Cynthia Melinda Boyd, M.D., M.P.H.

• Professor of Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0007719/cynthia-boyd

Actively seek the views of girls and boys of all ages and backgrounds cholesterol particle size trusted 40 mg simvastatin, so they can influence how assistance is delivered cholesterol levels g l cheap 10mg simvastatin with visa, monitored and evaluated cholesterol ratio british heart foundation purchase simvastatin 10 mg online. The Convention on the Rights of the Child states that "child" means every person under the age of 18 cholesterol test kit amazon cheap simvastatin 20mg overnight delivery. Analyse how the affected population defines children cholesterol uptake assay cheap simvastatin 5mg, to ensure that no child or young person is excluded from assistance good cholesterol foods to eat discount 5mg simvastatin with amex. Older people Older people are a fast-growing proportion of the population in most countries, but often neglected in humanitarian responses. In many cultures, being considered old is linked to circumstances (such as being a grandparent) or physical signs (such as white hair), rather than age. While many sources define old age as 60 years and older, 50 years may be more appropriate in contexts where humanitarian crises occur. Older people bring knowledge and experience of coping strategies and act as caregivers, resource managers, coordinators and income generators. Older people often embody traditions and history and act as cultural reference points. Isolation, physical weakness, disruption of family and community support structures, chronic illness, functional difficulties and declining mental capacities can all increase the vulnerability of older people in humanitarian contexts. Ensure that older people are consulted and involved at each stage of humanitarian response. Consider age-appropriate and accessible services, environments and information, and use age-disaggregated data for programme monitoring and management. Gender "Gender" refers to the socially constructed differences between women and men throughout their life cycle. Gender often determines the different roles, responsibilities, power and access to resources of women, girls, boys and men. Understanding these differences and how they have changed during the crisis is critical to effective humanitarian programming and the fulfilment of human rights. Crises can be an opportunity to address gender inequalities and empower women, girls, boys and men. Gender is not the same as sex, which refers to the biological attributes of a person. While women and girls most often face constraints within gender roles, men and boys are also influenced by strict expectations of masculinity. Gender equality programming requires their inclusion for the development of more equitable relationships and equal participation of women, girls, men and boys. Gender-based violence "Gender-based violence" describes violence based on gender differences between males and females. It underscores how inequality between males and females is the foundation of most forms of violence perpetrated against women and girls across the world. Crises can intensify many forms of gender-based violence, including intimate partner violence, child marriage, sexual violence and trafficking. Organisations are responsible for taking all necessary steps to prevent the sexual exploitation and abuse of people affected by crises, including in their own activities. When allegations of misconduct are found to be true, it is important that the competent authorities hold the perpetrator to account and that cases are dealt with in a transparent way. Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others. In humanitarian contexts, persons with disabilities are more likely to face barriers and obstacles to the physical environment, transportation, information and communications, and humanitarian facilities or services. Response and preparedness programming should consider the capacities and needs of all persons with disabilities and make deliberate efforts to remove physical, communication and attitudinal barriers to their access and participation. Risks to women and girls with disabilities can be compounded by gender inequality and discrimination. See References: Washington Group Questions for disaggregation of data by disability status, and the Humanitarian inclusion standards for older people and people with disabilities, for more information. Specific measures are often needed to protect against violence and discrimination among high-risk populations. This can be compounded by gender inequality and discrimination based on disability status, gender identity and sexual orientation. Those at the highest risk include men who have sex with men, people who inject drugs, sex workers, transgender people, persons with disabilities, and people in prisons and other closed settings see Essential healthcare ­ sexual and reproductive health standard 2. They may face barriers to accessing healthcare, housing, education, employment, information and humanitarian facilities. Such barriers affect their health and survival and may have longterm consequences on integration. Include specific, safe and inclusive protection responses in preparedness and planning. Mental health and psychosocial support People react differently to the stress of a humanitarian crisis. Some are more likely to be overwhelmed by distress, especially if they have been forcibly displaced, separated from family members, survived violence or experienced previous mental health conditions. Providing basic services and security in a socially and culturally appropriate way is essential to both prevent distress among affected populations and address discrimination. Strengthening community psychosocial support and self-help creates a protective environment, allowing those affected to help each other towards social and emotional recovery. They can also be provided by trained and supervised lay people see Essential healthcare standard 2. Affected populations often express a spiritual or religious identity and may associate themselves with a faith community. This is often an essential part of their coping strategy and influences an appropriate response across a wide range of sectors. There is growing evidence that affected populations benefit when humanitarians take account of their faith identity. Existing faith communities have great potential to contribute to any humanitarian response. A people-centred approach requires humanitarian workers to be aware of the faith identity of affected populations. Understanding the operational setting Humanitarian response takes place in vastly different contexts, ranging from urban to rural, and conflict to rapid-onset disaster, and often a combination of these over time. The effectiveness of the response in meeting the needs of the affected population will depend on geographic, security, social, economic, political and environmental factors. While the Minimum Standards have been developed to focus on immediate life-saving assistance, they are applicable in humanitarian responses that last a few days, weeks, months or even years. The humanitarian response should change and adapt over time and avoid creating aid dependency. A continuous analysis of the context and situation will signal when programmes should adapt to a changing environment, such as new security issues or seasonal constraints such as flooding. An ongoing evaluation of how the response affects local dynamics such as procurement of goods and services or hiring of transport is essential to make sure humanitarian action does not fuel conflict dynamics see Protection Principle 2. When crises become protracted, underlying systemic weaknesses may intensify needs and vulnerabilities, requiring additional protection and resilience-building efforts. Some of these will be better addressed through or in cooperation with development actors. Coordination mechanisms such as the cluster system are required to establish a clear division of labour and responsibility and to identify gaps in coverage and quality. The sharing of information and knowledge between stakeholders, along with joint planning and integrated activities, can also ensure that organisations manage risk better and improve the outcomes of a response. Supporting national and local actors Recognising the primary role and responsibility of the host state, the Handbook guides all those involved in humanitarian response and the role that humanitarian organisations can play in supporting this responsibility. In a conflict, the willingness of state or non-state actors to facilitate access to the population will have a determining effect. In such extraordinary cases, humanitarian actors may need to set up their own coordination mechanisms. Explore opportunities to work with existing service providers, local authorities, local communities, social protection networks or development actors to help meet needs. Assessments need to consider the context and the protection concerns, and how the rights of the affected population will be impacted. Involve individuals of both sexes and all ages, disabilities and backgrounds, including self-defined communities, in the