type of pathogen, patient characteristics, courses of combinations of antibiotics are warranted. A propensity-matched analysis, meta-analysis, Narrowing the spectrum of antimicrobial coverage and and meta-regression analysis, along with additional observa- reducing the duration of antimicrobial therapy will reduce the likelihood that the patient will develop superinfection with tional studies, have demonstrated that combination therapy other pathogenic or resistant organisms, such as Candida spe- produces a superior clinical outcome in severely ill, septic cies, Clostridium diffcile, or vancomycin-resistant Enterococcus patients with a high risk of death (86–90). However, the desire to minimize superinfections and increasing frequency of resistance to antimicrobial agents other complications should not take precedence over giving an in many parts of the world, broad-spectrum coverage gen- adequate course of therapy to cure the infection that caused erally requires the initial use of combinations of antimi- the severe sepsis or septic shock. Combination therapy used in this context connotes at least two different classes of antibiotics (usually 3. We suggest the use of low procalcitonin levels or similar a beta-lactam agent with a macrolide, fuoroquinolone, or biomarkers to assist the clinician in the discontinuation aminoglycoside for select patients). A controlled trial sug- of empiric antibiotics in patients who appeared septic, but gested, however, that when using a carbapenem as empiric have no subsequent evidence of infection (grade 2C). This suggestion is predicated on the preponder- tant microorganisms, the addition of a fuoroquinolone ance of the published literature relating to the use of procalcito- does not improve outcomes of patients (85). No evidence demon- selected patients with specifc pathogens (eg, pneumococ- strates that this practice reduces the prevalence of antimicrobial cal sepsis, multidrug-resistant Gram-negative pathogens) resistance or the risk of antibiotic-related diarrhea from C. One recent study failed to show any beneft of daily procal- ized clinical trials is not available to support combination citonin measurement in early antibiotic therapy or survival (84). In some clinical scenarios, combination therapies activity against the most likely pathogens based upon each are biologically plausible and are likely clinically useful even patient’s presenting illness and local patterns of infection. Combination therapy for suspected or known patients with severe sepsis (grade 2B) and for patients with Pseudomonas aeruginosa or other multidrug-resistant Gram- diffcult-to-treat, multidrug-resistant bacterial pathogens negative pathogens, pending susceptibility results, increases such as Acinetobacter and Pseudomonas spp. We suggest that the duration of therapy typically be 7 to 10 with an extended spectrum beta-lactam and either an ami- days if clinically indicated; longer courses may be appropri- noglycoside or a fuoroquinolone is suggested for P. Although patient factors may infuence the length tings where highly antibiotic-resistant pathogens are preva- of antibiotic therapy, in general, a duration of 7-10 days (in the lent, with such regimens incorporating carbapenems, colistin, absence of source control issues) is adequate. However, a recent controlled trial continue, narrow, or stop antimicrobial therapy must be made suggested that adding a fuoroquinolone to a carbapenem as on the basis of clinician judgment and clinical information. Cli- empiric therapy did not improve outcome in a population at nicians should be cognizant of blood cultures being negative in low risk for infection with resistant microorganisms (85). We suggest that combination therapy, when used empirically despite the fact that many of these cases are very likely caused in patients with severe sepsis, should not be administered by bacteria or fungi. De-escalation to the most appro- cultures will be negative in a signifcant percentage of cases of priate single-agent therapy should be performed as soon as severe sepsis or septic shock, despite many of these cases are the susceptibility profle is known (grade 2B). We suggest that antiviral therapy be initiated as early as pos- excluded as rapidly as possible, and intervention be under- sible in patients with severe sepsis or septic shock of viral taken for source control within the frst 12 hr after the diag- origin (grade 2C). Recommendations for antiviral treatment identifed as a potential source of infection, defnitive inter- include the use of: a) early antiviral treatment of suspected vention is best delayed until adequate demarcation of viable or confrmed infuenza among persons with severe infuenza and nonviable tissues has occurred (grade 2B).

