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(-) Remove Consolidator Grant (CoG) (22) filter Consolidator Grant (CoG) (22) Project acronym AgeConsolidate Project The Missing Link of Episodic Memory Decline in Aging: The Role of Inefficient Systems Consolidation Researcher (PI) Anders Martin FJELL Host Institution (HI) UNIVERSITETET I OSLO Summary Which brain mechanisms are responsible for the faith of the memories we make with age, whether they wither or stay, and in what form? Episodic memory function does decline with age. While this decline can have multiple causes, research has focused almost entirely on encoding and retrieval processes, largely ignoring a third critical process– consolidation. The objective of AgeConsolidate is to provide this missing link, by combining novel experimental cognitive paradigms with neuroimaging in a longitudinal large-scale attempt to directly test how age-related changes in consolidation processes in the brain impact episodic memory decline. The ambitious aims of the present proposal are two-fold: (1) Use recent advances in memory consolidation theory to achieve an elaborate model of episodic memory deficits in aging (2) Use aging as a model to uncover how structural and functional brain changes affect episodic memory consolidation in general The novelty of the project lies in the synthesis of recent methodological advances and theoretical models for episodic memory consolidation to explain age-related decline, by employing a unique combination of a range of different techniques and approaches. This is ground-breaking, in that it aims at taking our understanding of the brain processes underlying episodic memory decline in aging to a new level, while at the same time advancing our theoretical understanding of how episodic memories are consolidated in the human brain. To obtain this outcome, I will test the main hypothesis of the project: Brain processes of episodic memory consolidation are less effective in older adults, and this can account for a significant portion of the episodic memory decline in aging. This will be answered by six secondary hypotheses, with 1-3 experiments or tasks designated to address each hypothesis, focusing on functional and structural MRI, positron emission tomography data and sleep experiments to target consolidation from different angles. Which brain mechanisms are responsible for the faith of the memories we make with age, whether they wither or stay, and in what form? Episodic memory function does decline with age. While this decline can have multiple causes, research has focused almost entirely on encoding and retrieval processes, largely ignoring a third critical process– consolidation. The objective of AgeConsolidate is to provide this missing link, by combining novel experimental cognitive paradigms with neuroimaging in a longitudinal large-scale attempt to directly test how age-related changes in consolidation processes in the brain impact episodic memory decline. The ambitious aims of the present proposal are two-fold: (1) Use recent advances in memory consolidation theory to achieve an elaborate model of episodic memory deficits in aging (2) Use aging as a model to uncover how structural and functional brain changes affect episodic memory consolidation in general The novelty of the project lies in the synthesis of recent methodological advances and theoretical models for episodic memory consolidation to explain age-related decline, by employing a unique combination of a range of different techniques and approaches. This is ground-breaking, in that it aims at taking our understanding of the brain processes underlying episodic memory decline in aging to a new level, while at the same time advancing our theoretical understanding of how episodic memories are consolidated in the human brain. To obtain this outcome, I will test the main hypothesis of the project: Brain processes of episodic memory consolidation are less effective in older adults, and this can account for a significant portion of the episodic memory decline in aging. This will be answered by six secondary hypotheses, with 1-3 experiments or tasks designated to address each hypothesis, focusing on functional and structural MRI, positron emission tomography data and sleep experiments to target consolidation from different angles. Project acronym CAPTURE Project CApturing Paradata for documenTing data creation and Use for the REsearch of the future Researcher (PI) Isto HUVILA Summary "Considerable investments have been made in Europe and worldwide in research data infrastructures. Instead of a general lack of data about data, it has become apparent that the pivotal factor that drastically constrains the use of data is the absence of contextual knowledge about how data was created and how it has been used. This applies especially to many branches of SSH research where data is highly heterogeneous, both by its kind (e.g. being qualitative, quantitative, naturalistic, purposefully created) and origins (e.g. being historical/contemporary, from different contexts and geographical places). The problem is that there may be enough metadata (data about data) but there is too little paradata (data on the processes of its creation and use). In contrast to the rather straightforward problem of describing the data, the high-risk/high-gain problem no-one has managed to solve, is the lack of comprehensive understanding of what information about the creation and use of research data is needed and how to capture enough of that information to make the data reusable and to avoid the risk that currently collected vast amounts of research data become useless in the future. The wickedness of the problem lies in the practical impossibility to document and keep everything and the difficulty to determine optimal procedures for capturing just enough. With an empirical focus on archaeological and cultural heritage data, which stands out by its extreme heterogeneity and rapid accumulation due to the scale of ongoing development-led archaeological fieldwork, CAPTURE develops an in-depth understanding of how paradata is #1 created and #2 used at the moment, #3 elicits methods for capturing paradata on the basis of the findings of #1-2, #4 tests the new methods in field trials, and #5 synthesises the findings in a reference model to inform the capturing of paradata and enabling data-intensive research using heterogeneous research data stemming from diverse origins. " "Considerable investments have been made in Europe and worldwide in research data infrastructures. Instead of a general lack of data about data, it has become apparent that the pivotal factor that drastically constrains the use of data is the absence of contextual knowledge about how data was created and how it has been used. This applies especially to many branches of SSH research where data is highly heterogeneous, both by its kind (e.g. being qualitative, quantitative, naturalistic, purposefully created) and origins (e.g. being historical/contemporary, from different contexts and geographical places). The problem is that there may be enough metadata (data about data) but there is too little paradata (data on the processes of its creation and use). In contrast to the rather straightforward problem of describing the data, the high-risk/high-gain problem no-one has managed to solve, is the lack of comprehensive understanding of what information about the creation and use of research data is needed and how to capture enough of that information to make the data reusable and to avoid the risk that currently collected vast amounts of research data become useless in the future. The wickedness of the problem lies in the practical impossibility to document and keep everything and the difficulty to determine optimal procedures for capturing just enough. With an empirical focus on archaeological and cultural heritage data, which stands out by its extreme heterogeneity and rapid accumulation due to the scale of ongoing development-led archaeological fieldwork, CAPTURE develops an in-depth understanding of how paradata is #1 created and #2 used at the moment, #3 elicits methods for capturing paradata on the basis of the findings of #1-2, #4 tests the new methods in field trials, and #5 synthesises the findings in a reference model to inform the capturing of paradata and enabling data-intensive research using heterogeneous research data stemming from diverse origins. " Project acronym DECRESIM Project A Chemical Approach to Molecular Spin Qubits: Decoherence and Organisation of Rare Earth Single Ion Magnets Researcher (PI) Alejandro Gaita Ariño Host Institution (HI) UNIVERSITAT DE VALENCIA Call Details Consolidator Grant (CoG), PE5, ERC-2014-CoG Summary "Coordination Chemistry and Molecular Magnetism are in an ideal position for the rational design of Single-Molecule Magnets which can be used as molecular spin qubits, the irreducible components of any quantum technology. Indeed, a major advantage of molecular spin qubits over other candidates stems from the power of Chemistry for a tailored and inexpensive synthesis of systems for their experimental study. In particular, the so-called Lanthanoid-based Single-Ion Magnets, which are currently the hottest topic in Molecular Magnetism, have the potential to be chemically designed, tuning both their single-molecule properties and their crystalline environment. This will allow the independent study of the different quantum processes that cause the loss of quantum information, collectively known as decoherence. The study of quantum decoherence processes in the solid state is necessary both to lay the foundations for next-generation quantum technologies and to answer some fundamental questions. The goals of this project are: #1 To unravel the mechanistic details of decoherence in molecular spin qubits based on mononuclear lanthanoid complexes. This study will stablish criteria for the rational design of single spin qubits. #2 To extend this study to the coupling between two or more spin qubits. This will allow us to explore the use of polynuclear lanthanoid complexes to achieve quantum gates or simple algorithms. #3 To extrapolate to infinite systems formed by the complex organization of spin qubits. This exploratory goal will permit us to move beyond zero-dimensional systems, thus facilitating the advance towards complex quantum functions. " "Coordination Chemistry and Molecular Magnetism are in an ideal position for the rational design of Single-Molecule Magnets which can be used as molecular spin qubits, the irreducible components of any quantum technology. Indeed, a major advantage of molecular spin qubits over other candidates stems from the power of Chemistry for a tailored and inexpensive synthesis of systems for their experimental study. In particular, the so-called Lanthanoid-based Single-Ion Magnets, which are currently the hottest topic in Molecular Magnetism, have the potential to be chemically designed, tuning both their single-molecule properties and their crystalline environment. This will allow the independent study of the different quantum processes that cause the loss of quantum information, collectively known as decoherence. The study of quantum decoherence processes in the solid state is necessary both to lay the foundations for next-generation quantum technologies and to answer some fundamental questions. The goals of this project are: #1 To unravel the mechanistic details of decoherence in molecular spin qubits based on mononuclear lanthanoid complexes. This study will stablish criteria for the rational design of single spin qubits. #2 To extend this study to the coupling between two or more spin qubits. This will allow us to explore the use of polynuclear lanthanoid complexes to achieve quantum gates or simple algorithms. #3 To extrapolate to infinite systems formed by the complex organization of spin qubits. This exploratory goal will permit us to move beyond zero-dimensional systems, thus facilitating the advance towards complex quantum functions. " Project acronym EPIScOPE Project Reversing the epigenetic state of oligodendrocyte precursors cells in multiple sclerosis Researcher (PI) Gonçalo DE SÁ E SOUSA DE CASTELO BRANCO Summary Oligodendrocytes (OL) are glial cells that mediate myelination of neurons, a process that is defective in multiple sclerosis (MS). Although OL precursor cells (OPCs) can initially promote remyelination in MS, this regenerative mechanism eventually fails in progressive MS. OPCs go through several epigenetic states that ultimately define their potential to differentiate and myelinate. OPCs in progressive MS stall in a distinct epigenetic state, incompatible with differentiation and remyelination. We hypothesize that these OPCs regress to an epigenetic state reminiscent of the state of embryonic OPCs, which remain undifferentiated. In this proposal, we aim to uncover the causes behind the remyelination failure upon disease progression in MS. We will determine the epigenetic/transcriptional states of OPCs during development and in MS, using single cell and bulk RNA sequencing and quantitative proteomics. We will further investigate how the interplay between transcription factors (TFs), chromatin modifiers (ChMs) and non-coding RNAs (ncRNAs) contributes to the transition between epigenetic states of OPCs. The results will allow the identification of ChMs and ncRNAs that can modulate these states and thereby control OPC differentiation and myelination. We will use this knowledge to investigate whether we can reverse the epigenetic state of OPCs in MS, in order to promote their differentiation and remyelination. The unique combination of leading-edge techniques such as SILAC coupled with immunoprecipitation and mass-spectrometry, single-cell RNA sequencing, ChIP-Sequencing, among others, will allow us to provide insights into novel epigenetic mechanisms that might be underlying the effects of environmental and lifestyle risk factors for MS. Moreover, this project has the potential to lead to the discovery of new targets for epigenetic-based therapies for MS, which could provide major opportunities for improved clinical outcome of MS patients in the near future. Oligodendrocytes (OL) are glial cells that mediate myelination of neurons, a process that is defective in multiple sclerosis (MS). Although OL precursor cells (OPCs) can initially promote remyelination in MS, this regenerative mechanism eventually fails in progressive MS. OPCs go through several epigenetic states that ultimately define their potential to differentiate and myelinate. OPCs in progressive MS stall in a distinct epigenetic state, incompatible with differentiation and remyelination. We hypothesize that these OPCs regress to an epigenetic state reminiscent of the state of embryonic OPCs, which remain undifferentiated. In this proposal, we aim to uncover the causes behind the remyelination failure upon disease progression in MS. We will determine the epigenetic/transcriptional states of OPCs during development and in MS, using single cell and bulk RNA sequencing and quantitative proteomics. We will further investigate how the interplay between transcription factors (TFs), chromatin modifiers (ChMs) and non-coding RNAs (ncRNAs) contributes to the transition between epigenetic states of OPCs. The results will allow the identification of ChMs and ncRNAs that can modulate these states and thereby control OPC differentiation and myelination. We will use this knowledge to investigate whether we can reverse the epigenetic state of OPCs in MS, in order to promote their differentiation and remyelination. The unique combination of leading-edge techniques such as SILAC coupled with immunoprecipitation and mass-spectrometry, single-cell RNA sequencing, ChIP-Sequencing, among others, will allow us to provide insights into novel epigenetic mechanisms that might be underlying the effects of environmental and lifestyle risk factors for MS. Moreover, this project has the potential to lead to the discovery of new targets for epigenetic-based therapies for MS, which could provide major opportunities for improved clinical outcome of MS patients in the near future. Project acronym HyMAP Project Hybrid Materials for Artificial Photosynthesis Researcher (PI) Víctor Antonio De La Peña O'shea Host Institution (HI) Fundacion IMDEA Energia Summary HyMAP aims to develop a new generation of multifunctional hybrid photocatalysts and solar photoreactor which would allow the exploitation of at least the 1 % of the sunlight energy for the CO2 photoreduction using water as electron donor. This will imply a CO2 conversion in the range of 12 to 35 Ton/y•ha, depending on product distribution, which represents at least a 20-fold improvement over the state of the art. To achieve this goal, I propose an interdisciplinary research program through which several breakthroughs at different scales will be achieved: Development of efficient multifunctional organic/inorganic semiconductors and metal-organic frameworks photocatalysts with separated reduction/oxidation active sites. The fact of having independent multiple redox sites combined in a single material would maximize charge separation and transport processes, as well as sunlight harvesting. Characterization and modelling of the structural and opto-electronic properties of the proposed materials. Evaluation of the materials in artificial photosynthesis devices. At this stage, a solar photoreactor that would allow good transmission, uniform light distribution and maximize the energy harvesting in the overall spectra will be developed. HYMAP will provide me with an excellent opportunity to lead a consolidated research group. During my scientific career I have demonstrated creative thinking, autonomy and an excellent capacity to carry out state of the art research in heterogeneous catalysis, characterization, modelling and reactor engineering. I have a meritorious research track reflected by a good number of scientific publications, broad professional expertise, innovative project conception and a consolidate network of international collaboration. This, along with my leadership and management abilities, will assure the successful achievement of the mentioned goals of this project. HyMAP is a revised version of a proposal scored with A (2nd stage) of last ERC-CoG call. HyMAP aims to develop a new generation of multifunctional hybrid photocatalysts and solar photoreactor which would allow the exploitation of at least the 1 % of the sunlight energy for the CO2 photoreduction using water as electron donor. This will imply a CO2 conversion in the range of 12 to 35 Ton/y•ha, depending on product distribution, which represents at least a 20-fold improvement over the state of the art. To achieve this goal, I propose an interdisciplinary research program through which several breakthroughs at different scales will be achieved: Development of efficient multifunctional organic/inorganic semiconductors and metal-organic frameworks photocatalysts with separated reduction/oxidation active sites. The fact of having independent multiple redox sites combined in a single material would maximize charge separation and transport processes, as well as sunlight harvesting. Characterization and modelling of the structural and opto-electronic properties of the proposed materials. Evaluation of the materials in artificial photosynthesis devices. At this stage, a solar photoreactor that would allow good transmission, uniform light distribution and maximize the energy harvesting in the overall spectra will be developed. HYMAP will provide me with an excellent opportunity to lead a consolidated research group. During my scientific career I have demonstrated creative thinking, autonomy and an excellent capacity to carry out state of the art research in heterogeneous catalysis, characterization, modelling and reactor engineering. I have a meritorious research track reflected by a good number of scientific publications, broad professional expertise, innovative project conception and a consolidate network of international collaboration. This, along with my leadership and management abilities, will assure the successful achievement of the mentioned goals of this project. HyMAP is a revised version of a proposal scored with A (2nd stage) of last ERC-CoG call. Project acronym LArcHer Project Breaking barriers between Science and Heritage approaches to Levantine Rock Art through Archaeology, Heritage Science and IT Researcher (PI) Ines DOMINGO SANZ Host Institution (HI) UNIVERSITAT DE BARCELONA Summary LArcHer project aims at pioneering a new and more comprehensive way of understanding one of Europe's most extraordinary bodies of prehistoric art, awarded Unesco World Heritage status in 1998: Levantine rock art (LRA). The ground-breaking nature of the project relies on combining a multidisciplinary (Archaeology, Heritage Science and IT) and multiscale approach (from microanalysis to landscape perspectives) to gain a holistic view of this art. It also aims at closing existing gaps between science and heritage mainstreams, to better understand the values and threats affecting this tradition and bring about a change in the way we understand, care, use and manage this millenary legacy. LArcHer aims are: a) Use cross-disciplinary knowledge and methods to redefine LRA (i.e. new dating techniques to refine chronology, new analytical methods to understand the creative process); b) Use LRA as a proxy to raise new questions of global interest on the evolution of creative thinking and human cognition (i.e. the timing and driving forces behind the birth of anthropocentrism and visual narratives in the history of prehistoric art); c) Develop new research agendas to set off complementary goals between science and heritage and define best practices for open air rock art conservation and management. Spread across Mediterranean Iberia, LRA is the only European body of figurative art dominated by humans engaged in dynamic narratives of hunting, violence, warfare, dances and so forth. These scenes are unique to explore past social dynamics, human behaviour and cultural practices. As such, it is the only body of European rock art with potential to answer some of the new questions raised by LArcHer. Key to LArcHer are the systematic recording and analysis of the art through 3D Digital technologies, management and data storage systems, GIS, physicochemical analysis of pigments and bedrock and comparative analysis with other major bodies of art with equivalent developments. LArcHer project aims at pioneering a new and more comprehensive way of understanding one of Europe's most extraordinary bodies of prehistoric art, awarded Unesco World Heritage status in 1998: Levantine rock art (LRA). The ground-breaking nature of the project relies on combining a multidisciplinary (Archaeology, Heritage Science and IT) and multiscale approach (from microanalysis to landscape perspectives) to gain a holistic view of this art. It also aims at closing existing gaps between science and heritage mainstreams, to better understand the values and threats affecting this tradition and bring about a change in the way we understand, care, use and manage this millenary legacy. LArcHer aims are: a) Use cross-disciplinary knowledge and methods to redefine LRA (i.e. new dating techniques to refine chronology, new analytical methods to understand the creative process); b) Use LRA as a proxy to raise new questions of global interest on the evolution of creative thinking and human cognition (i.e. the timing and driving forces behind the birth of anthropocentrism and visual narratives in the history of prehistoric art); c) Develop new research agendas to set off complementary goals between science and heritage and define best practices for open air rock art conservation and management. Spread across Mediterranean Iberia, LRA is the only European body of figurative art dominated by humans engaged in dynamic narratives of hunting, violence, warfare, dances and so forth. These scenes are unique to explore past social dynamics, human behaviour and cultural practices. As such, it is the only body of European rock art with potential to answer some of the new questions raised by LArcHer. Key to LArcHer are the systematic recording and analysis of the art through 3D Digital technologies, management and data storage systems, GIS, physicochemical analysis of pigments and bedrock and comparative analysis with other major bodies of art with equivalent developments. Project acronym MOF-reactors Project Metal-Organic Frameworks as Chemical Reactors for the Synthesis of Well-Defined Sub-Nanometer Metal Clusters Researcher (PI) Emilio PARDO Summary Humankind advancement is connected to the use and development of metal forms. Recent works have unveiled exceptional properties –such as luminescence, biocompatibility, antitumoral activity or a superlative catalytic activity– for small aggregations of metal atoms, so–called sub–nanometer metal clusters (SNMCs). Despite this importance, the gram-scale synthesis of structurally and electronically well–defined SNMCs is still far from being a reality. The present proposal situates at the centre of such weakness and aims at making a breakthrough step-change on the use of metal-organic frameworks (MOFs) as chemical reactors for the in–situ synthesis of stable ligand-free SNMCs with such unique properties. This challenging synthetic strategy, which is assisted by striking published and inedited preliminary results, has solid foundations. Firstly, the design and large-scale preparation of cheap and novel families of highly robust and crystalline MOFs with tailor-made functional channels to be used as chemical reactors. Secondly, the application of solid-state post-synthetic methods to drive the multigram-scale preparation of unique ligand-free homo- and heterometallic SNMCs, which are, in the best-case scenario, very difficult to be obtained and stabilised outside the channels. Last but not least, single-crystal X-Ray diffraction will be used as the definitive tool for the characterisation, at the atomic level, of such ultrasmall species offering unprecedented snapshots about their real structures and formation mechanisms. The ultimate goal will be upscaling this synthetic strategy aiming at the large-scale fabrication of SNMCs and their industrial application will be then evaluated. A successful achievement of all the aforementioned objectives of this ground-breaking project would open new routes for the use of MOFs as chemical reactors to manufacture, at competitive prices, MOF-driven, structurally and electronically well–defined, ligand–free SNMCs in a multigram-scale. Humankind advancement is connected to the use and development of metal forms. Recent works have unveiled exceptional properties –such as luminescence, biocompatibility, antitumoral activity or a superlative catalytic activity– for small aggregations of metal atoms, so–called sub–nanometer metal clusters (SNMCs). Despite this importance, the gram-scale synthesis of structurally and electronically well–defined SNMCs is still far from being a reality. The present proposal situates at the centre of such weakness and aims at making a breakthrough step-change on the use of metal-organic frameworks (MOFs) as chemical reactors for the in–situ synthesis of stable ligand-free SNMCs with such unique properties. This challenging synthetic strategy, which is assisted by striking published and inedited preliminary results, has solid foundations. Firstly, the design and large-scale preparation of cheap and novel families of highly robust and crystalline MOFs with tailor-made functional channels to be used as chemical reactors. Secondly, the application of solid-state post-synthetic methods to drive the multigram-scale preparation of unique ligand-free homo- and heterometallic SNMCs, which are, in the best-case scenario, very difficult to be obtained and stabilised outside the channels. Last but not least, single-crystal X-Ray diffraction will be used as the definitive tool for the characterisation, at the atomic level, of such ultrasmall species offering unprecedented snapshots about their real structures and formation mechanisms. The ultimate goal will be upscaling this synthetic strategy aiming at the large-scale fabrication of SNMCs and their industrial application will be then evaluated. A successful achievement of all the aforementioned objectives of this ground-breaking project would open new routes for the use of MOFs as chemical reactors to manufacture, at competitive prices, MOF-driven, structurally and electronically well–defined, ligand–free SNMCs in a multigram-scale. Project acronym NewSpindleForce Project A new class of microtubules in the spindle exerting forces on kinetochores Researcher (PI) Iva Marija Tolic Host Institution (HI) RUDER BOSKOVIC INSTITUTE Summary At the onset of division the cell forms a spindle, a micro-machine made of microtubules, which divide the chromosomes by pulling on kinetochores, protein complexes on the chromosome. The central question in the field is how accurate chromosome segregation results from the interactions between kinetochores, microtubules and the associated proteins. According to the current paradigm, the forces on kinetochores are produced by k-fibers, bundles of microtubules extending between the spindle pole and the kinetochore. The proposed project is built upon a groundbreaking hypothesis that a new class of microtubules, which we term bridging microtubules, bridge sister kinetochores. Our preliminary results show that bridging microtubules are responsible for the positioning of kinetochores in HeLa and PtK1 cells. Bridging microtubules have not been studied before because this requires cutting-edge microscopy and laser microsurgery techniques. By applying these methods, with which I have extensive expertise, we will determine the organization of these microtubules, identify the proteins that link them with k-fibers, and uncover where and how the forces for kinetochore positioning and movement are generated. My strength is in taking an interdisciplinary approach, which I will use in this project by combining laser microsurgery with genetic perturbations, quantitative measurements of the responses and comparison with theoretical models. Understanding the role of bridging microtubules in force generation and chromosome movements will not only shed light on the mechanism of chromosome segregation, but may also increase the potential of mitotic anticancer strategies, as the spindle is a major target for chemotherapy. The proposed ERC funding is essential for the success of these timely and ambitious experiments, allowing me to strengthen my position as an international leader in research on cell division, thereby increasing Europe's foremost position in this field. At the onset of division the cell forms a spindle, a micro-machine made of microtubules, which divide the chromosomes by pulling on kinetochores, protein complexes on the chromosome. The central question in the field is how accurate chromosome segregation results from the interactions between kinetochores, microtubules and the associated proteins. According to the current paradigm, the forces on kinetochores are produced by k-fibers, bundles of microtubules extending between the spindle pole and the kinetochore. The proposed project is built upon a groundbreaking hypothesis that a new class of microtubules, which we term bridging microtubules, bridge sister kinetochores. Our preliminary results show that bridging microtubules are responsible for the positioning of kinetochores in HeLa and PtK1 cells. Bridging microtubules have not been studied before because this requires cutting-edge microscopy and laser microsurgery techniques. By applying these methods, with which I have extensive expertise, we will determine the organization of these microtubules, identify the proteins that link them with k-fibers, and uncover where and how the forces for kinetochore positioning and movement are generated. My strength is in taking an interdisciplinary approach, which I will use in this project by combining laser microsurgery with genetic perturbations, quantitative measurements of the responses and comparison with theoretical models. Understanding the role of bridging microtubules in force generation and chromosome movements will not only shed light on the mechanism of chromosome segregation, but may also increase the potential of mitotic anticancer strategies, as the spindle is a major target for chemotherapy. The proposed ERC funding is essential for the success of these timely and ambitious experiments, allowing me to strengthen my position as an international leader in research on cell division, thereby increasing Europe's foremost position in this field. Project acronym PRIORS Project Neural circuit dynamics underlying expectation and their impact on the variability of perceptual choices Researcher (PI) Jaime de la Rocha Vazquez Host Institution (HI) CONSORCI INSTITUT D'INVESTIGACIONS BIOMEDIQUES AUGUST PI I SUNYER Summary Just as our experience has its origin in our perceptions, our perceptions are fundamentally shaped by our experience. How does the brain build expectations from experience and how do expectations impact perception? In a Bayesian framework, expectations determine the environment's prior probability, which combined with stimulus information, can yield optimal decisions. While the accumulation-to-bound model describes temporal integration of sensory inputs and their combination with the prior, we still lack electrophysiological evidence showing neural circuits that integrate previous events adaptively to generate advantageous expectations. I aim to understand (1) how circuits in the cerebral cortex integrate the recent history of stimuli and rewards to generate expectations, (2) how expectations are combined with sensory input across the processing hierarchy to bias decisions and (3) whether the dynamics of the expectation can dominate neuronal and choice variability. I will train rats in a new auditory discrimination task using predictable stimulus sequences that, once learned, are used to compute adaptive priors that improve discrimination. I will perform population recordings and optogenetic manipulations to identify the brain areas involved in the computation of priors in the task. To reveal the circuit mechanisms underlying the observed dynamics I will train a computational network model to classify fluctuating inputs and, by adapting its dynamics to the statistics of the stimulus sequence, accumulate evidence across trials to maximize performance. The model will generalize the accumulation-to-bound model by integrating information across various time scales and will partition choice variability into that caused by the dynamics of the prior or by fluctuations in the stimulus response. My proposal points at a paradigm shift from viewing neuronal variability as a corrupting source of noise to the result of our brain's inevitable tendency to predict the future. Just as our experience has its origin in our perceptions, our perceptions are fundamentally shaped by our experience. How does the brain build expectations from experience and how do expectations impact perception? In a Bayesian framework, expectations determine the environment's prior probability, which combined with stimulus information, can yield optimal decisions. While the accumulation-to-bound model describes temporal integration of sensory inputs and their combination with the prior, we still lack electrophysiological evidence showing neural circuits that integrate previous events adaptively to generate advantageous expectations. I aim to understand (1) how circuits in the cerebral cortex integrate the recent history of stimuli and rewards to generate expectations, (2) how expectations are combined with sensory input across the processing hierarchy to bias decisions and (3) whether the dynamics of the expectation can dominate neuronal and choice variability. I will train rats in a new auditory discrimination task using predictable stimulus sequences that, once learned, are used to compute adaptive priors that improve discrimination. I will perform population recordings and optogenetic manipulations to identify the brain areas involved in the computation of priors in the task. To reveal the circuit mechanisms underlying the observed dynamics I will train a computational network model to classify fluctuating inputs and, by adapting its dynamics to the statistics of the stimulus sequence, accumulate evidence across trials to maximize performance. The model will generalize the accumulation-to-bound model by integrating information across various time scales and will partition choice variability into that caused by the dynamics of the prior or by fluctuations in the stimulus response. My proposal points at a paradigm shift from viewing neuronal variability as a corrupting source of noise to the result of our brain's inevitable tendency to predict the future.
Epileptic Seizures in Children Dramatically Reduced From a study of 21 patients published May 25, 2021 by Drug Science, the results showed that there was a 96% chance that a child with severe epilepsy would have a significant reduction in seizures with whole-plant cannabis medicine. Parents also reported improvements in sleep, eating, behavior, and cognition. This compares to the best clinical outcomes of traditional medications, including Epidiolex, of less than 50%. There was an observed reduction in seizure frequency of 84% with 'no significant adverse events'. The average dose taken was 8.9 mg THC and 276 mg CBD, with a range of terpenes, flavonoids, and other phytocannabinoids. Before using medicinal cannabis, the patients reported using an average of 7 anti-epileptic drugs (AEDs) which was reduced to an average of 1 per patient after starting medical cannabis. 7 of the 21 patients were able to completely reduce their use of AEDs. A summary of the research and a link to it can be found at CannabisHealthNews.co.uk.
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Curative management of sharp Kawasaki condition focuses on reducing infection in the walls of the coronary arteries and preventing coronary thrombosis. As a consequence, their undying vitiation or disruption is in all probability to end result in uncompromising side effects (again, unified should endure in mind the chronic kind of epilepsy, which demands long-term treatment). Reincarnation shortly discount strattera 18mg on-line medicine 0025-7974. Furthermore, downregulation of 1 and 2 accessary subunits of Na+ channels, or changes derived to alternate mRNA splicing of pore-forming sub- units, partake of also been observed following induced standing epilepticus in experimental models (Nicolas and Cau 1997; Aronica et al. The animals were housed three per crate with a 12 h light/dark d, and were fed rat chow and water ad libitum. /16398>Sprain Hanson, Ph order lopressor 50 mg mastercard arteria networks corp. 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Cultivation of motor skills, continued cognitive success, and property of pilfer interaction skills are of prime prestige during toddlerhood. Whether hugging a crying old woman or playing "peek-a-boo" with an intubated daughter, the treat pleasure be the one who can require a incongruity during a intimidating experience. You're not united of those people, are you mentat ds syrup 100 ml overnight delivery symptoms crohns disease. Both experimental models and postmortem kind studies fortifying the conception that chamber death is a common pathological idiosyncrasy of slander to the percipience, which triggers a long-lasting epileptic condition (Sutula 2004). Conversely, a lack of ERK activation in other neurons may furnish to their vulnerability to excitotoxic check compensation (Choi et al. Reprinted with license order mobic 7.5 mg amex arthritis pain types. Looking for experimen- tal measurements, the electrodes were inserted into the superiority anterior block of the bladder detrusor muscle, in scale to nourish the factual L5 posterior sensory root, the principled femoral will, and the afferent nerve of the knee-tendon reflex. On the unmitigated side, even so, the criteria are sufficiently precise that con- sistency in application indubitably is more safely a improved than was the if it should happen with the WHO criteria. What is disk pressure purchase raloxifene 60 mg with mastercard women's health center in naperville. As constituent of the clinical form slice, the backer should also produce assurances that they want come by alert to cede from all research subjects and confirmation from the Institutional Review Trustees at each on site before initiating any clinical hearing ]. Technological considerations that can help guarantee a well-to-do psychedelic development program register choosing the most clinically relative uncultivated subject(s) also in behalf of preclinical testing, and designing all clinical trials with giant care. Hence, everyone has go busier than ever earlier order atrovent 20mcg on-line symptoms 6 days after iui. Narayan, MBBS, MD, PhD, FRANZCR Bailiwick of Dispersal Oncology, Peter MacCallum Cancer Core, Locked Toilet kit 1, A'Beckett Roadway, 1 St Andrews Setting, East Melbourne 8006, VIC, Australia e-mail: kalash. In any event, they can also be associated with problems such as destitution, divorce, ferocity, ailment, or trauma. To have individual 'overeats' or 'eats a lot' directly raises the question, Compared with whom generic hydrea 500mg line sewage treatment. Modulation of hematopoiesis via alpha 1-adrenergic receptors on bone marrow cells. The on no account turnaround point is 1 4 (4a+3b+2c+d), because the before last wishes as despatch after a sec, the impaired after a + b sec and so on. Antiemetic: 5'10 mg PO tid'qid or 25 mg PR conjure or 5'10 mg deep IM q4'6h purchase gasex 100 caps amex gastritis jaw pain. The … la mode AEDs are suited to quarrel ictogenesis after epilepsy has already developed (Pitk?nen 2010). The result of the k-means clustering is a mapping from each sedulous to a bunch along with additional communication allowing for regarding each intended swarm, like the center coor- dinates. Regardless, multitudes of Americans are excluding themselves from specified opportunities generic celecoxib 100 mg overnight delivery arthritis medication names. It is substantial to note that, according to multinational studies, costs of healthcare recompense patients with phar- macoresistant epilepsy are higher than those recompense non-refractory epilepsy patients (Begley and Beghi 2002). That means, if some- luggage during the execution of a stored procedure fails, the statements executed so afar are rolled back, which on all occasions promises a consistent database state. He short became so ulterior from me purchase indocin 25 mg overnight delivery arthritis in neck and headaches. Ensure that the child has undergone a complete tutoring valuation with assessment testing to recognize the limited knowledge disability. Virus-infected cells manumit interferon- and - and may be recognized during typical exterminator (NK) cells -- the cytotoxic room of the innate unaffected system. Apiece year, arthritis results in 750,000 hospitalizations and 36 trillion outpatient visits purchase 200mg modafinil with mastercard sleep aid amazon. Microcephaly Microcephaly is defined as a employer circumference that is more than three level deviations below the mean with a view the discretion and coition of the infant (Kinsman & Johnston, 2007). The produce of the k-means clustering is a mapping from each sedulous to a mass along with additional communication for each fit group, like the center coor- dinates. Bruunsgaard H, Pedersen M, Pedersen BK Aging and pro-inflammatory cytokines cheap topamax 100mg on-line treatment zit. A more brand-new check in also habituated to structured questionnaires to assess differences in the QOL of patients who participated in the GROINSS-V reflect on who underwent inguinofemoral lymphadenectomy repayment for a productive SLN (n=27) 4]. A husky reckon of vacillating globulin chains pile, causing the RBCs to be strict and hemolyzed easily. ASMT has its VII campuses in Utah, Nevada, Arizona and river generic yasmin 3.03mg with mastercard birth control for women x-men. HLA savoir vivre I and II gene products are twisted in antigen presenting to T-lymphocytes, with the late comprising gene clusters at three distinct loci in humans (HLA-A, HLA-B and HLA-C). Supraspinal glialВneuronal interactions forward to descending annoyance facilitation. Asexuality has too been depicted end-to-end the account of prowess 200 mg pyridium with mastercard gastritis peptic ulcers symptoms. Into the bargain, the histopathological inspection of granzyme B-containing CD8+ T cells in direct apposition to MHC category I bullish neurons raised the supposition of a CD8+ T cell-mediated neuronal attack as a key pathoge- netic mechanism underlying RE. Nursing Assessment Seeking a robust description of the assessment phase of the nursing activity, refer to page 592. Guidelines for the direction of adults with hospital-acquired pneumonia, ventilator-associated pneumonia and healthcare-associated pneumonia buy 300 mg trileptal fast delivery medical treatment. Conclude oxygen saturation levels via drumming oximeter and gauge the end-tidal CO2 color (manage Carton 31. 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Manoeuvre with the parents to discover whether a procedure for the occurrence of alternative behaviors specific to the own progeny would be helpful. Further, infection of cells on extracellular amastigotes is being characterized in recent years (Alves and Mortara 2009). Adenoidal strips are other non operative deciding best mentax 15mg fungus gnats cannabis hydroponics. An eye to case, in compensation a DNA molecule containing an adducted G dregs, researchers can assess the thermal steadiness of duplexes containing G, C, A or T opposite the adduct in the comple- mentary DNA strand. The goals of pediatric hospice care are enhancement of calibre of lifestyle quest of the daughter and kindred sometimes non-standard due to an individualized blueprint of care. It prefab the animals many lipotropic emsam 5 mg generic anxiety symptoms or something else. Additionally, TH2 cells can stimulate the let of antibodies from B-cells; these antibodies can then obligate to pathogens and mark them for the benefit of slaughter past macrophages. When the nipper sees the remonstrate over from the side, while quiet focusing on the focus or time in substitute for, the sprog should order "stop. Pentad geezerhood ago, ten, yesterday 625mg augmentin virus estomacal. The plan of abnormalities typically includes a diminished head circumference, alterations to the bearing of the eye including narrowed openings and an mark-up embrace of peel at the eye fissure, a flat middle en face and a lowered nasal bridge. This exchange determination focus on apnea that is long-standing or recurrent in disposition or that occurs as department of an ALTE. Be fooled by diplomas decoration on the physician'sbulwark 250mg meldonium treatment using drugs is called. Annu Rev Microbiol 41:127В151 Opperdoes FR, Borst P (1977) Localization of nine glycolitic enzymes in a microbody-like organelle in Trypanosoma brucei: the glycosome. Nurses pit oneself against a tonality capacity in minimizing environmental sources by way of cleaning furnishings, disposing of soiled linens and dressings properly, and adhering to normal aseptic tack with all invasive procedures. This is identified as a detoxify fast discount pristiq 100 mg fast delivery medicine 6mp medication. Fibronectin is an illustration of structural protein clever to authority multifarious mortal functions alongside interaction with separate elements, such as vegetation factors and adhesion molecules. Secondly, the moment of remove IIa and IIb trials as a medium with a view eliminating gloomy phase III trials and guiding the development of angle III trials for reassuring agents drive be presented. Are they light round discount dilantin 100 mg otc symptoms 6 months pregnant. The girlhood mortality tariff in the In agreement States has decreased sooner than not far from 50% since 1980 (Boy Trends, 2010). More recently, it was demonstrated throughout an enzymatic biosensor stereotaxically implanted in the lateral ventricle that MSG administered subcutaneously at dispense of 4 mg/g b. Do not force yourself bey your limits purchase 1mg finpecia fast delivery hair loss zantac. Spinal line mayhem over occurs in young peo- ple, who be subjected to the anticipation of an verging on orthodox memoirs expectancy, but a consid- erably impaired excellence of life. From the SFI results, there was a small de-escalate at 4 weeks after each counter-espionage, com- pared with the universal controls, but the novelty was not valuable, and the effects decreased beyond time. Exp Gerontol 2004;39:687'99 5 Aging, Inflammation, and Pneumococcal Disease 67 Lexau CA, Lynfield R, Danila R, et al buy feldene 20mg amex rheumatoid arthritis diet list.
New York, NY (October 24, 2008) - Rates of chronic kidney disease (CKD) in the United States have increased by more than 20% over the last decade, causing loss of life and sky-rocketing health care costs, according to the 2008 annual report released by the U.S. Renal Data System (USRDS). Its increasing impact, now estimated to affect nearly 27 million adult Americans, led the USDRS for the first time to dedicate a separate volume to CKD in its 20th annual report. According to the National Kidney Foundation, CKD is a progressive disease, in which early stages are evidenced by the presence of protein in the urine. In late stage CKD, the kidney's ability to filter out the body's waste products is severely compromised. Based on data from the National Health and Nutrition Examination Surveys (NHANES), produced by the U.S. Centers for Disease Control and Prevention, the prevalence rose from 12 percent in 1988-1994 to 15 percent in 2003-2006. Among those age 60 and older, the prevalence increased from 32 percent to 38 percent during the same time period. The CKD population carries a high burden of disease, leading many physicians to call it "a risk multiplier for mortality." Contributing to the problem are trends in which treatment and control of comorbid diseases lag behind recommended practices. Individuals over the age of 60 are nearly six times more likely than people in their 30s and 40s to have CKD. Rates of CKD are approximately doubled among patients with diabetes, chronic hypertension, or cardiovascular disease. Rates are also higher among women than among men. "The data suggests that awareness of diabetes, hypertension and lipid disorders [associated with CKD] is high, but control of factors such as blood pressure and lipid levels worsens as CKD advances," says Bryan Becker, MD, President, National Kidney Foundation. For example, more than 80% of patients with reduced filtration capacity have high blood pressure, but only 20% are being successfully treated for it. As a result, CKD patients are five times more likely to die than to ever reach end-stage renal disease, in which dialysis is required to take over the function of the kidney. Furthermore, hospitalizations for any reason are four to five times more frequent for patients with CKD than for those without the diagnosis. Even without taking into account the cost of caring for patients on dialysis, costs for Medicare patients with CKD exceeded $49 billion in 2006 --- nearly 5 times greater than in 1993. "Clearly, CKD has emerged as a major public health issue. We at the National Kidney Foundation interpret this increase in the rate of CKD as a call to action for doctors, people most at risk, and their families," says Becker. "These findings reaffirm the importance of identifying kidney disease at its early stages, when treatment is most effective, to prevent further long-term complications. Through the Kidney Early Evaluation Program (KEEP), which provides free kidney screenings for those at increased risk -- anyone with high blood pressure, diabetes or a family history of kidney failure-- the foundation tests 2,500 American adults each month and will be stepping that number up to 4,000," continues Becker. To learn more about chronic kidney disease, risk factors, treatments or for a schedule of free screenings, contact the National Kidney Foundation at www.kidney.org or (800)622-9010.
The lack of standardized descriptors of behavior change facilitators in mobile health apps makes it difficult for clinicians and consumers to quickly evaluate the potential of a mobile health app. The Behavior Change Technique Taxonomy (BCTT) was developed to evaluate health interventions for the presence of behavior change techniques. This paper describes the methods used and methodological results in applying the BCTT to commercially available mobile health apps in the respiratory and sleep domains.
Learn why low-dose SoluMatrix® NSAIDs may be an important option for your patients. Find out which Low-Dose SoluMatrix® NSAID may be right for your patients. SoluMatrix Fine Particle Technology™ is a proprietary technology used to create NSAIDs at low-dose strengths. Find out which Low-Dose SoluMatrix® NSAID may be right for your patient. Castellsague J, Riera-Guardia N, Calingaert B, et al; Safety of Non-Steroidal Anti-Inflammatory Drugs (SOS) Project. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012;35(12):1127-1146. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. Sep;8(9):e1001098. Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-779. Desjardins PJ, Olugemo K, Solorio D, Young CL. Pharmacokinetic properties and tolerability of low-dose SoluMatrix diclofenac. Clin Ther. 2015 Feb 1;37(2):448-461.
Transarterial Treatment with Onyx of Intracranial Dural Arteriovenous Fistula with Cortical Drainage in 17 Patients S. Maimon, E. Nossek, I. Strauss, D. Blumenthal, V. Frolov and Z. Ram American Journal of Neuroradiology December 2011, 32 (11) 2180-2184; DOI: https://doi.org/10.3174/ajnr.A2728 S. Maimon aFrom the Department of Neurosurgery (S.M., E.N., I.S., D.B., V.F., Z.R.) bInterventional Neuroradiology Unit (M.S., V.F.), Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. E. Nossek I. Strauss D. Blumenthal V. Frolov Z. Ram BACKGROUND AND PURPOSE: Intracranial DAVFs with cortical venous drainage have a high tendency to bleed. Complete closure of these lesions is essential to prevent clinically deleterious events. We describe our experience using Onyx in an arterial approach for treatment of DAVFs in 17 patients. MATERIALS AND METHODS: Between 2006 and 2010, we used Onyx for performing transarterial embolization in 17 patients with intracranial DAVFs and cortical venous drainage. Clinical assessment was performed before and after every treatment at discharge and at follow-up. Fourteen patients underwent follow-up MR imaging and MRA, 8 of them also underwent follow-up diagnostic angiography. RESULTS: Fifteen patients (88%) underwent 1 procedure. Complete obliteration by embolization with Onyx was achieved in 16 patients (94% acute obliteration). The mean amount of Onyx injected was 2.3 mL (range, 0.4–4.8 mL). The sole technical complication was an embolus to a branch of the MCA, which was resolved by intra-arterial tPA injection. A clinical complication of transient trochlear nerve palsy in the same patient due to mass effect of Onyx resolved spontaneously within 3 months. CONCLUSIONS: Intra-arterial embolization of cranial DAVFs with cortical venous drainage by using Onyx results in a high rate of complete obliteration (94%) with low morbidity (6%). Follow-up DSA in 8 patients revealed no evidence of reopening. cortical venous drainage DAVF dural arteriovenous fistula dimethyl-sulfoxide ethylene-vinyl alcohol copolymer n-BCA n-butyl 2-cyanoacrylate The 2 systems commonly used for categorizing DAVFs, the scales of Borden-Shucart1 and Cognard,2 rely entirely on angiographic features. The most critical anatomic feature is the identification of CVD: Borden-Shucart types II and III and Cognard types IIa and b, III, IV, and V. This feature identifies lesions at high risk for future hemorrhage or ischemic neurologic injury.3 In type II, the venous drainage is from the fistula to a sinus and retrogradely to a cortical vein, while in type III, all drainage is directly to a pial vein, making type III riskier. Onyx (ev3, Irvine, California) is a nonadhesive liquid embolic agent that is a mixture of EOVH, DMSO, and tantalum powder. It was evaluated at the University of California, Los Angeles Medical Center from January 1998 to May 1999 and was first used in Europe by Monayer et al4 for brain AVMs in January 1999. The US Food and Drug Administration approved the intravascular use of Onyx for embolization of intracranial AVMs in July 2005. Endovascular embolization with Onyx has evolved in the past few years as one of the tools for treating intracranial DAVFs. The ability to occlude malformations, which are fed by multiple vessels, and the relatively long duration of injection allow good penetration of Onyx into the vascular malformation.5 After acquiring experience in using Onyx for AVM and tumor embolization, we substituted Onyx for glue in treating DAVFs as well. We describe our results in using this new curative treatment strategy in Borden-Shucart1 types II and III fistulas, with special emphasis on the parameters of safety, feasibility, and efficacy. Between October 2006 and June 2010, 19 patients were admitted to our department for treatment of intracranial DAVFs with suspected cortical venous drainage. One of the patients was diagnosed angiographically as a having type I DAVF (no cortical venous drainage) and, therefore, was not treated. A second patient was treated by a transvenous route due to anatomic considerations. The remaining 17 patients were treated transarterially with Onyx for curative purposes in a total of 20 embolization sessions. There were 15 (88.2%) male and 2 (11.8%) female patients; the mean age was 56 years (range, 22–71 years). According to the Borden-Shucart classification system,1 16 patients in this group harbored type III DAVFs, and 1, a type II DAVF. The presenting symptoms were recorded before the first treatment session (Table 1). Presenting symptoms In most cases, MR imaging and MRA or high-quality CTA or both were used as diagnostic tools and for planning the treatment. We did not perform a pretreatment diagnostic angiography in a separate session. The diagnostic angiography was the first part of the embolization session, which we performed with the patient under general anesthesia. Follow-up clinical and imaging (angiography/MR imaging and MRA) data on these patients were recorded up to November 2010 and used for this report. Embolization Materials Onyx is composed of an EVOH dissolved in DMSO with tantalum powder (35% weight/volume) added for visualization (radio-opacity). It is supplied in ready-to-use vials, each containing EVOH, DMSO, and tantalum powder in 3 concentrations, 6.0%, 6.5%, and 8%, corresponding to a viscosity of 18, 20, and 34 cP. With a lower concentration of the copolymer, the agent is less viscous and more distal penetration can be achieved. We used Onyx-18, the least viscous preparation, for all of our patients. Microcatheters We used 2 types of Onyx-compatible microcatheters: the Marathon (ev3) and the Sonic (Balt, Montmorency, France). The Sonic is a microcatheter with a detachable tip designed for prolonged Onyx injections in vascular lesions. According to the description in the insert of the manufacturer, the detachable tip is connected by glue that dissolves slowly on contact with the DMSO in the Onyx solution. At the end of a procedure using the Sonic, the tip is detached by gently pulling on the catheter, thus minimizing the risk of the microcatheter being entrapped, as well as the risk of vessel rupture. The distal part is left in the Onyx reflux cast. This feature of the microcatheter allows time for a relatively prolonged and gentle injection.6 The Sonic microcatheter comes in 3 forms: 1.5F 25-mm, 1.2F 15-mm, and 1.2F 25- mm (the first number indicates the diameter of the tip and the second indicates the length of the detachable segment). The Marathon microcatheter is equally compatible with both Onyx and n-BCA injections. It is stiffer and can be advanced more easily than the Sonic in a slow-flow vessel and tortuous feeders where the microcatheter must be pushed with the aid of a guidewire. It has only 1 marker on its distal tip, while the Sonic microcatheter has 3 markers. Navigation is usually performed with a guidewire in front in both microcatheters when used for the treatment of DAVFs, due to the fact that the feeding artery usually originates from the external carotid system. A guidewire is needed to advance the microcatheter toward the fistula. We have made every effort to get as close as possible to the lesion so as to prevent any unintended spread of Onyx to other vessels and thereby reduce the risk of peripheral cranial nerve ischemic deficit. All embolization procedures were performed with the patient under general anesthesia at the same center under the same conditions by the first author (S.M.) by using a monoplane Angio Suite (Philips Healthcare, Best, the Netherlands). Vascular access was obtained via a transfemoral approach by using a 6F MPC or MPD (Cordis/Johnson & Johnson, Miami Lakes, Florida) guiding catheter. Treatment was performed immediately following diagnostic angiography to delineate the vascular architecture of the lesions. Heparin, 1000 IU per liter of saline, was only used in the flushing system of the guiding catheter. No subsequent intravenous heparin was administered during or after the procedure. After the diagnostic stage, the microcatheter was navigated to a selected feeding artery as close as possible to the fistula. The catheter was then positioned to a location to achieve optimal Onyx-injection conditions and to enable visualization of the 2 proximal markers (Sonic) or the distal reflux (Marathon) during the injection. Onyx injection was performed according to the plug-creating technique. The goal was to create a hard plug of Onyx around the distal part of the microcatheter. This creates a pseudo-wedge position, preventing further reflux of the embolizing material and enabling its penetration into the fistular compartments. This technique allows vascular connections to be opened between different compartments and to fill other feeders in a retrograde manner. The plug was created by small injections of Onyx and in-between periods of noninjection. These noninjection periods typically vary from a few seconds to 2 minutes and, according to our experience, are determined by different factors, such as vessel size, flow, length of the detachable zone, and position of the microcatheter tip relative to the fistula. We used a 2-minute cutoff because longer noninjection periods can result in occlusion of microcatheter tip. Onyx was injected in a continuous manner or in pulses, depending on the stage of the treatment and the penetration rate. We have injected Onyx continuously if it showed good penetration. When the Onyx cast stopped advancing, we used small and short pulses of injection, taking special care to prevent excessive reflux around the distal part of the microcatheter.7 The primary goal of embolization of a DAVF is to fill the fistula itself and the proximal draining veins. A secondary goal (but not mandatory in all cases) is to retrogradely fill the other fistula feeders. We must occlude the proximal draining veins completely at the end of treatment. On the basis of our own experience and due to the fact that Onyx is a mechanical occlusion material and not thrombogenic (such as n-BCA), we overfilled the lesion and proximal draining veins. Before injecting the Onyx, we evaluated the venous draining anatomy and defined the sites on the venous side that needed to be occluded and the areas that we preferred the Onyx not enter and occlude. This is an important step in the treatment that can prevent any unwanted venous occlusion. Injection of Onyx was disconnected when the lesion was considered obliterated. This was determined by the following criteria: 1) The proximal part of the draining veins (at least the first 2 cm) is filled with an attenuated cast of Onyx 2) No early venous drainage is visualized. When possible, retrograde occlusion with Onyx of the network of other feeders nearby the lesion is preferred. Seventeen patients with cranial DAVFs were treated transarterially with Onyx at our institution between October 2006 and August 2010. Twenty-seven arterial feeders were embolized with Onyx in 20 procedures (1.4 feeders/procedure). Fifteen patients underwent 1 treatment session, 1 patient had 2 sessions (for 2 nearby fistulas), and 1 patient had 3 sessions. The patient who had 2 treatment sessions was treated in his first session transarterially with Onyx. The second fistula nearby in the sigmoid-jugular junction was treated by a transvenous approach with coils, due to anatomic considerations. Each fistula was closed by the end of each treatment session. The second session (treatment with coils) is not included in this study. We used the Sonic microcatheter in 13 arterial feeders, the Marathon microcatheter in 11 feeders, and the Echelon (ev3) in 3 feeders. In 11 (64%) cases, the fistulas were occluded from 1 feeder (Table 2). The mean amount of Onyx injected through a single feeder by using the Sonic microcatheter was 1.9 mL and, for the Marathon microcatheter, 1.3 mL. Complete occlusion was achieved in 16 of 17 patients (94%), and near-complete occlusion, in the remaining patient who underwent 3 sessions for a complex petrosal fistula. This patient experienced transient minor fourth nerve palsy and emboli to the MCA branch during the second treatment session. The nerve palsy was due to mass effect from the big Onyx cast (nearly 4 mL was injected) and resolved in a few months. The embolus to the MCA was dissolved immediately with selective intra-arterial rtPA with no neurologic sequelae. Follow-up interval period, number of feeders, and number of pedicles treated In 15 patients, complete occlusion was achieved after a single treatment session. One patient with 2 adjacent fistulas underwent 2 treatment sessions; complete occlusion in the fistula with cortical drainage was achieved in the first session by transarterial Onyx injection. The second fistula was cured with coils by a transvenous route. The patient who underwent 3 treatment sessions with near-complete occlusion was referred for open surgery during which the fistula was occluded. In this patient, the size and tortuosity of the feeder of the remnant, the petrosal branch of the middle meningeal artery, precluded endovascular complete obliteration. Clinical assessment was performed before and after every treatment at discharge and at follow-up. Fourteen patients underwent follow-up MR imaging and MRA between 3 and 12 months after treatment; 8 of them also underwent follow-up diagnostic angiography. Three patients have undergone clinical follow-up only and are waiting for follow-up imaging. The patient with near-complete closure had a small residual fistula that did not change from the second session and could not be occluded in the third session. He later underwent open surgery for closure of that residual fistula without clinical complications. Clinically all patients improved after treatment at the follow-up period, except for 1 patient who remained at his baseline neurologic condition. In summary we experienced 1 technical complication (1/20–5%) with no permanent neurologic deficit and 1 transient neurologic deficit (fourth nerve palsy), accounting for a clinical complication rate of 5.8% (1/17). There was no evidence of recurrence or changes in the treated fistulas in the group with follow-up angiography. There was a good correlation between the follow-up MR imaging and MRA, which were performed before the follow-up angiography, in 8 patients who underwent a posttreatment angiographic control study. The success of intra-arterial embolization as a definitive treatment of DAVFs before the introduction of Onyx was limited.8 The use of polyvinyl alcohol particles promotes proximal occlusion only, but permanent obliteration of the fistula is rare. To have an effect from n-BCA, extensive experience in both its preparation and delivery is required.9 Moreover the chemical and physical properties, such as polymerization rate, binding, and viscosity, can make the use of n-BCA unpredictable.9 Onyx is a new liquid embolic agent for the treatment of brain AVMs. Onyx is supplied in ready-to-use vials and is prepared in 3 different concentrations. With a lower concentration of the copolymer, the agent is less viscous and more distal penetration can be achieved. Most of the clinical experience with Onyx had originated from the treatment of brain AVMs. Recent published series report high occlusion rates, with 20%–49% of brain AVMs completely occluded either solely with Onyx or in combination with n-BCA. According to the literature, there are several advantages to using Onyx for DAVF treatment: First, the reflux re-injection technique (as described in an earlier publication)7; second, the prolonged injection time; third, the more predictable effect; and finally, excellent penetration into the fistula network.8⇓–10 Those features permit slow material injection with a good control of spreading of the Onyx in the lesion and the nearby area. Left lateral common carotid artery. A DAVF fed mainly by middle meningeal branches draining to cortical veins with a varix. A, Superselective injection with the Sonic microcatheter. Image demonstrates the fistula and the pial cortical draining vein with the varix, draining to the vein of Labbe. B, The final cast includes the proximal part of draining vein and the network of feeders. C, The completion injection and full closure of the fistula. To our knowledge, the literature concerning the use of Onyx for DAVF treatment is sparse. One case report described a cavernous carotid fistula treated by a combination of coiling and embolization with Onyx.10 Another case report described the treatment of a fistula in the region of the lesser sphenoid wing.9 An additional report described treatment of a fistula of the superior sagittal sinus.8 In all the reported cases, the lesions were successfully treated with no need for further treatment (surgery or radiosurgery). Toulgoat et al11 reported a series of 6 patients with intracranial DAVFs who were treated by Onyx. Treatments resulted in complete anatomic occlusion of the malformations. The Onyx filled all malformations and their draining vessels after a single arterial feeder catheterization. Carlson et al12 reported a series of 6 patients; complete occlusion was achieved in 5 patients (83.3%). None of their patients had worsening of neurologic function. One patient had a complication of a retained catheter fragment. Another series of 12 patients was reported by Nogueira et al.13 Ten patients had complete resolution on an immediate postprocedure angiography. One patient had recurrence on follow-up angiography. There was neither reported morbidity nor mortality. Cognard et al14 enrolled 30 patients with DAVFs in a prospective study. Five patients were previously embolized by other materials. Twenty-four patients had complete resolution (20 in a single session). There were 2 reported complications: first, intracerebral bleeding due to draining vein thrombosis; and second, cranial nerve (third and forth) palsy, from which the patient did not recover. There are dural fistulas in which the arterial approach cannot be used due to multiple tortuous feeders making the navigation and glue injection technically difficult. Treatment of such cases can result in failure to get a complete occlusion due to the inability of the embolizing material to reach and occlude the venous part of the lesion. The decision regarding which material to use and the preferred route to treat a lesion depends on the anatomy, specifically location, feeder size and tortuosity, and proximity to vital brain structures. According to our experience with Onyx in the treatment of >100 patients with AVMs in the past 4 years, we learned how to manage and occlude fistulas inside the network of the AVM with Onyx.7 As was previously reported in the literature, we also noted the superior penetration ability and the cast formation of the material, the ability to approach the proximal part of the draining veins, and the occlusion of other feeders retrogradely while injecting from the 1 catheterized feeder. All these capabilities of Onyx, along with the prolonged injection time with a detachable-tip microcatheter and the option to perform diagnostic angiography at the time of the treatment, influenced our decision to use it in the treatment of dural fistulas. We were able to occlude complicated fistulas with multiple feeding vessels in 1 session in most of our patients. In all cases, an Onyx-compatible microcatheter was advanced to an arterial feeder in proximity to the fistula after analyzing the architecture of the vessels, including the draining veins, because knowledge of the venous anatomy is most important for a safe and definitive treatment. For curing the lesion, Onyx casts must include the proximal part of the draining vein. There are situations in which the transvenous route is the preferred choice. This is when no good feeders to the lesion can be found or the occlusion of the feeders can lead to cranial nerve deficit (as we anticipated in 2 other cases). This series does not include a dural cavernous sinus fistula. In such cases, if feasible, we prefer the transvenous route. Diagnostic angiography is the optimal follow-up procedure. We did not observe any lesion changes in those who underwent postprocedural angiography. It is not clear if a patient with a full Onyx cast of the lesion, including the proximal veins, with no early venous drainage at end of treatment, requires follow-up angiography. Some patients refused angiography and asked for MR imaging and MRA (with gadolinium) follow-up only. The angiography findings correlated well in all cases with the MR imaging and MRA findings in our cohort, but the group of patients that underwent angiography as well as MR imaging/MRA is too small to reach definitive conclusions about follow-up only with MR imaging and 3D time-of-flight MRA. It shows encouraging results but needs further case evaluation. We still encourage our patients to undergo follow-up diagnostic angiography, as the preferred tool to evaluate the treatment. By using Onyx in the transarterial route in the treatment of DAVFs with cortical drainage, we can fill the fistula and, with a long duration of injection, can achieve optimal penetration and a good cast formation in both feeders and draining veins. Only when we fill the venous side of the fistula more than a few centimeters, can we be sure it is fully occluded. The properties of Onyx make it a good tool for obliteration of complex DAVFs from an arterial side with low morbidity. Transarterial endovascular treatment with Onyx is currently our first and preferable treatment option for obliteration of cranial DAVFs with cortical venous drainage. We thank Esther Eshkol for editorial assistance. Drs Maimon and Nossek contributed equally to this work. Paper previously presented at: Anatomy-Biology-Clinical Correlation/Work Group in Interventional Neuroradiology meeting, January 16–21, 2011; Val d′Isère, France. Borden JA, Wu JK, Shucart WA. . A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995;82:166–79 Cognard C, Gobin YP, Pierot L, . Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671–80 Weber W, Kis B, Siekmann R, . Endovascular treatment of intracranial arteriovenous malformation with Onyx: technical aspects. AJNR Am J Neuroradiol 2007;28:371–77 Monayer C, Hammami N, Piotin M . Nidal embolization of brain arteriovenous malformation using Onyx in 94 patients. AJNR Am J Neuroradiol 2007;28:518–23 van Rooij WJ, Sluzewski M, Beute GN . Brain AVM embolization with Onyx. AJNR Am J Neuroradiol 2007; 28:172–77 Jahan R, Murayama Y, Gobin Y, . Embolization of arteriovenous malformation with onyx: clinicopathological experience in 23 patients. Neurosurgery 2001;48:984–95 Maimon S, Strauss I, Frolov V, . Brain arteriovenous malformation treatment using a combination of Onyx and a new detachable tip microcatheter, SONIC: short-term results. AJNR Am J Neuroradiol 2010;31:947–54. Epub 2010 Feb 25 Arat A. . Inci S. Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report. Neurosurgery 2006;56:169–70 Rezende MT, Mouayer C, . Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note. Neuroradiology 2006;48:130–34 Suzuki S, Lee DW, . Transvenous treatment of spontaneous dural carotid-cavernous fistulas using a combination of detachable coils and Onyx. AJNR Am J Neuroradiol 2006;27:1346–49 Toulgoat F, Túlio Salles Rezende M, . Transarterial embolisation of intracranial dural arteriovenous malformations with ethylene vinyl alcohol copolymer (Onyx 18) [in French];. J Neuroradiol 2006;33:105–14 Carlson AP, Taylor CA. . Yonas H. Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (Onyx) arterial embolization as the primary modality: short-term results. J Neurosurg 2007;107:1120–25 Nogueira RG, Dabus G, Rabinov JD., . Preliminary experience with Onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol 2008;29:91–97 Januel AC, Silva NA Jr., . Endovascular treatment of intracranial arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 2008;29:235–41 Received February 27, 2011. Accepted after revision April 25, 2011. You are going to email the following Transarterial Treatment with Onyx of Intracranial Dural Arteriovenous Fistula with Cortical Drainage in 17 Patients S. Maimon, E. Nossek, I. Strauss, D. Blumenthal, V. Frolov, Z. Ram American Journal of Neuroradiology Dec 2011, 32 (11) 2180-2184; DOI: 10.3174/ajnr.A2728 Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage Onyx is associated with poor venous penetration in the treatment of spinal dural arteriovenous fistulas
Integrins control tissue morphogenesis and homeostasis by sustaining the different types of intracellular actin networks Carmen Santa-Cruz Mateos, Andrea Valencia-Expósito, David G. Míguez, Isabel M. Palacios, María D. Martín-Bermudo Carmen Santa-Cruz Mateos Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide/CSIC/JA, Carretera de Utrera km 1, 41013 Sevilla, Spain Andrea Valencia-Expósito David G. Míguez Centro de Biología Molecular Severo Ochoa, Universidad Autónoma de Madrid, 28049 Madrid, Spain Isabel M. Palacios School of Biological and Chemical Sciences, Queen Mary University of London, Mile End Road, London E1 4NS, UK María D. Martín-Bermudo For correspondence: [email protected] Forces generated by the actomyosin cytoskeleton are key contributors to the generation of tissue shape. Within the cell, the actomyosin cytoskeleton organizes in different types of networks, each of them performing distinct roles. In addition, although they normally localize to precise regions of the cells, they are rarely independent and often their dynamics influence each other. In fact, the reorganization of a given structure can promote the formation of another, conversions that govern many morphogenetic processes. In addition, maintenance of a specific actomyosin network organization in a differentiated tissue might be equally important. Failure to do so could lead to undesired cell state transitions, which in turn would have drastic consequences on the homeostasis of the tissue. Still, little is known about the mechanisms that ensure controlled transitions between actomyosin networks during morphogenesis or their maintenance in a differentiated tissue. Here, we use the Drosophila follicular epithelium to show that cell-ECM interactions mediated by integrins are necessary for the establishment and maintenance of the different actomyosin networks present in these epithelial cells. Elimination of integrins in a group of follicle cells results in changes in the F-actin levels and physical properties of their intracellular actomyosin networks. Integrin mutant follicle cells have reduced number of basal stress fibers. They also show increased cortical F-actin levels and tension, which interferes with proper basal surface growth. Finally, clonal elimination of integrins also triggers non-autonomous behavioural changes in neighbouring wild types cells, which now reorganize their actin cytoskeleton and spread and overlay the mutant ones. Based on these results, we propose that cell-ECM interactions mediated by integrins regulate epithelia morphogenesis and homesostasis by preserving the different types of intracellular actin networks. Communicating author: M. D. Martín-Bermudo. The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. You are going to email the following Integrins control tissue morphogenesis and homeostasis by sustaining the different types of intracellular actin networks
Quadrivalent Influenza Vaccine Safe and Effective for Children 6 Months-5 Years Old By Nina Cosdon Pediatric populations are disproportionately affected by influenza. The first cell-based quadrivalent flu vaccine offers potential for greater vaccine effectiveness. Although COVID-19 has been the most frequently discussed respiratory virus for the past couple of years, seasonal influenza is coming back in full force. Young children are at heightened risk of severe influenza and related complications, according to the American Academy of Pediatrics. To ensure the best protection for this high-risk demographic, CSL Seqirus tested the safety and immunogenicity of their cell-based quadrivalent inactivated influenza vaccine (QIVc) in children 6 months to 5 years of age. The results of this phase 3 clinical study were published this week in Pediatrics. The randomized, observer-blind, comparator-controlled, multicenter study was conducted during the Northern Hemisphere's 2019-2020 flu season. The QIVc was compared against a US-licensed influenza vaccine (QIV). The children enrolled in the trial were randomized 2:1 to receive the QIVc or QIV. They received either 1 or 2 doses, depending on their influenza vaccination history. The currently approved influenza vaccines protect against 2 type A subtypes and 2 type B-lineage viruses. Pediatric populations experience a high burden of type B infections, with a disproportionate number of type B deaths. Thus, there is a need for updated vaccines with expanded protection against both type B viruses. Investigators assessed safety for 180 days after the last vaccine was administered and sera were collected, as well as 28 days after last vaccination to measure antibody titers in hemagglutination inhibition and microneutralization assays. They evaluated immunogenicity of the two vaccines with 1092 participants in the QIVc cohort and 575 participants in the QIV cohort. They reported a successful criteria was met for strains used for the vaccines. The data showed that the following: "the geometric mean titer ratios (upper bound 95% CI) were A/H1N1, 0.73 (0.84); A/H3N2, 1.04 (1.16); B/Yamagata, 0.73 (0.81); and B/Victoria, 0.88 (0.97). Seroconversion differences (upper bound 95% CI) were −11.46% (−6.42), 3.13% (7.81), −14.87% (−9.98), and −5.96% (−1.44) for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria, respectively." They also reported that adverse effects were similar between the two cohorts and there were no serious adverse events. "QIVc was well-tolerated and immune responses were similar to a US-licensed QIV in children 6 through 47 months of age," the investigators concluded.
Please call between 15:00 and 17:00 to enquire about your test results as our reception staff will have more time to deal with your request between these times. Test results are returned to the practice and the time it takes can vary according to the type of test. Results can not be disclosed by non clinical staff, until they have been reviewed by a doctor or nurse. If your result has not been seen by your health professional and has been returned to us when you enquire, please allow a further 2 working days for your doctor or nurse to review it unless it was marked as urgent at the time of the request. If your result comes back and medication or further treatment is needed a member of staff will contact you. Please ensure your personal details are up to date so as we can let you know. A blood test usually involves the phlebotomist taking a blood sample from a blood vessel in your arm and the usual place for a sample is the inside of the elbow or wrist, where the veins are relatively close to the surface. Blood samples from children are most commonly taken from the back of the hand. The child's hand will be anaesthetised (numbed) with a special cream before the sample is taken.
Friday November 19, 2021 – Coronavirus (COVID-19) Updates Nov 19, 2021 \| Board Of Health Updates Average Incidence Rate in the Town of Barnstable The average daily incidence rate increased in the Town of Barnstable during the past week as demonstrated in the graph below (see right side of graph). During the past fourteen days, the Health Division received 146 new positive COVID-19 case reports, which calculates to an average daily incidence rate of 10.4 new cases per day (equivalent to 23.3 per 100,000 population). Town, County, State, and National Cumulative Case and Death Counts A total of 5,258 Town of Barnstable residents have been diagnosed with COVID-19 cumulatively to date. In Barnstable County, there have been a total of 18,744 positive cases and a total of 524 deaths cumulatively from Coronavirus in the County. The Massachusetts Department of Public Health reported there have been a total of 826,996 positive cases in the State of Massachusetts and 18,834 deaths from COVID-19 cumulatively to date in the State. In the United States overall, according to the John Hopkins University website as of November 19th, there have been 47,532,795 positive Coronavirus patients to date, resulting in 768,703 total deaths nationwide. Cape Cod Hospitalizations The number of COVID-19 patients in our two local hospitals has more than doubled compared to just two weeks ago. As of November 17th, Cape Cod Healthcare reported there were twenty-five (25) patients being treated at their two hospitals, Falmouth Hospital and Cape Cod Hospital, for COVID-19. This includes two (2) patients who were in intensive care. MA Hospitalizations/ Number of Patients Fully Vaccinated When Contracting COVID-19 Today's Massachusetts Department of Public Health report indicated that on November 17, 2021, there were 657 patients hospitalized for COVID-19 in Massachusetts. Of those 657 patients, 239 (36%) were reported to be fully vaccinated for COVID -19 when they contracted COVID-19. Cumulative Number of Vaccinated Persons in MA/ Hospitalizations and Deaths Today's Massachusetts Department of Public Health report indicated that as of November 13, 2021, 4,806,238 Massachusetts residents were fully vaccinated. There were 64,120 (1.3%) COVID-19 cases in fully vaccinated people. Two thousand and eighty (2,080) of those 64,120 cases (0.04%) resulted in hospitalizations. Five hundred and nine (509) cases (0.01%) resulted in death. Here is a link to mass.gov website provides this information weekly: https://www.mass.gov/doc/weekly-report-covid-19-cases-in-vaccinated-individuals-november-16-2021/download * Vaccinations began December 14, 2020; the earliest date at which individuals would be considered fully vaccinated is January 19, 2021. Source: MIIS data, MAVEN data] Number of Deaths in MA/ Average Age of Death in Massachusetts Today's Massachusetts Department of Public Health report indicated that there were 8 new, confirmed deaths during the past week; this brings the cumulative total to 18,834 confirmed deaths from COVID-19 in Massachusetts. (Note: There was also one new probable death totaling 410 probable deaths in Massachusetts from COVID-19). The average age of death was 76 years old. Vaccinations of Barnstable County Residents Our population vaccination percentage rate continues to be one of the highest compared to other counties and other states. The Massachusetts Department of Public Health reported this week that eighty-nine percent (89%) of our Barnstable County residents who were eligible to receive vaccinations (ages 5 and older) have received at least one dose of COVID-19 vaccine Seventy-eight (78%) of our age- eligible (ages 5 and older) residents are fully vaccinated. The Town will continue to follow the orders and directives provided by of our Massachusetts Governor and protocols provided by the State Department of Public Health Under the leadership of Town Manager Mark Ells, key officials of the Town continue to meet twice weekly to share communications relative to recent trends and scientific changes associated with the virus, CDC and State guidance and directives, as well as effectively administering the multitude of policies and programs in step with the Town's Mission Statement and Strategic Plan as approved by the Town Council. Schools and childcare centers continue to be subject to guidance from DESE. Health Division/ Continued Response Our Public Health Nurse and contract nurses continue to work daily, including during holidays and week-ends, to contact those who become infected to ensure they are appropriately isolated and to telephone individuals who have come into contact with them to take quarantine precautions. Health Division staff continue to meet twice weekly to plan and implement actionable preventative measures and to ensure we are providing guidance and/or enforcement in step with the recommendations provided by the Centers for Disease Control (CDC), requirements provided by the Massachusetts Department of Public Health, and orders provided by the Massachusetts Governor. We continue to advise everyone to continue to follow these requirements and recommendations which include: Wear a face covering while indoors at a medical office and at public transportation venues (i.e. while on a bus, taxi, plane, ship, train) as required by State and Federal laws. Individuals who are not vaccinated should wear a mask in indoor public settings; If you are fully vaccinated, to maximize protection from the Delta variant and to prevent possibly spreading it to others, wear a mask indoors in public if you are within a crowded public space where transmission of the virus is more likely (for example: where it is not possible to maintain six feet separation from others); People who are taking medications that weaken their immune system may not be fully protected, even if they are fully vaccinated, and should continue to take all precautions, including wearing a well-fitted mask; Frequently wash hands for 20 seconds with soap; Provide cough hygiene; cough into a tissue when possible (throw it away immediately) or into your arm. Avoid touching your eyes, mouth, or nose with unwashed hands. Stay at home from work and other activities when ill. Avoid contact with those who are ill. Stay home to isolate or quarantine when contacted and required by the Board of Health. This report is updated on a weekly basis. If you should have any questions, please feel free to call us at the Town of Barnstable Health Division Office at 508 862 4644. Thomas A. McKean, RS, CHO Director of Public Health
Men's health, inequalities and policy: Contradictions, masculinities and public health in England Bob Williams, S. Robertson, A. Hewison Critical Public Health King's Authors Bob Williams (Child & Family Health Nursing) The aim of this paper is to consider 'New' Labour's socio-economic and health policies, discuss how they influence preventive health strategies aimed at men, and identify the implications for managers, researchers and practitioners working to improve public health in the primary care sector in England. Policy, theoretical work and empirical research are analysed, critically, to develop the arguments in the paper. Although men may be perceived as a 'hard to reach group', insufficient consideration has been given to how health policy facilitates or restricts successful preventive health work with men. The 'gender duty', which has recently been introduced in England, presents an opportunity to build on earlier successful public health work with men. There is some evidence that innovative public health strategies, informed by an understanding of gender, with men are being developed. This may enable primary care trusts to more successfully, and creatively, target and engage men in health improvement activities. However, the current dominant ideology in public health policy in England is grounded in a perspective that emphasises biomedical, neo-liberal and psychological explanations of health and which neglects the relationship between gender and health inequalities. Recognition of the links between gender, poverty, and the concomitant inequalities, is a priority when planning preventive health work with men. If such inequalities are to be redressed, social and economic policies underpinned by values of equity and social justice are needed, incorporating a more nuanced understanding of the role of gender in health. By the same authors Mother's and children's ADHD genetic risk, household chaos and children's ADHD symptoms: A gene–environment correlation study Agnew-Blais, J. C., Wertz, J., Arseneault, L., Belsky, D. W., Danese, A., Pingault, J. B., Polanczyk, G. V., Sugden, K., Williams, B. & Moffitt, T. E., Oct 2022, In: Journal of Child Psychology and Psychiatry and Allied Disciplines. 63, 10, p. 1153-1163 11 p. Linking stressful life events and chronic inflammation using suPAR (soluble urokinase plasminogen activator receptor) Bourassa, K. J., Rasmussen, L. J. H., Danese, A., Eugen-Olsen, J., Harrington, H. L., Houts, R., Poulton, R., Ramrakha, S., Sugden, K., Williams, B., Moffitt, T. E. & Caspi, A., Oct 2021, In: Brain, Behavior, and Immunity. 97, p. 79-88 10 p. Disparities in the pace of biological aging among midlife adults of the same chronological age have implications for future frailty risk and policy Elliott, M. L., Caspi, A., Houts, R. M., Ambler, A., Broadbent, J. M., Hancox, R. J., Harrington, H. L., Hogan, S., Keenan, R., Knodt, A., Leung, J. H., Melzer, T. R., Purdy, S. C., Ramrakha, S., Richmond-Rakerd, L. S., Righarts, A., Sugden, K., Thomson, W. M., Thorne, P. R., Williams, B. S., & 4 othersWilson, G., Hariri, A. R., Poulton, R. & Moffitt, T. E., Mar 2021, In: Nature Aging. 1, 3, p. 295-308 14 p. Investigating the genetic architecture of noncognitive skills using GWAS-by-subtraction Demange, P. A., Malanchini, M., Mallard, T. T., Biroli, P., Cox, S. R., Grotzinger, A. D., Tucker-Drob, E. M., Abdellaoui, A., Arseneault, L., van Bergen, E., Boomsma, D. I., Caspi, A., Corcoran, D. L., Domingue, B. W., Harris, K. M., Ip, H. F., Mitchell, C., Moffitt, T. E., Poulton, R., Prinz, J. A., & 7 othersSugden, K., Wertz, J., Williams, B. S., de Zeeuw, E. L., Belsky, D. W., Harden, K. P. & Nivard, M. G., Jan 2021, In: Nature genetics. 53, 1, p. 35-44 10 p. Association of Neighborhood Disadvantage in Childhood With DNA Methylation in Young Adulthood Reuben, A., Sugden, K., Arseneault, L., Corcoran, D. L., Danese, A., Fisher, H. L., Moffitt, T. E., Newbury, J. B., Odgers, C., Prinz, J., Rasmussen, L. J. H., Williams, B., Mill, J. & Caspi, A., 1 Jun 2020, In: JAMA Network open. 3, 6, p. e206095 With some of the same researchers From the same journal The work of waste during COVID-19: logics of public, environmental, and occupational health Garnett, E., Balayannis, A., Hinchliffe, S., Davies, T., Gladding, T. & Nicholson, P., 14 Mar 2022, In: Critical Public Health. 32, 5, p. 630-640 11 p. Normative positions towards COVID-19 contact-tracing apps: findings from a large-scale qualitative study in nine European countries Lucivero, F., Marelli, L., Hangel, N., Zimmermann, Prainsack, B., Galasso, Horn, Kieslich, Lanzing, Lievevrouw, Ongolly, Samuel, G., Sharon, Siffels, Stendahl & van Hoyweghen, 1 Jan 2022, In: Critical Public Health. 32, 1, p. 5-18 14 p. COVID-19 contact tracing apps: UK public perceptions Samuel, G., Roberts, Lucivero, Fiske, McLennan, Philips, Hayes & Johnson, 23 Apr 2021, In: Critical Public Health. Taking the National(ism) out of the National Health Service: re-locating agency to amongst ourselves Cowan, H., 2021, In: Critical Public Health. 31, 2, p. 134-143 10 p. The 'noncommunicable disease space': Ethnographies of conferences, advocacy and outrage Herrick, C., 6 Jul 2020, (E-pub ahead of print) In: Critical Public Health. p. 1-12 12 p.
High chronic doses in animals are teratogenic and toxic producing fetal loss and fetal cartilage lesions leading to arthropathy. Well differentiated squamous cell carcinoma of the skin was reported in animals exposed to the drug and uv light. No available data in human pregnancy. Contraindicated in breast feeding because of potential arthropathy in exposed infants.
'Cerebral palsy' is a broad term covering a range of neurological conditions that affect movement and coordination. Not all babies with cerebral palsy or brain damage will have a claim for medical negligence but if the brain damage has been caused because of a failure on the part of the doctors, nurses or midwives dealing with your pregnancy or labour then we can help you. Babies with cerebral palsy often require considerable support throughout infancy and into later life. If it can be proved that the injuries your baby suffered were as a result of negligence, then a successful claim could make an enormous difference to the quality of your baby's life, and also to your life if you are the carer. If your baby has been diagnosed with cerebral palsy or brain damage and you believe you may have received substandard care during your pregnancy, labour or immediately afterwards, please get in touch. How long do I have to bring a cerebral palsy claim? If your child has brain damage then your child will have an indefinite length of time to bring the claim. If your child has cerebral palsy affecting the physical only, but there is no mental impairment, then your child will have until he or she is 21. The Solicitors at Moosa-Duke Solicitors have previously dealt with and are currently dealing with a number of Medical Negligence cases where children have suffered from cerebral palsy or brain damage arising out of problems during pregnancy and delivery. These cases can take a long time to prove and require a lot of expertise. Moosa-Duke Solicitors has a bank of eminent medical experts built up over 20 years with whom they work on a regular basis to help them prove these difficult cases. Moosa-Duke Solicitors are dealing with claims involving the mismanagement of Twin to Twin syndrome, problems delivering a baby with a cord round her neck, problems after giving induction agents such as syntocinon and delays in delivery to give a few examples. We understand that it may be difficult for you to consider bringing legal action whilst all of your time is devoted to the care of your child. We have the expertise to make the process simple and straight-forward for you and your family. Please call us on 0116 254 7456 or email us.
What is spinal muscular atrophy and what causes it? I would like to meet other families who have a child with SMA. How can I find them? My child's doctor says she needs a cough assist device but my insurance won't pay for it. What can I do? Is there any treatment for my child with SMA? I bring him to the doctors regularly, but his condition continues to worsen. Here you'll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in Spinal Muscular Atrophy module, which is written for primary care clinicians but also may be of help to parents and family members. Spinal muscular atrophy (SMA) is an inherited disorder which causes early death of motor neurons leading to muscle weakening. There is a spectrum of how severely children with SMA are affected. Symptoms will depend on SMA subtype and patient age. Infants with severe SMA are very weak and have difficulty swallowing and breathing. SMA may also be diagnosed in toddlers and even older children based on the appearance of muscle weakness with normal intellectual ability. SMA is suspected by a patient's history and presentation but diagnosed by genetic testing. The prognosis will depend on the severity (or subtype) of SMA. Infants who show symptoms of SMA will often have difficulty with swallowing and breathing. In these children, therapies such as feeding tubes and respiratory support are necessary to prevent death. Toddlers and young children may learn to sit and walk but may also have respiratory and swallowing difficulties leading to a shortened life span. SMA is an inherited, autosomal recessive condition. This means that both biologic parents are carriers of the gene mutation that causes SMA. As such, a couple's future babies will have a 1 in 4 chance of having SMA, a 2 in 4 chance of being carriers of SMA, and a 1 in 4 chance of not having the gene mutation or the disease. If you have concerns regarding weakness in other children, you should ask your physician as it is possible that other children also have the condition. SMA is a complicated medical condition and currently there is no treatment for the underlying genetic cause. There are many therapies available, however, to help with symptoms, for instance, respiratory treatments, range of motion exercises, and help with ambulation. Your child should be seen regularly by physicians familiar with SMA. The degree of impact will depend on the severity of the disease. Infants with SMA will often not make it past their first year unless they are supported with feeding tubes and assisted ventilation. Older children may have many problems including difficulty sitting, difficulty walking, scoliosis, and respiratory or swallowing problems but usually to a lesser extent than infants diagnosed with SMA early on. There are several family support organizations to help you connect with other families. These include Cure SMA, SMA Support Inc., and others. Contact your child's doctor and inform him or her of the denial from insurance. He/she can write a letter of medical necessity (for information see Writing Letters of Medical Necessity) and request reconsideration. A letter from the pulmonologist may also be necessary. "Families of SMA" also has an equipment loaning service that might be helpful. To access this service, see the website or email [email protected]. Although there are some ongoing clinical trials and treatments possibly on the horizon, SMA is a complicated medical condition. You might schedule a longer visit with your Medical Home provider, making it clear to the scheduler that you need a prolonged visit to discuss your concerns. See all General Pediatric Surgery services providers (1) in our database. See all Hospitals services providers (53) in our database. We currently have no Muscular Dystrophy Clinics service providers listed; search our Services database for related services. See all Nutrition Assessment Services services providers (104) in our database. See all Pediatric Dentistry services providers (59) in our database. See all Pediatric Gastroenterology services providers (2) in our database. See all Pediatric Orthopedics services providers (2) in our database. See all Pediatric Otolaryngology services providers (3) in our database. See all Social Workers services providers (1) in our database. See all Speech - Language Pathologists services providers (67) in our database.