analysis, assessment, decision-making and monitoring and evaluation. When humanitarian actors have the opportunity to establish long-term solutions, those should take precedence over temporary measures. Recognise that affected people are often the first to respond to their own needs and protect themselves. National and local authorities, civil society organisations, faith-based organisations and others provide critical assistance. Be aware of these pre-existing assistance networks and identify ways to support rather than undermine or duplicate them. Urban areas typically differ from other contexts in terms of: · · · Density: a higher density of people, houses, infrastructure, laws and cultures in a relatively small area; Diversity: social, ethnic, political, linguistic, religious and economically diverse groups live in close proximity; and Dynamics: urban environments are fluid and changing, with high mobility and rapidly shifting power relationships. The municipality will often be the key government authority, with links to other government actors and departments, such as line ministries. Access to basic services, food security and livelihoods should be carefully assessed, including any discrimination. The Minimum Standards for life with dignity apply, regardless of how the assistance is provided. The Sphere Minimum Standards can be used to support multiple entry points for providing assistance in urban areas, including through settlement, neighbourhood or area-based approaches. Working with local actors (such as the private sector, local government, neighbourhood leaders and community groups) can be vital in restarting, supporting and strengthening existing services instead of replacing them. Be mindful of how humanitarian assistance may support municipal investment planning, creating value during the crisis and in the longer term. As in any setting, a context analysis in urban environments should look at the existing resources and opportunities, such as commerce, cash, technology, public spaces, people with specialised skill sets, and social and cultural diversity, alongside risks and protection aspects. The analysis should inform response options and the final choice of delivery mode, such as deciding to provide in-kind or cash-based assistance (and the best way for doing so). The cash-based economy of towns and cities provides opportunities for partnerships with actors in markets and technology, which may facilitate the use of cash-based assistance. Communal settlements Planned communal settlements and camps, as well as collective centres and spontaneous settlements, are home to millions of people who have been forcibly displaced. The Sphere standards can be used to ensure the quality of assistance in community settings. They can also help identify priorities for multi-sectoral programmes to address public health concerns, and for access to basic services in spontaneous settlements. In communal settlements, dedicated camp management capacity can contribute to greater accountability and coordinated service delivery. For example, when the right to freedom of movement to leave the settlement is denied, people may not be able to access markets or pursue livelihoods. Special attention should also be paid to host communities, because real or perceived differences in treatment may lead to escalating tensions or conflict. In such cases, advocating for an alternative to camp-like settings and addressing host community needs too can help to ensure that affected populations are able to live with dignity. In disaster and conflict settings, humanitarian organisations may find themselves working closely 18 What is sphere? Humanitarian actors should note that host governments are obliged to provide assistance and protection to people affected by crisis in their territory. Humanitarian principles must guide all humanitarian­military dialogue and coordination at all levels and stages of interaction. Information sharing, planning and task division are three essential elements of effective civil­military coordination. While information sharing between humanitarian and military actors can occur, it must depend on the context of operational activities. Humanitarian agencies must not share information that gives one party to a conflict a tactical advantage or endangers civilians. At times, humanitarian organisations may need to use the unique capabilities of militaries to support humanitarian operations. Military support to humanitarian organisations should be limited to infrastructure support and indirect assistance; direct assistance is a last resort. Internationally agreed guidance documents should inform any humanitarian­military coordination arrangements see Core Humanitarian Standard Commitment 6 and References. Environmental impact in humanitarian response the environment in which people live and work is essential for their health, well-being and recovery from crisis. Understanding how affected people are dependent on the environment for their own recovery can also inform programme design and lead to more sustainable responses to cope with future shocks and reduce future risk. Effective humanitarian response should therefore carefully assess environmental risk alongside wider assessments and situational analysis. Programmes should minimise their environmental impact and consider how procurement, transport, choice of materials, or land and natural resource use may protect or degrade the environment further see Shelter and settlement standard 7: Environmental sustainability. Countries and regions facing poverty as well as fragile institutional capacity and ecology are at higher risk of natural disasters and instability, creating a vicious circle of social and environmental degradation. This has an impact on health, education, livelihoods and other dimensions of security, dignity and well-being. Environmental sustainability is an important component of a good quality humanitarian response see Core Humanitarian Standard Commitments 3, 9 and Shelter and settlement standard 7: Environmental sustainability. Appendix Delivering assistance through markets this appendix complements the Sphere Handbook introduction, providing further information and guidance on using markets to attain the Minimum Standards and help people meet their needs in the aftermath of a crisis. To respond effectively, humanitarian actors should understand what the needs are as well as how to practically meet them.

The following pages provide you with an idea of some of these causes and what you can do to alleviate the problems lowering cholesterol foods eat 10 mg simvastatin with mastercard. As more information is received high cholesterol test online buy discount simvastatin 10 mg on line, this will be the subject of one of the updates to this manual cholesterol chart range generic simvastatin 5mg mastercard. In the meantime cholesterol understanding buy simvastatin 10 mg with mastercard, use your analyzer to determine if the devices have a beneficial effect on you and your family cholesterol in small eggs buy 40 mg simvastatin overnight delivery. Pollution In Buildings: Modern buildings may be efficient cholesterol lowering foods american heart association buy 20mg simvastatin amex, but at times they create serious health problems. The metals pick up the frequency or vibrations and act as an antenna to draw in the various energies. The lighting does not contain the full spectrum needed by all animals so people are in a weakened stage because of lack of sunlight. You may be able to predict a problem a subject will have such as Multiple Sclerosis (M. One of the key items that tie radiation problems back to diet is the amount of boron in the body. It is not that you are questioning the integrity of the store owner, but some things may be better for you than others. Many people in Phoenix take boron pills every day because they live in a high radiation area. Electrical Appliances: Electrical appliances in the office, home, amusement areas etc. If you have a computer and you feel tired from working on the terminal, reach up and touch the screen once or twice a day to relieve the stress. One solution is to wear a diode that counters the effect of the electrical pollution. At night you should pull the plug on your waterbed and plug it in when not in use. Microwave: Microwaves are continually travelling through the air and affecting our wellbeing. In addition, many of the test blasts throughout the last few years all over the world have deposited some amounts of radioactive material in the surface water we drink, food we eat and the air we breathe. Radar: Radar is used in many aspects of navigation in our airlines and ocean travel as well as the armed forces. Television: Television is mentioned again because of the excessive amount of time we and our children spend in front of the set. Energy from television sets are especially dangerous when we get too close to the set to watch a show. X-Ray: X-Rays are another dangerous source of radiation that continues to affect us. We receive periodical examinations to determine our relative health and get an exposure to the X-Rays. Others: Other ways people can be exposed to these radiation causing problems are, Barium: Administered