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Marijuana Arrest Crusade: Racial Bias and Police Policy in New York City 1997-2007 order protonix master card. Racial Disparity in Criminal Court Processing in the United States: Submitted to the United Nations Committee on the Elimination of Racial Discrimination buy protonix with mastercard. Black Arrests for Drug Abuse Violations 40 mg protonix with visa, 1980 to 2009, generated using the Arrest Data Analysis Tool. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs Spohn, Cassia, and Jeffrey Spears. Substance Abuse in States and Metropolitan Areas: Model Based Estimates from the 1991-1993 National Household Survey on Drug Abuse. Administration of Justice, Rule of Law, and Democracy: Discrimination in the Criminal Justice System. Notes: (*) Includes some persons of Hispanic origin; however, there are additional persons of Hispanic origin who are new court commitments who were not categorized as to race and who are not included in these figures. Capacity to other ethnic1 disparities is limited by national arrest and imprisonment data, which either do not or only inadequately indicate the ethnicity of those arrested, sentenced, held in prison, and released from prison. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs No. Human rights treaties are binding both on the federal and state governments (Human Rights Watch and Amnesty International 2005, p. When scientists began to study addictive behavior in the 1930s, people addicted to drugs were thought to be Fmorally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punishment rather than prevention and treatment. Today, thanks to science, our views and our responses to addiction and other substance use disorders have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem. As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities. Despite these advances, many people today do not understand why people become addicted to drugs or how drugs change the brain to foster compulsive drug use. This booklet aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat substance use disorders. Every year, illicit and prescription drugs and alcohol contribute to the 4,5 A death of more than 90,000 Americans, while tobacco is linked to an estimated 480,000 deaths per year. This exposure can slow the child’s intellectual 6 development and affect behavior later in life. They often develop poor social behaviors as a result of their drug abuse, and their work performance and personal relationships suffer. Such conditions harm the well- being and development of children in the home and may set the stage for drug abuse in the next generation. Scientists study the effects that drugs have on the brain and on people’s behavior. They use this information to develop programs for preventing drug abuse and for helping people recover from addiction. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction. Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules. Scientists believe that these changes alter When they first use a drug, people may perceive what seem to the way the brain works and may help explain the compulsive be positive effects; they also may believe that they can control and destructive behaviors of addiction. Why do some people become addicted to Over time, if drug use continues, other pleasurable activities drugs, while others do not? In general, the more risk start to feel the need to take higher or more frequent doses, factors a person has, the greater the chance that taking drugs even in the early stages of their drug use. Consider how Risk Factors Protective Factors a social drinker can become intoxicated, get behind the wheel of a car, and quickly turn a pleasurable activity into a tragedy Aggressive behavior Good self-control in childhood that affects many lives. Lack of parental Parental monitoring supervision and support Is continued drug abuse a voluntary Poor social skills Positive relationships behavior? Drug experimentation Academic competence The initial decision to take drugs is typically voluntary. However, Availability of drugs School anti-drug with continued use, a person’s ability to exert self-control can at school policies become seriously impaired; this impairment in self-control is Community poverty Neighborhood pride the hallmark of addiction. Brain imaging studies of people with Children’s earliest interactions within the family are crucial to their healthy development and 8 risk for drug abuse. Risk and protective factors may be either envi- ronmental (such as conditions at home, at school, and in the neighborhood) or biological (for instance, a person’s genes, their stage of development, and even their gender n Genetics n Chaotic home and abuse n Gender n Parent’s use and attitudes or ethnicity). The influence of the home envi- ronment, especially during childhood, is a very impor- tant factor.