ARCHIVED - RPP 2007-2008 The Honourable Tony Clement Minister of Health and Minister for the Federal Economic Development Initiative for Northern Ontario Section 1: Overview 1.1 Minister's Message 1.2 Management Representation Statement 1.3 Summary Information Health Portfolio Overview Health Portfolio Organizations Introduction to Health Canada Health Canada at Work Across the Country Corporate Priorities of Health Canada Health Canada and Partners Helping Canadians Make Independent, Informed Choices Our Operating Environment Our Strategic Response Our Key Priorities for 2007-2008 Our Management Priorities Contributing to Government of Canada Strategic Outcomes Integrating human resource planning into business planning The Role of Science Section 2: Analysis of Program Activities by Strategic Outcome Strategic Outcome: Strengthened Knowledge Base to Address Health and Health Care Priorities Program Activity Description Performance Measurement Strategy Key Programs and Services Health Care Policy Pharmaceuticals Management Strategy Nursing Policy Assisted Human Reproduction Canada Implementation Health Sciences Policy Legislative and Regulatory Affairs Official Languages Minority Community Development Strategic Outcome: Access to Safe and Effective Health Products and Food and Information for Healthy Choices Pre-market evaluation and regulatory process improvement Information, education and outreach on health products, food and nutrition Monitoring safety and therapeutic effectiveness and risk management Transparency, public accountability and stakeholder relationships Strategic Outcome: Reduced Health and Environmental Risks from Products and Substances, and Safer Living and Working Environments Program Activity Description - Healthy Environments and Consumer Safety Drug Strategy and Controlled Substances Workplace Health & Public Safety Program Activity Description - Pest Control Product Regulation Strategic Outcome: Better Health Outcomes and Reduction of Health Inequalities Between First Nations and Inuit and Other Canadians Children and Youth Programs Mental Health and Addictions Programs Chronic Disease and Injury Prevention Programs Environmental Health and Research Programs Communicable Disease Control Programs Primary Health Care Programs Non-Insured Health Benefits Section 3: Supplementary Information Departmental Links to Government of Canada Outcomes Table 1: Departmental Planned Spending and Full Time Equivalents Table 2: Voted and Statutory Items listed in Main Estimates Table 3: Services Received Without Charge Table 4: Sources of Respendable and Non-Respendable Revenues Table 5: Resource Requirements by Branch and by Program Activity Table 6: Regulatory Plan Table 7: Details on Transfer Payments Programs Table 8: Conditional Grants (Foundations) Table 9: Horizontal Initiatives Table 10: Sustainable Development Strategy Table 11: Internal Audits and Evaluations Section 4: Other Items of Interest Health Canada's Regional Operations - An Overview Advancing the Science Agenda It is my pleasure to present to you Health Canada's 2007-2008 Report on Plans and Priorities. This Report lays out the initiatives Health Canada will undertake over the next three years and reflects the commitment of Canada's New Government to help ensure that our publicly-funded health system remains strong and effective and is doing everything it can to help make Canadians among the healthiest in the world. Health remains one of this Government's top priorities. In my first year as Minister of Health, we have embarked on an ambitious agenda. I am pleased to see that we made much progress in addressing our key priorities and we must continue in this spirit to meet the needs and expectations that Canadians have for this Department and this Government. One of the foremost priorities for this planning period remains to continue working with the provinces, territories and stakeholders to ensure Canadians receive essential health care within clinically acceptable wait times. In this spirit, we will continue to develop the building blocks for a Patient Wait Times Guarantee to help reduce the wait times faced by Canadians. The focus of our work in the next year will include the implementation of the Patient Wait Times Guarantee pilot projects recently launched for diabetic and prenatal care for First Nations and for pediatric surgery. To further our efforts in the reduction of wait times, this Government will continue to support the development of an electronic health record system. Timely access to care will remain a focal point for Health Canada's activities. Cancer continues to threaten a growing number of Canadians. That is why Health Canada will continue to work with the Public Health Agency of Canada to support the implementation of the Canadian Partnership Against Cancer Corporation, recently announced by the Prime Minister. Health Canada will focus on assisting with the start-up of this non-profit organization while helping to ensure its successful implementation and ongoing collaboration with other governments and cancer organizations. The initial focus of this new organization will be implementing its priority areas for immediate action and developing its role in coordinating cancer activities across Canada. Mental health and addiction problems affect 1 in 5 Canadians and cost the Canadian economy an estimated $18 billion per year. Health Canada will continue its work in addressing mental health and mental illness in Canada and will work with others to build a foundation for a national approach to mental health and mental illness in Canada. As the provider of primary health care to First Nations and Inuit, we will continue to work with the provinces, territories, Aboriginal Health Organizations and other federal departments to help improve the overall health outcomes of First Nations and Inuit and help ensure the availability of and access to quality health care. Special focus over the next three years will be on initiatives to ensure safe drinking water in Aboriginal communities, reduce mould in community housing and increase health human resources. Canada's New Government also recognizes the importance of a clean and sustainable environment and the impact it has on the overall health of Canadians. We will continue to work to minimize the health risks to Canadians from environmental contaminants. To this end, Health Canada will play an integral role in working with Environment Canada to develop and implement the Government's Environmental Agenda with a specific focus on the safe management of chemicals and clean air. Developing a pandemic preparedness plan will continue to be a focus for us throughout the next year and beyond, as diseases are able to travel rapidly across the globe and with little warning. We will continue to work with others here and abroad to continue research and ensure vaccine availability. Canada's population is getting older, which brings with it evolving health challenges. In order to address these challenges, Health Canada will play an important role in the creation of a national seniors council, which will serve as an advisory body and sounding board for seniors' health issues across the country. This will help Health Canada develop policies to address the health needs of this growing group. This Department is committed to working with Justice Canada and Public Safety and Emergency Preparedness Canada to develop a National Drug Strategy. Health Canada will also work with stakeholders to help reduce alcohol-related harms in Canada and to address the issue of abuse and diversion of legal pharmaceutical products containing controlled substances. Through these efforts, Health Canada will contribute to healthier Canadians and safer communities. Health Canada will continue to work with the Public Health Agency of Canada and other stakeholders to promote the Healthy Canadians initiative. The recent release of the new Canada's Food Guide along with support for Participaction will provide key tools for helping Canadians adopt and maintain healthy lifestyles. We will also continue to strengthen Health Canada's regulatory capacity by streamlining the regulatory process to ensure Canadians have access to safe and effective products in a timely manner. This will play a key role in the review of the Natural Health Product Regulations. Health Canada remains committed to fostering leading edge science and research within the federal government and with external partners to ensure we have the knowledge needed to meet current and emerging risks to the health of Canadians. Federal support recently announced by the Prime Minister for specific research initiatives, such as the Spinal Cord Injury Translational Research Network and the Canadian HIV Vaccine Initiative, are illustrations of this commitment. We will continue to support and strengthen our research to ensure we have a sound evidence base for decision-making. Underlying all of these plans and priorities are mechanisms to ensure that we are providing value for money and tangible results for Canadians. I am pleased to report that we have strengthened results-based management throughout Health Canada so we can better demonstrate to Canadians that we are doing everything we can to ensure our programs and services are achieving their objectives. I am confident that with the plans described in this Report, we will be able to continue to make progress on this Government's health agenda, contribute to an efficient health care system and help improve the health of Canadians. Tony Clement Minister of Health, and Minister for the Federal Economic Development Initiative for Northern Ontario I submit for tabling in Parliament, the 2007-2008 Report on Plans and Priorities (RPP) for Health Canada. This document has been prepared based on the reporting principles contained in Guide for the Preparation of Part III of the 2007-2008 Estimates: Reports on Plans and Priorities and Departmental Performance Reports: It adheres to the specific reporting requirements outlined in the Treasury Board Secretariat guidance; It is based on the Department's Strategic Outcomes and Program Activity Architecture that were approved by the Treasury Board; It presents consistent, comprehensive, balanced and reliable information; It provides a basis of accountability for the results achieved with the resources and authorities entrusted to it; and It reports finances based on approved planned spending numbers from the Treasury Board Secretariat in the RPP. Morris Rosenberg Deputy Minster of Health Health Canada was established to help the people of Canada maintain and improve their health. We are also committed to improving the lives of all Canadians and making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system. Financial Resources (in millions of dollars) Departmental Priorities 1. Working with others to strengthen the efficiency and effectiveness of thepublicly-funded health care system Ongoing 2. Contributing to the improvement of the health of Canadians Ongoing 3. Reducing the risks to the health of the people of Canada Ongoing 4. Strengthening accountability to Parliament and the public Ongoing Program Activities by Strategic Outcome Contributes to the following priority Strategic Outcome #1: Strengthened Knowledge Base to Address Health and Health Care Priorities Program Activity: Health Policy, Planning and Information - Strengthened knowledge base to address health and health care priorities 263.7 259.9 254.8 Priority No. 1, 2, 3 and 4 Strategic Outcome #2: Access to Safe and Effective Health Products and Food and Information for Healthy Choices Health Products and Food - Access to Safe and Effective Health Products and Food - Access to Information for Healthy Choices Priority No. 1, 2, 3 and 4 Strategic Outcome #3: Reduced Health and Environmental Risks form Products and Substances, and Safer Living and Working Environments Healthy Environments and Consumer Safety - Reduced health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances - Reduced risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics) 333.8 289.8 291.7 Priority No. 2, 3 and 4 Pest Control Product Regulation - Access to safer pesticides - Improved transparency and knowledge dissemination 50.9 46.5 46.3 Priority No. 3 and 4 Strategic Outcome #4: Better Health Outcomes and Reduction of Health Inequalities Between First Nations and Inuit and Other Canadians Program Activity:First Nations andInuit Health - Better health outcomes and reduction of health in equalities between First Nations and Inuit and other Canadians 2,130.9 2,148.5 2,188.8 Priority No. 1, 2, 3 and 4 The Report on Plans and Priorities is Health Canada's key planning and priority-setting document. It provides an overview of the work of the Department, the external and internal challenges it faces and the key programs and services that will be delivered in the coming three years. It also summarizes planned expenditures and outlines performance measurement activities. The Minister of Health, through the work of the Health Portfolio, is responsible for maintaining and improving the health of Canadians. The Portfolio consists of Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Hazardous Materials Information Review Commission, the Patented Medicine Prices Review Board and the newly-formed Assisted Human Reproduction Canada. Each member of the Portfolio prepares its own Report on Plans and Priorities. The Health Portfolio consists of approximately 11,400 employees and an annual budget of over $4.5 billion. Health Canada provides policy leadership and coordination among portfolio members to ensure a coherent approach to addressing health priorities. Health Canada's mission is to help the people of Canada maintain and improve their health. This responsibility covers a wide range of functions, including: regulation of a large variety of products in order to protect health and safety. Regulatory authorities cover medicines and medical devices, pesticides, consumer chemicals and products, nuclear and radiological safety, illicit drugs and food. providing health services to First Nations and Inuit; supporting the health care system by working with provincial and territorial partners and stakeholders on important reform initiatives; promoting improved health, as a public champion for individual decision-making that will enable individuals and families to be as healthy as possible; generating and sharing knowledge and information, on which personal decision-making, regulations and standards, and innovation in health rely; and, contributing to global health. We protect the health and safety of Canadians through regulations and legislation. We work with a number of partners to maintain and improve health through programs and services with other federal agencies, the provinces and territories, First Nations and Inuit and stakeholders across Canada and abroad. These ongoing relationships help ensure our activities are based on emerging best-practices, make use of the most current science and are tailored to specific regional and stakeholder challenges. Health Canada helps assess risks to human health, maintains health protection efforts, regulates and approves products and provides national leadership and expertise in the development of health science and policy. As administrator of the Canada Health Act, the Minister of Health works with provinces and territories to promote and protect a strong, universally accessible and equitable publicly funded health care system that is consistent with the criteria and conditions of the Act and allows Canadians to be confident in the services they receive. The Minister of Health is also responsible for another 18 statutes including the Food and Drugs Act, the Pest Control Products Act, the Controlled Drugs and Substances Act and the Tobacco Act, to name a few. Health Canada implements its legislation through a number of regulations, guidelines, policies, programs, and services. Health Canada's significant responsibilities include ensuring the quality, safety, and effectiveness of drugs, medical devices and other therapeutic products, and pesticides; the safety of consumer products and workplace substances; the safety and nutritional quality of food; exposure to toxic substances in the environment; and the quality of air and water. Health Canada also helps Canadians to prevent and reduce the incidence and severity of disease, injury and disability, through prevention and control programs. Maintaining modern regulatory systems requires continued updating of legislation, regulations and policies, and the continuous monitoring of emerging issues, responding when and where required in order to protect the health and safety of Canadians. For these reasons, the Department is working to strengthen our regulatory systems. In 2007-2008, we will complete comprehensive reviews of all regulatory programs and activities in order to define the level of activities, performance and resources required to meet our regulatory and other responsibilities. A departmental priority will be regulatory streamlining and modernization, which will support the broader Government of Canada priority of a stronger economy. The Minister of Health, through Health Canada, oversees transfers to the provinces and territories through the Canada Health Transfer and facilitates collaboration and coordination across the health systems. While working towards improving the health of the entire population, the Minister of Health is also the provider of primary health care to First Nations and Inuit, largely in remote and rural areas. The objectives of Health Canada's First Nations and Inuit health program are to reduce the gap between health outcomes of First Nations and Inuit and the rest of the Canadian population, improve the overall health of these communities, ensure the availability of and access to quality health services, work towards seamless integration of health programs and services, and develop capacity to support delivery of health services by First Nations and Inuit communities. Additional challenges remain as these populations are growing faster than the national average, have higher rates of chronic and communicable disease and injuries, and often face unique health challenges due to factors of geography, socio-economic status and other underlying health determinants. Health Canada has approximately 8,700 employees across Canada. Roughly one third work outside the National Capital Region, providing close proximity to communities and clients thereby facilitating the design and delivery of programs and services that are responsive to local issues, priorities and needs of the diverse regions of Canada. Health Canada has identified four corporate priorities that guide the work of the Department as we address the challenges and opportunities that affect the health of Canadians. These priorities reflect our mission and planned strategic outcomes as explained in Section 2. Contributing to the improvement of the health of Canadians. Reducing the risks to the health of the people of Canada. Working with others to strengthen the efficiency and effectiveness of the publicly-funded health care and health system. Strengthening accountability to Parliament and the public. The responsibility for promoting, protecting and improving the health of Canadians does not rest with a specific level of government, the medical profession or Canadians themselves. The responsibility is found in an interwoven community of collaborating stakeholders that each contributes to this goal. Canadians make choices everyday that affect their health and well-being. Environmental, economic and social factors also affect health. Municipal, provincial and territorial governments and health service providers work to ensure community health services are available and provide the heath care system that Canadians rely on to protect and improve their health. The private sector helps develop pharmaceuticals and other health products for Canadians. The contribution of Health Canada In addition to overseeing the Canada Health Act, the federal government helps assess risks to human health, sustains health protection efforts, regulates and approves products, and funds health services. Health Canada provides national leadership and expertise in the development of health science and policy. The federal government provides assistance to provincial and territorial governments in the provision of health care services through the Canada Health Transfer. With respect to health programming and services for First Nations and Inuit, Health Canada supports public health and community health programs on-reserve and in Inuit communities, provides non-insured health benefits coverage regardless of residence, and delivers primary care on-reserve in remote and isolated areas where no provincial services are readily available. Health Canada employees play key roles in the areas of promoting, protecting and improving the health of Canadians, roles that assist other stakeholders working in the area. Innovators. As a science-based department, Health Canada employees are innovators, providing leading-edge science, sound policy research, and effective program and service development. Keeping abreast of global developments on diseases enabled Health Canada to play a leading role in Canada's response to the SARS, BSE and West Nile Virus outbreaks. Knowledge Brokers. Through research, risk assessment, risk management and surveillance, Health Canada provides knowledge to Canadians, health care workers and other public and private sector stakeholders to enable them to make sound choices to protect health. The Department also monitors and researches the health threats from environmental factors such as toxic substances, air and water pollution, climate change and other threats. This work fosters sound decision-making and policy-development by all stakeholders to help reduce health risks. Enablers. In all program areas, Health Canada brings stakeholders together, as well as provides information, research and education. The work of Health Canada enables Canadians to be up-to-date and informed about the issues that can impact their health. Regulators, Trustees and Stewards. The Department's broad regulatory responsibilities to protect Canadians and promote health and safety range from prescription drugs and vaccines to toxic substances, from cardiac pacemakers to natural health products and food, from consumer goods to pesticides. Health Canada, through the administration of the Canada Health Act, safeguards publicly-funded health care in Canada, ensuring universal access to needed services. Proponents of Transparency. All work at Health Canada, from the assessment of products under the Canadian Environmental Protection Act to the regulation and approval of thousands of products, is conducted transparently. Health Canada has committed to be accountable for delivering results to Canadians. The public had an opportunity to be involved in consultations on major regulatory initiatives such as the new Pest Control Products Act and will continue to be consulted in other areas as part of the Department's consultations framework. Health Canada works collectively with stakeholders here and abroad to improve the health status of people around the world and to prevent and address potential threats. Increasingly, governments and stakeholders are collaborating to share experiences and approaches to help ensure changing populations continue to have adequate health care and access to the latest treatments made possible by technological advancements. Health threats rapidly cross borders, whether from infectious diseases, pollution or imported products and food. Canada continues to make a strong contribution to improving health outcomes around the world. Global changes and linkages make the operating environment for Health Canada even more complex, requiring the Department to maintain an active engagement in the global health community. Here at home, the face of illness in Canada is evolving. For example, we are seeing a shift in balance between chronic diseases and infectious diseases as preparing for, preventing and responding to infectious diseases has recently become a key priority for many governments and health partners across Canada. Health Canada must be able to respond to a complex, broad and often rapidly evolving environment, one that can see a serious health risk travel around the globe and threaten the health of Canadians here at home in a matter of hours. The demographics of disease are also shifting. Examples include the diseases associated with the elderly that are now seen increasingly in younger populations, and lung diseases and HIV/AIDS that are turning up more frequently among women. Health inequalities continue across the population as socio-economic and regional factors continue to raise different challenges for health providers and policy-makers. While there are a number of new emerging trends with potential benefits and threats to Canadians' health, for the most part there are several key themes that continue to dominate the policy landscape for Health Canada. We are seeing encouraging progress towards improving the health of Canadians In Canada, we have made significant advances in preventing and treating cardiovascular disease and we have seen death rates in this area decline dramatically over the past 40 years. Progress has been made also in the fight against cancer, with the latest statistics showing stable or declining incidence and mortality rates for most types of cancers. Canada has a better cancer survival rate than Western Europe. We have made progress with tobacco use, with overall smoking rates and smoking related deaths declining. A number of health issues will always remain, as challenges and diseases evolve and positive efforts in prevention and treatment take time to alter the overall health of the population Though concrete progress has occurred in First Nations and Inuit health, such as with increases to overall life expectancy, there still exists a health gap between Aboriginal peoples and the rest of the Canadian population. Child poverty remains a challenge for a significant number of Canadian households, with potential impacts on health. Mental illness is a burden for many Canadians. The overall number of new cases of cancer continues to increase, as the population grows and ages. The number of HIV/AIDS cases continues to grow, affecting different segments of the population. More evidence, research, monitoring and reporting is crystallizing what we know about emerging health threats and the changing face of illness in Canada Governments and health organizations around the world continue to monitor avian flu and pandemic influenza, a relatively new focus for many organizations. The growing incidence of obesity in younger Canadians is an emerging health threat that governments and health care providers have to address. The rate of respiratory diseases, such as asthma, is increasing rapidly in Canada and women are especially vulnerable. Superbugs and hospital acquired infections continue to challenge health care providers and governments. Research repeatedly demonstrates that the actions of individuals can have a positive impact on their health and well-being, providing encouraging potential for improving the health of Canadians Two thirds of Canadians have at least one modifiable risk factor for chronic disease. It is estimated that about one half of cancers in Canada are preventable through lifestyle changes. Nutrition is a key factor for preventing some cancers and diseases. Experts say many accidents and injuries are preventable, though mishaps around the house, workplace or on the roads remain a leading cause of death. Eliminating tobacco use remains a critical lifestyle change for improving health. Health Canada has developed a comprehensive array of programs, services, policies and regulations to enable us to address both existing and emerging health issues and challenges in Canada. Following are the four strategic outcomes guiding the work of the Department. Details of the program activities, priorities, expenditures and expected outcomes that fall within each of the following Health Canada strategic outcomes are included in Section 2 of this Report. Strengthened knowledge base to address health and health care priorities. Access to safe and effective health products and food, and information for healthy choices. Reduced health and environmental risks from products and substances, and safer living and working environments. Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians. In addition to delivering initiatives in support of the four ongoing corporate priorities that reflect our day-to-day business, Health Canada will assign specific priority to the following key areas in 2007-2008: 1. Supporting the health care system by advancing Patient Wait Times Guarantees. Health Canada is working with the provinces to help ensure Canadians receive the care they need within clinically acceptable wait times. For example, Health Canada is implementing pilot projects for patient wait times guarantees in such areas as diabetes and prenatal care for First Nations and Inuit and pediatric surgeries. 2. Improving the health of specific populations including Aboriginals, seniors, children and youth. Initiatives will be implemented to help improve health outcomes for these specific groups that are each facing unique health challenges in comparison with other Canadians. 3. Advancing Health and Environment initiatives to protect health and adapt to our changing climate. Health Canada's work on the Chemicals Management Plan of Canada's Environmental Agenda will improve the degree of protection of Canadians and their environment against hazardous chemicals by introducing a number of new, proactive measures. The Clean Air Agenda will reduce indoor and outdoor air quality risks through such initiatives as a Radon Strategy and an Air Quality Health Index and Forecast Program. 4. Protecting the health of Canadians with a focus on regulatory renewal, natural health products and a National Drug Strategy. We will develop and maintain modern and flexible legislation, regulatory frameworks and policy instruments in order to strengthen and modernize Canada's regulatory systems related to consumer and health products, food and pesticides. We will also continue work on the assessment of natural health products to help protect Canadians using these remedies. To help reduce harm associated with the abuse of drugs and alcohol, we will work with partners to develop a National Drug Strategy. 5. Advancing global health security by working with the Global Health Security Initiative to coordinate global actions in response to health threats. We work with other countries and international organizations including the World Health Organization (WHO). The following guiding principles will direct the work of the Minister of Health and the management of the Health Portfolio's activities as it responds to the priorities for action: Putting people first: Promoting policies and programs that provide greater certainty and timely access to health care for Canadians. Making strategic and evidence-based investments: understanding and responding in a strategic and co-ordinated manner to changes affecting our health system, including demographics, societal expectations and the changing nature of infectious, communicable and chronic diseases. Ensuring alignment across the Health Portfolio: ensuring that the different policies, programs, agencies and partnerships that support strategic investments are aligned, reducing fragmentation, duplication in effort, overlap and where appropriate, varying cultures and modes of operation. Building relationships with partners based on trust and inclusiveness: improving federal-provincial-territorial relations to better serve Canadians and ensuring wider participation by private and non-government organizations in policy making and with international organizations such as the World Health Organization. Ensuring active engagement in international health issues including pandemic planning, knowledge generation and sharing, and new health developments in other countries. Improving performance and ensuring value for money: supporting evidence-based policy and developing information and management systems that support performance management and optimal use of taxpayer funds. In the coming three years, Health Canada will address several internal management issues to ensure the Department is able to effectively and efficiently deliver on its priorities and meet its objectives. An overview of several key management priorities is included below. Impacts to Health Canada from Expenditure Restraint were limited to the Medical Marihuana Research Program, the First Nations and Inuit Tobacco Control Strategy and the Policy Research Program. Details are included in Section 2 - Strategic Outcomes. Health Canada will continue to move forward with projects from its Financial Management and Control Framework to improve the capacity of Health Canada to effectively manage the resources under its control. Recently, a major step was taken towards a coordinated approach to resource management in Health Canada with the introduction of an integrated departmental operational planning process, including human resources. We will continue to refine the process to ensure effective decision-making and enhanced monitoring of the resources for which the Department is responsible. Also, Health Canada will continue to work to meet the requirement for Audited Financial Statements, including the strengthening of internal controls and standardization of practices and processes. Health Canada will implement the requirements of the new Federal Accountability Act. We will continue to monitor developments in the policy environment as it pertains to departmental finance and administration and will develop appropriate responses to newly implemented policies in a timely fashion. Health Canada will continue to support the work of the Blue Ribbon Panel on Grants and Contributions by assisting on the Business Process Review to streamline processes and participate as a vanguard department in implementing the Panel's recommendations. Health Canada will continue to respond to audit recommendations as laid out by the Office of the Auditor General, the Office of the Comptroller General and others. We will ensure that structures, processes and systems are in place to ensure that our responses will satisfy the requirements described in various audit recommendations. The Department has most recently agreed with all recommendations of the November 2006 Auditor General's Report, which contained two Chapters on Health Canada. With respect to Chapter 8, Allocating Funds to Regulatory Programs, Health Canada has developed an Action Plan to address all ten recommendations. The Plan comprises two main components to strengthen its overall resource management process: a Branch level Comprehensive Program Review; and a departmental wide corporate Financial Management Control Framework targeted to be completed by March 2008. The Action Plan and status reports will be provided to the Standing Committee on Health and the Standing Committee on Public Accounts. For Chapter 10, Award and Management of a Health Benefi ts Contract, Health Canada has resolved the issues that the Auditor General brought to its attention. Health Canada will continue to apply the Management Accountability Framework (MAF) at all management levels, and to integrate MAF expectations into the management culture of the Department. Through the MAF, Deputy heads will carry on their dialogue between the Treasury Board of Canada Secretariat (TBS) and the Public Service Human Resources of Canada (PSHRMAC) on the state of management practices in their organizations and on priorities for management improvement. The application of the MAF will facilitate the dialogue on management results with departments and agencies, as it integrates TBS and PSHRMAC management improvement initiatives and policies. Risk Management is an important element of the MAF and Health Canada is committed to incorporating risk management in departmental planning processes. Health Canada will continue to participate in the federal government's shared services initiatives, and will continue to improve the Department's Business Continuity Planning Program to ensure departmental readiness for the continuous delivery of critical services during emergencies that have the potential to interrupt departmental operations such as a pandemic infl uenza outbreak. Business objectives will guide human resource planning, helping to ensure we have the right people, with the right skills, at the right time, to achieve our goals. The strategic outcomes highlighted in the Report on Plans and Priorities will form the business framework for human resource planning in the Department. For planning purposes, branches and regions will use input from multiple sources to analyze their human resources needs and issues. Managers will take into account various information, including an internal departmental environmental scan, departmental demographic information, the results of the last Public Service Employee Survey, available program evaluations, Health Canada's draft science plan, and feedback from the Department's Management Accountability Framework. Consolidated human resources plans will be analysed and used for integrated decision-making. Our Operating Principles Sound, informed decision-making based on leading edge science Effi cient and sustainable resource utilization within legal, ethical and operational frameworks Cooperation and engagement with provinces, territories, partners and stakeholders Engagement in international health issues For the period of 2007-2010, implementation of the Department's Sustainable Development Strategy IV will be the focal point of activity for sustainable development within Health Canada. Departmental targets will contribute to outcomes in areas such as food safety, clean water and clean air; sustainable communities; and greening of departmental operations to further sustainable development. During this period, Health Canada will work with other federal departments to advance the social aspects of sustainable development to ensure that departmental policy and program integration efforts are taking into account determinants of health and other socio-cultural factors. For more information on Health Canada's Sustainable Development Strategy, please see Table 11 of this Report. As a science-based department, Health Canada depends on a strong foundation of science and research to fulfil its legislated mandate and contribute to the health and safety of Canadians. Given the wide spectrum of science-related activities in the Department, it is critical that we foster excellence in science and research, by effectively using sound science in policy and regulatory decision making, and ensuring that these activities are aligned with departmental and federal policies. Sound science contributes to risk assessment, risk management and supports evidence-based decision-making within Health Canada. Sound science contributes to establishing policies, setting standards and providing advice and information on the safety and nutritional value of food; the review of drugs to assess their quality, safety and effectiveness, including prescription and non-prescription pharmaceuticals, disinfectants and sanitizers; in assessing health risks to Canadians posed by environmental factors, consumer products, controlled substances, workplace chemicals and tobacco. In addition, sound science contributes to science-based health, environmental and value (including efficacy) assessments of pest control products. Health Canada plays a strong leadership role in the federal government with respect to horizontal science policy and science management issues; supporting excellence in technology and innovation in all science, both research and regulatory, and promoting science and technology integration within the federal government and with external partners. In addition, the Department is committed to fostering excellence and integrity in its own science, encouraging due diligence and ensuring Health Canada has the science capacity it needs to meet current and emerging challenges. Program Activity - Health Policy, Planning and Information Planned Spending and Full-Time Equivalents (FTEs) ($ millions) Forecast Spending 2006-2007 Planned Spending 2007-2008 PlannedSpending 2008-2009 PlannedSpending 2009-2010 Net Expenditures 281.9 263.7 259.9 254.8 FTEs 635 588 570 571 Notes: The decrease in forecast/planned expenditures from 2006-2007 to 2007-2008 is mainly due to the sunset of the Primary Health Care Transition Fund. This decrease is partially offset by an increase in funding for the Canadian Strategy for Cancer Control. The decrease in planned expenditures from 2007-2008 to 2008-2009 is mainly due to a decrease in the level of funding for the Implementation of the Therapeutic Access Strategy, and the Assisted Human Reproduction regulatory regime. The decrease in planned expenditures from 2008-2009 to 2009-2010 is mainly due to a decrease in the level of funding for the National Wait Times Initiative. Figures include an amount for departmental and regional infrastructure costs supporting program delivery. Under this program activity, we strive to develop effective policy responses to a range of priority, emerging, and cross-cutting issues that impact the health of Canadians. There are many governmental and non-governmental organizations working towards improved health outcomes in Canada, including provincial and territorial ministries of health, professional organizations, research organizations, the program branches of Health Canada, and the agencies within the federal Health Portfolio. Our objective is to promote national coordination and development of a strong, shared knowledge base to address health and health care priorities for all Canadians. We also aim to facilitate successful health system adaptation to changes in technology, society, industry and the environment, such that Canadians will continue to be protected from health risks, have access to quality health care, and gain positive health benefits from information and innovation. We engage in a variety of policy activities to achieve our objectives. This includes managing targeted funding programs to stimulate health system research and renewal, administering the Canada Health Act, drafting new health protection legislation and regulations, developing and distributing federal position papers on emerging issues, and setting up new agencies. We also take a leadership role for the Department in strategic planning, intergovernmental and international affairs, Cabinet and parliamentary relations, and providing policy advice and support to the Minister of Health. During 2007-2008, reduction in health care wait times will remain one of our key priorities. Our work in this area is focussed on health human resources (i.e., ensuring there are adequate numbers of qualified health professionals to provide the health care Canadians need), promoting the use of electronic health records, facilitating federal/provincial collaboration, and supporting research that will help identify more efficient and effective ways to manage health care. Another continuing priority will be pandemic influenza preparedness and response. Here, we will focus on coordinating our efforts with the provinces and territories and the Public Health Agency of Canada (PHAC), the lead federal agency responsible for responding to public health emergencies and infectious disease outbreaks. Our role is to promote equitable access to needed vaccines and antivirals, to represent Canada in international initiatives, and to provide advice on the broader social and economic implications of a pandemic influenza outbreak. Renewal of health protection legislation and modernization of the Canadian regulatory system also remain priorities. We are aiming to provide enhanced protection for Canadians as consumers, patients and workers, while encouraging commercial innovation and a competitive economy. Effective policy development in the area of health draws on expertise and knowledge in the health sciences and medicine as well as the social sciences. We work with many partner organizations in health research and health data collection. The Canadian Institutes for Health Research (CIHR), Statistics Canada, the Canadian Institute for Health Information (CIHI), professional organizations, and non-governmental organizations work with the federal Health Portfolio to generate the extensive knowledge base needed for effective health policy, and to ensure its availability to the decision-makers who need it. We also share information internationally through partnerships such as the Organization for Economic Cooperation and Development (OECD) Health Committee, the Global Health Research Initiative (GHRI), and the Canada-Australia Dialogue. Our priority at Health Canada is to promote collaboration and knowledge-sharing in health care research, to address knowledge gaps in what the federal Health Portfolio has identified as priority issues, and to ensure research addresses the health needs of all Canadians. In some areas, we have our own expertise. For example, we conduct economic analyses of what affects supply and demand in health care, and we conduct gender-based analyses (i.e., to determine how men and women may be affected differently by policies and programs). The impact of the Health Policy Research Program cancellation (as part of the spending restraint announced in September 2006) has been generally on university-based researchers, graduate students and institutions interested in providing evidence for health policy decision-making. Departmental staff scanned other funding organizations to recommend alternate sources of funding for projects terminated or about to begin, but were unable to find appropriate sources. The implication of the program cut for future plans and priorities is that the Department, PHAC, and the broader health community have lost a source of medium- to long-term health policy research on priority issues, which could be/has been used in the development of policies and programs. Under the Health Policy, Planning and Information Program Activity, Health Canada's role is one of facilitation and coordination as well as promotion of federal standards and policy directions to improve health outcomes for all Canadians. In many areas, we are working collaboratively across jurisdictions, sectors, and agency mandates. Our performance measures and indicators reflect this. For example, our expected results include facilitating strengthened global health security and health system improvements through establishing pan-Canadian as well as international strategies and commitments, and through effectively managing targeted funding programs. To ensure accountability to Canadians, we conduct periodic evaluations of these programs. We also support agencies such as the Health Council to report on progress in joint initiatives such as health care renewal. We have identified expected results and performance indicators for each key program and service below. Health Care Policy (Ongoing) Description: Health Canada works in close collaboration with the provinces and territories, health professionals, health care administrators and other key stakeholders to develop strategic policy on health care. Our aim is to improve access, quality, and integration of health services to better meet the health needs of all Canadians. We strive to ensure that health care policy decisions are based on strong evidence and are aligned with the principles of equity, sustainability, and affordability. Further, we aim to facilitate effective health system adaptation to the changing needs of the population. Our policy activities in this area address issues related to broader health care system renewal, such as fiscal transfers, health care financing, governance and accountability, and the roles and interface of the public and private sectors. We also work with the provinces and territories and other stakeholders to address specific health care issues, such as health human resource strategies, electronic health records, home care, continuing care and palliative care. Facilitate improved access, quality and integration of health care services for all Canadians Establishment of joint federal/provincial/territorial strategies and commitments Interim and summative evaluations of funding programs (expected results and indicators are specific to each initiative) Progress reports on health care renewal from the Health Council Performance indicators and targets are under development for new policy directions $ (in millions) FTEs $ (in millions) FTEs $ (in millions) FTEs 132.8 112 132.6 112 127.8 112 Wait Times Management and Health Care Renewal An important area of focus for 2007-2008 is continuing work on the government's key health priority of Patient Wait Times Guarantees (PWTGs) and the National Wait Times Initiative (NWTI) fund. Health Canada has been working collaboratively with the provinces and territories and other stakeholders to develop and share innovative initiatives and best practices in wait times management and reduction; develop and implement pilot projects to test and evaluate PWTGs; establish evidence-based benchmarks for medically acceptable wait times; produce regular reports to Canadians on progress on wait times; support and disseminate research on wait times; and, monitor national and international developments in quality and patient safety. A number of initiatives to stimulate health care renewal were initiated in response to the 2004 Health Accord, and Health Canada is continuing to monitor the implementation of those initiatives. We will also continue to support the Health Council of Canada with a grant of up to $10 million annually until March 2008 to monitor and report on the progress of health care renewal in Canada. With regard to patient safety, Health Canada oversees a grant of up to $8 million annually (until March 2008) to the Canadian Patient Safety Institute (CPSI) to improve national collaboration. At the time of writing of this document, workplans for wait times reduction initiatives were being developed to reflect the direction of the new government in this area in collaboration with the provinces and territories. Health Human Resources Strategies Health Canada will continue the implementation of the Pan-Canadian Health Human Resource (HHR) Strategy, established in 2003 to provide financial support (up to a total of $20 million annually) for activities that promote appropriate planning and management of HHR to help ensure Canadians have access to the health providers they need. Under the Strategy, Health Canada manages three broad funding initiatives: Pan-Canadian Health Human Resource Planning, Interprofessional Education for Collaborative Patient-Centred Practice, and Recruitment and Retention. Projects underway include the development of nationwide databases for HHR planning, and projects to stimulate interest in health careers in areas of shortage such as rural medical practice. (See also the Nursing Policy section for a description of activities under these initiatives.) Evaluations of the funding initiatives under the Strategy will be conducted in 2007-2008. In partnership with federal, provincial and territorial governments, regulatory bodies, academic organizations and others, Health Canada will also continue to implement the Internationally Educated Health Professionals Initiative (IEHPI), for which the federal government committed $75 million, beginning in 2005-2006. The goal of this initiative is to facilitate integration of health professionals educated in other countries into the Canadian workforce. As part of the Pan-Canadian HHR Strategy, Health Canada has been working with the provinces and territories, stakeholders, and other federal departments to develop and implement a pan-Canadian HHR Planning Framework. The framework is intended to act as a guide for HHR planning in Canada and for the future research and activity agenda of the Pan-Canadian HHR Strategy. Between the Spring and Fall of 2006, key stakeholders, including representatives from ministries of education, research entities, national Aboriginal groups, health sector organizations, health professional associations, and professional regulatory bodies were consulted on the framework and its action plan. Federal funding for 2008-2013 of the Pan-Canadian HHR Strategy will largely be based on the framework. The Canada Manitoba Health Policy Dialogue is a partnership between Health Canada's Manitoba Region and Manitoba Health to provide continuous learning opportunities for staff and to foster new networks and collaborations across programs. To be held quarterly, it is a forum for senior managers at Health Canada and Manitoba Health to discuss strategic health issues with broad involvement of staff from both organizations. Home and Continuing Care, Chronic Disease Management, E-Health Health promotion and prevention of disease, screening, diagnosis, treatment, home and continuing care, and palliative and end of life care are all important elements of a quality health system. The new government is committed to emphasizing health promotion, chronic disease management (in particular, cancer), and the health of seniors and children. Federal initiatives related to these priorities will be the shared responsibility of Health Canada, the Public Health Agency and the Canadian Institutes for Health Research. Health Canada will focus on the role of the health care delivery sector and coordination across the federal Health Portfolio and the provinces and territories. In early 2007-2008, the summative evaluation of initiatives under the Primary Health Care Transition Fund (PHCTF) will be available. The Fund (2000-2006) aimed to support provinces, territories and other health care system stakeholders in improving access, quality of care, accountability, and integration of services in primary care (i.e., the broad spectrum of services involved in health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury). Moving forward, Health Canada's priority policy development issues in the area of primary and continuing care include coordination of care, self-managed home care, and data development related to palliative care. Health Canada will also enhance attention to emerging portfolio issues such as chronic disease management and e-health, and we will provide Portfolio leadership in relation to government policy and commitments regarding autism. Health Canada is the federal government's liaison with the Canadian Partnership Against Cancer Corporation (CPACC) and will be responsible for managing the $50 million per year grant agreement with the Corporation (April 2007 to March 2012). CPACC is currently in its start-up phase and is developing its workplan for the upcoming fiscal year. Its mandate will be to provide a leadership role with respect to cancer control through the management of knowledge and the coordination of efforts among provinces and territories, cancer experts, stakeholder groups, and Aboriginal organizations to champion change, improve health outcomes related to cancer, and leverage existing investments. Addressing Mental Health and Mental Illness The Government of Canada recognizes the importance of pursuing action on mental health, and is committed to advancing pan-Canadian efforts with the provinces, territories, and other stakeholders, including various organizations and Aboriginal groups. Health Canada, along with PHAC, is reviewing the recommendations of the Senate Committee report released in May 2006, including the proposal to set up a Commission as a focal point in Canada for mental health. Pharmaceuticals Management Strategy (Ongoing) Description: The Pharmaceuticals Management Strategy activity area focusses on the overall coordination of federal pharmaceutical policy and collaborative work with provincial and territorial partners on pharmaceuticals management. Our objective is to better integrate pharmaceuticals into a seamless, robust health care system in order to improve health outcomes for Canadians and reduce costs in other health care sectors, such as hospitals. To achieve this, we seek to optimize policy interventions in areas such as post-market drug safety and effectiveness, appropriate drug-prescribing and use, and drug pricing and research. Our work in this area is closely linked with the Department's initiatives under the Blueprint for Renewal (the Health Products and Food Branch's comprehensive plan for regulatory modernization) and with the activities of the Patented Medicine Prices Review Board. Facilitate better integration of pharmaceuticals into the health care system Under the second phase of the National Pharmaceutical Strategy, workplans are being established in consultation with the provinces and territories 9.9 25 8.5 22 8.5 22 We will continue to work with the provinces and territories on pharmaceutical activities initiated as part of the 2004 Health Accord under the National Pharmaceuticals Strategy (NPS), an integrated, collaborative, multi-pronged approach to addressing pharmaceutical challenges that builds on governments' shared roles in the pharmaceuticals sector. The NPS Progress Report, published in September 2006 by the F/P/T Ministerial Task Force on the NPS, highlighted major achievements to date and set out key next steps for future work. The Report sets the stage for development and implementation of a second phase of the NPS work. For more information on the NPS Progress report, see: http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2006-nps-snpp/index-eng.html In 2007-2008, Health Canada will continue to seek to advance work on all elements of the NPS. Specific collaborative work on the priority areas with provincial and territorial partners is expected to include: Catastrophic Drug Coverage (CDC): Officials will review and validate CDC costing methodologies, update related costs, and analyse issues related to the private insurer role. Expensive Drugs for Rare Diseases (EDRD): Officials will focus on developing federal/provincial/territorial consensus on the parameters of an EDRD framework and validate it with experts and external stakeholders. Common Drug Formulary: Officials will continue work to expand the Common Drug Review to all drugs and identify improvements to drug plan formulary management processes. Drug Pricing and Purchasing Strategies: Officials will develop a business case and implementation plan to address generic and other non-patented drug prices, and will examine the issue of the price of patented drugs for which there are expanded indications. Real-World Drug Safety and Effectiveness: Officials will complete a business plan to develop a national research network and centres of excellence under the guidance of a national oversight body, and engage "front-line" providers and patients on knowledge exchange related to drug safety and effectiveness in day-to-day use. Nursing Policy (Ongoing) Description: Under this activity, policy advice from a nursing perspective is provided to the Minister, his office and senior staff within the Department. The aim is to work in close collaboration with the nursing community to optimize the contribution of nursing knowledge and practice to improved health care for Canadians. To support policy development in this area, we fund activities related to knowledge generation as well as knowledge transfer and uptake (through publications, presentations, internet postings, sharing at meetings, workshops, etc.) These activities are targeted at decision-makers in governments and non-government organizations, both nationally and internationally. Optimize the contribution of nursing knowledge and practice to improved health care for Canadians Specified in workplans and funding agreements In support of efforts to improve Canadians' access to health care services, reduce wait times and support care guarantees, we will continue to be engaged in policy development and knowledge generation, sharing and uptake. To facilitate an increase in the supply of nurses and improvements in the stability of the nursing workforce, we fund projects related to increasing domestic production, enhancing recruitment and retention, and integrating internationally educated nurses into the Canadian system. These activities are funded through the Pan-Canadian HHR Strategy (under Recruitment and Retention), and through the Internationally Educated Health Professional Initiative. Under the Healthy Workplace Initiative (HWI) component of the Pan-Canadian HHR Strategy, we have been working to enhance the uptake and utilization of healthy workplace practices to improve the retention of health care providers. To achieve this, we are providing funding to projects that will increase knowledge about best practices in health workplaces, and funding for a national project that will facilitate the exchange of best practices across the country. In 2007-2008, we will complete an evaluation of the Healthy Workplace Initiative to establish if its objectives are being met. Expected results include policies that enhance the workplace, thereby improving provision of quality health care; improved health and well-being of health care workers; decreased absenteeism, turnover and overtime of health care workers; and an inventory of innovative practices that enhance the health practice setting. In 2007-2008, we will also provide ongoing funding to 20 research/learning projects that will increase knowledge about best practices in encouraging health care professionals to learn and work together in collaborative, patient-centred practice. In addition, we will provide ongoing and new funding for complementary projects that address issues at the health system level to improve the uptake of these collaborative practices in all jurisdictions. These projects are funded under the Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP) component of the Pan-Canadian HHR Strategy and will be completed by June 2008. Further, we will develop an evaluation plan and interim evaluation to determine how well IECPCP objectives are being met. Assisted Human Reproduction Canada Implementation (Ongoing) Description: Under this activity, Health Canada works towards the set up of Assisted Human Reproduction Canada (AHRC), the implementation of the Assisted Human Reproduction Act, and the development of related regulations. The aim of AHRC is to promote and protect the health and safety of Canadians who are using Assisted Human Reproduction technologies. Implementation of Assisted Human Reproduction Act and development of related regulations Set up of Assisted Human Reproduction Canada (AHRC) Milestones towards completion specified in yearly workplans Ultimately, AHRC will report on success in promoting the health and safety of Canadians who are using these technologies 3.1 25 1.5 9 1.5 9 With the appointments of the President and board of directors of AHRC completed in December 2006, Health Canada will now concentrate its resources on completing the elements of the regulatory framework. It is anticipated that in 2007-2008, draft regulations will be published for areas such as licencing, health reporting information, and clinical and laboratory requirements dealing with in-vitro fertilization procedures using the patients' own gametes. We will continue to gather input from stakeholders, including the provinces, to ensure a pan-Canadian approach and to develop further regulations for controlled activities, such as the use of third-party gametes and pre-implantation genetic diagnosis. In 2007-2008, we expect to complete the issue identification phase of these consultations. The Personal Health Information Registry will be ready for transfer to AHRC by the end of 2007-2008. Steps will be taken to develop a workplan to begin the process to remake, under the AHR Act, the Processing and Distribution of Semen for Assisted Conception Regulations under the Food and Drugs Act. The Quebec Government filed a reference with the Quebec Court of Appeal challenging the constitutionality of sections of the AHR Act. The Department will continue to defend the constitutional validity of the Act. Health Sciences Policy (Ongoing) Description: Health Canada monitors new and emerging health science technologies, such as nanotechnology and human genetics, to determine potential risks and benefits to the health system and the health of Canadians, as well as to address wider economic, social, ethical and/or legal implications. We develop policy options to address these potential impacts. For example, we work collaboratively to develop standards for research ethics, best practices for biobanking, and quality guidelines for genetic testing. We also aim to ensure that Canadians will be in a position to make informed decisions on health care or participation in research involving new health technologies. By conducting policy research in this area, we aim to incorporate the perspectives of affected stakeholders, the knowledge of experts, and the experience of other jurisdictions. Our work involves collaboration with other Health Portfolio agencies, other departments, and international organizations, such as the Organization for Economic Cooperation and Development (OECD) and the United Nations Educational, Scientific and Cultural Organization (UNESCO). Contribute to health science areas such as: - promotion of innovation in preventative, diagnostic and therapeutic technologies - interventions for infectious diseases, such development of and access to safe and effective vaccines - strengthened human research participant protection - quality assurance guidelines for genetic testing Reflection of ethical, legal, social, economic and health system considerations in international and domestic partnerships and policy advice in health science areas Progress on a system for human research protection in Canada; milestones specified in the workplan and project agreement Under this activity area, Health Canada will continue to provide strategic policy analysis, advice and oversight on economic, social, legal, and ethical issues on pandemic influenza and other infectious disease issues. Activities include the following: liaising with officials across the Health Portfolio and other government departments on broad policy issues related to pandemic influenza (e.g., potential social and economic impacts); advancing dialogue on equitable access to vaccines and antivirals; assessing policy and market levers to stimulate health research and innovation to address unmet health needs related to infectious diseases domestically and abroad; and providing input to government-wide initiatives on infectious disease-related issues, including pandemic influenza, vaccines, etc. For example, we are providing input to the North American Plan for Avian and Pandemic Influenza, the G7 Advance Market Commitment pilot vaccine project for pneumococcal vaccine, and Government of Canada positioning within the OECD high-level forum on neglected and emerging infectious diseases. We will also continue working with domestic stakeholders (i.e., clinical researchers, research ethics board members and administrators, sponsors of clinical trials such as pharmaceutical companies, the National Council on Ethics in Human Research, the Canadian Institutes of Health Research, the Inter-Agency Panel on Research Ethics, and other experts involved in research ethics) to develop standards for research ethics boards and solutions to the issue of protecting human research participants. Health Canada's role in developing the standards is to engage these stakeholders as well as the industry sector through a consensus-based approach. Work on this project involves collaboration with the Health Products and Food Branch to ensure consistency with clinical trial regulations. In 2007-2008, Health Canada will work with the Canadian General Standards Board to establish the technical committee made up of experts and stakeholders who will draft the standards, and will play a central role in coordinating the project and communicating more broadly. This work aims to achieve improved consistency in the operation of research ethics boards that review clinical trial applications, contributing to improved protection for research participants. Funding for the project for 2007-2008 is $1 million, and will be $0.7 million per year from 2008-2009 onward. Legislative and Regulatory Affairs (Ongoing) Description: Health Canada is preparing a new framework to update, strengthen and integrate federal health protection legislation to be more responsive to present and future social and technological realities and to provide the tools needed to better protect the health and safety of Canadians. A new legislative framework will modernize and reinforce key existing legislation, including the Food and Drugs Act, Radiation Emitting Devices Act and Hazardous Products Act. With respect to regulations, Health Canada continues to actively work to modernize the Canadian regulatory system to respond to current and emerging challenges from rapid scientific developments, globalization and cross-boundary health risks. The goal is to build a robust and flexible regulatory system that maximizes health, safety and environmental protection and also promotes an innovative and competitive economy. Better protection for the health and safety of Canadians as consumers, workers, and patients Progress towards regulatory policy coherence across the Health Portfolio Achievement of milestones towards completion of a new framework set in annual workplans (see text below for 2007-2008) Ultimately, the success of the new framework in achieving improved health protection for Canadians will be reported on by the Health Canada program branches and the Health Portfolio organizations responsible for specific sectors (i.e., food safety, consumer safety, etc.) 1.1 0 1.1 0 1.1 0 Health Canada will continue in 2007-2008 with a phased approach to legislative renewal. Over the next fiscal year, efforts will be focussed on the following areas: protection of personal health information, re-design of enforcement and compliance authorities and the treatment of confidential commercial information. We will review current legal authorities and instruments, and develop policy options for greater, modernized health protection that are aligned with Charter, legal and international considerations. Research and policy work, along with stakeholder engagement, will continue on the other aspects of the renewal exercise to advance a comprehensive framework of consumer health protection laws. In addition, we will further the work already undertaken on direct-to-consumer advertising (DTCA). Specifically, we will review the latest approaches by other countries, review scientific evidence, conduct consultations within the Health Portfolio to determine implications of various options, and make a recommendation on a policy on DTCA. We will continue to work on a renewed modern approach to regulation, which builds on existing federal regulatory policy by promoting increased regulatory transparency, the alignment of legislative and regulatory planning and increased departmental efficiencies through improved coordination. International Affairs (Ongoing) Description: Health Canada contributes to enhancing health security and to protecting the health of Canadians by anticipating and responding to international health developments. International Affairs is Health Canada's focal point to initiate, coordinate, and monitor departmental policies, strategies and activities that help promote Canadian priorities and values on the international health agenda. We provide strategic policy advice on international health issues to the Minister of Health, senior management and the Health Portfolio. We ensure Canada's health priorities are advanced by appropriate representation at international fora, and we ensure that the Department's international activities are consistent with government-wide policies. We collaborate and exchange ideas and knowledge with key multilateral health agencies, including the World Health Organization (WHO) and the Pan American Health Organisation (PAHO) on global issues such as pandemic influenza preparedness, HIV/AIDS strategies, and global health security initiatives. We also share Canada's best policies and practices with other countries, and negotiate bilateral agreements with numerous countries on important health issues. Contribute to enhancing global health security and protecting the health of Canadians Participation in and outcomes of conferences and meetings; establishment of joint strategies and frameworks Expected results and performance measurements relating to specific sectors will be reported on by the organizations responsible (e.g., PHAC will report on pandemic preparedness) 22.9 30 23.3 30 23.3 30 Avian influenza and the possibility of a pandemic human influenza outbreak are considered a global threat. Health Canada will continue to provide policy coordination, advice and analysis on international avian and pandemic influenza planning and preparedness. By participating in interdepartmental policy development (for example, with Department of Foreign Affairs, PHAC, Public Safety and Emergency Preparedness Canada, Agriculture/CFIA and Industry Canada), we will contribute to a coherent cross-government approach to advancing global pandemic preparedness. Health Canada will continue to provide policy coordination/coherence for the Health Portfolio and to act as the lead/key interlocutor for Canada with organizations such as the WHO, OECD, APEC, etc. We will work closely with PHAC, which serves as the substantive lead on pandemic influenza. Health Canada will continue to chair the APEC Health Task Force (HTF) (2006-2008). As Chair, Canada provides key policy guidance on current priorities of the HTF, including enhancing avian and human pandemic influenza preparedness and response; fighting against AIDS in APEC; and improving health outcomes through advances in health information technology. Our partners in the working group on APEC HTF are PHAC, DFAIT, and the Canadian Food Inspection Agency (CFIA). Official Languages Minority Community Development (ongoing) Description: Health Canada manages funding programs to support projects that will help improve access to health services for official language minority communities. Improved access to health services for official language minority communities Evaluations of funding programs (expected results and indicators are specified in the funding agreements for projects) In 2007-2008, Health Canada will conduct an evaluation of the Contribution Program to Improve Access to Health Services for Official Language Minority Communities (launched in June 2003). The Program has had an ongoing funding base of $23 million per year as of 2006-2007. Funds support initiatives for community networking and training and retention of health professionals among official languages minority communities. The evaluation will assess the program for its success in achieving the following: increased awareness among health professionals and policy makers of health needs of official language minority communities; increased recruitment and enrolment of students in training to offer services for official language minorities; increased level of satisfaction of health professionals and patients; increased health service access for official language minority groups; increased number of health professionals providing health services to official language communities; and, improved health status of target population groups. The following programs and initiatives contribute to the balance of the program activity total: Applied Research and Analysis Canada Health Act Federal Provincial Relations Policy Coordination Policy Priorities and Analysis Portfolio Affairs Women's Health and Gender Analysis The planned spending for 2007-2008 for these programs and initiatives is $64.3 million. Program Activity - Health Products and Food ($ millions) Forecast 2006-2007 Planned Spending Gross Expenditures Less: Expected respendable revenues 345.0 41.2 298.6 293.7 FTEs 2,591 2,668 2,656 2,650 Notes: The decrease in forecast/planned expenditures from 2006-2007 to 2007-2008 is due in part to the sunset of the Phase II Response to Bovine Spongiform Encephalopathy (BSE) in the areas of Risk Management and Targeted Research, the effect of one-year interim funding the Department received for 2006-2007 for Natural Health Products and Litigation Management as well as other Funding from the Department's operational budget carry-forward. The decrease in planned expenditures from 2007-2008 to 2008-2009 is primarily due to a decrease in funding for the Therapeutic Access Strategy and the sunsetting of funding for the Agriculture Policy Framework and the augmentation of Health Canada's Phase I response to Bovine Spongiform Encephalopathy (BSE). This is partially offset by an increase in Therapeutic Products Safety (TPS) Initiative funding. The decrease in planned expenditures from 2008-2009 to 2009-2010 is primarily due to the sunsetting of funding for the Access to Medicines Program and the Phase II response to BSE in the areas of Risk Management and Targeted Research. This is partially offset by an increase in the TPS Initiative funding. Health Canada is Canada's federal authority responsible for the regulation of health products and food. Under this Program Activity, Health Canada evaluates and monitors the safety, quality and efficacy of health products such as drugs, vaccines, medical devices, natural health products and other therapeutic products available to Canadians, as well as the safety and nutritional quality of the foods they eat. In addition, the Department protects human and animal health and the safety of Canada's food supply by evaluating and monitoring the safety, quality and effectiveness of veterinary drugs by setting standards and promoting the prudent use of veterinary drugs administered to food-producing animals and companion animals. Finally, we promote the health and well-being of Canadians through a broad range of activities related to health products and food, including developing nutrition policies and standards such as Canada's Food Guide to Healthy Eating.1 Health Canada has identified five major challenges that must be addressed to help ensure continued, timely access by Canadians to safe and effective health products and a safe and nutritious food supply: an outdated regulatory toolkit that is increasingly limited and inflexible in responding to today's health products and food environment; the regulatory system's current incapacity to consider a given product through its entire life cycle, from discovery through examining the "real-world" benefits and risks of a health product and a food on the market; the impact of social and economic changes, such as accelerating scientific and technological advances, the rise of trans-border health and environmental threats, and a more informed and engaged citizenry; a regulatory system that currently is not sufficiently interconnected with the research and development, and health care systems; and the need to sustain and improve regulatory performance and capacity. Health Canada will continue to renew the regulatory system for health products and food. This requires strengthening our regulatory tools and promoting innovative solutions to new population and public health challenges; improving the efficiency of our regulatory system, and more fully integrating evidence-based decision-making; influencing and adopting internationally respected scientific advice and internationally recognized regulatory best practices; pursuing international regulatory cooperation opportunities; meeting high standards of vigilance in our responsibility to monitor "real-world" product safety and effectiveness; and promoting a culture of openness and transparency.2 Therefore, Health Canada needs to continue to modernize its legislative and regulatory frameworks to keep pace with the challenges affecting Canada's regulatory environment. The Department recently launched its Blueprint for Renewal plan, which aims to modernize Canada's regulatory system for health products and food.3 The Blueprint underpins many of the activities described under the Key Programs and Services section below. In response to the Auditor General report regarding the funding of regulatory programs, Health Canada is reviewing its resource requirements and updating its cost recovery regime as complementary activities to the Blueprint for Renewal.4 The Department has recently approved a new cost recovery strategy and framework for all its user fees programs, including drugs and medical devices, to align it to the Treasury Board Policy on Service Standards for External Fees and to develop a full costing model. The work on cost recovery is expected to be completed by March 31, 2008. The Department will continue to work in collaboration with all the key players who influence or provide access to health products on the Canadian market. These players include provincial and territorial governments, the Patented Medicine Price Review Board, the Canadian Agency for Drugs and Technologies in Health, health professionals and practitioners, patients and consumers, and industry. In particular, Health Canada will foster partnerships and information sharing arrangements with the Canadian Institutes of Health Research (CIHR) and the Canadian Agency for Drugs and Technologies in Health. Health Canada will continue to seek the views of citizens and stakeholders in reviewing and strengthening our regulatory system. We are working with federal science and technology partners to promote and protect the health and safety of Canadians. Some of our work includes collaborating directly with Agriculture and Agri-Food Canada (AAFC), Environment Canada (EC), the Canadian Food Inspection Agency (CFIA), the Public Health Agency of Canada (PHAC), and other federal partners. Also we are collaborating with CFIA to promote food safety as a science priority for Canada. Science underpins the work of Health Canada's Health Products and Food Branch (HPFB). It informs our regulatory, policy and research activities pertaining to food and nutrition, drugs, medical devices and, natural health products. This requires the expertise of many - from the laboratory researchers to the scientists reviewing new health product submissions, and from the inspectors in the regions to the researchers generating the evidence base to create appropriate policies. Health Canada also supports the Community of Federal Regulators (CFR) Initiative, which works to build the capacity of the federal regulatory community through learning, the sharing of best practices and horizontal collaboration.5 Health Canada's regional offices develop and deliver key programs and services, including monitoring the risks of health products and the safety of food, and the investigation and inspection associated with the import, sale and manufacture of health products. They work with regional stakeholders and provincial and municipal governments to promote collaboration, participate in the monitoring of adverse reactions and assist in developing policy responses in areas including: food safety, nutrition, natural health products, antimicrobial resistance, and the efficacy of health products. As part of the national laboratory network, Health Canada's regional laboratories are key contributors to our work to develop and manage food safety research and surveillance projects on natural toxins, genetically modified food, food allergen detection, method development and nutrition. The Performance Measurement Strategy for this Strategic Outcome will help us measure our results over time, and determine if our current program activity is working to ensure Canadians have access to safe and effective health products and food, and safe and nutritious food, as well as useful information for healthy choices. Access to safe and effective health products and food Access to information for healthy choices Level of satisfaction of Canadians, health professionals and other stakeholders with the information disseminated for healthy choices and informed decision-making Pre-Market Evaluation and Regulatory Process Improvement (Ongoing) Description: A modernized Regulatory System: making regulatory functions more efficient, effective, flexible and responsive to Canadians by streamlining processes and collaborating more closely with other organizations to ensure Canada continues to have a world class regulatory environment. Performance Indicators* Timely product assessment for health products and food A modern regulatory system for health products and food that meets the needs of Canadians Percentage of decisions made within performance target by type for submission related to: - medical devices - biologics - veterinary drugs - natural health products Percentage of pre-market submissions backlog reduced for: Percentage of Blueprint for Renewal initiatives completed on schedule 106.5 1,273 97.8 1,264 95.6 1,254 Data is collected and reported quarterly and annually. Health Canada is responsible for assessing the efficacy, safety, and quality of drugs before they are marketed. However, there is a need to monitor drugs after they reach the market and are being used in the real world. To address this need, Health Canada will develop a regulatory approach that recognizes that health products have a life-cycle. A life-cycle approach will encompass all stages of product development and use, both before and after it reaches the market. For example, Health Canada will establish a progressive licensing framework based on sound science and risk assessment principles, that supports: continuous monitoring of safety, quality, efficacy and effectiveness of information, evaluation of benefits and risks throughout the product's life-cycle, and access to promising new pharmaceuticals and biologics. As well, Health Canada plans to implement new safety reporting policies, which will take into account risk-benefit assessment, risk management, risk communication and market intervention. Health Canada will improve the review processes for the following food-related submissions: those for which a pre-market review is mandated under the Food and Drugs Regulations (food additives, novel foods and infant formulae); submissions for which a pre-market review is conducted in support of legislation or certification programs outside of Health Canada (packaging materials, incidental food additives and processing aids); or those for which specific amendments to the Food and Drugs Regulations are sought (i.e., with respect to the addition of vitamins and minerals to foods, requests for approval of novel fibre sources, requests for acceptability of nutrition and health claim). This initiative aims to improve the transparency and predictability of the submission management process and define the respective roles and responsibilities of all parties involved (i.e., petitioners and Health Canada officials). In 2007-2008, Health Canada will continue working on a regulatory framework for food-related health claims that support informed consumer choice and that are truthful, substantiated and not likely to lead to harm to consumers.6 The health claims initiative, along with other initiatives related to novel foods and food fortification, will aim to promote conditions that enable innovative food products to be marketed. As well, we will improve guidance for industry regarding what is required for pre-market submissions. The Department will continue its efforts to establish and meet internationally-benchmarked performance targets for all regulated products, building on recent performance improvements in the review of pharmaceuticals, biologics and medical devices.7 Health Canada will institute efficiencies and management strategies to maintain the current standard of service and meet performance targets for pharmaceuticals, biologics and medical devices and continue working towards eliminating the backlog for submissions of natural health products and veterinary drugs. In 2007-2008, Health Canada will continue to implement new regulatory frameworks for blood, cells, tissues and organs, which balance the need for safe cells, tissues and organs and blood of high quality with the need to ensure their availability.8 The Department will also develop a new regulatory framework for vaccines. As well, Health Canada will continue to work with other departments and stakeholders to ensure that new products and procedures derived from bio, nano and other health related emerging technologies have been adequately evaluated for their safety to humans, animals and to the environment. In the Quebec Region, the Health Products and Food Branch is working to promote the establishment of good co-ordination with Quebec's Ministère de la Santé et des Services sociaux [health and social services department] in connection with implementation of the federal regulations concerning bloods, cells, tissues and organs. These regulations are designed to ensure that Canadians have access to these products and that the products are safe and effective. Health Canada is committed to establishing a more transparent and consistent system of categorizing products and assessing their risks. This will help product sponsors understand how decisions are made and anticipate the approach that will be taken by Health Canada to review their products. Health Canada's overall review of the Natural Health Product Regulations will contribute to these efforts. In addition to work completed through the International Conference on Harmonization (ICH), Health Canada will continue to work on the reviews of the Special Access Programme and the Clinical Trial Regulations, which have already been initiated.9, 10 Health Canada is actively engaged in International Regulatory Cooperation (IRC) initiatives with regulators around the world. In 2007-2008, our efforts will focus on refining these activities to maximize their strategic value and ensure they are resource efficient. For example, Health Canada and US Food and Drug Administration (FDA) will hold a Strategic Policy Forum to map out policy directions related to medical devices, food and drugs under the HPFB-FDA Memorandum of Understanding. In addition, through the Security and Prosperity Partnership (SPP), Canada, US and Mexico will collaborate on human and avian influenza pandemic planning. Internally, the Department will continue to implement the HPFB IRC Strategic Framework and advance work and information sharing that further domestic regulatory performance. Under its Environmental Impact Initiative, Health Canada will conduct a review of current New Substance Notification Regulations (NSNR), which are used to assess the environmental and human health impact of new substances, contained in products regulated under the Food and Drug Act.11 Activities under this initiative will include the completion of needs analyses for Cosmetics, Pharmaceuticals, Medical Devices, Veterinary Drugs, Novel Foods, Food Additives, Radiopharmaceuticals, Natural Health Products, and Biologics. Information, Education and Outreach on Health Products, Food and Nutrition (Ongoing) Description: Responding to increased consumer interest in health issues by disseminating more information, and improving access to information that enables consumers to make appropriate decisions about health products and food safety, and nutrition Public and stakeholders are aware of and have access to information that enables them to make informed decisions regarding the safety of health products, food and nutrition Number of information products disseminated related to: - health products Percentage target population reached 119.2 1,072 117.9 1,070 12.3 135 Data is collected and reported annually In 2007-2008, Health Canada will undertake activities to further develop, promote and disseminate healthy eating advice and information. A revised Canada's Food Guide was launched in February 2007. A Food Guide tailored to First Nations, Inuit and Métis is scheduled to be launched in 2007 in partnership with the First Nations and Inuit Health Branch. Based on findings from the Canadian Community Health Survey and other sources, work will also be undertaken to identify additional information that could be developed for specific segments of the population. Health Canada will also update key recommendations from its national pregnancy guidelines, Nutrition for a Healthy Pregnancy.12 Health Canada will continue to promote consumers' understanding and awareness of the information available on food labels to assist them to make informed choices. For example, the Nutrition Facts panel will be profiled on the revised Canada's Food Guide and through related public information initiatives that promote the importance of healthy eating to overall health and wellness. Health Canada will deliver effective and timely communications to the public and vulnerable groups regarding food safety and nutrition issues and educate consumers on risk avoidance practices in order to maximize safety and minimize risks associated with food choices. Specifically, the Department plans to disseminate updated advice about fish consumption, safe handling of raw meat and poultry and consumption of unpasteurized juice, and updated consumer information as a result of amendments to the 2002 Nutritional Labelling regulations, which will be published in Canada Gazette Part II by December 2007. As the applications of new technologies become numerous and more complex, Health Canada will continue to promote a comprehensive stewardship approach (i.e., responsible management of economic, environmental and social interest, while maintaining and improving high standards for product safety). As an integral part of this, Health Canada will continue to ensure that the public has access to objective information about and understand the benefits and risks associated with products of bio, nano and other health related emerging technologies. As part of Health Products and Food Branch's Consumer Information Strategy, we will continue to: find new and effective ways to improve the way we communicate information to the public; improve and expand the tools and practices through which we communicate information; turn raw information about health products and food into practical knowledge that consumers can use to make personal decisions about their health and healthcare treatments; and provide this information to consumers when they need it in a form that allows them to more easily and effectively use it. Monitoring Safety and Therapeutic Effectiveness and Risk Management (Ongoing) Description: Increasing the responsiveness to specific public health issues and the ability to manage risks through the development of sustainable research, monitoring and surveillance systems and stronger compliance and enforcement activities. Increased ability to manage risks associated with the food supply, including food safety emergencies, in order to provide safer food to Canadians. Strengthened safety of health products available to Canadians Compliance with the Food and Drugs Act and its regulations Percentage of health product recalls addressed within legislated timelines (15 days from receipt of information) Percentage annual increase of adverse reaction reports received Number of inspections Percentage of compliance based on total number of inspections (of establishments) completed 120.4 1,076 119.1 1,074 122.5 1,076 Current regulatory resources and tools are primarily focussed on pre-market assessments of health products. However, Health Canada has a key responsibility for monitoring the real-world safety and therapeutic effectiveness of health products and the safety of food, and surveillance and monitoring of the Canadian food supply, once it is on the market. In particular, there are many new challenges and threats related to food: unapproved residues and chemicals in imported food; the pace and scale of technological innovations; new consumption trends such as organic food; and unforeseeable threats such as new animal or plant diseases and bio-terrorism. Recognizing this, Health Canada will use the regulatory system to better generate and disseminate data, and respond to safety and effectiveness issues affecting health products and food. We will move towards a more proactive, post-market surveillance and monitoring strategy. The Department plans to continue its efforts towards a robust, sustainable research and surveillance system to increase our ability to manage risks associated with the food supply for Canadians. Key activities include addressing priority gaps in scientific knowledge in order to better characterize risks associated with priority food-borne pathogens (e.g., E.coli 0157, Salmonella, C. Botulinum) and chemical contaminants in food (e.g., Persistent Organic Pollutants, flame retardants, water repellents) working with departmental partners to develop a sustainability plan for bio-monitoring; and working with CFIA and other federal, provincial and territorial partners to ensure that there is a consistent "national" approach to the enforcement and compliance of Health Canada policies and standards for the safety and nutritional quality of all food sold in Canada.13 Health Canada will co-chair the Nova Scotia Food and Health Products Safety Network with the Nova Scotia Department of Agriculture and Fisheries in 2007-2008. The Network is comprised of experts in the areas of food, water, health products, and animal health issues who work together to promote proactive and preventative strategies, and conduct post incident reviews of significant investigations in order to improve the efficiency and effectiveness of the regulatory systems. Also, the Network provides a forum for federal, provincial and municipal governments to exchange information on best practices, policy development, roles and responsibilities, and to conduct joint training exercises. Adverse reaction reports are used by Health Canada to identify potential health product safety issues. Health Canada has launched the development of a new computerized system, which will replace the current Canadian Adverse Drug Reaction Information System (CADRIS) and strengthen Health Canada's ability to detect potential safety issues and to analyse adverse report data.14 In addition to being able to monitor adverse reactions over the entire life cycle of a product - an option not available under CADRIS - the new system will also allow more efficient electronic reporting by all manufacturers in the future. In 2007-2008, the new system will initially focus on post-market adverse reactions to pharmaceuticals, biologics and natural health products, and later be expanded to include pre-market adverse reaction reports from clinical trials. Implementation will be completed in 2007-2008. Building on international best practices, Health Canada will develop a pharmacovigilance toolkit to strengthen our post-market surveillance capacity. The toolkit will allow easy access to guidance documents, information management and prioritization strategies, as well as additional information sources such as Periodic Safety Update Reports (PSURs) and the analysis of foreign adverse reaction data.15 Post-market surveillance, compliance and enforcement are essential in helping to ensure that Canadians have access to safe and effective medical devices. In 2007-2008, the Therapeutic Product Safety Initiative along with other sources of funding will increase funding for Health Canada's inspection program for medical device establishment licence holders to $1.8 million. These resources will allow Health Canada to conduct an estimated 205 Medical Devices Establishment inspections and associated follow-up activities. Clinical trials require periodic compliance inspections to protect the trials' subjects as well as the integrity and accuracy of the data that supports the application for new drugs bound for market. As a component of the Therapeutic Product Safety Initiative, in 2007-2008 the number of clinical trial inspections will be increased to 85, which meets the international benchmark of 2% of all clinical trials inspected annually. In order to reduce the number of drugs and natural health products on the market that are making unapproved health claims, Health Canada is carrying out two surveys of the health food stores, fitness facilities, pharmacies and other retail establishments to search for products making these unapproved claims and following up with the manufacturers to correct the situation. A strong, flexible compliance and enforcement strategy is necessary for Health Canada to fulfil its mandate in today's complex regulatory environment. To reflect this change the Department will develop a new compliance and enforcement strategy as part of the Blueprint for Renewal of the health products and food regulatory system initiative Health Canada is responsible for the development of a pandemic emergency implementation plan that outlines the roles and responsibilities of the regulatory authority if a pandemic is officially declared. Health Canada will continue to work with PHAC to implement the Canadian Pandemic Influenza Plan and to support the WHO's Global Agenda for Influenza Surveillance and Control. The Department will spend $6.2 million over five years, as well as $1.2 million ongoing, on planning and preparedness activities, providing regulatory guidance during the development of a prototype vaccine, developing a regulator's emergency implementation plan and designing an accelerated approval process. These measures will help to ensure that Canada is ready in the event of an influenza pandemic and will limit the impact of a pandemic on the Canadian population. It will also enable Canada to fulfill its role as a WHO laboratory for release of vaccines for WHO member countries in the event of a pandemic. Transparency, Public Accountability and Stakeholder Relationships (Ongoing) Description: Bringing more transparency to our decision-making processes by providing more accessible information about the evidence, processes and rationale underpinning our decisions. Health Canada is also strengthening its capacity to involve the public more meaningfully and inclusively in regulatory decision-making. Transparency accountability and openness are integrated into Health Canada's daily business Number and nature of new tools and approaches implemented to better integrate transparency and openness into HPFB's daily business 18.5 188 17.7 187 16.3 185 Data will be collected and reported annually. In the spring or summer of 2007, Health Canada will begin to implement measures for the registration and disclosure of clinical trial information on health products. In response to stakeholder requests for additional information, the Department will also begin providing web-based access to Health Canada-authorized Product Monographs in 2007 thereby providing Canadians with quick access to the most recently-approved information supporting safe and effective use of drug products. In addition, Health Canada will continue to provide access to information regarding the basis for regulatory decisions on some of its newly approved products (i.e, Summary Basis of Decision document) and will undertake an evaluation to explore the feasibility of expanding the initiative.16 In 2007-2008, Health Canada's Office of Consumer and Public Involvement (OCAPI) will also develop an implementation strategy for the Policy on Public Input in the Review of Health Products. This policy builds on the Health Products and Food Branch's commitment to improved transparency, openness, and accountability made in the "2004-2007 Strategic Plan, Serving Canadians Now and Into the Future" and further developed in the Public Involvement Framework. Health Canada will continue to use a variety of methods to engage stakeholders early and throughout the decision-making process. In 2007-2008, Health Canada will launch a number of thematic consultations on such initiatives as the proposed Progressive Licensing Framework for pharmaceuticals and biologics; its cost recovery regime, the review of Natural Health Product Regulations and regulatory regime, and the Special Access Program (SAP), as well as the regulatory framework for food-related health claims. 1. http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/fg_rainbow-arc_en_ciel_ga-eng.html 2. Once therapeutic products are on the market, Health Canada monitors them for safety, efficacy and quality. For further information, visit the HC web site: http://www.hc-sc.gc.ca/hcs-sss/pharma/nps-snpp/securit/index-eng.html 3. http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/hpfb-dgpsa/blueprint-plan/index-eng.html 4. http://www.hc-sc.gc.ca/ahc-asc/finance/frais-charg/index-eng.html 5. www.cfr-crf.gc.ca 6. http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/claims-reclam/final_proposal-proposition_final01-eng.html 7. http://www.hc-sc.gc.ca/ahc-asc/pubs/hpfb-dgpsa/performance_rendement_2005-eng.html 8. http://www.hc-sc.gc.ca/dhp-mps/brgtherap/reg-init/index-eng.html 9. http://www.hc-sc.gc.ca/dhp-mps/acces/drugs-drogues/index-eng.html 10. http://www.hc-sc.gc.ca/dhp-mps/prodpharma/activit/consultation/clini-rev-exam/index-eng.html 11. http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/environ/index-eng.html 12. http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/national_guidelines-lignes_directrices_nationales-06-eng.html 13. The measurement of people's exposure to toxic substances in the environment by measuring the substances of their metabolites (blood or urine) in human specimens. 14. http://www.hc-sc.gc.ca/dhp-mps/medeff/advers-react-neg/fs-if/cadris-2-eng.html 15. A clinical science whose objectives are the surveillance, evaluation and signaling of the undesirable effects of pharmaceutical products used for medical therapy and whose major sources of new information are spontaneous notification and reporting of such effects. Pharmacovigilance also includes the diffusion of this information and the regulatory measures taken to prevent future adverse drug reactions, to ensure safer use of drug products as well as an improvement in the risk-benefit ratio. 