prior to the G. Use a microphone described in Other Devices, Section 8 of this manual to locate these frequencies. If you are having a problem getting a stick, put your hand on the food allergy sheet and dowse to see if anything on sheet is giving you a problem today or taking away your stick. If you get a stick before 500 or 1/2 the circle on the intensity dial, that is a yes. Some of the symptoms of radiation problems are continuing nervousness, irritability, insomnia, and tired run down feeling. If you chop off the top of the spectrum, you cut down the ultra-violet light that is related to the spiritual part of the body. Gradually reduce the size of the cups and reduce the number of cups taken in a day until the body can adjust to smaller and smaller amounts. Nicotine: If a person smokes and wants to quit, the best way is to light up a cigarette and take a puff and throw it away. To get rid of the craving to smoke, you can take a little sunflower tea, a few blades of a good shade grass or a little oat straw tea. If the index rate for drugs does not stay down, you may have other drugs in the body that are not on the sheet. If it is greater than 50, put the drug index on the other bank and scan for time just as you did above. You will get some benefit by balancing on the index only, but it is more effective if you use the specific rate. Detoxing a Person: the procedure to detoxing a person that is on a prescribed drug such as Valium and taking a large amount of pills a day is a serious process. You may have to use some of the drugs as a reagent and broadcast it to the person as they back off the physical form of the drug. In balancing a person radionically, if we remove one drug, the immune system should come up. The more drug residues you remove from the system, the better response you should get for the readings on original Analysis Chart. Many times we have a heavy residue of a drug where we have no control or recollection of getting a shot or treatment. If the farmer treated his cattle with antibiotics before they were sent to market, the drug residue in the meat can get into your system by eating the meat. For instance, 14 - 16 is the rate for Stilbestrol, an additive that was put in the feed given to beef cattle. This is the kind of situation that caused problems with exporting meat to the Common Market countries. Foreign countries are getting stricter with chemical additives to their food supply than we are in the United States. Greed or corporate profits override the safety factor in the Agra-chemical industry. Immunizations and Inoculations: Today most states have laws that require the administering of shots for such things as measles, diphtheria and whooping cough for children in school. To counter the problem or to nullify the effects of a shot, some doctors give the shot to the kid and then immediately put a raw lemon on the shot. Later if the health official asks the kid, if he/she got a shot for school, the kid remembers the shot. Some people believe the vaccine has created some problems that are just now beginning to manifest in people that took the vaccine many years ago. She later was vaccinated for polio and was told the effects of that vaccination are starting to manifest in a leg disorder to the point where the woman now requires crutches to walk. This is especially true of smallpox vaccine, polio (Salk) vaccines, diphtheria, tetanus, and typhoid vaccines. See the individually listed diseases and balance them out if any are present in any form. What happens is that as vitality reduces, the level of the (inoculation) disease increases due to the weakened state of the body. Most people are eventually overcome by these forms of diseases, and succumb to "old age". In some cases, vaccination and inoculations may be the cause behind the cause behind the cause. When you get into the etherics or thought patterns, radionics can be very powerful. A lot of people think they can tap into their own Vital Forces to effect a cure (radiesthesia). Go to the part of the book on Build Healing Condition pertaining to rates for the chakras. There are exercises to revitalize the chakras or to increase your Vital Life Forces. If a condition re-occurs after balancing, it is very likely that it is being caused by some other condition we have not addressed. Whether you are looking at it from a dietary standpoint or an organ standpoint, they are all interconnected. Each one can affect one or more other locations or the mineral or vitamin balance. If there is more than one rate in the book for a condition, it means that more than one frequency for that condition exists. If you look at the pancreas in the book where it says two alongside the insulin, the two means there are two frequencies for pancreas. If you look at the alphabetical section for fungus, you may see as many as fourteen different rates for fungus. Unfortunately, the food available today is not sufficient to sustain a person on a one day fast. If you take lemon Juice and dilute it 1 part lemon and 9 parts of distilled water, you have an excellent digestive aid. If you really want to get the digestion going drink water on the 1/2 hour and lemon Juice diluted on the hour. A good rule of thumb on the amount of water to drink a day is, 1/2 ounce of water per pound of body weight per day. Scan with the machine to determine how much water is needed and times of day to drink it. The pH will go from a low reading to normal and up into the alkalinity scale and finally Back down to normal. Hydrochloric Acid: Hydrochloric acid, food grade has been removed from the market. To get a substitute you can take 10% hydrochloric acid and dilute it to 1 drop to 2 ounces of water. If you put them into the system when you are eating, the gastric juices are the strongest and they will break them apart. You want your minerals to be ionized by the hydrochloric acid so you take them with your meals. These comments are directed to the dairy farmer, but they apply to all farmers, no matter what they are growing. When a farmer is trying to move from chemical to an organic method, be must back off the chemical program slowly. The first year will be the most difficult because you are going to unlearn years of experience and learn a vastly different way of doing business. You will have more opportunities and you will finally be able to take on more of the responsibilities of your own future. Then establish a plan to get you there in the least amount of time and the most economical method. This will be a radionic soil test of your soil st a time when the crops are dormant or have been harvested. It gives you a basic idea of the really give you the availability of each It is limited. It tells you a little more about your soil because you can get a truer picture of the availability of each nutrient in the soil. If you take a soil and put a seed in the soil and run a radionics analysis on the two together, it will tell you the quality of the crop you can expect from that seed and that soil. It is a better test when you check the soil and the seed you are going to plant in that soil. Or If you pull s leaf off a tree and run the test with the leaf and the soil, that is a valid test. When you have the plant that is growing in the soil and the soil, or the seed and the soil, then you have a good test. Soil tests by themselves are not really a good indication of what you need to raise a good crop. Different soils, different sources of the same kind of seed, time of year the soil test was run all contribute to the kind of crop you can expect from a field. I fully realize that to get your seed and fertilizer program put together in the middle of winter will force you to change your procedures. If you are serious about getting back to a better method of farming, stop and think about the changes you made in the last few years. Soil Sample/Mail: In a garden you can use a soil sample for an analysis of the condition of the soil in your garden. When the sample is run, the results are totally different from the condition of the field. Take a sample of your seed and of your soil or a picture of your field can be substituted for the soil to see if they are compatible. It changes from year to year so you will repeat the process with every crop you plant from now on. What happens if seed # 3 is open pollinated corn and you have been growing hybrid corn using muriate of potash and anhydrous ammonia? The fertilizing program of open pollinated corn requires a very heavy fertilizer program when you make the move from growing hybrid corn to organic farming with open pollinated corn. On a back yard garden, you can a good crop but forget it on a heavily on molybdenum, cobalt, when depending on conventional put enough fertilizer on the ground to get large field. Seed # 3 will give you the highest quality of corn for that field, but the quantity will not be there. One farmer literally tested hundreds of seeds to his soil before he came up with the right seed. He used nothing but lime, manure and sugar on his fields and he averaged 120 bushels of corn per acre. Building A Soil: You can take white sand and get good soil in 5 years, but good soil for one crop may not be satisfactory for a different crop.