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Coordinating care across diseases purchase protonix 40 mg with visa, settings protonix 40 mg generic, and clinicians: a key role for the generalist in practice buy line protonix. Quality indicators of continuity and coordination of care for vulnerable elder persons. Management strategies need to take into account the effects of aging on multiple organ systems and socioeconomic factors faced by our elderly society. As the number of geriatrics patients steadily rises, the internist will devote more time to the care of these patients. Nutritional needs of the elderly and adaptations needed in the presence of chronic illness. Key illnesses in the elderly, focusing on their often atypical presentation, including: • Cardiovascular and cerebrovascular disease. Basic treatment plans for illness in the elderly, with an awareness of the pharmacokinetic and pharmacodynamic changes seen as we age. Principles of screening in the elderly, including immunizations, cardiovascular risk, cancer, substance abuse, mental illness, osteoporosis, and functional assessment. Principles of Medicare (including who and what services are covered) and prescription drug coverage (who and what drugs are covered). Taking a complete and focused history from a geriatric patient with attention to current symptoms, chronic illnesses, and physical and mental functioning. Always obtaining historical information from collateral source, whenever possible. Performing a mental status examination to evaluate confusion and/or memory loss in an elderly patient. Developing a diagnostic and management plan for patients with the with symptoms/conditions common in the geriatric population. Communicating the diagnosis, treatment plan, and subsequent follow-up to the patient and their family. Eliciting input and questions from the patient and their family about the diagnostic and management plan. With guidance and direct supervision, participating in discussing basic issues regarding advance directives with patients and their families. With guidance and direct supervision participating in discussing basic end-of- life issues with patients and their families. Participating in an interdisciplinary approach to management and rehabilitation of elderly patients. Accessing and using appropriate information systems and resources to help delineate issues related to the common geriatric syndromes. Respect the increased risk for iatrogenic complications among elderly patients by always taking into account risks and monitoring closely for complications. Demonstrate respect to older patients, particularly those with disabilities, by making efforts to preserve their dignity and modesty. Always treat cognitively impaired patients and patients at the end of their lives with utmost respect and dignity. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for the common geriatric syndromes. Recognize the importance of patient needs and preferences when selecting among diagnostic and therapeutic options for the common geriatric syndromes. Demonstrate ongoing commitment to self-directed learning regarding care of the geriatric patient. Appreciate the impact the common geriatric syndromes have on a patient’s quality of life, well-being, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other health care professionals in the diagnosis and treatment of geriatric patients. Key indications, contraindications, risks to patients and health care providers, benefits, and techniques for each of the following basic procedures: • Venipuncture. Obtaining informed consent, when necessary, for basic procedures, including the explanation of the purpose, possible complications, alternative approaches, and conditions necessary to make the procedure as comfortable, safe, and interpretable as possible. Demonstrating step-by-step performance of basic procedures with technical proficiency. Appropriately documenting, when required, how the procedure was done, any complications, and results. Appreciate the fear and anxiety many patients have regarding even simple procedures. Regularly seek feedback regarding procedural skills and respond appropriately and productively. Internists, by virtue of their dedication to providing comprehensive care to their patients, must assess nutritional factors on a routine basis. Medical students should be prepared to provide patients with basic advice regarding ways to optimize their nutritional status. Students also need to have at least a basic working knowledge of the principles of nutritional assessment and intervention. Contributions of nutrition to medical problems such as obesity, hyperlipidemia, diabetes, and hypertension. How to perform a nutritional assessment and assist the patient in setting goals for dietary improvement. Daily caloric, fat, carbohydrate, protein, mineral, and vitamin requirements; adequacy of diets in providing such requirements; evidence of need for and potential risks of supplements (e. Common dietary supplements and their known adverse and beneficial effects on health. The consequences of poor nutrition on a critically ill patient, such as poor wound healing, increased risk of infection, and increased mortality. Nutritional needs of the elderly and adaptations needed in the presence of chronic illness. Identifying physical exam abnormalities that may suggest malnutrition, such as muscle wasting, decreased adipose stores, as well as stigmata of vitamin/mineral or protein-calorie malnutrition (e.