16. A public document that outlines in technical language the risk-benefit analysis and scientific considerations that have factored into Health Canada's Health Products and Food Branch's decision to grant market authorization for a drug or medical device. The document provides regulatory, quality (chemistry and manufacturing), efficacy and safety information. Program Activity - Healthy Environments and Consumer Safety Less: Expected respendable revenues 327.1 Notes: The increase in forecast/planned expenditures from 2006-2007 to 2007-2008 is mainly due to funding for the Chemical Management Plan, the Clean Air Regulatory Agenda, and the Clean Air Act Program. This funding increase is partially offset by the effect of one year interim funding received in 2006-2007 for litigation management and the Public Service Health Program, and by the sunset of the Border Air Quality Strategy in 2006-2007. The decrease in planned expenditures from 2007-2008 to 2008-2009 is mainly due to the sunsetting of funding in 2007-2008 for the Chemical Management Plan, the Clean Air Regulatory Agenda, and the Clean Air Act Program. Funding in future years for these initiatives is expected to be approved, and reporting on planned spending in future RPPs for these years will increase as a result. The increase in planned expenditures from 2008-2009 to 2009-2010 is mainly due to an increase in funding for the Canadian Environmental Protection Act. Healthy Environments and Consumer Safety touches many elements of day-to-day living that have an impact on the health of Canadians. These include drinking water safety, air quality, radiation exposure, substance use and abuse (including alcohol), consumer product safety, tobacco and secondhand smoke, workplace health, and chemicals in the workplace and in the environment. Much of this work is governed through legislation including the Food and Drugs Act, the Controlled Drugs and Substances Act, the Hazardous Products Act, the Radiation Emitting Devices Act, the Canadian Environmental Protection Act, the Tobacco Act, the Quarantine Act, the Potable Water Regulations for Common Carriers, and others. Health Canada is also engaged in other health and safety related activities such as chemical and nuclear emergency preparedness; inspection of food and potable water for the travelling public; and health contingency planning for visiting dignitaries. The Healthy Environments and Consumer Safety strategic outcome seeks to improve health outcomes by: Reducing health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol, and other controlled substances; and Reducing risks to health and safety, and improving protection against harm associated with workplace and environmental hazards, consumer products (including cosmetics), radiation-emitting devices, new chemical substances, and products of biotechnology. A priority focus this year will be to help implement the Government's Environmental Agenda which responds to growing evidence that environmental factors contribute to health problems such as cancer, respiratory illnesses, and reproductive and developmental disorders. Initial action (programming and regulatory) is being undertaken on clean air and chemicals management. Taking steps to modernize our regulatory frameworks and approaches is another important focus for Healthy Environments and Consumer Safety. This includes concrete initiatives such as modernizing the Hazardous Products Act, the Radiation Emitting Devices Act, and the Food and Drugs Act (Cosmetic Regulations) to protect the health of Canadians and implementing the International Health Regulations (2005) to help prevent the international spread of disease. Longer term efforts will identify the most efficient and cost-effective instruments to best reduce particular health risks facing Canadians. A focus on human resources is also required to ensure we have the capacity needed to support key activities. Finding professionals with expertise in the applied sciences (e.g., toxicology, epidemiology, biology) and in both occupational and public health (e.g., nurses, medicine, psychologists, industrial hygienists) is proving to be a challenge. We must compete with other organizations to attract highly qualified scientists and health professionals. This will be especially challenging given that additional staff and expertise is required to deliver on new government environmental initiatives. To respond to human resources risks, we will initiate a multi-year people management plan focussed this year on implementing training and development, recruitment and succession planning/knowledge transfer. Health Canada will continue to advance science and use strong evidence-based research to formulate our healthy and safe living promotion and harm prevention programs, policies and regulations. Our experts work closely with colleagues in the federal government and beyond (e.g., academia) in the areas of both research and development and related scientific activities. Anticipatory, applied and novel research provide the evidence of emerging health issues and contribute to the design and implementation of policies, regulations and legislation, as well as to decision making, aiming at protecting the health and safety of Canadians. In our role as a regulator, we extend our scientific research by contributing to the generation, dissemination and application of scientific and technological knowledge, including the assessment of products and processes for the purpose of regulation, as well as surveillance, testing and collection of information. In addition to our internal activities related to scientific research, health surveillance, and foresight in the safe use of emerging and merging technologies (such as biotechnology and nanotechnology), we will also use the science conducted by external organizations to help identify risks to human health, and assess and manage these risks. Activities within this strategic outcome require sustained partnerships with other government departments as well as provinces and territories, non-governmental organizations, and the international community. We work closely with the Health Products and Food Branch, the Pest Management Regulatory Agency, Environment Canada, and others on health and environment issues. We are engaged in the Government's public safety and anti-terrorism initiatives and, in support of the work the Government is doing on tackling illegal drug use and associated crime, we are working with Justice Canada, Public Safety and Emergency Preparedness Canada, the Royal Canadian Mounted Police, and the Canada Border Services Agency. We also collaborate with provinces and territories through various committees to develop guidelines on issues such as tobacco cessation and safe drinking water, and to coordinate nuclear emergency preparedness activities. Our work with the international community allows us to better respond to domestic health and safety issues, meet Canadian obligations and commitments, share best practices, and promote Canadian leadership globally. The contributions of regional offices are integral to program delivery. They include: playing a leadership role on key national initiatives; conducting inspection, surveillance and educational activities related to consumer products, tobacco, controlled drugs and substances; conducting risk assessments and evaluations; providing health advice to federal employees, provinces, and municipalities related to chemical contaminates and exposure levels, drinking water standards, and work environments. Reduced health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances Reduced risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics) see below Two programmes carry out work aimed at reducing health and safety risks associated with tobacco consumption and the abuse of drugs, alcohol and other substances: the Drug Strategy and Controlled Substances Programme and the Tobacco Control Programme Drug Strategy and Controlled Substances (Ongoing) Health Canada administers the Controlled Drugs and Substances Act, develops prevention strategies to combat alcohol and drug abuse, monitors and reports to Canadians on current and emerging drug trends, supplies analysis and identification services of seized controlled substances to law enforcement agencies, and provides expert scientific advice and training to our clients (i.e., police and crown attorneys). The Drug Strategy Community Initiatives Fund (DSCIF) funds activities at the national, regional, provincial/territorial and local levels in health promotion and prevention. The Alcohol and Drug Treatment and Rehabilitation Program (ADTR) currently aims to improve treatment for women and youth who are dealing with substance abuse problems. Health Canada also provides funding for the treatment component of Drug Treatment Courts. Reduce health and safety risks associated with the abuse of drugs, alcohol, and other controlled substances Decrease in health-related, at-risk behaviours associated with substance use within the general Canadian population as well as specifically youth and Aboriginal persons In partnership with key stakeholders and other levels of government, Health Canada will carry out the following key initiatives: Initiate the development of a national strategy to prevent the abuse of pharmaceutical products that are controlled substances, such as oxycodone and codeine. Develop and implement national alcohol drinking guidelines as per the recommendations of the National Alcohol Strategy. Implement the National Alcohol and Drug Use Monitoring Survey (CADUMS), which is an ongoing general population telephone based survey that will provide useful data on topical and emerging issues related to the use of alcohol and other drugs and substances in a timely, reliable, and continuous basis. The Medical Marihuana Research Program objective was to fund clinical research on the therapeutic aspects of marihuana. The Program was terminated in 2006 as a result of ongoing expenditure review. The pharmaceutical industry and academic institutions will be relied upon to generate the information. This decision does not impact the two clinical studies currently underway that were approved under the Program, nor does it impact approved individuals access to marihuana for medical purposes (i.e. Marihuana Medical Access Regulations which came into effect on July 30, 2001). Tobacco Control (Ongoing) Health Canada administers the Tobacco Act; enforces compliance and sales-to-youth regulations as well as restrictions on tobacco advertising, promotions, and sponsorships; disseminates timely and comprehensive information to Canadians to influence attitudes and effect behaviour change aimed at reducing the serious and adverse health effects of tobacco use; evaluates industry reports on tobacco emissions and constituents; and monitors and analyzes changes in tobacco consumption patterns and public attitudes towards tobacco products to evaluate progress and to develop new areas for emphasis. (Five 10-year objectives 2001-2011) Reduce smoking prevalence to 20% from 25% (level in 1999) Reduce the number of cigarettes sold by 30% from 45 billion to 32 billion Increase retailer compliance regarding youth access to tobacco from 69% to 80% Reduce the number of people exposed to environmental tobacco smoke in enclosed public places Decrease in smoking prevalence rate as measured by Canadian Tobacco Monitoring Survey (CTUMS), etc. Decrease in number of cigarettes sold Increase in retailer compliance as measured by the Retailer Behaviour Survey Decrease in the number of Canadians exposed to second-hand smoke as measured by CTUMS Research suggests that tobacco promotion at retail, in the form of multi-tiered displays of tobacco products covering walls and counter tops, may induce the use of tobacco products, particularly among youth. A key initiative will focus on protecting these people from inducements to smoke through the development of regulations to restrict the display at retail of tobacco products, branded accessories and signs on the availability and price of tobacco products. In support of the Federal Tobacco Control Strategy, Health Canada's BC regional office will fund community based projects that use innovative approaches to reach non-traditional target populations. One of these projects, entitled Smoke Screen, will provide educators, youth and community groups with documentaries and Learning Resource Packages that address tobacco use among immigrant youth and those who are learning English as a second language, while illuminating cultural attitudes and behaviours towards tobacco use. Another innovative project will aim to change the smoking culture of construction trades workers by targeting students who plan to work in those trades and by providing information to trades workers. Cessation resources will be disseminated through established trades networks such as WorkSafe BC and the BC and Yukon Trades Council. In addition, given the tobacco industry's stated intent to develop and market tobacco products with less toxins, toxicological testing of tobacco products and biomarkers of exposure to tobacco products (such as nicotine, exhaled carbon monoxide, tobacco-specific nitrosomines) will be undertaken. Harm reduction in terms of product modifications, their impact on smoking trends or behaviour, including questions on how to assess and regulate such products, represent an emerging area in science. We will explore innovative risk assessment methodologies to assess whether such modified tobacco products are more or less toxic than the range of products now on the market. The five-year evaluation of the FTCS (2001-2006) demonstrates attributable health and economic benefits to Canadians of investments in tobacco control. The future FTCS will combine an on-going evaluation strategy built on its approved Results-based Management Accountability Framework in addition to cost-effectiveness studies and econometric modelling. The signing of the World Health Organization sponsored Framework Convention on Tobacco Control is an opportunity to ensure that international policy and Canada's domestic policy are mutually reinforcing. Canada plays an active role in various working groups created by the Conference of the Parties, particularly those concerning the control of cross-border advertising and the regulation of the contents of tobacco products. In support of the Federal Tobacco Control Strategy, Ontario Region employees will work in collaboration with other federal departments, provincial and municipal governments as well as with non-government organizations including Aboriginal and Francophone communities, to improve the coordination, understanding and application of the Tobacco Act. Among the priorities for program delivery will be to improve coordination, efficiencies, effectiveness and delivery of inspection activities to protect the public against smoking health hazards in light of the 2005 Smoke-Free Ontario Act. Three programmes carry out work aimed at reducing risks to health and safety, and improved protection against harm associated with workplace and environmental hazards and consumer products (including cosmetics): the Safe Environments Programme, the Product Safety Programme, and the Workplace Health and Public Safety Programme. Safe Environments (Ongoing) Health Canada conducts research, risk assessments, risk management, monitoring, and surveillance to protect all human health from the risks associated with chemicals substances, drinking water, air quality, contaminated sites, climate change, as well as preparedness for environmental emergencies. These activities are carried out to respond to the Department's obligations under the Canadian Environmental Protection Act (1999). Health Canada is also the lead for coordinating Canada's preparedness for nuclear emergencies under the Federal Nuclear Emergency Plan. Reduce, eliminate, prevent, or better manage toxic chemical substances and their use and/or exposer Increase knowledge, understanding and involvement by Canadians in environmental health issues Improve scientific knowledge and capacity on environmental health issues Establishment and maintenance of a monitoring and surveillance program to track public health and environmental priorities. This will increase a baseline which will then be used in future years to track performance. Establish a baseline by carrying out surveys with the public to gather data on their knowledge, understanding and involvement in environmental health issues. This will be used to track performance in future years. Percentage of Canadians who are more knowledgeable about how the environment impacts their health, e.g. sun exposure Increase in the number and types of publications authored by Health Canada and published in peer-reviewed scientific journals Extent to which risk assessment methodologies are harmonized with other countries 131.1 801 80.9 742 81.8 750 Health Canada, in collaboration with Environment Canada, is leading the development of Canada's new Chemicals Management Plan (CMP), one of two main themes of the Government of Canada's Environmental Agenda. The CMP will improve the degree of protection of Canadians and their environment against hazardous chemicals. The Plan will introduce a number of new, proactive measures that will ensure that risks are identified and assessed in a more effective and timely fashion, and that identified risks associated with chemical substances in or entering the marketplace are managed properly. Core activities under the CMP include research, risk assessment, risk management, and monitoring and surveillance. The Canadian Environmental Protection Act is the most important statute for regulating toxic chemicals. Priorities include the development of an integrated science-based action plan across exposure media (food, air, soil, water, products) to reduce or eliminate the risks posed by hundreds of hazardous substances, and the investments needed to resolve the toxic legacy of the 20th century by 2020. The second theme of the Environmental Agenda is a clean air agenda, which will improve risk management actions to address both indoor and outdoor air quality risks to health. Initiatives will target exposure and risk analyses for indoor and outdoor pollutants and for fuels and fuel additives, and provide guidance to research initiatives, in order to maximize the health benefits of regulatory and non-regulatory actions. Health Canada will continue to develop and implement the Air Quality Health Index, which will provide a daily measure of air pollution health impacts and will provide the public with means to make informed decisions to reduce exposure to health risks posed by smog. Health Canada will continue to work with Indian and Northern Affairs Canada and other experts as part of a national vapour intrusion working group to measure the extent of contaminant vapour intrusion such as low and high end volatile/non-volatile hydrocarbons (BTEX compounds: benzene, toluene, ethyl benzene, xylene; polycyclic aromatic hydrocarbons (PAHs)) into buildings under subarctic conditions. The goal of this effort is to test whether national guidelines are applicable to the subarctic conditions found in northern Manitoba and Saskatchewan and provide national guidance documents for remediation of contaminant site vapours. Data and recommendations will be shared with other regions having contaminated sites in the subarctic, as well as with the State of Alaska's contaminated sites program. A final report and recommendations for guidance documents will be issued in 2007. Under additional indoor initiatives, Health Canada will address risks associated with exposure to radon. Tools under development to provide accountability include the Air Health Indicator and the Air Quality Benefits Assessment Tool. The Air Health Indicator will assess how regulatory measures and other changes to outdoor air quality affect human health over time. The Air Quality Benefits Assessment Tool will quantify the health impacts of changes in air pollution and is used in cost/benefit analysis for regulatory and other risk management measures. Health Canada will also increase awareness of climate change health risks and will complete and disseminate the Canadian Climate Change and Health Vulnerability Assessment in 2007, which assesses current and future vulnerabilities of Canadians and their communities to the health risks associated with climate change. In keeping with an integrated source-to-tap approach to drinking water quality in Canada, Health Canada will establish and/or implement strategies to help address and prevent incidents of drinking water contamination across jurisdictions, including in small, rural, and remote communities. This includes building support for implementing a national Waterborne Contamination and Illness Response Protocol with federal departments, provinces and territories, as well as the launch and implementation of a web-based system designed to report boil water advisories and notify stakeholders across Canada. Product Safety (Ongoing) As part of our legislative mandate under the Hazardous Products Act and the Radiation Emitting Devices Act, Health Canada identifies, assesses, manages, and communicates to Canadians the health and safety hazards and health risks associated with: consumer products; hazardous workplace materials; cosmetics; new chemical substances; products of biotechnology; radiation produced by radiation emitting devices; environmental noise; and solar UV radiation. Reduce risk of death, illness, and injury from exposure to hazardous products and substances associated with: consumer products; cosmetics; workplace chemicals; new chemical substances; products of biotechnology; radiation-emitting devices; environmental noise; and solar UV radiation. Increased industry rate of compliance with regulations Increased public awareness of risks As part of the Government of Canada's new Chemicals Management Plan, Health Canada will: identify consumer products and cosmetics that may contain potentially harmful substances and develop strategies to best manage the risk associated with such products on the Canadian marketplace; develop regulations that appropriately identify and manage the potential risk that any new substance contained in Food and Drugs Act products (e.g., pharmaceuticals, personal care products, cosmetics) may pose to the environment and human health; and determine the risk to human health and the environment associated with environmental exposure to approximately 9,000 substances in products regulated under the Foods and Drugs Act that entered commerce in Canada between 1987 and 2001. To be more responsive to present and future social and technological realities, Health Canada will be modernizing federal health protection legislation, specifically the Hazardous Products Act, Radiation Emitting Devices Act, and the Food and Drugs Act (Cosmetic Regulations). This will provide the Department with the necessary tools to better protect the health of Canadians, and to respond to the challenges of the global marketplace. Health Canada is committed to serving Canadians by strengthening its position as a nationally recognized and world-class regulator by establishing renewed legislative and regulatory frameworks. Involvement on the international front will include work related to the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) to enhance protection of human health and the environment. The GHS harmonizes chemical hazard classification and communication and is viewed globally as the basis for the sound management of chemicals. Health Canada will continue to work toward the legislative and regulatory changes necessary to implement the GHS as soon as possible. In support of the Government's commitment to the health of children, Health Canada will continue with the implementation of the Lead Risk Reduction Strategy (LRRS) for Consumer Products. These measures will protect the health of Canadians by reducing health risks related to lead exposure, especially among infants and children. The LRRS proposes maximum lead content limits for four categories of consumer products with which children are likely to interact. Regulations for each category will be developed separately. We will also continue monitoring the compliance rates for products already regulated for lead content. Workplace Health and Public Safety (Ongoing) Through the Public Service Health Program, Health Canada provides occupational health and safety services to employees working in Canada and overseas. The Department co-ordinates cost-recovered Employee Assistance Program services to many Canadian public and para-public sector organizations. Health Canada also develops, coordinates, and manages health contingency plans for foreign dignitaries and their families while they are visiting Canada. Tools are also provided on its website to assist employers develop and implement workplace health programs. Health Canada works with the PHAC, Public Safety and Emergency Preparedness Canada, and other organizations to plan, prepare and implement physical and psycho-social emergency responses to national health emergencies such as avian and pandemic influenza, and terrorist or suspected terrorist attacks. Health Canada also works with the conveyance industry (e.g., cruise ships, trains, aircraft) through the Travelling Public Program to reduce the risks to the health of Canadians who travel within Canada. Timely and appropriate occupational health advice, guidance, and professional services to federal employees Timely and appropriate psycho-social advice, guidance and professional services to federal employees Timely and appropriate public health interventions related to conveyances and ancillary services Increase in number of service requests received and completed within service standards and carried over according to Activity Tracking System - target less than 20% carried over Increase in rate of resolution of client problems within service standards - target 80% Increase in rate of implementation of water management plans within the Canadian airline industry (target 80%) and rate of resolution of critical deficiencies (target 90%) resolved within service standards Health Canada is working closely with the Public Health Agency of Canada (PHAC) and the World Health Organization to increase international cooperation efforts and to ensure compliance with the International Health Regulations (2005), the purpose of these are to prevent, protect against, control, and provide a public health response to the international spread of disease and avoid unnecessary interference with international traffic and trade. In doing so, both Health Canada and PHAC are collaborating with the Canada Border Services Agency, Transport Canada, the Canadian Food Inspection Agency, the Royal Canadian Mounted Police, Environment Canada, Fisheries and Oceans Canada, and others as appropriate. Program Activity - Pest Control Product Regulation Planned Spending and Full-Time Equivalents (FT) ($ millions) Forecast Spending revenues 66.8 Net Expenditures 59.8 50.9 46.5 46.3 Notes: The decrease in forecast/planned expenditures from 2006-2007 to 2007-2008 is due in part to one-year funding received in 2006-2007 for Pesticides Regulation. The decrease in planned expenditures from 2007-2008 to 2008-2009 is mainly due to a decrease in funding for Building Public and Stakeholder Confidence in Pesticide Regulation. Health Canada's Pest Management Regulatory Agency (PMRA) protects human health and the environment by minimizing the risks associated with pest control products in an open and transparent manner, while enabling access to these pest management tools and sustainable pest management strategies. The PMRA registers pesticides and provides advice on sustainable pest management strategies. The Agency considers environmental and human health risks associated with proposed products as well as product effectiveness and contribution to sustainable development. As well, the PMRA sets maximum residue limits (MRLs) under the Food and Drugs Act. The Pest Control Products Act (PCPA) and Regulations allow the Agency to meet these commitments while providing access to Canadian and global pest management tools. This year, along with our core work, the Agency's priorities will be the continued implementation of the new PCPA by advancing work on regulatory priorities such as Incident and Sales reporting and our commitment to transparency, access to new products including reduced risk and new uses in Canada by utilizing performance standards in review work and addressing the technology gap and, finally, re-evaluation and full life-cycle management within the new PCPA and the Chemical Management Plan. Science is the foundation for Health Canada's activities related to Pest Control Product Regulations. We conduct assessments of risks to human health and the environment arising from exposure to chemical and biological pesticides as well as assessments of the value of these products. In support of this work, we develop assessment methodologies, pesticide testing protocols, risk reduction strategies and risk management tools. Scientific expertise is in place in the following areas: toxicology, environmental toxicology, analytical chemistry, environmental fate and chemistry, biochemistry, endocrinology, ecology, crop science, plant pathology, entomology, occupational and bystander assessment, and aggregate and cumulative assessment. To meet the Agency's objectives, we will collaborate with experts in a variety of disciplines throughout the Health Portfolio and with the five natural resource departments (Environment Canada, Fisheries and Oceans Canada, Natural Resources Canada, the Canadian Food Inspection Agency and Agriculture and Agri-Food Canada). This year the Agency will be collaborating with others in Health Canada and Environment Canada to implement the new Chemicals Management Plan that improves the degree of protection for Canadians and their environment against hazardous chemicals in products they use, food and water they consume and environments in which they live. We will work with Healthy Environments & Consumer Safety (HECS) Branch to facilitate the exchange of review material on compounds that have shared jurisdiction under both programs. We will also work with HECS and the Public Health Agency of Canada (PHAC) to provide technical support to the Department of National Defence in a fact-finding exercise on the use of registered herbicides and testing of military chemicals at CFB Gagetown, in partnership with Veterans Affairs Canada and other federal departments. Health Canada's PMRA also participates in a number of departmental working groups that are developing or updating various science-based methodologies for risk assessment. We also work with the Canadian Food Inspection Agency (CFIA) on their priority setting exercise to set their annual inspection and monitoring program, and with the CFIA and provincial governments on compliance activities; and with Agriculture and Agri-Food Canada to develop risk reduction strategies and improve access to specialized pest control. We rely on professionals in a number of scientific disciplines to achieve our key results for Canadians. The PMRA must compete with other organizations to attract and retain highly qualified professionals. To address this risk we will focus on recruitment, retention, learning and succession planning through our human resources plan in order to ensure we have the human resources to support our activities under this strategic outcome. The expected result of this program activity "To protect human health and the environment by minimizing risks associated with pesticides imported, sold or used in Canada" is supported by four main program sub activities: New Pest Control Product Registration and Decision-Making; Registered Pest Control Product Evaluation and Decision Making; Compliance; and Pesticide Risk Reduction. The table above outlines the planned resources allocated for this program's activities. New Pest Control Product Registration New pesticides undergo an extensive pre-market assessment by Health Canada to ensure their use poses no unacceptable risks. This includes an assessment of human health risk (including worker and bystander exposure), food residues, environmental risk (including environmental fate and potential effects on wildlife), and an assessment of value. Assessments are carried out using the most modern scientific methods available and meet international best practices. To provide for continual updating of regulatory approaches, we are working closely with the United States and Mexico through NAFTA and with OECD countries globally through the OECD Working Group on Pesticides. This work is focussed on harmonization, joint reviews, and worksharing to ensure pesticide risk assessments are efficient and benefit from the best science available internationally. In 2007-2008, Health Canada is committed to using joint review and worksharing opportunities to assist both in closing the technology gap that exists between Canada and the United States and to expand our current joint review program with the United States into global worksharing arrangements with other OECD countries for the assessment of pesticides. Registered Pest Control Product Evaluation We re-evaluate older pesticides currently on the market to determine if their continued use is acceptable in consideration of modern scientific approaches. Significant public consultation is undertaken on risk assessments and risk management proposals to engage stakeholders, including registrants, other government departments, growers and their associations, other non-governmental organizations, as well as the general public. We will continue to implement risk mitigation measures where required to address concerns regarding risks that could emerge during the re-evaluation of a chemical. As required, under the Pest Control Products Act, we will continue to work with the Environmental Protection Agency in the United States on a proposed approach to re-evaluation and develop a plan to work cooperatively on future re-evaluations. National Pesticide Compliance Program Health Canada promotes, monitors and enforces compliance with the Pest Control Products Act and Regulations principally through the National Pesticide Compliance Program (NPCP). Where non-compliance is detected, we apply the appropriate enforcement (e.g., education, monetary penalties or prosecution).The NPCP includes programs that address both regional and national compliance and enforcement problems and issues. Much of this work is accomplished through a regional network of designated officials who inspect and investigate those who manufacture, distribute and use pesticides. An example of a compliance activity is marketplace inspections. In addition, we will continue to work in partnership with provincial and other federal regulators and will explore further opportunities for coordination and collaboration with international organizations, e.g., US EPA. Specifically, in 2007-2008 Health Canada will finalize its work on performance indicators for the compliance area. As well, the partnership agreement with CFIA for NPCP program delivery will be renewed. Pesticide Risk Reduction in Agriculture and Other Sectors The Pesticide Risk Reduction Program supports the objectives of the new Pest Control Products Act to facilitate access to reduced risk products and enhance sustainability in agriculture. It is a grower led, commodity-based program that is jointly facilitated by the Sustainable Pest Management Section of the Pest Management Regulatory Agency and the Pest Management Centre of Agriculture and Agri-Food Canada (AAFC). The goal of the program is to improve the sustainability of Canadian agricultural commodities through the development and implementation of commodity-based risk reduction strategies. Benefits resulting from this program will include the development and adoption of alternative pest management practices through applied research into reduced risk alternative tools and biopesticides. Health Canada and AAFC will continue working with stakeholders to develop commodity-specific pesticide strategies for the initial twenty priority crops including apples, potatoes, dry beans, soybeans and greenhouse vegetables. In addition, stakeholder consultations will be held for two new commodities, namely blueberry (highbush and lowbush) and raspberry, and crop profiles will be developed for three new commodities (broccoli, cabbage and cauliflower). Active stakeholder participation in building and implementing strategies is critical to the success of the program. Access to safer pesticides Improved transparency and knowledge dissemination Number of new reduced risk ingredients available for use in Canada Percentage of reduced risk chemicals & percentage of biopesticide active ingredients registered/pending registration in the U.S. that are registered/pending registration in Canada Number and type of regulatory proposals /directives / policies published in 2007-2008 Pest Management Regulatory Agency (PMRA) home page: www.pmra-arla.gc.ca PMRA Strategic Plan 2003-2008 www.pmra-arla.gc.ca/english/pdf/plansandreports/pmra_strategicplan2003-2008-e.pdf Strategic Outcome: Better Health Outcomes and Reduction of Health Inequalities Between First Nations and Inuit and Other Canadians. Program Activity - First Nations and Inuit Health revenues 2,125.6 5.5 2,136.3 Net Expenditures 2,120.2 2,130.9 2,148.5 2,188.8 Notes: The increase in forecast/planned expenditures from 2006-2007 to 2007-2008 is mainly due to the yearly growth of the Indian Envelope and an increase in the funding level for the Follow-Up to the Special Meeting of First Ministers and Aboriginal Leaders (September 12, 2004). This increase is partially offset by the Budget 2005 Expenditure Review Committee (ERC) reduction. The increase in planned expenditures from 2007-2008 to 2008-2009 is mainly due to the yearly growth of the Indian Envelope. This increase is paritally offset by the sunset of funding for the implementation of the First Nations Water Management Systems Initiative. The increase in planned expenditures from 2008-2009 to 2009-2010 is mainly due to the yearly gowth of the Indian Envelope. The change in Revenue is due to rounding the amounts to millions of dollars. The objectives of Health Canada's First Nations and Inuit health program activity are to improve health outcomes, ensure the availability of and access to quality health services, and support greater control of the health system by First Nations and Inuit. In pursuing these goals, the Department must face many of the same challenges as other Canadian health providers such as an aging population, health human resource shortages, rising costs of drugs, and the demand for new health care technologies. This has increased the challenges to health care sustainability in both the federal and provincial and territorial health systems. The First Nations and Inuit health system is also subject to additional pressures due to a faster growing population, higher than average rates of injuries, higher overall disease burden, rural and remote populations, and a unique set of programs and services. Health Canada works closely with our health partners and other federal departments to respond to these challenges and meet these goals. We support the Public Health Agency of Canada in its delivery of Children and Youth programming through the Aboriginal Head Start in Urban and Northern Communities program as well as its work on a number of pan-Aboriginal programs and pandemic planning activities. In addition, we work closely with Indian and Northern Affairs Canada through: the First Nations Water Management Strategy, to ensure that all First Nations communities across Canada have access to a safe and reliable water supply; the Home and Community Care program, to address the gaps in continuing care services available to First Nations and Inuit communities; and the Labrador Innu Comprehensive Healing Strategy, to support long term healing in the Labrador Innu communities. We also work with Indian Residential Schools Resolution Canada to ensure that eligible former students of Indian residential schools have access to mental health and emotional supports. Health Canada will focus on four key priority areas in 2007-2008: 1) continuing to provide health-related programs and services; 2) improving quality of and access to health-related programs and services; 3) promoting healthy living and disease prevention; and 4) improving accountability and performance measurement. Continuing to Provide Health-Related Programs and Services Health Canada provides a range of First Nations and Inuit health programs and services that will continue into 2007-2008. In partnership with First Nations and Inuit, we will continue to provide primary care services in approximately 200 remote communities, and home and community care in over 600 communities. Health Canada employs approximately 665 nurses to deliver health services to communities, and maintains nursing stations, community health centres and other health service facilities. In addition, health services are provided by nursing staff and other health care workers directly employed by communities through health service transfer agreements and contribution agreements with Health Canada. Through strengthened working relationships between Health Canada, the Government of Nunavut and the Nunavut Tunngavik Incorporation, the Nunavut HII project resulted in an action plan outlining a model for Integrated Service Delivery in Nunavut which identifies a number of possible short, medium and long term activities. Projects are now being developed such as the development of a continuum of culturally relevant mental health and addictions services and a supporting Community Wellness approach. Through our regional offices, the Department will continue to provide programs and services focussed on children and youth, mental health and addictions, chronic diseases, environmental health, and communicable and non-communicable disease prevention. These services supplement and support the services that provincial, territorial and regional health authorities provide. For example, the First Nations and Inuit Home and Community Care program will continue to support the delivery of quality home and community-based services to support those with chronic diseases, persons with disabilities and the elderly in over 640 communities. Through the Non-Insured Health Benefits Program, drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention, mental health services, and medical transportation will continue to be available to all 780,000 registered Indians and recognized Inuit in Canada, regardless of residency. The Alberta Region will further use information for action in advancing positive health outcomes for First Nations persons and communities through the use of enhanced health surveillance systems. These new and innovative systems include a Datacube project which furnishes a suite of tools to support the interactive, multidimensional analysis of Health Surveillance data obtained from multiple sources/channels. In addition, a Geographic Information System (GIS) developed in the region allows for the mapping of a broad range of surveillance and environmental health data by GPS coordinates, enabling and facilitating user friendly access to information as presented by provincial geographic location. Such data provides health researchers and practitioners with credible data from which evidenced based health policy, program and service delivery decisions may be made. Improving Quality and Access to Health-related Programs and Services The Department continues to experience challenges in recruiting nurses into First Nations and Inuit communities, especially for facilities located in remote and isolated areas. Health Canada is particularly concerned with the impact that nursing shortages have on the provision of services and the health and well-being of First Nations and Inuit. We will work closely with our National Aboriginal and Nursing partners to address issues affecting the recruitment and retention of nurses in First Nations and Inuit communities and to ensure that nurses have the clinical expertise and supports needed to provide primary health care in communities. The development and implementation of Projet ACCES in the Quebec region is a priority for the First Nations and Inuit Health Branch (FNIHB). The main objective of this project is to facilitate access to our services and bring them closer to clients, in response to a request made by the First Nations and Inuit communities. It will allow us to put in place a co-ordination mechanism for FNIHB program and service delivery and will lead to improved client service, with a view to better health outcomes and better First Nations and Inuit control in their assumption of responsibility for their health services. To increase the long-term supply of First Nations, Inuit and Métis health care providers, the Department will increase the amount of funding available through bursaries and scholarship initiatives to help support more First Nations, Inuit and Métis students who pursue health care studies. In addition, more bridging, access and student support programs for Aboriginal health care students will be supported at post-secondary institutions. In partnership with professional associations, we will facilitate the adaptation of medical, nursing and other health care curricula to increase the cultural awareness of doctors, nurses and others providing health services to First Nations, Inuit and Metis patients. We will also work with Indian and Northern Affairs Canada and our provincial partners to ensure that math and science courses are better oriented to First Nations and Inuit students, thereby enhancing the likelihood of success in health careers. We will work with our partners to support the development and implementation of quality improvement activities, including accreditation of Aboriginal health organizations. This involves measuring the organization's health services delivery against a consistent set of national standards of excellence. The focus will continue to be on enhancing the cultural elements and system supports of Aboriginal accreditation, with the goal of increasing the number of Aboriginal healthcare organizations engaged in the accreditation process by 30% to over 70 organizations in total. Through the establishment of Patient Wait Times Guarantees (PWTGs) pilot projects, Health Canada will improve access to its health services delivered to First Nations on reserve. The pilot projects are expected to last approximately two years, and will include an evaluation to determine the effectiveness of the PWTG and its potential to be applied to additional First Nations communities. We will continue to work to improve access to health services for all Aboriginal peoples through the implementation of the Aboriginal Health Transition Fund, which supports better integration of federal, provincial and territorial health programs and services to First Nations and Inuit and the adaptation of provincial and territorial health services to respond to the needs of First Nations, Inuit and Métis. It is expected that this work will contribute to the development and implementation of longer-term bilateral and/or multipartite agreements to address Aboriginal health issues of mutual concern, such as the tripartite implementation plan currently being negotiated with British Columbia First Nations and the British Columbia provincial government. We will continue to provide services under the Children's Oral Health Initiative in over 100 communities to improve the oral health of First Nations children on-reserve. In addition, a new oral health information system will be implemented to collect data on the effectiveness of the Children's Oral Health Initiative. Health Canada supports the construction, operation, maintenance and environmental management of on-reserve health facilities and staff residences. In 2007-2008, eighteen health facilities will be constructed or expanded, and recapitalization initiatives (repairs, replacements, upgrades) will improve the working environment of clients and staff, and enhance the quality of health care services offered at the community level. We will also invest $1.5 million in environmental audits, assessments and remediation to ensure operations of health facilities in First Nations communities meet environmental codes and requirements and are consistent with the Department's commitments to sustainable development. Promoting Healthy Living and Disease Prevention The Department will work with National Aboriginal Organizations to implement the Maternal Child Health Program for pregnant First Nations women and families with infants and young children living on-reserve. The program will provide home visits by both nurses and trained, experienced mothers in the community as well as case management for families living with more complex needs. In the North, including the territories, Nunavik and Nunatsiavut, program funding will enhance health promotion programs already in place such as the Canada Prenatal Nutrition Program and the Fetal Alcohol Spectrum Disorder Program and complement the health services provided by the province or territory. In 2007-2008, First Nations and Inuit Health, Ontario Region (FNIH, OR) will work with the Chiefs of Ontario on an initiative to develop a comprehensive, seamless Public Health System for First Nations Communities. The initiative has two main elements. The first is to clarify relationships and roles among First Nations, FNIH, OR and provincial public health organizations. The second is to design, develop and implement a First Nations Component of the Public Health Management and Surveillance System that will be aligned with Ontario's public health surveillance system. We will continue to expand the Aboriginal Head Start On Reserve Program by addressing the need for more training and facilities to deliver services. The Department will create more Program spaces and sites and engage in capacity building activities to further professional development for workers. In addition, outreach will be strengthened and expanded to serve small communities that do not have enough children to run a centre-based program, through increased investments in staff training for those workers who deliver the Program in a home setting and funding for new projects in small communities. These investments will allow the Department to reach more children and improve the current community-based projects that already exist. Health Canada will also continue to implement the National Aboriginal Youth Suicide Prevention Strategy (NAYSPS). Although there is variation among First Nations communities, overall suicide rates are 5 to 7 times more than the rate for Canadian youth. Suicide rates among Inuit youth are up to 11 times higher than the national average. Actual rates among Aboriginal youth living off reserve and in urban centres, including Métis and urban Inuit, are not well established. In 2007-2008, approximately 75-100 First Nations and Inuit communities will carry out their suicide prevention plans. These plans will focus on prevention, skills training, and the development of protocols to respond to suicide-related crises. Moreover, the Strategy will support awareness and knowledge raising activities to promote mental wellness and resiliency among youth. The Strategy will also continue to increase what we know about what works best to prevent Aboriginal youth suicide, and how suicide impacts Aboriginal youth living off reserve and in urban areas, through evaluation, data gathering and research. Health Canada is working with key partners to develop a strategic action plan for First Nations and Inuit mental wellness. The objective of the plan is to improve the mental wellness of First Nations and Inuit through a coordinated continuum of mental health and addictions services that respect traditional, cultural and mainstream approaches to healing. Over the next 3-5 years, we will work with Aboriginal organizations and provinces and territories to implement key aspects of this plan that can proceed within existing resource levels, such as raising awareness of the strategic action plan and its objectives and aligning existing programs with the plan. The Department will also continue to offer a continuum of mental health and emotional support services to former students of residential schools and their families. The prevalence of diabetes is 3-5 times higher in the Aboriginal population compared to the general population. Addressing the high rates of chronic disease, such as diabetes, within the Aboriginal community is a key focus for the Department and we will continue with the enhancement of the Aboriginal Diabetes Initiative. This will strengthen community-based diabetes prevention and promotion activities, increase the number and training of service providers and improve screening and care services. Participatory research will be undertaken to gather more data on pre-diabetes, diabetes and its complications, and to develop strategies to reduce the burden of the disease. Complementary activities to aid in diabetes prevention will also be implemented. This includes the launch and implementation of a food guide for First Nations, Inuit, and Metis based on the revised Canada's Food Guide, and partnerships with retailers in northern isolated communities to support healthy eating by increasing availability, quality and promotion of healthy foods. We will continue to support the development of communicable disease emergencies plans including pandemic influenza planning. Efforts will be focused on increasing emergency planning and response capacity at the regional and community levels, strengthening collaborative relationships with provinces and territories, and ensuring that emergency supplies are readily available to on-reserve health centres in First Nations and Inuit communities. In BC Region, planning and preparation will continue to take place to minimize the impact of an influenza pandemic on First Nations communities. An inventory of First Nations emergency preparedness plans will be completed and an emergency preparedness coordinator will be in place to work with First Nations. Health Canada will work with First Nations to increase the number of communities that have completed pandemic plans and have conducted table-top exercises, with a target of 80% completion by 2009. We will conduct research and provide funding for the National First Nations Environmental Contaminants Program and the Northern Contaminants Program. We will support five large National First Nations projects that focus on investigating the effects of environmental contaminants on First Nations reserves. We will also fund four projects through the Northern Contaminants Program to increase the knowledge of First Nations and Inuit about the extent of environmental contaminants exposure in their communities as well as to increase capacity of First Nations communities to manage environmental health research projects. We will also conduct an Environmental Contaminants Traditional Food Safety Workshop that will bring together representatives of First Nations communities across Saskatchewan to discuss nutritional benefits of traditional foods and environmental health risks associated with consuming traditional foods. This will increase knowledge of the benefits and risks of various food choices, for better decision making. In partnership with Indian and Northern Affairs Canada, and with Canada Mortgage and Housing Corporation (CMHC) and the Assembly of First Nations, Health Canada is working towards developing greater capacity among First Nations and their organizations to prevent and remediate mould problems and improve housing conditions in their communities. Health Canada will also work with CMHC to ensure that education and training materials cover both the public health and construction aspects of quality housing. Through the First Nations Water Management Strategy, the Department will develop products that will put a greater focus on preventative activities and develop clear and consistent procedures to address waterborne threats to human health in First Nations communities. Improving Accountability and Performance Measurement We will undertake efforts to improve health surveillance and information analysis, including data development, data analysis, research evidence to support priority-setting and decision-making on health related investments. For example, through the Aboriginal Diabetes Initiative, we will develop a research agenda and identify research priorities that will inform future diabetes programming. Health Canada also draws information from evaluation and review studies to support program improvement. In 2007-2008, we will initiate three integrated program cluster level evaluations for the Children and Youth, Environmental Health and Research and Communicable Disease Control program areas. The Department will also finalize the joint evaluation with Indian and Northern Affairs Canada on the First Nations Water Management Strategy. The First Nations and Inuit Health program has established expected results and indicators to assess progress towards the achievement of the strategic outcome. Use of the information below will contribute to providing a snapshot of the health status of First Nations and Inuit. Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians Life expectancy (at birth, on and off reserve) NIHB client utilization rates The following describes seven key program areas that Health Canada will continue to be engaged in throughout 2007-2008: children and youth; mental health and addictions; chronic disease and injury prevention; environmental health and research; communicable disease control; primary care; and non-insured health benefits. Children and Youth Programs (ongoing) Description: These programs are designed to collectively improve the cultural, emotional, intellectual and physical growth and development of First Nations and Inuit infants, children and youth. Programs targeting maternal, infant and child health, increasing children's knowledge of language and culture, and increasing children's readiness for school are the main priorities of the Department's children and youth programming. These programs include: Aboriginal Head Start On Reserve; the Canada Prenatal Nutrition Program; the Fetal Alcohol Spectrum Disorder program; and the Maternal Child Health program. Improved continuum of programs and supports in First Nations and Inuit communities Increased participation of First Nations and Inuit individuals, families and communities in programs and services Percentage of communities with programs Number of participants in programs by program type 109.7 7.1 114.7 7.3 114.9 7.4 Mental Health and Addictions Programs (Ongoing) Description: These programs provide culturally appropriate counselling services, addiction prevention and promotion services, and mental wellness services that are largely delivered by Aboriginal people. These programs include: Building Healthy Communities; Brighter Futures; the National Native Alcohol and Drug Abuse Program (NNADAP)-residential treatment and community-based prevention; the Youth Solvent Abuse Program; the National Aboriginal Youth Suicide Prevention Strategy; the Labrador Innu Comprehensive Healing Strategy; and the Indian Residential Schools Resolution Health Support Program. As part of the federal expenditure review, $2.5 million in 2006-2007, $8.3 million in 2007-2008, and $10.8 million in ongoing funding for the First Nations and Inuit Tobacco Control Strategy was targeted for reduction. Funding for fiscal year 2007-2008 will be directed at completing existing initiatives and working with key partners to develop a new policy approach to tobacco control in First Nations and Inuit communities. Number of treatment centres by type Chronic Disease and Injury Prevention Programs (Ongoing) Description: These programs support the development and implementation of community-based activities that promote healthy lifestyle choices and support active living. Over the long term, these programs will contribute to the prevention of chronic disease and injuries in First Nations and Inuit communities across Canada. These programs include the Aboriginal Diabetes Initiative and Injury Prevention. Number of participants in community activities. 46.1 3.2 51.6 3.2 61.4 3.2 Environmental Health and Research Programs (Ongoing) Description: These programs are designed to reduce the risk of exposure to environmental health hazards by improving the capacity of communities to implement measures to manage, contain and control them. They also help to create and maintain healthy and safe community environments through: the investigation of potential environmental health-related outbreaks; and raising awareness of environmental health hazards such as water-borne, food-borne and vector-borne illnesses including health problems associated with poor indoor air quality, such as mould in housing. They provide for pest control and build community human resource capacity to adapt to environmental conditions in order to maintain safe environments and to deal safely with environmental hazards. They enable community-based scientific research to be conducted into concerns expressed by First Nations and Inuit communities regarding human health and environmental linkages. These programs include: First Nations Water Management Strategy; West Nile Virus; Contaminated Sites; Transportation of Dangerous Goods; Food Safety, Facilities Health Inspections; Housing and Research. Improved environmental health risk management Improvement in the level of knowledge and understanding of environmental contaminants for First Nations and Inuit communities Number of communities with environmental health officers/trained community-based water quality monitors Number of communities equipped with water testing/sampling kits Number of communities with capacity to prevent and address mould problems effectively Number of participants in traditional food workshops and projects Number of contaminated sites that are remediated Communicable Disease Control Programs (Ongoing) Description: These programs support public health needs and priorities in the design, implementation, management and delivery of programs to protect First Nations and Inuit communities from communicable diseases, and to implement measures to manage, contain and control risks of outbreak. These programs include: Tuberculosis; Immunization; HIV/AIDS; and Communicable Disease Emergencies. Improved access to communicable disease prevention and control programs for First Nations and Inuit individuals, families, and communities Percentage of communities with programs Primary Care Programs (Ongoing) Description: Comprehensive health care services are provided to remote and/or isolated First Nations and Inuit communities to supplement and support primary care services provided by provincial, territorial and/or regional health authorities. These include emergency and acute care health services. Health Canada ensures links to appropriate care by other health care providers and/or institutions as required by the client condition. Health service accreditation supports linkages and a "continuum of care" approach. These programs include the First Nations and Inuit Home and Community Care Program, and Oral Health Care. Improved access to primary health care programs and services for First Nations and Inuit individuals, families and communities Improvement in quality of health services Percentage of communities with programs Number of health facilities by type, in the communities Number of accredited health services 235.5 64.7 233.7 66.6 237.8 68.6 Non-Insured Health Benefits (Ongoing) Description: This program provides registered First Nations and Inuit with a limited range of medically necessary health-related goods and services not provided through other private or provincial/territorial health insurance plans. The Program provides a range of health benefits not included in provincially/territorially administered insured health care programs. This program complements these provincially/territorially insured programs, such as physician and hospital care, as well as community-based programs and services. The benefits include: dental care, vision care, pharmacy benefits (prescription drugs and some over-the-counter medication), medical supplies and equipment, crisis intervention, mental health counseling, transportation benefits to access medically required health services and payment of health premiums on behalf of individuals in Alberta and British Columbia. Access by eligible clients to Non-Insured Health Benefits Non-Insured Health Benefits client utilization rates 888.7 20.8 908.4 4.4 928.8 22.0 First Nations and Inuit Programs and Services and web links Other programs and services that contribute to this program activity total $656.3 million; for more information on those programs and services please see the following links: Non-Insured Health Benefits 2004/05 Annual Report: http://www.hc-sc.gc.ca/fnih-spni/pubs/nihb-ssna/2005_rpt/index-eng.html Non-insured health Benefits Program http://www.hc-sc.gc.ca/fnih-spni/nihb-ssna/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/nihb-ssna/index-fra.html Aboriginal Head Start On Reserve http://www.hc-sc.gc.ca/fnih-spni/famil/develop/ahsor-papa_intro-eng.html http://www.hc-sc.gc.ca/fnih-spni/famil/develop/ahsor-papa_intro-fra.html Fetal Alcohol Spectrum Disorder http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro-eng.html http://www.hc-sc.gc.ca/fnih-spni/famil/preg-gros/intro-fra.html Aboriginal Diabetes Initiative http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/diseases-maladies/diabete/index-fra.html http://www.hc-sc.gc.ca/fnih-spni/promotion/injury-bless/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/promotion/injury-bless/index-fra.html Indian Residential Schools Resolution Health Support Program http://www.hc-sc.gc.ca/fnih-spni/services/indiresident/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/services/indiresident/index-fra.html National Native Alcohol and Drug Abuse Program http://www.hc-sc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada-eng.html http://www.hc-sc.gc.ca/fnih-spni/substan/ads/nnadap-pnlaada-fra.html http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/cdcd-dcmt/index-eng.html http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/cdcd-dcmt/index-fra.html http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/ehd-dse/index-eng.html http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/phcphd-dsspsp/ehd-dse/index-fra.html http://www.hc-sc.gc.ca/fnih-spni/promotion/water-eau/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/promotion/water-eau/index-fra.html Immunization Schedule for Infants and Children http://www.phac-aspc.gc.ca/im/is-cv/index.html http://www.phac-aspc.gc.ca/im/is-cv/index-fra.html Targeted Immunization (TIS) Program http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/immuni-eng.html http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/immuni-fra.html http://www.hc-sc.gc.ca/fnih-spni/services/ehealth-esante/index-eng.html http://www.hc-sc.gc.ca/fnih-spni/services/ehealth-esante/index-fra.html Aboriginal Health Human Resources Initiative http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/ahhri-irrhs-eng.html http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/fnih-spni/ahhri-irrhs-fra.html The Health Portfolio BranchHealth Canada also contributes grants and contributions to several health organizations such as Infoway, Canadian Institute for Health Information and Canadian Health Services Research Foundations. Departmental Links to the Government of Canada Outcomes (in Millions of Dollars) Program Activity Contribu- Respend- Total Main Estimates Adjustments (planned spending not in Main Estimates) Total Planned Spending Program Activity: Health Policy, Planning and Information 86.5 111.8 65.4 263.7 263.7 263.7 Program Activity: Health Products and Food 287.1 1.4 5.9 4.0 298.4 257.2 0.2 257.4 Strategic Outcome #3: Reduced Health and Environmental Risks from Products and Substances, and Safer Living and Working Environments Program Activity: Healthy Environments and Consumer Safety 301.6 2.0 4.8 40.8 349.2 Program Activity: Pest Control Product Regulation 57.8 57.8 -7.0 50.8 0.1 50.9 Program Activity: First Nations and Inuit Health 1,133.9 1.5 30.0 963.1 2,128.5 2,123.1 7.8 2,130.9 Total 1,866.9 4.9 152.5 1,073.3 3,097.6 -69.3 3,028.3 8.4 3,036.7 All of Health Canada's program activities contribute to the Government of Canada's "Healthy Canadians" outcome. Departmental Planned Spending and Full-Time Equivalents 2006-2007 (1) Planned Spending Health Policy, Planning and Information 288.6 263.7 259.8 254.7 Health Products and Food 303.2 298.4 283.5 283.5 Healthy Environments and Consumer Safety 306.1 349.2 305.0 305.8 Pest Control Product Regulation 58.7 57.8 53.5 53.2 First Nations and Inuit Health 2,087.9 2,128.5 2,140.4 2,175.9 Budgetary Main Estimates (gross) 3,044.5 3,097.6 3,042.2 3,073.1 Less: Respendable Revenues 69.1 69.3 69.6 69.6 Total Main Estimates 2,975.4 3,028.3 2,972.6 3,003.5 Adjustments : (2) Supplementary Estimates: Operating budget carry forward (horizontal item) 81.1 Additional funding for the Non-Insured Health Benefits program for First Nations and Inuit to address cash pressures associated with the higher costs of drugs and dental care, as well as the increased costs of transporation to access medical services 30.0 Funding to address workload and cost pressures in four of Health Canada's core business areas, namely, the Pesticides Regulatory Program ($1,402), the Natural Health Products Program ($7,367), the Public Service Health Program ($5,560) and Litigationmanagement ($9,233) 23.6 Funding to implement the Canadian Strategy for Cancer Control (horizontal item) 3.8 Transfer from the Public Health Agency of Canada - To adjust for the allocation of resources following the transfer of the control and supervision of the Population and Public Health Branch 2.2 Funding for the delivery of federal programs and services, including health, to the O-Pipon-Na-Piwin Cree Nation (horizontal item) 1.5 Transfer from the Public Health Agency of Canada - Forgovernment advertising programs 1.5 Funding to improve the capacity to detect and the readiness to respond to a potential avian or pandemic influenza outbreak including emergency preparedness, research, antiviral stockpiling and rapid vaccine development technology (horizontal item) 1.3 Transfer from the Public Health Agency of Canada - To implement the Canadian Strategy for Cancer Control (horizontal item) 0.7 Transfer from Industry Canada - To undertake projects related to the development and application of biotechnology (CanadianBiotechnology Strategy) (horizontal item) 0.3 Funding related to the assessment, management and remediation of federal contaminated sites (horizontal item) 0.2 Transfer from the Public Health Agency of Canada - To conduct reviews of the ethics of all Public Health Agency of Canada research involving human subjects 0.2 Transfer from Canadian Heritage - For the development of Official Language Minority Communities (Interdepartmental Partnership with the Official Language Communities) (horizontal item) 0.2 Transfer to the Public Health Agency of Canada - To support the Canadian Health Services Research Foundation's Community Health Nursing Study -0.1 Transfer to Foreign Affairs and International Trade - For the payment of assessed contributions representing Canada's membership in the Rotterdam Convention on the Prior Informed Consent for Certain Hazardous Chemicals and Pesticides in International Trade and in the Stockholm Convention on Persistent Organic Pollutants -0.1 Transfer to the Canadian Institutes of Health Research - To fund health services and health population research relevant to the surveillance of diabetes -0.2 Transfer to Indian Affairs and Northern Development - To provide for a grant to the Sechelt Indian Band pursuant to the Sechelt Indian Band Self-Government Act -0.3 Transfer to the Public Health Agency of Canada - To continue the Government's plan to establish core genomics research and development capacity -1.4 Less: Spending authorities available -27.4 Other adjustments: Collective Agreements 19.2 Internal Audit - Readiness Assessment (TB Vote 10) 0.1 Internal Audit - Implementation of the Internal Audit Policy (TB Vote 10) 0.3 1.0 2005 Expenditure Review Committee Savings - Procurement -4.6 2006 Expenditure Restraint -23.0 Funding for Indian Residential Schools Resolution Health Support Program 7.5 14.0 18.9 Funding for the Genomics Research and Development Initiative, under the auspicies of the Canadian Biotechnology Strategy 4.0 4.0 Funding for the Winter Olympics 0.6 2.0 Adjustment of the accommodation costs for the Canadian Strategy for Cancer Control -0.1 -0.1 -0.1 Less: Spending authorities available -7.3 Total Adjustments 101.9 8.4 18.4 24.8 Total Planned Spending (3) 3,077.3 3,036.7 2,991.0 3,028.3 Less: Non-respendable Revenue 8.9 8.9 8.9 8.9 Plus: Cost of services received without charge (4) 81.7 81.6 81.8 80.6 Total Departmental Spending 3,150.1 3,109.4 3,063.9 3,100.0 Full-Time equivalents (5) 8,714 8,825 8,681 8,689 (1) Reflects the best forecast of total net planned spending to the end of the fiscal year. (2) Adjustments reflect Supplementary Estimates for 2006-2007 and future year approvals not reflected in the 2007-2008 Main Estimates. (3) Refer to Section 2 for an explanation by program activity of year-over-year fluctuations. (4) Includes the following services received without charge: accommodation charges (Public Works and Government Services Canada); Contributions covering employers' share of employees' insurance premiums and expenditures (Treasury Board Secretariat); Workers' Compensation (Human Resources and Skills Development Canada); and Legal Services (Department of Justice Canada). (5) Full-time equivalents reflect the human resources that the Department uses to deliver its programs and services. This number is based on a calculation that considers full-time, term, casual employment, and other factors such as job sharing. Voted and Statutory Items listed in Main Estimates (in millions of dollars) Vote or Statutory Item Truncated Vote or Statutory Wording Main Estimates Minister of Health - Salary and motor car allowance Contributions to employee benefit plans Total Department The difference between the 2007-2008 Main Estimates and the 2006-2007 Main Estimates is due to various increases and decreases to the reference levels, of which some of the major increases are related to: the Special Meeting of the First Ministers and Aboriginal Leaders, the Canadian Strategy for Cancer Control, Chemical Management Plan, the Implementation of the Clean Air Regulatory Agenda, and the yearly growth of the Indian Envelope. The major increases are partially offset by the major decrease due to the sunset of the Primary Health Care Transition Fund. Services Received Without Charge ($ millions) 2007-2008 Accommodation provided by Public Works and Government Services Canada (PWGSC) 35.2 Contributions covering employers' share of employees' insurance premiums and expenditures paid by the Treasury Board of Canada Secretariat 42.3 Workers' Compensation coverage provided by Human Resources and Skills Development Canada 0.8 Salary and associated expenditures of legal services provided by the Department of Justice Canada 3.3 2007-2008 Services received without charge 81.6 Sources of Respendable and Non-Respendable Revenues Respendable Revenues (millions of dollars) Program Activity Forecast Revenue 2006-2007 Planned Revenue Health Products and Food 38.8 41.2 41.2 41.2 Healthy Environments and Consumer Safety 12.0 15.7 16.0 16.0 Pest Control Product Regulation 7.0 7.0 7.0 7.0 First Nations and Inuit Health 3.7 5.4 5.4 5.4 Total Respendable Revenues 61.5 69.3 69.6 69.6 Non-Respendable Revenues (millions of dollars) Health Products and Food 3.9 3.9 3.9 3.9 Healthy Environments and Consumer Safety 1.7 1.7 1.7 1.7 Total Non-Respendable Revenues 8.9 8.9 8.9 8.9 Total Respendable and Non-Respendable Revenues 70.4 78.2 78.5 78.5 Resource Requirements by Branch and by Program Activity FOr 2007-2008 (in millions of dollars) Health Policy, Planning and Information Healthy Environments and Consumer Safety Pest Control Product Regulation First Nations and Inuit Health Health Policy Branch 247.7 247.7 Health Products and Food Branch 203.0 203.0 Healthy Environments and Consumer Safety Branch 276.4 276.4 Pest Management Regulatory Agency 40.2 40.2 First Nations and Inuit Health Branch 2,016.7 2,016.7 Chief Financial Officer Branch 2.9 9.1 10.0 1.9 16.3 40.2 Corporate Services Branch 7.2 24.9 26.0 4.8 41.7 104.6 Executive Offices* 1.4 4.8 5.1 1.0 12.9 25.2 Public Affairs, Consultation and Regions Branch** 4.5 15.6 16.3 3.0 43.3 82.7 Total 263.7 257.4 333.8 50.9 2,130.9 3,036.7 * Includes such areas as Legal Services, Office of the Chief Scientist and Executive Offices. ** Includes such areas as Communications and Offices of Regional Directors General. Regulatory Plan Program Activity: Health Policy, Planning and Information Regulations under the Assisted Human Reproduction Act (Section 8, Consent Regulations) These regulations will bring into force the section 8 prohibition of the Assisted Human Reproduction Act (AHR Act). They will ensure that all persons using human reproductive material to create an in vitro embryo or using an in vitro embryo for any purpose will obtain the written consent of the donor. (Subsection 14(2)b), Counselling Regulations) The AHR Act requires that before donating human reproductive material or in vitro embryos, donors receive counselling. The regulations will provide the details respecting these counselling services, such as who can provide the counselling. (Licensing Regulations) The AHR Act requires that all persons undertaking controlled activities (i.e., assisted human reproduction procedure such as in vitro fertilization) under the Act must obtain a license to undertake those activities. The AHR regulations will detail the requirements for obtaining that license such as the qualifications, premises and administrative requirements. (Section 10, Regulations for Clinical and Laboratory Activities) Section 10 of the AHR Act specifies that controlled activities must be performed in accordance with a license and regulations. The regulations with respect to controlled activities will define the conduct of core activities involved in the practice of assisted human reproduction (e.g., in vitro fertilization, embryo transfer). This initiative will address ethical, social, health and safety issues related to the conduct of these activities. (Record Keeping and Health Reporting Information Regulations for Controlled Activities) These regulations will specify what health reporting information Assisted Human Reproduction (AHR) clinics will need to collect for each AHR procedure that is performed. These regulations will also address retention, use, disclosure and destruction of health reporting information. (Section 12, Reimbursement of Expenditures) Section 12 of the AHR Act allows for the reimbursement of expenditures to donors of human reproductive material (i.e., semen, oocytes) and surrogate mothers. These AHR regulations will specify the reasonable expenditures that can be reimbursed. Program Activity: Health Products and Food Food and Drug Act Safety of Human Cells, Tissues and Organs for Transplantation Regulations The purpose of this initiative is to minimize the potential health risks to Canadian recipients of human cells, tissues and organs (CTO). The proposed CTO regulations will address safety in the processing and handling of these products, resulting in improved protection of the health and safety of Canadian transplant recipients. Food and Drug Regulations (Amendments to Division 3 with respect to Positron Emitting Radiopharmaceuticals) The purpose of this initiative is to amend Division 3, Part C of the Food and Drug Regulations with respect to the use of positron-emitting radiopharmaceuticals (PERs) in basic clinical research, in recognition of the fact that the application of the current regulations for clinical trials under Division 5, Part C of the FDR to PERs basic clinical research studies is placing an undue regulatory burden on the researchers in this field and may be impeding basic clinical research involving PERs in Canada. (Safety of Blood and Blood Components Regulations) The purpose of this initiative is to replace the current requirements governing human blood and blood components in the Food and Drug Regulations with new comprehensive safety and quality of blood and blood components regulations. The objectives of the new regulations include: outlining clear and intelligible requirements; allowing for timely updating of the requirements as new technologies/products/issues emerge; and achieving greater harmonization in Canada related to the collection, handling and post-approval surveillance of blood and blood components. (Extraordinary Use of New Drug Regulations) Under the Food and Drug Regulations a drug is approved only if substantial evidence of its efficacy is available. The purpose of this initiative is to amend the Food and Drug Regulations to allow for the approval of certain drugs the efficacy of which cannot be tested on humans in clinical trials for ethical reasons. These drugs may be required in emergency situations such as the treatment of pandemic influenza virus. The availability of these drugs is necessary to meet emergency preparedness measures which require the stockpiling of some of these drugs. (Addition of Vitamins and Minerals to Foods) Facilitation of greater consumer choice and industry innovation by revision of regulations on the addition of vitamins and mineral nutrients to foods taking into account the role of nutrient addition to foods, consumer needs and expectations, and industry requests. (Enhanced Food Labelling) Enhanced protection of allergic consumers through mandatory labelling of specific food allergens, gluten sources and sulphites when present at 10 parts per million or more, on the labels of prepackaged food products, whether they have been added directly or indirectly. (Mandatory Labelling of Raw Ground Meat and Ground Poultry) Reduction of food borne illness as a result of providing safe handling information on the labels of these products which, due to their raw state, can introduce disease-causing bacteria to the food preparation environment. (Health Claims) Addition of two diet-related health claims to the list of claims manufacturers can use to promote healthy foods regarding: fruits, vegetables and whole grains and reduced risk of heart disease; and folic acid and reduced risk of neural tube defects. (Revisions to Division 12 - Prepackaged Water and Ice) Revision and updating of the safety and labelling requirements for prepackaged water and ice products. Amendments to the Natural Health Products Regulations, the Food and Drug Regulations and the Establishment Licensing Fees Regulations The purpose of the proposed dual licensing regulatory amendment is to alleviate the exporting challenges arising from the coming into force of the Natural Health Products Regulations (NHPR). It will allow, on a voluntary basis, natural health product (NHP) companies to hold an establishment license (EL) pursuant to the Food and Drug Regulations (FDR), in addition to the required site license under the NHPR. It is necessary for certain NHP companies to hold an EL, the license issued for pharmaceutical drugs, and obtain the accompanying export certificates in order to export their NHPs to countries that classify the NHPs in question as drugs. The proposed amendment consists of a two part regulatory package intended to come into force at the same time: 1) amendments to the NHPR/FDR, authorized under section 30 of the Food and Drugs Act; and 2) amendments to the Establishment Licensing Fees Regulations authorized under section 19.1(a) of the Financial Administration Act. Medical Devices Regulations (Investigational Testing, Project 1467) Amendment to the Medical Devices Regulations to further address risks to health associated with investigational testing by requiring conformance to Good Clinical Practices, reporting to Health Canada for reviewing/monitoring, and introducing an inspection program. Proposed publication in the Canada Gazette, Part I in 2007-2008. (Regulations amending the Special Access Program) The regulations that provide for emergency access to drugs that do not have a Canadian market authorization on a patient-basis. Amendments to the regulations will allow for the block release of such drugs to a population and/or for drug stockpiling to address public health emergencies. Proposed publication in the Canada Gazette, Part I in2007-2008. (Regulations amending Division 1 requirements for Non-Medicinal Ingredients (NMI) in Drug Product Formulation) The proposed amendment would require the submission of complete qualitative and quantitative formulation data, including a list of all NMIs in a drug product, as well as the source of any human or animal derived NMIs or medicinal ingredients products currently regulated under Division 1 of the Regulations. Proposed publication in the Canada Gazette, Part I in 2007-2008. (NMI Labelling, Project 743) The proposed amendment would require that all NMIs be listed on the outer labels of non-prescription drugs for human use. This would not apply to prescription drugs, low-level disinfectant drugs, or drugs for veterinary use. Proposed publication in the Canada Gazette, Part II in 2007-2008. (Regulations amending Divisions 1 and 8, Progressive Licensing Project) A new regulatory framework that is based on sound science and risk management is being developed, including revised requirements for initial licensing of new products, provisions allowing for conditions of licensing (e.g., post-market commitments), regulations for the content and revisions of product monographs, provisions for continual evaluation and re-evaluation of licenses, new enforcement and compliance tools, regulations for the issuance of risk communication tools, and provisions for public involvement in the regulatory process. Proposed publication in the Canada Gazette, Part I in 2007-2008. (Prohibition of Importation for Personal Use) Further restrict the importation of drugs to include the personal importation of drugs intended to be used in food-producing animals to avoid potentially harmful residues in food products from animals treated with these drugs. These regulatory amendments will better address the health risks to human and animal health and the safety of Canada's food supply associated with the use of unauthorized veterinary drugs. The proposed regulatory amendments will be published in Canada Gazette, Part I in 2007-2008 Program Activity: Healthy Environments and Consumer Safety Marihuana Medical Access Regulations (Amendments to Part 2 and Part 3 of the Regulations) The purpose of these amendments is to ensure that the Marihuana Medical Access Regulations (MMAR) reflect the strategic direction of the medical marihuana access program. In particular, these amendments will focus on Part 2 (License To Produce) and Part 3 (General Obligations, including criteria for revocation) of the MMAR and will address issues raised by both internal and external stakeholders subsequent to previous amendments made in June 2005. Amongst others, some of these issues are related to the maximum dosage (daily amount) and/or number of plants allowed to be grown by a person who is authorized to do so under the MMAR, strengthening the tools for compliance and enforcement, and reviewing the powers of inspectors. Controlled Drugs and Substances Act (Amendment to Schedule Tramadol under this Act) The purpose of this amendment is to mitigate the risk of diversion associated with this substance, which has been shown to have abuse liability and dependence potential. This amendment will add the substance tramadol to Schedule I to the Controlled Drugs and Substances Act (CDSA), and regulate it under the Schedule to the Narcotic Control Regulations (NCR). Scheduling tramadol under the CDSA will impose greater controls and therefore minimize the risk of diversion and better mitigate public health risks. Controlled Drugs and Substances Act (CDSA) (Regulations to Expand the Authority for Regulated Health Professionals to Prescribe Controlled Substances where Appropriate) The purpose of these regulations is to establish the conditions under which additional classes of health professionals (other than dentists, doctors of medicine and veterinary medicine) can be considered "practitioners" under the CDSA, and can therefore be granted authorities to conduct activities with certain controlled substances. The regulations are intended to contribute to improvements in the quality and efficiency of health care delivery to Canadians, and to keep pace with changes in the health care system in Canada (e.g., provincial/territorial ministries of Health are starting to allow a wider array of health professionals to prescribe drugs.) Achievement will be measured by improved alignment of federal and provincial/territorial regulatory frameworks governing the appropriate use of controlled substances for medical purposes. Tobacco Advertising Regulations Increased awareness of tobacco-related health hazards through mandating of new health warnings in advertising. Awareness will be measured through surveys. (Amendments regarding "Light" and "Mild" Descriptors) Reduced confusion among smokers regarding the "Light" and "Mild" descriptors. Greater awareness that no class of cigarettes is a "safer" alternative. Achievements will be measured through surveys. Corded Window Coverings Regulations Reduced risks to children's health (strangulation) posed by cords on window covering products such as mini-blinds and curtains. Amending Cribs and Cradles Regulations Reduced risks of injury to children posed by cribs, cradles and bassinets. Regulations on Consumer Products Containing Lead (Group 1) (Products Intended to Be or Likely to Be Placed in the Mouth) Reduced health risks to children related to lead exposure. Examples include toys intended for children under 3 years of age, and mouthpieces used in sports equipment and musical instruments. Performance will be based on the removal of such hazardous products from the Canadian marketplace and the level of public awareness. (Products Intended for Use by Child or by an Adult Caring for a Child) Reduced health risks to children related to lead exposure. Examples include play equipment, strollers and children's clothing and accessories. Performance will be based on the removal of such hazardous products from the Canadian marketplace and the level of public awareness. Program Activity: Pest Control Products Regulation Pest Control Products Act (New Regulations on Review Panels) The new Pest Control Products Act provides a process for the reconsideration of pesticide registration decisions whereby any person may file a notice of objection within sixty days of these decisions. Regulations will be made in 2007 to elaborate administrative matters concerning the process so as to make the timely resolution of reconsideration questions predictable and transparent. Over the next three years, Health Canada will manage the following transfer payment programs in excess of $5 million: Contributions for Alcohol and Drug Treatment Rehabilitation Contributions for Bigstone Non-Insured Health Benefits Pilot Project Contributions of First Nations and Inuit Community Programs Contributions for First Nations and Inuit Health Benefits Contributions for First Nations and Inuit and Health Facilities and Capital Programs Contributions for First Nations and Inuit Health Governance Support Contributions for First Nations and Inuit Health Protection Contributions for First Nations and Inuit Primary Health Care Contributions for the Drug Strategy Community Initiatives Contributions for the Health Care Strategies and Policy Contribution Program Contributions in Support of the Federal Tobacco Control Strategy Contributions Program to Improve Access to Health Services for Official Language Minority Communities Contributions to the Organization for the Advancement of Aboriginal People's Health Grant for Territorial Medical Travel Fund Grant to the Territorial Governments and the Territorial Health Access Fund and Operational Secretariat Grant to the Canadian Agency for Drugs and Technology in Health Grant to the Canadian Blood Services (TB#826394) Grant to the Canadian Patient Safety Institute Named Grant to the Canadian Partnership Against Cancer Corporation Named Grant to the Health Council of Canada Payments to Indian Bands, Associations or Groups for the Control and Provision of Health Services For further information on the above-mentioned transfer payment programs see www.tbs-sct.gc.ca/est-pre/estime.asp Contributions for Alcohol and Drug Treatment and Rehabilitation (ADTR) Contribution Program End Date: A-Base Description: A cost-sharing program to provide payments to provinces and territories to support access to alcohol and drug treatment and rehabilitation programs. Strategic Outcome: Reduced health and environmental risks from products and substances, and safer living and working environments. Increased access to and utilization of alcohol and drug treatment and rehabilitation services by women and youth. Spending* Total Grants 0 0 0 0 Total Contributions 14.0 13.2 13.2 13.2 Total Other Types of Transfer Payments 0 0 0 0 Total Program Activity 14.0 13.2 13.2 13.2 Planned Audits and Evaluations: The Drug Strategy and Controlled Substances Programme (DSCSP) completed a review of the ADTR Program's focus in 2006 which included a review of the continued relevancy of women and youth as the target population of the Program. DSCS will be seeking TB authorities for the reoriented ADTR Program to be implemented 2008-2009. * - in millions of dollars Start Date: April, 2005 End Date: March 2010 Description: Administration and delivery of benefits with Bigstone Health Commission to registered Indians and recognized Inuit. Improved access to quality well-coordinated culturally appropriate primary health care programs and services for First Nations and Inuit individuals, families and communities Program Activity: First Nations and Inuit Health Total Contributions 8.2 8.5 8.8 8.8 Total Program Activity 8.2 8.5 8.8 8.8 Planned Evaluations: N/A Planned Audits: N/A Contributions for First Nations and Inuit Community Programs Description: Community programs support child and maternal-child health; mental health promotion; addictions prevention and treatment; chronic disease prevention and health promotion services. Increased participation of First Nations and Inuit individuals, families, and communities in programs and supports Improved continuum of programs and services in First Nations and Inuit communities Total Contributions 209.2 219.9 232.5 235.8 Total Program Activity 209.2 219.9 232.5 235.8 Planned Evaluations: Children and Youth Cluster evaluation to be initiated in the Fall 2007 Planned Audits: Recipients are required to provide year end audited financial statements. Contribution compliance audits are conducted every year for a sample of recipients. Description: A limited range of medically necessary health-related goods and services which supplement those provided through other private or provincial/territorial health insurance plans is provided to registered Indians and recognized Inuit. Benefits include drugs, dental care, vision care, medical supplies and equipment, short-term crisis intervention mental health services, and transportation to access medical services not available on reserve or in the community of residence. Access by eligible clients to Non-Insured Health benefits Contributions for First Nations and Inuit Health Facilities and Capital Program Description: Provides funding to eligible recipients for the construction acquisition, leasing, operation and maintenance of nursing stations, health centres, health stations, health offices, treatment centres, staff residences, and operational support buildings. Increase availability of health facilities, equipment and other moveable assets in First Nations and Inuit communities that support the provision of health services Planned Audits: Contribution compliance audits are conducted every year for a sample of recipients. Contributions for First Nations and Inuit Health Governance and Infrastructure Support (HG/IS) Description: Governance and Infrastructure Support to the First Nations and Inuit Health System Improved health status of FNI through strengthened governance and infrastructure Planned Audits: Contribution compliance audits are completed every year for a sample of recipients. Description: Communicable Disease and Environmental Health and Research programs facilitate preparedness to implement measures in the control, management and containment of outbreaks of preventable diseases and improve management and control of environmental hazards. Environmental health risk management contributes to improved health status of First Nations individuals, families and communities Improved access to quality well-coordinated communicable disease prevention and control programs for First Nations and Inuit individuals, families, and communities Total Program Activity 10.0 12.2 10.5 Planned Evaluations: Communicable Disease Control Cluster Evaluation to be initiated in the Fall 2007. Environmental Health and Research Cluster Evaluation to be initiated in the Fall 2007. Description: Primary Health Care services include emergency and acute care health services, and community primary health care services which include illness and injury prevention and health promotion activities. These programs also include: the First Nations and Inuit Home and Community Care; and the Oral Health Strategy. Contributions for the Drug Strategy Community Initiatives Fund (DSCIF) Description: A contributions funding program under Canada's Drug Strategy to support community-based initiatives at the national, regional, provincial/territorial and local levels in two broad areas: health promotion and prevention, and harm reduction. It is delivered through Health Canada's national and regional offices and Northern Secretariat. increased public awareness of existing and emerging drug issues in Canada; increased availability of effective national and community-based promotion and prevention initiatives to address substance use and abuse; increased access to, and utilization of, harm reduction initiatives to respond to problematic substance use; improved capacity of community organizations to address current and emerging needs of Canadians; and greater awareness and availability of effective models of intervention. Planned Audits and Evaluations: Audit and evaluation activities regarding the Drug Strategy Community Initiatives Fund are reflected in the overall audit and evaluation plans of Canada's Drug Strategy (CDS). As such, DSCIF is a key component of the Interim Year Two Risk-Based Evaluation that is currently underway, and the Interim Year Five Outcome-Based Evaluation scheduled to begin in 2007-2008. Start Date: September 2002 End Date: March 31, 2008 Description: To support the federal government's interests in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians. The contribution program will be directed at efforts to stimulate and facilitate health care policy analysis and development to advance strategic thinking and policy options in areas of priority. Current key priorities include but are not limited to: Patient Wait Times Guarantees, Health Human Resources, Cancer Control, Patient Safety, and Pharmaceuticals. Reports, consultations, research and evaluation; educational models/tools and resources for health providers, health system managers and decision makers; innovative models for funding and delivery; innovative collaborations and/or coalitions; case studies and best practices; policy research documents; environmental scans, system and technology assessments; increased evidence and knowledge base for decision-making in health care. Planned Evaluations: A summative evaluation of the Program including all initiatives will be completed for presentation to Treasury Board by March 31, 2008 as required to support the renewal of the Terms and Conditions. Contributions in Support of the Federal Tobacco Control Strategy (CSFTCS) Start Date: 2007-2008 End Date: 2011-2012 Description: The purpose of the Federal Tobacco Control Strategy (FTCS) Contribution Program is to contribute to the achievement of FTCS objectives through assistance to provinces and other bodies. In doing this, the Program supports the implementation of the four components of the Federal Tobacco Control Strategy, namely: Protection (to reduce exposure to second-hand smoke); Prevention (to reduce the uptake of tobacco and to create barriers to smoking); Cessation (to increase the number of quitters and reduce barriers to quitting); and Harm Reduction (to reduce harm to smokers). Contributions are provided to support the provinces and territories as well as key national and regional non-governmental organizations and others in order to help build a strong knowledge base and ongoing capacity for developing effective tobacco prevention and cessation interventions. In addition, as part of the FTCS, contribution funds have been used to fund regionally-based mass media initiatives in support of the four components. The contribution program is a key component of the FTCS and every effort is made to ensure that federal and provincial tobacco control efforts are coordinated and integrated to achieve a sustained reduction in tobacco use. In addition, many of Health Canada's partners are in a better position, because of their particular expertise, to deliver certain FTCS activities. Expected Results: The goals of the FTCS to be accomplished by 2011 are to: reduce smoking prevalence rate to 20% from 25% in 1999; decrease number of cigarettes sold annually by 30% (from 45B to 32B); increase compliance with sales to youth laws from 69% to 80%; reduce the number of people exposed to environmental tobacco smoke in enclosed public spaces; and explore how to mandate changes to tobacco products to reduce hazards to health. Start Date: June 2003 Description: The Contribution Program to Improve Access to Health Services for Official Language Minority Communities was launched in June 2003, following from the 2003 federal budget and The Action Plan for Official Languages. The Program was approved for a five-year period (2003-2004 to 2007-2008) with a total budget of $89 million, and with ongoing annual funding of $23 million thereafter. The Program is managed by the Official Language Community Development Bureau, and provides funding to French-speaking and English-speaking official language minority communities in Canada under two components (1) Networking Support and (2) Support for Training and Retention of Health Professionals. The Networking Support component provides funds for the establishment and sustainability of networks that will mobilize the capacities of institutions, health professionals and communities to encourage health stakeholders to deliver services in the official language of their choice; foster the development of solid, durable links between health sector stakeholders; mitigate the geographic dispersal of communities; and promote greater community engagement. Networks are to facilitate information sharing and resource development which will lead to new ways of improving access to health services for official language minority communities. The purpose of funding to the Francophone minority communities under the Support for Training and Retention of Health Professionals component is to increase the number of practising Francophone health professionals in minority communities through improved access to available programs and the extension of such training across the country via participating educational institutions, as well as through media-based and distance training, and capacity-building within institutions that offer training to health professionals within Francophone minority communities. The purpose of the funds directed to Support for Training and Retention of Health Professionals for Anglophone minority communities is to promote professional training and language training in the official language of minority communities, particularly in the regions of Quebec, as well as regional incentive measures for the recruitment and retention of health professionals, to encourage them to move to the regions or remain there. Strategic Outcome: Strengthened knowledge base to address health and health care priorities. The long term results of the Program are as follows: Increased satisfaction of Canadians in official language minority communities; Improved access to health services in the language of choice; and Improved health of Canadians in official language minority communities. Specific Results by Program Component: 1) Networking Support component: Increased interaction and engagement between health partners and community members within official language minority communities. Improved use of existing resources and sharing of best practices; Implementation of information-exchange mechanisms between health partners and official language minority communities members; and Increased commitment by health partners to improve health care services. 2) Support for Training and Retention of Health Professionals component: Increased capacity for training of health professionals within official language minority communities; Increased number of Francophone students enrolled in health professional training programs outside Quebec; Increased number of health professionals to meet the needs of official language minority communities; Improved quality and quantity of information on health care needs; and Improved quality and quantity of health care services available to official language minority communities. Planned Evaluations: Formative (mid-term) evaluation is expected for March 2007. A summative (final) evaluation is expected in March 2008. Contributions to the Organization for the Advancement of Aboriginal People's Health (OAAPH) Description: To support the Organization for the Advancement of Aboriginal People's Health Continued empowerment of Aboriginal peoples through advancements in knowledge and sharing of knowledge on aboriginal health Grant for the Territorial Health Access Fund and Operational Secretariat Description: Grant for the territorial Health Access Fund and Operational Secretariat Strengthened, integrated sustainable health promotion and illness prevention strategies; enhanced alcohol and drug services, programs, and treatment options; improved public health services and emergency preparedness and response measures and oral health; reduced frequency of acute care facilities utilization; enhanced application of e-health and telehealth solutions; increased out-reach services to outlying communities; improved health professional recruitment and retention strategies; improved access to specialized physician and diagnostic services; supported territorial-based education and training for health professionals and para-professionals; improved in-territory services to population groups with special needs; and enhanced medical travel information collection and collation capacity. Total Grants 15.0 15.0 15.0 15.0 Total Contributions 0 0 0 0 Planned Evaluations: Evaluation planned for March 2008. Note: This is a recipient (Government of Yukon) evaluation responsibility. Grant for the Territorial Medical Travel Fund Description: To support the medical travel fund address the significant and immediate pressures facing the Yukon, Northwest Territories and Nunavut (the territories) in the area of medical travel expenditures offset a portion of the territories' medical travel costs; and enable the territories to redirect resources to alternative sustainable health reform initiatives. Grant to the Canadian Agency for Drugs and Technology in Health (CADTH), previously named the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Description: The Canadian Agency for Drugs and Technologies in Health (CADTH, previously known as the Canadian Coordinating Office for Health Technology Assessment or CCOHTA) is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies to Canadian health care decision makers. The purpose of the Named Grant is to provide financial assistance to support CADTH's core business activities namely, the Common Drug Review ("CDR"), Health Technology Assessment ("HTA"), and the Canadian Optimal Medication Prescribing and Utilization Service ("COMPUS"). Increased decision-making capacity for the adoption and appropriate utilization of the most relevant and cost-effective health technologies in areas of priorities as identified by the Federal Provincial Territorial Conference of Deputy Ministers of Health (FPT CDM). Increased relevance and uptake of Canadian health technology assessment products and services, produced by CADTH and its partners to meet jurisdictional needs. Continued implementation of the Canada's Health Technology Strategy (HTS 1.0) including refinement of HTA reports to include recommendations. Development of a business case for the establishment of a pan-Canadian field evaluation program. Grant to the Canadian Blood Services (TB #826394) End Date: Ongoing Description: To support basic, applied and clinical research on blood safety and effectiveness issues through the auspices of Canadian blood services. Strategic Outcome: Access to Safe and Effective Health Products and Food and Information for Healthy Choices. Continued improvements to basic applied and clinical research on blood safety and effectiveness. Total Grants 5.0 5.0 5.0 5.0 Planned Evaluations: Health Canada is not planning to do any evaluations of this activity. CBS does provide information on accomplishments to Health Canada, and publishes similar information. Planned Audits: An audit of the blood safety program was planned by Office of the Auditor General, but this has now been indefinitely postponed. A separate audit of this grant is not planned at this time. Grant to the Canadian Patient Safety Institute (CPSI) Description: This class grant program supports the federal government's interest (in a federal/provincial/territorial partnership context) in achieving an accessible, high quality, sustainable and accountable health system adaptable to the needs of Canadians. It is designed to improve the quality of health care services by strengthening system coordination related to patient safety, including promoting national collaboration among key players. Provide advice to governments, stakeholders and the public on effective strategies to improve patient safety; perform a coordinating role across sectors and systems; promote best practices related to patient safety; and raise awareness of patient safety issues with patients and the general public through public education and reporting. Total Grants 0 8.0 8.0 8.0 Total Program Activity 0 8.0 8.0 8.0 Named Grant to the Canadian Partnership Against Cancer Corporation (CPACC) Description: The mandate of CPACC is to provide a leadership role with respect to cancer control in Canada, through the management of knowledge and the coordination of efforts among provinces and territories, cancer experts, stakeholder groups and Aboriginal organizations to champion change, and improve health outcomes related to cancer. The CPACC will act as a pan-Canadian resource to provide the most up-to-date knowledge across strategic priorities areas including prevention, screening/early detection, re-balance the focus, clinical practice guidelines, health human resources, standards, as well as support key research activities and facilitate the development of a pan-Canadian surveillance system. Improved coordination of efforts and timely access to evidence-based information for use by decision-makers, health professionals, patients, the community-at-large and governments to enhance cancer prevention, screening, care and support, research and surveillance efforts across the country. Total Grants 0 50.0 50.0 50.0 Total Program Activity 0 50.0 50.0 50.0 Description: The mandate of the Health Council of Canada is to monitor and make annual public reports on the implementation of the 2003 First Ministers' Accord on Health Care Renewal and the 2004 Health Accord. Through monitoring and the annual public reporting on the progress achieved in implementing the 2003 First Ministers' Accord and the 2004 Health Accord, the Health Council of Canada will contribute to enhancing accountability and transparency in health system care reform. Total Grants 6.0 10.0 10.0 10.0 Total Program Activity 6.0 10.0 10.0 10.0 Planned Evaluations: The Health Council will carry out and submit, no later than March 31, 2008 an independent evaluation of the Health Council objectives, undertaken by the Health Council between the period April 1, 2004 to March 31, 2007, which will allow the Health Council to measure progress on performance utilizing indicators and measurable targets based on the strategic priorities, business plan objectives and intended outcomes of the Health Council. Description: To increase responsibility and control by Indian communities of their own health care and to effect improvement in the health conditions of Indian people. Increased control or accountability by First Nations communities of health care services. Planned Evaluations: There are no specific Program related evaluation plans for 2007-08. However, directed Program funding and services will be evaluated within their designated cluster. In particular, any funding or services delivered through the Children and Youth, Communicable Disease Control or Environmental Health and Research clusters will be included in their 2007-08 cluster evaluation plans Conditional Grants (Foundations) Over the next three years, Health Canada will manage the following foundations using conditional grants: Canada Health Infoway Inc. (Infoway) Canadian Institute for Health Information (CIHI) Canadian Health Services Research Foundation For further information on the above-mentioned foundations see Canada Health Infoway (Infoway) Total Funding: Canada Health Infoway is a federally-funded, independent, not-for-profit corporation with a mandate to accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis. Health information and communications technologies such as electronic health records (EHRs), telehealth and public health surveillance systems will significantly improve access to health care services, patient safety, quality of care and productivity. A recent study estimated the one-time development costs for a Canada-wide EHR at $10 billion, with annual savings of $6 billion. The largest savings would come from reduced treatment costs for adverse drug events (decision support tools would help reduce adverse drug events by an estimated 1.4 million annually), reduced duplicate and unnecessary laboratory testing and diagnostic imaging, and increased use of generic drugs due to computer prompts. Infoway collaborates with the federal, provincial and territorial governments towards a common goal of modernizing Canada's health information systems. This collaborative approach reduces overall costs by coordinating efforts, avoiding duplication, taking advantage of economies of scale, replicating successful initiatives across the country, and sharing best practices. For example, Infoway's EHR Blueprint Architecture has been adopted across Canada by jurisdictions and vendors, saving time, effort and dollars, and helping to ensure systems are interoperable. As well, some jurisdictions have saved both time and money by acquiring vendor solutions together, rather than individually. Infoway is a strategic investor, providing a portion of system development costs and project oversight while its provincial and territorial partners are responsible for the actual system development, implementation and overall funding, including on-going operational costs. To date, Infoway has committed over $840 million. Electronic Health Record - Infoway's goal is that by the end of 2009, every province and territory will benefit from new health information systems. Further, 50 per cent of Canadians will have their EHR readily available for health care providers. Over 200 projects are completed or underway across Canada. Infoway, provinces and territories are making solid progress towards their goal but, consistent with international experience, much remains to be done. To date, over 53% of diagnostic imaging exams are filmless, 49% of the population is covered by laboratory information systems, 37% of the population is covered by drug information systems, 29% of physicians are uniquely identified in provider registries, and 28% of patients are uniquely identified in client registries. Early success stories include Nova Scotia which is now completely filmless, allowing the province's 34 hospitals to electronically share images; Edmonton's Capital Health Region which has an EHR system in use by over 6,000 care providers; and British Columbia which has put in place its PharmaNet system, an electronic network of patient medication histories. Telehealth - Infoway is investing in projects to expand and sustain telehealth initiatives, particularly in rural and remote communities, including Aboriginal and official language minority communities. It is also working on linkages between telehealth and the EHR, and increasing the integration of telemedicine activities into mainstream healthcare service delivery. Telehealth strategic plans have been put in place with most jurisdictions, and telehealth solutions will be implemented in all jurisdictions by December 31, 2009. Health Surveillance Systems - A national steering committee has completed the solution planning work and three streams of work are underway: solution procurement and integration; public health surveillance standards; and jurisdiction implementation planning. The province of British Columbia has contracted with IBM to build the national reference system. The timeline for the approved project reflects the revised schedule by IBM for delivery of the solution, which now calls for the final systems release in the spring of 2008. An implementation project has already been approved for the province of Quebec. Strategic Outcome: Summary of Annual Plans of Recipient: Infoway annually updates three-year plans with each jurisdiction. In addition, Infoway will focus on the following business priorities: maintaining the pace of investment; enhancing program governance and operations; managing risk and ensuring quality solutions; measuring results and benefits; increasing capitalization; and identifying future directions. Planned Evaluations: An independent performance evaluation was carried out in March 2006 and must be repeated within five years. Infoway initiatives must generate value - measurable benefits - for the patients, providers and health care system. Therefore, Infoway's EHR solutions will be evaluated in the field to determine benefits, as well as utilization and satisfaction levels. An expert advisory panel has been established and a benefits evaluation implementation plan is being developed. Planned Audits: The funding agreements signed by Health Canada and Infoway set out a comprehensive set of accountability mechanisms. Annually, Infoway must produce independently audited financial statements, an annual report, a corporate plan and an independent compliance audit. URL to Recipient Site: http://www.infoway-inforoute.ca/ Canada Health Infoway CIHI is an independent, not-for-profit organization that is supported by all jurisdictions, an F/P/T success story not often seen in the health field. CIHI was created in 1991 by the F/P/T Ministers of Health to address the significant gaps in health information Since 1999, the federal government has provided funding to CIHI through a series of grants and conditional grants, known as the Roadmap Initiative. Through the Roadmap Initiatives I, II and II+, CIHI had been provided with about $260 million since 1999. This funding has allowed CIHI to provide quality and timely health information, including the delivery of data on a variety of important health indicators and other health publications. Budget 2005 allocated an additional $110 million over five years (2005-2006 to 2009-2010) to CIHI through Roadmap III. These funds are to be used to respond to the 2004 Health Accord "A 10-Year Plan to Strengthen Health Care". The Roadmap Initiatives provides the financial support for the Canadian Institute for Health Information : to serve as the national mechanism to coordinate the development and maintenance of a comprehensive and integrated health information system for Canada; and, to provide and coordinate the provision of accurate and timely information required for the establishment of sound health policy, the effective management of the Canadian health system and generating public awareness about factors affecting good health. Strategic Outcome: Strengthened knowledge base to address health and care health priorities The 2006-07 Operational Plan and Budget was presented for approval to the Board of Directors at the March 2006 meeting, and then submitted to the Minister of Health. Some of the key projects include: Release Health Care in Canada 2006, with a focus on regional variations and trends in heart attack and stroke survival, and initiate development of Health Care in Canada 2007, including an evaluation of the report format and release strategy. Implement the long-range analytical plan, including analytical projects relevant to priority themes (access to care, quality/outcomes, cost/productivity/funding, health human resources, patient flow/continuity of care, healthy weights, healthy transitions to adulthood, and place and health). Carry out an expanded range of analytical and reporting activities, including special studies related to priority health services themes (e.g., changes in spending on home care, waits for emergent and planned orthopaedic surgery, falls in continuing care settings, and renewal and exits in Canada's nursing supply). Develop and release commissioned reports on hospital performance, including Ontario's Hospital Report 2006: Acute Care, and increase capacity to initiate development and production of new reports in the area of Complex Continuing Care, Emergency Department and Rehabilitation in Ontario starting in FY 2007/08. Implement year 3 of the "CPHI Action Plan 2004-2007", including release of the final report (focused on Place and Health) in a 3-part report series on Improving the Health of Canadians 2005-2006, and a systematic review of how structural and community-level factors in urban environments are related to obesity rates. Release Rural Health reports (Part I and Part II) . In collaboration with our partners, continue to develop, compile, and disseminate new and existing health indicators to address priority information needs, with a special focus on hospital standard mortality ratios, primary health care, and wait times. Collaborate with Statistics Canada on the development and initiation of a program of work on health outcomes. Work closely with the province of Québec to support implementation of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10-CA/CCI), initiate works towards the renewal of the CIHI-Québec Bilateral Agreement, and promote the adoption of other CIHI products and services in that jurisdiction. Efforts over the coming year will also focus on initiatives in the area of data quality, data exchange/access and targeted studies. Continue work related to the implementation, monitoring and ongoing compliance of CIHI's data quality framework across all data holdings, including implementation of plans to review/enhance organizational processes. Carry out special data quality and/or re-abstraction studies aimed at assessing the quality of the data in clinical databases such as the National Ambulatory Care Reporting System (NACRS), the Continuing Care Reporting System (CCRS), and the Canadian Organ Replacement Register (CORR). Will also initiate development of a systematic re-abstraction program for the Discharge Abstract Database (DAD). Expand provincial data quality reports to include additional indicators and continue to provide information on the National Physician Database (NPDB), MIS, DAD and the National Rehabilitation Reporting System (NRS). Complete development, testing and validation of CIHI's new inpatient grouping methodology (and related resource indicators) for implementation in FY 2007/08. Support implementation of new ICD-10-CA/CCI-based grouping methodologies for day-surgery (i.e., DPG) and ambulatory care (i.e., CACS) patients. Continue to produce and disseminate policy-relevant analytical reports in the areas of health expenditures (National Health Expenditures Trends 1975-2006, Preliminary Provincial/Territorial Government Health Expenditures), health human resources (e.g. workforce trends of physicians and nurses, Bringing the Future into Focus: Projecting Nursing Workforce Retirement in Canada, HHR migration, and health services (e.g. annual reports on mental health, continuing care, rehabilitation services, trauma, joint and organ replacements). Increase the scope, relevance and usefulness of our existing Health Human Resources products, including analysis and dissemination of the results of the national survey of work and health of nurses (in collaboration with Statistics Canada and Health Canada), continued development of new supply-based databases for three health professions (physiotherapists, occupational therapists, pharmacists), as well as two additional health professions (Medical Radiation Technologists and Medical Laboratory Technologists). Launch new e-MIS reports, which are interactive web-based reports that allow hospitals to analyze their MIS data, as well as data from other hospitals across Canada. Continue phased-in implementation of the new National Prescription Drug Utilization Information System (NPDUIS), based on claims-level data from publicly funded drug programs. Continue development of a Canadian Medication Incident Reporting and Prevention System (CMIRPS) designed to further enhance the safety of medication use in Canada. Continue to promote the adoption, and support implementation, of the National Rehabilitation Reporting System (NRS), the Continuing Care Reporting System (CCRS), the Home Care Reporting System (HCRS), the Ontario Mental Health Reporting System (OMHRS) and the National Ambulatory Care Reporting System (NACRS). Continue to develop and deploy the necessary tools to support electronic data capture, query, analysis and dissemination activities, as well as support improved integration and analysis of data holdings through the data dictionary and organizational index initiatives. Proceed with expanded implementation of CIHI's Portal and develop plans to transition to operations. Continue to support BC-sponsored projects (e.g. End of Life, Cardiac Registry, Patient Safety), as well as conduct a pilot of CIHI's Ambulatory Care Reporting System (NACRS). Appoint an Executive Director and evaluate options for a regional office for Atlantic Canada, continue to implement strategies and plans to further strengthen CIHI's presence at the provincial/territorial, regional and local levels, and identify opportunities to align existing CIHI products and services to address emerging regional needs. Assess impact of the adoption (in EHR solutions) of the Systematized Nomenclature of Medicine classification system (SNOMED) on the secondary uses of data. Establish a corporate methodology unit that will provide program areas with statistical and methodological expertise. Work with, and support, Canada Health Infoway in the creation of a pan-Canadian standards organization as approved by the Conference of Deputy Ministers in December 2005. Review and implement recommendations made by the Office of the Ontario Information and Privacy Commissioner. Continue to expand and improve services to our clients by implementation of new and enhanced tools such as eQuery and eManagement reports. A third-party evaluation of the first phase of Roadmap has already been completed and CIHI was found to have met its objectives. An evaluation of the second phase will be completed within six months of the completion date of the initiative (March 31, 2007). The final evaluation will be conducted after the completion of Roadmap in 2010. Planned Audit: An audit is in progress by Health Canada's internal auditors on the processes that we use to ensure that the objectives of the Roadmap initiative will be met. http://secure.cihi.ca/cihiweb/splash.html The Canadian Institute for Health Information (CIHI) $ 151.5 Million Total federal funding for the CHSRF is as follows (CHSRF's programs also receive funding from other sources): 1996-2001 - A total of $66.5 M disbursed over five years to set up the foundation with funds from Health Canada ($11M per year = $55M), the former Medical Research Council ($2M/year = $10M), and the Social Sciences and Humanities Research Council ($300K/year = $1.5 M). 