Parents should be educated about the side effects of these drugs and reassured about the risk of drug addiction when they are used properly is there cholesterol in eggs good for you cheap 10 mg simvastatin with amex. If home management fails cholesterol test uk nhs simvastatin 10 mg low cost, parents are encouraged to call for consultation or a hospital visit cholesterol score of 5.7 buy simvastatin 40 mg overnight delivery. Further studies will be required to identify those at high risk in order to consider therapies such as hydroxyurea top cholesterol lowering foods generic 10mg simvastatin otc, chronic transfusions age vs cholesterol chart cheap simvastatin 40mg without prescription, or bone marrow transplants definition high cholesterol levels purchase simvastatin 40 mg online. Often emergency room physicians, radiologists, anesthesiologists, surgeons, and critical care specialists also become involved. Facilities generally should have medical consultants, hematology and microbiology laboratories, a radiology service, and blood bank available 24 hours a day. These activities should include education, genetic counseling, and preparation for independent living. The schedule of visits in the first 2 years of life should be every 2 to 3 months, planned to coincide with the immunization schedule. After the age of 2, the frequency of visits depends on patient/ family needs and access to medical consultation, but it should be at least every 6 months. Preventive measures include newborn screening, protective vaccinations, teaching caregivers to recognize early signs of illness, and prompt treatment of suspected infections. Together these serotypes account for 87 percent of bacteremia and 83 percent of meningitis due to pneumococcus in the United States. The recommended schedules of vaccination for the prevention of pneumococcal infection in U. Meningococcal vaccination has not been recommended routinely for children at most U. If children live in or travel to areas with a high prevalence of meningococcal infection, this vaccine should be given. For patients allergic to penicillin, erythromycin ethyl succinate (20 mg/kg) divided into 2 daily doses can provide adequate prophylaxis. The importance of prophylactic antibiotics should be emphasized at all visits because parents may become noncompliant with this essential treatment. Penicillin is given twice daily from as early as 2 months of age, a treatment supported by the hallmark Penicillin Prophylaxis Studies of the 1980s. Penicillin may be given as a liquid or tablet; finely crushed pills may be given to young children. Pills have an important advantage because they are stable for years, compared to liquid forms of penicillin that must be discarded after 2 weeks. A study in children older than 5 years of age, found no clinical benefit of penicillin prophylaxis compared with placebo, indicating that treatment may be stopped at that age (14). Patients on penicillin had no increased infections with Nutrition counseling is an important part of routine health care. Mothers should be encouraged to breastfeed their infants; ironfortified formulas are an alternative. Standard antibiotic prophylaxis should be used to cover dental procedures such as extractions and root canal therapy. The basic premise is that parents should treat their affected child as normally as possible, and they should encourage activities that foster self-esteem and self-reliance. These feelings will help children and adolescents to cope more effectively with their illness. Academic and Vocational Counseling Patients should be encouraged to exercise regularly on a self-limited basis. School-age children should participate in physical education, but they should be allowed to rest if they tire and encouraged to drink fluids after exercise. Children and adolescents may engage in competitive athletics with caution because signs of fatigue may be overlooked in the heat of competition. Coaches are advised against blanket exclusion from participation or excessive demands for athletic excellence. Flying in pressurized aircraft usually poses no problems for sickle cell patients; however, they should dress warmly to adjust for the cool temperature inside, drink plenty of fluids, and move about frequently when possible. On the other hand, travel above 15,000 feet in nonpressurized vehicles can induce vaso-occlusive complications. Illness often interrupts schooling and extracurricular activities, so tutoring or other assistance may be needed. Patients are encouraged to consult their physicians before travel, and they are advised to carry with them specific medical information about their diagnosis, baseline hematologic values, a list of current medications, and the name and telephone number of their physicians. Providers should give patients the names of physicians or health care facilities to contact in case of emergencies. The change from a pediatric to an adult care setting is often difficult, and adolescents should be given help to access adult care facilities. In some centers, this transition is eased by concurrent pediatric/adolescent/adult sickle cell clinic sessions. Sickle Cell Disease: Screening, Diagnosis, Management, Counseling in Newborns and Infants. Reference values and hematological changes from birth to five years in patients with sickle cell disease. State of California, Department of Health Services Genetic Disease Branch, Revised 1991. Rockville, Maryland: Agency for Health Care Policy and Research, Public Health Service, U. Concern about issues such as body size, sexual function, pain management, and death often is expressed as rebellion, depression, or refusal to heed treatment plans and medical advice. Postpubertal adolescents should be educated about sexuality, safe sex practices, and the use of condoms to prevent sexually transmitted diseases. Adolescents may view their long-time pediatric health care providers as too close to their parents and not speak frankly to them. In this case, families could be referred to adolescent medicine specialists to discuss sensitive issues and preparation for adulthood. Alternatively, adolescents may be able to express their concerns through "teen support groups. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Technical report: prevention of pneumococcal infections, including the use of pneumococcal conjugate and polysaccharide vaccine, and antibiotic prophylaxis. They desire acceptance by their peers but, at the same time, wish to become more independent. Additional help is needed to transition to new health care providers and facilities (1). Patients older than age 20 with frequent painful events had the greatest risk of early death, indicating that continuity of care is important to minimize morbidity and mortality. Communication with the patient, family, and multiple providers is needed, but coordination may be difficult between different departments, such as pediatric and adult clinics. Moreover, the current health care environment tends to neglect the needs of patients with chronic disorders. To reduce expensive hospitalizations, integrated transition programs can provide age-appropriate treatment and continuity of care from pediatric to adult facilities. Patients with active coping styles (use of multiple cognitive and behavioral strategies) had fewer emergency room visits. Those using passive adherence coping styles (reliance on concrete, passive approaches to pain, such as resting, without resourcefulness when initial efforts fail) had more emergency room visits and participated in fewer activities at home and in school. Another study found that negative thinking (expression of fear and anger) correlates with psychological distress (4). Nine months after the initial assessment, these studies showed that the coping strategies of younger children and adults are relatively stable, but those of adolescents are in flux. Adolescent bravado may result in a tendency to deny illness and a reluctance to go to a strange adult care facility. Adolescents desire independence as adults but may not be ready to face new responsibilities for appointments and medications. They also need support to deal with issues such as contraception, sexually transmitted diseases, and family planning. Some show little psychological variation between adjustment in siblings and patients, and little difference from population norms (5), while others show significant stress on siblings (6). Programs exist to improve the education and coping of family members, reduce daily strain, and teach stress management techniques (8,9). This structure was established because all children need to see pediatricians for development checks and routine immunizations. By contrast, most adolescents and young adults ages 18­30 are healthy, so few see health care providers for preventive measures. Because patients must take the initiative for health maintenance, their readiness to accept this responsibility should be assessed. Some 18-year-old youths are not ready to go from pediatric to adult care, so developmental age is a more appropriate guide. Similarly, a patient who has just experienced a serious complication, such as acute chest syndrome, is unprepared psychologically for transition to new providers. Social service workers play a major role in assessment, since they have more contact with patients and parents than any other members of the team and can judge how families deal with psychosocial problems of chronic illness, such as anxiety and depression. If they concur that the patient and family are ready for transition, the subject should be broached to the parents and child well ahead of time to prepare them. Each of these providers views patients from a different perspective, so they must meet together often to assess readiness of patients and their families for transition. New providers can miss problems when presented with just a discharge summary and list of medications. The meetings also give providers who treat adults a chance to ask questions and to assure pediatricians that patient needs will be met. This is a process that occurs gradually, in contrast to an abrupt transfer of locale. The idea of transition is mentioned a year or so before the process begins, to prepare families mentally; reading material can reinforce the concept between clinic visits. Patients and providers should make plans together to ensure they are clear to all. Providers can gauge success at each point, and patients may ask questions and voice concerns. They often have difficulty relinquishing the central role, and this can produce resistance to the transition effort. Reassurance that the pediatric and adult providers will remain in contact is important to alleviate the fear that the pediatricians are abandoning them. One of the most effective ways to dispel fears of transition is to make contact with people who have gone through the process. Community events, such as picnics or holiday celebrations, often work better than meetings because they focus on activity rather than disability, and discussion is easier without health providers. Institutional administrators are also important to support transition programs, which require personnel allocated by the administration. A single provider without nursing or social service support cannot deliver care or transition patients adequately. Some pediatric facilities have an upper age limit for inpatient care, and transition may be suboptimal if patients with delayed development are transferred to adult facilities just because of age. In this familiar environment, the family will have a chance to clarify details of the transition before a last pediatric visit. Pediatric providers should not simply give patients the phone number and instruct them to call. At the last pediatric visit, providers should schedule the next appointment as they normally do, but it will be with the adult team. A member of the adult team should escort the family to the new facility, and introduce them to the staff there. For example, a pain episode is not the best time to meet new providers in a strange place. A "no show" at the adult facility may be an indirect way to ask for more help with the transition process. Often, patients are reluctant because the adult clinic is unfamiliar, yet they will not return to the pediatric clinic, which they perceive to have discharged them. For example, asymptomatic retinal blood vessel proliferation may result in ocular hemorrhage unless treated by an ophthalmologist before visual loss occurs. They have fewer chronic complications than adults, and hospitalizations occur mainly for self-limited painful events. Thus they often require government assistance, but these programs lack full coverage, such as for transition programs. Adult providers sometimes feel they are given only problem patients, while pediatricians keep those who are easiest to treat. Frequent transition team meetings where adult and pediatric providers discuss the patients can dispel such misconceptions. If no local adult care program exists, pediatricians may hold on to their patients and treat problems outside their area of expertise. Nevertheless, they also should empower the patients to deal with an unfamiliar system. This should include copies of basic records, such as immunizations, blood type, complications, and current medications, especially those that work during an acute pain episode. The primary charge lies with the pediatric providers, whose first step is to assess the readiness of the patient and family. The transition process encourages the gradual maturation of relationships with adult providers via steps that are designed individually, due to differences among institutions, providers, and patients. Such development does not occur automatically, and a comprehensive transition program is not always possible. Nevertheless, adult providers and administrators should be enlisted to deliver continuous care, which can avert medical disasters. Transfer as a component of the transition of adolescents with sickle cell disease to adult care: adolescent, adult, and parent perspectives.

Onchocerciasis (River Blindness) by · this disease is caused It is Onchocerca volvulus cholesterol test sheffield simvastatin 5mg with mastercard. They can enter the eye where adult worms are visible in the subconjuctival space around the iris cholesterol data chart buy discount simvastatin 40mg on-line. Dracunculiasis Visceral Larva Migrans by Toxocara · this disease is causeddisease of canis cholesterol test youtube buy simvastatin 10 mg on line. The larval form matures in the intestines cholesterol diet chart in urdu cheap 20 mg simvastatin visa, then migrates to the liver cholesterol and eggs truth discount 40 mg simvastatin amex, brain cholesterol risk ratio formula buy 40mg simvastatin with visa, and eyes (only the larvae cause disease). The disease is treated by removing subcutaneous worms-formerly by winding them on a thin stick, now usually by surgery. These filarial worms block the flow of lymph, causing edematous arms, legs, and scrotum. Trichinosis Trichinella spiralis-an · this disease is caused byencysts in the tissue of human intestinal nematode that and porcine hosts. In its earlycoiled encysted larvae in a stages, the disease is treated with thiabendazole; no treatment is available for the late stages. Trichuriasis (Whipworm Disease) disease · this infectionisiscaused by Trichuris trichiura. The usually asymptomatic; however, abdominal pain, diarrhea, flatulence, and rectal prolapse can occur. Hookworm Disease · this disease is caused by Ancylostoma Ascariasis (Roundworm Disease) · this disease isItcaused by Ascaris lumbricoides. Larva grow in the intestine, causing abdominal symptoms, including intestinal obstruction. Strongyloidiasis (Threadworm Disease) · this disease is caused by Strongyloides stercoralis. It is a relatively benign disease in healthy individuals, but can progress to fatal outcome in immunocompromised patients. The mode of transmission varies widely, depending on the species and includes direct skin penetration by infectious larvae, ingestion of contaminated soil, eating undercooked pork, and insect bites. The parasites can invade almost any part of the body: liver, kidneys, intestines, subcutaneous tissue, or eyes. Generally, nematodes are categorized by whether they infect the intestine or other tissues (Figures 22. Alternatively, they can be divided into those for which the eggs are infectious and those for which the larvae are infectious. The most common nematode infection in the United States is enterobiasis (pinworm disease), which causes anal itching (Figure 22. A more serious disease of worldwide occurrence is ascariasis, caused by Ascaris lumbricoides (see Figure 22. Lacking a more specific identification of the causative organism, which of the following drugs would most likely be effective? Niclosamide Thiabendazole Praziquantel Diethylcarbamazine Tetracycline Correct answer = E. Filariasis Onchocerciasis Taeniasis Schistosomiasis Visceral larval migrans Correct answer = A. In the insect, the embryos develop into infective filariform larvae that are injected into the human host. Filariasis Onchocerciasis Dracunculiasis Schistosomiasis Visceral larval migrans Correct answer = D. Schistosome cercaria released from snails in fresh water are capable of penetrating human skin. Many viruses have additional structural features, for example, an envelope composed of a protein-containing lipid bilayer, whose presence or absence further distinguishes one virus group from another (Figure 23. In functional terms, a virion can be envisioned as a delivery system that surrounds a nucleic acid payload. The delivery system is designed to protect the genome and enable the virus to bind to host cells. The payload is the viral genome and may also include enzymes required for the initial steps in viral replication-a process that is obligately intracellular. The pathogenicity of a virus depends on a great variety of structural and functional characteristics. Therefore, even within a closely related group of viruses, different species may produce significantly distinct clinical pathologies. Within a virus family, differences in additional specific properties, such as host range, serologic reactions, amino acid sequences of Figure 23. Introduction to the Viruses viral proteins, degree of nucleic acid homology, among others, form the basis for division into genera (singular = genus) and species (Figure 23. Species of the same virus isolated from different geographic locations may differ from each other in nucleotide sequence. Genome the type of nucleic acid found in the virus particle is perhaps the most fundamental and straightforward of viral properties. Capsid symmetry the protein shell enclosing the genome is, for most virus families, found in either of two geometric configurations (see Figure 23. The capsid is constructed of multiple copies of a single polypeptide type (found in helical capsids) or a small number of different polypeptides (found in icosahedral capsids), requiring only a limited amount of genetic information to code for these structural components. Family ("­viridae") for example, Herpesviridae A Subfamily ("­virinae") B for example, alphaherpesvirinae Genus ("­virus") for example, Herpesvirus Species for example, Herpes simplex virus Figure 23. Helical symmetry: Capsids with helical symmetry, such as the 235 paramyxoviridae (see p. Several rows of protomers have been removed to reveal nucleic acid surrounded by a hollow protein cylinder. Because the nucleic acid of a virus is surrounded by the capsid, it is protected from environmental damage. Icosahedral symmetry: Capsids with icosahedral symmetry are more complex than those with helical symmetry, in that they consist of several different polypeptides grouped into structural subassemblies called capsomers. These, in turn, are hydrogen-bonded to each other to form an icosahedron (Figure 23. The nucleic acid genome is located within the empty space created by the rigid, icosahedral structure. Envelope An important structural feature used in defining a viral family is the presence or absence of a lipid-containing membrane surrounding the nucleocapsid. In enveloped viruses, the nucleocapsid is flexible and coiled within the envelope, resulting in most such viruses appearing to be roughly spherical (Figure 23. However, the cellular membrane proteins are replaced by virus-specific proteins, conferring virus-specific antigenicity upon the particle. In practice, this is determined by following events in a large population of infected cells in which the infection is proceeding as nearly synchronously as can be achieved by manipulating the experimental conditions. Whereas the time scale and yield of progeny virus vary greatly among virus families, the basic features of the infectious cycle are similar for all viruses. The one-step growth curve begins with the eclipse period, which is followed by a period of exponential growth (Figure 23. Introduction to the Viruses Infectious viruses per cell 1000 100 10 1 0 Eclipse period 0 10 Hours Exponential growth period Yield per cell Following initial attachment of a virus to the host cell, the ability of that virus to infect other cells disappears. This is the eclipse period, and it represents the time elapsed from initial entry and disassembly of the parental virus to the assembly of the first progeny virion. The eclipse period for most human viruses falls within a range of one to twenty hours. Exponential growth the number of progeny virus produced within the infected cell increases exponentially for a period of time, then reaches a plateau, after which no additional increase in virus yield occurs. The maximum yield per cell is characteristic for each virus-cell