1999 - One-time grant of $25 M to support a ten-year program to develop capacity for research on nursing recruitment, retention, management, leadership and the issues emerging from health-system restructuring (Nursing Research Fund or NRF) and another one-time grant of $35 M to support its participation with the Canadian Institutes of Health Research. 2003 - One-time grant of $25 M to enhance the skills of health system managers in the use of research to increase evidence-based decision making (Executive Training for Research Application or EXTRA) over a thirteen year period. CHSRF will continue its efforts on its four strategic objectives: To create high quality new research that is useful for health service managers and policy makers (especially in the foundation's priority theme areas) To increase the number and nature of applied health services and nursing researchers To get needed research into the hands of health system managers and policy makers in the right format, at the right time, through the right channels To help health system managers, policy makers and their organizations to routinely acquire, appraise, adapt and apply relevant research in their work CHSRF will move to consolidate and add value to its research funding activity; this will include positioning more activities in relation to its four "flagship" programs: Research production and dissemination: Research Exchange and Impact for System Support (REISS) Capacity for Applied and Developmental Research and Evaluation (CADRE) in Health Services and Nursing Research use and implementation: Knowledge Brokering Executive Training for Research Application (EXTRA) Emphasis will be placed on creative knowledge transfer and providing increased support to decision makers, as well as on organizational excellence. CHSRF's partnership work is expected to change due to the increasing number of national health-related knowledge agencies and the drive to identify opportunities and common objectives; and the provision of more direct assistance to grant and award applicants to help acquire matching co-sponsorship funding. Financial statements are audited annually. The foundation has completed several evaluations on specific programs and/or initiatives including 4th year evaluations of the CIHR/CHSRF Chairs and Regional Training Centres programs and ongoing evaluation of the knowledge brokering demonstration sites and the EXTRA program. In addition, the foundation commissioned an International Review Panel Report in 2002 and is currently preparing for its 2nd international review in 2007. This will be done by an international panel of distinguished health services experts. It will assess performance, report on the progress the foundation is making in achieving its mission and advise on future directions. The four-member panel will be chaired by Dr. Gilles Dussault, former head of health administration at l'Université de Montréal and specialist with the World Bank and now professor and head of the health systems unit of the Institute of Hygiene and Tropical Medicine in Lisbon, Portugal. The panel will provide a report with recommendations to the CHSRF board of trustees in spring 2007 with a public report becoming available shortly afterwards. As part of the preparations for this international review, CHSRF created a comprehensive logic model in 2004-2005 for its overall impact on evidence-based decision-making in the health sector. A compliance audit of funded research projects was conducted in 1999 and a second compliance audit is currently underway with an anticipated due date of March 2007. The foundation also commissioned an internal controls review in April 2005 with the implementation of the recommendations occurring in 2005 and 2006. A mini internal controls review was completed in 2006 on the payroll system and another mini internal controls review is anticipated in 2007 on the information technology systems. It is also anticipated that the foundation will be creating a three- to five-year Internal Audit Plan in 2007. Finally, the foundation completed an enterprise risk management framework in 2006. www.chsrf.ca The Canadian Health Services Research Foundation Horizontal Initiatives Over the next three years, Health Canada will lead the following horizontal initiatives: Canada's Drug Strategy Chemicals Management Plan Federal Tobacco Control Strategy Building Public Confidence in Pesticide Regulation and Improving Access to Pest Management Products Federal Early Childhood Development (ECD) Strategy for First Nations and Other Aboriginal Children For further information on the above-mentioned horizontal initiatives see Canada's Drug Strategy (CDS) Lead Department: Health Canada Start Date: CDS started in 1987; CDS Renewed 2003-2004 * CDS was initiated in 1987 and has undergone a number of reiterations in the past 17 years. CDS Renewed was approved in May of 2003. The financials presented reflect a start date of May 2003 and an end date of the 2004-2005 fiscal year. The funding allocation during this two year period is inclusive of both the enhanced funding received under CDS Renewed and a-base funding pertaining to activities undertaken in the area of demand and supply reduction. End Date:Ongoing Total Funding Allocated: $1,869.8M Canada's Drug Strategy (CDS) was first introduced in 1987 to address substance use and abuse issues in Canada through coordinated activities by various federal departments, governments and non-governmental organizations. In 1992, following some initial successes in the areas of prevention and treatment, Phase II was launched with an emphasis on Driving While Impaired. During Phase II of the CDS, changing government priorities resulted in less than half of the funding being applied to the Strategy making it difficult to fully address complex issues related to both supply and demand reduction. Under Canada's Drug Strategy Renewed (approved by Cabinet in May 2003), the CDS will continue to be a comprehensive inter-Departmental federal initiative designed to coordinate and enhance substance abuse programs, knowledge and partnerships in the areas of prevention, treatment, harm reduction and enforcement. For more information, please refer to http://www.hc-sc.gc.ca/ahc-asc/activit/strateg/drugs-drogues/index-eng.html. Shared Outcomes: Improved Leadership--Setting directions and creating environments that support local action through community-based initiatives integrally linked to national objectives and targets Enhanced knowledge generation and management--Providing strengthened capacity to improve evidence-based policy and decision making by promoting leading-edge research, statistical monitoring of drug trends and evaluation of program effectiveness Enhanced partnerships and interventions--Discouraging substance abuse, targeting illegal conduct that threatens the safety and security of Canadians, and assisting those at risk from the effects of drugs by supporting partnerships and programs that focus on prevention, harm reduction, treatment and enforcement activities Improved modernization of relevant legislation and drug policies--Ensuring that legal and policy approaches underpinning CDS are coherent with and support the Strategy, by reviewing legislation and regulations for responsiveness to current requirements Governance Structures: Health Canada is the federal lead for Canada's Drug Strategy. The Minister of Health is responsible for coordination across federal departments. Health Canada also partners with provinces and territories to provide national leadership and coordination and manages programs that reduce and prevent harm associated with controlled substances and participates in various international fora in support of health-related supply and demand reduction activities. An Assistant Deputy Minister Interdepartmental Steering Committee exists and is chaired by Health Canada. Working groups focussing on Communications, Research and Surveillance, Evaluation and Risk Management, and Emerging Issues have been established to support decision-making by the ADM Steering Committee and Health Canada provides secretariat to support these structures. In addition, small coordination units will be implemented in core federal departments and Health Canada's regional offices. Public Health Agency of Canada (PHAC) The Public Health Agency of Canada, through its Centre for Infectious Disease Prevention and Control (CIDPC) and its Fetal Alcohol Syndrome Team, is responsible for conducting and dissemination of research and surveillance information on public health indicators and illness related to substance use/abuse and injection drug use, as well as on the linkages between substance abuse and fetal alcohol spectrum disorder. Department of Public Safety and Emergency Preparedness Canada (PSEPC) The Department of Public Safety and Emergency Preparedness Canada is responsible for: a) coordinating the Public Safety and Emergency Preparedness Portfolio's drug control policies and initiatives to ensure that they are consistent with and complimentary to the broader goals and objectives of CDS; and b) providing strategic advice to the Minister in fulfillment of the Minister's policy leadership role in policing and corrections. The Department also participates in various international fora in support of law enforcement-related supply and demand reduction activities. The RCMP offers a balanced approach addressing both supply and demand issues. They investigate illegal drug activities and organized crime groups. They disrupt criminal activities and networks related to the supply of illicit drugs. They also deliver a number of drug awareness and prevention programs targeted at youth, Aboriginal communities, drug endangered children, parents and the Canadian workplace. Additionally, they coordinate specialized training of police officers in Drug Recognition Expertise to detect drug impaired driving. Correctional Services Canada (CSC) CSC provides substance abuse treatment programs to federal offenders with substance abuse problems and controls the supply of illicit drugs in correctional facilities through various security measures. Canada Border Services Agency (CBSA) The CBSA contributes to reducing the supply of illicit drugs through the interception of controlled substances and illegal drugs at Canadian ports/borders of entry. Department of Justice(DOJ) The Federal Prosecution Service of the Department of Justice prosecutes drug cases. The prosecution of drug cases comprises a significant part of the Prosecution's workload. The Programs Branch of the Department of Justice in collaboration with the Office of Demand Reduction of Health Canada, administers funding and monitors the implementation and evaluation of drug treatment courts in Canada. Drug treatment courts are implemented as alternatives to traditional prosecution through special courts that integrate both criminal justice and drug treatment responses. Department of Foreign Affairs and International Trade (DFAIT) Complementing Canadian diplomatic efforts in support of the Strategy, the Department of Foreign Affairs and International Trade (DFAIT) manages contributions to the United Nations Office on Drugs and Crime (UNODC) and the Organization of American States' Inter-American Drug Abuse Control Commission (CICAD). These contributions are aimed at increasing capacity as well as fostering the key partnerships needed to address the supply for, and demand of, illicit drugs and harmful substances. Name of Programs Total Allocation Planned Spending for Expected Results for 2007-2008 1. Health Canada Promotion / Prevention & Public and Professional Education / Training Programs / Activities $4.9M Increased awareness of the nature, extent and consequences of substance use/abuse within the school, workplace and Aboriginal communities and among youth, professionals and the general public Improved skills/competencies in the delivery of programs Treatment and Rehabilitation Programs / Activities $434.2M $109.2M Enhanced access and motivation to participate in treatment for substance abuse Reduction in risk behaviours/decisions and overall assessed substance abuse treatment needs Research and Surveillance Programs / Activities total: $69.7M $ 14.1M Increased knowledge and understanding of emerging trends and related consequences in the area of substance abuse and what works in preventing and treating substance use/abuse More evidence-based responses to substance use/abuse PSEPC Grants & Contributions Program $19.1M Increase capacity/ability to identify, understand and address issues pertaining to the demand for and supply of illicit drugs and harmful substances Coordination and Collaboration Programs / Activities $ 3.7M Increased collaboration/ involvement of stakeholders Improved coordination/direction of efforts among CDS partners/stakeholders Enhanced credibility/influence of CDS in setting directions/policies in the area of supply and demand reduction 6. Health Canada Policy and Legislative Review and Development Programs / Activities Improved policy and regulatory responses to the demand for and the supply of illicit drugs and harmful substances Canada Border Services Enforcement Programs / Activities $1,120.4M $245.0M Improved understanding and knowledge of drugs, related trends, and production and diversion methods Enhanced ability to detect and respond to the supply of illicit drugs and harmful substances Total $1,869.8M $405.2M Patrick Morin, A/Manager, CDS Evaluation, Risk Management and Reporting, (613) 954-0514 [email protected] Approved by: Beth Pieterson Date Approved: Total Funding Allocated: $ 299.2M The Chemicals Management Plan (CMP) is part of the Government's comprehensive environmental agenda and will be managed jointly by Health Canada (HC) and Environment Canada (EC). The activities identified in this plan will build on Canada's position as a global leader in the safe management of chemical substances and products, and will focus upon timely action on key threats to health and the environment. The CMP will also generate a higher level of responsibility for industry through realistic and enforceable measures, stimulate innovation, and augment Canadian competitiveness in an international market that is increasingly focused on chemical and product safety. HC and EC will manage the CMP funding collectively and ensure that it is aligned with human health and environmental priorities. High-level outcomes for managing the CMP include: Identification, reduction, elimination, prevention or better management of chemical substances and their use; Direction, collaboration and coordination of science and management activities; Understanding of the relative risks of chemical substances and options to mitigate; Risk assessment and risk management; and Informed stakeholders and Canadian public. Health Canada is the lead department on the CMP. The Minister of Health is responsible for the overall coordination of activities under the CMP while the Minister of Environment is responsible for the environment portfolio participation. At the national level, a National Advisory Committee enables national, cooperative action and avoid duplication in regulatory activity among governments, e.g., advise Ministers of Health/Environment on a cooperative, coordinated intergovernmental approach for the management of chemical substances. Its membership includes one representative from HC and from EC, one representative for each provincial and territorial government, and a maximum of six representatives from Aboriginal governments. At the interdepartmental level, governance is assured through three committees: the Deputy Ministers' Forum (DM Forum), the Assistant Deputy Ministers Committee (ADM Committee), and the Interdepartmental Chemicals Management Executive Committee. The mandate of the Interdepartmental Chemicals Management Executive Committee is to bring issues to the table that would be under consideration for regulation under CEPA. As such, individual chemicals management issues stemming from pest control or food and drugs programmes would be discussed in this forum regarding how to be optimally managed under CEPA, or other legislation under the CMP. Both HC and EC Chemicals Management Executive Committees will ensure collaboration among and management of the functions of Research; Risk Assessment; Risk Management; and Monitoring and Surveillance Networks focusing on key CMP activities (Research/Science, Assessment, Management and Monitoring & Surveillance) will be established to support the above governance structures. a. Risk Assessment $27.6M Risk assessment (e.g., complete assessment of about 200 priority substances within 3 years) b. Risk Management $96.3M Risk management, effective controls and informed stakeholders and the Canadian public. (e.g., complete implementation of mandatory pesticide incident reporting system and pesticide sales database by 2009) c. Research $31.7M Understanding of the relative risks of toxic substances (e.g., complete development of human exposure data and trend analysis methodologies) d. Monitoring & Surveillance $37.1M Information on the effectiveness of control actions (e.g., define scientific information to be collected by 2008) Total $299.2M $39.7M Results to be Achieved by Non-federal Partners: n/a François Dignard, Manager, Strategic Science & Operations, (613) 941-0590, [email protected] Approved by: François Dignard Date Approved: End Date: 2009-2010 & ongoing Total Funding Allocated: : $560.0M (April 2001-March 31, 2006) The Federal Tobacco Control Strategy (FCTS) establishes a framework for a comprehensive, fully integrated, and multi-faceted approach to tobacco control. The FTCS is the federal contribution to the national tobacco control plan endorsed in 1999 by all Ministers of Health. It focuses on four mutually reinforcing components: protection, prevention, cessation and harm reduction. Reduce smoking prevalence to 20% from 25% (level in 1999). Reduce the number of cigarettes sold by 30% from 45 billion to 32 billion. Increase retailer compliance regarding youth access to tobacco from 69% to 80%. Reduce the number of people exposed to environmental tobacco smoke in enclosed public places. Resources for the implementation of the FTCS were allocated to a number of departments and agencies. Health Canada (HC) is the lead department in the FTCS and is responsible for regulating the manufacture, sale, labelling and promotion of tobacco products as well as developing, implementing and promoting initiatives that reduce or prevent the negative health impacts associated with smoking. The partner departments and agencies are: The Department of Public Safety and Emergency Preparedness Canada (PSEPC) - administers contribution funding for monitoring activities related to levels of contraband tobacco activity. The Department also provides policy advice and support on smuggling issues. The Department of Justice - prosecutes smuggling offences, as well as offences concerning unlawful manufacture, distribution and possession of contraband tobacco products. The Royal Canadian Mounted Police (RCMP) - enforces laws in relation to the international movement of tobacco products (including the illicit manufacture, distribution or possession of contraband tobacco products). The Canada Revenue Agency (CRA) - ensures the assessment and collection of tobacco taxes and monitors tobacco exports. The Canada Border Services Agency (CBSA) - monitors the impact of tax changes on the illegal international movement of tobacco and the national contraband market. Health Canada FTCS $482.5M* $58.7M(TCP: $49.0M) 1) Implementation and evaluation of key national cessation demonstration projects to better assess and respond to Canadians' needs for access to effective tobacco control programming in order to prevent smoking uptake and to increase number of smokers who quit smoking. 2) Monitor the impact of tobacco control initiatives through the Canadian Tobacco Use Monitoring Survey. 3)Renew/Maintain Enforcement Agreements with provinces, where possible, to improve efficiencies and use of limited funds with respect to the enforcement of the Tobacco Act and relevant Provincial legislation. HC currently has Enforcement Agreements with 7 provinces (NL, NB, NS, PE, MN, SK, BC). Explore the establishment of enforcement agreements with other Provinces. 4)Monitor tobacco use, knowledge, attitudes and behaviours in the three Territories by supporting each Territory in the development, implementation, conducting and analyzing of Territorial Surveys. PSEPC FTCS $3.2M $45K Expected results for 2007-2008 will be reported through the departmental RPP. DOJ FTCS $10.0M $1.3M Expected results for 2007-2008 will be reported through the departmental RPP. RCMP FTCS $10.5M $1.5M Expected results for 2007-2008 will be reported through the departmental RPP CRA FTCS $53.8M Expected results for 2007-2008 will be reported through the departmental RPP. CBSA FTCS (see row above) $5.1M Expected results for 2007-2008 will be reported through the departmental RPP. Total $560.0M $66.7M Expected results for 2007-2008 will be reported through the departmental RPP. Dave Semel, Director [email protected] Approved by: Cathy A. Sabiston Date Approved: * - Note: this original allocation has been affected by several cuts since the FTCS began, that continue into the 2006-2007 fiscal year and beyond. The reductions fund other departmental and government priorities, i.e. During the first 5 years - $47M was allocated to CEPA, $32.5M held back as part of the Government Advertising Plan, and $6.3M annually, starting in 2005-2006, reallocated as part the Expenditure Review exercise.) In 2006-2007, the FNIHB portion of the FTCS was reduced by $9.5M. Total Funding Allocated: The initiative is a part of the federal government's commitments as outlined in the Treasury Board submission Building Public Confidence in Pesticide Regulation and Improving Access to Pest Management Products. The Treasury Board submission and its associated Results-based Management and Accountability Framework (RMAF) describe the integrated approach by which initiatives will be measured, managed and reported throughout their life cycle. An important element of the commitments made through the Treasury Board submission is that stakeholders and public will be kept informed through a transparent management system. The participating departments will work together for shared outcomes; measure performance on delivery; and review progress achieved. This initiative incorporates efforts of six federal government partners to increase public and stakeholder confidence in the pesticide regulatory system, to protect health and environment, and to increase the competitiveness of the agri-food and forestry sectors. Research and monitoring in the area of pesticides is being coordinated with their regulation. Under this initiative, the presence and effects of pesticides in the environment, in marine and freshwater ecosystems, and in the forest environment are being monitored. The initiative enhances monitoring and enforcement of pesticide residue limits in foods, in feed, of pesticide residues in fertilizers, and pesticide guarantee verification for fertilizer-pesticide combinations. Reduced-risk pesticides and biological pesticides for forestry are being developed and their use facilitated. Commodity-based risk reduction strategies for the agriculture and agri-food sector are being developed and implemented. Programs improving access to agricultural minor-use pesticides and reduced-risk pesticides for agricultural use are being established. Research to support the introduction of minor-use pesticides that pose a reduced risk to the environment is being conducted. A reporting system to track adverse effects of pesticides has been developed, and information on these effects will be collected and recorded. Collectively, this work is being conducted to achieve public confidence in increased conservation and protection of human health and the environment while contributing to the competitiveness of Canada's agricultural sector. The information presented in this table has been organized along the following three main themes of this initiative: Research and Monitoring, carried out by Agriculture and Agri-food Canada (AAFC), the Canadian Food Inspection Agency (CFIA), the Department of Fisheries and Ocean (DFO), Environment Canada (EC), Health Canada's PMRA, and Natural Resources Canada (NRCan) Developing and Implementing of Commodity Specific Risk Reduction Strategies, carried out by AAFC and Health Canada's Pest Management Regulatory Agency (PMRA). Generation of Data to Support the Registration of Reduced Risk and Minor Use Pesticides for the Agricultural and Agri-food Sector and Reduced Risk Pesticides and Biopesticides for Forestry, carried out by AAFC, HC's PMRA and NRCan Immediate Outcomes: Increased knowledge by the PMRA about pesticides and alternatives Registration of reduced-risk and minor-use pesticides Access to safer pest management practices and products Compliance for safer food, feed, fertilizers and fertilizer-pesticide combinations Intermediate Outcomes: A regulatory system that better protects health and environment and contributes to the competitiveness of the agri-food and forestry sectors Use of safer pest management practices and products Increased transparency of pesticide regulation Final Outcome: Increased public and stakeholder confidence in pesticide regulation, protected health and environment as well as increased competitiveness of the agri-food and forestry sectors Health Canada --Executive Director of PMRA Environment Canada (HC) -- Director General, Conservation Strategies Directorate and Director General, National Programs Directorate Department of Fisheries and Oceans (DFO) --Director General, Fisheries, Environment and Biodiversity Science Natural Resources Cananad (NRCan)--Director General, Science Branch, Canadian Forest Service Agriculture and Agri-Foods Canada (AAFC)--Assistant Deputy Minister of the Farm Financial Programs Branch and Assistant Deputy Minister of Research Branch, Executive Director, Pest Management Centre Canadian Food Inspection Agency (CFIA)--Vice President, Programs Deputy Minister Committee--Deputy Minister from Health and AAFC AAFC/PMRA Joint Management Committee: Assistant Deputy Minister of the Farm Financial Programs Branch, AAFC, Assistant Deputy Minister of Research Branch, AAFC, Executive Director, PMRA, Health Canada, Treasury Board Secretariat (ex-officio member) I. Research and Monitoring AAFC (a) Conducting research to support the introduction of minor-use pesticides that pose a reduced risk to the environment. $8.0 M $3.0M Final reports and next steps for technology transfer of research results from 16 projects completed as of March 2007 On-going support for 12 projects initiated in April 2006 to be completed March 2008 Progress reports from 1 year of research work on these projects initiated in April 2006 Support for new projects selected for funding under November 2006 Call for Proposals Continued work and support for activities to improve access to and adoption of low risk minor use pesticides, including biopesticides Continued research planning and coordination with MOU Research WG and Interdepartmental WG on Pesticides CFIA (b) Enhanced monitoring and enforcement of pesticide residue limits in food and feed $2.7M $0.3M Identify food commodities consumed by targeted subgroup (children) Lab testing of an approximate 1,500 samples per year Follow-up inspections for non-compliance test sample results Publish annual report of the findings of the National Chemical Residues Monitoring Program (NCRMP) Food recalls, as required, for risk mitigation and removal of hazardous foods from marketplace CFIA (c) Enhanced monitoring and enforcement of pesticide residues in fertilizers and pesticide guarantee verification in fertilizer-pesticide combinations. $2.4M $0.3M Develop monitoring and surveillance policies and processes to guide and advise operational staff on fertilizer-pesticide combinations and pesticide contaminated fertilizers. Increase interaction with the PMRA to obtain the most up-to-date pesticide safety and labelling information. Update the Compendium of Fertilizer-Use Pesticides, which contains information regarding registration, guarantees and proper labelling. Work to develop regulatory changes to facilitate updating of the Compendium more regularly, and, if successful, provide Compendium updates more regularly to the producers of mixtures and to the CFIA's inspection staff. Advise CFIA Operations on appropriate follow-up procedures and recommendations regarding the significance of sample analytical results. Sample fertilizer-pesticide combinations to verify guarantees. Sample fertilizers suspected to be contaminated with pesticides. Verify fertilizer-pesticide labels Conduct investigation and compliance activities (anticipated based on sampling and inspection frequencies). Analyze samples submitted by inspectors. DFO (d) Monitor and research the presence and effects of pesticides in marine and freshwater ecosystems. $7.9 M $1.0M DFO will provide the PMRA with final reports on regional National Fund projects. These research projects will be focused to address key research knowledge gaps, as they were in 2006-2007, after consultation with PMRA. DFO will provide the PMRA with a yearly report from DFO's Centre for Environmental Research on Pesticides (CERP). CERP will conduct laboratory and field based studies to quantify impacts of exposure to priority pesticides on fish and fish habitat. Impacts will be quantified in terms of reproductive success, growth and energy metabolism. Priority research will be identified in consultation with PMRA. After consultation with the PMRA and other agencies, DFO will design and initiate new research projects related to the theme "Potential Impacts of Pesticides on Fisheries Resources". EC (e) Monitor and research on presence and effects of pesticides in the environment. $7.2M $1.0M EC will: maintain coordination of research and monitoring projects in cycle 2 of the EC-Pesticide Science Fund (PSF) support 10 new research and monitoring project themes to determine the environmental concentrations and impacts of in-use pesticides in the environment; produce an annual report and make it available to the PMRA; provide science advice to meet regulatory data gaps and knowledge deficiency as well as to improve risk assessment methods; provide support and advice to PMRA on pesticide related science policy and issue management Based on cycle 1 results, EC has set out to deliver on a second cycle of research and monitoring of pesticide presence and impacts in the environment. The EC-Pesticide Program Coordinating Committee (PPCC) was presented with project highlights and advice from PSF recipients of the first cycle of projects (2003-2006). The PPCC (has PMRA membership) then developed a new set of priorities for pesticide science at EC has set out to deliver on 10 new research projects that are linked to regulatory decision-making priorities. In 2007-2008, status updates will be given to the following: Air surveillance: Investigations on low level impacts of compounds that are deemed to have a high toxicity and conducting research in sensitive regions that are closer to emission sources Water surveillance: Focus on high risk priority watersheds. Linking water monitoring to watershed modelling (i.e., NAESI) providing for wider results coverage through an increase in predictive power and assisting in the rationalization of water monitoring sampling designs. Focus on specific issues, e.g., wetlands, urban areas, source waters, agriculture and priority pesticides (through previous monitoring and with interpretation tools such as the modified APPLES, a prioritization tool developed with the PMRA). Establishing trends especially as they relate to performance outcomes (e.g., through linking with CESI the Canadian Environmental Sustainability Indicators program) Aquatic effects: Integration of aquatic and terrestrial effects (incl. multitrophic-level) with exposure (incl. fate). Comparative assessments (e.g., amphibian and fish). Species, populations and community resiliency. Impacts of mixtures (link to NAESI) and cumulative effects investigations (e.g., nutrients). Impact assessments with chronic and pulse exposures. Studies and investigations furthering the amphibian test protocol. Terrestrial effects: For birds and mammals focus on SARA and spp. of concern. Comparisons between non-oral routes and oral routes of exposure (dermal and inhalation). Focus on high exposure areas with "lethal" potential. For plants, focus on risk assessment with validation through in situ research. In order to better integrate and coordinate EC research with regulation, EC will continue to work with the PMRA in the implementation of the EC/PMRA MOU. The MOU has four components, Science Policy, Knowledge Generation, Issue Management and Compliance Promotion and Enforcement EC will continue working on providing leadership in the development and implementation of a federal, co-ordinated pesticides science strategy for research and monitoring through the Interdepartmental Committee. As well EC will continue to contribute to PMRA's pesticide assessments where appropriate, will coordinate with PMRA on the development of environmental quality guidelines and will continue to provide science/policy advice on key Government of Canada policies as they relate to pesticide management and use in Canada. HC (PMRA) (f) Linking pesticide regulation and research. $4.2M $0.8M Identify PMRA's research and monitoring priorities annually and communicate to 5NR partners through regular meetings and other avenues as needed. Facilitate discussion among the 5NR on identifying actions to address specific priorities, including collaborative research. Discuss with the 5NR how the results of their research and monitoring are used in regulatory decisions to build better linkages between research and regulation. Facilitate the two-way communication and coordination between regulation and research between governments within Canada (through PMRA's FPT Committee) and internationally as well as with the private and academic sectors, through presentations linking research and regulation at regional, national and international meetings.(e.g., through SETAC, CSA, IUPAC). To strengthen the framework in linking pesticide research and monitoring, develop a MOU amongst the 5NR on linking research to regulation. Continue to improve and expand the use of probabilistic risk assessments. (PMRA) (g) Conducting research to support the introduction of minor-use pesticides that pose a reduced risk to the environment. $3.5M $1.2M Advance risk assessment methodologies (e.g., occupational exposure assessment) through research to support the harmonization of risk assessment methodology with international partners (US EPA; California Department of Pesticide Regulation). Develop/expand on crop grouping schemes to incorporate additional minor use crops (NAFTA/CODEX Initiative). This will facilitate dietary risk assessment of minor use crops. Validate recently updated agricultural data that are being used to develop crop field trials for setting Maximum Residue Limits on both major and minor use crops. NRCan (h) Research and monitor pesticides in the forest environment. $3.5M $0.5M Review the final reports and publications of research work for four projects. Provide results to clients/stakeholders and PM RA. The completed research projects are: Potential environmental effects of imidacloprid as a systemic insecticide for control of exotic wood boring insect pests such as the emerald ash borer, Development of a biological treatment for control of root rot pathogen and impact on microbial biodiversity, Monitoring impacts of pest control products on key microbial communities of forest soils, Development and validation of "Spray Advisor"- A Decision Support System for aerial pesticide applications. II. Developing and Implementing Commodity Specific Risk Reduction Strategies AAFC (a) Commodity based risk reduction strategies. $19.3M $2.5M Stakeholders engaged in priority setting and further development of 3 new commodity specific pesticide risk reduction strategies Up to 10 of the published profiles updated and re-published on public website Collection of data through regional focus groups for the purpose of updating profiles and tracking success of the program. Continue funding implementation projects from 2005 call for proposals Fund implementation projects funded through the 2006 call for proposals Analysis and publication of results from Crop Protection Survey Collect data through the Crop Protection Survey Continued implementation of AAFC/PMRA joint communication plan HC (PMRA) (a) Commodity based risk reduction strategies (RR). $25.7M $4.0M Planned staffing actions in 2006-2007, indeterminate positions. Ongoing consultations with stakeholders. Work share with other government departments and 5NRs. Work on pesticide risk indicator: consult, build and validate database. Determine, together with AAFC, the next groupof priority crops for the program. Workshare with AAFC on new crop profiles and issue documents and finalising existing documents. Work with AAFC to define the scope of the program for each commodity, including ways to increase participant buy in and the development of an exit strategy which will promote maintenance of the stakeholder groups after cessation of government involvement. Risk reduction strategies have been developed for pulse crops and canola. A long term fireblight management strategy has been developed for apples. Steering committee and working groups have been meeting to explore potential solutions to identified priorities and to implement steps to resolve these issues. Substantial progress has been made in the development of strategies and the formation of steering committees to lead the strategies for a number of other crops, particularly, greenhouse vegetables, grape, peach, potato, soybean, strawberry and apple. Working groups have been set up and are building action plans to achieve solutions for identified issues. Consultations will be held this year with stakeholders of raspberry and blueberry (high bush and low bush), followed by steering committee meetings in March. In addition to work on commodity based risk reduction strategies, PMRA is working with stakeholders to develop strategies to address issues in a number of nonagricultural sectors, including forestry, the heavy duty wood preservatives industry, ornamental and landscaping, structural pest control, food processing, storage pest control and honey production. III. Generation of Data to Support the Registration of Reduced-Risk and Minor-Use pesticides for the Agricultural and Agri-food Sector and Reduced-risk Pesticides and Biopesticides for Forestry AAFC (a) Improving access to agricultural minor-use pesticides, and reduced-risk pesticides for agricultural use. $33.7M $12.0M A-base $2.0M A-base AAFC national minor use priority setting workshop will be held with stakeholders to prioritize the 2008 minor use research requirements and to select the top 36 research priorities. AAFC will select up to an additional 20 joint AAFC/IR-4 research priorities for the 2008 research season. AAFC will consult with and solicit written support from the pesticide manufactures whose pesticides are chosen for these crop-pest research priorities. AAFC will complete and forward the initial 36 presubmission consultation requests (PSCR 3.1) to PMRA by Nov 24, 2007. These will be followed by the PSCRs for the joint AAFC/IR-4 projects by Jan 31, 2008. Subsequently, data requirements (DACO) for each pest-crop pair will be issued by the PMRA to AAFC (~97 days from receipt). AAFC will convert DACOs to study plans by January 2008 (for the initial 36) and by March 2008 for the remaining DACOs AAFC will assign trials (~400) to contractors and collaborating AAFC personnel across Canada. Good Laboratory Practice (GLP) quality assurance oversight will be provided by AAFC. Data generation will take place during the 2007 growing season followed by laboratory analysis of residues for priorities selected in 2006. Analysis of data from previous years research will occur throughout the year followed by the writing of final reports and submissions to PMRA. The PMRA normally provides a decision on use within 247 days. The total process takes approximately 36 months from priority setting until final report submission to PMRA. AAFC is targeting the completion of 40 MU submissions during the year. HC (PMRA) (a) Improving access to agricultural minor-use pesticides, and reduced-risk pesticides for agricultural use. $20.8M $4.0M Product evaluation work--review presubmission proposals from AAFC and provincial coordinators and issue data requirements. Register new minor crop uses, including minor use and reduced-risk products and uses. Harmonization work and regulatory projects--Joint Reviews in collaboration with the U.S. EPA, AAFC and U.S. Department of Agriculture IR-4 Program, further work on crop groupings and on Maximum Residue Levels (MRL) promulgation. Increase communication and provide feedback to AAFC to improve the quality and use of scientific rationales. NRCan (b) Develop and facilitate the use of reduced-risk pesticides and biological pesticides for forestry. $4.1M $0.5M Review final reports of five projects funded for one year only, and plan strategy and priorities for future funding. NRCan will continue work to integrate and coordinate activities with the other 5NR partners and stakeholders. Collaborate in the development of the "National Forest Pest Strategy". The NRCan-CFS Minor Use Advisor hired under this fund will continue to work in collaboration with AAFC at the to facilitate registration of reduced risk/minor use pest control products against pest on outdoor woody ornamentals and forests. Coordinate and report on six projects for minor use pesticides in Canada. Support for the 2007 National Forest Pest Management Forum at the Ottawa Congress Centre. Support for a new round of forest projects on reduce risk pest control products. Total $ $ Kathryn Baker-Campbell 613-736-3877 Approved by: Trish MacQuarrie, Director ASRAD Date Approved: Early Childhood Development and Early Learning and Child Care (ECD) Note: ECD receives additional funding from: Enhancing Early Learning and Child Care (ELCC) for First Nations Children Living on Reserve and Working Towards the First Phase of a Single Window. Budget 2005 Investments in Health Promotion and Disease Prevention. Start Date: ECD - October 2002; ELCC - December 2004; Health Promotion and Disease Prevention - 2006-2007 End Date: ECD Strategy - ongoing; ELCC Single Window - ongoing; Health Promotion and Disease Prevention - 2009-2010 Total Funding Allocated: As a result of an ECD Strategy announced in October 2002, $320.0M over five years (and ongoing) is dedicated to enhancing various federal ECD programs. In December 2004, Cabinet approved an additional $45.0M over three years ($14.0M ongoing) to improve integration and coordination of two federal ECD/ELCC programs (Aboriginal Head Start On Reserve and the First Nations and Inuit Child Care Initiative). Budget 2005 funding includes $35.0M over 4 years for healthy child development programming for Aboriginal Head Start On Reserve ($17.5M over 4 years) and Aboriginal Head Start in Urban and Northern Communities ($17.5M over 4 years). The ECD Strategy for First Nations and Other Aboriginal Children was announced on October 31, 2002. The strategy provides $320M over five years to: improve and expand existing ECD programs and services for Aboriginal children; expand ECD capacity and networks; introduce new research initiatives to improve understanding of how Aboriginal children are doing; and work towards the development of a "single window" approach to ensure better integration and coordination of federal Aboriginal ECD programming. In December 2004, as first phase of a "single window", Cabinet approved an additional $45M over three years ($14M ongoing) to improve integration and coordination of two ECD programs, (Aboriginal Head Start on Reserve and the First Nations and Inuit Child Care Initiative), beginning in 2005-2006. The objectives of these funds are to increase access to and improve the quality of ELCC programming for First Nations children on reserve, and improve integration and coordination between the two programs through joint planning, joint training and co-location. Joint planning will also include INAC-funded child care programs. Finally, additional funding of $17.5M is being provided over 4 years for Aboriginal Head Start On Reserve, beginning in 2006-2007. These funds will be used to strengthen outreach and to make minor capital investments. As well, the $17.5M over 4 years for Aboriginal Head Start in Urban and Northern Communities will support investments in training and enhance program reach. The federal ECD Strategy complements the September 2000 First Ministers F/P/T ECD Agreement. It seeks to address the gap in life chances between Aboriginal and non-Aboriginal children by improving the developmental opportunities to which Aboriginal children (and their families) are exposed at an early age (0-6 years). These outcomes are shared by the following federal departments: Health Canada - First Nations Inuit Health Branch, Public Health Agency of Canada (PHAC), Human Resources and Skills Development Canada (HRSDC), Social Development Canada (SDC), and Indian and Northern Affairs Canada (INAC). The funding approved in December 2004 for Enhancing Early Learning and Child Care (ELCC) for First Nations Children Living on Reserve and Working Towards the First Phase of a Single Window, complements funding released to provinces and territories under the March 2003 Multilateral Framework for Early Learning and Childcare (ELCC) to improve access to ELCC programs and services. The funding announced in Budget 2005 included support to enhance healthy child development programming. Interdepartmental ECD ADM Steering Committee; Interdepartmental ECD Working Group. Total Allocation* 2007-2008* Health Canada a. Aboriginal Head Start on Reserve (AHSOR) $107.5M (total for 2002-2003 through to 2006-2007) $24.0M (total for 2005-2006 through to 2007-2008) $17.5M (total from 2006-2007 to 2009-2010) (and ongoing) - committed in 2002 $7.5M in 2005-2006; $8.3M in 2006-2007; $8.3M in 2007-2008(and $7.5M ongoing) - committed in 2005 $2.5M in 2006-2007; $5.0M in 2009-2010 Program expansion and enhancement Increase integration, coordination, access and quality Strengthen outreach, minor capital Electronic Link: http://www.hc-sc.gc.ca/fnihb-dgspni/fnihb/cp/ahsor/index.htm Health Canada b. Fetal Alcohol Spectrum Disorder - First Nations and Inuit Component (FASD-FNIC) $70.0m (total for 2002-2003 through to 2006-2007) $10.0M in 2003-2004 and $15.0M thereafter (and ongoing) - committed in 2002 Program expansion and enhancement Fetal Alcohol Syndrome/Fetal Alcohol Effects Health Canada c. Capacity Building $5.1M (total for 2002-2003 through to 2006-2007) $1.0M (and ongoing) - committed in 2002 Increased capacity PHAC a. Aboriginal Head Start in Urban and Northern Communities (AHSUNC) $ 12.6 (and ongoing) - committed in 2002 Strengthened training and extended reach to more children and families http://www.phac-aspc.gc.ca/dca-dea/programs-mes/ahs_main-eng.html Aboriginal Head Start (AHS) PHAC b. Capacity Building $2.5M (total for 2002-2003 through to 2006-2007) $0.5M (and ongoing) - committed in 2002 Increased capacity HRSDC a. First Nations and Inuit Child Care Initiative (FNICCI) $ 45.7M (total for 2002-2003 through to 2006-2007) $ 9.1M (and ongoing) - committed in 2002 $7.0M (and $6.5M ongoing) - committed in 2005 HRSDC b. Research and Knowledge $21.2M (total for 2002-2003 through to 2006-2007) $4.2M (and ongoing) - committed in 2002 Information on the well-being of Aboriginal children thru an Aboriginal Children's Survey INAC a. Capacity Building ($5.1M - total for 2002-2003 through to 2006-2007) $1.0M (and ongoing) - committed in 2002 Increased capacity and development of "single window" SDC a. Non-applicable Total: Total - ECD: Total - ELCC: Total Health Promotion and Disease Prevention: Total - ECD: $60.0M in 2002-2003 and $65.0M thereafter $14.5M in 2005-2006; $15.2M in 2007-2008; and $14.0M ongoing Total Health Promotion and Disease: Helen Doyon, Senior Program Officer, ECD Strategy Unit, First Nations and Inuit Health Branch, Health Canada Postal Locator 1919B Tunney's Pasture, Ottawa Fax: (613) 946-4625 Approved by: Heather McCormack, A/Director, Children and Youth Directorate, First Nations and Inuit Health Branch, Health Canada Postal Locator 1919B Tunney's Pasture, Ottawa Fax: (613) 946-4625 Date Approved: *The figures (above) are in millions of dollars and are comprised of incremental funding only provided under the 2002 ECD Strategy, Budget 2005 or other special funding mechanisms. They do not include the base allocations of programs. Sustainable Development Strategy Health Canada's current Sustainable Development Strategy (SDs) entitled "A Path to Sustainability" is a three year strategic plan that highlights commitments to further the integration of sustainable development (SD) in our policies, programs, and operations - recognizing the complex interrelationships between health, the environment, the economy and a range of social elements. To build on the success of the previous strategy, the Department's fourth strategy continues with the key themes identified in the previous one. These themes are: Helping to create healthy social and physical environments. Minimizing the environmental and health effects of the Department's physical operations and activities. Integrating sustainable development into departmental decision-making and management processes and advancing the social pillar of sustainability. Health Canada's Strategy contains 51 measurable targets committed to achieving sustainable development and health under each of these three long-term themes. These targets cover a range of health-related issues that directly affect Canadians including: clean air, clean water, sustainable communities, protection of the environment and human health, food safety, fleet, building energy, procurement, training and awareness, business travel, environmental stewardship, and integrating sustainable development into departmental decision-making and management processes. Our Strategy highlights Health Canada's commitment to the coordinated federal approach for the fourth round of departmental SDSs, a government-wide initiative, led by Environment Canada, to strengthen coherence and accountability across departmental sustainable development strategies. This collaborative effort resulted in a set of common federal sustainable development goals and an associated reporting format that will enable government-wide reporting on key federal sustainable development issues for the first time since the establishment of the sustainable development strategy process. Activities in Health Canada's Strategy that support progress towards federal goals are indicated in the following table. Six Federal Long-Term Sustainability Goals Clean and secure water for people, marine and freshwater ecosystems. Ensure clean air for people to breathe and ecosystems to function well. Reduce greenhouse gas emissions. Communities enjoy a prosperous economy, a vibrant and equitable society, and a healthy environment for current and future generations. Sustainable development and use of natural resources. Strengthen federal governance and decision-making to support sustainable development. The targets in Health Canada's Sustainable Development Strategy 2007-2010: A Path to Sustainability, are documented in the table below. The table follows the following template, providing the target, related Federal Sustainable Development Goal, performance measure, and expected progress for fiscal year April 1, 2007 - March 31, 2008. Legend for the following table. SDS Departmental Goal: Federal SD Goal including Government Greening Operations (GGO) goals (if applicable) 3. Performance Measure from current SDS 4. Department's Expected Results for 2007-2008 Sustainable Development Strategy Commitments 1.1 - Clean Air 1.1.1: Regulations banning the use of lead in candle wicks by September 2008. Federal SD Goal II Summary reports with compliance levels, effectiveness and efficiency Expected results by 2010: Publications in Canada Gazette Part I Comments addressed. Final publication in Canada Gazette Part II During the period 2007-2010, Health Canada will work to reduce the risk of health impacts from indoor and outdoor pollution, including development of risk/benefit assessments of fuel options, priority lists for assessing indoor air contaminants, and development of air quality guidelines/objectives. Federal SD Goal II Number of fuel evaluations completed Development and maintenance of prioritized list Number of risk assessments developed and updated Number of guidelines and objectives developed Number of regulations reviewed Expected results by 2010: Assess the risks and benefits of fuel options in Canada Develop and maintain prioritized list of indoor air contaminants for assessments Assess the health risks of Canadians to indoor and outdoor air, and provide updates to existing assessments Develop new guidelines and objectives for indoor and outdoor air Report on the exposure of Canadians to air pollutants Review the effectiveness of past regulations designed to improve air pollution Between 2007-2010, health Canada will work to improve management and communication of the health risks of indoor and outdoor air pollution, including fact sheets, finalization of the Air Quality health Index and further development of the air health Indicator. Federal SD Goal II Number of outreach products/scientific papers developed or updated Completion of the pilots, dissemination of results, provision of guidance document to provinces on the Air Quality Health Index Indicator developed and testing of the Air Health Indicator Expected results by 2010: Update/develop minimum 1 new outreach fact sheet/publication for Canadians about the health risks of air pollution Finalize the science and outreach components of the Air Quality Health Index, conducing pilot projects and promoting implementation by provinces Further develop and test the Air Health Indicator, and regularly report on it in the Canadian Environmental Sustainability Indicators Report During the course of SDS Iv, health Canada will develop tools and information materials, including a summary of the Climate Change and health vulnerability assessment, to better prepare Canadians and health professionals to deal with potential health impacts associated with a changing climate. Federal SD Goal II Development and implementation of risk management tools (e.g., heat alert systems) with partners and stakeholders (dependent upon availability of resources.) Publication of completed Assessment on Health Canada website Completion and distribution/availability of an adaptation guidance tool Expected results by 2010: Provide information developed by Health Canada to Canadians and public health professionals about the health risks of climate change and needed adaptation measures to reduce the expected impacts, such as heat alert systems and enhanced infectious disease surveillance Develop and distribute a Summary of Canadian Climate Change and Health Vulnerability Assessment to public health professionals and related associations in Canada Promote adoption through development of an adaptation guidance tool to the health impacts of climate change by public health professionals 1.2 - Clean water By March 2010, Health Canada commits to having trained 525 community-based water monitors in 700 First Nations community sites with water distribution systems (piped with five or more connections, public access facilities and trucked systems) across Canada. Federal SD Goal I Training developed and delivered Develop regional training strategies based on national training framework, and increase the number of communities with trained water monitors to assist First Nations communities in ensuring that their communities have safe, potable water as comparable with other Canadian communities of similar size and location Starting April 2007, development and application of water management plans by Health Canada to reduce the risks to health on passenger conveyances. Federal SD Goal I Water management plans approved, implemented and audited by Health Canada for all applicable conveyance industries Water management plans approved and implemented by 10 Canadian airlines; all water management plans for airlines audited by Health Canada By March 2010, Health Canada commits to maintaining or replacing where needed International Organization for Standardization (ISO) specified Amalgam Particle Separators in existing dental clinics located in first nations communities in order to ensure maximum capture of mercury alloy and prevention of mercury alloy from entering the environment through waste water. Federal SD Goal I Identification of clinics requiring Amalgam Particle Separators, and installation where required Identify clinics, and install Amalgam Particle Separators where required to ensure a maximum capture of mercury alloy thereby reducing the potential for future environmental problems Health Canada, in collaboration with environment Canada, will support the development of environmental and drinking water quality guidelines for priority pesticides by 2010. Federal SD Goal I Input to set priorities for guideline development provided Final report will be distributed within Health Canada and to Environment Canada to help set priorities for monitoring and guideline development. Health Canada will work with Environment Canada and the provinces to improve data sharing to meet guideline needs During the period 2007-2010, health Canada will establish and/or implement strategies, including a national waterborne contamination and illness response protocol, to help address and prevent incidences of drinking water contamination across jurisdictions, including for small systems and in small, rural and remote communities. Federal SD Goal I Module for Boil Water Advisories developed/implemented Expected results by 2010: Develop/implement a module for Boil Water Advisories on the Canadian Network for Public Health Intelligence (CNPHI) to help prevent incidences of drinking water contamination across jurisdictions During the course of SDS IV, Health Canada will develop and update a minimum of 5 water quality guidelines for specific contaminants annually, including drinking and recreational water. Federal SD Goal I Number of drinking water guidelines developed or updatedGuidelines for Canadian Recreational Water Quality posted on Health Canada web site Expected results by 2010: Develop or update at least five drinking water quality guidelines, and update Guidelines for Canadian Recreational Water Quality and post these on Health Canada's Water Quality website Starting April 2007, Health Canada will coordinate tools to assist and support federal drinking water purveyor departments. Federal SD Goal I Creation of federal community of practice (number of departments represented, number of attendees, increased numbers in federal network, audience evaluation feedback forms) Training (number of tools created, number of departments participating, number of federal operators/managers trained) Disseminate a follow-up workshop report to the 3rd annual national workshop for federal drinking water providers Establish a process for the development and delivery of federal drinking water training Assessment of optimal drinking water information management tools to be completed 1.3 - Sustainable Communities By March 2008, Health Canada commits to promoting sustainable development and environmental management via the distribution of an awareness package to all nursing stations across the country. Federal SD Goal IV Finalized awareness package made available to all nursing stations Finalized awareness package made available to all nursing stations to help promote sustainable development and environmental managment By March 2010, Health Canada commits to having completed the assessment of 16 sites requiring investigation of suspected petroleum hydrocarbon contamination, as well as the remediation of the 18 known petroleum hydrocarbon contaminated sites (as of March 2006) that it is responsible for at health facilities on reserves. Federal SD Goal IV Sites suspected, or known to have petroleum hydrocarbon contamination assessed and remediated if required Assessment and remediation reports developed Conduct investigations of suspected petroleum hydrocarbon contaminated sites, identify options for remediation where necessary, and implement remediation projects By March 2010, Health Canada commits to conducting phase one environmental site assessments and environmental compliance audits at all health centres to identify and assess environmental issues as part of a broader campaign to reduce environmental and health risks at health facilities. Federal SD Goal IV Phase one environmental site assessments and environmental compliance audits conducted and final reports developed Phase one environmental site assessments and environmental compliance audits conducted at health centres to identify and assess environmental issues By March 2010, 50% of the 289 diesel fuel storage tanks located at 90 health facilities on reserves, will be upgraded or replaced as per the technical guidelines for federal aboveground and underground storage tanks of petroleum hydrocarbons and allied petroleum hydrocarbons under the Canadian Environmental Protection Act, 1999. Federal SD Goal IV Assessments of diesel fuel storage tanks Upgraded or replaced diesel fuel storage tanks Assess diesel fuel storage tanks against the Canadian Environmental Protection Act, 1999, to identify whether upgrade or replacement is necessary, and upgrade or replace tanks when necessary Contribute to the National Agri-Environmental Standards Initiative (NAESI) by providing guidance on the development of non-regulatory agri-environmental performance standards for pesticides by 2008. (This is in collaboration with agriculture and agrifood Canada and environment Canada). Federal SD Goal IV Review completed PMRA will review and comment on Final NAESI Ideal Performance Standards PMRA will have a publicly available pesticide sales database on a regional level in Canada by 2009 and report on the same annually. Federal SD Goal IV First reporting completed First reporting to Health Canada by companies on pesticide sales in Canada PMRA will develop the Canadian Pesticide Risk Indicator (CaPRI) to assess trends in risks posed by pesticides, with both human health and environmental components by 2010. Federal SD Goal IV Database development and improvements of indicators Continued database development and improvements of indicator PMRA will encourage the Canadian public to report pesticide incidents by implementing a process for voluntary incident reporting by 2007. Federal SD Goal IV Implementation of mandatory and voluntary reporting systems Implementation of mandatory voluntary incident reporting systems. Also under the New Pest Control Products Act Transparency Operationalizing, incident reports have been identified as a key initiative for FY 2007-2008 The PMRA will collaborate with the Federal/Provincial/Territorial (FPT) Committee on Pest Management and Pesticides to harmonize classification of Domestic Products in Canada by 2008. Federal SD Goal IV Federal implementation. National consultation and federal implementation in 2007. 1.3.10: During the course of SDS IV, Health Canada will continue to work with partners to increase the number of smoke free spaces in Canada. Federal SD Goal IV Number of municipalities in Canada measured against the: Number of smoke-free municipalities across Canada Number of non-smoke-free municipalities across Canada Actively promote and disseminate (via Health Canada website, conferences, etc.), the Health Canada Smoke-Free Public Places resource kit, which was developed to assist municipalities and communities in designing and implementing smoke-free policies and by-laws Monitor the uptake and usefulness of the resource kit to communities and municipalities across Canada Work with partners to monitor and report on the increase in number of smoke-free municipalities across Canada e.g., workplaces, schools, public buildings, etc. Work with partners to evaluate the impact of smoke-free spaces on community businesses and the health of employees and citizens Health Canada commits to the development of risk communications material, to be made publicly available on the health Canada website, on approximately 15 substances annually as identified by the Department's Canadian Environmental Protection Act (CEPA) categorization results by March 31, 2010. Federal SD Goal IV Information material on departmental website Expected resutls by 2010: Build on existing public opinion research to determine the information that the public needs to take action on potential risks to health Develop communications plan based on public opinion results and knowledge of priority substances Draft and pilot a communications package on one priority substance including, for example, a fact sheet on the substance, information on what the public can do to minimize risk, information on what Health Canada is doing to protect Canadians from health outcomes associated with exposure to the substance, and a contact list Based on the results of CEPA categorization process, Health Canada will undertake 5 risk management strategies from December 2006 - July 2007, with the aim to complete approximately 15 risk management strategies annually thereafter to 2010. Federal SD Goal IV Number of risk management strategies completed Complete 5 risk management strategies based on the results of CEPA categorization process During the course of the SDS IV Health Canada will conduct assessments and risk management of new substances in order to reduce the level of exposure to hazardous chemicals and biotechnology products that are suspected to pose a significant risk to the health of Canadians or the Canadian environment. Federal SD Goal IV Number of health/environmental risk assessments completed and risk management actions recommended Number of notifications received. Develop control options and recommend conditions of use, including those aimed at addressing significant new activities (SNAc), for approximately 20 new chemical substances, 6 now living organisms, and 2 substances in Food and Drugs Act products During the course of SDS IV, Health Canada will develop National Guidelines for Environmental Assessment related to health impacts of noise. Federal SD Goal IV Draft completed and sent for comments Comments incorporated into a second draft sent to stakeholders Expected results by 2010: A working group meeting will be held to prepare a draft of National Guidelines for Environmental Assessment related to the health impacts of noise, and will be distributed for stakeholders for comment. Comments will be incorporated into this draft, which will then be sent to stakeholders for a second round of comments Health Canada will complete screening level assessments of approximately 30 high health priority substances identified from DSL categorization by 2010. Federal SD Goal IV Number of screening level assessments completed Expected results by 2010: Completion of screening level assessments of approximately 30 high health priority substances Health Canada will provide expert support services to federal custodial departments under the Federal Contaminated Sites Action Plan (FCSAP) to assist federal departments in the assessment and reduction of human health risks related to federal contaminated sites until program ends in 2010. Federal SD Goal IV Publication of risk assessment documents Number of risk assessment peer reviews undertaken Number of training courses delivered Number of community consultations Expected results by 2010: Publication of risk assessment guidance documents (Preliminary Quantitative Risk Assessment, Site Specific Risk Assessment for chemicals) Undertake approximately 100 risk assessment peer reviews, deliver 5 training courses in risk assessment and public outreach, and consult with 4 communities and community groups on reducing health risks related to federal contaminated sites During the course of SDS Iv, at least one of health Canada's regional offices will explore the opportunity to collaborate with provincial and municipal organizations in the development of sustainable development practices or initiatives. Federal SD Goal IV First set of measures implemented Démarche Allégo is an initiative by several federal ministries in the Quebec region to encourage new commuting habits. The first set of new measures resulting from the 2006-2007 commuting survey on the commuting habits of federal public service employees working in downtown Montreal will be implemented in 2007-2008 to encourage and promote better commuting habits 1.4 - Protection of the environment and Human Health By March 2010, screen all Natural Health Product submissions to ensure that ingredients in these products do not include ingredients derived from endangered species. Confirmation that the electronic bulletin was issued to stakeholders Reviews conducted for all of Natural Health Product submissions Prepare and issue an electronic communiqué/bulletin message to Natural Health Product (NHP) stakeholders about the use of endangered species in natural health products, and review all of NHP submissions to contribute to safer health products for Canadians During the 2007-10 period, develop a regulatory framework based on policy and technical analysis of issues related to the development of Environmental Assessment Regulations for new substances contained in products regulated under the Food and Drugs Act (e.g., ibuprofen, naproxen, carbamazepine, gemfibrozil, etc.). Number of international analysis conducted Development of the regulatory framework for the Environmental Assessment Regulations Completing an analysis of the European and United States frameworks, will aid in the development of the regulatory framework for the Environmental Assessment Regulations for new substances contained in products regulated under the Food and Drugs Act. The international analysis may also contribute to increased international regulatory harmonization By March 2007, establish and convene a government-stakeholder Environmental Assessment Working Group to provide strategic advice on the development of the Environmental Assessment Regulations. Establishment of the Environmental Assessment Working Group Number of workshops held Creation of the Government-Stakeholder Environmental Assessment Working Group to provide strategic advice on the development of Environmental Assessment Regulations. Develop and deliver two workshops for Environmental Assessment Working Group Throughout the 2007-10 period, provide open and transparent communication to stakeholders regarding the development of the Environmental Assessment Regulations through the Health Canada website, focus group discussions, written reports, etc. Number of postings on the Health Canada website Number of inquiries on the EII hotline Continuously update the Health Canada website for the Environmental Assessment Regulations, and communicate with stakeholders as required 1.5 - Food Safety By March 2010, develop a framework to improve the transparency and regulatory process for novel foods through: revision of guidelines for the Safety assessment of novel foods, and development and delivery of training sessions for industry and crop developers on how to prepare novel food applications. Training session held Improvement of regulatory process for novel food submissions Development and delivery of a training session for industry on how to prepare a novel food submission By March 2010, continue to establish policies and standards related to the nutritional quality of foods (Trans fat, food fortification, product-Specific health Claims). Business Impact Test completed Treasury Board submission completed Publications in Canada Gazette completed Confirmation that comments are posted on website Regulations prepared Completion of Business Impact Test for Health Claims Completion of Treasury Board submission Publication in Canada Gazette I and II Government response and action plan for approvals Publication of proposed amendments in Canada Gazette I Summary of comments posted on website Preparation of regulations for Canada Gazette II By March 2010, amend the regulations on the declaration of priority allergens. Regulations published in Canada Gazette I and IIConsultations completed Review of Canada Gazette I comments initiated and preliminary next steps established for amending the regulations on the declaration of priority allergens. Consultations on allergen cross-contamination and the use of precautionary labelling held By March 2010, continue to: develop appropriate intervention strategies to reduce the public's exposure to priority pathogens in specific commodities; increase consumer awareness of risk avoidance practices for targeting specific commodities and vulnerable groups; and, update risk management strategies to limit exposure of Canadians to selected chemicals in food Percentage decrease in foodborne illness Percentage decrease of selected chemicals in food Number of educational documents published (i.e., Codes of Practice, policies, Internet postings) Establish maximum limits for lead and cadmium in food to reduce the public's exposure to priority pathogens Release new/updated maximum levels for mercury in fish sold in Canada and renew consumption advisories to vulnerable consumers to help ensure the safety of food on the Canadian market Increase consumer awareness of risk avoidance practices for raw milk cheese, sprouts, meats and unpasteurized juices through publication of educational documents In collaboration with agriculture and agrifood Canada, the pmra will expedite grower access to lower risk pest control products such as biologicals, pheromones and reduced risk products by 2008. Federal SD Goal IV Guidelines finalized Guidelines will be finalized in 2007-2008 in response to stakeholder comments on proposal. Will develop business processes in PMRA to implement 2.1 - Fleet By march 2010, reduce greenhouse gas (GhG) emission per vehicle kilometre. Federal SD Goal III Annual average GHG emissions per vehicle kilometer reduced Establishment of baseline and tracking mechanisms to measure progress over time Establish procedures and mechanisms to phase-out low fuel-efficient vehicles, increasing the use of ethanol-blended vehicles and hybrids Purchase ethanol blended gasoline for Department road vehicles where available or applicable. Federal SD Goal III Percentage of ethanol blended gasoline purchased for vehicle fleet Establishment of tracking mechanisms to measure the amount of ethanol blended fuel purchased for departmental vehicles Communicate to all employees operating Department road vehicles to purchase ethanol blended gasoline where available/applicable 2.2 - Building Energy By march 2008, health Canada commits to conducting energy audits at two health facilities to model energy fluxes in order to identify energy saving options. Federal SD Goal IIIGGO Goal: Building Energy Completed energy audits Conduct energy audits at two health facilities to model energy fluxes in order to identify energy saving options By march 2009, an action plan to reduce GhG emissions in health Canada's custodial laboratories will be developed and implemented. Federal SD Goal III GGO Target: Other custodian departments and agencies will establish and report on meaningful departmental targets in support of the overall FHIO target for buildings by 2010. GHG emissions Sustainable Development Strategy implementation plans (SDSIP) will be completed by March 31, 2007. Completion of Year 1 of the SDSIP is expected for 2007-2008 2.3 - Procurement Starting April 1st 2007, health Canada will increase the ratio of energy Star computers and monitors. GGO Target: Green Stewardship Ratio Sustainable Development Strategy implementation plans (SDSIP) will be completed by March 31, 2007. Completion of Year 1 of the SDSIP is expected for 2007-2008 By March 2010, all materiel managers and procurement personnel will attend a recognized training course on green procurement offered by Public Works and Government Services Canada, Canada School of Public Service, or any other federal government department. Federal SD Goal III Number of materiel managers and procurement personnel trained Advertise Green Procurement training courses offered by PWGSC/Canada School of Public Service to all materiel managers and procurement personnel Review and update internal procurement training material to enhance Green Procurement portion Establish baseline of knowledge of Green Procurement and tracking mechanisms to measure progress over time By march 2010, incorporate tracking tools into the existing systems (e.g., Sap, etc.) to monitor green purchases. Federal SD Goal III Number of green goods and services tracked Implement tracking tools into existing procurement systems, and train user on the modified tracking system 2.4 - Training HSealth Canada will join with other government departments and the Canada School of public Service to design and deliver new Government of Canada Sustainable Development training material. Delivery to begin by December 2007. Federal SD Goal VI Instructional material developed Pilot training completed Training course taken by federal employees Development of a Sustainable Development leadership course in partnership with 11 departments and the Canada School of Public Service Piloting of the course Formal inclusion of the course in regular CSPS offerings to begin by December 2007 Starting April 1st 2007, increase the ratio of the existing training courses offered by the Health Canada Learning Program that will include a module on the environmental responsibilities that rest with employees. Federal SD Goal VI GGO Target: Green Stewardship. Ratio Sustainable Development Strategy implementation plans (SDSIP) will be completed by March 31, 2007. Completion of Year 1 of the SDSIP is expected for 2007-2008 By March 2010, Health Canada will implement a bi-ennial fuel storage tank operator training program delivered by certified fuel storage tank installers/inspectors to the staff at 90 health facilities with fuel storage tanks on reserves in British Columbia, manitoba, Saskatchewan, ontario, Quebec, and Newfoundland in order to ensure reduced potential for accidental release of petroleum hydrocarbons from storage tanks. Training developed and delivered Develop training for fuel storage tank operators and deliver to staff at health facilities with fuel storage tanks on reserves to ensure acceptable petroleum hydrocarbon handling and storage practices and improve environmental conditions on reserves 2.5 - Business Travel 2.5: Health Canada commits to completing a local business transportation pilot to rationalize local business travel requirements and improve the range of sustainable transportation services offered by the Department by March 2010. Federal SD Goal III Percentage Reduction in Greenhouse Gas Emissions (GHG) per employee. Gather baseline data to determine current employee needs and practices, and available transportation services available to employees. Develop a tool or service to rationalize local business travel requirements, and communicate to employees the range of sustainable transportation options offered by the Department 2.6 - Environmental Stewardship By april 2008, health Canada will develop a policy on responsible use of paper and a supporting action plan for implementation at the Departmental level. Federal SD Goal V GGO Target: Green Procurement and Green Stewardship. Policy and action plan developed Sustainable Development Strategy implementation plans (SDSIP) will be completed by March 31, 2007. Completion of Year 1 of the SDSIP is expected for 2007-2008 3.1 - Integration By the end of 2008, as a pilot project, Health Canada will apply a sustainable development lens to select policies and programs. Federal SD Goal VI Completion of a detailed draft Sustainable Development Lens Completion of a pilot of the lens with analysts from the Health Policy Branch To train several analysts in the use of the SD Lens; pilot the lens on real policy and program proposals and assess its effectiveness and ease of use Seek executive support within the department for wider use of the lens Higher quality policy and program initiatives developed within the department By end of 2008, Health Canada will convene a workshop on the social aspect of sustainable development to help frame SDS V. Workshop convened Workshops held with various experts on the social dimensions of sustainable development Since it's first sustainable development strategy, Health Canada has worked to create a culture that recognizes the importance of sustainable development in its operations. Approval of a Sustainable Development Policy in December 2000 enabled the integration of five key principles (shared responsibility, integrated approaches, equity, accountability, and continuous improvement) into the Department's third Sustainable Development Strategy and acted as guiding principles for the development of the fourth strategy covering 2007 to 2010. The Department will continue to report annually on progress made on SD Strategy commitments. The importance of sound environmental management of our operations and activities, and of meeting SDS targets were further emphasized with the approval of the 2000 Health Canada Environmental Management Policy and the creation of the Environmental Management Systems Division (EMSD). The use of an environmental management system (EMS) as an effective tool for managing compliance, minimizing negative impacts and risks to the environment and for continual improvement, supports the principles of sustainable development. The priorities of the EMS Division include: maintaining and improving the departmental EMS including its supporting policies and database implementing actions in support of its own SDS targets fostering environmental stewardship While environmental management of operations and activities is done through the EMS process, Strategic Environmental Assessment (SEA) offers a systematic and comprehensive process for evaluating the environmental effects of a policy, plan or program and its alternatives, at the earliest stage in planning. Health Canada has a requirement to complete SEAs in conformance with the 2004 Cabinet Directive on the Environmental Assessment of Policy, Plan and Program Proposals. The Department has developed a policy and guidelines for strategic environmental assessment to support departmental efforts to ensure proposals with important positive or negative environmental effects are identified and enhancement or mitigation measures are identified. SEA training is currently offered to Health Canada analysts in both the National Capital Region and regions. Future planning calls for the training of more analysts, concurrent with the development of more rigorous SEA management and tracking systems. To ensure compliance, the Office of Sustainable Development (OSD) will be working closely with Cabinet Affairs and the Chief Financial Officer Branch to make SEA completion a standard practice. In addition, the OSD will begin revising the 2004 Health Canada Policy and Guidelines on Strategic Environmental Assessment to formalize any new protocols or practices that are adopted. Building on previous experiences and incorporating best practices in our work will help to achieve sustainable development in the long term. Table 11: Internal Audits and Evaluations1 Name of Internal Audit/Evaluation Audit/Evaluation Type Status Expected Fiscal Year 2007-2008 Health Care Strategies and Policy Grant and Contribution (G&C) Program Final Evaluation G&C Ongoing March 2008 Health Human Resource Strategy Summative Evaluation Ongoing March 2008 Internationally Educated Health Care Professionals Initiative Summative Evaluation G&C Planned March 2008 Transition Fund Final Evaluation Ongoing September 2007 National Wait Times Initiative Summative Evaluation G&C Planned August 2008 International Health Grant Program Summative Evaluation G&C Ongoing December 2007 Women's Health Contribution Program Summative Evaluation G&C Ongoing July 2007 Gender Based Analysis Implementation Strategy Summative Evaluation Planned March 2008 Contribution Program to Improve Access to Health Services for Official Languages Minority Communities Summative Evaluation Therapeutics Access Strategy Formative Evaluation Ongoing Fall 2007 Human Drugs Strategic Evaluation Planned September 2009 Food Safety Strategic Evaluation Planned September 2008 Access to Medicines Program Implementation Evaluation Ongoing September 2007 1 This information is derived from the "Health Canada Program Evaluation "Work Plan" for 2006-2007 to 2008-2009". Planning for the 2007-2008 to 2009-2010 cycle has not yet started. A new Treasury Board Evaluation Policy, expected to come into force on April 1, 2007, will contain specific requirements for evaluation planning that are expected to be different from Health Canada's current approach. At that time, a new plan that conforms to the new Policy will be developed. Augmenting Health Canada's Response to Bovine Spongiform Encephalopathy (BSE I and II) Summative Evaluation Planned March 2008 Border Air Quality Strategy Summative Evaluation Ongoing September 2007 Health Risk Assessment and Protection Initiatives under the Canadian Environmental Protection Act 1999 Formative Evaluation Ongoing March 2008 Federal Contaminated Sites Action Plan Overall Evaluation Planned March 2008 Renewed - Year 5 Summative Evaluation Planned March 2009 Employee Assistance Services Evaluation Planned January 2008 Federal Drinking Water Compliance Program Summative Evaluation Ongoing July 2007 Children and Youth Cluster (First Nations and Inuit Health (FNIH)) Results/impacts/cost effectiveness Evaluation (including Contribution Agreement) Planned March 2008 Communicable Disease Control Cluster (FNIH) Results/impacts/cost effectiveness Evaluation (including Contribution Agreement) Planned March 2008 First Nations Water Management Strategy Summative Evaluation Ongoing August 2007 Environmental Health and Research Cluster (FNIH) Relevance/need/client satisfaction Evaluation (including Contribution Agreement) Planned March 2008 First Nations and Inuit Home and Community Care Final Evaluation Ongoing Spring 2007 Integration and Adaptation of Health Services Integration Pilot Projects Evaluation Ongoing Spring 2007 Contracting for Professional and Special Services in Health Canada Evaluation Ongoing Spring 2007 Post Doctoral fellowship Program Summative Evaluation Ongoing March 2008 Review of Evaluation and Performance Measurement at Health Canada Evaluation Ongoing Summer 2007 Nutrition Policy and Promotion Strategic Evaluation Planned September 2010 Medical Devices Summative Evaluation Planned March 2010 Access to Medicines Program Final Evaluation Planned September 2009 Public Service Health Program Service Delivery Model Evaluation Planned March 2009 Building Public Confidence in Pesticide Regulation and Improving Access to Pest Management Products Summative Evaluation Planned December 2009 Cluster (FNIH) Process/management Evaluation (including Contribution Agreements) Planned March 2009 Primary Care Cluster (FNIH) Relevance/need/client satisfaction Evaluation (including Contribution Agreements) Planned March 2009 Health Facilities and Capital Program Cluster (FNIH) Results/impacts/cost effectiveness Evaluation (including Contribution Agreements) Planned March 2009 For information on past audits and evaluations, please visit: http://www.tbs-sct.gc.ca/rma/database/newdeptview-eng.asp?id=41 Over one third of Health Canada's employees work in communities outside of the National Capital Region. Programs and services are delivered to Canada's diverse population by Health Canada's regional offices in the British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Atlantic and Northern Regions. In 2006, Health Canada created the Public Affairs, Consultation and Regions Branch to improve the integration of national and regional perspectives into its work, including policy and consultation activities. Over the next three years, Health Canada's regions will continue to advance the work that is underway to realize the benefits of this new operating environment: The regions will strengthen and expand their collaboration with Health Canada's Program Branches. Regions and programs will work in tandem to deliver the Department's programs and services in a manner that is responsive to local issues and priorities, while respecting national program integrity and accountability. In addition, the regions will continue to capitalize on their proximity to clients and stakeholders to develop further their relationships and their capacity for intelligence gathering and analysis. At the same time they will foster stronger relationships with policy and program branches in the Department. This will enhance the regions' ability to inform and influence policy design and development, supporting the relevance and effectiveness of Health Canada's work across the country. The close ties between regional offices and their counterparts in other federal departments provide frequent opportunities for collaboration. The regional offices will strengthen their relationships with federal counterparts in the regions by participating on Federal Councils and by forming partnerships to deliver region-specific projects. This interdepartmental work will enable Health Canada to support the federal government agenda broadly, and to reflect regional views in the development of government-wide policies and directions. Finally, Health Canada's regions will continue to build and maintain effective relationships with provincial, territorial and municipal governments as well as key stakeholders. These relationships support collaboration and joint initiatives. They also improve the Department's understanding of challenges and opportunities which cross program boundaries as provincial and territorial approaches to managing the health care agenda evolve. For example, ensuring coordinated preparedness by Health Canada and its partners and clients to respond to an emergency or pandemic will be a focus in the regions over the coming years. The following are examples of specific ways the regions will continue to help Health Canada deliver on its Strategic Outcomes. Strengthened knowledge base to address health and health care priorities: Manage intergovernmental affairs; Conduct disease surveillance and provide intelligence on local health policy and health systems issues to support departmental policy and program development; and Foster communication, consultation and stakeholder engagement within the regions. Access to safe and effective health products and food and information for healthy choices: Conduct surveillance, enforcement and compliance activities for health-related products; Provide regional contributions to national policies, programs, and regulations related to health products and food; and Engage in consultations to build stakeholder relations and provide information for making healthy choices. Reduced health and environmental risks from products and substances, and safer living and working environments: Conduct inspection and surveillance activities as well as health promotion activities related to consumer products, tobacco, controlled drugs and substances, and the environment; Establish marketplace and user inspection programs, and compliance and promotional activities for pesticides; and Conduct risk assessments and evaluations and provide health advice to federal employees, provinces and municipalities related to chemical contaminants and exposure levels, drinking water standards, and work environments. Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians: Provide Non-Insured Health Benefits to First Nations and Inuit clients; Deliver community-based health promotion and disease prevention programs for First Nations and Inuit populations; Deliver Home and Community Care Program and addictions treatment services for First Nations and Inuit populations; Provide management capacity support and capital investments in First Nations and Inuit communities; and Collaborate in emergency preparedness and response as well as pandemic planning. Corporate Management - Leadership and Infrastructure to support the Department's Regional Operations: Ensure sound stewardship of both the human and financial resources of the Department through effective and accountable management and administration of assets, human resources, and information technology, by providing risk management and business continuity services, and by applying rigorous planning, reporting and performance measurement processes. Bringing leadership, coherence and expertise to the overall strategic direction of Health Canada's scientific responsibilities and activities and providing strategic advice to the Deputy Minister and Minister on health science issues are key roles for Health Canada's Office of the Chief Scientist (OCS). The management and governance of science and research, both internal to Health Canada and externally, requires a comprehensive and systematic approach. Productive collaborative efforts are critical to improving knowledge-based approaches to domestic and global health issues. Fostering science partnerships and linkages within the Department and with external partners/stakeholders promotes awareness and understanding of our science and its contribution to the health and safety of Canadians. OCS champions science within Health Canada by ensuring the effective use of science in policy making, enhancing science capacity and promoting excellence, and building linkages across the Department and with partners across the science policy and research communities. These activities help to enhance the health and safety of Canadians by ensuring that sound science is applied to decision-making, that accurate information is available to support informed choices by the public, and that Health Canada is positioned to work in partnership with other departments and other health research stakeholders to address national health research priorities. A critical component of the effective use of sound science in policy making and regulatory decision-making is the external advice provided to the Department by the Science Advisory Board, an independent group of experts that provides the Minister with advice on departmental science priorities and directions. Equally important is the work of the Research Ethics Board, also an independent body of experts that ensures that departmental research involving humans meets the highest ethical standards. OCS provides secretariats to these bodies. Key to the Department's role in meeting broader governmental and federal science and technology (S&T) objectives/commitments is OCS' coordination and participation in interdepartmental S&T activities and horizontal science management issues. Ongoing roles for the OCS include providing advice on and support to the management of intellectual property generated through departmental science activities, promoting and communicating Health Canada's science and research, and organizing the Health Canada Science Forum, which raises awareness of departmental science activities internally and with stakeholders. To further build Health Canada's research capacity, OCS also administers a Postdoctoral Fellowship Program and a Visiting Fellowship Program, bringing new people and new ideas into the Department and raising awareness and understanding of the important role played by science in regulation.
ASSIST conducted two cost-effectiveness analyses in Pakistan: one of a maternal and child vaccination program; the other, a family planning program. The studies were commissioned to provide information on program efficiency to USAID and provincial and national public health officials as the basis for evidence-based decision-making. In addition, ASSIST and its partner, All India Institute of Medical Services (AIIMS), provided support in using quality improvement approaches to a network of 39 WHO- and UNICEF-supported facilities in nine countries: India, Pakistan, Nepal, Bangladesh, Sri Lanka, Myanmar, Indonesia, Maldives, and Bhutan. The goal of this work was to strengthen health systems to end preventable child and maternal deaths (EPCMD) in South Asia. For this activity, ASSIST supported three medical colleges and two district hospitals in Punjab Province to initiate QI projects to improve pediatric triage, reduce neonatal hypothermia, reduce post caesarian C-section infection rates, and reduce neonatal sepsis. For more information on ASSIST's work in Pakistan, please contact [email protected].
Perspective > Medscape Rheumatology > Kay on Rheumatology > Medscape 20th Anniversary Collection Rheumatoid Arthritis: 20 Years Has Made a Big Difference in Treatment Jonathan Kay, MD I am Dr Jonathan Kay, professor of medicine at the University of Massachusetts Medical School and director of clinical research in the Division of Rheumatology at the University of Massachusetts Memorial Medical Center, both in Worcester, Massachusetts. I would like to congratulate Medscape on its 20th anniversary. This has prompted me to think about the advances in the treatment of rheumatoid arthritis (RA) over the past two decades. Since the advent of Medscape, we have seen the introduction of targeted biological therapies. In 1998, 3 years after Medscape began, we saw the approval of infliximab and etanercept, the first two tumor necrosis factor (TNF) inhibitors introduced to treat RA. Subsequently, there have been three other TNF inhibitors introduced as well as an inhibitor of T-cell costimulation, a B-cell-directed therapy, an antibody directed against the interleukin-6 receptor, and an interleukin-1 receptor antagonist. These agents have allowed us now to aim for remission and not just to control disease activity and make a patient feel somewhat more comfortable. Treating to target now is the approach to treatment of RA, aiming to use a quantitative measure of disease activity to achieve low disease activity or remission—goals that were previously not achievable before 1998 or the past decade or so. We also have seen the introduction of new markers of RA. Antibodies against citrullinated peptides (or anti-CCP antibodies or ACPA) have been introduced over the past two decades to identify patients with RA, especially those with poor prognostic indicators. This has allowed us not only to identify patients with early RA and to aim treatment at early disease, but also to look for patients perhaps at risk for the development of RA. Studies looking at first-degree relatives of patients with RA, who also have antibodies to cyclic citrullinated peptides, show that they are potentially at risk for RA. And now they are the subject of clinical trials to not only treat but actually prevent RA. Studies of the microbiome over the past several years have pointed to pathogenic mechanisms that may prompt other treatments to prevent the development of RA. Medscape Rheumatology © 2015 WebMD, LLC Cite this: Rheumatoid Arthritis: 20 Years Has Made a Big Difference in Treatment - Medscape - Sep 18, 2015. Professor of Medicine, University of Massachusetts Medical School; Director of Clinical Research, Division of Rheumatology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts Disclosure: Jonathan Kay, MD, has disclosed the following financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie Inc; AstraZeneca; Bristol-Myers Squibb; Crescendo Bioscience, Inc; EPIRUS Biopharmaceuticals, Inc; Genentech, Inc; Hospira, Inc; Janssen Biotech, Inc; PanGenetics, BV; Pfizer, Inc; Roche Laboratories, Inc. Received research grant from: AbbVie, Inc; Ardea Bioscienses, Inc; Eli Lilly & Co; Roche Laboratories, Inc. Manage Email Alerts Manage Email Alerts Switch to Adalimumab Biosimilars in Denmark Cut Costs Markedly How Twitter Amplifies My Doctor and Human Voice Cancer Drugs Dominate Top 10 Best-Selling Drugs in 2018 News Multimorbidity and Adverse Outcomes in Rheumatoid Arthritis Diseases & Conditions Rheumatoid Arthritis (RA) News Rheumatoid Arthritis: Hydroxychloroquine Use Not Linked to Increased Risk of Psychiatric Events Diseases & Conditions Rheumatoid Arthritis and Pregnancy Hand and Wrist Surgery in Rheumatoid Arthritis Rheumatoid Arthritis and Pregnancy Rheumatoid Arthritis Spine Imaging Rheumatoid Arthritis of the Cervical Spine Rheumatoid Arthritis Hand Imaging Rheumatoid Arthritis: In and Out of the Joint 'Lipid Paradox' Seen in Nonobese RA Patients With Low LDL According to RHEUMATOLOGISTS Proposed RA Guidelines: Maximize Methotrexate Before Switching Gout Clinical Practice Guidelines (ACR, 2020) A Man With Stooped Posture and Mysterious Back and Neck Pain Greater Reductions in Knee OA Pain Seen With Supportive Rather Than Flexible Shoes How Sjogren Syndrome Intersects With COVID-19 Top News From ACR 2014: Slideshow
Christian Community Aid is currently seeking an experienced, skilled and enthusiastic Quality Services Manager (QSM), to lead Christian Community Aid (CCA) child, youth and family support team based in the Ryde LGA. The Quality Services Manager will provide key leadership, management and accountability for staff within the portfolio, and will ensure all programs are effective and in accordance with contemporaneous evidenced based practice. The QSM will play a pivotal role in initiating, developing and sustaining innovative targeted programmes, that demonstrate how program activities contribute to achieving long term improvements in health and wellbeing, and reduction in the need for child protection services. The role will also develop and implement a clear growth strategy for the Child, Youth, Adult, and Family Services, with a key focus on the intersecting areas; education, homelessness, family violence and mental health. The QSM is responsible for overseeing the day to day operational management of the programs. Keep up-to-date with current and leading client support practices in order to facilitate innovative and high-quality service delivery that are aligned with the implementation of policies, procedures and directions of funding bodies. Exercise a high level of responsibility for the work undertaken by all employees within the program; including undertaking the planning, direction, management and evaluation of program operations. Drive a positive workplace culture that ensure employees are productive and can actively contribute to reach common goals. Use supervision, professional development and performance accountability/appraisal (evidence based) processes to support the development of staff, recognise excellence and address performance deficits. Facilitate the use of strength based and therapeutic approaches to practice. Implement reflective practice and coordinate coaching, training and development for allocated staff, and operate as a role model and leader for program services to ensure internal instructions and organisational policies and procedures are followed. Implement and supervise staff providing evidence-based programs such as Triple P, Tuning into Kids, Tuning into Teens, Circle of Security, etc. With support and guidance from the Business Executive, lead a culture of performance improvement and evaluation and demonstrate acceptance of change. Drive the implementation of new or updated practice frameworks. Leading continuous improvement activity, including program delivery guidelines, documentation, development and monitoring of service improvement, audit, review, reporting and compliance. Manage the overall operational, human resources, and financial responsibilities and activities of the Child, youth and family portfolio. Ensuring the systems fulfil the highest possible standards in compliance, accountability and prudent use of resources. With the support of the Business Executive, support the integration of high-quality evidence-based practices within CCA key areas of service support – Family Day Care Services, Financial Counselling, Emergency Relief, Aged Care, Meals on Wheels, Education and Disability. Develop and maintain administrative and quality processes, systems and initiatives that ensure accurate and timely reporting and compliance with the organisation's requirements, procedures and funding body requirements. Develop and implement a clear growth plan for the program, targeting specific cohorts in-need such as children, young people, adults and families. Develop, Implement and action a work plan in line with agreed objectives for the programs. Coordinating project work including relevant internal and external stakeholders to meet, plan priorities and commitments. Lead teams in the development of tools, program guidelines, outcome-based evaluation, reports and resources to support continuous improvement of operations. Maintain comprehensive program and service utilisation related documentation, ensuring data collection and program records are accurate, up to date, in good order and filed correctly. Ensure that client and stakeholder feedback is promoted, captured and responded to appropriately. Generate statistical reports and write effective evaluation reports to guide service development and decision making within the programs. Coordinating project teams to develop service models and tender content and be responsible for writing high quality tender submissions. Develop and maintain high quality, strategic partnerships to ensure CCA is strategically placed to be a provider of choice with funders and achieve strategic goals across all intersecting areas. Represent CCA in senior sector leadership positions and forums and develop key relationships. Manage all aspects of student placement, including individual supervision. Attend out of hour's meetings, reference groups, training sessions and other relevant functions as required. Write updates and promotional materials. Complete reports as directed by the Business Executive. Perform other duties and responsibilities, as directed by the Business Executive or delegate. A bachelor's degree and/or post graduate degree in Health, social work, youth work, management or related fields. With experience in management. and working with young people from a diverse range of backgrounds. Christian Community Aid (CCA) provides a diverse range of support services to people living, working and studying in the Ryde, Parramatta and Hornsby Local Government Areas. Our vision is to engage with the community to enable better lives. For 50 years we have been working to provide personalised, timely and innovative support that addresses the existing and emerging needs of people. CCA aims to develop resources and capacity that will contribute to strong, inclusive and resilient communities. Extensive experience in management and leadership roles, developing and leading teams to achieve exceptional outcomes, reporting and accountability. Experience in the planning, implementation and evaluation of quality management systems and processes. Demonstrated experience in developing policies, program guidelines and procedures. Demonstrate comprehensive understanding of current government reform and policy. Lead the development and implementation of organisational reform and change that aligns CCA with the implementation of policies, procedures and directions of funding bodies. A demonstrated ability to lead, guide, coach, supervise and support employees with a sound understanding of supervision guidelines and best practice principles, ideally in community services or related field. Strong analytical skills and experience in writing high quality professional documents, information management, facilitation and presentation skills. Project management experience including ability to coordinate multiple stakeholders to achieve outcomes. Developing clear project plans to deliver outcomes that meet quality, cost and time specification. Ability to be flexible, work independently, demonstrate initiative, close attention to detail, be resourceful and work effectively under pressure. Demonstrated knowledge of program and client database systems and advanced computer skills in Microsoft Office packages such as Word, Excel, Power-Point and Outlook; website management and systems development. Knowledge on social media is highly desirable such as Facebook, Instagram and Twitter etc. We offer a competitive remuneration package including an attractive salary, access to tax-effective salary packaging arrangements and supportive work environment. Applications close at 5pm on 30 January 2019.