system, and reflects the balance between the rate at which virus components continue to be synthesized and assembled into virions, and the rate at which the cell loses the synthetic capacity and structural integrity needed to produce new virus particles. This may be from 8 to 72 hours or longer, with yields of 100 to 10,000 virions per cell. Gene expression and replication are followed by assembly and release of viral progeny. Adsorption the initial attachment of a virus particle to a host cell involves an interaction between specific molecular structures on the virion surface and receptor molecules in the host cell membrane that recognize these viral structures (Figure 23. Attachment sites on the viral surface: Some viruses have spe- Virus fails to bind to host cell receptor cialized attachment structures, such as the glycoprotein spikes found in viral envelopes (for example, rhabdoviruses, see p. In both cases, multiple copies of these molecular attachment structures are distributed around the surface of the virion. Not surprisingly, these receptors have been found to be molecular structures that usually carry out normal cell functions. Steps in the Replication Cycles of Viruses membrane receptors for compounds such as growth factors may also inadvertently serve as receptors for a particular virus. Many of the compounds that serve as virus receptors are present only on specifically differentiated cells or are unique for one animal species. Therefore, the presence or absence of host cell receptors is one important determinant of tissue specificity within a susceptible host species, and also for the susceptibility or resistance of a species to a given virus. Penetration Penetration is the passage of the virion from the surface of the cell, across the cell membrane and into the cytoplasm. There are two principal mechanisms by which viruses enter animal cells: receptormediated endocytosis and direct membrane fusion. Receptor-mediated endocytosis: this is basically the same pro- Formation of an endocytotic vesicle Endocytotic vesicle 4 Release of the virion into cytoplasm cess by which the cell internalizes compounds such as growth regulatory molecules and serum lipoproteins, except the infecting virus particle is bound to the host cell surface receptor in place of the normal ligand (Figure 23. The cell membrane invaginates, enclosing the virion in an endocytotic vesicle (endosome). Release of the virion into the cytoplasm occurs by various routes, depending on the virus but, in general, it is facilitated by one or more viral molecules. In the case of an enveloped virus, its membrane may fuse with the membrane of the endosome, resulting in the release of the nucleocapsid into the cytoplasm. Enveloped virus Binding of a virus to a host cell membrane receptor 1 Failure to exit the endosome before fusion with a lysosome generally results in degradation of the virion by lysosomal enzymes. Therefore, not all potentially infectious particles are successful in establishing infection. Membrane fusion: Some enveloped viruses (for example, human Fusion of viral envelope with the host cell membrane immunodeficiency virus, see p. One or more of the glycoproteins in the envelope of these viruses promotes the fusion. The end result of this process is that the nucleocapsid is free in the cytoplasm, whereas the viral membrane remains associated with the plasma membrane of the host cell. Introduction to the Viruses "Uncoating" refers to the stepwise process of disassembly of the virion that enables the expression of the viral genes that carry out replication. For enveloped viruses, the penetration process itself is the first step in uncoating. In general, most steps of the uncoating process occur within the cell and depend on cellular enzymes; however in some of the more complex viruses, newly synthesized viral proteins are required to complete the process. The loss of one or more structural components of the virion during uncoating predictably leads to a loss of the ability of that particle to infect other cells, which is the basis for the eclipse period of the growth curve (see Figure 23. It is during this phase in the replication cycle that viral gene expression begins. The wide range of viral genome sizes gives rise to great differences in the number of proteins for which the virus can code. In general, the smaller the viral genome, the more the virus must depend on the host cell to provide the functions needed for viral replication. Unlike (+) strand genomes, however, the (­) strand genomes cannot accomplish these goals without prior construction of a complementary (+) strand intermediate (Figure 23. This makes the (+) strands available as templates for the synthesis of genomic (­) strands. Further, segmented genome viruses have the additional problem of assuring that all segments are incorporated into the progeny virions. The various capsid components begin to self-assemble, eventually associating with the nucleic acid to complete the nucleocapsid. Naked viruses: In naked (unenveloped) viruses, the virion is com- 1 Virus-specific glycoproteins are synthesized and transported to the host cell membrane. Release of progeny is usually a passive event resulting from the disintegration of the dying cell and, therefore, may be at a relatively late time after infection. Enveloped viruses: In enveloped viruses, virus-specific glyco- Viral protein 2 the cytoplasmic domains of membrane proteins bind nucleocapsids. The cytoplasmic domains of these proteins associate specifically with one or more additional viral proteins (matrix proteins) to which the nucleocapsids bind. Final maturation then involves envelopment of the nucleocapsid by a process of "budding" (Figure 23. A consequence of this mechanism of viral replication is that progeny virus are released continuously while replication is proceeding within the cell and ends when the cell loses its ability to maintain the integrity of the plasma membrane. A second consequence is that with most enveloped viruses, all infectious progeny are extracellular. The exceptions are those viruses that acquire their envelopes by budding through internal cell membranes, such as those of the endoplasmic reticulum or nucleus. Viruses containing lipid envelopes are sensitive to damage by harsh environments and, therefore, tend to be transmitted by the respiratory, parenteral, and sexual routes. Nonenveloped viruses are more stable to hostile environmental conditions and often transmitted by the fecaloral route. Effects of viral infection on the host cell the response of a host cell to infection by a virus ranges from: 1) little or no detectable effect; to 2) alteration of the antigenic specificity of the cell surface due to presence of virus glycoproteins; to 3) latent infections that, in some cases, cause cell transformation; or, ultimately, to 4) cell death due to expression of viral genes that shut off essential host cell functions (Figure 23. Viral infections in which no progeny virus are produced: In this 5 the enveloped virion is released from the host cell. An abortive response to infection is commonly caused by: 1) a normal virus infecting cells that are lacking in enzymes, promoters, transcription factors, or other compounds required for complete viral replication, in 1See Figure 23. Steps in the Replication Cycles of Viruses which case the cells are referred to as nonpermissive; 2) infection by a defective virus of a cell that normally supports viral replication (that is, by a virus that itself has genetically lost the ability to replicate in that cell type); or 3) death of the cell as a consequence of the infection, before viral replication has been completed.

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Comprehensive lifestyle interventionІInterventions that are designed to address chronic disease risk factors and improve health cholesterol what is normal quality simvastatin 5 mg. They generally include three principal componentsІa diet component hdl cholesterol ratio and risk discount simvastatin 20 mg on line, a physical activity component cholesterol young adults generic 40 mg simvastatin mastercard, and a program of behavior change to facilitate adherence to diet and physical activity recommendations cholesterol content chart buy discount simvastatin 10mg online. Comprehensive lifestyle intervention teamІA multidisciplinary team of highly trained professionals cholesterol medication with grapefruit 5 mg simvastatin for sale, including registered dietitians and nutritionists cholesterolosis buy simvastatin 5mg on-line, exercise specialists, and behaviorists who work with individuals on weight loss or other lifestyle behavior change to improve health and reduce chronic disease risk. Cup equivalent (cup eq)ІThe amount of a food product that is considered equal to 1 cup from the vegetable, fruit, or milk food group. A cup equivalent for some foods may differ from a measured cup in volume because (1) the foods have been concentrated (such as raisins or tomato paste), (2) the foods are airy in their raw form and do not compress well into a cup Child-care settingsІLocations that include child-care centers and child-care provided in homes. Early childhood education settings, such as preschool and Head Start programs, also are included. Competitive foodsІFoods and beverages offered at schools that are sold or offered outside of the Federally reimbursed school lunch and breakfast programs. Dietary patternІThe quantities, proportions, variety or combinations of different food and beverages in diets, and the frequency with which they are habitually consumed. Eating outІA behavior that includes meals eaten outside of the home at a variety of venues and takeout or ready-to-eat meals purchased and consumed either away from or in the home. Empty caloriesІThe calories from components of a food or beverage that contribute few or no nutrients. In some foods, such as soda and many candies, all the calories are empty calories. However, empty calories also can be found in foods that contain important nutrients. For example, whole milk contains solid fats (butterfat) and sweetened applesauce contains added sugars, which means that some of their calories are empty calories. Energy drinkІA beverage that contains caffeine as a major active ingredient, along with other ingredients, such as taurine, herbal supplements, vitamins, and sugar. It is usually marketed as a product that can improve perceived energy, stamina, athletic performance, or concentration. EnrichmentІThe addition of specific nutrients (iron, thiamin, riboflavin, and niacin) to refined grain products in order to replace losses of the nutrients that occur during processing. Environmental sustainabilityІLong-term maintenance of ecosystem components and functions for future generations. Primary sources are nuts and liquid vegetable oils, including soybean oil, corn oil, and safflower oil. Major sources include animal products such as meat and dairy products, and tropical oils such as coconut or palm oils. Sources of trans fatty acids include partially-hydrogenated vegetable oils that have been used to make traditional shortening and some commercially prepared baked goods, snack foods, fried foods, and traditional stick margarine. Food categoriesІA method of grouping similar foods in their as-consumed forms, for descriptive purposes. In contrast to food groups, items are not disaggregated into their component parts for assignment to food categories. Food environmentsІFactors and conditions that influence food choices and food availability. These environments include settings such as home, child care (early care and education), school, after-school programs, worksites, food retail stores and restaurants, and other outlets where children and their families make eating and drinking decisions. The food environment also includes macro-level factors and includes food marketing, food production and distribution systems, agricultural policies, Federal nutrition assistance programs, and economic price structures. Food groupsІA method of grouping similar foods for descriptive and guidance purposes. Some of these groups are divided into subgroups, such as dark-green vegetables or whole grains, which may have intake goals or limits (for more information, see Appendix E3. For assignment to food groups, mixed dishes are disaggregated into their major component parts. For example, pizza may be disaggregated into the grain (crust), dairy (cheese), vegetable (sauce and toppings), and protein foods (toppings) food groups. Food pattern modelingІThe process of developing and adjusting daily intake amounts from food categories or groups to meet specific criteria, such as meeting nutrient intake goals, limiting nutrients or other food components, or varying proportions or amounts of specific food categories or groups. Food policiesІRegulations, laws, policy-making actions or formal or informal rules established by formal organizations or government units. Food and nutrition policies are those that influence the food environment and eating behavior to improve eating and body weight. Food securityІA condition in which all people, now and in the future, have access to sufficient, safe, and nutritious food to maintain a healthy and active life. Greenhouse gases include carbon dioxide, methane, nitrous oxide, ozone, chlorofluorocarbons, hydrochlorofluorocarbons, hydrofluorocarbons, perfluo rocarbons, and sulfur hexafluoride. HealthІA state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Household food insecurityІCircumstances in which the availability of nutritionally adequate and safe food, or the ability to acquire acceptable foods in socially acceptable ways, is limited or uncertain. Progressing household food insecurityІA change in situation from food secure to food insecure or from acute or temporary food insecurity to persistent food insecurity. Meta-analysisІThe statistical analysis of multiple individual studies for the purpose of integrating the findings and deriving conclusions from the body of literature. Mobile Health (mHealth)ІThe use of mobile and wireless technologies to support the achievement of health objectives. Moderate alcohol consumptionІAverage daily consumption of up to one drink per day for women and up to two drinks per day for men, with no more than three drinks in any single day for women and no more than four drinks in any single day for men. One drink is defined as 12 fluid ounces of regular beer, 5 fluid ounces of wine, or 1. Nutrient-dense foodsІFoods that are naturally rich in vitamins, minerals, and other substances that may have positive health effects, and are lean or low in solid fats and without added solid fats, sugars, starches, or sodium and that retain naturally-occurring components such as fiber. All vegetables, fruits, whole grains, fish, eggs, and nuts prepared without added solid fats or sugars are considered nutrient-dense, as are lean or low-fat forms of fluid milk, meat, and poultry prepared without added solid fats or sugars. Nutrient-dense foods provide substantial amounts of vitamins and minerals (micronutrients) and relatively few calories compared to forms of the food that have solid fat and/or added sugars. This rigorous, protocoldriven methodology is designed to minimize bias, maximize transparency, and ensure relevant, timely, and high-quality systematic reviews to inform Federal nutrition-related policies, programs, and recommendations. In a few cases, lay persons are used as trained interventionists; they received instruction in protocols (designed by health professionals) for programs that have been validated in high-quality trials and published in peer-reviewed journals. For example, two dietary patterns that vary in macronutrient proportions but have the same calorie content are isocaloric. Examples include 95% lean ground beef, cooked; broiled beef steak, lean only eaten; baked pork chop, lean only eaten; roasted chicken breast or leg, no skin eaten; and smoked/cured ham, lean only eaten. The general categories of environmental impacts needing consideration include resource use, human health, and ecological consequences. Some common oils include canola, corn, olive, peanut, safflower, soybean, and sunflower oils. A number of foods are naturally high in oils, such as: nuts, olives, some fish, and avocados. Foods that are mainly made up of oil include mayonnaise, certain salad dressings, and soft (tub or squeeze) margarine with no trans fats. Oils are high in monounsaturated or polyunsaturated fats, and lower in saturated fats than solid