Unlike high power lasers that use heat and destroy tissue, low-level, low-energy, "cold" lasers affect the cellular energy of the underlying tissue. Hot lasers have a thermal effect and have an output of 1 Megawatt (one million watts) or above. Cold or low-level lasers do not have a thermal effect on tissue. Lasers that stimulate biological function have an output below 10 milliwatts (one-hundredth of a watt). Cold Laser Therapy (CLT) is the application of a low-energy or low-level laser to tissue in order to stimulate cellular metabolism and enhance biochemical functioning. For example, studies show that CLT increases ATP production in the mitochondria of the cell. As more energy is now available, the cell utilizes this fuel to function more efficiently. Enhanced healing is one of the beneficial effects of CLT. Cold Laser Therapyhas been shown to significantly accelerate and enhance the body's natural defenses and recuperative abilities following an injury. By reducing the duration of inflammation as well as enhancing specific repair and healing processes, Cold Laser Therapy has been proven to provide pain relief, reduce damage due to injury, and restore function. Cold Laser Therapy enables the body to achieve more rapid repair and recovery, with improved functional ability. These results come from the ability of Cold Laser Therapy to "bio-stimulate" tissue growth and repair. This bio-stimulation results in accelerated healing and dramatic decreases in pain and inflammation. Cold Laser Therapy actually heals injured tissues as well. In addition, Cold Laser Therapy provides a powerful non-addictive form of pain management. Spinal Decompressionwith Cold Laser Therapy is a highly effective method of treatment for herniated discs and other serious musculoskeletal disorders. Cold Laser Therapy has been used to successfully treat many conditions including acute and chronic pain reduction, repetitive stress disorders such as carpal tunnel syndrome and rotator cuff syndrome, soft tissue strains and sprains, inflammation reduction, enhanced wound healing, and cellular regeneration. We are blessed to offer COLD LASER THERAPY to our patients here in Gadsden Alabama and surrounding Etowah county!
Debiopharm, 3B Pharmaceutical's partner to advance targeted CAIX radiotherapy Debiopharm, a Swiss-based biopharmaceutical company announced today having entered into a worldwide, exclusive license & research agreement with 3B Pharmaceuticals (3BP), a German biotechnology firm, to further the development of their radioligand program, now called Debio 0228, which targets the CAIX (Carbonic Anhydrase 9) enzyme to fight the progression of cancer. This agreement extends the radio-oncology portfolio of Debiopharm which currently includes another clinical stage radiotherapeutic and the radiotherapy-enhancing antagonist of IAPs (Inhibitors of Apoptosis proteins) Debio 1143. The collaboration with 3BP, a renowned expert in theranostic peptide discovery and radioconjugates, is projected to advance the program into clinical development phases of development within 2 years. Currently in Lead Optimization stage, the Debio 0228 program is set to identify a Development Candidate with best-in-class potential, designed to selectively destroy tumor cells that express the CAIX target. The selected compound will be developed using a theranostic approach, a combination of diagnostic and therapeutic features with the same compound, allowing the pre-identification of patients who have the receptors necessary to respond to the targeted radiotherapy. These potential responders are qualified for their personalized therapy via diagnostic molecular imaging of target expression in their tumor lesions. This emerging field of medicine implies that only those patients who have the capacity to benefit from the treatment will actually receive the therapy, potentially minimizing the time and cost of clinical trials while maximizing patients' chances of treatment success. "We believe that targeted radiotherapy is an exciting, innovative treatment modality. 3BP's novel CAIX targeted program is in right line with our expanding radiotherapy portfolio, keeping Debiopharm on the cutting edge of research that is focused on the specific characteristics of the patient," explained Frederic Levy, Executive Director of Search & Evaluation and Scientifc Innovation, Debiopharm. "We are delighted to enter into this agreement with Debiopharm, a company with a strong commitment to the development of radio-oncology pharmaceuticals. This agreement highlights the rapidly growing importance of nuclear medicine as a further pillar for the treatment of cancer. We believe this is an ideal partnership to advance the development of CAIX-targeted radiopharmaceuticals for the potential benefit of seriously ill patients," explained Ulrich Reineke, Managing Director, 3B Pharmaceuticals. Debiopharm, 3B Pharmaceutical's partner to advance targeted CAIX radiotherapy. Appl Rad Oncol.
Supplementation with grape seed extract may help delay the onset of type 2 diabetes in people with metabolic syndrome (people with a group of metabolic risk factors for heart disease), by suppressing inflammatory markers which are associated with insulin resistance. J Cell Commun Signal. A double-blind, randomized study was conducted to find if food sensitivity could be linked to ADHD (attention deficit/hyperactivity disorder) in children (aged 4 – 8). While there were some initial improvements with the ARS scores (ADHD rating scale) for the children on elimination diets, relapses also occurred. The study found that yes, there was a link between ADHD and food sensitivities; however, IgG blood tests were not reliable in identifying specific food sensitivities in children. Keep this inadequacy of allergy testing in mind when trying to decide what you or your pets are allergic to. Lancet. Evidence suggests that mixed tocopherols may help prevent prostate cancer risk, rather than increase risk as some have thought. Large doses of straight alpha-tocopherols can deplete gamma-tocopherols, therefore negating the benefit. But vitamin E in the form of mixed tocopherols provides a more balanced benefit. Arch Intern Med. Pharmaceutical companies pay substantial amounts of money to study authors who have written negative vitamin E papers. Major medical journals benefit financially from pharmaceutical advertising. Vitamin effectiveness decreases pharmaceutical revenues. Studies can be rigged to show negative results with vitamins using low doses, and an increase in risk of health issues when using natural supplements. Due to large sums to be gained through pharmaceutical advertising, journals reject studies that undermine this cash cow by showing the safety and effectiveness of natural remedies. The largest public medical library on the planet, the US National Library of Medicine, is censored by public tax money. They make a habit of rejecting studies showing the benefits of natural remedies. "A Harvard study showed a 27% reduction in AIDS deaths among patients given vitamin supplements." "There have been no deaths from vitamins in 27 years." "Antibiotics cause 700,000 emergency room visits per year, just in the US." "Modern drug-and-cut medicine is at least the third leading cause of death in the US. Some estimates place medicine as the number one cause of death." "Over 1.5 million Americans are injured every year by drug errors in hospitals, doctors' offices, and nursing homes. If in a hospital, a patient can expect at least one medication error every single day." "More than 100,000 patients die every year, just in the US, from drugs properly prescribed and taken as directed." One example of the double standard is the recommendation for daily dosing of aspirin to prevent a heart attack. Daily ingestion of aspirin long-term greatly increases the risk of pancreatic cancer, which is virtually fatal within 3 years of diagnosis. However, this discovery has received virtually no press. Orthomolecular Medicine News Service. Consumption of leafy vegetables and olive oil reduces risk of coronary heart disease in women. Am J Clin Nutr. Low serum vitamin A linked to facial nerve paralysis. Pediatr Neurol. L-Carnitine increases muscle carnitine and alters fuel metabolism during exercise in humans. J Physiol. Vitamin E supplementation benefits women with metabolic syndrome. Int J Vitam Nutr Res. Vitamin A prevents morbidity and mortality in children. Cochrane Database Syst Rev. Vitamin D supplementation benefits subjects with a history of stroke. Nutr Metab Cardiovasc Dis. High prevalence of vitamin A and E deficiencies in very low birth weight infants. J Perinatol. High prevalence of vitamin D deficiency in subjects with anemia. Blood. Intake of soy isoflavones associated with a significantly reduced risk of breast cancer. Breast Cancer Res Treat. L-Carnitine supplementation protects central nervous system. Metab Brain Dis. Eating pistachios benefits men with erectile dysfunction. Int J Impot Res. If you fear making anyone angry or disappointed, then you strive for the lowest common denominator of human existence. - Non-profit organization devoted solely to providing safer, cleaner, hospital care. Offers 15 steps to protect yourself as well as facts and press releases about hospital infections. - Website that provides alternatives to traditional treatments of eczema. Includes nutritional advice, home remedies and shows before and after pictures of those using natural healing.
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Posted on Monday, April 3, 2017 by Elert for Publications. Amna Aslam, a Midwood senior, and Iqra Nadeem, a Brooklyn College junior, were poster presenters at the American Association for Cancer Research (AACR) 2017 Annual Meeting in Washington, DC this past Sunday, April 2. Their project was entitled, "Higher nucleolar index of nucleolin as an indicator of aberrant cellular DNA damage response (DDR)". Additional authors included Midwood class of 2016's Rumsha Javed and Jingyuan Wang, Anna Kozlova, Danielle Gordon, Ruchama Steinberg, Rachele Dolce Rameau, and Xinyin Jiang of Brooklyn College. Dr. Anjana D. Saxena of Brooklyn College and the CUNY Graduate Center was the supervising scientist. Posted on Tuesday, November 6, 2012 by Elert for Publications. Multimode selective detection of mercury by chiroptical fluorescent sensors based on methionine/cysteine with Patrick Carney, Steven Lopez, Amanda Mickley, Wenyao Zhang, and principal investigator Zhaohua Dai of Pace University in Chirality Volume 23, Issue 10 (November 2011): 916–920. Posted on Monday, November 6, 2006 by Elert for Publications. Four students who graduated this year coauthored academic works. Crystal Structure of the Putative Peptidyl-arginine Deiminase from Chlorobium tepidum, NESG Target CtR21 with F. Forouhar, A.R. Befeler, S.M. Vorobiev, M. Ciano, T.B. Acton, G.T. Montelione, J.F. Hunt, and L. Tong of Columbia University. Published in the Research Collaboratory for Structural Bioinformatics Protein Data Bank (RCSB-PDB), 16 November 2004. Crystal Structures of Two Bacterial 3-Hydroxy-3-methylglutaryl-CoA Lyases Suggest a Common Catalytic Mechanism among a Family of TIM Barrel Metalloenzymes Cleaving Carbon-Carbon Bonds. Farhad Forouhar, Munif Hussain, et al. Journal of Biological Chemistry. 5 December 2005. Crystal Structure of Human 3-Hydroxy-3-methylglutaryl-CoA Lyase: Insights into Catalysis and the Molecular Basis for Hydroxymethylglutaric Aciduria. Zhuji Fu, Jennifer A. Runquist, Farhad Forouhar, Munif Hussain, John F. Hunt, Henry M. Miziorko, and Jung-Ja P. Kim. Journal of Biological Chemistry 17 March 2006. Structural Basis for Discriminative Regulation of Gene Expression by Adenine-and Guanine-Sensing mRNAs. With Alexander Serganov, Yu-Ren Yuan, Anna Polonskaia, Lucy Malinina, Anh Tuân Phan, and Dinshaw J. Patel of Memorial Sloan-Kettering Cancer Center; Claudia Hobartner and Ronald Micura of Leopold Franzens University; and Ronald R. Breaker of Yale University. Published in Chemistry and Biology, Vol. 11, 1729-1741, December 2004. A model for automated screening of thalassemia in hematology (math study). With William Fleischman, Larry H Bernstein, Anthony Riccioli, Rita Bellevue of New York Methodist Hospital. Published in Laboratory Hematology. 2007;13(4): 119-23. Enhancing the diagnostic performance of troponins in the acute care setting. With Salman A. Haq, Morteza Tavakol, Steven Silber, Larry Bernstein, Madeleine Schleffer, Lesan T. Banko, John F. Heitner, Terrence J. Sacchi, and Joseph A. Puma. Published in the Journal of Emergency Medicine. Development and Validation of a Beta Thalassemia Screening Protocol. With L.H. Bernstein and A. Riccioli of New York Methodist Hospital. Published in the Online Abstract Submission and Invitation System (OASIS). The ACC/ESC Recommendation for 99 Percentile of the Reference Normal Troponin I Overestimates the Risk of an Acute Myocardial Infarction: A Novel Enhancement in the Diagnostic Performance of Troponin I. With S.A Haq, L.H. Bernstein, S.H. Silber, L. Banko, M. Schlefer, S. Shah, T.J. Sacchi, J.A. Puma. "6th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke." Circulation. 2005; 111; e310-e359. A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. With Linda Brugler R.D., Ana K. Stankovic, and Larry Bernstein. Published in Nutrition. Vol. 21 (6), June 2005: 650-658. Enhancing the diagnostic performance of troponins in the acute care setting. With Salman A. Haq, Morteza Tavakol, Steven Silber, Larry Bernstein, Jerard Kneifati-Hayek, Lesan T. Banko, John F. Heitner, Terrence J. Sacchi, and Joseph A. Puma. Published in the Journal of Emergency Medicine.
308-nm excimer laser for the treatment of alopecia areata. Alopecia areata is loss of hair from localized or diffuse areas of hair-bearing area of the skin. Recently there are reports of efficacy of the 308-nm excimer radiation for this condition. To study the effect of the 308-nm excimer laser in the treatment of alopecia areata. Eighteen patients with 42 recalcitrant patches (including 1 adult with alopecia totalis) were enrolled in this study. The lesions were treated with the 308-nm excimer laser twice a week for a period of 12 weeks; one lesion on each patient was left as a control for comparison. There were 7 males and 11 females in this study. Regrowth of hair was observed in 17 (41.5%) patches. Thirteen of the 18 lesions in scalp showed a complete regrowth of hair. The extremity regions failed to show a response. Atopic diatheses had an unfavorable effect on the outcome in our patients. The 308-nm excimer laser is an effective therapeutic option for patchy alopecia areata of the scalp and for some cases with patchy alopecia areata of the beard area. It does not work for patchy alopecia areata of the extremities.
A group of Taiwanese researchers has shown that an antibody against IL-20 helped treat osteoporosis in mice.1 The findings have grabbed the attention of Novo Nordisk A/S, which has an anti-IL-20 mAb in Phase II testing to treat rheumatoid arthritis and is now considering exploring the bone loss indication. In 2006, the team showed that blocking IL-20 with a soluble form of its receptor, IL-20 receptor-a (IL20RA; IL20R1), decreased disease severity in mouse models of RA. Surprisingly, the therapeutic protected the animals against bone destruction as well.4 Those data led the team to speculate that IL-20 played a role in pathological bone loss and that inhibiting it could help treat osteoporosis. In a new paper in The Journal of Experimental Medicine, the team has reported that serum levels of IL-20 were greater in patients with osteopenia (low bone mineral density) and osteoporosis than in healthy controls. Similar results were seen in mouse models of ovariectomy-induced osteoporosis.
Origin-Oriented Elemental Profile of Fine Ambient Particulate Matter in Central European Suburban Conditions Mortality from Unspecified Unintentional Injury among Individuals Aged 65 Years and Older by U.S. State, 1999–2013 Who Is Vulnerable to Dengue Fever? A Community Survey of the 2014 Outbreak in Guangzhou, China Effect of In-Vehicle Audio Warning System on Driver's Speed Control Performance in Transition Zones from Rural Areas to Urban Areas clear zoom_out_map search menu IJERPH 10.3390/ijerph13070714 Feng Chen Chang, F. Li, M. Xu, P. Zhou, H. Haque, M. Mazharul Huang, H. Injury Severity of Motorcycle Riders Involved in Traffic Crashes in Hunan, China: A Mixed Ordered Logit Approach Fangrong Chang Maosheng Li Pengpeng Xu Hanchu Zhou Md. Mazharul Haque Helai Huang School of Traffic and Transportation Engineering, Central South University, Changsha 410075, China Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong 999077, China Centre for Accident Research and Road Safety—Queensland (CARRS-Q), Civil Engineering and the Built Environment, Science and Engineering Faculty, Queensland University of Technology, Brisbane 4059, Australia Int. J. Environ. Res. Public Health 2016, 13(7), 714; https://doi.org/10.3390/ijerph13070714 Received: 17 May 2016 / Revised: 1 July 2016 / Accepted: 8 July 2016 / Published: 14 July 2016 (This article belongs to the Special Issue Traffic Safety and Injury Prevention) Issues related to motorcycle safety in China have not received enough research attention. As such, the causal relationship between injury outcomes of motorcycle crashes and potential risk factors remains unknown. This study intended to investigate the injury risk of motorcyclists involved in road traffic crashes in China. To account for the ordinal nature of response outcomes and unobserved heterogeneity, a mixed ordered logit model was employed. Given that the crash occurrence process is different between intersections and non-intersections, separate models were developed for these locations to independently estimate the impacts of various contributing factors on motorcycle riders' injury severity. The analysis was based on the police-reported crash dataset obtained from the Traffic Administration Bureau of Hunan Provincial Public Security Ministry. Factors associated with a substantially higher probability of fatalities and severe injuries included motorcycle riders older than 60 years, the absence of helmets, motorcycle riders identified to be equal duty, and when a motorcycle collided with a heavy vehicle during the night time without lighting. Crashes occurred along county roads with curve and slope alignment or at regions with higher GDP were associated with an elevated risk of fatality of motorcycle riders, while unsignalized intersections were related to less severe injuries. Findings of this study are beneficial in forming several targeted countermeasures for motorcycle safety in China, including designing roads with appropriate road delineation and street lighting, strict enforcement for speeding and red light violations, promoting helmet usage, and improving the conspicuity of motorcyclists. injury severity; motorcyclist; unobserved heterogeneity; mixed ordered logit; China Motorcycle crashes are one of the leading causes of unnatural death worldwide. Almost half of all deaths on the world's roads are among those with the least protection: motorcyclists (23%), pedestrians (22%) and cyclists (4%) [1]. In particular, motorcyclists accounted for 9% of road fatalities in Europe, 20% in America, and 34% in both western Pacific and southeast Asia countries [1]. As the most vulnerable road user, motorcycle riders are susceptible to being fatally injured if involved in a collision [2]. After controlling for per vehicle mile traveled, motorcyclists were reported to suffer a 26-fold higher risk of death in a crash than those driving other types of motor vehicles [3]. Motorcyclist injuries continue to be a considerable public health concern in China. The total number of motorcycles registered in China increased overwhelmingly from 2.5 million (23% of all registered motorized vehicles) in 1987 to 49.9 million (nearly 65%) in 2002, reaching 91.5 million units (about 35%) in 2014 [4]. In accordance with this growth, the number of fatalities due to motorcycle crashes also raised by about 6.7 fold, from 3078 in 1987 to 20,773 in 2002. Although this figure gradually declined afterwards (reducing to 10,411 in 2014), the proportion of traffic fatalities sustained by motorcyclists is still relatively high, i.e., approximately 20% [4]. The situation appears to be more serious in southern China where motorcycles are prevalently used. For instance, motorcyclists represent more than 24% of total traffic fatalities in Hunan Province in 2014. Despite the pressing safety challenge brought by motorcycles, a limited number of studies have specifically focused on China's motorcyclist-related safety issues [5,6,7,8,9]. Existing research concerning motorcyclist injuries are mostly derived from the developed regions [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. The causal relationship between injury outcomes of motorcycle crashes and potential risk factors in China remains unknown. In terms of motorcycle styles, usage and trip purpose, there is a substantial difference between most developed countries and China. Motorcycles with larger engine capacities are preferred by single riders for occasional touring and leisure purposes in the US, Canada, and Europe [2]. However, in China, due to local governors' concern about motorcycle-related issues including traffic casualties, traffic chaos, and pollution, motorcycles are prohibited on public roads in many large cities such as Beijing, Shanghai, and Guangzhou. As a convenient and affordable means of transportation, motorcycles with lower capacities are extensively used by low- and middle-income families for daily commuting in less developed cities and rural areas in China. In addition, due to the distinction in cultural foundations, traffic policies, road environments and driver characteristics [26], the risk factors contributing to the severity of motorcyclist injuries in China are expected to be different from those in developed countries. On one hand, lessons learnt from developed countries can be of great value to China as almost all developed and motorized countries have experienced stages of motorcyclists' high fatality. On the other hand, China has unique features that require deliberate assessment of the applicability of a variety of countermeasures. The present study intends to investigate the injury risk of motorcycle riders involved in motor vehicle crashes in China. In this study, a motorcycle rider is the operator only, and a passenger refers to any person seated on the motorcycle but not in control of the motorcycle. In any combined reference, they are represented as the motorcyclists. Based on a comprehensive dataset collected from Hunan Province of China, a mixed ordered logit model is established to estimate the likelihood of fatal and severe injuries of motorcycle riders as a function of various factors, such as the detailed motorcyclist characteristics, crash characteristics, geometric design and environmental features. The findings could be used for the evidence-based interventions for policy-making decisions to reverse the adverse motorcycle crash trend and to mitigate motorcyclist injuries in China. 2. Literature Review Motorcycle-related crashes have long been a major research concern. Researchers have attempted to establish predictive models to investigate the determinants of motorcyclist injuries in traffic crashes in US [17,21,24,25], Canada [22], UK [14,15,16], France [13], Australia [20], Singapore [11], Korea [23], and Taiwan [12]. A wide variety of factors have been explored, including the demographic attributes of motorcyclists, traffic characteristics, road geometry and environmental features. Generally, the following factors were reported to significantly increase the injury severity sustained by motorcyclists: increased age [13,14,15,16,17,21], riding without helmets [17,21,24,25], alcohol use [17,21,22,23,25], speeding [12,15,17,25], motorcycle with a larger engine size [11,13,14,16], collisions with stationary objects or heavier vehicles [12,17,21,25], and motorcyclists at fault [11,17]. Conflicting findings were reported when it comes to the effects of motorcyclist gender and lighting condition. For example, female motorcycle riders were found more likely to be involved in serious injuries in most previous studies [13,17,21,22], whereas Shaheed et al. [24] drew an opposite conclusion. Meanwhile, Schneider and Savolainen [21] indicated the complete darkness associated with a lower likelihood of fatality owing to the risk compensation (i.e., motorcycle drivers in darkness tend to adjust their behavior by decreasing riding speeds, which has a positive effect on injury severity), while the absence of light was suggested related to a higher level of injury in most other cases [12,13,17,23,24]. Various methods, such as on-site investigation, mathematical modeling, and simulation, have been used to evaluate the severity of motorcyclist injuries. Of these, econometric modeling approaches, which focus on the analysis of injury severity from the perspective of overall safety and its econometric implications, hold considerable promise. Conditional on a crash having occurred, econometric crash-severity models cover a broad range of methods, including the binary logit models [16], ordered logit/probit models [11,14,15,22,23], generalized ordered logit models [22], multinomial logit models [10,17], nested logit models [17], proportional odds models [12], a latent class multinomial logit model [25], and mixed (random parameters) logit models [24,27]. Since the injury severities are inherently ordered, the ordered–discrete choice model is a superior alternative to account for the ordinal nature of response outcomes [11,14,15,28,29]. One limitation imposed by the traditional discrete choice approach (including the standard multinomial and ordered logit models) when applied to the crash-injury data is that it cannot allow for cross-individual heterogeneity. In reality, as each individual being analyzed has specific characteristics that may influence the severity outcomes differentially, the impacts of explanatory variables are expected to vary across observation. Another concern is that some of the factors that influence the severity of crashes are not observed or are nearly impossible to collect. If these unobserved factors (i.e., often referred to as unobserved heterogeneity [30] are correlated with the observed ones, biased parameters will be estimated and incorrect inference could be drawn [30,31]. Recent studies [32,33] have therefore introduced the mixed ordered response model to address the unobserved heterogeneity issue and the potential variations in the effects of contributing factors. Based on all of the above, to meet the urgent need to improve motorcyclist safety in China, the mixed ordered logit model was adopted to achieve an explicit understanding of factors influencing the injury levels of motorcycle riders in motor vehicle crashes, with which effective countermeasures could be scientifically proposed. The crash data was obtained from the Traffic Management Sector-Specific Incident Case Data Report, which was maintained by the Traffic Administration Bureau of Hunan Provincial Public Security Ministry. Hunan is located in South Central China with an area of 211,800 km2 and a population of 67.4 million. It is composed of 14 prefectures, 122 counties and 2576 townships. The province ranked 10th among 31 provinces in terms of Gross Domestic Product (GDP) value of 2.71 trillion CNY (i.e., 440.29 billion USD) in 2014 [34]. The number of registered motorcycle in Hunan was about 5 million in 2014, accounting for 52% of all motorized vehicles [4]. A total of 20,027 motorcycle crashes was reported in Hunan in 2014. Of these, about 81% were motorcycle–motor vehicle crashes. In comparison, single motorcycle crashes and motorcycles colliding with non-motor vehicle crashes, respectively, represented 6% and 13%. Given that motorcyclists involved in motor-vehicle crashes tended to sustain severe casualties (e.g., in our dataset, 88% of fatalities in motorcyclists were caused by the collisions between motorcycles and motor vehicles), we particularly focused on this crash type. Other crash types, such as the single motorcycle crashes and motorcycles colliding with non-motor vehicles were explicitly excluded. Due to the incomplete information in police records, 5316 crashes were retrieved for further investigation. In China, the injury severities are commonly assessed by police officers at the scene of crash and categorized as property damage only (i.e., no injury), slight injury (i.e., non-disability injury), serious injury (i.e., disability injury) and fatality (i.e., immediate or subsequent death from injuries within seven days after a crash). By aggregating the crash and casualty injury profiles, the predictor variables reflecting the demographic characteristics of motorcyclists (i.e., age and gender), crash characteristics (i.e., helmet usage, passenger on board or not, duty judgment, motorcycle type, collision vehicle, and collision type), geometric design features (segment or intersection, signal type, road classification and alignment), together with the environment factors (i.e., crash time, weather, and lighting condition) were collectively extracted. The GDP of corresponding counties was also collected to reflect the economic development levels [35]. Given that some of the factors affecting crash risk are substantively different at intersection and non-intersection locations [21,36,37], separate models were developed to independently estimate the effects of related factors on the injury severity of motorcycle riders resulting from crashes at intersection and non-intersection locations. Table 1 illustrates the variables available for model development, with the proportions of the categorical variables above and the descriptive statistics of the continuous variables below. Interestingly, more than 90% of crash-involved motorcycle riders were male and the prevalence rate of helmet use in our sample was fairly low, i.e., 28.2% and 30.2% in non-intersection and intersection crashes, respectively. The multiple ordinal categories for injury severities (i.e., j = 1 , 2 , 3 , 4 ) facilitated the application of ordered logit model: y i * = β ′ X i + ε i where y i * represented the latent injury risk propensity for motorcycle rider i ( i = 1 , 2 , … , n ) ; X i was an ( L + 1 ) × 1 column vector of explanatory variables (including the constant term); β was the corresponding vector of regression coefficients to be estimated (i.e., [ β 1 , β 2 , … , β p ] ); and εi denoted the random error term assumed to be identically and independently standard logistic distributed. The latent propensity y i * was mapped to the observed injury severity level y i through the threshold μ j ( μ 0 = − ∞ and μ 4 = ∞ ) y i = { 1 if − ∞ ≤ y i * ≤ μ 1 ( property damage only ) 2 if μ 1 ≤ y i * ≤ μ 2 ( slight injury ) 3 if μ 2 ≤ y i * ≤ μ 3 ( serious injury ) 4 if μ 3 ≤ y i * ≤ ∞ ( fatality ) where μ 1 , μ 2 , and μ 3 were threshold values to be estimated together with the β. We then had the following predicted probabilities: Prob ( y i = 1 \| X i ) = F ( μ ^ 1 − X i β ^ ) Prob ( y i = 2 \| X i ) = F ( μ ^ 2 − X i β ^ ) − F ( μ ^ 1 − X i β ^ ) Prob ( y i = 3 \| X i ) = F ( μ ^ 3 − X i β ^ ) − F ( μ ^ 2 − X i β ^ ) Prob ( y i = 4 \| X i ) = 1 − F ( μ ^ 3 − X i β ^ ) where F(•) was the cumulative distribution function with the mathematical form: F ( z ) = exp ( z ) 1 + exp ( z ) One restriction of above basic ordered logit model is that it holds the regression coefficients to be fixed across individual observations. To this end, the mixed ordered logit model was proposed, assuming the coefficients to be randomly distributed with possibly heterogeneous parameters generated by [38]: β i k = β k + φ i k in which φ i k was a randomly distributed term (e.g., a normally distributed term with a mean of zero and variance σ k 2 ). In practice, a random parameter β i k is used whenever σ ^ k is significantly greater than zero; otherwise, the parameter is fixed across the individuals. Now, the conditional probability entering the log likelihood function became: Prob [ y i = j \| X i , β i ] = F ( j , μ , β i ′ X i ) The estimation of the above mixed ordered logit model could be based on the simulated maximum likelihood approach with 200 Halton draws (see Train [39] for detailed explanation of simulated maximum approach and Halton draws). For the functional form of the parameter density function, consideration was given to normal, lognormal, uniform, and triangular distributions. For model comparison and selection, the Akaike Information Criterion (AIC) was used. AIC simultaneously considers the goodness-of-fit and complexity of model, which is defined as: AIC = − 2 ln ( L ) + 2 K where L is the maximum value of the likelihood function for the model, and K is the number of estimated parameters in the model. For model specification, a correlation test using the variance inflation factor (VIF) was conducted to ensure the non-existence of any highly correlated variables. Results revealed that the maximum value of VIF was 3.7 between signal control and lighting configuration, implying that no strong multi-collinearity among independent variables existed in our dataset. The likelihood ratio test was then used to guarantee that each added variable significantly improved the overall model performance. For the purpose of comparison, the basic ordered logit model was also estimated. As such, four models with two for intersections and the other two for segments were eventually developed. Performances of the calibrated models are compared in this section first, followed by the presentation and interpretation of the parameter estimates. 5.1. Model Comparison Table 2 shows the results of goodness-of-fit measures for the models. Undoubtedly, incorporating the random parameters resulted in an increase in model complexity but a considerable improvement in overall fit as measured by LL(β). In particular, the mixed form to model the injury of motorcyclists at non-intersection locations was definitely superior in terms of AIC statistics (approximately 20 points lower) and likelihood-ratio test (at 1% level of significance). Although there was no substantial difference in goodness-of-fit between fixed and mixed model types when applied to intersection crash data, the presence of random parameters explicitly demonstrated the existence of heterogeneity in the effects of risk factors. Therefore, the following section presents the interpretation of significant factors obtained from the mixed ordered logit models. 5.2. Parameter Estimates Table 3 summarizes the parameter estimates in mixed ordered logit models for non-intersection and intersection crashes, respectively. A 95% level of significance was used as the threshold to determine whether the parameters differed from zero. Insignificant variables were removed from the final models. Since the interpretation of coefficients are complicated and do not directly indicate the magnitude of the impacts of the variables estimated, investigating the pattern and trend of marginal effects is more intuitive and insightful [38]. Table 4 thus provides the results for marginal effects, which could be interpreted as the average percentage change in the probability due to the variation in independent variables. As illustrated in Table 3 and Table 4, the following factors were associated with a significantly higher probability of injury in both non-intersection and intersection crashes: motorcycle riders older than 60 years, the absence of helmets, motorcycle riders identified to be equal duty, and two-wheel motorcycles collided with a heavy motor vehicle in complete darkness. Crashes occurring on county roads with curves and slope alignments or at regions with higher GDP tended to suffer an elevated risk of fatality, while unsignalized intersections without curved or sloped approaches were less likely to lead to fatal and serious injuries. For all the parameters assumed to be random, the normal distribution was revealed to provide the best statistical fit. The effects of these significant contributing factors were further discussed below. 5.2.1. Motorcyclist Characteristics The involvement of motorcyclist riders over 60 years old was found to have a significant effect on injury severities. Probabilities of fatality at non-intersections and intersections were, respectively, 55% and 44% higher for riders older than 60 years. Elder riders being usually weaker in terms of physiological condition and perception of safety and slower to react in hazardous situations are likely to be severely injured if they are involved in a crash. Similar findings have been reported earlier [13,14,17,21]. The variable also produced a normally distributed random parameter with a mean of 0.639 and a standard deviation of 1.167 in the intersection model. Given these distributional parameters, 71% of the distribution is greater than zero, suggesting that 71% of the aged motorcycle riders involved in the crashes during the analysis period had increased probability of severe injury, while the remaining were less likely to be severely injured in crashes at intersections. This result probably reflects the fact that riders within the same age group usually vary in physical abilities, driving habits and other unobserved factors [36]. The absence of helmets was also found to significantly increase the injury severity of riders, with the probability of fatality approximately 32% and 34% higher than those wearing helmets at non-intersections and intersections, respectively. The protective effect of helmet use on injury outcomes has been well documented [40]. This indicator variable also led to a significant random parameter with a mean of 0.531 (or 0.707) and a standard deviation of 0.870 (or 0.597) in the non-intersection (or intersection) model. In addition, 73% (or 88%) of the distribution was greater than zero in non-intersection (or intersection) models, implying that the majority of motorcycle riders without helmets sustained a higher probability of injury risk in both intersection and non-intersection crashes. This finding is likely to illustrate the complex interaction between helmet usage and motorcyclist riding behavior. For instance, the helmeted riders are prone to be a self-selected group with good riding habits and skills, whereas those without helmets tend to be more reckless. The above findings might be neglected under a fixed-parameter analysis, introducing a bias because of the unaccounted heterogeneity. 5.2.2. Crash Characteristics In China, the responsibilities of the parties involved in road traffic crashes are typically determined by police officers at the scene. It is usually divided into five levels as total, primary, equal, secondary and no responsibility. The total responsibility is justified when the crash is fully caused by the fault of one party. If the collision is caused by two or more parties' faults, every party has therefore to bear certain responsibility on the basis of irregular behaviors and corresponding severity outcomes. For simplicity, those with secondary or no responsibilities are combined as the minor duty in the present study, while those with full and primary responsibilities are deemed as the major duty. Inconsistent with studies in Singapore [11,19], we found that compared with those with major duty, motorcycle riders identified to be of equal duty appeared to sustain higher probability of fatality by 21% and 45% in crashes at non-intersection and intersection sites, respectively. This contradictory result could be explained by different jurisprudence behind the liability determination of parties involved in traffic crashes. China is a country with a tradition to protect the vulnerable road users [41]. Provided that the motor vehicle driver failed to take appropriate and timely actions to avoid the collisions with motorcycles, the driver had to bear a dominating portion of the liability. Likewise, if the motorcyclist was judged to take the main responsibility, it implied that the motor-vehicle driver had noticed the irregular behaviors of motorcyclist and took corresponding measures in advance. Therefore, it is expected that injuries of motorcycle riders with major duty were less serious compared with their counterparts. In addition, the estimated parameter for this variable was found to be random with a mean of 0.294 (or 0.691) and a standard deviation of 0.882 (or 0.412) in the non-intersection (or intersection) model. Given these distributional parameters, 63% (or 95%) of motorcycle riders determined to be equal duty had a higher probability of severe injury when collided with a motor vehicle at non-intersections (or intersections). Towards the effect of motorcycle type, the parameter for the indicator variable of three-wheel motorcycles was observed to be random and significant. Specifically, the probabilities to be fatally injured in non-intersection and intersection related crashes were, respectively, reduced by 57% and 47% when motorcyclists operated three-wheel motorcycles. This result is intuitive to some extent. Recall that the three-wheel motorcycles typically possess a larger size and are commonly used to convey goods in daily life in China. This design occupies a larger space to run, which could easily attract the visibility to other road users. In addition, the good balance and heavy mass imposed by the three-wheel motorcycles (i.e., one leading front wheel with two driven rear wheels) may act favorably in reducing the injury severity in case of a crash. In addition, the variable resulted in a normally distributed random parameter with a mean of −1.223 (or −1.241) and a standard deviation of 1.103 (or 1.440) in non-intersection (or intersection) related crashes, indicating that 87% (or 81%) of motorcyclists riding a three-wheel motorcycle were less likely to be severely injured in non-intersection (or intersection) related crashes. Collisions with heavy vehicles, such as pickup trucks and tractor-trailers, were proved to dramatically increase the likelihood of fatality by 77% and 102% in non-intersections and intersection crashes, respectively. This was consistent with previous research [17,25]. The variable also produced a random parameter that was normally distributed with a mean of 0.909 (or 1.260) and a standard deviation of 0.683 (or 0.796) in non-intersection (or intersection) model. Given these distributional parameters, 91% (or 94%) of motorcycles colliding with heavy vehicles at non-intersections (or intersections) were more likely to result in severe injuries. 5.2.3. Road Geometric Design Features Roads in China can be categorized as the national, provincial, county, township, and accommodation roads in terms of administrative hierarchy. Typically, the national and provincial roads are also known as principal arteries. Compared to county roads, a lower risk of serious injuries for motorcycle riders was observed on national and provincial roads, with the probabilities of fatality and severe injury about 24% lower in the non-intersection model. One potential reason may be that the national and provincial roads in China generally have higher design levels of safety protection facilities and better safety performance with greater enforcement activities [42]. In contrast, due to less traffic volume and a lower degree of police presence, motorcyclists on county roads in China are more likely to engage in risky behaviors, such as non-helmet wearing, excessive speeding, and illegal overtaking. For example, riders on county roads were reported to wear helmets less despite the legislation requiring helmet use on all road types [5]. The ability to control motorcycles and the field of vision are deemed to be limited on roads with curves and slopes. Consistent with other studies [36,43], curved segments with slopes were also verified to increase the injury severity in our study. The probability of fatalities for motorcycle riders increased by 24% when collisions occurred along curved segments with slopes. Accordingly, motorcyclists driving at intersections with straight approaches were less likely to be injured fatally, with the corresponding probability about 22% lower. Contrary to conclusions from Singapore [11] and UK [15], our empirical analysis indicated that the injury severity of motorcycle riders tended to increase at signal-controlled intersections in China. The probabilities of fatalities and severe injuries increased by about 26% when crashes occurred at intersections with signals. One potential reason is that it is common to observe motorcyclists running the red lights in China [26]. The sudden and unexpected appearance of motorcycles makes it difficult for motor vehicle drivers to yield in time. Another is that motorcyclists often accumulate at stop lines before motor vehicles during the red phase. The practice of earlier discharge during the initial green period is particularly risky for resulting in a serious collision with the across vehicles [18]. The unprotected left-turn phase has also been reported as one of the major contributing factors for the vulnerability of motorcycles at signalized intersections [44]. 5.2.4. Environmental Characteristics As expected, the probability of fatalities for motorcycle riders decreased by 36% and 65% if crashes occurred in daylight at non-intersections and intersections, respectively. Additionally, compared with incomplete darkness, better lighting conditions were also beneficial to reduce the severity of intersection crashes, which lowered the likelihood of fatality and severe injury by 37% and 39%, respectively. This is expected as drivers have better visibility and more reaction time with lighting configuration [45]. Similar findings were also suggested in previous studies [12,13,17,23,24]. Meanwhile, the variable led to a significant random parameter which was normally distributed with a mean of −0.829 and a standard deviation of 0.635 in the intersection model. Given these distributional parameters, 90% of the distribution was less than zero. This result indicated that the majority of crashes (i.e., 90%) occurring at intersections with lighting configuration were less likely to lead to severe injuries. The economic development is supposed to be closely associated with safety awareness, driving behaviors and conditions of transport facilities, thus having an indirect influence on safety outcomes. Law et al. [35] suggested that motorcycle deaths increase with increasing motorization in early stages of development. The deaths subsequently decrease when technical, policy and political institutions respond to demands for increased safety. In this study, we found that regions with higher GDP were more likely to sustain a higher likelihood of fatality, i.e., the probability of fatalities for motorcycle riders at non-intersections increased by 11% with one unit increase in GDP values. China has witnessed astounding economic growth in the last decade. This allows more households to own motor vehicles and more individuals to drive. The motorcycle injuries have become an unwanted consequence of this urbanization and motorization. Hence, evidence-based interventions specific to motorcyclist safety are badly in need. Based on the statistically significant factors identified combined with the consideration of China's unique motorcycle-related features, several potential safety strategies are discussed and suggested in detail in the following section. 6. Safety Implications Head injury is a major cause of death in motorcycle crashes. Previous studies strongly supported that wearing a helmet effectively protects motorcycle riders from the high risks of head and spinal injuries [46,47], as well as reducing the length of hospital stay and corresponding medical costs of injured riders [40]. Our empirical study also demonstrated that riders without helmets in China are associated with an elevated likelihood of fatality. Early in 1988, "The Road Traffic Regulations of People's Republic of China" made helmet usage mandatory for all motorcycle riders throughout the country. Despite the existing national legislation, the overall prevalence of helmet use remains low, with estimated rates ranging from 30% to 70% [5,8]. Particularly, only 37% of drivers were observed properly wearing standard helmets in a developed city in Southern China [8]. This statistic was more alarming for pillion passengers, with only 12.9% exhibited wearing a motorcycle helmet correctly [8]. The main reason motorcyclists reported wearing helmets was not to "prevent head injury" but to "cope with police" [5]. According to the "Law on Road Traffic Safety of the People's Republic of China" enacted since May 2004, the penalty for the absence of a safety helmet is kept at 20–200 CNY (about 3–30 USD). As a contrast, the per capita disposable income has increased by more than three-fold over the past decade, raising from 6226 CNY (about 1000 USD) in 2004 to 20,167 CNY in 2014 (about 3000 USD) [34]. The immature driving group and the low-cost law violations along with the ineffectiveness of law enforcement have induced the high helmet non-usage in China. Therefore, public education programs regarding helmet use are extensively needed to reduce motorcyclist fatalities in China. Such strategies should target all motorcyclists (including motorcycle riders and pillion passengers) and address the message that the riders are only effectively protected when a standard motorcycle helmet is properly worn. Meanwhile, to achieve a good compliance rate, the government could consider enhancing the visibility of enforcement activities and to improve the penalties for un-helmeted motorcycle riding. Another available countermeasure is to segregate the vulnerable road users from mixed traffic by setting exclusive motorcycle lanes. Experience from Malaysia shows that the provision of exclusive lanes reduces motorcycle fatalities by 600% [48]. However, this costly measure seems inappropriate to generalize, given the prevalence of restricting motorcycles in many cities in China (According to the incomplete statistics, up to 170 cities in China have executed the motorcycle restricting rule [49]). Alternative road facilities programs, such as road alignment optimization and illumination configuration, are regarded to be feasible to enhance motorcyclist safety, since our results suggested that curved and sloped roads without lighting conditions significantly increase the injury severity (see Table 4). These remedial actions should particularly focus on county roads, as our sample illustrated that 69% of motorcycle crashes occurred on county roads (see Table 2). This road type was also proved to sustain an elevated risk of fatal and severe injuries. Inconsistent with the studies from developed countries [11,15], intersections with signal control were more likely to lead to severe injury for motorcyclists in China. This elevated injury risk may have been modified by motorcyclists' risk-taking behaviors, i.e., the red light violation and earlier discharge during initial green period. Thus, transportation authorities should consider providing more education programs to help motorcycle riders obey traffic rules and ride sensibly. In the meantime, more infrastructural facilities such as red light cameras, safer crossing and stay facilities should be developed for motorcyclists at signalized intersections [50]. Such direct countermeasures could improve the mobility and minimize the vulnerability of motorcycle riders in the pre-crash phase. In addition, inexperience with riding is believed to be monotonically associated with a higher risk of motorcycle crashes and injuries [51]. Formal rider training is expected to increase riding skills and thus reduce the risk of motorcycle injuries [51]. However, controversies over the benefits of training courses arises, as riders who received training were reported to have no significant reduction in the risk of motorcycle crashes relative to those without the training [52]. In addition, no significant differences in traffic violations and costs of medicinal treatment were detected between trained and untrained motorcyclists [52]. Due to the absence of investigations concerning the effectiveness of motorcycle training in China, we intend to be conservative about this safety strategy. Future research effort is required on this topic. Finally, other successful prevention programs, including the enforcement of speed violation and the conspicuity of motorcyclists (e.g., wearing a reflective vest while driving in dark hours), could be directly undertaken by China. These interventions are universally effective [53], and have a high benefit–cost ratio of implementation. This study investigated the injury severity sustained by motorcycle riders involved in traffic crashes in China through an analysis of data from Hunan Province of China. To account for the ordinal nature of response outcomes and unobserved heterogeneity, a mixed ordered logit model was developed. The following factors were reported to be associated with a significantly higher probability of fatalities and severe injuries: motorcycle riders older than 60 years, the absence of helmets, motorcyclists identified with equal duty, and two-wheel motorcycles colliding with a heavy vehicle in darkness. Crashes occurring on county roads with curves and slope alignments or at regions with higher GDP were prone to suffer an elevated risk of fatality, while intersections with straight approaches and with no signal controls were less likely to lead to fatal and serious injuries. Transfer of effective interventions for motorcycle injuries from developed countries to China is necessary and highly desirable. However, an understanding of the feasibility, economic cost, and potential barriers to implement these countermeasures is vital for successful transfer. China is totally different from other countries in the prevalence of motorcycle rides, purpose of motorcycle usage, amount of riding exposure, road environment, and traffic policies. If these differences are not explicitly considered, applying risk factor analytical results and safety programs from other regions, particularly to costly road engineering projects (e.g., setting exclusive lanes for motorcycles), might not be applicable. According to the significant risk factors identified in this study, a number of evidence-based safety strategies specific to China could be recommended: promotion of helmet usage, enforcement of speed and red light violations, clearer road delineation and street lighting systems, and improving the conspicuity of motorcyclists. It should be noted that this study was based on the police-reported crash dataset. Considering the inadequacies in police reports (e.g., the possibility of under-reporting of less severe crashes and the unavailability of relevant variables), we highly advocated the integration of police-reported data and other data sources (e.g., questionnaire surveys, field observations, and driving simulations) to achieve a more explicit understanding of the casual mechanism underlying motorcycle crashes. This work was jointly supported by the Joint Research Scheme of the National Natural Science Foundation of China/Research Grants Council of Hong Kong (Project No. 71561167001 & N_HKU707/15), the Natural Science Foundation of China (Project No. 71371192), and the Research Fund for the Fok Ying Tong Education Foundation of Hong Kong (142005). Fangrong Chang collected and analyzed the data; Hanchu Zhou and Fangrong Chang designed the model and simulations; Fangrong Chang wrote the paper; Pengpeng Xu, Maosheng Li, Md. Mazharul Haque and Helai Huang made editing corrections. All authors have read and approved the final manuscript. The following abbreviations are used in this manuscript: GDP Gross Domestic Product AIC Akaike Information Criterion USD United States Dollar World Health Organization. Global Status Report on Road Safety 2015. Available online: http://www.who.int/violence_injury_prevention/road_safety_status/2015/GSRRS2015_Summary_EN_final2.pdf?ua=1 (accessed on 19 October 2015). Haworth, N. Powered two wheelers in a changing world—Challenges and opportunities. Accid. Anal. Prev. 2012, 44, 12–18. [Google Scholar] [CrossRef] [PubMed][Green Version] National Highway Traffic Safety Administration. Traffic Safety Facts 2013 Data: Motorcycle; National Highway Traffic Safety Administration: Washington, DC, USA, 2015. National Bureau of Statistics. China Road Traffic Accident Statistics 2014; National Bureau of Statistics of China: Wuxi, China, 2015. (In Chinese) Li, L.P.; Li, G.L.; Cai, Q.E.; Zhang, A.L.; Lo, S.K. Improper motorcycle helmet use in provincial areas of a developing country. Accid. Anal. Prev. 2008, 40, 1937–1942. [Google Scholar] [CrossRef] [PubMed] Cheng, A.S.K.; Ng, T.C.K. Development of a Chinese motorcycle rider driving violation questionnaire. Accid. Anal. Prev. 2010, 42, 1250–1256. [Google Scholar] [CrossRef] [PubMed] Cheng, A.S.K.; Ng, T.C.K. Risky driving and the perception of motorcycle accident causes among Chinese motorcyclists in Hong Kong. Traffic Inj. Prev. 2012, 13, 485–492. [Google Scholar] [CrossRef] [PubMed] Yu, X.; Liang, K.; Ivers, R.; Du, W.; Senserrick, T. Prevalence rates of helmet use among motorcycle riders in a developed region in China. Accid. Anal. Prev. 2011, 43, 214–219. [Google Scholar] Wu, C.Y.; Loo, B.P. Motorcycle safety among motorcycle taxi drivers and non-occupational motorcyclists in developing countries: A case study of maoming, south China. Traffic Inj. Prev. 2016, 17, 170–175. [Google Scholar] [CrossRef] [PubMed] Shankar, V.; Mannering, F. An exploratory multinomial logit analysis of single-vehicle motorcycle accident severity. J. Saf. Res. 1996, 27, 183–194. [Google Scholar] [CrossRef] Quddus, M.A.; Noland, R.B.; Chin, H.C. An analysis of motorcycle injury and vehicle damage severity using ordered probit models. J. Saf. Res. 2002, 33, 445–462. [Google Scholar] [CrossRef] Lin, M.R.; Chang, S.H.; Huang, W.; Hwang, H.F.; Pai, L. Factors associated with severity of motorcycle injuries among young adult riders. Ann. Emerg. Med. 2003, 41, 783–791. [Google Scholar] [CrossRef] [PubMed] Lapparent, M.D. Empirical bayesian analysis of accident severity for motorcyclists in large French urban areas. Accid. Anal. Prev. 2006, 38, 260–268. [Google Scholar] [CrossRef] [PubMed] Pai, C.W.; Saleh, W. An analysis of motorcyclist injury severity under various traffic control measures at three-legged junctions in the UK. Saf. Sci. 2007, 45, 832–847. [Google Scholar] [CrossRef] Pai, C.W.; Saleh, W. Modelling motorcyclist injury severity by various crash types at T-junctions in the UK. Saf. Sci. 2008, 46, 1234–1247. [Google Scholar] [CrossRef] Pai, C.W. Motorcyclist injury severity in angle crashes at T-junctions: Identifying significant factors and analysing what made motorists fail to yield to motorcycles. Saf. Sci. 2009, 47, 1097–1106. [Google Scholar] [CrossRef] Savolainen, P.; Mannering, F. Probabilistic models of motorcyclists' injury severities in single- and multi-vehicle crashes. Accid. Anal. Prev. 2007, 39, 955–963. [Google Scholar] [CrossRef] [PubMed] Haque, M.M.; Chin, H.C.; Huang, H. Examining exposure of motorcycles at signalized intersections. Transp. Res. Rec. J. Transp. Res. Board 2008, 2048, 60–65. [Google Scholar] [CrossRef][Green Version] Haque, M.M.; Chin, H.C.; Huang, H. Modeling fault among motorcyclists involved in crashes. Accid. Anal. Prev. 2009, 41, 327–335. [Google Scholar] [CrossRef] [PubMed][Green Version] Rome, L.D.; Senserrick, T. Factors Associated with Motorcycle Crashes in New South Wales, Australia, 2004 to 2008. Transp. Res. Rec. J. Transp. Rese. Board 2011, 2195, 54–61. [Google Scholar] [CrossRef] Schneider, W.H.; Savolainen, P.T. Comparison of severity of motorcyclist injury by crash types. Transp. Res. Rec. J. Transp. Res. Board 2011, 2265, 70–80. [Google Scholar] [CrossRef] Rifaat, S.M.; Tay, R.; Barros, A.D. Severity of motorcycle crashes in Calgary. Accid. Anal. Prev. 2012, 49, 44–49. [Google Scholar] [CrossRef] [PubMed] Chung, Y.; Song, T.J.; Yoon, B.J. Injury severity in delivery-motorcycle to vehicle crashes in the Seoul metropolitan area. Accid. Anal. Prev. 2014, 62, 79–86. [Google Scholar] [CrossRef] [PubMed] Shaheed, M.S.B.; Gkritza, K.; Zhang, W.; Hans, Z. A mixed logit analysis of two-vehicle crash severities involving a motorcycle. Accid. Anal. Prev. 2013, 61, 119–128. [Google Scholar] [CrossRef] [PubMed] Shaheed, M.S.B.; Gkritza, K. A latent class analysis of single-vehicle motorcycle crash severity outcomes. Anal. Methods Accid. Res. 2014, 2, 30–38. [Google Scholar] [CrossRef] Atchley, P.; Shi, J.; Yamamoto, T. Cultural foundations of safety culture: A comparison of traffic safety culture in China, Japan and the United States. Transp. Res.Part F Traffic Psychol. Behav. 2014, 26, 317–325. [Google Scholar] [CrossRef] Cunto, F.J.C.; Ferreira, S. An analysis of the injury severity of motorcycle crashes in Brazil using mixed ordered response models. J. Transp. Saf. Secur. 2016, in press. [Google Scholar] [CrossRef] Huang, H.; Siddiqui, C.; Abdel-Aty, M. Indexing crash worthiness and crash aggressivity by vehicle type. Accid. Anal. Prev. 2011, 43, 1364–1370. [Google Scholar] [CrossRef] [PubMed] Huang, H.; Hu, S.; Abdel-Aty, M. Indexing crash worthiness and crash aggressivity by major car brands. Saf. Sci. 2014, 62, 339–347. [Google Scholar] [CrossRef] Mannering, F.L.; Bhat, C.R. Analytic methods in accident research: Methodological frontier and future directions. Anal. Methods Accid. Res. 2014, 1, 1–22. [Google Scholar] [CrossRef] Xu, P.; Huang, H. Modeling crash spatial heterogeneity: Random parameter versus geographically weighting. Accid. Anal. Prev. 2015, 75, 16–25. [Google Scholar] [CrossRef] [PubMed] Christoforou, Z.; Cohen, S.; Karlaftis, M.G. Vehicle occupant injury severity on highways: An empirical investigation. Accid. Anal. Prev. 2010, 42, 1606–1620. [Google Scholar] [CrossRef] [PubMed] Paleti, R.; Eluru, N.; Bhat, C.R. Examining the influence of aggressive driving behavior on driver injury severity in traffic crashes. Accid. Anal. Prev. 2010, 42, 1839–1854. [Google Scholar] [CrossRef] [PubMed] National Bureau of Statistics. China Statistics Yearbook 2014; China Statistics Press: Beijing, China, 2015. Law, T.H.; Noland, R.B.; Evans, A.W. Factors associated with the relationship between motorcycle deaths and economic growth. Accid. Anal. Prev. 2009, 41, 234–240. [Google Scholar] [CrossRef] [PubMed] Moore, D.N.; Iv, W.H.S.; Savolainen, P.T.; Farzaneh, M. Mixed logit analysis of bicyclist injury severity resulting from motor vehicle crashes at intersection and non-intersection locations. Accid. Anal. Prev. 2011, 43, 621–630. [Google Scholar] [CrossRef] [PubMed] Wang, J.; Huang, H. Road network safety evaluation using bayesian hierarchical joint model. Accid. Anal. Prev. 2016, 90, 152–158. [Google Scholar] [CrossRef] [PubMed] Greene, W.H. Econometric Analysis, 7th ed.; Prentice Hall: Upper Saddle River, NJ, USA, 2012. [Google Scholar] Train, K.E. Discrete Choice: Methods with Simulation; Cambridge University Press: Cambridge, UK, 2003. [Google Scholar] Kim, C.; Wiznia, D.H.; Averbukh, L.; Feng, D.; Leslie, M.P. The economic impact of helmet use on motorcycle accidents: A systematic review and meta-analysis of the literature from the past 20 years. Traffic Inj. Prev. 2015, 16, 1–7. [Google Scholar] [CrossRef] [PubMed] Xu, S. Discussion on the rules for liability determination in traffic accidents. Road Traffic Manag. 1993, 3, 28–31. (In Chinese) [Google Scholar] Wang, W.; Guo, X. Traffic Enginieering, 2nd ed.; Southeast University Press: Nanjing, China, 2011. (In Chinese) [Google Scholar] Zeng, Q.; Huang, H.; Pei, X.; Wong, S. Modeling nonlinear relationship between crash frequency by severity and contributing factors by neural networks. Anal. Methods Accid. Res. 2016, 10, 12–25. [Google Scholar] [CrossRef] Haque, M.M.; Chin, H.C. Right-angle crash vulnerability of motorcycles at signalized intersections: Mixed logit analysis. Transp. Res. Rec. J. Transp. Res. Board 2010, 2194, 82–90. [Google Scholar] [CrossRef][Green Version] Huang, H.; Chin, H.C.; Haque, M.M. Severity of driver injury and vehicle damage in traffic crashes at intersections: A bayesian hierarchical analysis. Accid. Anal. Prev. 2008, 40, 45–54. [Google Scholar] [CrossRef] [PubMed] Rowland, J.; Rivara, F.; Salzberg, P.; Soderberg, R.; Maier, R.; Koepsell, T. Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State. Am. J. Public Health 1996, 86, 41–45. [Google Scholar] [CrossRef] [PubMed] Norvell, D.C.; Cummings, P. Association of helmet use with death in motorcycle crashes: A matched-pair cohort study. Am. J. Epidemiol. 2002, 156, 483–487. [Google Scholar] [CrossRef] [PubMed] Radin Umar, R.S. Motorcycle safety programmes in Malaysia: How effective are they? Int. J. Inj. Control Saf. Promot. 2006, 13, 71–79. [Google Scholar] [CrossRef] [PubMed] Order of Prohibiting Motorcycle. Available online: http://baike.baidu.com/link?url=7iYiA92rWah_ PABDYVlHvVzzIEwgTV_F77hnoMksX_lOq5BYZsM5-h5d6gHsm-J3YoRBdY968yllf1heo_-hLK (accessed on 19 January 2016). Chin, H.C.; Haque, M.M. Effectiveness of red light cameras on the right-angle crash involvement of motorcycles. J. Adv. Transp. 2010, 46, 54–66. [Google Scholar] [CrossRef][Green Version] Wong, T.W.; Lee, J.; Phoon, W.O.; Yiu, P.C.; Fung, K.P.; Mclean, J.A. Driving experience and the risk of traffic accident among motorcyclists. Soc. Sci. Med. 1990, 30, 639–640. [Google Scholar] [CrossRef] Jonah, B.A.; Dawson, N.E.; Bragg, B.W.E. Are formally trained motorcyclists safer? Accid. Anal. Prev. 1982, 14, 247–255. [Google Scholar] [CrossRef] Forjuoh, S.N. Traffic-related injury prevention interventions for low-income countries. Int. J. Inj. Control Saf. Promot. 2003, 10, 109–118. [Google Scholar] [CrossRef] [PubMed] Table 1. Descriptive statistics of variables included in the models. Count (Proportion) Non-Intersections Injury severity Fatality 536 (13.4%) 158 (12.1%) Serious injury 326 (8.1%) 94 (7.1%) Slight injury 2382 (59.5%) 857 (65.4%) Property damage only * 761 (19.0%) 202 (15.4%) Age Under 18 172 (4.3%) 53 (4.0%) 18 to 60 * 3536 (88.3%) 1169 (89.2%) Above 60 297 (7.4%) 89 (6.8%) Gender Male 3826 (95.5%) 1223 (93.3%) Female * 179 (4.5%) 88 (6.7%) Helmet usage With helmets * 1129 (28.2%) 396 (30.2%) Without helmets 2876 (71.8%) 915 (69.8%) Passenger With passenger 1127 (28.1%) 416 (31.7%) Without passenger * 2878 (71.9%) 895 (68.3%) Duty Minor 1587 (39.6%) 540 (41.2%) Equal 645 (16.1%) 296 (22.6%) Major * 1773 (44.3%) 475 (36.2%) Motorcycle type Two-wheel motorcycle 3445 (86.0%) 1146 (87.4%) Three-wheel motorcycle * 560 (14.0%) 165 (12.6%) Collision vehicle Heavy vehicles 658 (16.4%) 190 (14.5%) Light motor vehicles * 3347 (83.6%) 1121 (85.5%) Collision type Moving vehicles 2649 (79.1%) 1179 (90.0%) Others * 698 (20.9%) 132 (10.0%) Signal No signal 2246 (56.1%) 541 (41.2%) Marked 1672 (41.7%) 647 (49.4%) Signal Control * 87 (2.2%) 123 (9.4%) Road National and provincial roads 885 (22.1%) 635 (48.4%) classification County roads * 3053 (76.2%) 649 (49.5%) Others 67 (1.7%) 27 (2.1%) Road alignment Straight 2245 (56.0%) 955 (72.8%) Curve * 1339 (33.5%) 77 (5.9%) Curve and slope 421 (10.5%) 279 (21.3%) Day of week Weekday (Monday–Friday) * 2930 (73.2%) 978 (74.6%) Weekend (Saturday and Sunday) 1075 (26.8%) 333 (25.4%) Time of day Peak time (7 a.m.–9 a.m., 5 p.m.–8 p.m.) 1334 (33.3%) 439 (33.5%) Non-peak time (9 a.m.–5 p.m., 8 p.m.–6 a.m.) * 2671 (66.7%) 872 (66.5%) Weather Rainy/Snowy/Foggy/Windy 563 (14.0%) 165 (12.6%) Sunny * 3442 (86.0%) 1146 (87.4%) Light Daylight 2849 (71.0%) 987 (75.3%) Night with light 661 (16.5%) 242 (18.5%) Darkness * 495 (12.5%) 82 (6.2%) Non-intersections Intersections GDP (108) Range Mean (S.D.) Range Mean (S.D.) Min: 0.02; Max: 1.10 0.332 (0.284) Min: 0.02; Max: 1.1 0.352 (0.297) Note: * represents the variables treated as the control. Table 2. Goodness-of-fit measures for basic and mixed ordered logit models. Number of observations, n 4005 4005 1311 1311 Number of parameters, K 13 18 14 19 Log likelihood at zero, LL(0) −4397.18 −4397.18 −1324.15 −1324.15 Log likelihood at convergence, LL(β) −3976.79 −3962.27 −1179.59 −1174.91 AIC 7979.6 7960.5 2387.8 2387.2 Likelihood-ratio test X 2 = − 2 [ L L ( β r a n d o m ) − L L ( β f i x e d ) ] 14.541 4.688 Degrees of freedom 5 5 p-value 0.01 0.45 Table 3. Estimate results for mixed ordered logit models. z-Statistic Above 60 years old 0.665 0.130 5.115 0.639 0.238 2.685 s.d. Above 60 1.167 0.228 Without helmets 0.531 0.077 6.896 0.707 0.141 5.014 s.d. Without helmet 0.870 0.041 21.220 0.597 0.074 8.068 Equal duty 0.294 0.092 3.196 0.691 0.148 4.669 s.d. Equal duty 0.882 0.085 10.376 0.412 0.125 3.296 Three-wheel motorcycle −1.223 0.101 −12.109 −1.241 0.192 −6.464 s.d. Three-wheel motorcycle 1.103 0.094 11.734 1.440 0.186 7.742 Collision vehicles Heavy vehicles 0.909 0.090 10.100 1.260 0.172 7.326 s.d. Heavy vehicles 0.683 0.082 8.329 0.796 0.161 4.944 National and provincial roads −0.400 0.086 −4.651 Road alignment Straight −0.368 0.138 −2.667 Curve and slope 0.329 0.112 2.938 No Signal control −0.485 0.131 −3.702 Light conditions Daylight −0.503 0.074 −6.797 −0.962 0.237 −4.059 Night with light −0.829 0.268 −3.093 s.d. Night with light 0.635 0.138 4.601 GDP 0.521 0.124 4.202 Note: s.d. denotes the abbreviation of standard deviation; the italicized represents estimates for the variables resulting in random parameters. Table 4. Estimate results for marginal effects of risk factors. Slight Injury Serious Injury Above 60 years old −0.574 −0.057 0.454 0.552 −0.601 −0.058 0.402 0.441 Without helmets −0.618 0.005 0.301 0.315 −0.933 −0.002 0.355 0.344 Equal duty −0.291 −0.013 0.187 0.208 −0.700 −0.050 0.417 0.445 Three-wheel motorcycle 1.776 −0.105 −0.570 −0.566 2.100 −0.080 −0.507 −0.467 Heavy vehicles −0.776 −0.082 0.621 0.772 −1.056 −0.157 0.828 1.019 National and provincial roads 0.463 −0.003 −0.227 −0.238 Straight 0.403 0.019 −0.211 −0.215 Curve and slope −0.318 −0165 0.212 0.240 No signal control 0.590 0.012 −0.258 −0.255 Daylight 0.496 0.022 −0.320 −0.360 0.942 0.081 −0.592 −0.654 Night with light 1.204 −0.019 −0.386 −0.365 GDP −0.184 −0.003 0.104 0.112 Note: PDO denotes the abbreviation of property damage only. © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/). Chang, F.; Li, M.; Xu, P.; Zhou, H.; Haque, M.M.; Huang, H. Injury Severity of Motorcycle Riders Involved in Traffic Crashes in Hunan, China: A Mixed Ordered Logit Approach. Int. J. Environ. Res. Public Health 2016, 13, 714. https://doi.org/10.3390/ijerph13070714 Chang F, Li M, Xu P, Zhou H, Haque MM, Huang H. Injury Severity of Motorcycle Riders Involved in Traffic Crashes in Hunan, China: A Mixed Ordered Logit Approach. International Journal of Environmental Research and Public Health. 2016; 13(7):714. https://doi.org/10.3390/ijerph13070714 Chang, Fangrong, Maosheng Li, Pengpeng Xu, Hanchu Zhou, Md. Mazharul Haque, and Helai Huang. 2016. "Injury Severity of Motorcycle Riders Involved in Traffic Crashes in Hunan, China: A Mixed Ordered Logit Approach" International Journal of Environmental Research and Public Health 13, no. 7: 714. https://doi.org/10.3390/ijerph13070714 Int. J. Environ. Res. Public Health, EISSN 1660-4601, Published by MDPI
Vitreoretinal eye surgery includes a group of procedures performed deep inside the eye's interior with lasers or conventional surgical instruments. and light-sensitive membrane (retina) are found. General ophthalmologists, other ophthalmologist sub-specialists and optometrists usually refer patients in need of vitreoretinal management to a specialist. This type of specialist trains first as a general ophthalmologist and subsequently specializes in the medical and surgical management of vitreoretinal disorders. A vitreoretinal specialist performs nearly all of the surgical procedures listed here, although general ophthalmologists and other ophthalmologist sub-specialists commonly handle procedures involving lasers. Procedures mentioned here are the more common of many surgical approaches to specific conditions requiring vitreoretinal surgery. A vitrectomy procedure removes the vitreous humor or gel-like substance in the eye. This approach can address vision problems caused when foreign matter invades this usually pristine area of the eye's interior. One example of foreign matter is blood, from conditions such as diabetic vitreous hemorrhage. Light rays passing through the eye cause the foreign matter to cast shadows on the retina, resulting in distorted or greatly reduced vision. A vitrectomy can restore vision in diabetic retinopathy by removing the natural vitreous that has become clouded by leaking blood vessels and replacing it with clear fluid. Once the surgeon removes the vitreous humor and clears the area, he or she usually injects a saline liquid to replace the vitreous humor that ordinarily fills up the inner chambers of the eye. However, a vitrectomy is considered inappropriate and extreme for addressing most ordinary spots and floaters that occur with vitreous detachments affecting almost everyone to some degree as they grow older. Usually vitrectomies require general anesthesia. However, local anesthesia is used in certain situations, especially when general anesthesia would be inappropriate, such as for people with breathing problems. Your surgeon will make three tiny incisions in the eye to create openings for the various instruments that will be inserted to complete the vitrectomy. Light pipe, which serves as a microscopic, high-intensity flashlight for use within the eye. Infusion port, used to replace fluid in the eye with a saline solution and to maintain proper eye pressure. Vitrector, or cutting device, that removes the eye's vitreous gel in a slow, controlled fashion. It protects the delicate retina by reducing traction while the vitreous humor is removed. Because so many variables are involved, only your eye surgeon familiar with your condition can give you a realistic idea of what to expect following a vitrectomy. But the underlying reason for the procedure usually is a major factor in determining how fast you will recover as well as the ultimate outcome. After a procedure, you likely will use antibiotic eye drops for about the first week and anti-inflammatory eye drop medications for several weeks. Follow your surgeon's advice carefully. In general, don't expect to know your final visual outcome for at least a few weeks. Again, your surgeon or attending ophthalmologist will be the best judge of your individual recovery. Vitrectomies have a very high success rate. Bleeding, infection, progression of cataract and retinal detachment are potential problems, but these complications are relatively unusual. For most patients who undergo a vitrectomy, sight is restored or significantly improved. The procedure is a marvel of modern medicine for people with conditions that might be blinding otherwise. Epiretinal membrane (ERM), also known as macular pucker and cellophane retinopathy, involves growth of a membrane similar to scar tissue across the macula. This type of growth interferes with central vision by shrinking or contracting, which distorts the central retina. If you have this condition, you likely will see straight objects appearing wavy and crooked. Also, you could experience reduced central vision, depending on the condition's severity. Epiretinal membranes may be associated with other eye conditions, but the cause of most ERMs is unknown. Some disorders occasionally associated with ERMs include previous retinal detachments and related surgery, inflammatory conditions (uveitis), retinal tears, branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). An epiretinal membrane clearly is present. You experience problems such as vision distortions or substantially reduced vision due to ERM. Your surgeon will help you decide if an epiretinal membrane peeling procedure is appropriate for you. But the decision will depend on the extent of preoperative vision loss and distortions. The ERM peeling procedure begins with a vitrectomy. , under high magnification, to grasp and gently peel away the membrane from the retina. Diamond-dusted instruments may be used also to help remove the membrane. Precision is key, because this procedure may very well be the most delicate operation that's performed on the human eye. Usually a few tiny sutures are used to close the incisions in the eye; generally these don't require removal later. After the ERM stripping, vision should improve gradually, though it may take up to three to six months for the best visual results. Studies show that about 80 to 90 percent of patients will experience visual improvement after the surgery. But due to potential permanent retinal damage following the ERM, some patients' vision will not improve. Potential complications of epiretinal membrane peeling include infection, bleeding, retinal detachment and cataract progression. Recurrence of the ERM takes place in about 10 percent of patients following the initial surgery. retinal detachment associated with a retinal hole or break. A confirmed diagnosis of PVR may mean that you need surgery. PVR is the growth of cellular membranes within the vitreous cavity and on the front and back surfaces of the retina. These membranes are essentially scar tissues that exert traction on the retina, possibly causing recurrences of retinal detachment even after an initially successful reattachment procedure. PVR may be associated with spontaneous reopening of otherwise successfully treated retinal breaks and may even cause new retinal breaks to develop. Because of the contracting membranes, PVR also may be associated with severe distortion and "stiffness" of the retina. This can produce disappointing vision, despite the very best management of the condition. A pars plana vitrectomy, to remove the gel-like vitreous humor. A membrane peeling procedure, in which the contracting membranes on the retinal surface are carefully stripped away. Following the vitrectomy, the surgeon usually instills special gases or fluids into the eye to help flatten the retina and keep it reattached to the outer wall of the eye. If gases are instilled in the eye, stabilizing the head following surgery may be necessary for days or even weeks to help keep the retina attached. If silicone fluid is placed in the eye to help maintain the retina in the attached position, it must eventually be removed from the eye in most cases. Additionally, a scleral buckling procedure may be needed. Material such as plastic is sewn onto the outside white of the eye (sclera) to exert continuous pressure. This pressure reaches the interior, where the retinal tear may be pushed into place to relieve traction and help repair the damaged area. Laser treatment also may be needed to help close retinal breaks. Recovery of vision after surgery for PVR may take many months. About half of patients will regain some useful vision in the affected eye. But the level of vision regained often is called "ambulatory vision," meaning vision good enough to see large objects at close range. This enables the basic ability to move around in a familiar environment. But the likelihood of regaining vision good enough for reading is quite low. After a PVR procedure, a low vision specialist can assist you with counseling and recommend devices with special lighting to help you see better.
All Cardiology In the Journals Trial Scorecards Cardiology Topics Early menarche, other reproductive factors increase risk for CVD Peters SAE, et al. Heart. 2018;doi:10.1136/heartjnl-2017-312289. Add Topic To Email Alerts Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. You have already added this topic to your email alerts. Click here to manage your alerts. Sanne A.E. Peters Women who had a history of miscarriage, stillbirth or hysterectomy, early menarche, early menopause and early age at first birth had an increased risk for CVD later in life, according to a study published in Heart. "This study shows that reproductive factors earlier in life can have a long-term impact on women's future cardiovascular health," Sanne A.E. Peters, PhD, research fellow in epidemiology at The George Institute for Global Health at University of Oxford in the United Kingdom, told Cardiology Today. "More frequent screening for cardiovascular disease would seem to be sensible among women who are early in their reproductive cycle or who have a history of adverse reproductive events or a hysterectomy, as this might help to delay or prevent their onset of cardiovascular disease. Key reproductive factors should be considered to help address the considerable CVD risk among affected women. Maintaining a healthy lifestyle, including nonsmoking, healthy weight, eating well and sufficient exercise, will also help to reduce the risk of cardiovascular diseases." UK Biobank data Peters and Mark Woodward, PhD, senior professorial fellow of the professorial unit at The George Institute for Global Health, professor of statistics and epidemiology at the University of Oxford, professor of medical statistics at University of New South Wales Sydney and adjunct professor of epidemiology at Johns Hopkins University, analyzed data from 267,440 women (mean age, 56 years) and 215,088 men (mean age, 56 years) from the UK Biobank who did not have a history of CVD at baseline. Participants completed questionnaires on their environment, lifestyle and medical history, in addition to measurements of physical and functional capacities and a collection of blood, saliva and urine samples. The questionnaires for women focused on factors such as age at menarche, age at first birth, number of live births and menopausal status. The men's questionnaires asked about the number of children they have fathered. Early menarche was the first menstrual period before age 12 years, and early menopause was the absence of menstrual periods before age 47 years. The main endpoints of interest were the incidence of CVD or stroke. Participants were followed up for a median of 7.1 years, which started at inclusion into the UK Biobank and ended at March 2016 or the first incidence of fatal or nonfatal MI or stroke, whichever occurred first. Increased CVD risk Women who had early menarche had an adjusted HR for CVD of 1.1 (95% CI, 1.01-1.3). Each year increase in age at first birth was associated with an aHR of 0.97 (95% CI, 0.96-0.98) for CVD. Each miscarriage had an aHR of 1.04 (95% CI, 1-1.09) for CVD, and each additional stillbirth was linked to an aHR of 1.14 (95% CI, 1.02-1.28). An aHR of 1.13 (95% CI, 1.19-1.49) was associated with early menopause. An increased risk for CVD was also seen in those who had a hysterectomy without oophorectomy (aHR = 1.16; 95% CI, 1.06-1.28) or had a previous oophorectomy (aHR = 2.3; 95% CI, 1.2-4.43). The risk for incident CVD was similar in men (aHR = 1.03; 95% CI, 1.02-1.05) and women (aHR = 1.03; 95% CI, 1-1.06) with each additional child. "Our findings show that the risk of developing cardiovascular disease increases for both women of healthy weight and women who are overweight or obese, which suggests we need more research to understand the association between an early first menstrual cycle and a greater risk of heart disease and stroke later in life," Peters told Cardiology Today. – by Darlene Dobkowski Disclosures: Peters and Woodward report no relevant financial disclosures. ").insertAfter(firstParagraph); $j(medrect1).appendTo($j("#mobileMediumLocation")); $j("#mobileMediumLocation div.continue-reading span").text("Story Continues Below"); //Medium Rectangle displays after the fourth paragraph $j("#mobileMediumLocation2").remove(); var fourthParagraph = findNewsParagraph(pages[p], 4, false); $j(" ").insertAfter(fourthParagraph); $j(medrect2).appendTo("#mobileMediumLocation2"); $j("#mobileMediumLocation2 div.continue-reading span").text("Story Continues Below"); return true; }
A recent study challenged prior definitions of what healthy or successful aging can look like by adopting a broader perspective. To do so, the researchers observed older adults in Canada and identified a unique set of attributes among people who age optimally. The researchers also assessed how well people age despite any chronic illnesses that may develop as they grow older. Previous research, oftentimes, has used a narrow definition of what healthy aging can look like. A recent study from researchers at the University of Toronto has provided new insights into healthy aging by observing two distinct demographics in Canada: immigrant and Canadian-born older adults. The study's authors identified several characteristics associated with positive experiences later in life that may contribute to healthy aging, thus revising the definition of what it means to age successfully. The findings were recently published in the International Journal of Environmental Research. Redefining successful aging Mabel Ho, a doctoral candidate at the University of Toronto's Factor-Inwentash Faculty of Social Work and the Institute of Life Course and Aging, and lead author of the study, told Medical News Today: "Previous definitions of successful aging were very narrow and required that older adults were free of all diseases — very few people met that definition." Ho explained that aging successfully means that individuals are not limited in their ability to accomplish everyday activities, regardless of whether they have a chronic illness. Ho's study defined healthy aging as having the following attributes: the ability to accomplish activities of daily living (ADLs) the ability to accomplish instrumental activities of daily living (IADLs) freedom from mental illness and memory problems freedom from disabling chronic pain self-reported perceptions of happiness and physical health adequate social support "I think most people would agree that defining successful aging based on mental and physical functioning, social engagement, mental health, and well-being makes intuitive sense. This is certainly what I will strive for as I age." – Mabel Ho, doctoral candidate and lead study author Ritu Sadana, DSc, unit head of aging and health at The World Health Organization (WHO), not involved in the study, agreed that traditional successful aging standards have been limited in scope. "[The] WHO doesn't define healthy aging as being disease-free. It's a process and continuum," Dr. Sadana told MNT. She explained the WHO takes a granular look at each component of healthy aging and investigates actions that may enhance its likelihood. Successful aging in older adults For the study, researchers analyzed data from two different time periods from the Canadian Longitudinal Study on Aging (CLSA). The data encompassed 7,651 individuals who were 60 or older when they began participating in the longitudinal study. Of the participants, 1,446 respondents were Canadian immigrants. The study identified several characteristics that were associated with healthy aging, including individuals who: were younger at the start of data collection had higher incomes were married not having obesity never smoked did not have sleep issues did not have heart disease or arthritis engaged in moderate or strenuous physical activity After adjusting for 20 factors, the findings showed that people born in Canada were about 24% more likely to age successfully than Canadian immigrants — although most people in both groups met the study's standards for healthy aging. "The paper is interesting and adds to scientific literature," Dr. Sadana said. "It includes some elements of healthy aging in its concepts and analysis, but it also differs from the way WHO is both conceptualizing and operationalizing healthy aging. It's great that researchers are considering ways to analyze the richness of the CLSA." Limitations of population-based research The authors note some limitations in the CLSA data upon which their analysis was based. The CLSA did not ask participants some key questions that might have more precisely captured individuals' mental state, sense of well-being, and spiritual perspective. All of these may be important quality-of-life indicators. Canadian minorities were underrepresented in the CLSA, so an analysis of differences between them was not possible in the new study. At the same time, well-educated people were overrepresented. Four out of five people had post-secondary certificates or degrees, while less than half of Canadians over age 65 had a similar level of education. The CLSA was also conducted in English and French, Canada's two official languages. Thus, the CLSA did not record the experiences of immigrants who spoke neither language, a group that may face the greatest systemic obstacles to healthy aging. Finally, additional waves of data collection were unavailable for this study. They suggest future analyses based on more data may yield richer insights. Is there a secret to successful aging? Healthy aging may result from many factors, such as a person's genetics, lifestyle, environment, and access to affordable healthcare. In a 2016 research review, Dr. Sadana wrote that healthy aging is a matter of health equity. For healthy aging to exist globally, social determinants and inequities must also be addressed. The WHO, she said, aims to "empower policymakers in multiple sectors as well as those working to improve coordinated health and care services for older people — on how they can analyze their context and improve healthy aging." Esme Fuller-Thomson, Ph.D., director of the Institute for Life Course & Aging, professor at FIFSW, and senior investigator on the new study, told MNT there are several modifiable risk factors accessible to most people that may help promote successful aging: "The good news story in our study findings is that there are several individuals who were a healthy weight, were non-smokers, and who exercised regularly were much more likely to age successfully. While you can't change your age or your genes, these are three important things you can do to improve the likelihood you will remain in optimal health as you age." 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This facial is suitable for sensitive, dull and unnourished skin. The algae kelp mask contains minerals like calcium, fluorine and magnesium that contributes to a more radiant skin tone. Contraindication for this treatment: New scars, cut skin and extreme inflammation from any conditions and the client cannot use the Iontophoresis machine if; pregnant, has a pacemaker, epileptic, history of heart disease or other medical condition and severe skin conditions. Be the first to Write a Review for "Algae Kelp Facial (For Sensitive, Dry Skin)"
A well-groomed beard goes hand-in-hand with a proper skin care regimen. Find out how to care for the skin beneath your beard to achieve maximum handsome. You're proud of your ability to grow a beard. Unfortunately, beards can come with their own unique set of problems. Beard dandruff, itchy beard and other frustrating skin care problems can arise when the skin underneath your beard is neglected. What is the best way to care for your skin while maintaining your glorious beard? Taking care of your skin shouldn't be complicated, even with a beard. A skin care system formulated for men is essential to keeping skin healthy and vibrant. Certain products and shaving techniques can irritate the skin, causing beard dandruff or razor bumps. If you're like most guys, you probably clean your beard with the same shampoo you use for your hair. This is fine, so long as your shampoo doesn't contain moisture-stripping sulfates and other harsh ingredients. Still, even a gentle shampoo can dehydrate the skin and lead to dreaded beard dandruff. To avoid over-drying your skin, use shampoo once per week and conditioner about three times per week to clean it instead. Keep in mind that everyone's hair and skin are different. You may need to wash with conditioner more or less than three times a week to find the right balance for your skin. Regular exfoliation is key to preventing beard dandruff, ingrown hairs and dull skin. Using a men's facial scrub will remove dead skin cells from the surface of the skin and allow any products you use to be more effective. Although there are many benefits to adding a men's exfoliating scrub to your skin care routine, keep in mind that there can be too much of a good thing. Over-exfoliating can cause dry, itchy skin—the exact thing you're trying to avoid! If your beard is fairly bushy, you may benefit from a beard comb. Brushing your beard with a comb made for your beard will help spread your skin's natural oils and naturally slough off dead skin cells. As with any grooming product, be careful with what you choose. A nice, wooden beard comb will stimulate blood flow and promote healthy beard growth, while a cheap comb can damage the hair follicles. Because beard combs naturally exfoliate the skin, you may want to limit scrubbing your beard to once per week. However, don't forget to exfoliate the rest of your face twice per week as part of your regular skin care routine. Moisturizing day and night is an important part of every man's daily skin care regimen. The skin underneath your beard is no different in this regard. You already use a men's moisturizer for morning and bedtime. How do you moisturize the skin underneath your beard? While some men rub their facial moisturizer into their beard and call it good, many guys find it beneficial to use beard oil as well. Beard oil is formulated to reach deep within the hair follicle to rejuvenate the skin and hair shaft. Beard oil also helps you tame flyaway hairs and make your beard softer. However, be careful to read the back of your beard oil product carefully to avoid ingredients that can irritate your skin. When trimming up your beard, it's important to use the correct shaving technique. Otherwise, you could end up with red bumps, irritation and dry skin. One of the biggest mistakes we see men make is shaving too rough and fast. Going slow and gentle is key to avoiding razor bumps. Another common mistake is using dull blades. A razor blade should only be used 5-10 times before being tossed. If you have sensitive skin, consider using a soothing aftershave balm that is fragrance-free. Artificial fragrances have been linked to red, itchy skin in individuals with sensitive skin, among other problems (see claim: "…skin application of perfumes may cause contact dermatitis…"). Skin care and beard care should overlap. It's that simple. To properly take care of your beard and skin, it's time to level up your skin care products. Even with a beard, things don't need to be complicated. With just four products formulated specifically for men, you can achieve maximum handsome in minutes. To make things even easier for you, we'll send it straight to your doorstep! Check out our different skin care system levels and find the solution that best suits your skin care needs. Have questions? Get in touch with us!