fats. A few plant oils, termed tropical oils, including coconut oil, palm oil and palm kernel oil, are high in saturated fats and for nutritional purposes should be considered as solid fats. Partially-hydrogenated oils that contain trans fats should also be considered as solid fats for nutritional purposes. An ounce equivalent for some foods may be less than a measured ounce in weight if the food is concentrated or low in water content (nuts, peanut butter, dried meats, flour) or more than a measured ounce in weight if the food contains a large amount of water (tofu, cooked beans, cooked rice or pasta). They can persist for long periods of time and can accumulate and pass from one species to the next through the food chain. A portion is not a standardized amount, and the amount considered to be a portion is subjective and varies. Processed meatІMeat, poultry, or seafood products preserved by smoking, curing or salting, or addition of chemical preservatives. Processed meat includes bacon, sausage, hot dogs, sandwich meat, packaged ham, pepperoni, and salami. Proteins are composed of amino acids, nine of which are indispensable, meaning they cannot be synthesized by humans and therefore must be obtained from the diet. Protein quality is determined by two factors: digestibility and amino acid composition. Vegetable proteinІProtein from plants such as dry beans, whole grains, fruit, nuts, and seeds. Refined grainsІGrains and grain products missing the bran, germ, and/or endosperm; any grain product that is not a whole grain. Many refined grains are low in fiber but enriched with thiamin, riboflavin, niacin, and iron, and fortified with folic acid. Screen timeІTime in front of a computer, television, video or computer game system, or smart phone or tablet or related device. Seafood includes fish, such as salmon, tuna, trout, and tilapia, and shellfish, such as shrimp, crab, and oysters. Sedentary behaviorІAny waking activity predominantly done while in a sitting or reclining posture. Self-monitoringІSelf-monitoring refers to the process by which an individual observes and records specific information about his or her behaviors. For example, in weight management self-monitoring, 402 2015 Dietary Guidelines Advisory Committee Report observations and records would reflect dietary intake, physical activity, and/or body weight. Solid fats are found in animal foods except for seafood, and can be made from vegetable oils through hydrogenation. Some tropical oil plants, such as coconut and palm, are considered as solid fats due to their fatty acid composition. Common fats considered to be solid fats include: butterfat, beef fat (tallow, suet), chicken fat, pork fat (lard), stick margarine, shortening, coconut oil, palm oil and palm kernel oil. Foods high in solid fats include: butter, full-fat cheeses, creams, whole milk, full fat ice creams, marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked goods made using these products (such as cookies, crackers, doughnuts, pastries, and croissants). These beverages include, but are not limited to , soda, fruitades, and sports drinks. Sustainable dietsІA pattern of eating that promotes health and well-being and provides food security for the present population while sustaining human and natural resources for future generations. Trophic levelІA functional classification of species that is based on feeding relationships. Generally, aquatic and terrestrial green plants comprise the first, or lowest, trophic level, herbivores comprise the second, and primary carnivores comprise the third, or highest level. Whole grainsІGrains and grain products made from the entire grain seed, usually called the kernel, which consists of the bran, germ, and endosperm. If the kernel has been cracked, crushed, or flaked, it must retain the same relative proportions of bran, germ, and endosperm as the original grain in order to be called whole grain. Senate Select Committee on Nutrition and Human Needs, led by Senator George McGovern, recommended Dietary Goals for the American people (U. The Goals consisted of complementary nutrientbased and food-based recommendations. The first Goal focused on energy balance and recommended that, to avoid overweight, Americans should consume only as much energy as they expended. For the food-based Goals, the Senate Committee recommended that Americans: Increase consumption of fruits, vegetables, and whole grains; x Decrease consumption of: o refined and processed sugars and foods high in such sugars; o foods high in total fat and animal fat, and partially replace saturated fats with polyunsaturated fats; o eggs, butterfat, and other high-cholesterol foods; o salt and foods high in salt; and x Choose low-fat and non-fat dairy products instead of high-fat dairy products (except for young children). The Dietary Goals was met with considerable debate and controversy, as industry groups and the scientific community expressed doubt that the science available x at the time supported the specificity of the numbers provided in the Dietary Goals. Ideas for incorporating a variety of foods to provide essential nutrients while maintaining recommended body weight were a focus. The brochure also provided guidance on limiting dietary components such as fat, saturated fat, cholesterol, and sodium, which were beginning to be considered risk factors in certain chronic diseases. Both the Dietary Goals and the first Dietary Guidelines for Americans were different from previous dietary guidance in that they reflected emerging scientific evidence and changed the historical focus on nutrient adequacy to also identify the impacts of diet on chronic disease. These documents discussed the concepts of moderation as well as nutrient adequacy. Even though the recommendations of the 1980 Dietary Guidelines for Americans were presented as innocuous and straightforward extrapolations from the science base, they, too, were met with controversy from a variety of industry and scientific groups. The Departments made relatively few changes from the first edition, but this second edition was issued with much less debate from either industry or the scientific community. The 1985 Dietary Guidelines were widely accepted and were used as the framework for consumer nutrition education messages. They also were used as a guide for healthy diets by scientific, consumer, and industry groups. For the first time, the Guidelines also suggested quantitative goals for total fat and saturated fat, though they stressed that the goals were to be met through dietary choices made over several days, not through choices about one meal or one food. The 1980, 1985, and 1990 editions of the Dietary Guidelines were issued voluntarily by the two Departments. A Dietary Guidelines Advisory Committee was established to prepare technical reports that advised the Federal government on the status of the evidence on nutrition and health. Since 1980, the Dietary Guidelines have been notably consistent in their recommendations on the components of a healthful diet, but they also have changed in some significant ways to reflect emerging science as well as public health concerns, such as the increasing prevalence of major chronic diseases among the majority of the general population. In keeping with growing emphasis on data quality in developing recommendations, the 2005 Committee used a modified systematic approach for reviewing the scientific literature. This rigorous, protocol-driven methodology is designed to minimize bias, maximize transparency, and ensure relevant, timely, and high-quality systematic reviews to inform Federal nutrition-related policies, programs, and recommendations. The Dietary Guidelines have proven to be a mechanism for addressing public health concerns by providing focused guidance that can help to promote health and reduce chronic disease risk.

References

• Antman EM, Hand M, Armstrong PW, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction, writing on behalf of the 2004 Writing Committee. Circulation. 2008;117(2):296-329.
• Wilkinson GR, Shand DG: Commentary: A physiological approach to hepatic drug clearance, Clin Pharmacol Ther 18:377, 1975.
• Romson JL, Leung JM, Bellows WH, et al. Effects of dobutamine on hemodynamics and left ventricular performance after cardiopulmonary bypass in cardiac surgical patients. Anesthesiology 1999; 91:1318-1328.
• Younger DS. Motor neuron disease or malignancy. Muscle Nerve. 2000;23(5):658-660.
• Servoss SJ, Januzzi JL, Muller JE. Triggers of acute coronary syndromes. Prog Cardiovasc Dis 2002;44:369-380.
• Hughes JL, Brown T, Edgar JD, et al. Peanut allergy and allergic airways inflammation. Pediatr Allergy Immunol 2010; 21: 1107-1113.
• Dietrich WD, Busto R, Halley M, et al. The importance of brain temperature in alterations of the blood-brain barrier following cerebral ischemia. J Neuropathol Exp Neurol 1990;49(5): 486-97.