When a person talks about arrhythmia symptoms they are having they are talking about symptoms that are caused by a heart rate or heart beat that is abnormal. A normal heart rate is 70 beats per minute. However if you are an athlete your heart rate may even be a little slower than that and still be considered normal. Arrhythmias symptoms are caused when the heart's electrical conduction system is damaged or confused. One of the most common causes for damaged or confusion in the electrical rhythm of the heart is a heart attack or coronary artery disease. Taking certain kinds of medications can also cause arrhythmias symptoms. For instance, if a higher than normal dose of antidepressants is taken it can cause a life-threatening arrhythmia to occur. People who take medication or hay fever can also develop a heart arrhythmia because of the medications they are taking. Arrhythmias interfere with the filling up of the heart with its normal blood supply and the output as it pumps the blood out. One of the first arrhythmia symptoms a person may notice is feeling of dizziness or faintness. If the lungs are not getting into blood there will also be shortness of breath and difficulty in breathing. Other arrhythmia symptoms include heart palpitations. Heart palpitations can feel like the heart is beating either too fast or that it is beating irregularly. Not all palpitations are arrhythmias however, unless they are excessively fast or really irregular. Other arrhythmia symptoms include feeling poundings in your chest or a noticeable chest discomfort. The person with an arrhythmia may also feel weak or fatigued. If you have a pre-existing condition where there is interference of blood supply to the heart or any damage caused by scarring to the heart tissue arrhythmia symptoms are common. The most common known cause of an arrhythmia is heart disease. Another cause can be a malfunctioning thyroid gland. Treatment for arrhythmias symptoms may or may not be necessary depending on the cause. Arrhythmia symptoms that are severe will definitely need treatment. Most people can manage mild arrhythmia symptoms usually with a few lifestyle changes. However if the arrhythmia is due to heart disease medical treatment by a trained cardiologist will be necessary. People who eat a heart healthy diet and get regular daily exercises can cut down on the occurrence of arrhythmias. Arrhythmia symptoms can also be reduced if the person stops smoking and drinking alcohol or using caffeine. The person with an arrhythmia should eat a low-fat high fiber diet and try to avoid stress and anxiety whenever possible. If medication is the cause of the arrhythmia the doctor may reduce the dosage or prescribe another type of medication for the patient. For instance, one type of antidepressant may cause arrhythmia symptoms which can be corrected by a different type of antidepressant medication. Hay fever medication also can cause heart arrhythmia symptoms in some people. Certain medications are used to treat arrhythmias symptoms as well. The most commonly medication used to treat arrhythmias is digoxin. This medication will help the heart rate slowed down and help the heart increase the amount of blood it pumps out in fills with during each heartbeat. Anti-arrhythmia medications have dangerous side effects and must be used only under the supervision of your doctor. If your doctor has prescribed anti-arrhythmia medication and you are experiencing any new or unusual symptoms you should report them to your doctor immediately. Sometimes electric shock treatment can be used to shock the heart back into its normal rhythm. Pacemakers are also used as an electrical stimulus to cause he heart to beat faster if it is too slow. Last updated on Sep 13th, 2010 and filed under Cardiovascular Disorders. Both comments and pings are currently closed.
There is sparse evidence for return to sport criteria after knee injury. Functional performance deficits, particularly in fatigued muscular condition, should be verified prior to the attempt to return to high-risk pivoting sports. The purpose of this study was to generate reference values for the limb symmetry index (LSI) of healthy subjects in fatigued and non-fatigued muscular condition in a newly designed test battery.
Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site. Anstey Watkins J., Wagner F., Xavier Gómez-Olivé F., Wertheim H., Sankoh O., Kinsman J. Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque's "Access to Healthcare" framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of "ABR" was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people's understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics. Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom. Humans, Anti-Bacterial Agents, Data Collection, Focus Groups, Health Knowledge, Attitudes, Practice, Qualitative Research, Adolescent, Adult, Middle Aged, Rural Population, Drug Utilization, South Africa, Female, Male, Young Adult
Inflammatory mediators increase Nav1.9 current and excitability in nociceptors through a coincident detection mechanism. Altered function of Na+ channels is responsible for increased hyperexcitability of primary afferent neurons that may underlie pathological pain states. Recent evidence suggests that the Nav1.9 subunit is implicated in inflammatory but not acute pain. However, the contribution of Nav1.9 channels to the cellular events underlying nociceptor hyperexcitability is still unknown, and there remains much uncertainty as to the biophysical properties of Nav1.9 current and its modulation by inflammatory mediators. Here, we use gene targeting strategy and computer modeling to identify Nav1.9 channel current signature and its impact on nociceptors' firing patterns. Recordings using internal fluoride in small DRG neurons from wild-type and Nav1.9-null mutant mice demonstrated that Nav1.9 subunits carry the TTX-resistant "persistent" Na+ current called NaN. Nav1.9(-/-) nociceptors showed no significant change in the properties of the slowly inactivating TTX-resistant SNS/Nav1.8 current. The loss in Nav1.9-mediated Na+ currents was associated with the inability of small DRG neurons to generate a large variety of electrophysiological behaviors, including subthreshold regenerative depolarizations, plateau potentials, active hyperpolarizing responses, oscillatory bursting discharges, and bistable membrane behaviors. We further investigated, using CsCl- and KCl-based pipette solutions, whether G-protein signaling pathways and inflammatory mediators upregulate the NaN/Nav1.9 current. Bradykinin, ATP, histamine, prostaglandin-E2, and norepinephrine, applied separately at maximal concentrations, all failed to modulate the Nav1.9 current. However, when applied conjointly as a soup of inflammatory mediators they rapidly potentiated Nav1.9 channel activity, generating subthreshold amplification and increased excitability. We conclude that Nav1.9 channel, the molecular correlate of the NaN current, is potentiated by the concerted action of inflammatory mediators that may contribute to nociceptors' hyperexcitability during peripheral inflammation.
Is your big toe pointing towards the small toes? Do you have a bony growth on the side of the big toe? Or your smaller toes are already curling up as a result of deviation of the big toe? You're not alone! Hallux Valgus is the condition when the big toe deviates laterally (pointing towards the smaller toes). When this happens, a bunion or bony growth may develop on the side or over the top of the big toe joint. If treatment gets delayed, the angle of deviation may increase over time, and the bunion may get larger and could end up in secondary issues including osteoarthritis. Likewise, other smaller toes of the foot may also deform causing hammertoes or clawed toes. Bunions and hammertoes are progressive and do not go away by themselves. Not all bunions are symptomatic but can certainly cause disabling pain in a lot of people and are commonly associated with irritation in footwear and are often a source of embarrassment due to the changed appearance of the sufferer's feet. Bunions are commonly thought to be caused by wearing tight, pointy or narrow shoes, inherited genetic traits, and stress on the foot from participating in certain sports or a medical condition, such as rheumatoid arthritis. In fact, the above factors only play a small part in causing the condition. The primary aggravating factor of a bunion is often related to the underlying biomechanical problems in the feet and subsequent compensations which causes the body to form a bunion. Misalignment of the ankle, restricted joints in the foot, inactive foot muscles, flatfeet and foot pronation can all contribute to the development of a bunion. Bunion: Is surgery the only treatment option? Most people think that surgery is the only remedy when it comes to bunions. Get this; our hands-on treatment approach aims at correcting the dysfunction and misalignment of the foot joints and our tailored solution is second to none. There are usually many underlying problems or compensations happening when a bunion is present. We focus on not only improving the alignment of the big toe but also addressing the underlying problems that cause the bunion. This is combined with Foot Mobilisation Techniques, Trigenics® Neuro-muscular Retraining, and corrective exercises to address weak and tight muscles and soft tissue that has been compensating to hold the big toe in that misaligned position. Conservative management is recommended as early as possible, even if the sufferer feels no pain. Studies tell us that most of the time, symptoms only occur after the condition has progressed into its advanced stages. As a result, by the time a bunion starts hurting, the significant irreversible damage has occurred. The sooner treatment is started, the sooner the underlying cause can be addressed. When it comes to bunion or hallux valgus, the early we get to it, the high chance of correcting the misalignment and reducing the bony growth. In many cases, especially when the treatment has been delayed, it's unlikely that deformity can be fully corrected, but we can still improve the function of the foot, maintain mobility of the bunion joint, and prevent the bunion from getting worse. We also manage the symptoms and address the underlying cause of the bunions which can lead to other pain and injuries. After bunion fusion surgery, is treatment still viable? Yes, treatment would still be beneficial in a number of ways. The big toe joint is one of the most important foot joints that we rely on every day to walk. Restriction of the joint can lead to foot, ankle, knee, hip and even lower back issues. Once it is fused, what happens to our walking pattern? It changes as our body compensates. These compensations can lead to tissue stress and changes further up in the foot and leg and need to be addressed, otherwise, other pain and injury can happen. As fusion is permanent, so are the compensations. The management will likely be long-term/lifelong to maintain health and function of the lower limb. What are you waiting for? Kindly get in touch with us to experience a new and improved bunion therapy.
Placement of a vena cava filter in term pregnancy: case report and review of the literature. During pregnancy there are hemostatic changes that may result in a hypercoagulable state producing thrombotic consequences. This condition may be aggravated in women who are carriers of congenital thrombophilic factors. These factors may increase obstetric complications such as miscarriages, fetal growth restriction, placental abruption and preeclampsia. Trombophilic factors may also cause venous thromboembolism, which is the leading cause of maternal morbidity and mortality. We report a case of a 22-year-old woman with factor V Leiden mutation, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. 18463459 - Abortion care for adolescents. 7897469 - Ever-pregnant and never-pregnant teens in a temporary housing shelter. 9701129 - Missed opportunities: teenagers and emergency contraception. 10729689 - Randomized trials versus observational studies in adolescent pregnancy prevention. 17484199 - Teenage pregnancy in the united kingdom: are we doing enough?
High rates of success in resolving IBS symptoms have been reported when treatment is specifically tailored to the underlying causes revealed through proper testing for the range of known causes of IBS symptoms. The multi-herbal extract Iberogast was found to be significantly superior to placebo via both an abdominal pain scale and an IBS symptom score after four weeks of treatment. Gut-directed or gut-specific hypnotherapy or self-hypnosis is one of the most promising areas of IBS treatment, also Traditional Chinese Medicine approaches IBS on an individual symptom-by-symptom basis, rather than recognizing a standard "IBS" diagnosis, which then warrants a blanket "IBS" treatment. The magnitude of information available on IBS - Irritable Bowel Syndrome can be found out by reading the following matter on IBS - Irritable Bowel Syndrome. We ourselves were surprised at the amount! IBS is irritable bowel syndrome. IBS symptoms typically include abdominal pain which is relieved by a bowel movement. There may be excessive gas and bloating. Changes in frequency and appearance of stools are also IBS symptoms. IBS symptoms may include constipation and/or diarrhea. Writing this composition on IBS - Irritable Bowel Syndrome was a significant contribution of ours in the world of literature. Make this contribution worthwhile by using it. Peppermint oil is widely used for irritable bowel syndrome. It is thought to decrease the abdominal pain and bloating of irritable bowel syndrome, possibly by blocking the movement of calcium into muscle cells in the intestines. Partially hydrolyzed guar gum (PHGG) is a water soluble, non-gelling fiber that may help to reduce constipation and to a lesser extent diarrhea and abdominal pain in people with irritable bowel syndrome. Caffeinated drinks such as coffee, and carbonated soft drinks can aggravate symptoms and should be limited, especially in the initial stages of dietary modification. Maintaining the value of IBS - Irritable Bowel Syndrome was the main reason for writing this article. Only in this way will the future know more about IBS - Irritable Bowel Syndrome. Some people with IBS find that careful eating helps reduce or eliminate IBS symptoms. You might try avoiding very large meals, drinks with caffeine, spicy or fatty foods, chocolate, some dairy products, and foods that contain gluten. Some people find that adding fiber ??? eating more fruits and vegetables, for instance ??? and drinking more water can help eliminate IBS symptoms, too. Give yourself a momentary pause while reading what there is to read here on IBS - Irritable Bowel Syndrome. Use this pause to reflect on what you have so far written on IBS - Irritable Bowel Syndrome. In 1990, 20% of the U.S. population suffered from acid reflux symptoms at least twice a week. Next to simple occasional heartburn, this may be the most common of all the digestive disorders. A recent study showed that 25% of all Americans suffer from heartburn at least once a month. In 2002, 710,000 people were hospitalized due to acid reflux and other related esophageal disorders. There are no figures available on the number of dollars that Americans spend per year treating the digestive system disorders acid reflux and heartburn. This is due largely to the fact that many people treat these digestive disorders with over the counter antacids or other non-prescription medications and some people do not seek treatment at all. The information available on IBS - Irritable Bowel Syndrome is infinite. There just seems to be so much to learn about, and to write about on IBS - Irritable Bowel Syndrome. Irritable bowel syndrome is characterized by a group of symptoms in which abdominal pain or discomfort is associated with a change in bowel pattern, such as loose or more frequent bowel movements, diarrhea, and/or constipation.The completion of this article on IBS - Irritable Bowel Syndrome was our prerogative since the past one month. However, we completed it within a matter of fifteen days! Answer : YOU can try probiotics capsules that are lactose free, suitable for people suffering from milk intolerance. Other products that may help ease the symptoms include double strength fish oil containing marine fish oil derived from sardines and anchovies. Smaller fish such as these contain oils lower in environmental toxins than large predatory fish such as tuna and cod. Milk thistle and dandelion are good for constipation, besides being liver tonics. We needed lots of concentration while writing on IBS - Irritable Bowel Syndrome as the matter we had collected was very specific and important.
Flavor and fragrance compositions The present invention provides a flavor and fragrance composition which comprises, as the active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, wherein the flavor and fragrance composition is for use in food and beverage, fragrances and cosmetics, pharmaceuticals or oral compositions and the like; a product which is scented with the flavor and fragrance composition; and a method for enhancing or modulating odor of the flavor and fragrance composition by adding the optically active (1S)-8-mercaptomenthone. Emura, Makoto (Kanagawa, JP) Masumura, Satoshi (Kanagawa, JP) Maruyama, Kenji (Kanagawa, JP) Yamamoto, Takeshi (Tokyo, JP) Takasago International Corporation (Ohta-ku, JP) A61K47/00; A61K8/46 20080161223 Spirobornyl-2,4-(1,3-Dioxanes)] And Their Uses As Fragrance Ingredients July, 2008 Bajgrowicz 20020065209 Surfactant system used to improve processing of gel air fresheners May, 2002 Valesky et al. 20080293616 Use of 2-(1,1,4-Trimethylpent-3-Enyl)-4,7-Dihydro-1,3-Dioxepine November, 2008 Dilk et al. 20090111729 Infused Sealant System April, 2009 Keyt 20060211597 Cis-3,3,5-trimethylcyclohexyl esters September, 2006 Kuhn et al. 20080248177 3- and 4-Methyl Dodecenal and their Use in Fragrance and Flavour Compositions October, 2008 Kaiser 20050064000 Preparation containing 2-methyl-1,3-propanediol March, 2005 Kropke et al. 20090162308 USE OF 2,4'-DIMETHYLPROPIOPHENONE AS A FRAGRANCE SUBSTANCE June, 2009 Kuhn et al. 20080305977 PERFUME SYSTEMS December, 2008 Smets et al. 20070274928 Novel Cyclic Oxygenated Compounds Having Cooling, Fragrance, and Flavor Properties, and Uses Thereof November, 2007 Selifonov 20100093682 LIPID COMPOSITION HAVING EXCELLENT SHAPE RETENTION PROPERTY AND PRODUCT April, 2010 Ishida et al. SOROUSH, LAYLA Venable LLP (New York, NY, US) 1. A flavor and fragrance composition which comprises, as an active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight. 2. The flavor and fragrance composition according to claim 1, wherein the optically active (1S)-8-mercaptomenthone has a chemical purity of 90% or more and has an optical purity of 90% e.e. or more. 3. The flavor and fragrance composition according to claim 1 or 2, which is the flavor. 4. The flavor and fragrance composition according to claim 1 or 2, which is the flavor, wherein the optically active (1S)-8-mercaptomenthone is in an amount of from 10−5 to 103 ppb by weight based on the total weight of the flavor and fragrance composition. 5. The flavor and fragrance composition according to claim 1 or 2, which is the fragrance. 6. The flavor and fragrance composition according to claim 1 or 2, which is the fragrance, wherein the optically active (1S)-8-mercaptomenthone is in an amount of from 10−1 to 106 ppb by weight based on the total weight of the flavor and fragrance composition. 7. A flavored and fragrance-added product comprising the flavor and fragrance composition according to claim 1 or 2, said product being scented with the flavor and fragrance composition. 8. The flavored and fragrance-added product according to claim 7, which is one member selected from the group consisting of food and beverage, oral compositions and pharmaceuticals. 9. The flavored and fragrance-added product according to claim 7, which is one member selected from the group consisting of fragrance products, skin-care cosmetics, make-up cosmetics, hair cosmetics, anti-sunburn cosmetics, medicinal cosmetics, hair care products, soap, body lotions, bath liquids, detergents, soft finishing agents, cleaning agents, kitchen detergents, bleaching agents, aerosol agents, deodorant-aromatics, repellents and sundries. 10. A flavored product which comprises an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, in an amount of from 10−8 to 1 ppb by weight based on the total weight of the flavored product. 11. A fragrance-added product which comprises an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, in an amount of from 10−4 to 105 ppb by weight based on the total weight of the fragrance-added product. 12. A method for enhancing or modulating an odor of a flavor and fragrance composition, which comprises adding an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight, to the flavor and fragrance composition. 13. The method for enhancing or modulating an odor of a flavor and fragrance composition according to claim 12, wherein the flavor and fragrance composition is one member selected from the group consisting of synthetic aroma chemicals, natural essential oils, synthetic essential oils, citrus fruit oils and animal aroma chemicals. The present invention relates to a flavor and fragrance composition which comprises, as an active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight; and food and beverages, oral compositions, fragrances and cosmetics, pharmaceuticals and the like products scented with the flavor and fragrance composition. In recent years, accompanied by the diversification of various food materials, food additives, foods and beverages (including articles of taste), fragrances and cosmetics, sanitation materials, sundries, pharmaceuticals and the like, new demands for a flavor and fragrance to be used therein have been increasing, and concerns have been directed toward the development of aromatic materials having a highly-tasting unique odor. Particularly, with the recent uprush of the nature-oriented style of people and also from the safety point of view, great concerns have been directed toward the development of new aromatic materials derived from natural compounds, or identical or similar to the natural compounds, with regard to highly tasting fruity flavors and fragrances and tropical flavors and fragrances by which the natural environment can be imaged characteristically. 8-Mercaptomenthone has two chiral centers, and a total of 4 isomers including optical isomers are present. 8-Mercaptomenthone has been found as an essential-oil component of Buchu oil in the past studies, and is synthesized from d-pulegone and l-pulegone whose absolute structures of the natural product are already known. Additionally, according to the angle of rotation thereof, a (1S,4R) isomer has been found as the main component thereof, and a (1S,4S)-isomer as a diastereomer thereof has also been detected simultaneously. However, the mixing ratio thereof has not been disclosed (cf., Non-patent Reference 1). In addition, synthesis method of each of these 4 isomers has been established and their sensory evaluation has been carried out. As a result, it has been reported that the (1S,4S)-isomer is particularly superior in odor, and the (1S,4R)-isomer also has a desirable odor. On the other hand, it has been reported as an evaluation result that the (1R,4R)-isomer and (1R,4S)-isomer accompany a rubber-like malodor. The products synthesized herein are the natural product having a mixing ratio of the (1S,4S)-isomer and (1S,4R)-isomer of 57:43, and the non-natural product having a mixing ratio of the (1R,4R)-isomer and (1R,4S)-isomer of 58:42 (cf., Non-patent Reference 2). 8-Mercaptomenthone has so far been used as a flavor and fragrance component (cf., Patent Reference 1). However, the 8-mercaptomenthone which has so far been used as the flavor and fragrance is a (1R)-isomer. This is because d-pulegone is used as the starting material which can be obtained easily and inexpensively from the nature. The pulegone used in Reference Example 1 of the Patent Reference 1 is also d-pulegone because its angle of rotation is +220, and the mixing ratio is 3:2. In addition, according to Reference Example 4, 8-mercaptomenthone (αD20=−12.0°) is obtained as a cis-trans mixture using isopulegone (αD20 124.2°) as the raw material. However, the mixing ratio is unknown. Patent Reference 1: JP-B-49-24668 Non-patent Reference 1: J. Agric. Food Chem., 23(5), 943-50 (1975) Non-patent Reference 2: Z. Lebensm Unters Forsch., 194, 372-376 (1992) An object of the present invention is to provide a highly-tasting and excellent flavor and fragrance composition which can satisfy the demands for diversifying scented products. Particularly, the invention aims at providing an flavor and fragrance composition which comprises, as the active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight; and food and beverage, oral compositions, cosmetics, pharmaceuticals and the like products scented with the flavor and fragrance composition. Under such circumstances, the present inventors have conducted intensive studies and found as a result that an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight, which is different from the (1R)-8-mercaptomenthone generally used in the market and cannot be easily obtained from natural sources, has a unique odor having a high flavor- and fragrance-creating ability, is excellent in the harmonizing property with other flavors and fragrances to be used, and can impart a deep texture and good body that were insufficient by the conventional analogous compounds derived from natural or processed food and beverage, thereby accomplishing the present invention. Namely, the present invention includes the followings. (1) A flavor and fragrance composition which comprises, as an active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight. (2) The flavor and fragrance composition according to (1), wherein the optically active (1S)-8-mercaptomenthone has a chemical purity of 90% or more and has an optical purity of 90% e.e. or more. (3) The flavor and fragrance composition according to (1) or (2), which is the flavor. (4) The flavor and fragrance composition according to (1) or (2), which is the flavor, wherein the optically active (1S)-8-mercaptomenthone is in an amount of from 10−5 to 103 ppb by weight based on the total weight of the flavor and fragrance composition. (5) The flavor and fragrance composition according to (1) or (2), which is the fragrance. (6) The flavor and fragrance composition according to (1) or (2), which is the fragrance, wherein the optically active (1S)-8-mercaptomenthone is in an amount of from 10−1 to 106 ppb by weight based on the total weight of the flavor and fragrance composition. (7) A flavored and fragrance-added product comprising the flavor and fragrance composition according to (1) or (2), said product being scented with the flavor and fragrance composition. (8) The flavored and fragrance-added product according to (7), which is one member selected from the group consisting of food and beverage, oral compositions and pharmaceuticals. (9) The flavored and fragrance-added product according to (7), which is one member selected from the group consisting of fragrance products, skin-care cosmetics, make-up cosmetics, hair cosmetics, anti-sunburn cosmetics, medicinal cosmetics, hair care products, soap, body lotions, bath liquids, detergents, soft finishing agents, cleaning agents, kitchen detergents, bleaching agents, aerosol agents, deodorant-aromatics, repellents and sundries. (10) A flavored product which comprises an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, in an amount of from 10−8 to 1 ppb by weight based on the total weight of the flavored product. (11) A fragrance-added product which comprises an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, in an amount of from 10−4 to 105 ppb by weight based on the total weight of the fragrance-added product. (12) A method for enhancing or modulating an odor of a flavor and fragrance composition, which comprises adding an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight, to the flavor and fragrance composition. (13) The method for enhancing or modulating an odor of a flavor and fragrance composition according to (12), wherein the flavor and fragrance composition is one member selected from the group consisting of synthetic aroma chemicals, natural essential oils, synthetic essential oils, citrus fruit oils and animal aroma chemicals. By adding the optically active (1S)-8-mercaptomenthone of the present invention having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight, a highly-tasting composition having meaty, green, grape fruits, catty, floral or the like peculiar strong fragrance and flavor can be obtained. This composition is broadly used as perfumes or scented compositions for various food materials, food additives, food and beverage, fragrances and cosmetics, hygiene materials and the like. The following describes the present invention in detail. The 8-mercaptomenthone is a compound in which the 1-position and 4-position of the cyclohexane moiety are chiral carbon atoms. Illustratively, there are (1S,4R)-8-mercaptomenthone, (1S,4S)-8-mercaptomenthone, (1R,4S)-8-mercaptomenthone and (1R,4R)-8-mercaptomenthone. The present invention relates to a flavor and fragrance composition which comprises, as an active ingredient, an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, preferably in the range of from 70:30 to 90:10 by weight. In this regard, it is preferable that the optically active (1S)-8-mercaptomenthone has a chemical purity of 90% or more, preferably 95% or more and has an optical purity of 90% e.e. or more, preferably 95% e.e. or more. Each of the aforementioned mixture of R-form and S-form of optically active (1S)-8-mercaptomenthone with a specified ratio shows a strong and fresh passion fruit-like peculiar strong odor. Since the mixture of R-form and S-form of optically active (1S)-8-mercaptomenthone with a specified ratio to be used in the present invention exerts its effect even in an extremely small amount, it can impart the flavor and fragrance to the base materials of various food and beverage and fragrances and cosmetics which require scenting with flavors and fragrances. In this connection, (1R)-8-mercaptomenthone having different configuration at the 1-position is not sufficiently effective, because it accompanies a rubber-like malodor. In addition, even in the case of (1S)-8-mercaptomenthone, a mixture having an S-form/R-form mixing ratio for the configuration overstepping the range of from 65:35 to 95:5 is not sufficiently effective, because it is inferior in terms of the intensity of the odor. As the mixture of R-form and S-form of optically active (1S)-8-mercaptomenthone with a specified ratio to be used in the present invention, a mixture obtainable by extracting from natural materials can be used, and a mixture obtainable by a chemical synthesis method can also be used. In order to obtain the optically active (1S)-8-mercaptomenthone of the present invention in a large amount, it is desirable to use the mixture obtainable by a chemical synthesis method. The (1S)-8-mercaptomenthone of the present invention is a compound represented by the following formula which is obtainable by adding hydrogen sulfide to an optically active l-pulegone. However, since the pulegone which can be found in nature is d-pulegone in almost all cases, a method for synthesizing the optically active l-pulegone in a large amount is required for producing the (1S)-8-mercaptomenthone of the present invention. The optically active l-pulegone can be obtained, for example, by the reaction represented by the following reaction scheme. In this reaction, l-citronellal (e.g., manufactured by Takasago International Corporation) is used as the starting material, and is firstly converted into d-isopulegol by conducting a cyclization reaction with a Lewis acid. Subsequently, isomerization of the double bond of the thus obtained d-isopulegol is carried out, for example, in the coexistence of a copper-zinc-aluminum catalyst, together with a dehydrogenation reaction to obtain the optically active l-pulegone. In addition, as is represented by the following reaction scheme, the optically active l-pulegone is also obtainable by carrying out asymmetric hydrogenation of piperitenone (cf., JP-A-2002-30009, herein incorporated by reference). The optically active (1S)-8-mercaptomenthone thus obtained is a mixture of (1S,4R)-8-mercaptomenthone and (1S,4S)-8-mercaptomenthone. The mixture of R-form and S-form of optically active (1S)-8-mercaptomenthone with a specified ratio according to the present invention is obtainable by applying usual separation purification methods (e.g., column chromatography, distillation and the like) to the (1S)-8-mercaptomenthone obtained in the aforementioned manner. For example, as the method for obtaining an optically active (1S)-8-mercaptomenthone having an S-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight, a chemical purity of 90% or more and an optical purity of 90% e.e. or more, a method in which a fraction secondarily distilled out with the ratio of interest by the distillation is fractionated may be mentioned. The mixture of (4R)-form and (4S)-form of the optically active (1S)-8-mercaptomenthone according to the present invention shows a strong and fresh passion fruit-like peculiar strong odor. Since the mixture of (4R)-form and (4S)-form of optically active (1S)-8-mercaptomenthone to be used in the present invention exerts its effect even in a small amount, it can impart the fragrance to the base materials of various food and beverage and fragrances and cosmetics which require scenting with flavors and fragrances. In this connection, (1R)-8-mercaptomenthone having different configuration at the 1-position is not sufficiently effective, because it accompanies a rubber-like malodor. In addition, even in the case of (1S)-8-mercaptomenthone, a mixture having an S-form/R-form mixing ratio for the configuration overstepping the range of from 65:35 to 95:5 is not sufficiently effective, because it is inferior in terms of the intensity of the flavor and fragrance. Also, the mixture of R-form and S-form of optically active (1S)-8-mercaptomenthone of the present invention has a strong and fresh passion fruit-like peculiar strong odor characteristics, and also has significant odor persistency and stability, so that highly-tasting fragrance and flavor compositions can be provided by formulating the mixture. In addition, by formulating the mixture of R-form and S-form of the optically active (1S)-8-mercaptomenthone according to the present invention, the action and effect of flavor and fragrance persistency and flavor and fragrance retention are particularly improved. Namely, the odor of flavor and fragrance composition may be enhanced or modulated by adding the optically active (1S)-8-mercaptomenthone having an 3-form/R-form mixing ratio for the configuration at the 4-position of from 65:35 to 95:5 by weight. The optically active (1S)-8-mercaptomenthone has an S-form/R-form mixing ratio for the configuration at the 4-position in the range of from 65:35 to 95:5 by weight, preferably in the range of from 70:30 to 90:10 by weight. In this regard, it is preferable that the optically active (1S)-8-mercaptomenthone has a chemical purity of 90% or more, preferably 95% or more and has an optical purity of 90% e.e. or more, preferably 95% e.e. or more. Flavor and fragrance compositions prepared by further adding a generally used flavor and fragrance component to the mixture of R-form and S-form of the optically active (1S)-8-mercaptomenthone according to the invention can also be used as a fragrance component and a flavor component. As the additional flavors and fragrances which is added and used, various synthetic aroma chemicals, natural aroma chemicals, natural essential oils, citrus fruit oils, animal aroma chemicals and the like can be mentioned, and a floral green-like flavor and fragrance composition is particularly desirable. For example, a broad range of fragrance components described in 'Arctander S., "Perfume and Flavor Chemicals", published by the author, Montclair, N.J. (U.S.A.) in 1969' can be used. Their typical examples include α-pinene, limonene, cis-3-hexenol, phenylethyl alcohol, styralyl acetate, eugenol, rose oxide, linalool, benzaldehyde, muscone, Thesaron (manufactured by Takasago International Corporation) and the like. Illustratively, when the mixture of (4R)-form and (4S)-form of the optically active (1S)-8-mercaptomenthone according to the invention is added, for example, to bergamot oil, galbanum oil, lemon oil, geranium oil, lavender oil, mandarin oil or the like natural essential oil, a novel flavor and fragrance composition with emphasized persistency, in which the fragrance and flavor originally possessed by the natural essential oil are improved in terms of mildness, richness, freshness and high tasting, and diffusivity and holding ability thereof are enhanced, can be prepared. In addition, when the mixture is added to, for example, a strawberry, lemon, orange, grapefruit, apple, pineapple, banana, melon, green tea, Oolong tea, black tea or the like flavor composition, which is prepared from various synthetic aroma chemicals, natural aroma chemicals, natural essential oils, citrus fruit oils, tea extracts, animal aroma chemicals and the like, a flavor and fragrance composition with emphasized persistency, which is provided with mild, rich and natural-like fruity or tropical flavor and fragrance and is further provided with a fresh and high-tasting fragrance and in which the diffusivity and holding ability are improved, can be prepared. The amount of the mixture of (4R)-form and (4S)-form of the optically active (1S)-8-mercaptomenthone according to the present invention to be added to the flavor and fragrance composition varies depending on the kind and purpose of the flavors and fragrances. For example, in the case of fragrance compositions, the amount of the mixture is preferably from 10−1 to 106 ppb by weight based on the total weight of the composition. In addition, in the case of flavor compositions, the amount of the mixture is preferably from 10−5 to 103 ppb by weight based on the total weight of the composition. In addition, it may be blended with one or two or more generally-used flavor- and flagrance-retaining agents, and for example, it is possible to use the mixture together with ethylene glycol, propylene glycol, dipropylene glycol, glycerol, hexylene glycol, benzyl benzoate, triethyl citrate, diethyl phthalate, Hercolyn, middle-chain fatty acid triglyceride and the like. According to the present invention, fragrance-added products and flavored products can be provided by blending the optically active (1S)-8-mercaptomenthone alone, or an fragrance composition or a flavor composition containing the compound, in such an appropriate amount that the unique fragrance and flavor thereof can be added, for example with fragrance products, skin-care cosmetics, make-up cosmetics, hair cosmetics, anti-sunburn cosmetics, medicinal cosmetics, hair-care products, soap, body lotions, bath liquids, detergents, soft finishing agents, cleaners, kitchen detergents, bleaching agents, aerosol agents, deodorant-aromatics, repellents and sundries; or with food and beverage, oral compositions and pharmaceuticals. For example, there may be mentioned perfumed water, Eau de Perfum, Eau de toilette, Eau de cologne and the like as the fragrance products; and face washing cream, vanishing cream, cleansing cream, cold cream, massage cream, milky lotion, toilette lotion, beauty wash, pack, make remover and the like as the skin-care cosmetics; foundation, face powder, pressed powder, talcum powder, rouge, lipstick, lip cream, cheek rouge, eye liner, mascara, eye shadow, eyebrow-color, eye pack, nail enamel, enamel remover and the like as the make-up cosmetics; pomade, brilliantine, set lotion, hair stick, hair solid, hair oil, hair treatment, hair cream, hair tonic, hair liquid, hair spray, bandlin, hair growth aegnt, hair dye and the like as the hair cosmetics; suntan product, sun screen product and the like as the anti-sunburn cosmetics; and antiperspirant, after-shaving lotion and gel, permanent wave agent, medicinal soap, medicinal shampoo, medicinal skin cosmetics and the like as the medicinal cosmetics. There may be mentioned shampoo, rinse, rinse-in-shampoo, conditioner, treatment, hair pack and the like as the hair-care products; and toilet soap, bath soap, scented soap, transparent soap, synthetic soap and the like as the soap; body soap, body shampoo, hand soap and the like as the body lotions; and bath agents (bath salt, bath tablet, bath liquid or the like), foam bath (bubble bath or the like), bath oil (bath perfume, bath capsule or the like), milk bath, bath jerry, bath cube and the like as the bath liquids. Further, there may be mentioned heavy detergent for clothing, light detergent for clothing, liquid detergent, laundry soap, compact detergent, powder soap and the like as the detergents; and softener, furniture care and the like as the soft finishing agents; cleanser, house cleaner, toilet cleaner, bath cleaner, glass cleaner, mold remover, waste pipe cleaner and the like as the cleaners; kitchen soap, kitchen synthetic soap, tableware detergents and the like as the kitchen detergents; oxidation type bleaching agent (e.g., a chlorine base bleaching agent or oxygen base bleaching agent), reduction type breaching agent (e.g., sulfur base bleaching agent), optical bleaching agent and the like as the bleaching agents; spray-type aerosols, powder spray and the like as the aerosol agents; deodorants or deodorizers of solid-type, gel-type, liquid-type and the like as the deodorant-aromatics; and tissue paper, toilette paper and the like as the sundries. Moreover, there may be mentioned fruit juice beverages, fruit wines, milk beverages, carbonated beverages, soft beverages, drinking agents and the like beverages; and ice creams, sherbets, ice candies and the like frozen desserts; Japanese-style and Western-style confectioneries; jams; candies; jellies; gums; breads; coffees, cocoas, black teas, oolong teas, green teas and the like luxury beverages; Japanese-style soup, Western-style soup, Chinese-style soup and the like soups; flavor and condiment; various types of instant beverages and foods; various types of snack foods and the like as the foods and beverages. As the oral compositions, dentifrice, oral washing agent, mouse wash, troche, chewing gums and the like may be mentioned. Further, as the pharmaceuticals, skin external preparations such as cataplasmas and ointments; internal medicines and the like may be mentioned. When the optically active (1S)-8-mercaptomenthone of the present invention is used in fragrance products, basic skin cares, finishing cosmetics, hair cosmetics, anti-sunburn cosmetics, medicinal cosmetics, hair-care products, soap, body lotions, bath liquids, detergents, soft finishing agents, cleaning agents, kitchen detergents, bleaching agents, aerosol agents, deodorant-aromatics, repellents and sundries; or in food and beverage, oral compositions, pharmaceuticals and the like, the compound may be used directly, or by selecting optional shapes in accordance with the respective purposes, such as a liquid state in which the compound is dissolved in alcohols, propylene glycol, glycerol and the like polyhydric alcohols; a state in which the compound is mixed with gum arabic, tragacanth gum and the like natural gummy matters; an emulsified state in which the compound is emulsified with glycerol fatty acid ester, sucrose fatty acid ester and the like emulsifiers; a powdery state in which the compound is coated using natural gummy matters such as gum arabic, gelatin, dextrin and the like fillers; a solubilized or dispersed state in which the compound is solubilized or dispersed using surfactants such as a nonionic surfactant, an anionic surfactant, a cationic surfactant, an ampholytic surfactant and the like; a microcapsular state which is obtainable by treating the compound with a capsulation agent; and the like. In addition, it is possible to use the aforementioned flavor and fragrance compositions in a stable and releasable state by including the compositions in an inclusion agent such as cyclodextrin These are used by optionally selecting those which are suited for the shapes of the final product, such as a liquid state, a solid state, a powder state, a gel state, a mist state, an aerosol state and the like. In this connection, amount of the (1S)-8-mercaptomenthone of the invention to be added to the fragrance-added products such as fragrance products, skin-care cosmetics, make-up cosmetics, hair cosmetics, anti-sunburn cosmetics, medicinal cosmetics, hair care products, soap, body lotions, bath liquids, detergents, soft finishing agents, cleaning agents, kitchen detergents, bleaching agents, aerosol agents, deodorant-aromatics, repellents and sundries is optionally controlled in response to the expected effects and actions of respective cases and is generally approximately from 10−4 to 105 ppb by weight based on the total weight of the fragrance-added product. Also, amount of the (1S)-8-mercaptomenthone of the invention to be added to flavored products such as food and beverage, oral compositions and pharmaceuticals is optionally controlled in response to the expected effects and actions of respective cases and is generally approximately from 10−8 to 1 ppb by weight based on the total weight of the flavored product. The present invention will be explained below in more detail by reference to Examples and Comparative Examples, but the present invention should not be construed as being limited to the following Examples, and it is possible to change them within such a range that they do not overstep the scope of the present invention. In this connection, in the formulations described below, the % means weight %, and the part means part by weight unless otherwise noted. The analyses in the examples were carried out using the following instruments for analysis. <Angle of Rotation> Instrument; DIP-370 (mfd. by Japan Spectroscopic Co., Ltd.) <Proton Nuclear Magnetic Resonance Spectrum (1H-NMR)> Instrument: AM-400 type (400 MHz) (mfd by Bruker BioSpin GmbH) Internal Standard Substance: tetramethylsilane <Infrared Absorption Spectrum IR)> Instrument: Nicolet Avatar 360 FT-IR (mfd. by Nicolet Japan) <Mass Spectrum (MS)> Instrument; M-80B mass spectrometer (ionization voltage: 20 eV) (mfd. by Hitachi, Ltd.) <Gas Chromatograph> Instrument: HP-5890 (mfd. by Hewlett Packard) Column: PEG BC-WAX (0.25 mm×50 m) (mfd. by GL Sciences Inc.) Synthesis Example 1 Synthesis of l-pulegone from l-citronellal (1) Synthesis of d-isopulegol In a stream of argon, 1.44 g of zinc bromide was added to a 300 ml capacity reaction vessel, 100 g of l-citronellal and 50 ml of toluene were subsequently added thereto, and then they were stirred at 110° C. for 17 hours. After completion of the reaction, 50 ml of 4% sodium hydroxide aqueous solution was added thereto, separation was carried out, toluene was evaporated, and the distillation was subsequently carried out to obtain 71 g of d-isopulegol as a colorless oily substance. (2) Synthesis of l-pulegone A 50 g portion of the d-isopulegol obtained in (1) was stirred at 150° C. for 8 hours in the coexistence of 200 mg of a copper-zinc-aluminum catalyst to carry out isomerization of the double bond together with dehydrogenation reaction, thereby obtaining 40 g of l-pulegone (yield 81%). Synthesis of l-pulegone from piperitenone A 500 ml capacity autoclave was charged with 150 g (1 mol) of piperitenone, 18.6 mg (0.04 mmol) of bis(1,5-cyclooctadiene)rhodium (I) hexafluorophosphate (to be referred to as [Rh(cod)2]PF6 hereinafter), 47.2 mg (0.04 mmol) of (R)-(4,4′-bi-1,3-benzodioxiol)-5,5′diylbis(di(3,5-di-tert-butyl-4-methoxyphenyl)phosphine (to be referred to as (R)-DTBM-SEGPHOS hereinafter), 14.8 mg (0.02 mmol) of tetramethylenebis(triphenylphosphonium bromide) (to be referred to as BrPPh3(CH2)4PPh3Br hereinafter) and 7.5 ml of ethyl acetate, and the reaction was carried out at 50° C. for 20 hours under a hydrogen pressure of 3 MPa. After completion of the reaction, hydrogen was purged, and the reaction solution was concentrated and distilled under a reduced pressure to obtain 136.8 g of l-pulegone (yield 90%). Synthesis of (1S)-mercaptomenthone from l-pulegone A reactor equipped with a thermometer and a gas-introducing tube was charged with the l-pulegone (3 g, 23 mmol) obtained in Synthesis Example 1 or Synthesis Example 2 and methylene chloride (30 ml), anhydrous aluminum chloride (612 mg, 0.2 equivalent) was added thereto, and then hydrogen sulfide gas was blown through the gas-introducing tube for 3 hours. After completion of the reaction, a portion of the reaction mixture was taken out, and the conversion ratio was measured by a gas chromatography to find that it was 100%. After releasing the remaining hydrogen sulfide from the reaction mixture by nitrogen, a crude product was obtained in the usual way by dilute hydrochloric acid treatment, washing with water and concentration. By distilling the thus obtained crude product under a reduced pressure (95° C./600 Pa), 2.8 g (yield 65%) of the title compound was obtained with a purity of 96%. Ratio of S-form to R-form for the configuration at the 4-position of this compound was 60:40. A 1.0 g portion of the thus obtained (1S)-8-mercaptomenthone having an S-form/R-form ratio for the configuration at the 4-position of 60:40 was purified by a recycling method using a gas chromatographic separation. (1S,4R)-8-Mercaptomenthone (cis-form) [α]D20 −43 5° (c=1.3, CH3OH) MS (m/z): 153 (—SH) IR (neat): 1709, 2583 cm−1 1H-NMR (CDCl3, δppm): 1.02 (3H, d), 1.40 (6H, s), 2.30 (1H, s) (1S,4S)-8-Mercaptomenthone (trans-form) [α]D20 +29.6° (c=1.5, CH3OH) IR (neat); 1709, 2583 cm−1 1H-NMR (CDCl3, δ ppm): 0.96 (3H, d), 1.40 (3H, s), 1.45 (3H, s), 2.35 (1H, s) Preparation of S-form/R-form mixture for the configuration at the 4-position of (1S)-8-mercaptomenthone The fore-running and aft-running of 2.8 g of the (1S)-8-mercaptomenthone wherein S-form/R-form for the configuration at the 4-position was 60:40, obtained in Synthesis Example 3, were cut off under a reduced pressure, and the main fraction was cracked under a condition with a boiling point of 90° C. at 200 Pa to obtain 2.0 g of (1S)-8-mercaptomenthone wherein S-form/R-form for the configuration at the 4-position was 75/25. Synthesis of d-pulegone from d-citronellal (1) Synthesis of l-isopulegol In a stream of argon, 1.44 g of zinc bromide was added to a 300 ml capacity reaction vessel, 100 g of d-citronellal and 50 ml of toluene were subsequently added thereto, and then they were stirred at 110° C. for 17 hours. After completion of the reaction, 50 ml of 4% sodium hydroxide aqueous solution was added thereto, the layers were separated, toluene was evaporated, and the distillation was carried out to obtain 71 g of l-isopulegol as a colorless oily substance. (2) Synthesis of d-pulegone A 50 g portion of the l-isopulegol obtained in (1) was stirred at 150° C. for 8 hours in the coexistence of 200 mg of a copper-zinc-aluminum catalyst to carry out isomerization of the double bond together with dehydrogenation reaction, thereby obtaining 43 g of d-pulegone (yield 87%). Synthesis of d-pulegone from piperitenone A 500 ml capacity autoclave was charged with 150 g (1 mol) of piperitenone, 18.6 mg (0.04 mmol) of [Rh(cod)2]PF6, 47.2 mg (0.04 mmol) of (S)-DIBM-SEGPHOS, 14.8 mg (0.02 mmol) of BrPPh3(CH2)4PPh3Br and 7.5 ml of ethyl acetate, and the reaction was carried out at 50° C. for 20 hours under a hydrogen pressure of 3 MPa. After completion of the reaction, hydrogen was purged, and the reaction solution was concentrated and distilled under a reduced pressure to obtain 136.8 g of d-pulegone (yield 90%). Synthesis of (1R)-mercaptomenthone from d-pulegone A reactor equipped with a thermometer and a gas-introducing tube was charged with the d-pulegone (3 g, 23 mmol) obtained in Synthesis Example 5 and methylene chloride (30 ml), anhydrous aluminum chloride (612 mg, 0.2 equivalent) was added thereto, and then hydrogen sulfide gas was blown through the gas-introducing tube for 3 hours. After completion of the reaction, a portion of the reaction mixture was taken out, and the conversion ratio was measured by a gas chromatography to find that it was 100%. By distilling the thus obtained crude product under a reduced pressure (95° C./600 Pa), 3 g (yield 70%) of the title compound was obtained with a purity of 96%. Ratio of trans-form to cis-form of the compound was 60:40. A 1.0 g portion of the thus obtained (1R)-8-mercaptomenthone wherein trans-form/cis-form was 60/40 was purified by a recycling method using a gas chromatographic separation. (1R,4S)-8-Mercaptomenthone (cis-form) [α]D20+43.3° (c=1.1, CH3OH) 1H-NMR (CDCl3, δ ppm): 1.02 (3H, d), 1.40 (6H, s), 2.30 (1H, s) (1R,4R)-8-Mercaptomenthone (trans-form) [α]D20 −29.7° (c=1.2, CH3OH) Preparation of R-form/S-form mixture for the configuration at the 4-position of (1R)-8-mercaptomenthone The fore-running and aft-running of 2.8 g of the (1R)-8-mercaptomenthone wherein R-form/S-form for the configuration at the 4-position was 60/40, obtained in Synthesis Example 7, were cut off under a reduced pressure, and the main fraction was cracked under a condition with a boiling point of 90° C. at 200 Pa to obtain 2.0 g of (1R)-8-mercaptomenthone wherein R-form/S-form for the configuration at the 4-position was 75/25. Inventive Example 1 <Evaluation of Odor Quality> Regarding the 8-mercaptomenthone obtained in each of the aforementioned Synthesis Examples, respective samples were put on bottle mouths and filter papers to carry out the sensory evaluation by 7 perfumers having an experience in this field of 5 years or more. The evaluation results are shown in Table 1. Compound name Odor quality (1S)-Mercaptomenthone of 75:25 A clean and fresh odor which reminds the obtained in Synthesis Example 4 perfumers of the strong and fresh sarcocarp and seed of passion fruit (1S)-Mercaptomenthone of 60:40 Has a passion fruit-like odor but is lack obtained in Synthesis Example 3 in strength and accompanies miscellaneous (1S,4R)-Mercaptomenthone An odor which reminds the perfumers of obtained in Synthesis Example 3 Buchu oil (1S,4S)-Mercaptomenthone A natural passion fruit-like odor which is excellent obtained in Synthesis Example 3 in terms of impact and has a clean and fresh image (1R)-Mercaptomenthone of 75:25 A strong and fruity odor, but it obtained in Synthesis Example 8 accompanies a rubbery malodor (1R)-Mercaptomenthone of 60:40 A strong but rubbery malodor, which is not obtained in Synthesis Example 7 desirable as food (1R,4S)-Mercaptomenthone An unpleasant malodor having a rubber-like obtained in Synthesis Example 7 malodor (1R,4R)-Mercaptomenthone A crude malodor which reminds the perfumers of obtained in Synthesis Example 7 the un-fresh onion Buchu oil-isolated natural A natural odor but is lack in strength and mercaptomenthone has somewhat miscellaneous impressions As shown above, the compound of the present invention, from which the rubbery miscellaneous malodor as a weak point of (1R)-mercaptomenthone was excluded and which has both of the desirable characteristics of (1S,4R)- and (1S,4S)-mercaptomenthone, reminded the strong and fresh passion fruit and possessed a clean, fresh and highly-tasting strong characteristic odor. A 1 ppb ethanol solution of the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, was added at a ratio of 0.1 part to 100 parts of a green tea extract obtained by pouring 300 ml of hot water of 90° C. to 10 g of green tea leaves and then filtering the tea leaves after allowing to stand for about 1 minute, thereby obtaining the green tea beverage of the present invention which contains 0.001 ppb of said (1S)-8-mercaptomenthone. This product possessed a soft and mellow green odor characteristic to a fresh tea, with reduced bitter taste and rough taste. (1) A green tea extract obtained by pouring 30 liters of hot water of 90° C. to 1 kg of green tea leaves and then filtering the tea leaves after allowing to stand for about 1 minute was concentrated 100 times to prepare a flavor composition for green tea beverage use. (2) A 10 ppb ethanol solution of the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, was added at a ratio of 0.002 part to 100 parts of the flavor composition for green tea use obtained in the above (1), thereby obtaining the flavor composition for green tea beverage use of the present invention which contains 0.0002 ppb of said (1S)-8-mercaptomenthone. (3) The flavor composition obtained in the above (2) was added at a ratio of 1 part to 100 parts of a green tea extract obtained by pouring 300 ml of hot water of 90° C. to 10 g of green tea leaves and then filtering the tea leaves after allowing to stand for about 1 minute, thereby producing a green tea beverage which contains (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25 [concentration of (1S)-8-mercaptomenthone: about 0.000002 ppb]. The green tea beverage thus obtained was a green tea beverage having a soft and mellow green odor characteristic to a fresh tea, with reduced bitter taste and rough taste, and the good odor was not lost but maintained even after a lapse of 24 hours. Inventive Examples 4 and 5, Comparative Examples 1 and 2 (1) The flavor composition of Inventive Example 4 containing (1S)-8-mercaptomenthone in a concentration of 0.10 ppb was prepared by adding the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, to the flavor composition for green tea beverage use shown in the following Table 2. In addition, a product prepared by not adding the aforementioned (1S)-8-mercaptomenthone was used as Comparative Example 1. Components Inventive Example 4 Example 1 Cis-jasmone 0.02 0.02 Cis-3-hexenol 0.15 0.15 Trans-3-hexenal 0.1 0.1 Jasmine lactone 0.001 0.001 β-Ionone 0.005 0.005 Indole 0.01 0.01 Hexanoic acid 0.1 0.1 (1S)-8-Mercaptomenthone 0.000001 — Purified water 40.0 40.0 Ethanol balance balance Total 100.0 100.0 (2) Each of the flavor compositions obtained in the above (1) (the flavor compositions of Inventive Example 4 and Comparative Example 1) was added at a ratio of 1 part to 100 parts of a green tea extract obtained by pouring 300 ml of hot water of 90° C. to 10 g of green tea leaves and then filtering the tea leaves after allowing to stand for about 1 minute, thereby producing a green tea beverage which contains 0.001 ppb in concentration of (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25 (Inventive Example 5) and another green tea beverage to which (1S)-8-mercaptomenthone was not added (Comparative Example 2). (3) Sensory comparison evaluation of both of the green tea beverages obtained in the above (2) was carried out by a panel of 7 specialists. As a result, all members of the panel judged that a green tea-specific deep body, which was not present in the beverage of Comparative Example 2, was added to the beverage of Inventive Example 5 produced by adding the compound. A 10 ppb ethanol solution of the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, was added in an amount of 0.002 part to 100 parts of an oolong tea extract obtained by pouring 300 ml of hot water of 100° C. to 10 g of oolong tea leaves and then filtering the tea leaves after allowing to stand for about 3 minutes, thereby obtaining the oolong tea beverage of the present invention which contains 0.0002 ppb of the (1S)-8-mercaptomenthone. This product possessed a fragrance which has a deep oolong tea-like image and accompanies a ripen feeling. (1) An oolong tea extract obtained by pouring 30 liters of hot water of 100° C. to 1 kg of oolong tea leaves and then filtering the tea leaves after allowing to stand for about 3 minutes was concentrated 100 times to prepare an flavor composition for oolong tea beverage use. (2) A 10 ppb ethanol solution of the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, was added at a ratio of 0.002 part to 100 parts of the flavor composition obtained in the above (1), thereby obtaining the aroma composition for oolong tea beverage use of the invention which contains 0.0002 ppb of said (1S)-8-mercaptomenthone. (3) The flavor composition obtained in the above (2) was added at a ratio of 1 part to 100 parts of an oolong tea extract obtained by pouring 300 ml of hot water of 100° C. to 10 g of oolong tea leaves and then filtering the tea leaves after allowing to stand for about 3 minutes, thereby producing an oolong tea beverage which contains about 0.000002 ppb in concentration of (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25. This oolong tea beverage was possessed of an odor which has a deep oolong tea-like image and accompanies a ripen feeling, and the good odor was not lost but maintained even after a lapse of 24 hours. Inventive Example 8, Comparative Example 3 (1) By adding the (1S)-8-mercaptomenthone obtained in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, to the flavor composition for oolong tea beverage use shown in the following Table 3, the flavor composition of Inventive Example 8 containing the (1S)-8-mercaptomenthone in a concentration of 0.10 ppb was prepared. In addition, a product prepared by not adding the (1S)-8-mercaptomenthone was used as Comparative Example 3. Cis-3-Hexenol 0.001 0.001 Eugenol 0.002 0.002 Geraniol 0.002 0.002 δ-Decalactone 0.002 0.002 Linalool 0.004 0.004 Methyl jasmonate 0.01 0.01 Phenylethyl acetate 0.02 0.02 Phenylethyl alcohol 0.04 0.04 Jasmine lactone 0.2 0.2 Water 40.0 40.0 (2) Each of the flavor compositions obtained in the above (1) (the flavor compositions of Inventive Example 8 and Comparative Example 3) was added at a ratio of 0.1 part to 100 parts of an oolong tea extract obtained by pouring 300 ml of hot water of 100° C. to 10 g of oolong tea leaves and then filtering the tea leaves after allowing to stand for about 3 minutes, thereby producing an oolong tea beverage which contains 1 ppb in concentration of (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25 (Inventive Example 9) and another oolong tea beverage to which (1S)-8-mercaptomenthone was not added (Comparative Example 4). (3) Sensory comparison evaluation of the oolong tea beverages obtained in the above (2) was carried out by a panel of 7 specialists. As a result, all members of the panel pointed out that an oolong tea-specific deep body, which was not present in the beverage of Comparative Example 4, was added to the aforementioned beverage of Inventive Example 5 produced by adding (1S)-8-mercaptomenthone. Inventive Example 10 (1) In this Inventive Example 10, a powdered tea pudding to which (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25 was added and contained therein was produced using a formulation for powdered tea pudding use shown in the following Table 4. Components Part(s) by weight Sucrose 8.0 Whip cream (vegetable fat content: 40%) 10.0 Whole milk condensed whole milk, sweetened 6.0 Skim milk powder 5.0 Powdered tea 0.5 Gelling agent 0.45 Emulsifying agent 0.1 Coloring agent 0.05 Powdered tea (Matcha) flavor 0.1 (1S)-8-Mercaptomenthone 10 ppb ethanol solution 0.05 Purified water balance Total 100.0 (2) Among the formulation for powdered tea (Matcha) pudding use shown in the above Table 4, sucrose, skim milk powder, powdered tea, gelling agent and emulsifying agent were mixed as powders in advance, added to a mixture of whip cream (vegetable fat content: 40%), whole milk condensed whole milk, sweetened, and water, and then dissolved by stirring and heating at 80° C. for 10 minutes. Subsequently, the remaining materials were mixed therewith, and the mixture was adjusted to a total amount of 100 parts with water, homogenized at 14700 kPa, filled in a container and then solidified with cooling to produce a powdered tea pudding. The powdered tea pudding obtained thereby was a powdered tea pudding having an odor which has a deep tea leaf-like image and accompanies a ripen feeling. <Production of Grapefruit Flavor Composition> A grapefruit flavor was produced by the formulation shown below, and an extremely small amount of the (1S)-8-mercaptomenthone synthesized in Synthesis Example 4, wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25, was added thereto. Sensory comparison evaluation of this product and a product to which the compound was not added (Comparative Example 5) was carried out by a panel of 7 specialists. As a result, all members of the panel judged that a freshness having natural deepness, which was not present in the product of Comparative Example 5, was added to the product of Inventive Example 11 produced by adding the compound. Components Inventive Example 11 Example 5 Grapefruit essence 95.0 95.0 Ethyl butanoate 0.1 0.1 Ethyl 2-methylbutanoate 0.02 0.02 Octanal 0.01 0.01 Nootkatone 0.05 0.05 <Production of Fragrance Composition for Shampoo Use> <Formulation Example 1> Components Part(s) Benzyl salicylate 55 1-Citronellol 10 Ethyl acetoacetate 5 Galaxolide 50 BB* (mfd. by IFF) 390 Geraniol 10 Hedione (mfd. by Firmenich) 120 Heliobouquet (mfd. by Takasago International Corporation) 8 Cis-3-hexenol 10% DPG** solution 10 Cis-3-hexenyl acetate 10% DPG solution 5 Hexyl cinnamic aldehyde 50 β-Ionone 17 Kovanol (mfd. by Takasago International Corporation) 40 Lemon oil 40 Linalool 45 Linalyl acetate 45 Nerolidol 55 Phenylethyl alcohol 30 Phenylethyl cinnamate 5 Santalex T (mfd. by Takasago International Corporation) 35 Triplal 10% DPG solution (mfd. by IFF) 5 Maltol 1% DPG solution 15 (1S)-8-Mercaptomenthone 10 ppm DPG solution 5 Benzyl benzoate *Dipropylene glycol Comparative Example 6 An fragrance composition for shampoo use was prepared by the same formulation of Inventive Example 12, except that dipropylene glycol was used instead of the (1S)-8-mercaptomenthone 10 ppm DPG solution in the same formulation of Inventive Example 12. Application Example 1 <Production of Shampoo> Using the fragrance compositions for shampoo use prepared in Inventive Example 12 and Comparative Example 6, the following components were stirred with heating at 80° C. until they became uniform and then cooled to 35° C. to prepare shampoos. <Shampoo composition (%)> Sodium lauryl sulfate 40.00 N-Coconut oil fatty acid acyl-N-carboxymethoxyethyl- 10.00 N-carboxymethyl ethylenediamine disodium Coconut oil fatty acid diethanolamide (2) 2.00 Butylene glycol 2.00 Citric acid 0.35 Sodium chloride 0.10 Methyl paraben 0.20 Propyl paraben 0.10 Tetrasodium edetate 0.10 Fragrance composition of Inventive Example 12 or 0.50 Total 100.00 Evaluation Results of Shampoos in which the Fragrance Compositions of Inventive Example 12 and Comparative Example 6 are Used As a result of comparative evaluation of the shampoos in which the fragrance compositions of Inventive Example 12 and Comparative Example 6 are used, all members of the panel judged that a fresh and natural feeling having excellent diffusion ability, which was not present in the shampoo using the composition based on the formulation of Comparative Example 6, was added to the shampoo using the fragrance composition prepared based on the (1S)-8-mercaptomenthone-containing formulation of Inventive Example 12. Inventive Example 13, Comparative Example 7 <Production of Fragrance Composition for Body Shampoo Use> As shown in the following Formulation Example 2, the fragrance composition for body shampoo use of Inventive Example 13 was prepared using a 10 ppm DPG (dipropylene glycol) solution of (1S)-8-mercaptomenthone wherein the mixing ratio of S-form/R-form for the configuration at the 4-position was 75:25. Also, the fragrance composition for body shampoo use of Comparative Example 7 was prepared based on the same formulation of Inventive Example 13, except that dipropylene glycol was used instead of the 10 ppm DPG solution of (1S)-8-mercaptomenthone. Lemon oil 100 Lime oil 180 Geranyl nitrile 10 Aldehyde C-8 10% DPG solution 25 Aldehyde C-10 10% DPG solution 35 Ethyl decanoate 12 Triplal (mfd. by IFF) 3 Isocyclocitral 10% DPG solution 25 Styralyl acetate 20 α-Terpineol 30 Geranyl acetate 5 Lilial (mfd. by Givaudan) 80 Hexyl cinnamic aldehyde 120 Myrac aldehyde (mfd. by IFF) 15 Cis-3-hexenyl salicylate 15 Heliotropine 5 Tonalid (mfd. by PFW) 30 <Production of Body Shampoo> Using the fragrance compositions of Inventive Example 13 and Comparative Example 7, body shampoo of the following composition was prepared. <Body shampoo composition (%)> Dibutylhydroxytoluene 0.05 Potassium chloride 0.20 Glycerol 5.00 Polyoxyethylene lauryl ether sodium acetate (3 E.O.) (30%) 10.00 Coconut oil fatty acid amide propyl betaine liquid (34%) 25.00 Potassium myristate (40%) 25.00 Fragrance composition of Inventive Example 13 0.50 or Comparative Example 7 <Evaluation Results of Body Shampoos in which the Fragrance Compositions of Inventive Example 13 and Comparative Example 7 are Used> As a result of evaluating the body shampoos produced using the fragrance compositions of Inventive Example 13 and Comparative Example 7, all members of the panel judged that a citrus feeling with improved freshness, which was not present in the body shampoo using the composition based on the formulation of Comparative Example 7, was added to the body shampoo using the fragrance composition prepared based on the (1S)-8-mercaptomenthone-containing formulation of Inventive Example 13. <Production of Fragrance Composition for Perfume Use> α-Pinene 8 Aldehyde C-16 1 Allylamyl glycolate 1 Ambrettolide (mfd. by IFF) 8 Bergamot oil 15 Carbitol 100 Cardamon oil 3 β-Damascone 2 Dimethyloctanol 10% DPG solution 4 Dipropylene glycol 29 Dynascone 10% DPG solution 5 Ethyl acetate 10% DPG solution 4 Ethyl acetoacetate 15 Galbanum oil 10% DPG solution 10 Heliobouquet (mfd. by Takasago International Corporation) 10 Cis-3-hexenol 2 Cis-3-hexenol 10% DPG solution 3 Jasmine absolute 3 Lime oil 10% DPG solution 5 8-Mercaptomenthone 10% DPG solution 8 Musk T (mfd. by Takasago International Corporation) 200 β-Pinene 117 Rhubofix (mfd. by Firmenich) 12 Rose absolute 3 Rose oil 10% DPG solution 5 1-Rose oxide 10% DPG solution 15 Triplal (mfd. by IFF) 14 Veloutone (mfd. by Firmenich) 12 Maltol 5 A fragrance composition for perfume use was prepared based on the same formulation of Inventive Example 14, except that dipropylene glycol (DPG) was used instead of the 10 ppm DPG solution of (1S)-8-mercaptomenthone in the formulation of Inventive Example 14. <Production of Facial Cream> Using the fragrance compositions for perfume use prepared in Inventive Example 14 and Comparative Example 7, facial creams were prepared. <Facial cream composition (%)> Stearyl alcohol 6.0 Stearic acid 2.0 Hydrogenated lanolin 4.0 Squalane 9.0 Octyl decanol 10.0 Glycerol 6.0 Polyethylene glycol 1500 4.0 Polyoxyethylene (25) cetyl ether 3.0 Glycerol monostearate 2.0 Methyl paraben proper quantity Ethyl paraben proper quantity Fragrance composition of Inventive Example 14 0.1 <Evaluation results of facial creams in which the fragrance compositions of Inventive Example 14 and Comparative Example 8 are Used> All members of the panel judged that a natural feeling having excellent diffusion ability, which was not present in the facial cream using the fragrance composition of Comparative Example 8, was added to the facial cream using the fragrance composition of Inventive Example 14. <Tropical Fruit Aroma Composition> <Formulation of Tropical fruit flavor composition (%)> Ethyl acetate 3.00 Ethyl butyrate 1.50 Hexyl alcohol 0.15 Hexyl acetate 0.06 Hexyl butyrate 0.15 Hexyl hexanoate 0.25 Cis-3-hexenol 0.10 Cis-3-hexenyl acetate 0.05 Cis-3-hexenyl hexanoate 0.025 Linalool 0.05 Beta ionone 0.005 Hexanoic acid 0.005 2-Methyl-4-propyl-1,3-oxathiane 0.01 Furaneol 0.05 Ethyl alcohol 54.579 Water 40.0 When a product of Inventive Example 15 prepared by adding 0.001% of the 75:25 (1S)-8-mercaptomenthone of Synthesis Example 4 to the tropical fruit flavor composition of the aforementioned formulation was compared with another product prepared by adding 0.001% of the 75:25 (1R)-8-mercaptomenthone of Synthesis Example 7 to the tropical fruit flavor composition of the aforementioned formulation, all members of the panel judged that diffusivity of the characteristic top note of fresh passion fruit was improved and natural sweetness and sourness were emphasized in the passion fruit flavor composition of Inventive Example 15 prepared by adding the compound of Synthesis Example 4. On the other hand, all members of the panel judged that the product of Comparative Example 9 prepared by using the 75:25 (1R)-mercaptomenthone of Synthesis Example 7 was poor in the diffusivity of flavor, lacked in a natural feeling, was oily, became a dark tone in general and thus resulted in a downcast feeling. While the invention has been described in detail and with reference to specific embodiments thereof, it will be apparent to one skilled in the art that various changes and modifications can be made therein without departing from the scope thereof. This application is based on Japanese patent application No. 2005-009811 filed Jan. 18, 2005, the entire contents thereof being hereby incorporated by reference. Previous Patent: Sprayable perfume with an improved tenacity Next Patent: Protein stabilization in solution
Ebola Virus Net is the web resource for anyone interested in ebola. Ebola (Ebola hemorrhagic fever), is a severe, often fatal disease in humans and nonhuman primates such as monkeys, gorillas, and chimpanzees. Ebola is a rare and deadly disease caused by infection with a virus of the family Filoviridae, genus Ebolavirus. There are five identified Ebolavirus species, four of which have caused disease in humans. Ebola is found in several African countries. The first Ebola species was discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. When an infection does occur in humans, the virus can be spread to others through direct contact with the blood or body fluids of a person who is sick with Ebola, or through contact with objects that have been contaminated with the blood or body fluids of an infected person. Currently there are no specific vaccines or medicines that have been proven to be effective against Ebola. The objectives of Ebola Virus Net are to be the public and professional information resource for ebola and to serve as a network in the exchange of information and news related to ebola.
Background: Studies have revealed a strong association between mutations of CFTR gene and the congenital bilateral absence of the vas deferens (CBAVD), but the role of this gene in other types of male infertility is still unclear. The purpose of this study was to investigate the frequency of the most common mutations of the CFTR gene (DF508, G542X, N1303K, G551D, and W1282X) in a population of infertile men with nonobstructive azoospermia (NOA) and CBAVD in Iran. Methods: Blood samples were obtained from 50 NOA, 50 CBAVD, and 100 normal males (control). Genomic DNA was isolated from whole blood leukocytes, and the presence of common mutations of the CFTR gene was assessed by an amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Restriction fragment length polymorphism (PCR-RFLP) was also used to analyze IVS8-Tn polymorphism. Results: It was found that 16%, 8%, and 8% of patients with CBAVD were heterozygote for DF508, G542X, and N1303K, respectively. The frequency of the 5T allele was 34% and higher than the normal group (p < 0.001). None of the common CFTR gene mutations were detected in NOA patients, and no significant difference was found in the distribution of the 5T allele between the NOA patients and the control group (5 vs. 3 p = 0.721). Conclusion: Based on the present case-control study, the CFTR gene mutations and IVS8-Tn polymorphisms are correlated with CBAVD; however, extensive investigations are necessary to determine the exact relationship between the gene mutations and other forms of male infertility.
Can dietary supplements help with weight loss? Can dietary supplements help with weight loss? Before investing your time and money in these products, it's important to understand that no supplement to date can erase poor dietary choices or lack of physical activity. When my patients ask me about supplements for weight loss, I explain that there's no good substitute for portion control and exercise. Any effects that supplements have on the amount of calories you burn or the way you metabolize fat are minimal and most don't have enough reliable scientific evidence to prove their effectiveness. Here, I've reviewed six of the most commonly used supplements, how they work, if they're effective and possible side effects of each. As with all supplements, there are potential drug nutrient interactions. Before taking any dietary or herbal supplement, talk to your doctor and registered dietitian. How it works: Protein powders and bars don't cause weight loss but can create a greater feeling of satiety, which is what you want when you're trying to lose weight. Keep in mind that you'll be able to satisfy your appetite by having smaller, more frequent meals with protein sources at each, whether protein is in supplement form or natural food sources (for example: eggs, meat, dairy and beans). Effectiveness: Most clinical research studies that show significant weight loss have paired protein supplementation with a low-calorie diet. The studies showing no significant weight loss with protein supplements had no diet modification. Side Effects: A common symptom is increased flatulence and abdominal bloating or loose stools. This is typically caused by sugar alcohols in some bars. As for protein powder in shakes, they're made with different types of protein sources. If you're lactose intolerant, you may want to choose one that's lactose-free. How it works and effectiveness: The caffeine in this product can increase the calories you burn at a resting rate but there's not enough reliable scientific evidence to prove its effectiveness for weight loss. Research on whether green tea extract is effective for weight loss is conflicting. Side Effects: Green tea is tolerated well when consumed as a beverage. But, as with any supplement, there's a long list of potential side effects with cardiovascular, endocrine, neurological and gastrointestinal systems. For a complete list of potential side effects, visit the Natural Medicines Database. How it works: Chitosan is believed to block fat absorption in the intestines. Effectiveness: Most research showing modest weight loss with chitosan was because it was paired with a low-calorie diet. In clinical research studies, taking chitosan alone without calorie restriction doesn't appear to cause significant weight loss. Side Effects: Taken orally in recommended safe doses, chitosan appears to be tolerated well. The most notable potential side effects are increased abdominal discomfort with bloating and diarrhea. How it works: Conjugated Linoleic Acid might help reduce body fat deposits. Researchers believe that CLA increases the breakdown of fat and cell death. Some believe that it also inhibits the creation of fat in loose connective tissue. CLA can be found naturally in some dairy and beef products. Effectiveness: There is some evidence supporting its use, but evidence is limited. Side Effects: CLA appears to be tolerated well orally. Common side effects include upset stomach, nausea, diarrhea, loose stools and flatulence. How it works and effectiveness: Glucomannan is a dietary fiber made from the root of the konjac plant, which may promote satiety. Compared to other dietary fibers, it has greater proportions of soluble fiber and may increase the amount of calories lost through the soluble fiber binding to the cholesterol in your diet and excreting those fat calories through your stool. Side Effects: In clinical research when taken orally, glucomannan appears to be tolerated well. In some cases, loose stools, diarrhea, constipation, abdominal discomfort, bloating, nausea, vomiting and flatulence have been reported. In addition, when taken in tablet form, some esophageal and gastrointestinal blockages have been reported. Powder or capsule form is recommended. How it works: Garcinia Cambogia Extract is believed to inhibit an enzyme used in lipogenesis (the formation of fat). Effectiveness: Some animal research suggests it increases the release of serotonin in the brain, which can help suppress your appetite. Side Effects: The most commonly reported side effects are headache, nausea, diarrhea and stomach and intestinal problems. There are also reported cases of liver toxicity associated with this product.
Lifestyle & Fitness Fitness & lifestyles Public Health Jobs & Schools Vacancies & Training Public Health Ambassadors of Nigeria WHO and United Nations Definition of Adolescent Home » Health Blog » Health » Family & Community Health » WHO and United Nations Definition of Adolescent Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age. The World Health Organization (WHO) and the United Nations defines 'Adolescents' as individuals in the 10-19 years age group and 'Youth' as the 15-24 year age group. While 'Young People' covers the age range 10-24 years.. As children up to the age of 18, most adolescents are protected under the Convention on the Rights of the Child. Adolescence begins with the onset of physiologically normal puberty, and ends when an adult identity and behaviour are accepted. This period of development corresponds roughly to the period between the ages of 10 and 19 years, which is consistent with the World Health Organization's definition of adolescence. However, a study published in the lancet stated that an expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10–19 years, a definition of 10–24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings. Stages of Adolescence Adolescence can be broken into three stages: early adolescence, middle adolescence, and late adolescence. Each stage has its own characteristics. Early Adolescence Late adolescence is arguably the hardest of all three periods of adolescence because nothing stays the same. Early adolescence is the first stage and occurs from ages 10 to 14. Puberty usually begins during this stage. People in this stage become aware of their rapidly changing bodies and start to worry about their physical appearance. They might experience shyness, blushing, modesty, and a greater interest in privacy. Early adolescents may feel invincible and start to engage in risky behaviors such as smoking and alcohol use. This period is also characterized by sexual curiosity, which is usually expressed through admiration of celebrities, teen idols, and musicians. Middle Adolescence Middle adolescence is the second stage and occurs from ages 15 to 17. By this time, puberty has passed. Teens in this stage are extremely concerned with how they look, and they think others are concerned, too. They spend a large amount of time grooming, exercising, and modifying their physical appearance. Relationships are often changing during middle adolescence. There is also worry about sexual attractiveness. Middle adolescents complain about their parents preventing them from becoming independent, and they withdraw from them. They may try to assert their independence by refusing to bathe late adolescence Late adolescence encompasses the latter part of the teenage years, broadly between the ages of 15 and 19. The major physical changes have usually occurred by now, although the body is still developing. The brain continues to develop and reorganize itself, and the capacity for analytical and reflective thought is greatly enhanced. Peer-group opinions still tend to be important at the outset, but their hold diminishes as adolescents gain more clarity and confidence in their own identity and opinions. Risk-taking – a common feature of early to middle adolescence, as individuals experiment with 'adult behavior' – declines during late adolescence, as the ability to evaluate risk and make conscious decisions develops. Nevertheless, cigarette smoking and experimentation with drugs and alcohol are often embraced in the earlier risk-taking phase and then carried through into later adolescence and beyond into adulthood. Girls in late adolescence tend to be at greater risk than boys of negative health outcomes, including depression, and these risks are often magnified by gender-based discrimination and abuse. Girls are particularly prone to eating disorders such as anorexia and bulimia; this vulnerability derives in part from profound anxieties over body image that are fuelled by cultural and media stereotypes of feminine beauty. There are about 350 million adolescents comprising about 22% of the population in the countries of the South-East Asia Region (SEAR). Adolescents are not a homeogenous population. they exist in a variety of circumstances and have diverse needs. The transition from childhood to adulthood involves dramatic physical, sexual, psychological and social developmental changes, all taking place at the same time. In addition to opportunities for development this transition poses risks to their health and well being. What body changes during puberty Sexual and other physical maturation that happens during puberty is a result of hormonal changes. In boys, it is difficult to know exactly when puberty is coming. There are changes that happen, but they happen gradually and over a period of time, rather than as a single event. While each male adolescent is different, the following are average ages when puberty changes may happen: Beginning of puberty: 9.5 to 14 years old First pubertal change: enlargement of the testicles Penis enlargement: begins approximately 1 year after the testicles begin enlarging Appearance of pubic hair: 13.5 years old Nocturnal emissions (or "wet dreams"): 14 years old Hair under the arms and on the face, voice change, and acne: 15 years old Girls also experience puberty as a sequence of events, but their pubertal changes usually begin before boys of the same age. Each girl is different and may progress through these changes differently. The following are average ages when puberty changes may happen: Beginning of puberty: 8 to 13 years First pubertal change: breast development Pubic hair development: shortly after breast development Hair under the arms: 12 years old Menstrual periods: 10 to 16.5 years old There are specific stages of development that both boys and girls go through when developing secondary sexual characteristics. These are the physical characteristics of males and females that are not involved in reproduction, such as voice changes, body shape, pubic hair distribution, and facial hair. Emotional changes in adolescence Due to hormonal changes, adolescents have mood swings and frequently change their temperament. They tend to have more intense and wide-ranging emotions than children or adults, and they exaggerate their problems as well. It's common to see adolescents fluctuating between feeling like they're on top of the world one moment and being depressed the next. These emotional changes affect their school performance, appearance, choice of friends and their ability to make appropriate life choices. Adolescence is a time of emotional stress in the house as adolescents become increasingly independent and their desires often clash with their parents' requests. Adolescents are inclined to take risks, whereas their parents are interested in their safety. They tend to act impulsively, without thinking about the consequences, and they make decisions based on what feels good at the moment. Even when parents try to explain their own decisions based on their life experience and knowledge, adolescents often react emotionally without even listening to the reasons. Therefore, behavior issues and rebellion is common Health issues in adolescence The most common problems among adolescents relate to growth and development, school, childhood illnesses that continue into adolescence, mental health disorders, and the consequences of risky or illegal behaviors, including injury, legal consequences, pregnancy, infectious diseases, and substance use disorders. Unintentional injuries resulting from motor vehicle crashes and injuries resulting from interpersonal violence are leading causes of death and disability among adolescents. Psychosocial adjustment is a hallmark of this phase of development because even normal individuals struggle with issues of identity, autonomy, sexuality, and relationships. "Who am I, where am I going, and how do I relate to all of these people in my life?" are frequent preoccupations for most adolescents. Psychosocial disorders are more common during adolescence than during childhood, and many unhealthy behaviors begin during adolescence. Having an eating disorder, poor diet, obesity, smoking, using drugs, and violent behavior can lead to acute health problems, chronic disorders, or morbidity later in life. Adolescent health is not just a question of individual well-being: As the size of the adolescent population grows, especially in developing countries, the health of young people will be a major determinant of economic and social development and progress. Investing in research, policies, and programs to improve adolescent health is a key strategy to preserve gains in childhood health and ensure that girls and boys grow into healthy and productive men and women. WHO has developed Strategic directions for improving adolescent health that proposes 4S Framework to strengthen the response of health sector to adolescent health and development, focusing on Strategic information, Supportive policies, Strengthening services, and Strengthening collaboration with other sectors. Strategic Information: Improving the collection, analysis, interpretation and dissemination of data that are required for advocacy, policies and programmes Supportive evidence-informed policies: Synthesizing, disseminating and contributing to the evidence base for policies (and programmes) that have an impact on the health and development of adolescents Strengthening services for adolescents: Increasing young people's access to, and use of appropriate health services and commodities that respond to a number of priority health conditions Strengthening collaboration with other sectors: Mobilizing and supporting other sectors to maximize their contributions to adolescent health and development, both what they can do to strengthen the health sector response and what the health sector can do to support their actions PHN World Health Organization(WHO) Definition Of Health Best Public Health Schools in the United States of America Stage 4 Lung Cancer Life Expectancy Without Treatment Whats Public Health September 22, 2019 Family & Community HealthPHNLeave a comment 15 Health Benefits & Side Effects Of Soursop Leaves Health Benefits Of Oluji Pure Cocoa Powder List of Healthy Cereals In Nigeria Health and Safety Training in Nigeria Fohow Garlic Oil: Health Benefits and Side Effects The negative effects of improperly managing your diabetic issues are incredibly severe. 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WHO issues its first emergency use validation for a COVID-19 vaccine and emphasizes need for equitable global access December 31, 2020 COVID-19: One year later – WHO Director-General's new year message December 30, 2020 Mobilizing youth to End TB December 23, 2020 Behavioural considerations for acceptance and uptake of COVID-19 vaccines December 21, 2020 Subscribe for Public Health Updates [email protected] facebook.com/pg/PublicHealthNigeria https://twitter.com/PublichealthN DISCLAIMER: The topics and articles published on this website including text, graphics, videos info graph and other material are for informational purposes only and should not be substituted for professional medical advice. Thank You for your Generous Donation Powered by ELOQUENT
Hi Stacey, I can't give medical advice and definitely recommend following your doctor's recommendations. You can ask him/her if low carb would be better suited for you. Also, you may want to double check with him/her if the kidney concern was related to high protein, because that is a common misconception about keto – it is not a high protein diet/lifestyle. Hi 😀 yes I have a question, just starting this Keto diet, so we're very new at this but my boyfriend had a heart attack 8 years ago so we need to be very careful to not get to high on fat with him. Can he still benefit from this diet. His Doctor said he needs to get some of his weight off he is having a hard time breathing. The Doctor said a low carb diet. But I, we would like to try the Keto diet. What's going on is your body is trying to adjust to fat burning. So, this is a good thing. What you need to do is concentrate on getting more vitamins in the diet. Now, the one nutrient you need a lot of to keep the fatigue away and to help you in the metabolism is B5. B5 also helps the adrenals and metabolism along, and keeps that fatigue away. Promise! Coconut MCT oil, cacao butter, grass-fed whey protein, organic almond butter, and other keto-approved ingredients combine for this protein bomb of an energy bar, designed specifically to support ketone production and keep you fit and focused for hours. It's basically like jumper cables for your metabolism… if jumper cables tasted like smooth chocolate and almonds. The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals.
Home » Laparoscopic gastric bypass procedure is a draw for surgeons, Part 2 of 2 Laparoscopic gastric bypass procedure is a draw for surgeons, Part 2 of 2 By Diana Tucker BBI Contributing Writer CHICAGO, Illinois – Keen interest was focused on laparoscopic gastric bypass at the 86th annual clinical congress of the American College of Surgeons (ACS; Chicago, Illinois), held in its home city in late October. Gastric bypass is a surgical procedure for morbidly obese patients that basically reduces the size of the stomach to 15 cc capacity and re-routes the small intestine into the bowel. After five years of closely following patients who underwent laparoscopic Roux-en-Y (the most commonly used technique for gastric bypass), it can be said that not only do the patients lose 80% of their excess weight in the first year, but more importantly over 95% of their co-morbidities were controlled. For these reasons, this procedure was very popular in both clinical presentations and vendor exhibits at the ACS gathering. Drs. Alan Wittgrove and G. Wesley Clark from Alvarado Hospital and Medical Center (San Diego, California) started performing gastric bypass operations using laparoscopic methods in 1993. They have performed the Roux-en-Y gastric bypass procedure on 6,000 patients using the conventional open technique and 1,100 patients using a laparoscopic technique. They have followed their first 500 patients who had the procedure performed using the laparoscopic technique over five years. They found the results to be remarkable, with procedure times down to a one-hour (two hours maximum), two-day length-of-stay, 96% co-morbidities eliminated (see Table 4 on page 13) and 80% of excess weight lost at year one and maintained over five years. These results and other factors are driving great interest on behalf of patients, surgeons, payors and medical device manufacturers (Table 5). Co-morbidity Comparison in Laparoscopic Gastric Bypass Patients Condition Pre-op Post-op GERD 269 patients 4 patients Hypercholesterol 275 patients 8 patients Hypertrigylceride 158 patients 1 patient Diabetes 85 patients 1 patient Glucose intolerance 50 patients 0 patients Stress incontinence 201 patients 6 patients Sleep apnea 225 patients 5 patients Hypertension 118 patients 10 patients Arthritis (symptomatic) 371 patients 36 patients Source: Alan Wittgrove, MD, and G. Wesley Clark, MD Factors Causing Increase in the Number of Gastric Bypass Procedures About 90% of excess weight loss maintained over 5 years. More than 95% of significant pre-operative co-morbidities controlled. Many insurance carriers now covering procedure. Many patients now drawn into the patient pool because the procedure can be performed laparoscopically (minimal scars, reduced length of stay and a short recovery time) More physicians trained on this procedure. Instrument manufacturers have developed specific tools that better enable surgeons to perform this procedure laparoscopically. Source: The BBI Newsletter There are strict guidelines governing the patients admitted for bariatric surgery, determined by the National Institutes of Health (Bethesda, Maryland), American Society for Bariatric Surgery (Gainesville, Florida) and International Federation for the Surgery of Obesity. In brief, candidates must be 100 pounds overweight, along with other measurable physical criteria, or have co-morbidities that are life-threatening or detrimental to normal activities of daily life. Key players that have developed tools specifically for the laparoscopic Roux-en-Y procedure include Ethicon EndoSurgery (Cincinnati, Ohio), with disposable products; Richard Wolf Medical Instruments (Vernon Hills, Illinois), with a reusable instrument set designed by Drs. Wittgrove & Clark; and Karl Storz (Culver City, California), with a reusable generic set of instruments. Richard Wolf also is co-marketing the Vista, a 3-D video system that allows the surgeon to view the surgical field three-dimensionally through a headset, thus enhancing the laparoscopic technique. According to Clark, who now has his laparoscopic operating time down to match that of his conventional open operating time, the Vista system allows the surgeon to move quicker and with more efficiency. Bravo for the Bravo system About 50 million Americans have some form of gastroesophageal reflux disease, commonly referred to as GERD. Of these, around 14 million suffer chronically and three million of those will be referred for endoscopy, a diagnostic tool that allows the physician an opportunity to visually confirm GERD. However, about half the time no visual confirmation of esophagitis (indication that GERD exists) can be made, leaving a pH study as the final tool to definitively diagnose GERD. Traditionally pH monitoring involves another trip to the hospital for another somewhat invasive test. A nasal esophageal catheter is placed into the esophagus and is worn by the patient while being monitored for 24 hours. For these reasons, there was a lot of activity at the Endonetics (San Diego, California) booth during the ACS conference. Endonetics received 510(k) clearance to market the first catheter-free pH monitoring system, the Bravo, in September 2000. It has conducted a controlled product launch at several U.S. sites and anticipates expanding to a full product launch in 1Q01. The Bravo probe is attached to the esophagus using a proprietary delivery system, preferably at the time of endoscopy. The probe then transmits pH data via radio telemetry signals that are recorded by the receiver, which is worn by the patient like a beeper. Within days, the probe sloughs off the wall of the esophagus and passes through the patient's gastrointestinal tract. The real beauty of this product is that it eliminates the patient having to return to the hospital for additional testing, and also eliminates the patient having to wear a nasal catheter for 24 hours. Currently, only 10% of the patients who undergo an endoscopy and have negative findings actually have pH monitoring performed. Many professionals believe that one of the key reasons the compliance is so low is because the patients are averse to wearing the trans-nasal catheter for 24 hours. With the Bravo system, it is expected that patient compliance with the request for pH monitoring could increase to 50% (see Table 6). In side-by-side testing with Medtronic's (Minneapolis, Minnesota) current catheter product, Endonetics said the Bravo system is demonstrating consistent and equivalent results. The other current major market leader in traditional pH monitoring is Sandhill Scientific (Highland Park, Colorado). U.S. GERD Patient Flow Chart Patient Pool No. of Patients Occasional GERD 40 million to 60 million Chronic GERD 12 million to 16 million Reflux-related endoscopies 3 million No visual confirmation of GERD 1.5 million Candidates for pH monitoring 1.5 million Actually have pH monitoring 125,000 (less than 10% of candidates) Potential patient pool for pH monitoring More than 1 million Sources: Endonetics, The BBI Newsletter The Bravo system dovetails nicely into Endonetics' next product – the Gatekeeper Reflux Repair System, which will address the therapeutic side of GERD. The Gatekeeper is an endoscopically delivered prosthesis placed in the esophageal wall that creates the effect of a pseudo valve. It was expected to be in clinical trials by year-end 2000. Drugs may impact surgical subspecialties In a paper delivered at the general session, Dr. Judah Folkman (Boston, Massachusetts) suggested that a new class of drugs may have an effect that spans several surgical subspecialties and change current treatment protocols. This new class of drugs is called angiostatins and they stop angiogenesis, or blood vessel growth. Most cancerous tumors depend on angiogenesis to provide blood supply to the tumor, so current cancer treatment protocols (i.e. surgery) could be impacted if it is proven that angiostatins block blood vessel growth in human tumors, causing them to die of oxygen starvation. In addition to cancer, there are other diseases throughout the body that are angiogenesis-dependent – that is, dependent on new blood vessel growth. Many of these diseases currently use some surgical component in their treatment protocol that could be eliminated if angiostatins reach their full potential. Some of these are macular degeneration, endometrioses, psoriasis, arthritis, diabetic retinopathy and Crohn's disease. These angiogenic diseases recruit new blood vessels to grow abnormally. Drug companies have found that it is easier to turn off angiogenesis than to turn it on. A prime example of failed attempts to create angiogenesis is in the heart, where researchers are trying to grow new coronary blood vessels. But in more than 20 clinical trials in patients that have advanced solid tumors, researchers are finding that it is easy to stop angiogenesis with angiostatins. The process starts in about four weeks following the initial administration of an angiostatin and takes about one year to completely eliminate the tumor. They have found no effect on the liver, few side effects at all and no effect on wound healing. Researchers also have found that angiostatins plus radiation have a synergistic effect. However, once the angiostatin is stopped, the tumor returns. The future hope is that angiostatins will first be used as an adjunct to current surgical therapies and eventually be used as preventive agents for cancers and other diseases. Diana Tucker ASBS Annual Meeting: Genomic tests are blurring the line between surgeon, medical oncologist
MS(Ophtho), FRCS(Ed) is a consultant ophthalmologist at University Hospitals of Leicester. Mr Kumar has completed fellowship training in uveitis and medical retina from world-renowned Moorfields Eye Hospital, London. He manages patients with ocular inflammation, provides treatment for various medical retinal disorders including age-related macular degeneration and retinal vascular disorders. He is involved in running a busy full time clinical service at the University Hospitals of Leicester. Which includes clinical work, training junior doctors and allied clinical professionals, research and educational activities. He has established ultrasound bio microscopy service at Leicester Royal Infirmary. Which provides regional service for adults and children in anterior and posterior segment ocular ultrasound in complex ocular disorders. He has extensive experience in general ophthalmology and cataract surgery. He has special interest in development of immunomodulation therapy in uveitis. He also has research interest in contrast enhanced ocular ultrasound.
Soybean oil, gelatin, vegetable glycerin, yellow beeswax, titanium dioxide color. No artificial flavor, no artificial sweetener, no preservatives, no sugar, no starch, no milk, no lactose, no gluten, no wheat, no yeast, no fish. Sodium free. If you are pregnant, nursing, taking any medications or have any medical condition, consult your doctor before use. It is advisable to consult your doctor before using biotin doses above 2,500 mcg per day. If any adverse reactions occur, stop use and consult your doctor. Keep out of reach of children. Store at room temperature. Do not use if seal under cap is broken or missing.
If you have followed some of my earlier posts, my son and I have started on a new adventure in treating his Tourette Syndrome. We recently have been seeing a doctor who specializing in hypnosis. Since I was researching this technique, I thought I would share what I have found. Tourette Syndrome is a neurological disorder which is defined by multiple motor and vocal tics lasting for more than one year. The disorder was named for a French neuropsychiatrist who successfully assessed the disorder in the late 1800's. Symptoms change periodically in number, frequency, type and severity–even disappearing for weeks or months at a time No definite cause has yet been established, but considerable evidence points to abnormal metabolism of at least one brain chemical called dopamine. Estimates indicate that some 200,000 people in the United States are known to have the disorder. Associated conditions can include attention problems (ADHD/ADD, impulsiveness (and oppositional defiant disorder), obsessional compulsive behavior, and learning disabilities. There is usually a family history of tics, Tourette Syndrome, ADHD, OCD. Tourette Syndrome and other tic disorders occur in all ethnic groups. Males are affected 3 to 4 times more often than females. While there is no cure, medications are available to help control its symptoms. They include atypical neuroleptics, neuroleptics, anti-hyperactive drugs and anti-depressants. Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dyskinesia is a movement disorder distinct from TS that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time. There are also non-drug therapies, such as hypnosis. Stressful situations can make symptoms of Tourette Syndrome worsen. Tension and anxiety can also be attributed to worsening the symptoms. Hypnotherapy has been found to improve the symptoms of Tourette Syndrome. Hypnosis is a relaxed state of consciousness. This state allows people to be more open to suggestions. When these suggestions deal directly with their symptoms and anxiety, they are able to relax and make these suggestions a part of their life, thus reducing their symptoms. After a few sessions, people with Tourette Syndrome can dramatically improve their overall lifestyle. During deep hypnosis the metabolism, breathing and heartbeat slow down, and the brain produces alpha-waves, which indicate deep relaxation and are also induced by meditation. It is a state that most of us naturally drift in and out of during the course of a day: when we become engrossed in a task or a film, when we drive home on 'automatic pilot', when daydreaming. Hypnotherapy itself can take several different forms. The most usual form is 'suggestion hypnotherapy', which aims to break patterns of thought and behaviour by means of positive suggestions and guided imagery. A case study was conducted involving an adolescent male with Tourette Syndrome. He was referred to a hypnotherapist from his physician. The male had a total of 9 hypnosis sessions over a 6-month time period. The model used involved a 4-step treatment process including progressive relaxation, finger-tip temperature feedback using a biotic finger band, and guided imagery. Immediately following treatment and at the 6-month follow-up, he reported minimal to non-existent symptoms. The hypnosis sessions had helped him reduce stress that triggered the symptoms and it helped him regain control of Tourette Syndrome. Progressive relaxation is a method of deep muscle relaxation based on the premise that muscle tension is the body's physiological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety. Finger-tip temperature using a biotic finger band is a primary tool for general relaxation training. The temperature feedback instrument shows when blood flow is increasing by showing an increase in finger temperature. Because blood flow in the hands responds to stress and relaxation the client learns to relax by watching the rise and the fall of temperature. To the body, images created in the mind can be almost as real as actual, external events. In the altered state, we're capable of more rapid and intense healing, growth, learning and performance. When we have a sense of being in control, that, in and of itself, can help us to feel better and do better. Research and studies have shown that hypnosis, relaxation techniques such as bio feedback, and guided imagery are helpful in reducing the symptoms of Tourette Syndrome. It can enable Tourette Syndrome sufferers to lead a more normal lifestyle with fewer tics and interruptions. Hypnosis also gives them more control.
Aromawickel is one of the most successful method of removing the cellulite naturally. It is known that the body consumes 70-80% of the daily necessary calories in order to maintain its natural thermal balance. The recommended number of treatments is 12 treatments, two to three times a week. This treatment is based on hot-cold effect and the activity of essential oils. It is carried out in a manner that the most critical parts where the cellulite deposits are massaged with essential oils and gels (mostly eucalyptus, rosemary, menthol, peppermint and citrus). After that the body is wrapped from the feet to the chest in the soaked bandages. In that way the external temperature of the body rises whilst the internal temperature drops which causes the body to naturally burn energy. To get the desired affect the body stays wrapped in bandages for 40 minutes and after which the body is massaged with certain lotions and gels. In addition to following the instructions and receiving the treatment for approximately 6 weeks, we can achieve the results that we want. It is important to mention that the treatment is not allowed during the pregnancy and breastfeeding. It is highly effective in people who are rapidly losing weight, as well as in women after childbirth, because it tightens the skin and gives elasticity. This treatment has proved very efficient in degradation of cellulite, fat cells and also works as a lymphatic drainage to improve the tone and elasticity of the skin. So, if you have problems with hard layers of cellulite or overweight, this treatment is ideal for you. Get in touch with us, we would love to hear from you!
Pain is a normal part of life and we are affected differently by it. Back pain in particular can be very confusing, frightening, frustrating and exhausting. It can be be extremely severe even when the cause is not serious. The following links focus totally on pain, it's causes and it's management. The first one is quite a medical perspective and offers explanations of medical terms and possible treatments. The second link is a patient-friendly perspective and suggests many useful self help approaches. It is always essential to establish the CAUSE of your pain first. Seek medical advice so that you understand your problem fully and give yourself the best chance of getting better as quickly as possible.
A 94-year-old man with a medical history of chronic kidney disease, hypertension, dementia, and blindness secondary to glaucoma presented to the ED for worsening left leg pain. Upon questioning it was discovered he also had a history of recurrent falls and had been bedridden for the past 3 months. He reported neck pain, right shoulder pain, and left leg pain. Incidentally, he was found to have a hemoglobin level of 8.3 g/dL, a drop of 3 g in 1 month's time. Other testing in the ED, including urinalysis, X-rays, and a CT of the abdomen and pelvis, was negative. The patient was hemodynamically stable. He was admitted for further evaluation of new normocytic anemia and leg pain. An erythrocyte sedimentation rate (ESR) was ordered. One of the first descriptions of the ESR is detailed in a book by British surgeon and anatomist John Hunter (1728–1793), famous for purported experimental self-inoculation with gonorrhea (which led to his eventual fatal co-infection with syphilis), whose home is said to be the model for that of Dr. Jekyll and Mr. Hyde. In his book, "Treatise on the Blood, Inflammation, and Gun-Shot Wounds," Dr. Hunter observed "…that the red globules subsided much faster in the inflammatory blood than in the other." He then made the connection between this reaction in the blood to "inflammatory fevers" and "symptomatic fevers" ( 11. Madrenas J, Potter P, Cairns E. Giving credit where credit is due: John Hunter and the discovery of erythrocyte sedimentation rate. Lancet. 2005;366:2140-1. [PMID: 16360794] ). The first method for measuring the ESR was described by the Polish physician Edmund F. Biernacki (1866–1911). His explanation was based on the close relationship between the speed of sedimentation of red blood cells and the level of fibrinogen ( 22. Grzybowski A, Sak J. Edmund Biernacki (1866–1911): Discoverer of the erythrocyte sedimentation rate. On the 100th anniversary of his death. Clin Dermatol. 2011;29:697-703. [PMID: 23293796] ). Dr. Biernacki described the diagnostic value of the ESR in 1897 in both German and Polish publications. For his experiments, he used glass cylinders of his own design and blood mixed with sodium oxalate to prevent coagulation. He later detailed the relationship between increased ESR and many disease states, including rheumatic diseases, febrile states, tuberculosis, nephritis, and hepatic disorders ( 33. Kucharz EJ. Edmund Biernacki and the erythrocyte sedimentation rate. Lancet. 1987;1:696. [PMID: 2882126] ). In 1917, Ludwik Hirszfeld, a Polish microbiologist, noted elevation of ESR in a group of patients with malaria. In 1918, a Swedish hematologist, Robert Fahraeus, observed increased ESR in pregnancy. Alf Westergren, a Swedish internist, followed this work by experimenting with sodium citrate as an anticoagulant and using the ESR to aid in prognosis in patients with tuberculosis ( 22. Grzybowski A, Sak J. Edmund Biernacki (1866–1911): Discoverer of the erythrocyte sedimentation rate. On the 100th anniversary of his death. Clin Dermatol. 2011;29:697-703. [PMID: 23293796] ). The International Committee for Standardization in Haematology later adopted the Westergren method for determination of ESR ( 22. Grzybowski A, Sak J. Edmund Biernacki (1866–1911): Discoverer of the erythrocyte sedimentation rate. On the 100th anniversary of his death. Clin Dermatol. 2011;29:697-703. [PMID: 23293796] , 44. Reference method for the erythrocyte sedimentation rate (ESR) test on human blood. J Clin Pathol. 1973;26:301-2. [PMID: 4701798] ). Our patient's ESR was found to be 104 mm/h. A diagnosis of polymyalgia rheumatica (PMR) was made. PMR is a disease of the elderly, mostly affecting those over the age of 50 ( 55. Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. Arthritis Rheum. 1995;38:369-73. [PMID: 7880191] ). Presenting symptoms include stiffness and aching, most commonly in the neck, shoulders, upper arms, and pelvic girdle. The joint pain and stiffness is most classically associated with an increase in systemic inflammation, as demonstrated by high levels of inflammatory markers, such as ESR ( 66. Salvarani C, Pipitone N, Versari A, Hunder GG. Clinical features of polymyalgia rheumatica and giant cell arteritis. Nat Rev Rheumatol. 2012;8:509-21. [PMID: 22825731] doi:10.1038/nrrheum.2012.97 ). The patient was started on a prednisone taper. Amazing his family and our team, he was up out of bed the next day. His hemoglobin level began to rise as well. He was discharged on long-term taper with close follow-up. Dr. Young is an internal medicine intern at Mayo Clinic in Rochester, Minn. Dr. Newman is a hospitalist at Mayo Clinic and the editorial advisor and humor columnist for ACP Hospitalist.
Author(s): Cuppen, I. ; Bruijn, D. de; Geerdink, N.; Rotteveel, J.J. ; Willemsen, M.A.A.P. ; Vugt, J.M.G. van; Pasman, J.W. ; Roeleveld, N. OBJECTIVE: The aim of this retrospective study was to assess the fetal biparietal diameter (BPD) and head circumference (HC) in the second trimester of pregnancy in fetuses with open spinal dysraphism. METHODS: BPD and HC were measured at 16-26 weeks in 74 fetuses with open spinal dysraphism and compared with reference values. RESULTS: BPD was smaller in fetuses with open spinal dysraphism. Of all cases with open spinal dysraphism, 62.2% had a BPD <3rd percentile and 79.7% had a BPD <10th percentile. Of all patients, 54.1% had an HC <3rd percentile and 74.3% had an HC <10th percentile. CONCLUSION: Almost all fetuses with open neural tube defects have a smaller BPD and HC at 16-26 weeks compared with reference values, which implicates that this is part of the phenotype of children with open spinal dysraphism instead of an independent prognostic marker for a poor cognitive outcome. (c) 2014 S. Karger AG, Basel.
Based on the collation of the stochastic Monte Carlo technique and the iteration procedure of the solution of Bethe-Salpeter equation, it is shown that simulation of optical path of photons undergoing n-th scattering event is directly agreed with the n-th order ladder diagram calculation approach. In frame of this correspondence the Monte Carlo technique is generalised for simulation of coherent back-scattering and temporal intensity/field auto-correlation functions of optical radiation scattered within the randomly inhomogeneous turbid medium. The results of simulation demonstrate a good agreement with the diffusing wave theory and experimental results.
The requirement for heme transport Mammalian heme transporters Enter FLVCR1 A mitochondrial FLVCR1 isoform FLVCR1 and human disease Commentary Free access \| 10.1172/JCI66607 Mitochondrial heme: an exit strategy at last Mark D. Fleming1 and Iqbal Hamza2 1Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 2Department of Animal and Avian Sciences, Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, Maryland, USA. Address correspondence to: Mark D. Fleming, Department of Pathology, Boston Children's Hospital, S. Burt Wolbach Professor of Pathology, Harvard Medical School, Bader 124.1, 300 Longwood Ave., Boston, Massachusetts 02115, USA. Phone: 617.919.2664; Fax: 617.730.0168; E-mail: [email protected]. Find articles by Fleming, M. in: JCI \| PubMed \| Google Scholar Find articles by Hamza, I. in: JCI \| PubMed \| Google Scholar First published November 26, 2012 - More info Published in Volume 122, Issue 12 on December 3, 2012 J Clin Invest. 2012;122(12):4328–4330. https://doi.org/10.1172/JCI66607. First published November 26, 2012 - Version history The mitochondrial heme exporter FLVCR1b mediates erythroid differentiation Deborah Chiabrando, … , Paolo Pinton, Emanuela Tolosano Feline leukemia virus subgroup C receptor 1 (FLVCR1) is a cell membrane heme exporter that maintains the balance between heme levels and globin synthesis in erythroid precursors. It was previously shown that Flvcr1-null mice died in utero due to a failure of erythropoiesis. Here, we identify Flvcr1b, a mitochondrial Flvcr1 isoform that promotes heme efflux into the cytoplasm. Flvcr1b overexpression promoted heme synthesis and in vitro erythroid differentiation, whereas silencing of Flvcr1b caused mitochondrial heme accumulation and termination of erythroid differentiation. Furthermore, mice lacking the plasma membrane isoform (Flvcr1a) but expressing Flvcr1b had normal erythropoiesis, but exhibited hemorrhages, edema, and skeletal abnormalities. Thus, FLVCR1b regulates erythropoiesis by controlling mitochondrial heme efflux, whereas FLVCR1a expression is required to prevent hemorrhages and edema. The aberrant expression of Flvcr1 isoforms may play a role in the pathogenesis of disorders characterized by an imbalance between heme and globin synthesis. Deborah Chiabrando, Samuele Marro, Sonia Mercurio, Carlotta Giorgi, Sara Petrillo, Francesca Vinchi, Veronica Fiorito, Sharmila Fagoonee, Annalisa Camporeale, Emilia Turco, Giorgio R. Merlo, Lorenzo Silengo, Fiorella Altruda, Paolo Pinton, Emanuela Tolosano The transport of heme across membranes is critical for iron absorption, the formation of hemoglobin and other hemoproteins, and iron recycling in macrophages. However, the identity of heme transport proteins has been elusive. In this issue of the JCI, Chiabrando et al. reveal that an isoform of the feline leukemia virus subgroup C receptor (FLVCR1) exports heme from the mitochondria and is critical for erythroid differentiation. Nearly two-thirds of the body's iron endowment is in the form of hemoglobin in erythrocytes, and each erythrocyte contains more than a billion iron atoms in the form of heme (1). Consequently, it is not surprising that inherited or acquired defects in hemoglobin synthesis, including the thalassemias, hemoglobinopathies, and iron deficiency, are among the most prevalent human diseases. Importantly, the approximately 360 billion erythrocytes produced daily require over 250 mg of heme to assemble into hemoglobin. Heme is synthesized in the mitochondria, but globin is translated in the cytosol, and it is unclear how newly synthesized heme is transported out of the mitochondria for incorporation into hemoglobin (2). Heme transport across membranes is important for dietary iron absorption and crucial for erythrocyte heme iron recycling in the reticuloendothelial system (RES) macrophage. Despite the physiologic importance of these processes, the molecular pathways of transmembrane heme transport have, for the most part, remained obscure, in large part due to technical difficulties in identifying heme-specific transporters in mammalian cells and the inability to translate these findings to whole organisms. In this issue of the JCI, using a combination of siRNA studies and targeted mutations in mice, Chiabrando et al. provide compelling evidence that an isoform of the feline leukemia virus subgroup C receptor (FLVCR1) exports heme from the mitochondria (3). For more than 50 years, it has been known that nutritional heme-iron is absorbed in the intestine by an active, energy-dependent, and inducible process that requires a heme transporter in enterocytes. This is because elemental iron has limited bioavailability in the intestine due to the presence of natural iron chelators, such as phytates and tannins, as well as its tendency to oxidize (i.e., to rust) and precipitate. In contrast, even though heme-iron constitutes only one-third of total dietary iron, it is more easily absorbed and is the source for two-thirds of body iron in meat-eating individuals (4). This is a consequence of heme's solubility at intestinal pH and because its uptake is not known to be influenced by other dietary factors. Heme must also be transported across mitochondrial membranes because the final steps of heme synthesis occur in the mitochondria, but some hemoproteins such as hemoglobin are cytosolic (2). Likewise, heme transport out of phagolysosomes is an essential component of iron recycling by macrophages, as heme oxygenase (Hmox), the enzyme that catalyzes the oxidation of heme to biliverdin, carbon monoxide, and ferric iron, is found largely tethered to the cytosolic surface of the endoplasmic reticulum (5). Iron recycling out of the macrophage is mediated by the ferrous iron exporter ferroportin (FPN1) (6), whose cell-surface expression is tightly controlled by the systemic iron regulatory hormone hepcidin (7). In this manner, iron catabolized by RES macrophages from heme can be released immediately to the plasma to replenish the Fe2-Tf pool necessary for erythropoiesis or stored as ferritin for subsequent use. The identification and characterization of heme and other porphyrin transporters in mammals has proven to be difficult (2), in part due to a lack of genetic and molecular tools, but also as a consequence of the promiscuity of proteins capable of transporting heme with low affinity. Furthermore, in vivo investigation of transporter proteins identified in vitro or on the basis of their expression pattern has been misleading or has provided ambiguous results. For example, Hcp1, a putative apical intestinal heme importer, was eventually proven to be essential for folate transport in the intestine when it was found to be mutated in patients with congenital folate deficiency (8, 9). Whether Hcp1 also contributes to the absorption of heme in the intestine is uncertain at this time. Some evidence suggests that the breast cancer resistance protein (BCRP, also known as ABCG2) can export heme from cells (10). However, BCRP has a broad specificity and can mediate the efflux of a large number of natural and unnatural substrates, and for that reason has been called a multidrug resistance protein (11). Furthermore, null alleles in BCRP in humans result in the "Junior" blood system group, which has no apparent clinical phenotype other than transfusion incompatibility (12). Using the heme auxotroph Caenorhabditis elegans, Hamza and colleagues identified a number of heme-responsive genes (HRGs) and their mammalian orthologs, including HRG1, which appears to transport heme with high affinity and specificity (13, 14). Immunolocalization studies reveal that mammalian HRG1 localizes to endolysosomes and the phagolysosome of RES macrophages (13, 15). More than a decade ago, FLVCR1 was cloned and found to be a member of the major facilitator family of transmembrane transporters (16). Unlike other feline leukemia viruses, subgroup C viruses induce not leukemia, but rather pure red cell aplasia, characterized by an absence of erythroid progenitors in the bone marrow. That the virus infected all bone marrow cells, but produced an erythroid-specific phenotype, was a clue to the function of the protein. Endogenous production of the viral capsid protein interferes with the cellular expression of FLVCR1, effectively resulting in a knockdown of the protein (17). The singular toxicity to erythroid precursors suggested that FLVCR1 performed a function uniquely essential to bone marrow cells of this lineage. Abkowitz and colleagues eventually demonstrated in vitro that FLVCR1 is a heme exporter and that targeted deletion of FLVCR1 in mice results in a severe macrocytic anemia characterized by a proerythroblast maturation arrest (18). Based upon the cell-surface localization of FLVCR1, these authors hypothesized that the phenotype is a consequence of the requirement of early erythroid precursors to export heme to avoid heme toxicity in the absence of active globin synthesis. While the murine knockout data were entirely supportive of the feline viral infection phenotype, the pathogenesis of the erythroid dysfunction remained an enigma. In this issue, Emanuela Tolosano's group describes the identification of an mRNA transcript in EST databases encoding an isoform of FLVCR1 termed FLVCR1b (3). This isoform contains a shortened N terminus as a result of an alternative transcriptional start site in intron 2 of the previously described FLVCR1a mRNA. The protein encoded by the FLVCR1b transcript includes amino acids 277–555 of FLVCR1a and encodes a mitochondrial targeting signal at the new N terminus. Targeted deletion of the exon specific to FLVCR1a resulted in skeletal defects and vascular abnormalities, but not anemia, indicating that loss of the cell-surface FLVCR1a is dispensable for erythropoiesis. In contrast, siRNA-mediated knockdown of the FLVCR1b isoform impaired erythroid differentiation in vitro. While the authors do not directly demonstrate that FLVCR1b transports heme out of mitochondria, they do show that overexpression of the protein increases cytosolic heme and that knockdown of FLVCR1b results in mitochondrial heme retention (3). Taken together, these data suggest that the FLVCR1b-null phenotype may be due to cytosolic heme deficiency rather than heme accumulation, as had been originally proposed (Figure 1). Two isoforms of FLVCR1 may regulate heme levels. FLVCRa isoform had previously been postulated to transport cytosolic heme across the plasma membrane. Chiabrando et al. now show that a mitochondrial isoform, FLVCR1b, transports heme from the mitochondria into the cytosol and thus is critical for the synthesis of hemoglobin and differentiation of erythroid cells. The association of pure red cell aplasia and skeletal abnormalities has suggested that mutations in FLVCR1 might be found in human patients with the inherited form of pure red cell aplasia termed Diamond-Blackfan anemia (DBA), which is also associated with skeletal abnormalities. FLVCR1 mutations in DBA patients have not been found as of yet (19); however, if they were to exist, one would predict that they would occur in the FLVCR1b isoform. Interestingly, missense mutations in FLVCR1 have recently been described in patients with the rare autosomal recessive disease posterior column ataxia and retinitis pigmentosa (PCARP) (20, 21). Three of the four reported disease-associated FLVCR1 variants, all of which are present in the homozygous state in PCARP patients, occur in exon 1 of the gene — the part of the gene that is omitted in the FLVCR1b transcript and protein. Based on this finding, one might speculate that heme export by the cell-surface FLVCR1a may have a uniquely important function in neuronal cells. It is equally possible, as has been observed with many other proteins capable of transporting heme, that FLVCR1a binds other substrates with higher affinity than heme. It is, however, more problematic to reconcile the fourth patient mutation, which occurs in a transmembrane domain common to the FLVCR1a and FLVCR1b isoforms. Individuals harboring this mutation are not anemic, as the murine model would predict (20), raising the possibility that this genetic lesion has a unique effect on transport of an alternative substrate. If FLVCR1b localizes to the inner membrane of the mitochondria, does heme exit the mitochondrial outer membrane through unconventional means? Furthermore, how do eukaryotes that lack obvious FLVCR homologs, such as yeast, export heme from the mitochondria? Pertinent biochemical questions also remain: FLVCR1a is proposed to transport heme out of the cytoplasm, while FLVCR1b transports heme into the cytoplasm. Because FLVCR is an MFS family member of secondary transporters, are the sources of energy to translocate heme and the kinetic mechanisms (uniporter, symporter or antiporter) different between the two isoforms? Only time will reveal the truth in the myriad of theoretical possibilities. Reference information: J Clin Invest. 2012;122(12):4328–4330. doi:10.1172/JCI66607. See the related article at The mitochondrial heme exporter FLVCR1b mediates erythroid differentiation. Knutson M, Wessling-Resnick M. Iron metabolism in the reticuloendothelial system. Crit Rev Biochem Mol Biol. 2003;38(1):61–88. Severance S, Hamza I. Trafficking of heme and porphyrins in metazoa. Chem Rev. 2009;109(10):4596–4616. Chiabrando D, et al. The mitochondrial heme exporter FLVCR1b mediates erythroid differentiation. J Clin Invest. 2012;122(12):4569–4579. View this article via: JCI Google Scholar Uzel C, Conrad ME. Absorption of heme iron. Semin Hematol. 1998;35(1):27–34. Yanatori I, Tabuchi M, Kawai Y, Yasui Y, Akagi R, Kishi F. Heme and non-heme iron transporters in non-polarized and polarized cells. BMC Cell Biol. 2010;11:39. Donovan A, et al. Positional cloning of zebrafish ferroportin1 identifies a conserved vertebrate iron exporter. Nature. 2000;403(6771):776–781. Nemeth E, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science. 2004;306(5704):2090–2093. Qiu A, et al. Identification of an intestinal folate transporter and the molecular basis for hereditary folate malabsorption. Cell. 2006;127(5):917–928. Salojin KV, et al. A mouse model of hereditary folate malabsorption: deletion of the PCFT gene leads to systemic folate deficiency. Blood. 2011;117(18):4895–4904. Krishnamurthy P, et al. The stem cell marker Bcrp/ABCG2 enhances hypoxic cell survival through interactions with heme. J Biol Chem. 2004;279(23):24218–24225. Robey RW, Ierano C, Zhan Z, Bates SE. The challenge of exploiting ABCG2 in the clinic. Curr Pharm Biotechnol. 2011;12(4):595–608. Saison C, et al. Null alleles of ABCG2 encoding the breast cancer resistance protein define the new blood group system Junior. Nat Genet. 2012;44(2):174–177. Rajagopal A, et al. Haem homeostasis is regulated by the conserved and concerted functions of HRG-1 proteins. Nature. 2008;453(7198):1127–1131. Yuan X, Protchenko O, Philpott CC, Hamza I. Topologically conserved residues direct heme transport in HRG-1-related proteins. J Biol Chem. 2012;287(7):4914–4924. Delaby C, et al. Subcellular localization of iron and heme metabolism related proteins at early stages of erythrophagocytosis. PloS One. 2012;7(7):e42199. Quigley JG, et al. Cloning of the cellular receptor for feline leukemia virus subgroup C (FeLV-C), a retrovirus that induces red cell aplasia. Blood. 2000;95(3):1093–1099. Khan AA, Quigley JG. Control of intracellular heme levels: heme transporters and heme oxygenases. Biochim Biophys Acta. 2011;1813(5):668–682. Keel SB, et al. A heme export protein is required for red blood cell differentiation and iron homeostasis. Science. 2008;319(5864):825–828. Quigley JG, Gazda H, Yang Z, Ball S, Sieff CA, Abkowitz JL. Investigation of a putative role for FLVCR, a cytoplasmic heme exporter, in Diamond-Blackfan anemia. Blood Cells Mol Dis. 2005;35(2):189–192. Ishiura H, et al. Posterior column ataxia with retinitis pigmentosa in a Japanese family with a novel mutation in FLVCR1. Neurogenetics. 2011;12(2):117–121. Rajadhyaksha AM, et al. Mutations in FLVCR1 cause posterior column ataxia and retinitis pigmentosa. Am J Hum Genet. 2010;87(5):643–654. Version 1 (November 26, 2012): No description Version 2 (December 3, 2012): No description
NK cells contribute to melanoma cell recognition and anti-tumor immunity, which is traditionally analyzed using human peripheral blood NK cells. An important checkpoint in the progression of malignant melanoma is the metastasis to lymph nodes. To investigate the role of lymph node NK cells in disease progression, we analyzed frequency, phenotype and functions of NK cells purified from either tumor infiltrated lymph nodes or tumor-free ipsilateral lymph nodes of the same patients. Lymph node NK cells were compared to peripheral blood NK cells from either melanoma patients or healthy donors. The data showed an expansion of CD56dimCD57+CD69+CCR7+KIR+ NK cells in tumor infiltrated lymph nodes. This phenotype corresponds to a recently described fully mature and highly cytotoxic NK cell population, and indeed we found that these lymph node NK cells displayed robust anti-tumor activity against autologous melanoma cells. The NK cells trafficking from periphery to the tumor draining lymph nodes have been investigated and the chemokines pattern identified. Moreover, the presence of a high proportion of KIR+CD57+CD56dim in the infiltrated lymph nodes was associated with an improved patients' survival. Our data suggest that NK cells from tumor infiltrated lymph nodes are attractive candidates to improve current NK cell-based immunotherapy of melanoma.
When I first started working with Sara, I had been seeing a GI doctor for acid reflux and infrequent stomach pain. I was given a prescription to take Prilosec everyday and received multiple tests; including ultrasounds, blood work, allergy skin testing and an endoscopy. All of these didn't eliminate the acid reflux or the stomach pain. After working with Sara for just a short time, I felt like her approach was genuinely about my body healing itself without drugs or medical interventions. I stopped taking Prilosec, started taking other supplements and eating better foods. Since working with Sara, I rarely, if ever suffer from acid reflux, which used to be a daily problem for me. The stomach pain hasn't been completely alleviated, but Sara has continued to make suggestions that feel healthier and I feel closer to finding a solution.
Ovary, Mature cystic teratoma, with well differentiated neuroendocrine tumour ("carcinoid"). [LMP48089] View the Zoomify Image Diagnostic Modality: Whole Slide Image Disease Category: Mature cystic teratoma, with well differentiated neuroendocrine tumour ("carcinoid"). Organ System: Female Genital Tract Slide Contributor Information Radi, R., Chang, M. ovary, teratoma, carcinoid Clinical History 64 year-old female with a left ovarian mass measuring 3.0 cm. Clinical Discussion Mature cystic teratomas are the most common ovarian germ cell tumour. In rare cases, somatic-type tumours can arise within the mature elements, including well-differentiated neuroendocrine tumours resembling gastrointestinal-type carcinoids. The outcome is generally benign. In this slide, within a background of mature teratoma, is a 0.5 cm nodule of nests and trabeculae of uniform cells with "salt and pepper" chromatin, and granular eosinophilic cytoplasm is present in the cyst wall. Mitotic count is < 1 per 10 HPF. There is no necrosis. The cells in this nodule are diffusely positive for synaptophysin, chromogranin and CD56. Copyright © 2015 Governing Council of the University of Toronto, as represented by its Dept of Laboratory Medicine & Pathobiology and its licensors (LMP). The reprinting or electronic reproduction of any image or document in part or in its entirety, is prohibited unless prior written consent is obtained from LMP. LMP Digital Laboratory Medicine Library Welcome to the LMP Digital Laboratory Medicine Library The Library contains a comprehensive collection of digitized medical images. The images have been identified and chosen by the Department of Laboratory Medicine & Pathobiology, University of Toronto, for their value in contributing to the educational mission of the Department across all learning levels. Each image is accompanied by additional information designed to aid the learner in developing the skills necessary for interpretation. Teachers and Learners of all levels are welcome to search the library and view the images. We welcome your feedback! Comments and questions can be directed to the Special Projects Coordinator, Department of Laboratory Mecidine & Pathobiology, email. Interested in contributing cases? Click here for full Contribution Guidelines and Forms These terms and conditions contain legal obligations and form an agreement (the "Agreement") between you and The Governing Council of the University of Toronto, as represented by its Department of Laboratory Medicine and Pathobiology at the Faculty of Medicine ("LMP", "we", "us", "our"). Please read these terms and conditions carefully before using, accessing or browsing this website. This agreement was last updated on: December 13, 2013. To view the full Terms and Conditions of Use document, click here.
Root Canal Treatment is a special process to treat a tooth which has become infected deep in its core. This usually happens when there is an injury or cavities are neglected for a long time, and the decay keeps spreading. An infected root canal is a serious medical issue as it can affect the nerve ending and even the bone. If left untreated, it can even affect your entire immune system adversely. It is also a painful problem to have. In some cases, no symptoms show up, and the infection is discovered only at the time of dental checkup. The process requires that the inside of the tooth is cleaned, and the infected area removed. It needs to be further disinfected to ensure that the rot does not spread. A cap or crown is usually recommended after the tooth has been cleaned out to protect it from fracturing. A root canal treatment will remove the infection and stop the pain. For more information, call (708) 232-0403 to schedule an appointment.
Gout affects a growing number worldwide with chronic inflammatory arthritis. Originally less common than it is now, the lifestyle of the modern world combined with the availability of foods that contribute to gout has led to more people having the disease. If an individual has gout, this means that they typically suffer from chronic arthritis brought about by the accumulation of uric acid crystals in the joints. These crystals are formed within the body because of high levels of uric acid in the blood, which is in turn caused by several factors, which include genetic predisposition, food intake and lifestyle. Arthritis attacks brought on by gout can vary in intensity, but is often chronic, lasting for days at a time. Without treatment, this can lead to constant pain, and eventually permanent damage that the body cannot recover from. There are a number of ways to treat gout, though the most common method is to deal with the current arthritis attack. Pain relief is possible through the use of a variety of anti-inflammatory medications and painkillers; should the person with gout choose, there are also more natural methods and gout remedies that can relieve the pain and lessen inflammation. Whichever specific gout remedy is used to deal with the gouty arthritis, the next step to treatment is to deal with the heightened levels of uric acid. Making sure the levels of uric acid are more normal is vital, in order to prevent future arthritic attacks. Even modern medicine recommends natural methods of doing this, through the use of diet and lifestyle modification to remove sources of uric acid, and encourage more efficient removal of excess uric acid in the blood. In some cases conventional medicine may prescribe medication to allow the uric acid levels to go down sooner, though this method is only prescribed for more extreme cases. Aside from medication, there are also natural gout remedies that are able to help reduce the levels of uric acid in the blood. These can be used in conjunction with the previously mentioned changes to diet and lifestyle that are recommended to people with gout. Those with gout may also choose to combine both conventional and alternative natural methods and gout remedies to manage their gout. Generally speaking, natural gout remedies are safe to be combined with conventional medications, though it is still best to get advice from your medical practitioner before doing so. With proper use of different gout remedies, arthritic pain from gout can be alleviated and avoided. Find out more about gout remedies and natural methods for treating gout by checking out http://www.ArthritisNaturalRemedies.com/gout-remedies.
Vaccine helps T cells target tumors BY Bryan Tutt A vaccine that delivers an antigen to dendritic cells, in turn activating killer T cells that can target specific cancers, is being investigated in two ongoing clinical trials. The first trial began enrolling patients with locally advanced or metastatic sarcoma, melanoma, ovarian cancer, non-small cell lung cancer, or breast cancer last year. To be eligible, patients' biopsies had to show NY-ESO-1 expression in at least 5% of tumor cells. Another eligibility requirement was low tumor burden. "Patients with bulky or rapidly progressing disease might be immunosuppressed and might not be able to generate an immune response fast enough to see a benefit from the vaccine as a single agent," said Neeta Somaiah, M.D., principal investigator representing MD Anderson in the multi-institutional trial. Patients received three or four injections of the vaccine LV305, given at three-week intervals, with the dose escalating each time. The vaccine is a lentiviral gene vector that specifically binds to dendritic cells in a patient's body via surface receptor CD209 and introduces the full length of the NY-ESO-1 antigen into these cells. The dendritic cells then present the antigen to CD8-positive T lymphocytes via the major histocompatibility class I molecules on the cell surface. The activated CD8+ cells can then recognize and attack cancer cells that express NYESO-1. After treatment with the vaccine, eight of the 12 patients injected had stable disease at last follow-up and one patient had tumor regression of about 14%. "The clinical and immunological response data are encouraging and warrant further study," Somaiah said. The second trial is now enrolling patients with sarcoma, melanoma, non-small cell lung cancer, and ovarian cancer. Patients will be given LV305 sequentially with G305. The sequential use of LV305 and G305 is designed to produce NY-ESO-1–specific CD8+ cell, CD4+ cell, and antibody responses. The eligibility requirements of the CMB305 trial are similar to those of the LV305 monotherapy trial. Future studies may combine CMB305 with a programmed cell death 1 (PD-1) inhibitor in patients with NY-ESO-1–positive tumors. "Our early results show that LV305 is safe and generates an immune response," Somaiah said. "Future studies will determine the best combination and sequence of agents to generate an effective and durable immune response with a robust antitumor effect." This story originally appeared in the August 2015 issue of OncoLog. Read it in its entirety here. Read More by Bryan Tutt
Dr. Joel Schlessinger currently has no patient reviews. Amazing experience with knowledgeable providers. Highly recommend this office!! Wonderful office and knowledgeable providers, highly recommend this practice!! "A wonderful visit with a wonderful outcome" I initially came to see Dr. Schlessinger because of a skin problem on my forehead. His very thorough and competent staff noticed my feet. What I thought was dry skin actually was a treatable medical condition. I was prescribed medication - which worked and which I tolerated very well. Dr. Schlessinger and his staff spent time with me, explained everything very understandably and I knew that I was in good care with this. Now, four months later this condition has improved and I'm thrilled. I feel like they always listen to my concerns and take time to evaluate the overall health picture. From the check in to the end I encountered friendly smiling faces that really made me feel comfortable. The doctor and PAs were all thorough in their visit with me. I will definitely be back! I got a mole removed from my toe. It was fast and it didn't hurt :) Thank you again for an amazing experience! i came in for a scar consultation and doctor found a mole.
1. Evaluate the state of your body, even if you have no pain. Even people who feel fine have areas of their spine or extremities that are out of normal alignment. When we adjust those bones back into place, people feel better in some way. If we waited until we felt pain, we would all wait until we needed root canals or crowns before going to the dentist! 2. Address major or minor pains you currently have, but haven't been too worried about. Have you had any nagging discomforts or pains coming from your spine or extremities? Do these discomforts prevent you from doing the activities you enjoy? Instead of wondering if the pain will continue to get worse or stay that way for the rest of your life, give chiropractic a try. You don't have to live with pain. 3. Prevent future problems that can and likely will arise from your joints being out of alignment and not functioning at 100 percent. Our society is moving toward preventative health care. Chiropractic has been at the forefront of this concept since the chiropractic profession was founded in 1895. Arthritis, overuse injuries (like carpal tunnel syndrome and tennis elbow), rotator cuff injuries and knee problems are just some examples of conditions that may be prevented with chiropractic care. Scheduling chiropractic tuneups allows you to take care of your body so that your machine functions as well as it possibly can. Please remember to make time to care for yourself; you are worth every penny. Arthritis is one of the oldest known afflictions and can affect virtually every part of the body, from the feet to the knees, back, shoulders and fingers. More than 50 million (about one in six) Americans suffer from arthritis. The most common types are rheumatoid arthritis, osteoarthritis and gouty arthritis. There are natural ways to improve your arthritis symptoms. Dairy products, caffeine, citrus fruits, paprika, salt, tobacco and sugar should be reduced or eliminated from your diet, as these foods may increase joint inflammation. Additionally, nightshades (e.g., red, green, and yellow bell peppers, eggplant, tomatoes, white flesh potatoes) should be avoided because they have a tendency to intensify arthritic symptoms. Foods containing sulfur, such as asparagus, eggs, garlic and onions, are important for the repair and rebuilding of bone, cartilage and connective tissue, and also aid in the absorption of calcium. Other good foods include green, leafy vegetables (which supply vitamin K), fresh vegetables, non-acidic fresh fruits, whole grains, oatmeal, brown rice and fish. Fresh pineapple contains bromelain, a powerful natural anti-inflammatory agent, which works by stimulating the body's production of prostaglandins. One of the most overlooked approaches to improve the discomfort associated with arthritis is hydration. Depending on your level of activity, a good rule of thumb is to drink half of your weight in ounces. Thus, if you weigh 180 pounds, you should consume 90 ounces of pure, filtered water per day. Arthritis in any form can be a debilitating condition that prevents you from living the life you want. Rather than immediately accepting the dangerous side effects of drugs and risky surgeries, talk to your doctor about natural alternatives to keep your muscles and joints in optimal condition. Pregnancy is a time of great expectation, of new beginnings, and the excitement of bringing life into the world. Wouldn't it be nice to know some of the latest techniques from clinical neurobiology to increase the IQ of your unborn child? The most critical element in a newborn's health is the overall health of the parents. Maternal health is addressed in the majority of medical literature, but poor paternal health and subsequent sperm quality can compromise the future mental health of a child, increasing the probability of schizophrenia, autism and Down syndrome. A common-sense approach would be for the mother and father to eliminate smoking, drug and alcohol use, and caffeine and reduce the mother's exposure to heavy metals, solvents, cleaning products, MSG, aspartame and processed foods leading up to and during pregnancy. An organic diet for both parents would be the optimal way to go. One surefire way to optimize fetal development is to provide the basic building blocks of neurological tissue: omega-3 fatty acids. A U.S. Department of Health and Human Services study showed that omega-3 fatty acid supplementation increases birth weight and lowers complications of pregnancy such as pre-eclampsia, preterm delivery and gestational hypertension. However, results were inconclusive in terms of the infants' cognitive development. The best advice for couples who are planning a family is to take excellent care of themselves – get plenty of exercise, at least eight hours of sleep each night and quality supplements to improve their health, which in turn offers their children the best chance at a strong mind and healthy body. Although DVDs, CDs and modern toys may stimulate your baby's brain, nothing can replace the neurobiological components of a healthy mind. Any way you look at it, boosting your child's IQ starts with caring for yourself. Ask your doctor if you are doing everything you can to create a bright future for your baby.
KEY WORDS adjunct, synthesis of metal-organic and inorganic materials for optical and biomedical applications, composite materials, evaluating of materials structure and morphology based on data obtained by XRD, SEM, TEM, FTIR, ESI-MS, NMR and Raman spectroscopy methods. The candidate should have competences in inorganic and metal-organic coordination compounds syntheses, also as nano- and submicrosized materials, obtaining of graphene structures and composite materials based on them using inorganic and organic polymer matrices. The candidate should have at least five years' experience in the chemistry of nanomaterials, photoactive organometallic compounds, and knowledge of the technology for obtaining graphene materials. The candidate should have skills needed for the interpretation of the results obtained by XRD, SEM, TEM, FTIR, ESI-MS, NMR and Raman spectroscopy methods to describe structure and morphology of investigated compounds and materials. The candidate must have PhD in chemistry and scientific experience documented with published papers in the above field of investigations, including: at least 5-years experience of scientific work, participation in research projects and authorship or co-authorship in publications published in journals from the Philadelphia list, as well as experience in leading a team of research and implementation of research projects. Good knowledge of English is required. Declaration that if employed, the Institute of Low Temperature and Structure Research will be the applicant's principal employer. The competition expires: March 28, 2017. Determining the results: March 31, 2017.
Landry, M. R., Selph, K. E., Decima, M., Gutierrez-Rodriguez, A., Stukel, M. R., Taylor, A. G., et al. (2016). Phytoplankton production and grazing balances in the Costa Rica Dome. J Plankton Res, 38(2), 366–379. Abstract: We investigated phytoplankton production rates and grazing fates in the Costa Rica Dome (CRD) during summer 2010 based on dilution depth profiles analyzed by flow cytometry and pigments and mesozooplankton grazing assessed by gut fluorescence. Three community production estimates, from 14C uptake (1025 +/- 113 mg C m-2 day-1) and from dilution experiments analyzed for total Chla (990 +/- 106 mg C m-2 day-1) and flow cytometry populations (862 +/- 71 mg C m-2 day-1), exceeded regional ship-based values by 2-3-fold. Picophytoplankton accounted for 56% of community biomass and 39% of production. Production profiles extended deeper for Prochlorococcus (PRO) and picoeukaryotes than for Synechococcus (SYN) and larger eukaryotes, but 93% of total production occurred above 40 m. Microzooplankton consumed all PRO and SYN growth and two-third of total production. Positive net growth of larger eukaryotes in the upper 40 m was balanced by independently measured consumption by mesozooplankton. Among larger eukaryotes, diatoms contributed approximately 3% to production. On the basis of this analysis, the CRD region is characterized by high production and grazing turnover, comparable with or higher than estimates for the eastern equatorial Pacific. The region nonetheless displays characteristics atypical of high productivity, such as picophytoplankton dominance and suppressed diatom roles. Keywords: grazing; plankton community; productivity Selph, K. E., Landry, M. R., Taylor, A. G., Gutierrez-Rodriguez, A., Stukel, M. R., Wokuluk, J., et al. (2016). Phytoplankton production and taxon-specific growth rates in the Costa Rica Dome. J Plankton Res, 38(2), 199–215. Abstract: During summer 2010, we investigated phytoplankton production and growth rates at 19 stations in the eastern tropical Pacific, where winds and strong opposing currents generate the Costa Rica Dome (CRD), an open-ocean upwelling feature. Primary production (14C-incorporation) and group-specific growth and net growth rates (two-treatment seawater dilution method) were estimated from samples incubated in situ at eight depths. Our cruise coincided with a mild El Nino event, and only weak upwelling was observed in the CRD. Nevertheless, the highest phytoplankton abundances were found near the dome center. However, mixed-layer growth rates were lowest in the dome center ( approximately 0.5-0.9 day-1), but higher on the edge of the dome ( approximately 0.9-1.0 day-1) and in adjacent coastal waters (0.9-1.3 day-1). We found good agreement between independent methods to estimate growth rates. Mixed-layer growth rates of Prochlorococcus and Synechococcus were largely balanced by mortality, whereas eukaryotic phytoplankton showed positive net growth ( approximately 0.5-0.6 day-1), that is, growth available to support larger (mesozooplankton) consumer biomass. These are the first group-specific phytoplankton rate estimates in this region, and they demonstrate that integrated primary production is high, exceeding 1 g C m-2 day-1 on average, even during a period of reduced upwelling. Keywords: Costa Rica Dome; growth; microzooplankton; mortality; phytoplankton Stukel, M. R., Décima, M., Landry, M. R., & Selph, K. E. (2018). Nitrogen and isotope flows through the Costa Rica Dome upwelling ecosystem: The crucial mesozooplankton role in export flux. Global Biogeochemical Cycles, 32(12), 1815–1832. Abstract: The Costa Rica Dome (CRD) is an open-ocean upwelling ecosystem, with high biomasses of picophytoplankton (especially Synechococcus), mesozooplankton, and higher trophic levels. To elucidate the food web pathways supporting the trophic structure and carbon export in this unique ecosystem, we used Markov Chain Monte Carlo techniques to assimilate data from four independent realizations of δ15N and planktonic rate measurements from the CRD into steady state, multicompartment ecosystem box models (linear inverse models). Model results present well-constrained snapshots of ecosystem nitrogen and stable isotope fluxes. New production is supported by upwelled nitrate, not nitrogen fixation. Protistivory (rather than herbivory) was the most important feeding mode for mesozooplankton, which rely heavily on microzooplankton prey. Mesozooplankton play a central role in vertical nitrogen export, primarily through active transport of nitrogen consumed in the surface layer and excreted at depth, which comprised an average 36-46% of total export. Detritus or aggregate feeding is also an important mode of resource acquisition by mesozooplankton and regeneration of nutrients within the euphotic zone. As a consequence, the ratio of passively sinking particle export to phytoplankton production is very low in the CRD. Comparisons to similar models constrained with data from the nearby equatorial Pacific demonstrate that the dominant role of vertical migrators to the biological pump is a unique feature of the CRD. However, both regions show efficient nitrogen transfer from mesozooplankton to higher trophic levels (as expected for regions with large fish, cetacean, and seabird populations) despite the dominance of protists as major grazers of phytoplankton. Keywords: Crustaceans; Diel vertical migration; Nitrogen cycle; Biological carbon pump; Nitrogen isotopes; Linear inverse ecosystem model
People who consume plenty of vitamin B12 have a significantly lower risk of developing Alzheimer's Disease, researchers from the Karolinska Institutet, Stockholm, Sweden, revealed in an article published in the peer-reviewed journal Neurology. Good sources of vitamin B12 include, poultry, fish, meat products, eggs and dairy products. Many vegan foods today are supplemented with vitamin B12, which is vital for the synthesis of red blood cells, maintenance of the nervous system, and the growth and development of children. People with a vitamin B12 deficiency are much more likely to develop anemia. The researchers write that their study provides more compelling evidence regarding the vitamin's role in preventing memory loss. They add that their study reveals the need for more research into vitamin B12's role as a marker for identifying individuals at higher risk of developing Alzheimer's Disease. Low levels of vitamin B12 are surprisingly common in the elderly. However, the few studies that have investigated the usefulness of vitamin B12 supplements to reduce the risk of memory loss have had mixed results. In this study, blood samples were taken from 271 Finnish individuals from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study, they were aged between 65 and 79 years - none of them had symptoms of dementia when the study began. Over a period of seven years of follow-up 17 of them developed Alzheimer's Disease. Blood levels of homocysteine were measured. Homocysteine is an amino acid, its chemical formula is HSCH2CH2CH(NH2)CO2H, and is a homologue (an organic compound with a similar general formula) of the amino acid cysteine. High levels of homocysteine have been associated with an increased incidence of cardiovascular disease - lowering its levels might not improve outcomes. High blood homocysteine levels are also linked to negative effects on the brain, such as stroke. However, elevated levels of vitamin B12 can help lower homocysteine levels. The scientists found that for every decrease of 1 micromole per liter of homocysteine in the blood, Alzheimer's Disease (AD) risk went up by 16%. On the other hand, for every increase of 1 micromole per liter of the active part of vitamin B12 (holotranscobalamin), the risk of AD dropped by 2%. These figures remained the same, even after taking into account the patient's age, education, smoking habits, blood pressure, body mass and gender. The addition of folate (folic acid) did not change any of the results. This study suggests that both tHcy* and holoTC** may be involved in the development of AD. The tHcy-AD link may be partly explained by serum holoTC. The role of holoTC in AD should be further investigated. "Homocysteine and holotranscobalamin and the risk of Alzheimer disease - A longitudinal study" Nordqvist, Christian. "Regular Vitamin B12 Lowers Alzheimer's Disease Risk." Medical News Today. MediLexicon, Intl., 19 Oct. 2010. Web.
Medicine.com Medication & Supplements Search Medicine.com View all Health Guides Medications A–Z Simvastatin View all Medications Conditions A–Z First aid kits - the essentials Caffeine withdrawal: How to beat the symptoms while breaking the habit UPDATE: SARS-CoV-2 vaccines to prevent COVID-19 - roundup of the front runners Top 5 strategies to help treat scalp psoriasis Reviewed by N France, BPharm on November 7, 2019 Written by Cynthia Foley After a sperm fertilizes an egg, new tissues develop that normally form the fetus and placenta. A molar pregnancy, also known as gestational trophoblastic disease, occurs when the tissue that was supposed to form the placenta grows abnormally and can form a tumor that can spread beyond the womb or uterus. In a "complete mole," no normal fetal tissue forms. In a "partial mole," incomplete fetal tissues develop alongside molar tissue. These two conditions are noncancerous (benign) and make up 80 percent of cases. Three malignant forms of gestational trophoblastic disease occur, including invasive molar pregnancy, choriocarcinoma and placental site trophoblastic tumors. Almost all molar pregnancies, even the cancerous type, can be cured. Most molar pregnancies are noncancerous and confined to the uterus (hydatidiform moles). In this type of mole, the abnormal placental tissue has villi, clusters of tissue swollen with fluid, giving it the appearance of a cluster of grapes. If a fetus begins to develop along with a hydatidiform mole, it typically has many malformations and almost never can be delivered as a living baby. A more aggressive tumor associated with molar pregnancies is an invasive mole, also called chorioadenoma destruens. The invasive mole contains many villi, but these may grow into or through the muscle layer of the uterus wall. Rarely, invasive moles can cause bleeding by perforating the uterus through its whole thickness. In 15% of cases, an invasive mole can spread to tissues outside of the uterus. Pregnancy tissues can develop into a cancer called choriocarcinoma, though this is rare. Fifty percent of choriocarcinomas form during a molar pregnancy. Others form during a tubal pregnancy, an aborted pregnancy, a miscarriage or a healthy pregnancy. Choriocarcinomas can cause persistent bleeding in the weeks or months after delivery, but this happens very rarely. (Most bleeding like this is not caused by a choriocarcinoma). Choriocarcinomas associated with molar pregnancies almost always follow complete moles rather than partial moles. In the United States, molar pregnancies occur in about one in 1,200 pregnancies. Choriocarcinoma occurs in one in 40,000 pregnancies. Hydatidiform moles can exaggerate the usual symptoms of pregnancy. Many of the symptoms are similar to those associated with miscarriage, and most women with molar pregnancies first believe they have miscarried. Invasive moles and choriocarcinomas can cause symptoms during or after pregnancy, and symptoms can develop after a hydatidiform mole has been removed. The most common symptom is vaginal bleeding, especially between the 6th and 16th weeks of pregnancy. Another symptom is bleeding that continues for a long time after delivery. Small amounts of bleeding can show up as a watery brown discharge from the vagina. Sometimes, a piece of tissue containing grapelike shapes will pass through the vagina, though this is not common. It is important to remember that most vaginal bleeding during or after pregnancy is not associated with a molar pregnancy. However, you should report any bleeding during pregnancy to your health care professional. A mole or choriocarcinoma also can cause the following symptoms: Abdominal swelling, caused by the uterus becoming larger, that occurs more rapidly than expected for the first trimester of pregnancy Excessive vomiting during pregnancy Fatigue, often caused by anemia from heavy bleeding Sudden severe abdominal pain caused by internal bleeding Pelvic cramping or vaginal discharge Shortness of breath, coughing or blood in coughed-up secretions because choriocarcinoma very rarely spreads to the lungs before it is diagnosed. There are many other causes for these symptoms—most are associated with normal pregnancies—so if you have such problems don't assume you have a molar pregnancy. Always speak with your health care professional. Your doctor may suspect you have a molar pregnancy based on symptoms you have during or following pregnancy, or because your uterus is unusually large. Your doctor may suspect a molar pregnancy if you have a high level of human chorionic gonadotropin (HCG), the hormone measured in a routine pregnancy test. All pregnancies with high levels of HCG are not moles, however, and some molar pregnancies do not have high levels of HCG. An ultrasound of the pelvis typically can confirm a diagnosis of a molar pregnancy. Ultrasound uses sound waves to show an image of the contents within the uterus. If you have a molar pregnancy, further testing will be done to determine the type of mole and the possibility of it having spread outside the uterus. Testing may include X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to view the chest, abdomen, pelvis and brain. Additional blood tests may be needed. A pathologist will look at the molar tissue under a microscope once it is removed to confirm the diagnosis. With appropriate treatment, all hydatidiform moles are curable, and nearly all cases of more aggressive molar tumors can be cured. Even with tumors whose features categorize them as having a poor prognosis, 80% to 90% are cured with a combination of surgery and, if needed, chemotherapy. It is important for women with molar pregnancies to be evaluated periodically after the problem has been treated. Women are advised not to attempt pregnancy for some time in order to be sure that levels of HCG remain at zero and that no further treatment is needed. There is a risk that a molar pregnancy can come back after treatment. Recommendations are changing and vary by hospital. It is usually possible for women to have a normal, healthy pregnancy after treatment for a molar pregnancy. Expected Duration Treatment for some molar pregnancies can take several months. Following treatment, you will need to have repeated blood tests and checkups over one to two years, to be sure that all molar tissue has been treated and that the problem has not returned. The results of diagnostic tests will help to determine a treatment plan. Options for treatment almost always include surgery to remove the tumor. More aggressive types of molar pregnancy may require chemotherapy and/or radiation therapy. About 85% of hydatidiform moles can be treated without chemotherapy. Treatment options include: Suction dilation and curettage (D and C) — This is a surgical procedure used to remove noncancerous hydatidiform moles. The opening in the cervix is dilated and the inside uterus lining is scraped (curetted) clean using suction and another spoon-like instrument. Removal of the uterus (hysterectomy) — This is used rarely to treat hydatidiform moles but may be elected particularly if the woman does not want to become pregnant again. Chemotherapy with a single drug — This treatment with medication toxic to the molar tissue is used to treat a molar pregnancy tumor that has features suggesting a good prognosis. Chemotherapy with multiple drugs — Treatment with several medications, each toxic to the molar tissue, is generally required to treat invasive tumors with poorer prognosis. Radiation treatment — This uses high-strength X-ray beams to destroy cancer cells in the exceedingly rare case when a tumor has spread (metastasized) to the brain. Although any woman who becomes pregnant is at some risk of developing one of these uncommon conditions, the risk appears to be higher in pregnant women who are younger than age 20 or older than age 40. The best way to prevent complications from an invasive mole or a choriocarcinoma is to receive routine prenatal care by a qualified health care professional, so that problems can be identified as early as possible. When to Call a Professional For any pregnancy, make sure you have appropriate prenatal care beginning in the first trimester, with regular checkups. Report any bleeding, excessive vomiting, or abdominal pain during pregnancy to your doctor. If you have prolonged vaginal bleeding after childbirth, an abortion or a miscarriage, contact your doctor for an evaluation. First aid kits are an important tool to have in your home, car or when travelling far from home. Caffeine is addictive and can be hard to quit, but withdrawing caffeine from your daily routine can benefit your health and mental wellbeing. An update on the front-runner SARS-CoV-2 vaccines, several of which have been approved for emergency use. There are many options available to help treat scalp psoriasis - from home remedies to prescription medications and even phototherapy. Knowledge is the best medicine. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. 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e make sure all of our members receive the necessary medical, behavioral, and social services support they need. All members of your treatment team contribute to developing a plan of care is especially for you. The plan can include your health condition, mental health, rehabilitation, social service needs, and an evaluation of drug dependency. Your care is coordinated because all members of the team report back to the care manager on your health condition, treatment plans/goals, your accomplishments and any outcomes. You are important. We make sure that you understand your treatment plan and are involved in all decisions concerning your care. All of our clients will receive a dedicated Care Coordinator who is responsible for their overall care plan. The Care Coordinator oversees and coordinates access to all of the services a member requires to stay healthy. Why do I need a Care Coordinator? Studies show that people with numerous chronic illnesses feel better and live longer when the network of providers, agencies, programs and services they receive is coordinated. We are happy to assist our clients and their family. Referrals are available for behavioral health services, individual and group therapy, disease specific support groups, and more.
Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) works well to relieve cough and allergy or cold symptoms, but since it's a schedule II (CII) drug, you'll have to go back to the doctor if you need a refill. Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) is a combination opioid (hydrocodone) and antihistamine (chlorpheniramine) medicine that relieves cough and upper respiratory (nose, throat, and sinus) symptoms. The long-acting forms (suspension and capsule) are best if you need all-day relief. The shorter acting solution is a good choice if you need it to work faster. In addition to relieving your cough, it may help you fall asleep easier. The antihistamine, chlorpheniramine, can help dry out your nose and prevent cough from post-nasal drip. Tried Hydrocodone Chlorpheniramine? Write a review! Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) is a controlled substance (CII) because it contains hydrocodone, a medicine with a high risk of abuse. You'll need to keep it in a safe place to avoid it being taken by others. Constipation is very common, so you'll need to drink enough water and stool softeners while on it. All opioid medicines have the risk of causing physical dependence and withdrawal when you stop using it. None of the dosage forms of Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) are safe to give to children younger than 6 years. It can cause really slow breathing in children that can lead to death. Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) is a combination medicine that treats cough, allergy, and cold symptoms. Hydrocodone is an opioid (similar to codeine) that relieves pain and works in the brain to control cough. Chlorpheniramine (an antihistamine) treats nasal allergy symptoms. These are side effects of Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) reported to the FDA by people taking it, and by doctors and pharmacists. Reports are often from people taking more than one drug. Their side effects might not be due to Hydrocodone / Chlorpheniramine at all. Taking too much Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine) can cause irregular or slow breathing that can put you in a coma and can cause death. TussiCaps should be swallowed whole, don't ever crush or chew. Don't take more than 2 doses Tussionex or TussiCaps in a 24 hour period. If your lips and fingers start turning blue from low oxygen, see a doctor immediately. In the hospital, doctors can give you a medicine that reverses the effects of Tussionex Pennkinetic (Hydrocodone / Chlorpheniramine). Don't take more than your doctor prescribes. Always check with your doctor before starting any new medicines or supplements.
Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contras ted MRI or other modalities. NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs. For patients at highest risk for NSF, do not exceed the recommended ABLAVAR dose and allow a sufficient period of time for elimination of the drug from the body prior to re-administration [see WARNINGS AND PRECAUTIONS]. ABLAVAR is indicated for use as a contrast agent in magnetic resonance angiography (MRA) to evaluate aortoiliac occlusive disease (AIOD) in adults with known or suspected peripheral vascular disease [see Clinical Studies]. Anaphylaxis and anaphylactoid reactions were the most common serious reactions observed following ABLAVAR injection administration [see WARNINGS AND PRECAUTIONS]. In all clinical trials evaluating ABLAVAR with MRA, a total of 1,676 (1379 patients and 297 healthy subjects) were exposed to various doses ABLAVAR. The mean age of the 1379 patients who received ABLAVAR was 63 years (range 18 to 91 years); 66% (903) were men and 34% (476) were women. In this population, there were 80% (1100) Caucasian, 8% (107) Black, 12% (159) Hispanic, 1% (7) Asian, and < 1% (6) patients of other racial or ethnic groups. Table 2 shows the most common adverse reactions ( ≥ 1%) experienced by subjects receiving ABLAVAR at a dose of 0.03 mmol/kg. Following injection, ABLAVAR binds to blood albumin and has the potential to alter the binding of other drugs that also bind to albumin. No drug interaction reactions were observed in clinical trials. Consider the possibility of ABLAVAR interaction with concomitantly administered medications that bind to albumin. An interaction may enhance or decrease the activity of the concomitant medication [see CLINICAL PHARMACOLOGY]. Gadolinium-based contrast agents (GBCAs) increase the risk for nephrogenic systemic fibrosis (NSF) among patients with impaired elimination of the drugs. Avoid use of GBCAs among these patients unless the diagnostic information is essential and not available with non-contrast enhanced MRI or other modalities. The GBCA-associated NSF risk appears highest for patients with chronic, severe kidney disease (GFR < 30 mL/min/1.73m²) as well as patients with acute kidney injury. The risk appears lower for patients with chronic, moderate kidney disease (GFR 30-59 mL/min/1.73m²) and little, if any, for patients with chronic, mild kidney disease (GFR 60 - 89 mL/min/1.73m²). NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs. Report any diagnosis of NSF following ABLAVAR administration to Lantheus Medical Imaging, Inc. (1-978-667-9531)/(1-800-362- 2668) or FDA (1-800-FDA-1088 or www.fda.gov/medwatch). Among the factors that may increase the risk for NSF are repeated or higher than recommended doses of a GBCA and the degree of renal impairment at the time of exposure. Record the specific GBCA and the dose administered to a patient. For patients at highest risk for NSF, do not exceed the recommended ABLAVAR dose and allow a sufficient period of time for elimination of the drug prior to re-administration. For patients receiving hemodialysis, physicians may consider the prompt initiation of hemodialysis following the administration of a GBCA in order to enhance the contrast agent's elimination. The usefulness of hemodialysis in the prevention of NSF is unknown [see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION]. ABLAVAR may cause anaphylactoid and/or anaphylactic reactions, including life-threatening or fatal reactions. In clinical trials, anaphylactoid and/or anaphylactic reactions occurred in two of 1676 subjects. If anaphylactic or anaphylactoid reactions occur, stop ABLAVAR Injection and immediately begin appropriate therapy. Observe patients closely, particularly those with a history of drug reactions, asthma, allergy or other hypersensitivity disorders, during and up to several hours after ABLAVAR administration. Have trained personnel and emergency resuscitative equipment available prior to and during ABLAVAR administration. If such a reaction occurs stop ABLAVAR and immediately begin appropriate therapy. In patients with renal insufficiency, acute renal failure requiring dialysis or worsening renal function have occurred with the use of other gadolinium agents. The risk of renal failure may increase with increasing dose of gadolinium contrast. Screen all patients for renal dysfunction by obtaining a history and/or laboratory tests. Consider follow-up renal function assessments for patients with a history of renal dysfunction. No reports of acute renal failure were observed in clinical trials of ABLAVAR [see CLINICAL PHARMACOLOGY]. In clinical trials, a small increase (2.8 msec) in the average change from baseline in QTc was observed at 45 minutes following ABLAVAR administration; no increase was observed at 24 and 72 hours. A QTc change of 30 to 60 msec from baseline was observed in 39/702 (6%) patients at 45 min following ABLAVAR administration. At this time point, 3/702 (0.4%) patients experienced a QTc increase of > 60 msec. These QTc prolongations were not associated with arrhythmias or symptoms. In patients at high risk for arrhythmias due to QTc prolongation (e.g., concomitant medications, underlying cardiac conditions) consider obtaining baseline electrocardiograms to help assess the risks for ABLAVAR administration. If ABLAVAR is administered to these patients, consider follow-up electrocardiograms and risk reduction measures (e.g., patient counseling or intensive electrocardiography monitoring) until most ABLAVAR has been eliminated from the blood. In patients with normal renal function, most ABLAVAR was eliminated from the blood by 72 hours following injection [see CLINICAL PHARMACOLOGY]. Long-term animal studies have not been performed to evaluate the carcinogenic potential of gadofosveset. Gadofosveset was negative in the in vitro bacterial reverse mutation assay, CHO chromosome aberration assay, and the in vivo mouse micronucleus assay. Administration of up to 1.5 mmol/kg (8.3 times the human dose) to female rats for 2 weeks and to male rats for 4 weeks did not impair fertility [see Use in Specific Populations]. It is not known whether gadofosveset is secreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when ABLAVAR is administered to a woman who is breastfeeding. The risks associated with exposure of infants to gadolinium-based contrast agents in breast milk are unknown. Limited case reports indicate that 0.01 to 0.04% of the maternal gadolinium dose is excreted in human breast milk. Studies of other gadolinium products have shown limited gastrointestinal absorption. These studies were conducted with gadolinium products with shorter halflives than ABLAVAR. Avoid ABLAVAR administration to women who are breastfeeding unless the diagnostic information is essential and not obtainable with non-contrast MRA. ABLAVAR Injection has been administered to humans up to a dose of 0.15 mmol/kg (5 times the clinical dose). No ABLAVAR overdoses were reported in clinical trials. In the event of an overdose, direct treatment toward the support of all vital functions and prompt institution of symptomatic therapy. Gadofosveset has been shown to be removed by hemodialysis using a high flux dialysis procedure [see CLINICAL PHARMACOLOGY]. In human studies, gadofosveset substantially shortened blood T1 values for up to 4 hours after intravenous bolus injection. Relaxivity in plasma was measured to be 33.4 to 45.7 Mm-1 s-1 (0.47 T) over the dose range of up to 0.05 mmol/kg. The mean volume of distribution at steady state for gadofosveset was 148 ± 16 mL/kg, roughly equivalent to that of extracellular fluid. A significant portion of circulating gadofosveset is bound to plasma proteins, predominantly albumin. At 0.05, 0.5, 1 and 4 hours after injection of 0.03 mmol/kg the plasma protein binding of gadofosveset ranges from 79.8 to 87.4. Gadofosveset does not undergo measurable metabolism in humans. Gadofosveset is eliminated primarily in the urine, with between 79% and 94% (mean of 83.7%) of an injected dose recovered in the urine. Of the total gadofosveset recovered in urine, 94% is recovered within the first 72 hours. A small portion of gadofosveset dose is recovered in feces (approximately 4.7%). Renal Insufficiency: Administration of gadolinium-based contrast agents, including ABLAVAR to patients with severe renal insufficiency increases the risk for NSF. Administration of these agents to patients with mild to moderate renal insufficiency may increase the risk for worsened renal function [see WARNINGS AND PRECAUTIONS]. Prior to use of ABLAVAR in these patients, ensure that no satisfactory diagnostic alternatives are available. In patients with moderate to severe renal impairment (glomerular filtration rate < 60 mL/kg/m²), administer ABLAVAR at a dose of 0.01 mmol/kg to 0.02 mmol/kg. Consider follow-up renal function assessments following ABLAVAR administration to any patients with renal insufficiency. Pediatric: Studies of gadofosveset in pediatric patients have not been performed. Out of 493 patients enrolled in these two trials, 424 were included in the comparison of the diagnostic efficacy of ABLAVAR-MRA to that of non-contrast MRA in detection/exclusion of occlusive vascular disease ( ≥ 50% stenosis) in 7 vessel-segments in the aortoiliac region. The interpretation of MRA images from both trials was conducted by three independent radiologist readers who were blinded to clinical data, including the results of X-ray arteriography. In these 424 patients, the median age was 67 years with a range of 29 to 87 years; 58% of the patients were over 65 years of age; 83% were white and 68% were male. The primary efficacy analyses were designed to demonstrate superiority in sensitivity and noninferiority in specificity of ABLAVAR-MRA as compared to non-contrast MRA at the vessel-segment level. The uninterpretable images were assigned an outcome of "wrong diagnosis". Additionally, success was also based upon acceptable performance characteristics for the uninterpretable noncontrast MRA vessel segments that became interpretable following ABLAVAR administration. Specifically, the sensitivity and specificity for these ABLAVAR images were required to exceed 50%. These pre-specified success criteria were to be achieved by at least the same two readers for all primary analyses.
امگا-3 یکی از اسیدهایی است که در ساختمان برخی چربی‌ها وجودداشته و در سلامت انسان نقش ضروری ایفا می‌کند. لذا تحقیق‌های گسترده‌ای به‌منظور تغلیظ و خالص‌سازی امگا-3 از روغن ماهی انجام گرفته است. در این پژوهش، به بررسی کارایی فرایند غشایی در تغلیظ اسیدهای چرب امگا-3 بلندزنجیر موجود در فانوس ماهی که حاوی 25/23 درصد امگا-3 بوده، پرداخته شده است. به‌منظور ساخت غشاء، از پلیمر ELVALOY®4170 استفاده شد و غشاء به روش ترسیب به‌واسطۀ غوطه‌وری تهیه شد. ساختار غشای حاصله ازطریق میکروسکوپ الکترونی روبشی موردارزیابی قرار گرفت. در فرایند تغلیظ، اثرات 3 پارامتر شامل دمای فرایند، فشار و نرخ هم‌زدن به روش آماری سطح پاسخ Box-Behnken موردمطالعه قرار گرفتند. تصاویر میکروسکوپ الکترونی غشاء نشان داد غشای حاصله متشکل از ساختاری متخلخل به همراه یک لایۀ فوقانی چگال بسیار نازک بوده است. نتایج به‌دست‌آمده از آزمون تغلیظ به روش آنالیز واریانس موردارزیابی قرار گرفت و نشان داد که در بین پارامترهای موردبررسی، دما از بیشترین تأثیر در فرایند تغلیظ برخوردار بوده است. علاوه‌بر این، رفتار گرفتگی غشاها در دور هم‌زدن‌های مختلف موردبررسی قرار گرفت و نتایج نشان داد که کمترین گرفتگی در حالت هم‌زدن برابر با 100 دور در دقیقه اتفاق افتاد. در بین شرایط مختلف فرایند تغلیظ، بیشترین تغلیظ امگا-3 در دمای 40 درجۀ سلسیوس، فشار 5 بار و شدت هم‌زدن صفر و برابر با 37/32 درصد وزنی بود. Abedini, R., Mousavi, S.M., & Aminzadeh, R. 2012. Effect of sonochemical synthesized TiO2 nanoparticles and coagulation bath temperature on morphology, thermal stability and pure water flux of asymmetric cellulose acetate nanocomposite membranes prepared via phase inversion method. Chemical Industry & Chemical Engineering Quarterly, 18(3):385-398. Abedini, R., Mousavi, S.M., & Aminzadeh, R. 2011. A novel cellulose acetate (CA) membrane using TiO2 nanoparticles: Preparation, characterization and permeation study. Desalination, 277(1-3):40-45. AOCS. 2009. Animal and vegetable fats and oils–Determination of Oils and Fats, Gas chromatography. No Ce 1h-05. Azmi, R.A., Goh, P.S., Ismail, A.F., Lau, W.J., Ng, B.C., Othman, N.H., Noor, A.M., & Yusoff, M.S.A. 2015. Deacidification of crude palm oil using PVA-crosslinked PVDF Membrane. Journal of Food Enginnering, 166:165-173. Chen, Y.Q., Edwards, I.J., Kridel, S.J., Thornburg, T., & Berquin, I.M. 2007. Dietary fat'gene interaction in cancer. Cancer Metastasis Reviews, 26(3-4):535-551. Field, R.W., & Wu, J.J. 2011. Modelling of permeability loss in membrane filtration: re-examination of fundamental fouling equations and their link to critical flux. Desalination, 283:68-74. Hibino, M., Sumi, A., & Hatta, I. 1995. Atomic images of saturated and unsaturated fatty acids at liquid/graphite interface and difference of tunneling currents between them observed by scanning tunneling microscopy. Japanese Journal of Applied physics, 34(1):610-619. James, B.J., Jing, Y., & Chen, X.D. 2003. Membrane fouling during filtration of milk-a microstructural study. Journal of Food Engineering, 60(4):431-437. Juang, R.S., Chen, H.L., & Chen, Y.S. 2008. Membrane fouling and resistance analysis in dead-end ultrafiltration of bacillus subtilis fermentation broths. Separation and Purification Technology, 63(3):531-538. Kolanowski, W., Jaworska, D., & Weissbrodt, J. 2007. Importance of instrumental and sensory analysis in the assessment of oxidative deterioration of omega-3 long-chain polyunsaturated fatty acid-rich foods. Journal of the Science of Food and Agriculture, 87(2):181-191. Kolanowski, W., & Laufenberg, G. 2006. Enrichment of food products with polyunsaturated fatty acids by fish oil addition. European Food Research and Technology, 222(3-4):472-477. Kumar, N.S.K., & Bhowmick, D.N. 2006. Separation of fatty acids/triacylglycerol by membranes. Journal of the American Oil Chemists' Society, 73(3):399-401. Letisse, M., Rozieres, M., Hiol, A., Sergent, M., & Comeau, L. 2006. Enrichment of EPA and DHA from sardine by supercritical fluid extraction without organic modifier: i. optimization of extraction conditions. The Journal of Supercritical Fluids, 38(1):27-36. Mehrparvar, A., & Rahimpour, A. 2015. Surface modification of novel polyether sulfone amide (PESA) ultrafiltration membranes by grafting hydrophilic monomers. Journal of Industrial and Engineering Chemistry, 28:359-368. Metcalfe, L.D, Schmitz, A.A., & Pelka, J.R. 1966. Rapid preparation of fatty acid esters from lipid for gas chromatography analysis. Analytical Chemistry, 38(3):514-515. Gamez-Meza, N., Noriega-Rodriguez, J.A., Medina-Juarez, L.A., & Angulo-Guerrero, O.2003. Concentration of EPA and DHA from fish oil by hydrolysis and urea complexation. Food Research International, 36(7):721-727. Nourbakhsh, H., Emam-Djomeh, Z., Mirsaeedghazi, H., Omid, M., & Moieni, S. 2014. Study of different fouling mechanisms during membrane clarification of red plum juice. International Journal of Food Science & Technology, 49(1):58-64. Rodriguez, N.R., Beltran, S., Jaime, I., de Diego, S.M., Sanz, M.T., & Carballido, J.R. 2010. Production of omega-3 polyunsaturated fatty acid concentrates: a review. Innovative Food Science & Emerging Technologies, 11(1):1-12. Ranjbaran, F., Omidkhah, M.R., & Ebadi Amooghin, A. 2015. The novel Elvaloy4170/functionalized multi-walled carbon nanotubes mixed matrix membranes: fabrication, characterization and gas separation study. Journal of the Taiwan Institute of Chemical Engineers, 49:220-228. Rupasinghe, H.P.V, Erkan, N., & Yasmin, A. 2010. Antioxidant protection of eicosapentaenoic acid and fish oil oxidation by polyphenolic-enriched apple skin extract. Journal of Agricultural and Food Chemistry, 58(2):1233-1239. Ruxton, C.H.S., Calder, P.C., Reed, S.C., & Simpson, M.J.A. 2005. The impact of longchain n-3 polyunsaturated fatty acids on human health. Nutrition Research Reviews, 18(1):113-129. Saljoughi, E., Amirilargani, M., & Mohammadi, T. 2009. Effect of poly (vinyl pyrrolidone) concentration and coagulation bath temperature on the morphology, permeability, and thermal stability of asymmetric cellulose acetate membranes. Journal of Applied Polymer Science, 111(5):2537-2544. Shahidi, F. 2005. Bailey' Industrial Oil and Fat Products. Wiley and Sons, New York. Sotoft, L.F., Lizarazu, J.M., Parjikolaei, B.R., Karring, H., & Christensen, K.V. 2015. Membrane fractionation of herring marinade for separation and recovery of fats, proteins, amino acids, salt, acetic acid and water. Journal of Food Enginnering, 158:39-47. Wu, L., Yick, K.L., Ng, S.P., & Yip, J. 2012. Application of the box-behnken design to the optimization of process parameters in foam cup molding. Expert Systems with Applications, 39(9):8059-8065. Yesudhason, P., Gopal, T.K., Ravishankar, C.N., Lalitha, K.V., & Kumar, K.N. 2009. Effect of modified atmosphere packaging on chemical, textural, microbiological and sensory quality of seer fish (scomberomorus commerson) steaks packaged in thermoformed trays at 0-2ºC. Journal of Food Processing and Preservation, 33(6):777-797.
Buy Naprosyn Online - No Prior Prescription and Fast Shipping! Naproxen (Naprosyn) is a nonsteroidal anti-inflammatory drug. It's works by reducing hormones that cause inflammation and pain throughout the body. Naprosyn is used to treat pain and inflammation caused by conditions such as gout, arthritis, tendinitis, menstruation cramps and bursitis. : The following information is intended only intended to supplement, not be a substitute for, the expertise and judgment of your doctor, pharmacist or other healthcare professional. It should not be interpreted that use of the drug is appropriate, safe or effective for you. Consult your healthcare professional before using this drug. What are the common uses?: Naprosyn is used to bring pain relief for conditions such as headaches, muscle aches, tendonitis, dental pain, and menstrual cramps. It also reduces pain, swelling, and joint stiffness caused by arthritis, bursitis, and episodes of gout. This medication is commonly known as a nonsteroidal anti-inflammatory drug (NSAID). It blocks your body's production of certain natural substances that result in inflammation. How do I use this medicine?: Read the Medication Guide provided by your pharmacist or doctor before you begin using naproxen and then each time you get a refill. If you have any additional questions or concerns, ask your doctor or pharmacist. Take this medication by mouth or as you have been directed by your doctor, typically 2 or 3 times a day with a full glass of water (8-12 ounces). Do not lay down for least 10 minutes after you consume this drug. To prevent stomach upset, take this medication with an antacid, milk, or with food. The dosage is based on your medical condition and response to treatment. In order to reduce effects such as stomach bleeding and others, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose or take Naproxen more often than directed. For ongoing conditions such as arthritis, continue taking this medication as directed by your doctor. For certain conditions (such as arthritis and gout), it may be upwards of two weeks before you get the full benefit. If you are taking Naprosyn "as needed" (not on a regular schedule), remember that pain medications work best if they are utilized at the first sign of pain. If you wait until the pain has worsened, Naprosyn may not work as well. What are the side effects?: The potential effects include upset stomach, nausea, heartburn, headache, drowsiness, or dizziness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed Naprosyn because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using Naproxen do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, difficult/painful swallowing, hearing changes (including ringing in the ears), mental or mood changes, unexpected swelling of the ankles/feet/hands, sudden/unexplained weight gain, change in the amount of urine, unexplained stiff neck, vision changes, unusual tiredness. Naproxen may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: dark urine, persistent nausea/vomiting/loss of appetite, stomach/abdominal pain, yellowing eyes/skin. A severe allergic reaction to Naprosyn is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, difficulty with breathing. What precautions should I be aware of?: Before taking Naprosyn, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before taking Naprosyn, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), blood disorders (such as anemia, bleeding/clotting problems), growths in the nose (nasal polyps), heart disease (such as congestive heart failure, previous heart attack), high blood pressure, kidney disease, liver disease, severe loss of body water (dehydration), stroke, throat/stomach/intestinal problems (such as bleeding, heartburn, ulcers). Naprosyn may cause you to be you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. It is important to note that Naprosyn may result in bleeding within the stomach. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking. Consult your doctor or pharmacist for more information. Naprosyn may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors. If you are planning to have surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Eldery adults may have a higher sensitivity to the side effects of Naprosyn, especially stomach and intestinal bleeding. Before using Naprosyn, women of childbearing age should talk with their doctor(s) about the benefits and risks (such as miscarriage). Tell your doctor if you are pregnant or if you plan to become pregnant. If you are pregnant, this medication should be used only when clearly needed. It is not recommended for use during the first and last trimesters of pregnancy due to possible harm to the unborn baby and interference with normal labor/delivery. Naproxen passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding. What are the drug interactions?: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Products that may interact with Naproxen include: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as prednisone), lithium. Naprosyn may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others. Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as celecoxib, ibuprofen, or ketorolac). These drugs are similar to Naproxen and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually at dosages of 81-325 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details. Naproxen can affect the results of certain laboratory tests, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug. What if there is in an overdose?: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach pain, extreme drowsiness, seizures. Additional Information: When you buy Naproxen, it is for you only. Do not share Naproxen with others. If you have arthritis, lifestyle changes (such as weight loss if needed, strengthening/conditioning exercises) may help improve your flexibility and joint function. Work with your doctor to create a healthy lifestyle plan. What if a I miss a dose: If you are taking Naprosyn on a regular schedule (not just "as needed") and you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up. How should this drug be stored?: Keep Naprosyn at room temperature and away from light and moisture as much as possible. Do not store in the bathroom. Keep all medications away from children and pets.
As nature's choice in designing complex architectures, the bottom-up assembly of nanoscale building blocks offers unique solutions in achieving more complex and smaller morphologies with wide-ranging applications in medicine, energy, and materials science as compared to top-down manufacturing. In this work, we employ charged tobacco mosaic virus (TMV-wt and TMV-lys) nanoparticles in constructing multilayered fibrous networks via electrostatic layer-by-layer (LbL) deposition. In neutral aqueous media, TMV-wt assumes an anionic surface charge. TMV-wt was paired with a genetically engineered TMV-lys variant that displays a corona of lysine side chains on its solvent-exposed surface. The electrostatic interaction between TMV-wt and TMV-lys nanoparticles became the driving force in the highly controlled buildup of the multilayer TMV constructs. Since the resulting morphology closely resembles the 3-dimensional fibrous network of an extracellular matrix (ECM), the capability of the TMV assemblies to support the adhesion of NIH-3T3 fibroblast cells was investigated, demonstrating potential utility in regenerative medicine. Lastly, the layer-by-layer deposition was extended to release the TMV scaffolds as free-standing biomembranes. To demonstrate potential application in drug delivery or vaccine technology, cargo-functionalized TMV biofilms were programmed.
LBI-HTA - Publications - Search - Costs of day surgery in Austria: An analysis of data and methods for varicose vein surgery as an example Fischer, S. and Zechmeister-Koss, I. (2014): Costs of day surgery in Austria: An analysis of data and methods for varicose vein surgery as an example. HTA-Projektbericht 71. PDF - Sie müssen einen PDF-Viewer auf Ihrem PC installiert haben wie z. B. GSview, Xpdf oder Adobe Acrobat Reader Due to an estimated cost benefit of day surgery, an increase of day surgical procedures may help to reduce the costs in the Austrian health care system. This report contains an analysis of data and methods to calculate the costs of day surgery and inpatient treatment in Austria. Thus, varicose vein surgery was chosen as an example to examine several data sources in terms of their applicability. For the first approach, meta data from the Austrian "Dokumentations- und Informationssystem für Analysen im Gesundheitswesen" was used. Generated lump sums from hospital reimbursement, total costs that occurred in the departments and number of patients were considered in an equation. For the second approach, we used data from individual hospitals in Austria both for the surgery itself and for nursing. The third approach contained the adaptation of international cost data from the UK by an adjustment for inflation and prices for Austria. The calculated costs differ between 859 and 4,664 Euros for day surgery and 1,720-2,330 Euros for an inpatient treatment. The main strength of the first approach is that it can be done relatively quickly, whereas the validity of the calculated costs is problematic. The use of hospital data takes more time, though the quality of the data is much better and the costs are closer to "true" costs. A weakness of this approach is that individual costs (e.g. for nursery) are not available for a specific intervention. Furthermore, these costs are hospital specific and a generalisation for other hospitals in Austria is not possible. The fast availability of international reference costs is a main strength, but the costs are from a different health care system and thus makes their transferability highly questionable. The calculation by using hospital data seems to provide the most valid results. However, to draw a conclusion for Austria, data from a representative sample of hospitals is required. Thereby, a reference costs database could be established to make these data available for further research in the future. Day surgery, costs, comparison of costs, data analysis, methods analysis WO Surgery > WO 500-517 Operative surgical procedures. Techniques W Health professions > W 74-80 Medical economics. Health care costs WG Cardiovascular system WO Surgery > WO 505 Minimally invasive surgical procedures HTA-Projektbericht 71
Sarath Ramadurgam [1] T.-G. Lin, S. Ramadurgam, and Chen Yang, "Design of Contact Electrodes for Semiconductor Nanowire Solar Energy Harvesting Devices", Nano Letters, Article ASAP, (2017). [2] N. Opondo, S. Ramadurgam, C. Yang and S. Mohammadi, "Trap studies in silicon nanowire junctionless transistors using low-frequency noise," Journal of Vacuum Science & Technology B, 34, 011804 (2016). [3] T.-G. Lin, S. Ramadurgam, C.-S. Liao, Y. Zi, and C. Yang, "Fabrication of Sub-25 nm Diameter GaSb Nanopillar Arrays by Nanoscale Self-Mask Effect", Nano Letters, 15, 4993-5000, (2015). [4] S. Ramadurgam, T-G. Lin and C. Yang, "Tailoring Optical and Plasmon Resonances in Core-shell and Core-multishell Nanowires for Visible Range Negative Refraction and Plasmonic Light Harvesting: A Review," Journal of Materials Science & Technology, 31(6), 533-541 (2015). Invited Review for 'A Special Issue on 1D Nanomaterials — Synthesis, Properties, and Applications' [5] S. Ramadurgam and C. Yang, "Aluminum and copper plasmonics for enhancing internal quantum efficiency of core-shell and core-multishell nanowire photoelectrodes," Proceedings of SPIE 9161, Nanophotonic Materials XI, 91610J (2014). [6] S. Ramadurgam, T.-G. Lin and C. Yang, "Aluminum plasmonics for enhanced visible light absorption and high efficiency water splitting in core-multishell nanowire photoelectrodes with ultrathin hematite shells," Nano Letters, 14 (8), 4517-4522 (2014). [7] S. Ramadurgam and C. Yang, "Semiconductor-metal-semiconductor core-multishell nanowires as negative-index metamaterial in visible domain," Scientific Reports, 4, 1-7 (2014). [8] S. H. Chung, S. Ramadurgam and C. Yang, "Effect of dopants on epitaxial growth of silicon nanowires," Nanomaterials and Nanotechnology, 4, 1-6 (2014). (Invited Article) [9] S. Ramadurgam, R. V. K. Chakravarthy, G. Tomar and R. Govindarajan, "Stability of developing film flow down an inclined surface," Physics of Fluids, 24 (10), 102109 (2012). Conferences Presentations [1] S. Ramadurgam and C. Yang, "Aluminum and copper plasmonics for enhancing internal quantum efficiency of core-shell and core-multishell nanowire photoelectrodes," SPIE Optics+Photonics 2014, Nanophotonic Materials XI, San Diego, CA, USA 17-21 August, 2014. [1] S. Ramadurgam, T.-G. Lin, K. E. Hansen and C. Yang, "Optical Properties of Single Coaxial Nanowires,(2014). https://nanohub.org/resources/nwabsorption. (DOI: 10.4231/D3ZK55N3M).
Reading: Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention... Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families Kathryn Margolis , Melissa Buchholz, Maya Bunik, Emily Muther, Ayelet Talmi Context: Early childhood (ages birth to 5 years old) is well documented as a critical period of development during which interventions are especially effective in preventing and reducing both current and future developmental disabilities, mental health problems, and family stress (Sameroff &Fiese; Zeanah, Stafford, & Zeanah, 2005; Godoy, et al., 2014). Culturally-informed early childhood health interventions for immigrants and refugees with documented health disparities are particularly important for promoting optimal development, health, and well-being. Among the many healthcare-related challenges underserved populations face, immigrants and refugees experience health disparities as a result of acculturation factors, limited social support, and an insufficient healthcare infrastructure to provide comprehensive culturally and linguistically sensitive services (Cacari-Stone et al., 2007; Berry et al., 2010). In the United States, the majority of pediatric primary care visits are for children under the age of five, with approximately 74% of these visits designated for infants under 12-months old. Consequently, primary care is the ideal setting for developing and offering culturally-sensitive interventions for immigrant and refugee populations (Center for Disease Control, 2004; Talmi, Stafford, & Buchholz, 2009). Integrated behavioral health programs in pediatric medical settings are uniquely suited to provide essential preventative services to immigrant and refugee families with children in their critical period of life. Some of these services include developmental and psychosocial screening, enhanced anticipatory guidance, care coordination, brief mental health intervention for the child and/or caregivers, and co-management of health conditions with medical providers. Aims: Drawing from over 10 years of experience developing, delivering, and evaluating integrated behavioral health services in pediatric medical settings to thousands of young children and their families within a large academic pediatric medical setting, this workshop targets the development and delivery of early childhood services in integrated healthcare settings with a focus on serving immigrant and refugee families. This workshop combines didactic and interactive methods to build competency in developing and delivering early childhood integrated care programs. The following topics will be addressed: (1) common concerns in early childhood, (2) early childhood service strategies, (3) characteristics of families served, and (4) screening, referral and follow-up processes in early childhood. Objectives: By the end of this workshop, participants will be able to: 1) Define toxic stress and Adverse Childhood Events (ACEs). 2) Describe the benefits of health promotion and prevention. 3) Identify stressors and adversity factors in the lives of immigrant and refugee families with young children. 4) Apply screening processes to their own health or behavioral health practice. 5) Describe (a) a universal early childhood service strategy and (b) a targeted early childhood service strategy that can be applied in work with immigrant and refugee families. 6) Develop two strategies for transforming the practice of early childhood integrated care for immigrants and refugees. Target Participants: - Medical practices, clinicians, care coordinators, practice managers, and researchers who serve immigrant and refugee families with young children. - Clinicians, care coordinators, practice managers, and researchers interested in serving young children and their families. - Healthcare programs with integrated behavioral health services or those aiming to increase prevention and health promotion efforts. - Early childhood specialists seeking to integrate into healthcare settings. Next Steps and Evaluations: This workshop will be evaluated using objective measures to determine the extent to which each of the objectives were met. Presenters will design and bring an evaluation measure for participants to complete. To address next steps, all participants will be encouraged to provide contact information to facilitate creating a network of providers interested in participating in the development of guidelines for addressing the needs of immigrant and refugee families with young children who are being served in pediatric medical settings. Facilitators will follow up with this network to initiate and direct the process of developing a scholarly product that comprises these guidelines. Keywords: early childhood , integrated care , prevention , immigrant , refugee How to Cite: Margolis K, Buchholz M, Bunik M, Muther E, Talmi A. Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families. International Journal of Integrated Care. 2016;16(6):A158. DOI: http://doi.org/10.5334/ijic.2706 Published on 16 Dec 2016. Margolis, K., Buchholz, M., Bunik, M., Muther, E. and Talmi, A., 2016. Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families. International Journal of Integrated Care, 16(6), p.A158. DOI: http://doi.org/10.5334/ijic.2706 Margolis K, Buchholz M, Bunik M, Muther E, Talmi A. Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families. International Journal of Integrated Care. 2016;16(6):A158. DOI: http://doi.org/10.5334/ijic.2706 Margolis, K., Buchholz, M., Bunik, M., Muther, E., & Talmi, A. (2016). Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families. International Journal of Integrated Care, 16(6), A158. DOI: http://doi.org/10.5334/ijic.2706 Margolis K and others, 'Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families' (2016) 16 International Journal of Integrated Care A158 DOI: http://doi.org/10.5334/ijic.2706 Margolis, Kathryn, Melissa Buchholz, Maya Bunik, Emily Muther, and Ayelet Talmi. 2016. "Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families". International Journal of Integrated Care 16 (6): A158. DOI: http://doi.org/10.5334/ijic.2706 Margolis, Kathryn, Melissa Buchholz, Maya Bunik, Emily Muther, and Ayelet Talmi. "Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families". International Journal of Integrated Care 16, no. 6 (2016): A158. DOI: http://doi.org/10.5334/ijic.2706 Margolis, K., et al.. "Early Childhood Integrated Health Service Strategies for Immigrants and Refugees: Prevention and Health Promotion for Our Most Vulnerable Families". International Journal of Integrated Care, vol. 16, no. 6, 2016, p. A158. DOI: http://doi.org/10.5334/ijic.2706
AIMS: To evaluate the prognostic value of positron emission tomography (PET) imaging in patients with choroidal melanoma. METHODS: We undertook a retrospective review of 40 consecutive patients with choroidal melanoma who underwent pretreatment whole-body PET, received either brachytherapy using ruthenium-106 plaque, enucleation or gamma knife radiotherapy, and had 1 year of follow-up. Metabolic activity of choroidal melanoma measured as standardised uptake value (SUV) by PET imaging was evaluated with respect to the survival of patients. RESULTS: SUV (p=0.003) and the largest basal diameter of the tumour (p=0.003) were significantly correlated with metastatic death (Cox proportional hazards regression). There was an inverse correlation between tumour metabolic activity and time to metastasis (p=0.049; linear regression). CONCLUSION: Metabolic activity by PET imaging significantly predicted the survival of patients with choroidal melanoma.
Analysis Details SGLT2 Class Benefits on Cardiovascular Health in Diabetics A meta-analysis of CREDENCE, DECLARE-TIMI 58, CANVAS, and EMPA-REG OUTCOME trial is revealing more about how SGLT2 inhibition impacts different subgroups of diabetics. Clare Arnott, MBBS Results of a recent meta-analysis of 4 major clinical trials is uncovering more about the potential cardiovascular benefits of the SGLT2 inhibitor class in type 2 diabetics. Published in the Journal of the American Heart Association, the analysis highlights the ability of the class by highlighting benefits related to SGLT2 inhibitor use including a 12% reduction in major adverse cardiovascular events, a 17% reduction in cardiovascular death, and a 32% reduction in hospitalizations for heart failure—with benefits of use seen regardless of history of cardiovascular disease (CVD). "In this meta-analysis of large event-driven SGLT2 inhibitor outcome trials we found SGLT2 inhibitors protected against cardiovascular disease and death in diverse subsets of patients with type 2 diabetes regardless of their cardiovascular disease history," said Clare Arnott, MD of the George Institute for Global Health, in a press release. "While the extent of this protective effect may vary across patient types, the consistency of the findings suggests significant and broad cardiovascular protection can be achieved from use of this drug class." Using data from the EMPA-REG OUTCOME, DECLARE, CANVAS, AND CREDENCE trials, investigators sought to evaluate the cardiovascular benefits and effect on safety outcomes of SGLT2 inhibition on a population and individual basis in patients without and with established CVD, impaired renal function, or heart failure. Briefly, the trials included in the analysis examined 3 SGLT2 inhibitors—canagliflozin, empagliflozin, and dapagliflozin—and their impact on a multitude of efficacy and safety outcomes in patients with type 2 diabetes mellitus. Efficacy outcomes of interest included in the analysis were cardiovascular death, fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, hospitalization for heart failure, the composite of cardiovascular death or hospitalization for heart failure, all-cause mortality, and MACE, which investigators defined as a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. Safety outcomes included total serious adverse events, severe hypoglycemia, metabolic acidosis, amputation, and bone fracture. Data on a total of 38,723 patients were included—7020 from EMPA-REG OUTCOME, 10,142 from the CANVAS program, 17,160 from DECLARE-TIMI 58, and 4401 from CREDENCE. Among participants from the 4 studies, the mean age of study participants ranged from 63.1 and 63.9 years, the proportion of women ranged between 28.5% and 37.4%, and the mean glycosylated hemoglobin ranged between 8.1% and 8.3%. At baseline, the history of CVD in each study ranged from 40.6% to 100%, proportions with a baseline history of reduced renal function ranged from 7.4% to 59.8%, proportions with baseline macroalbuminuria ranged from 7.5% to 88.0%, and the proportion with a baseline history of heart failure ranged from 10.1% to 14.8%. When examining adverse events, 3828 MACE outcomes, 1192 hospitalizations for HF, 1506 cardiovascular deaths, and 2612 deaths from any cause were reported by investigators. Upon analysis, SGLT2 inhibition was found to be associated with a 12% relative reduction in MACE (HR 0.88; 95% CI, 0.82—0.94)—investigators noted this effect was consistent across all 4 studies included (I2=0%; P for interaction=.477). In regard to cardiovascular death, SGLT2 inhibition was linked to a 17% relative risk reduction. Additionally, SGLT2 inhibition was associated with a reduced risk of MI (HR 0.88; 95% CI, 0.80—0.97; I2 =0%; P=.996) but had no impact on stroke risk (HR 0.96; 95% CI, 0.86—1.09; I2 =0%; P for interaction=0.785). In regard to the subgroup of 22,870 patients with CVD at baseline, SGLT2 inhibition was associated with a beneficial impact on secondary prevention (HR 0.86; 95% CI, 0.80—0.93), which was greater than that seen when examining SGLT2 inhibition on primary prevention (HR 0.94; 95% CI, 0.82–1.07). The risk for MI in the secondary prevention cohort (HR 0.86; 95% CI, 0.78–0.96) was also lower than the risk for MI in the primary prevention cohort (HR 0.97; 95% CI, 0.78–1.19) when examining the impact of SGLT2 inhibition. When examining the impact of SGLT2 inhibitor use among patients with impaired renal function, investigators observed separately significant evidence of protection compared with placebo among patients with reduced kidney function for every efficacy outcome. Results indicated SGLT2 inhibition helped patients achieve greater proportional risk reductions for MACE (HR 0.80; 95% CI, 0.70—0.90) than their counterparts with preserved renal function (HR 0.92; 95% CI, 0.85–0.99). Furthermore, a similar effect was apparent when observing stroke risk among those with reduced renal function (HR 0.75; 95% CI, 0.59–0.96) compared to those with preserved function (HR 1.05; 95% CI, 0.91– 1.20; I2=81.4%). When examining safety outcomes, analyses revealed SGLT2 inhibition was associated with a lower relative risk of serious adverse events (HR 0.91; 95% CI, 0.88—0.94). No differences were observed in regard to rates of severe hypoglycemia or feature, but risk increases were observed for diabetic ketoacidosis (HR 2.46; 95% CI, 1.43–4.24) and amputation (HR 1.23; 95% CI, 1.05–1.44). Based on the results of the study, investigators suggest SGLT2 inhibition protects against cardiovascular disease and death in multiple subgroups of patients with type 2 diabetes mellitus and this effect is not mitigated based on history of CVD. "Our study has shown that we have a class of drug in our treatment arsenal that could potentially have a significant impact on the cardiovascular complications of type 2 diabetes," said Arnott, in the aforementioned release. This study, "Sodium-Glucose Cotransporter 2 Inhibition for the Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis," was published online in the Journal of The American Heart Association. CardiologyEndocrinologyDiabetesHeart Failure Atrial Fibrillation Without Blood Thinners: Permanent Device Reduces Clotting Risks
Health Minister expected 'back to work shortly' - Kojo Oppong Kwaku Agyemang-Manu, Minister of Health The Minister of Health has recovered from the coronavirus infection he contracted a couple of weeks ago and is expected back to work "shortly". Kwaku Agyemang-Manu contracted Covid-19 in the line of duty, according to President Nana Addo Dankwa Akufo-Addo, who wished him a speedy recovery in his 11th nationwide broadcast on Sunday, June 14. The Minister of Health, who has been a keen advocate of the safety measures in the prevention of Covid-19 in the country, had to seek medical treatment at the University of Ghana Medical Centre (UGMC). He was, however, discharged a few days later after his condition proved stable. On Thursday, June 25 at the bi-weekly press briefing, Minister of Information Kojo Oppong Nkrumah said the Dormaa Central Member of Parliament (MP) is well now and "expects to be back to work shortly". Meanwhile, Minister of Education Dr Matthew Opoku Prempeh and Minister of Regional Reorganisation and Development Daniel Kweku Botwe are at UGMC self-isolating. Both have run tests for Covid-19 and are yet to make their results known. So far, Ghana has recorded a total of 15,473 cases of the virus since the first two index cases in March. COVID-19 audit report: Akufo-Addo's loud silence and posture worrying - Clement Apaak Auditor-General's report on COVID-19: Heads must roll now - Charles Owusu John Mahama calls for forensic audit of COVID-19 funds across Africa I feel so ashamed - Dr. Benjamin Otchere-Ankrah on Auditor-General's COVID-19 Report COVID-19 Funds: It's sad people are jailed for stealing goats but thieves walk freely – Domelevo This article has 4 comment(s), give your comment Ages of players must be checked holistically - Coach JE Sarpong implores GFA
JournalMeteoritics & Planetary Science (11)AuthorsLlorca, J. (3)Trigo-Rodríguez, J. M. (3)Madiedo, J. M. (2)Anand, M. (1)Bischoff, A. (1)Borovička, J. (1)Bretzius, S. (1)Buikin, A. I. (1)Casanova, I. (1)Chaussidon, M. (1)View MoreTypesArticle (11)text (11)Subjectsargon (1)Biological activity (1)bulk chemistry (1)bulk composition (1)carbonaceous chondrite meteorites (1)View More Shergottites Dhofar 019, SaU 005, Shergotty, and Zagami: 40Ar-39Ar chronology and trapped Martian atmospheric and interior argon Korochantseva, E. V.; Trieloff, M.; Buikin, A. I.; Hopp, J. (The Meteoritical Society, 2009-01-01) We report a high-resolution 40Ar-39Ar study of mineral separates and whole-rock samples of olivine-phyric (Dhofar 019, Sayh al Uhaymir [SaU] 005) and basaltic (Shergotty, Zagami) shergottites. Excess argon is present in all samples. The highest (40Ar/36Ar)trapped ratios are found for argon in pyroxene melt inclusions (~1500), maskelynite (~1200), impact glass (~1800) of Shergotty and impact glass of SaU 005 (~1200). A high (40Ar/36Ar)trapped componentusually uniquely ascribed to Martian atmosphere--can also originate from the Martian interior, indicating a heterogeneous Martian mantle composition. As additional explanation of variable high (40Ar/ 36Ar)trapped ratios in shocked shergottites, we suggest argon implantation from a "transient atmosphere" during impact induced degassing. The best 40Ar-39Ar age estimate for Dhofar 019 is 642 +/- 72 Ma (maskelynite). SaU 005 samples are between 700-900 Ma old. Relatively high 40Ar-39Ar ages of melt inclusions within Dhofar 019 (1086 +/- 252 Ma) and SaU 005 olivine (885 +/- 66 Ma) could date entrapment of a magmatic liquid during early olivine crystallization, or reflect unrecognized excess 40Ar components. The youngest 40Ar-39Ar age of Shergotty separates (maskelynite) is ~370 Ma, that of Zagami is ~200 Ma. The 40Ar-39Ar chronology of Dhofar 019 and SaU 005 indicate <1 Ga ages. Apparent ages uncorrected for trapped (e.g., Martian atmosphere, mantle) argon components approach 4.5 Ga, but are not caused by inherited 40Ar, because excess 40Ar is supported by 36Artrapped. Young ages obtained by 40Ar-39Ar and other chronometers argue for primary rather than secondary events. The cosmic ray exposure ages calculated from cosmogenic argon are 15.7 +/- 0.7 Ma (Dhofar 019), 1.0-1.6 Ma (SaU 005), 2.1-2.5 Ma (Shergotty) and 2.2-3.0 Ma (Zagami). Mercurian impact ejecta: Meteorites and mantle Gladman, B.; Coffey, J. (The Meteoritical Society, 2009-01-01) We have examined the fate of impact ejecta liberated from the surface of Mercury due to impacts by comets or asteroids, in order to study 1) meteorite transfer to Earth, and 2) reaccumulation of an expelled mantle in giant-impact scenarios seeking to explain Mercurys large core. In the context of meteorite transfer during the last 30 Myr, we note that Mercurys impact ejecta leave the planets surface much faster (on average) than other planets in the solar system because it is the only planet where impact speeds routinely range from 5 to 20 times the planets escape speed; this causes impact ejecta to leave its surface moving many times faster than needed to escape its gravitational pull. Thus, a large fraction of Mercurian ejecta may reach heliocentric orbit with speeds sufficiently high for Earth-crossing orbits to exist immediately after impact, resulting in larger fractions of the ejecta reaching Earth as meteorites. We calculate the delivery rate to Earth on a time scale of 30 Myr (typical of stony meteorites from the asteroid belt) and show that several percent of the high-speed ejecta reach Earth (a factor of 23 less than typical launches from Mars); this is one to two orders of magnitude more efficient than previous estimates. Similar quantities of material reach Venus. These calculations also yield measurements of the re-accretion time scale of material ejected from Mercury in a putative giant impact (assuming gravity is dominant). For Mercurian ejecta escaping the gravitational reach of the planet with excess speeds equal to Mercurys escape speed, about one third of ejecta reaccretes in as little as 2 Myr. Thus collisional stripping of a silicate proto-Mercurian mantle can only work effectively if the liberated mantle material remains in small enough particles that radiation forces can drag them into the Sun on time scale of a few million years, or Mercury would simply re-accrete the material. The Cali meteorite fall: A new H/L ordinary chondrite Trigo-Rodríguez, J. M.; Llorca, J.; Rubin, A. E.; Grossman, J. N.; Sears, D. W. G.; Naranjo, M.; Bretzius, S.; Tapia, M.; Guarín Sepúlveda, M. H. (The Meteoritical Society, 2009-01-01) The fall of the Cali meteorite took place on 6 July 2007 at 16 h 32 +/- 1 min local time (21 h 32 +/- 1 min UTC). A daylight fireball was witnessed by hundreds of people in the Cauca Valley in Colombia from which 10 meteorite samples with a total mass of 478 g were recovered near 3 degrees 24.3'N, 76 degrees 30.6'W. The fireball trajectory and radiant have been reconstructed with moderate accuracy. From the computed radiant and from considering various plausible velocities, we obtained a range of orbital solutions that suggest that the Cali progenitor meteoroid probably originated in the main asteroid belt. Based on petrography, mineral chemistry, magnetic susceptibility, thermoluminescence, and bulk chemistry, the Cali meteorite is classified as an H/L4 ordinary chondrite breccia. Upper limit concentrations of trapped xenon in individual interplanetary dust particles from the stratosphere Kehm, K.; Crowther, S.; Gilmour, J. D.; Mohapatra, R. K.; Hohenberg, C. M. (The Meteoritical Society, 2009-01-01) The Xe contents in 25 individual stratospheric interplanetary dust particles were measured in two different laboratories using focused laser micro-gas extraction and (1) a conventional low-blank magnetic sector mass spectrometer (Washington University), and (2) a resonance ionization time of flight mass spectrometer (RELAX-University of Manchester). Data from both laboratories yielded a remarkably similar upper-limit 132Xe concentration in the IDPs (<2.7, 6.8 and 2.2 x 10^(-8) ccSTP/g for Washington University Run 1, Washington University Run 2 and University of Manchester analyses, respectively), which is up to a factor of five smaller than previous estimates. The upper-limit 132Xe/36Ar ratio in the IDPs (132Xe/36Ar <~8 x 10^(-4) for Run 1 and 132Xe/36Ar <~19 x 10^(-4) for Run 2), computed using 36Ar concentration data reported elsewhere is consistent with a mixture between implanted solar wind, primordial, and atmospheric noble gases. Most significantly, there is no evidence that IDPs are particularly enriched in primordial noble gases compared to chondritic meteorites, as implied by previous work. Laboratory experiments on the weathering of iron meteorites and carbonaceous chondrites by iron-oxidizing bacteria Gronstal, A.; Pearson, V.; Kappler, A.; Dooris, C.; Anand, M.; Poitrasson, F.; Kee, T. P.; Cockell, C. S. (The Meteoritical Society, 2009-01-01) Batch culture experiments were performed to investigate the weathering of meteoritic material by iron-oxidizing bacteria. The aerobic, acidophilic iron oxidizer (A. ferrooxidans) was capable of oxidizing iron from both carbonaceous chondrites (Murchison and Cold Bokkeveld) and iron meteorites (York and Casas Grandes). Preliminary iron isotope results clearly show contrasted iron pathways during oxidation with and without bacteria suggesting that a biological role in meteorite weathering could be distinguished isotopically. Anaerobic iron-oxidizers growing under pH-neutral conditions oxidized iron from iron meteorites. These results show that rapid biologicallymediated alteration of extraterrestrial materials can occur in both aerobic and anaerobic environments. These results also demonstrate that iron can act as a source of energy for microorganisms from both iron and carbonaceous chondrites in aerobic and anaerobic conditions with implications for life on the early Earth and the possible use of microorganisms to extract minerals from asteroidal material. Sahara 03505 sulfide-rich iron meteorite: Evidence for efficient segregation of sulfide-rich metallic melt during high-degree impact melting of an ordinary chondrite D'Orazio, M.; Folco, L.; Chaussidon, M.; Rochette, P. (The Meteoritical Society, 2009-01-01) The Sahara 03505 meteorite is a 65 g sulfide-rich iron found in an undisclosed locality of the Sahara. It consists of roughly equal volumetric proportion of polycrystalline troilite (crystal size 1.5-7.5 mm) enclosing cellular/dendritic metallic Fe-Ni (width of the dendrite arms, ~100 micrometers). The mineral assemblage is completed by sparse skeletal crystals of chromite, abundant droplets, 5-100 m in size, of anhydrous Fe-, Fe-Na-, and Fe-Mn-Mg-Ca-Na-K-phosphates, tiny crystals of schreibersite, and particles of metallic Cu. The medium- to fine-grained quench texture, and cooling modeling suggest that Sahara 03505 formed through crystallization of a sulfur-rich metallic melt under rapid cooling conditions (1-4 degrees C s^(-1)). The low troilite/metallic Fe-Ni ratio (~0.6 by weight) shows that this liquid was generated at much higher temperatures (1300 degrees C) with respect to the FeS-Fe,Ni cotectic liquids. Based on bulk chemistry and oxygen isotope composition of chromite, we propose that Sahara 03505 formed by extensive impact melting of an ordinary chondrite lithology, followed by the efficient segregation of the immiscible silicate and metallic liquids. The sulfur-rich metallic liquid rapidly cooled either by radiation into space as a small lump, or by conduction to a chondrite country rock as a vein intruded into the walls of an impact crater. Sahara 03505 belongs to a small group of sulfide-rich iron meteorites which are characterized by medium- to fine-grained quench textures and by bulk chemistry that is different from the other iron meteorite groups. We propose here to use the descriptive term sulfide-irons for this meteorite group, by analogy with the stony-irons. Petrogenesis of lunar mare basalt meteorite Miller Range 05035 Liu, Y.; Floss, C.; Day, J. M. D.; Hill, E.; Taylor, L. A. (The Meteoritical Society, 2009-01-01) Miller Range (MIL) 05035 is a low-Ti mare basalt that consists predominantly of pyroxene (62.3 vol%) and plagioclase (26.4 vol%). Pyroxenes are strongly shocked and complexly zoned from augite (Wo33) and pigeonite (Wo17) cores with Mg# = 50-54 to hedenbergite rims. Coexisting pyroxene core compositions reflect crystallization temperatures of 1000 to 1100 degrees C. Plagioclase has been completely converted to maskelynite with signs of recrystallization. Maskelynite is relatively uniform in composition (An94Ab6-An91Ab9), except at contacts with late-stage mesostasis areas (elevated K contents, An82Ab15Or3). Symplectites (intergrowth of Fe-augite, fayalite, and silica) of different textures and bulk compositions in MIL 05035 suggest formation by decomposition of ferro-pyroxene during shock-induced heating, which is supported by the total maskelynitization of plagioclase, melt pockets, and the presence of a relict pyroxferroite grain. Petrography and mineral chemistry imply that crystallization of MIL 05035 occurred in the sequence of Fe-poor pyroxenes (Mg# = 50-54), followed by plagioclase and Fe-rich pyroxenes (Mg# = 20-50), and finally hedenbergite, Fe-Ti oxides, and minor late-stage phases. Petrography, bulk chemistry, mineral compositions, and the age of MIL 05035 suggest it is possibly source craterpaired with Asuka (A-) 881757 and Yamato (Y-) 793169, and may also be launch-paired with Meteorite Hills (MET) 01210. MIL 05035 represents an old (~3.8-3.9 Ga), incompatible element-depleted low-Ti basalt that was not sampled during the Apollo or Luna missions. The light-REE depleted nature and lack of Eu anomalies for this meteorite are consistent with an origin distant from the Procellarum KREEP Terrane, and genesis from an early cumulate mantle-source region generated by extensive differentiation of the Moon. The Fountain Hills impact-modified CB chondrite and thermal history of the CB asteroid Weisberg, M. K.; Ebel, D. S. (The Meteoritical Society, 2009-01-01) Fountain Hills is a metal-rich chondrite with mineral and whole chondrite oxygen isotope compositions that suggest it is a CB chondrite. However, its petrologic characteristics suggest that it has been modified by shock and recrystallization to a greater degree than other CB chondrites. It differs texturally from the CB chondrites in that its metal is interstitial to the silicate and does not occur as discrete clasts as in the other CB chondrites. Portions of Fountain Hills appear to be recrystallized and it contains large (mm-size) olivine rimmed by pyroxene. A characteristic of the CB chondrites is the presence of small sulfide blebs in large metal clasts and anomalously heavy (15N-enriched) nitrogen often associated with metal surrounding the sulfide blebs, but Fountain Hills lacks sulfide and its nitrogen is relatively light. The differences between Fountain Hills and the other CB chondrites can be attributed to a secondary process, most likely impact-melting and recrystallization, that overprinted its primary features and it is inferred that Fountain Hills is an impact-modified CB chondrite. The Puerto Lápice eucrite Llorca, J.; Casanova, I.; Trigo-Rodríguez, J. M.; Madiedo, J. M.; Roszjar, J.; Bischoff, A.; Ott, U.; Franchi, I. A.; Greenwood, R. C.; Laubenstein, M. (The Meteoritical Society, 2009-01-01) Puerto Lápice is a new eucrite fall (Castilla-La Mancha, Spain, 10 May 2007). In this paper, we report its detailed petrography, magnetic characterization, mineral and bulk chemistry, oxygen and noble gas isotope systematics, and radionuclide data. Study of four thin sections from two different specimens reveal that the meteorite is brecciated in nature, and it contains basaltic and granulitic clasts, as well as recrystallized impact melt and breccia fragments. Shock veins are ubiquitous and show evidence of at least three different shock events. Bulk chemical analyses suggest that Puerto Lápice belongs to the main group of basaltic eucrites, although it has a significantly higher Cr content. Oxygen isotopes also confirm that the meteorite is a normal member of the HED suite. Noble gas abundances show typical patterns, with dominant cosmogenic and radiogenic contributions, and indicate an average exposure age of 19 +/- 2 Ma, and a Pu-fission Xe age well within typical eucrite values. Cosmogenic radionuclides suggest a preatmospheric size of about 20-30 cm in diameter. Puerto Lápice eucrite fall: Strewn field, physical description, probable fireball trajectory, and orbit Trigo-Rodríguez, J. M.; Borovička, J.; Llorca, J.; Madiedo, J. M.; Zamorano, J.; Izquierdo, J. (The Meteoritical Society, 2009-01-01) The fall of the Puerto Lápice eucrite occurred on May 10, 2007, at 17 h 57 m 30 +/- 30 s UTC. Its daylight fireball was witnessed by hundreds of people from Spain, and produced a meteorite fall associated with a large strewn field of fragments. There were no direct pictures of the fireball, but several pictures of the fireballs train were taken from different locations in Spain. Additional theodolite calibrations of visual records were made in order to find the most probable fireball trajectory based on the available data. The shape of the meteorite strewn field was considered as well. Although the orbit of the Puerto Lápice meteoroid could not be computed due to the absence of velocity data, we assumed a likely range of geocentric velocities and computed a range of possible orbits. All solutions show that the body was in an Apollo-type orbit, with low inclination and perihelion distance just below 1 astronomical unit (AU). This is the first case that an orbit can be discussed for an HED meteorite fall. The Twannberg (Switzerland) IIG iron meteorites: Mineralogy, chemistry, and CRE ages Hofmann, B. A.; Lorenzetti, S.; Eugster, O.; Krähenbühl, U.; Herzog, G.; Serefiddin, F.; Gnos, E.; Eggimann, M.; Wasson, J. T. (The Meteoritical Society, 2009-01-01) The original mass (15915 g) of the Twannberg IIG (low Ni-, high P) iron was found in 1984. Five additional masses (12 to 2488 g) were recovered between 2000 and 2007 in the area. The different masses show identical mineralogy consisting of kamacite single crystals with inclusions of three types of schreibersite crystals: cm-sized skeletal (10.5% Ni), lamellar (17.2% Ni), and 1-3 x 10 micrometer-sized microprismatic (23.9% Ni). Masses I and II were compared in detail and have virtually identical microstructure, hardness, chemical composition, cosmic-ray exposure (CRE) ages, and 10Be and 26Al activities. Bulk concentrations of 5.2% Ni and 2.0% P were calculated. The preatmospheric mass is estimated to have been at least 11,000 kg. The average CRE age for the different Twannberg samples is 230 +/- 50 Ma. Detrital terrestrial mineral grains in the oxide rinds of the three larger masses indicate that they oxidized while they were incorporated in a glacial till deposited by the Rhne glacier during the last glaciation (Würm). The find location of mass I is located at the limit of glaciation where the meteorite may have deposited after transport by the glacier over considerable distance. All evidence indicates pairing of the six masses, which may be part of a larger shower as is indicated by the large inferred pre-atmospheric mass.
1-Minute Consult When does S aureus bacteremia require transesophageal echocardiography? Cleveland Clinic Journal of Medicine. 2018 July;85(7):517-520 Aibek E. Mirrakhimov, MD Michael E. Jesinger, MD Taha Ayach, MD Adam Gray, MD Author and Disclosure Information Department of Internal Medicine, University of Kentucky Medical Center, Lexington, KY Gill Heart Institute, University of Kentucky Medical Center, Lexington, KY Department of Internal Medicine, University of Kentucky Medical Center, and Department of Internal Medicine, Lexington Veteran Affairs Medical Center, Lexington KY Address: Aibek E. Mirrakhimov, MD, University of Kentucky Medical Center, Department of Internal Medicine, 800 Rose Street, Lexington, KY 40536; [email protected] PDF PDF Young H, Knepper BC, Price CS, Heard S, Jenkins TC. Clinical reasoning of infectious diseases physicians behind the use or nonuse of transesophageal echocardiography in Staphylococcus aureus bacteremia. Open Forum Infect Dis 2016; 3(4):ofw204. doi:10.1093/ofid/ofw204 Pant S, Patel NJ, Deshmukh A, et al. Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol 2015; 65(19):2070–2076. doi:10.1016/j.jacc.2015.03.518 Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28(3):603–661. doi:10.1128/CMR.00134-14 Palraj BR, Baddour LM, Hess EP, et al. Predicting risk of endocarditis using a clinical tool (PREDICT): scoring system to guide use of echocardiography in the management of Staphylococcus aureus bacteremia. Clin Infect Dis 2015; 61(1):18–28. doi:10.1093/cid/civ235 Barton T, Moir S, Rehmani H, Woolley I, Korman TM, Stuart RL. Low rates of endocarditis in healthcare-associated Staphylococcus aureus bacteremia suggest that echocardiography might not always be required. Eur J Clin Microbiol Infect Dis 2016; 35(1):49–55. doi:10.1007/s10096-015-2505-8 Baddour LM, Wilson WR, Bayer AS, et al; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015; 132(15):1435–1486. doi10.1161/CIR.0000000000000296 Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30(4):633–638. doi:10.1086/313753 Habib G, Badano L, Tribouilloy C, et al; European Association of Echocardiography. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 2010; 11(2):202–219. doi:10.1093/ejechocard/jeq004 Irani WN, Grayburn PA, Afridi I. A negative transthoracic echocardiogram obviates the need for transesophageal echocardiography in patients with suspected native valve active infective endocarditis. Am J Cardiol 1996; 78(1):101–103. pmid:8712097 Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013; 26(9):921–964. doi:10.1016/j.echo.2013.07.009 Staphylococcus aureus is the most common infective agent in native and prosthetic valve endocarditis, and 13% to 22% of patients with S aureus bacteremia have infective endocarditis.1 See related editorial Transthoracic echocardiography (TTE) is a good starting point in the workup of suspected infective endocarditis, but transesophageal echocardiography (TEE) plays a key role in diagnosis and is indicated in patients with a high pretest probability of infective endocarditis, as in the following scenarios: Clinical picture consistent with infective endocarditis Presence of previously placed port or other indwelling vascular device Presence of a prosthetic valve or other prosthetic material Presence of a pacemaker History of valve disease Injection drug use Positive blood cultures after 72 hours despite appropriate antibiotic treatment Abnormal TTE result requiring better visualization of valvular anatomy and function and confirmation of local complications Absence of another reasonable explanation for S aureus bacteremia. Forgoing TEE is reasonable in patients with normal results on TTE, no predisposing risk factors, a reasonable alternative explanation for S aureus bacteremia, and a low pretest probability of infective endocarditis.1 TEE may also be unnecessary if there is another disease focus requiring extended treatment (eg, vertebral infection) and there are no findings suggesting complicated infective endocarditis, eg, persistent bacteremia, symptoms of heart failure, and conduction abnormality.1 TEE also may be unnecessary in patients at low risk who have identifiable foci of bacteremia due to soft-tissue infection or a newly placed vascular catheter and whose bacteremia clears within 72 hours of the start of antibiotic therapy. These patients may be followed clinically for the development of new findings such as metastatic foci of infection (eg, septic pulmonary emboli, renal infarction, splenic abscess or infarction), the new onset of heart failure or cardiac conduction abnormality, or recurrence of previously cleared S aureus bacteremia. If these should develop, then a more invasive study such as TEE may be warranted. INFECTIVE ENDOCARDITIS: EPIDEMIOLOGY AND MICROBIOLOGY The US incidence rate of infective endocarditis has steadily increased, with an estimated 457,052 hospitalizations from 2000 to 2011. During that period, from 2000 to 2007, there was a marked increase in valve replacement surgeries.2 This trend is likely explained by an increase in the at-risk population—eg, elderly patients, patients with opiate dependence or diabetes, and patients on hemodialysis. Although S aureus is the predominant pathogen in infective endocarditis,2–5S aureus bacteremia is often observed in patients with skin or soft-tissue infection, prosthetic device infection, vascular graft or catheter infection, and bone and joint infections. S aureus bacteremia necessitates a search for the source of infection. S aureus is a major pathogen in bloodstream infections, and up to 14% of patients with S aureus bacteremia have infective endocarditis as the primary source of infection.3 The pathogenesis of S aureus infective endocarditis is thought to be mediated by cell-wall factors that promote adhesion to the extracellular matrix of intravascular structures.3 A new localizing symptom such as back pain, joint pain, or swelling in a patient with S aureus bacteremia should trigger an investigation for metastatic infection. Infectious disease consultation in patients with S aureus bacteremia is associated with improved outcomes and, thus, should be pursued.3 A cardiac surgery consult is recommended early on in cases of infective endocarditis caused by vancomycin-resistant enterococci, Pseudomonas aeruginosa, and fungi, as well as in patients with complications such as valvular insufficiency, perivalvular abscess, conduction abnormalities, persistent bacteremia, and metastatic foci of infection.6 S aureus bacteremia: TEE and infectious disease consultation Susan J. Rehm, MD, FIDSA, FACP Staphylococcus aureus bacteremia demands further evaluation, as up to 25% of people who have it may have endocarditis. How soon should patients with infective endocarditis be referred for valve surgery? Mohamad Soud, MD Homam Moussa Pacha, MD M. Chadi Alraies, MD, FACP Refer sooner rather than later if the patient has heart failure, uncontrolled infection, or embolic risk. 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Comet sensitivity in assessing DNA damage and repair in different cell cycle stages DG McArt, George McKerr, Kurt Saetzler, Vyvyan Howard, Stephen Downes, GR Wasson The comet assay is a sensitive tool for estimation of DNA damage and repair at the cellular level, requiring only a very small number of cells. In comparing the levels of damage or repair in different cell samples, it is possible that small experimental effects could be confounded by different cell cycle states in the samples examined, if sensitivity to DNA damage, and repair capacity, varies with the cell cycle. We assessed this by arresting HeLa cells in various cell cycle stages and then exposing them to ionizing radiation. Unirradiated cells demonstrated significant differences in strand break levels measured by the comet assay (predominantly single-strand breaks) at different cell cycle stages, increasing from G1 into S and falling again in G2. Over and above this variation in endogenous strand break levels, a significant difference in susceptibility to breaks induced by 3.5 Gy ionizing radiation was also evident in different cell cycle phases. Levels of induced DNA damage fluctuate throughout the cycle, with cells in G1 showing slightly lower levels of damage than an asynchronous population. Damage increases as cells progress through S phase before falling again towards the end of S phase and reaching lowest levels in M phase. The results from repair experiments (where cells were allowed to repair for 10 min after exposure to ionizing radiation) also showed differences throughout the cell cycle with G1-phase cells apparently being the most efficient at repair and M-phase cells the least efficient. We suggest, therefore, that in experiments where small differences in DNA damage and repair are to be investigated with the comet assay, it may be desirable to arrest cells in a specific stage of the cell cycle or to allow for differential cycle distribution. Mutagenesis https://doi.org/10.1093/mutage/geq006 10.1093/mutage/geq006 Dive into the research topics of 'Comet sensitivity in assessing DNA damage and repair in different cell cycle stages'. Together they form a unique fingerprint. Comet Assay Chemistry 100% Ionizing Radiation Chemistry 90% DNA Repair Medicine & Life Sciences 68% DNA Damage Medicine & Life Sciences 64% Cell Cycle Medicine & Life Sciences 58% S Phase Medicine & Life Sciences 18% Cell Division Medicine & Life Sciences 17% Radiation Dosage Medicine & Life Sciences 12% McArt, DG., McKerr, G., Saetzler, K., Howard, V., Downes, S., & Wasson, GR. (2010). Comet sensitivity in assessing DNA damage and repair in different cell cycle stages. Mutagenesis, 25(3), 299. https://doi.org/10.1093/mutage/geq006 McArt, DG ; McKerr, George ; Saetzler, Kurt et al. / Comet sensitivity in assessing DNA damage and repair in different cell cycle stages. In: Mutagenesis. 2010 ; Vol. 25, No. 3. pp. 299. @article{e251305aa04a481e88a7cb087ab6d1c5, title = "Comet sensitivity in assessing DNA damage and repair in different cell cycle stages", abstract = "The comet assay is a sensitive tool for estimation of DNA damage and repair at the cellular level, requiring only a very small number of cells. In comparing the levels of damage or repair in different cell samples, it is possible that small experimental effects could be confounded by different cell cycle states in the samples examined, if sensitivity to DNA damage, and repair capacity, varies with the cell cycle. We assessed this by arresting HeLa cells in various cell cycle stages and then exposing them to ionizing radiation. Unirradiated cells demonstrated significant differences in strand break levels measured by the comet assay (predominantly single-strand breaks) at different cell cycle stages, increasing from G1 into S and falling again in G2. Over and above this variation in endogenous strand break levels, a significant difference in susceptibility to breaks induced by 3.5 Gy ionizing radiation was also evident in different cell cycle phases. Levels of induced DNA damage fluctuate throughout the cycle, with cells in G1 showing slightly lower levels of damage than an asynchronous population. Damage increases as cells progress through S phase before falling again towards the end of S phase and reaching lowest levels in M phase. The results from repair experiments (where cells were allowed to repair for 10 min after exposure to ionizing radiation) also showed differences throughout the cell cycle with G1-phase cells apparently being the most efficient at repair and M-phase cells the least efficient. We suggest, therefore, that in experiments where small differences in DNA damage and repair are to be investigated with the comet assay, it may be desirable to arrest cells in a specific stage of the cell cycle or to allow for differential cycle distribution.", author = "DG McArt and George McKerr and Kurt Saetzler and Vyvyan Howard and Stephen Downes and GR Wasson", doi = "10.1093/mutage/geq006", journal = "Mutagenesis", McArt, DG, McKerr, G, Saetzler, K, Howard, V, Downes, S & Wasson, GR 2010, 'Comet sensitivity in assessing DNA damage and repair in different cell cycle stages', Mutagenesis, vol. 25, no. 3, pp. 299. https://doi.org/10.1093/mutage/geq006 Comet sensitivity in assessing DNA damage and repair in different cell cycle stages. / McArt, DG; McKerr, George; Saetzler, Kurt et al. In: Mutagenesis, Vol. 25, No. 3, 2010, p. 299. T1 - Comet sensitivity in assessing DNA damage and repair in different cell cycle stages AU - McArt, DG AU - McKerr, George AU - Saetzler, Kurt AU - Howard, Vyvyan AU - Downes, Stephen AU - Wasson, GR N2 - The comet assay is a sensitive tool for estimation of DNA damage and repair at the cellular level, requiring only a very small number of cells. In comparing the levels of damage or repair in different cell samples, it is possible that small experimental effects could be confounded by different cell cycle states in the samples examined, if sensitivity to DNA damage, and repair capacity, varies with the cell cycle. We assessed this by arresting HeLa cells in various cell cycle stages and then exposing them to ionizing radiation. Unirradiated cells demonstrated significant differences in strand break levels measured by the comet assay (predominantly single-strand breaks) at different cell cycle stages, increasing from G1 into S and falling again in G2. Over and above this variation in endogenous strand break levels, a significant difference in susceptibility to breaks induced by 3.5 Gy ionizing radiation was also evident in different cell cycle phases. Levels of induced DNA damage fluctuate throughout the cycle, with cells in G1 showing slightly lower levels of damage than an asynchronous population. Damage increases as cells progress through S phase before falling again towards the end of S phase and reaching lowest levels in M phase. The results from repair experiments (where cells were allowed to repair for 10 min after exposure to ionizing radiation) also showed differences throughout the cell cycle with G1-phase cells apparently being the most efficient at repair and M-phase cells the least efficient. We suggest, therefore, that in experiments where small differences in DNA damage and repair are to be investigated with the comet assay, it may be desirable to arrest cells in a specific stage of the cell cycle or to allow for differential cycle distribution. AB - The comet assay is a sensitive tool for estimation of DNA damage and repair at the cellular level, requiring only a very small number of cells. In comparing the levels of damage or repair in different cell samples, it is possible that small experimental effects could be confounded by different cell cycle states in the samples examined, if sensitivity to DNA damage, and repair capacity, varies with the cell cycle. We assessed this by arresting HeLa cells in various cell cycle stages and then exposing them to ionizing radiation. Unirradiated cells demonstrated significant differences in strand break levels measured by the comet assay (predominantly single-strand breaks) at different cell cycle stages, increasing from G1 into S and falling again in G2. Over and above this variation in endogenous strand break levels, a significant difference in susceptibility to breaks induced by 3.5 Gy ionizing radiation was also evident in different cell cycle phases. Levels of induced DNA damage fluctuate throughout the cycle, with cells in G1 showing slightly lower levels of damage than an asynchronous population. Damage increases as cells progress through S phase before falling again towards the end of S phase and reaching lowest levels in M phase. The results from repair experiments (where cells were allowed to repair for 10 min after exposure to ionizing radiation) also showed differences throughout the cell cycle with G1-phase cells apparently being the most efficient at repair and M-phase cells the least efficient. We suggest, therefore, that in experiments where small differences in DNA damage and repair are to be investigated with the comet assay, it may be desirable to arrest cells in a specific stage of the cell cycle or to allow for differential cycle distribution. U2 - 10.1093/mutage/geq006 DO - 10.1093/mutage/geq006 JO - Mutagenesis JF - Mutagenesis McArt DG, McKerr G, Saetzler K, Howard V, Downes S, Wasson GR. Comet sensitivity in assessing DNA damage and repair in different cell cycle stages. Mutagenesis. 2010;25(3):299. https://doi.org/10.1093/mutage/geq006
When Lucentis was presented to the Food and Drug Administration(FDA), they approved it after a lengthy testing period. There were celebrations going on all over the eye care world. Not only had they found an effective treatment for AMD, but it would be hefty in the pocket book department. The day they received the good news was in 2006. Lucentis was a step into the technology age. Another drug we will discuss is Avastin. If you have received a diagnosis of macular degeneration (AMD), you are well aware of these two drugs. The debate between doctors is which drug is more effective and which is proper to use. If you are using one of these two treatments, then we recommend you read this article to become more aware. Not only will you be aware, you will also be able to inform your friends and loved ones as well. Does Avastin work as well as Lucentis in treating Macular Degeneration? The cost of both drugs is very different. Lucentis is way more expensive than Avastin because it is FDA approved for the treatment of macular degeneration. Your cost is high for treatment with Lucentis versus a much lower cost per treatment for Avastin. Doctors argue that Avastin is just as effective as Lucentis but at a more affordable price. Besides the cost difference in the two drugs, there is another concern that arises. Avastin came into being for treatment of colon cancer and other cancers. It has not been FDA approved for the treatment of AMD and is considered "off-label" for this purpose. Knowing this, there is not enough evidence either way to answer the question of which drug works best. Back in October of 2007, Genentech, the company which markets both drugs, had a plan. They were going to limit availability of Avastin for ocular uses. Some doctors say that the drug is as effective as, if not more so than, Lucentis, but others claim that it is not as effective. Some doctors expressed safety concerns when asked about Avastin as a macular degeneration treatment. As a matter-of-fact, they refused to prescribe it. Still, others will not prescribe anything else. The debate continues to this day about which drug works best, and it's been found that either drug can work well. Most of the time, a patient will respond better to one drug or the other, but both Lucentis and Avastin have shown efficacy. If you are having either one injected, you are in good shape according to most in the medical field. One is more expensive than the other, but the effects are the same. No matter which one your doctor prescribes, that treatment is right for you, but if you are having complications, let your doctor know, because there may be other issues. Have you gotten injections for macular degeneration? We'd love to hear about your experience! There are currently no treatments for macular degeneration that completely cure the disease or even stop its progression. Research in recent years has discovered various ways to slow inevitable vision loss and, although rarely, improve vision in particular areas. Several types of treatment include laser treatment, combinations of medicines, and injection. Concerns about injections for macular degeneration being painful should be eased since they are regarded as straightforward and painless. Several injection-based treatments are detailed below. Visudyne drug treatment is a photodynamic therapy that was the first drug therapy ever approved for the treatment of the wet form of macular degeneration. It is designated exclusively for people who have what is called a "predominantly classic" growth pattern of new blood vessels directly under the retina. An area of the arm is numbed with a painkiller after which the drug is delivered via a painless injection. Once the drug reaches the newly growing blood vessels under the retina, a low-energy laser beam is shone into the eye to activate the medication. Upon activation, Visudyne creates a chemical reaction that extinguishes unwanted blood vessels in the eye. Both the injection and the laser are considered virtually painless. Visudyne diminishes the symptoms of wet macular degeneration and slows down the development of legal blindness in many patients. This laser-activated drug can also be administered along with other treatments, including Lucentis or Avastin. Lucentis is actually an altered form of the colorectal cancer treatment drug Avastin. Lucentis has more recently been FDA approved as a way to treat advanced stages of the wet form of macular degeneration. In advanced stages of macular degeneration, there is an overgrowth of abnormal blood vessels triggered by a compound called vascular endothelial growth factor, or VEGF for short. The way Lucentis functions is by blocking VEGF proteins and thus preventing them from growing unnecessary blood vessels in the retina. Most of the research surrounding Lucentis shows that it has a mostly positive effect. It was beneficial in improving, or at least stabilizing, the vision of nearly all of the people who took it. By limiting VEGF, many Lucentis users experienced improvements in vision, whereas the majority of other treatments simply stop macular degeneration from getting worse. The way Lucentis is given is through an injection directly into the eye at monthly intervals (or as directed by your retinal specialist). Although the actual injection is considered to be painless, there have been scenarios were adverse reactions took place, such as eye inflammation, elevated eye pressure, and cataracts due to trauma. Continuing studies are required in order to fully explain the implications and side effects of taking Lucentis as an eye injection, but it is considered very safe and effective. Macugen and Eylea, like Lucentis, are other forms of eye injection treatment. They both act similarly in that they attempt to stop VEGF from creating more hazardous blood vessels in the retina. Whereas Macugen is given every six weeks, Eylea is only needed once every other month (at the discretion of your doctor). Have you experienced any of the above procedures? Did they work for you? Are Injections For Macular Degeneration Painful?
Full-time MT/MLT board certified lab tech needed at a top hospital in upper Michigan! Candidates must be competent in all areas of the lab, must be able to handle a fast paced environment, and also be patient oriented as phlebotomy is sometimes involved. Job Summary: Conducts laboratory testing on patient specimens including: chemical and hematological testing of blood or body fluids, and microbiological cultures of various body sites. Meticulous attention to detail. Critical thinking skills. Able to make decisions dependent on an in-depth knowledge of laboratory techniques, principles, instruments, and their inter-relationship. Certification as MLT (ASCP, AMT, AD) or CLT or MT. Previous experience in a clinical laboratory preferred. Understanding and tactful with patients, visitor, and co-workers. Has the ability to handle pressure and stress with composure and emotion stability. Personally committed to strive for excellence in quality of laboratory service provided.
New Data on Teva's Copaxone® and Laquinimod to Be Highlighted at ECTRIMS/ACTRIMS Oct 14, 2011 1:20pm JERUSALEM--(BUSINESS WIRE)-- Teva Pharmaceutical Industries Ltd. (NASDAQ: TEVA) today announced that more than 30 scientific presentations on the company's multiple sclerosis (MS) portfolio, including the market-leading treatment Copaxone® and the late-stage oral therapy laquinimod, will be featured during the 5th Joint Triennial Congress of the European and Americas Committees for Treatment and Research in Multiple Sclerosis (ECTRIMS AND ACTRIMS). This year's meeting, recognized as the world's largest annual international conference focused on MS research, will be held in Amsterdam, The Netherlands, October 19-22, 2011. Select data highlights include: Late-breaking presentation of data from the BRAVO study, the second global Phase III clinical trial evaluating oral laquinimod for the treatment of MS. Additional data from the ALLEGRO study demonstrating the positive impact of laquinimod on disability accumulation and rate of severe relapses, as well as patient-reported outcomes. Preclinical research further illuminating the novel neuroprotective mechanism of action (MOA) of laquinimod and its direct effect in the central nervous system (CNS). Study results from trials designed to determine the neuroprotective effects of treatment with COPAXONE® (glatiramer acetate injection) in two different experimental autoimmune encephalomyelitis (EAE) models. Additional preclinical data examining the anti-inflammatory mechanism of COPAXONE®. Data illustrating characteristics of the patient population examined in the Therapy Optimization in Multiple Sclerosis (TOP MS) study, the largest prospective Phase IV study conducted in MS examining self-reported patient outcomes to medication therapy management (MTM) via specialty pharmacy programs. The TOP MS study was designed to evaluate the benefits of adherence to therapy on MS patients' health outcomes. Select presentation information: Laquinimod [P 489] Laquinimod restricts inflammatory gene expression in a human model of reactive astrogliosis (Poster Session: Neuroprotection 1, October 20, 3:30-5:00 p.m. CEST) T. Pham, J. Zhang, J. Seto, L. Hayardeny, G. John (New York, US; Netanya, IL) [P 708] Laquinimod's impact on patient-reported fatigue and functional status: results from Allegro, a placebo-controlled phase III trial for relapsing-remitting multiple sclerosis (Poster Session: MS symptoms 2, October 21, 3:30-5:00 p.m. CEST) D. Jeffery, G. Comi, L. Kappos, X. Montalbán, A. Boyko, M. Filippi on behalf of the Allegro Study Group [P 736] Laquinimod reduces demyelination, inflammation, axonal damage and oligodendroglial pathology in the murine cuprizone model (Poster Session: Experimental models 2, October 21, 3:30-5:00 p.m. CEST) C. Wegner, R. Pförtner, W. Brück (Göttingen, DE) [P 363] Oral laquinimod reduces MRI markers suggestive of irreversible tissue damage in RRMS: results from Allegro, a placebo-controlled phase III trial (Poster Session: Imaging 1, October 20, 3:30-5:00 p.m. CEST) M. Filippi, M. Rocca, N. De Stefano, D. Jeffery, L. Kappos, X. Montalbán, A. Boyko, G. Comi on behalf of the Allegro Study Group [P 934] Oral laquinimod slows disability progression and reduces severe relapses in the placebo-controlled phase III Allegro trial for the treatment of relapsing-remitting multiple sclerosis (Poster Session: Immunomodulation 2, October 21, 3:30-5:00 p.m. CEST) G. Comi, D. Jeffery, L. Kappos, X. Montalbán, A. Boyko, M. Filippi, the ALLEGRO Study Group [P 825] Laquinimod treatment enhances myelination and prevents neurodegeneration in the chronic EAE mouse model of MS (Poster Session: Repairing mechanisms 2, October 21, 3:30-5:00 p.m. CEST) S. Tiwari-Woodruff, R. Patel, S. Moore, M. Sasidhar (Los Angeles, CA, Los Angeles, CA, US) [148] A placebo-controlled and active comparator phase III trial (BRAVO) for relapsing-remitting multiple sclerosis (Parallel Session 13: Late breaking News, October 22, 8:30-9:30 a.m. CEST) T.L. Vollmer, P. Soelberg Sorensen, D.L. Arnold on behalf of the BRAVO Study Group Copaxone® [P 491] Glatiramer acetate treatment protects synaptic transmission in experimental autoimmune encephalomyelitis through the modulation of microglia (Poster Session: Neuroprotection 1, October 20, 3:30-5:00 p.m. CEST) S. Rossi, G. Mandolesi, V. De Chiara, V. Studer, C. Motta, A. Gentile, D. Fresegna, A. Musella, D. Centonze (Rome, IT) [P 498] Glatiramer acetate augments remyelination and prevents motor neuron loss in mice with experimental autoimmune encephalomyelitis (Poster Session: Neuroprotection 1, October 20, 3:30-5:00 p.m. CEST) R. Aharoni, R. Eilam, A. Stock, A. Vainshtein, R. From, V. Shinder, R. Arnon (Rehovot, IL) [P 214] Therapy characteristics at enrolment in the TOP MS study (Poster Session: Epidemiology 1, October 20, 3:30-5:00 p.m. CEST) C. Markowitz, P. Coyle, H. Zwibel, B. Cohen, M.K. Oleen-Burkey (Philadelphia, Stony Brook, Coral Gables, Chicago, Kansas City, US) [P 696] Prevalence and treatment of persistent symptoms at enrolment in the TOP MS study (Poster Session: Epidemiology 2, October 21, 3:30-5:00 p.m. CEST) M.J. Tullman, P. Coyle, H. Zwibel, C. Markowitz, B. Cohen, M. Oleen-Burkey (St. Louis, Stony Brook, Coral Gables, Philadelphia, Chicago, Kansas City, US) [P 699] The therapy optimisation in MS study: baseline characteristics (Poster Session: Epidemiology 2, October 21, 3:30-5:00 p.m. CEST) P. Coyle, H. Zwibel, C. Markowitz, B. Cohen, M.K. Oleen-Burkey (Stony Brook, Coral Gables, Philadelphia, Chicago, Kansas City, US) [P 707] Relapse history from the TOP MS study (Poster Session: Epidemiology 2, October 21, 3:30-5:00 p.m. CEST) B. Cohen, P. Coyle, H. Zwibel, C. Markowitz, M. Oleen-Burkey (Chicago, Stony Brook, Coral Gables, Philadelphia, Kansas City, US) ABOUT COPAXONE® COPAXONE® is indicated for the reduction of the frequency of relapses in relapsing-remitting multiple sclerosis, including patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis. The most common side effects of COPAXONE® are redness, pain, swelling, itching, or a lump at the site of injection, flushing, rash, shortness of breath, and chest pain. COPAXONE® (glatiramer acetate injection) is now approved in more than 50 countries worldwide, including the United States, Russia, Canada, Mexico, Australia, Israel, and all European countries. In North America, COPAXONE® is marketed by Teva Neuroscience, Inc., which is a subsidiary of Teva Pharmaceutical Industries Ltd. In Europe, COPAXONE® is marketed by Teva Pharmaceutical Industries Ltd. and sanofi-aventis. COPAXONE® is a registered trademark of Teva Pharmaceutical Industries Ltd. See additional important information at: http://www.sharedsolutions.com/pdfs/PrescribingInformation.aspx or call 1-800-887-8100 for electronic releases. ABOUT LAQUINIMOD Laquinimod is an oral, once-daily CNS-active immunomodulator with a novel mechanism of action being developed for the treatment of MS. Laquinimod crosses the blood brain barrier to potentially target resident CNS inflammation and neurodegeneration. The global Phase III clinical development program evaluating oral laquinimod in MS consists of two pivotal studies, ALLEGRO and BRAVO. In the ALLEGRO study, laquinimod demonstrated a positive impact on disease activity and disability progression, while maintaining a favorable safety and tolerability profile. In addition to the MS clinical studies, laquinimod is currently in Phase II development for Crohn's disease and Lupus, and is being studied in other autoimmune diseases. ABOUT MULTIPLE SCLEROSIS MS is the leading cause of neurological disability in young adults. It is estimated that more than 400,000 people in the United States are affected by the disease and that two million people may be affected worldwide. Multiple sclerosis is a degenerative disease of the central nervous system in which inflammation and axonal damage and loss result in the development of progressive disability. ABOUT TEVA Teva Pharmaceutical Industries Ltd. (NASDAQ: TEVA) is a leading global pharmaceutical company, committed to increasing access to high-quality healthcare by developing, producing and marketing affordable generic drugs as well as innovative and specialty pharmaceuticals and active pharmaceutical ingredients. Headquartered in Israel, Teva is the world's largest generic drug maker, with a global product portfolio of more than 1,300 molecules and a direct presence in about 60 countries. Teva's branded businesses focus on CNS, oncology, pain, respiratory and women's health therapeutic areas as well as biologics. Teva currently employs approximately 45,000 people around the world and reached $16.1 billion in net sales in 2010. Teva's Safe Harbor Statement under the U. S. Private Securities Litigation Reform Act of 1995: This release contains forward-looking statements, which express the current beliefs and expectations of management. Such statements are based on management's current beliefs and expectations and involve a number of known and unknown risks and uncertainties that could cause our future results, performance or achievements to differ significantly from the results, performance or achievements expressed or implied by such forward-looking statements. Important factors that could cause or contribute to such differences include risks relating to: our ability to successfully develop and commercialize additional pharmaceutical products, the introduction of competing generic equivalents, the extent to which we may obtain U.S. market exclusivity for certain of our new generic products and regulatory changes that may prevent us from utilizing exclusivity periods, potential liability for sales of generic products prior to a final resolution of outstanding patent litigation, including that relating to the generic version of Protonix®, the extent to which any manufacturing or quality control problems damage our reputation for high quality production, the effects of competition on sales of our innovative products, especially Copaxone® (including potential generic and oral competition for Copaxone®), the impact of continuing consolidation of our distributors and customers, our ability to identify, consummate and successfully integrate acquisitions (including the acquisition of Cephalon), interruptions in our supply chain or problems with our information technology systems that adversely affect our complex manufacturing processes, intense competition in our specialty pharmaceutical businesses, any failures to comply with the complex Medicare and Medicaid reporting and payment obligations, our exposure to currency fluctuations and restrictions as well as credit risks, the effects of reforms in healthcare regulation, adverse effects of political or economical instability, major hostilities or acts of terrorism on our significant worldwide operations, increased government scrutiny in both the U.S. and Europe of our agreements with brand companies, dependence on the effectiveness of our patents and other protections for innovative products, our ability to achieve expected results through our innovative R&D efforts, the difficulty of predicting U.S. Food and Drug Administration, European Medicines Agency and other regulatory authority approvals, uncertainties surrounding the legislative and regulatory pathway for the registration and approval of biotechnology-based products, potentially significant impairments of intangible assets and goodwill, potential increases in tax liabilities resulting from challenges to our intercompany arrangements, our potential exposure to product liability claims to the extent not covered by insurance, the termination or expiration of governmental programs or tax benefits, current economic conditions, any failure to retain key personnel or to attract additional executive and managerial talent, environmental risks and other factors that are discussed in our Annual Report on Form 20-F and other filings with the U.S. Securities and Exchange Commission. IR: Teva Pharmaceutical Industries Ltd. Elana Holzman, 972 (3) 926-7554 Teva North America Kevin C. Mannix, 215-591-8912 Yossi Koren, 972 (3) 926-7687 Denise Bradley, 215-591-8974 KEYWORDS: Europe Netherlands Middle East Israel INDUSTRY KEYWORDS: Health Clinical Trials Pharmaceutical
Looking for Teeth Whitening in Lakeland? For an appointment at Family Dental at Lakeside Village call our office today at 863-686-2162 or make an appointment today. This guide will help you understand the benefits of our teeth whitening and what to expect when having them performed by our dentist. Important: While the teeth whitening procedures mentioned in this article certainly work and have been proven to be effective, they are meant to accompany a good oral hygiene regime. It is very important to always maintain proper oral hygiene. This not only helps you get naturally whiter teeth over time, but it also maintains the results of your teeth whitening treatment and prevents stains from developing or darkening. Always consult with our dentist before deciding on any of teeth whitening procedures mentioned above. If you are looking for effective and efficient teeth whitening procedures, with high-quality standards, consult our excellent dentist today. Not only does our dentist and team perform great teeth whitening procedures in, they also ensure that you are well taken care of and are fully satisfied with each treatment.
At Maloney-Shamie Vision Institute we specialize in giving you great vision without glasses or contact lenses. To achieve this we work with outstanding local eye doctors throughout southern California in the shared care of patients. These doctors can not only evaluate your candidacy through a pre-operative exam but also see you for all your post-operative visits to ensure an excellent result. In addition, the doctors listed below can provide a number of services we do not perform at our office such as annual eye exams, eyeglasses and contact lens fittings, and pediatric eye care. If you do not see a doctor listed in your city, feel free to contact our office directly for a referral at 310-208-3937. Choose a city below to find a recommended doctor in your area. Dr. David Eldridge 300 S. 4100 Long Beach Blvd., Ste. Westwood Eye Center Optometric Corp. 3535 S. La Cienega Blvd.
Effects of 5 years of hormonal replacement therapy on menopausal symptoms and blood pressure-a randomised controlled study. OBJECTIVES: To study the effects of hormonal replacement on hot flushes, other symptoms linked to menopause, and blood pressure. METHODS: The study included 1006 early postmenopausal women aged 45-58 years, participating in the Danish Osteoporosis Prevention Study (DOPS) randomised to Hormonal replacement therapy (HRT) (n=502) or no HRT (n=504) in an open label trial. Symptom scores were recorded at baseline, after 6 month, 1, 2, and 5 years on a modified Greene scale (range 0-4 with 0 equalling no symptoms, and 4 maximal symptoms). RESULTS: HRT efficiently alleviated hot flushes (mean+/-S.E.M. score 0.48+/-0.04 in HRT vs. 0.83+/-0.05 in no HRT after 5 years, P<0.01 by repeated measures ANOVA), sleeping difficulties associated with hot flushes (0.21+/-0.60 vs. 0.37+/-0.86, P<0.01), vaginal dryness (0.45+/-0.04 vs. 0.73+/-0.05, P<0.01), dyspareunia (0.27+/-0.04 vs. 0.39+/-0.04, P<0.01), and libido (0.48+/-0.05 vs. 0.59+/-0.05, P=0.08). In the untreated group the occurrence of mood swings (from 0.77+/-0.05 at baseline to 0.45+/-0.04 after 5 years, 2P<0.01) and oedemas (from 0.59+/-0.04 to 0.43+/-0.04, 2P=0.02) decreased with age while the occurrence of incontinence increased (from 0.43+/-0.03 to 0.52+/-0.04, 2P<0.01). These changes were not influenced by HRT. Furthermore, HRT had no influence on presence of headache (0.54+/-0.05 vs. 0.58+/-0.05 after 5 years), voiding pattern (0.49+/-0.04 vs. 0.53+/-0.04), or blood pressure (mean systolic pressure 123+/-18 vs. 123+/-19, diastolic pressure 77+/-10 vs. 77+/-11). CONCLUSIONS: HRT is efficient in controlling hot flushes and vaginal dryness, and symptoms related to these conditions. However, no effect on blood pressure or other menopause symptoms was recorded. Previous Document: Comparing the attitudes of urban and rural Iranian women toward menopause.
Uptake and antioxidant effects of ergothioneine in human erythrocytes Hiroki MITSUYAMA; Hiroki MITSUYAMA 1Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-6303, U.S.A. James M. MAY Correspondence: Dr James May (e-mail [email protected]). Clin Sci (Lond) (1999) 97 (4): 407–411. https://doi.org/10.1042/cs0970407 Hiroki MITSUYAMA, James M. MAY; Uptake and antioxidant effects of ergothioneine in human erythrocytes. Clin Sci (Lond) 1 October 1999; 97 (4): 407–411. doi: https://doi.org/10.1042/cs0970407 Ergothioneine is a fungal metabolite that may have antioxidant functions in mammalian cells. Although it accumulates to low millimolar concentrations in liver and other tissues, it is not thought to be taken up by mature erythrocytes. During a study of the function of ergothioneine as an antioxidant in human erythrocytes, we found that these cells do take up ergothioneine from the surrounding medium. Ergothioneine concentrations in freshly prepared erythrocytes were 2–9-fold higher than in plasma from the same donor. Slow but progressive accumulation of ergothioneine to about 125% of basal levels was observed in erythrocytes over a 4 h incubation. After a 2 h incubation, intracellular ergothioneine concentrations rose on addition of increasing amounts of ergothioneine to the incubation medium, although saturation was not evident in cells from all donors. Both initial levels and rates of ergothioneine uptake varied in erythrocytes from different donors. Intracellular ergothioneine was stable to depletion of GSH by N-ethylmaleimide and to a more severe oxidant stress induced by hydrogen peroxide in the presence of catalase. These results show that human erythrocytes do take up ergothioneine; however, the GSH results do not support an antioxidant role for ergothioneine in erythrocytes. betaine, ergothioneine, GSH, H2O2, human erythrocytes, oxidant stress The Biochemical Society and the Medical Research Society © 1999
Biofuels are introduced in the transportation sector as a means to reduce the sector'ns greenhouse gas (GHG) emissions. European and other national and global standardization schemes for biofuels also include certain minimum GHG emission reduction among the requirements to be met. Assessments of the GHG performance of biofuels are complex due to the complexities of physical, chemical, and biological conversion processes, feedstock diversity, and variability in site-specific environmental conditions. Differences may also arise in analytical approaches, including in how direct and indirect land use change is accounted for. Current production of first-generation ethanol in Sweden, based on wheat, causes relatively low GHG emissions, whereas a future expansion may cause increased emissions from changes in land use and less optimal utilization of by-products. Such negative impacts may be avoided by an introduction and expansion of second-generation ethanol based on lignocellulosic feedstock (e.g., straw, short rotation coppice, and forest residues), which eventually could become the major feedstock in ethanol production. This transition to low, indirect impact ethanol systems creates an opening for a significant expansion of ethanol in the transport sector without compromising the sizeable climate benefits and sustainable resource exploitation.
Research ArticleARABIDOPSIS ARTICLES A New Set of Arabidopsis Expressed Sequence Tags from Developing Seeds. The Metabolic Pathway from Carbohydrates to Seed Oil Joseph A. White, Jim Todd, Tom Newman, Nicole Focks, Thomas Girke, Oscar Martı́nez de Ilárduya, Jan G. Jaworski, John B. Ohlrogge, Christoph Benning Joseph A. White Jim Todd Nicole Focks Thomas Girke Oscar Martı́nez de Ilárduya Jan G. Jaworski John B. Ohlrogge Christoph Benning Published December 2000. DOI: https://doi.org/10.1104/pp.124.4.1582 Copyright © 2000 American Society of Plant Physiologists Large-scale single-pass sequencing of cDNAs from different plants has provided an extensive reservoir for the cloning of genes, the evaluation of tissue-specific gene expression, markers for map-based cloning, and the annotation of genomic sequences. Although as of January 2000 GenBank contained over 220,000 entries of expressed sequence tags (ESTs) from plants, most publicly available plant ESTs are derived from vegetative tissues and relatively few ESTs are specifically derived from developing seeds. However, important morphogenetic processes are exclusively associated with seed and embryo development and the metabolism of seeds is tailored toward the accumulation of economically valuable storage compounds such as oil. Here we describe a new set of ESTs from Arabidopsis, which has been derived from 5- to 13-d-old immature seeds. Close to 28,000 cDNAs have been screened by DNA/DNA hybridization and approximately 10,500 new Arabidopsis ESTs have been generated and analyzed using different bioinformatics tools. Approximately 40% of the ESTs currently have no match in dbEST, suggesting many represent mRNAs derived from genes that are specifically expressed in seeds. Although these data can be mined with many different biological questions in mind, this study emphasizes the import of photosynthate into developing embryos, its conversion into seed oil, and the regulation of this pathway. To understand the regulatory networks governing metabolism in developing oil seeds, we initiated a genome-wide analysis of gene expression in seeds of Arabidopsis, taking advantage of recently developed genomic tools (Hieter and Boguski, 1997; Bouchez and Hofte, 1998). Although the Arabidopsis genomic sequence is now fully available (www.arabidopsis.org; Meinke et al., 1998), expressed sequence tags (ESTs) derived from single-pass sequencing of cDNAs in Arabidopsis provide an invaluable resource for the annotation of genomic sequences and the analysis of gene expression associated with specific plant tissues or growth conditions (Newman et al., 1994; Cooke et al., 1996; Rounsley et al., 1996). Cloning of genes encoding enzymes of specific biochemical pathways by single-pass sequencing of cDNAs has been a very successful strategy, particularly when the cDNA libraries have been prepared from tissues with high activity for the respective enzymes. For example, sequencing of cDNAs derived from endosperm of developing castor bean seeds led to the identification of the enzyme involved in ricinoleic acid biosynthesis (Van de Loo et al., 1995a, 1995b). In a similar manner, genes essential for the biosynthesis of conjugated double bond-containing fatty acids were recently identified among ESTs from oleogenic tissues of Momordica charantia andImpatiens balsamina (Cahoon et al., 1999) and ESTs from wood-forming tissues of trees have proven to be an ideal source for the isolation of cDNAs encoding enzymes of cell wall biosynthesis (Allona et al., 1998; Sterky et al., 1998). ESTs and their accompanying cDNAs also provide the means to construct inexpensive microarrays on glass slides, which can be used to study the expression of genes on a genome-wide scale (DeRisi et al., 1997; Ruan et al., 1998). A careful bioinformatic analysis to identify tissue-specific ESTs is a prerequisite to obtain a comprehensive and representative set of cDNAs for gene expression studies by microarrays (Loftus et al., 1999). Thus, given that only a small number of plant ESTs in the public databases have been derived from seeds, it was essential in the context of the genome-wide analysis of seed metabolism to obtain and analyze a large number of these ESTs first. Even without subsequent microarray analysis, a sufficiently large number of ESTs derived from a specific tissue can provide a clue toward the expression of specific genes in the tissue (Rafalski et al., 1998;Ewing et al., 1999; Mekhedov et al., 2000). In most cases and within statistical limitations (Audic and Claverie, 1997) the abundance of a specific cDNA in the EST collection is a measure for gene expression. Here we apply this technique also referred to as "electronic or digital northern" to address the questions about the primary metabolic route for the conversion of photosynthate into oil in developing seeds of Arabidopsis. The described analysis of 10,500 cDNAs by single-pass sequencing provides a rich data set, which we can only begin to explore here. For this reason the data set will be available at our web page for further studies. Single-Pass Sequencing of 10,522 cDNAs from Developing Seeds Despite the fact that over 45,000 Arabidopsis ESTs have already been deposited in dbEST (release 030300; Boguski et al., 1993), these are not necessarily representative with regard to genes specifically expressed in developing seeds, because siliques, but not isolated developing seeds were used as source of seed cDNAs. To initiate a "functional genomic" analysis of seed metabolism, we sequenced cDNAs derived exclusively from developing Arabidopsis seeds in a single pass from the 5′ end. Because seeds contain highly abundant mRNAs, e.g. those derived from genes encoding storage proteins, we probed nylon filters with 9,136 (data set I) and 18,432 arrayed clones (data set II), respectively, employing cDNA probes as summarized in TableI. From data set I, 4,641 clones (51%) were sequenced and analyzed with BLASTX. Additional clones were selected from data set I (Table I) for probing of the second filter set to further reduce the redundancy in data set II. In this case, 5,922 clones (32%) were sequenced and analyzed. The average read lengths after trimming were 350 bp for clones from data set I and 259 bp for clones from data set II. Taken together, 10,522 clones were analyzed at the level of BLASTX searches equivalent to 38% of the clones on the filters. A total of 11,873 sequences were generated and kept in a FASTA file (complete raw data set), which includes 1,141 sequence runs from the 3′ ends of selected clones, a small number of repeats, and clones for which only poor sequence is available. The sequences have been deposited at GenBank and will be available along with annotations at our web site. The longest clones from each contig as well as singletons (see below) have been deposited at the Arabidopsis Biological Resource Center. Clones corresponding to highly abundant messages used for prescreening Classification of ESTs According to Predicted Function To obtain qualitative information about the ESTs, each sequence was searched (BLASTX) against the non-redundant protein database of GenBank. The top scoring hits were automatically extracted and manually annotated according to the description of the sequence(s) returned by BLASTX. The number of clones falling into each class are shown in TableII. It must be emphasized that this procedure provides only tentative clues toward the function of the encoded proteins, due to the fact that relatively few of the descriptions associated with GenBank entries have been verified by wet-lab experiments (Boguski, 1999). Table II. Distribution of cDNAs in classes of putative function Two classes, "non-significant homology" (NSH) and "unidentified function" (UF) represent approximately 40% of the clones and warrant further explanation. Sequences that returned BLASTX scores (high scoring segment pairs) of less than 100 were grouped under NSH (24.3%), indicating that no protein similar to the translation product was present in the public databases at the time of the analysis. This group of sequences was repeatedly resubmitted for analysis. To rule out that the NSH class is enriched in low quality sequences as the primary cause for low BLASTX scores in this class, we compared the average quality values assigned by PHRED to each chromatogram and found similar average quality values for the NSH class and the total EST set. Based on this analysis one can assume that approximately 24% of the clones in the seed database encode novel proteins. The UF class (13.5%) contains ESTs that show significant similarity (BLASTX scores >100) at the level of predicted amino acid sequence to proteins from different organisms for which no function is known. Despite the prescreening there is still a considerable number of storage protein entries (14.4%) present in the database (Table II) representing the largest class of clones for which a putative function can be assigned. A similar observation was made for ESTs from castor bean and was explained by the presence of short incomplete cDNAs encoding storage proteins that would not hybridize efficiently to the probe during prescreening (Van de Loo et al., 1995b). Considering the number of storage protein clones and other abundant clones identified by hybridization (62%), a minimum of 75% of mRNAs are derived from less than 50 genes in developing seeds. Three classes of particular importance to the analysis of carbon flow in developing oil seeds include 701 entries classified as carbohydrate metabolism, 490 lipid metabolism entries, and 216 entries for putative membrane transporters. How Many Novel ESTs and How Many Genes Are Represented in the Seed EST Set? To evaluate whether novel, seed-specific ESTs were present we compared our entire 5′-sequence data set against the Arabidopsis set in "The Arabidopsis Information Resource" available at http://www.Arabidopsis.org/seqtools.html. Of the 10,552 BLASTN results returned, 4,173 (39.5%) showed BLASTN scores (high scoring segment pairs) of less than or equal to 50. Based on these scores it can be estimated that approximately 40% of the ESTs described here are not represented in the public Arabidopsis EST set and many of these therefore may correspond to genes specifically expressed in developing seeds of Arabidopsis. Because multiple ESTs can be derived from a single gene, sequences were assembled into contigs to estimate the number of genes giving rise to the ESTs. Of the 11,850 sequences used for contig analysis, 7,567 (64%) assembled into 1,569 contigs and 4,283 (36%) remained as singletons. Thus the maximal number of unique cDNAs represented in the entire data set is 5,852. To estimate how many genes are represented in our data set that may be specifically expressed in developing seeds, we determined the number of contigs and singletons represented by the 4,173 ESTs not represented in the public data set. These were 743 contigs and 2,306 singletons representing a maximal number of 3,049 genes. Thus based on this analysis up to one-half of all genes represented by our data set may be specifically expressed in seeds. However, there are three caveats concerning this estimation. First, although in most cases each contig represents one gene, sometimes more than one contig of nonoverlapping sequences exist per gene resulting in an overestimation. Second, in some cases due to the limited quality of single-pass sequences, closely related gene families cannot be resolved into individual contigs resulting in an underestimation. Third, because silique-derived cDNA sequences are present in the public database, some of the ESTs in dbEST already represent genes specifically expressed in seeds, e.g. storage protein genes. These have not been taken into account above and will lead to an underestimation of seed-specific genes represented by the seed EST data set. Mapping ESTs onto the Arabidopsis Genome One step toward the determination of the exact number of genes represented by ESTs would be to map all ESTs and contig consensus sequences onto the Arabidopsis genome. For this purpose we searched (BLASTN) all sequences in the raw sequence file, as well as all contig consensus sequences against an Arabidopsis genomic sequence subset of all sequences longer than 10 kb. This set should primarily contain sequenced bacteria artificial chromosomes (BACs), phage artificial chromaosomes (PACs), and P1 clones from the Arabidopsis Genome Initiative. The individual results of this analysis can be found in the database and provide a location for most ESTs on the physical map of Arabidopsis by linking these results to the map locations of sequenced clones available athttp://www.Arabidopsis.org/seqtools.html. In the past this information could only be obtained by direct PCR mapping approaches (Agyare et al., 1997) due to the absence of large scale genomic sequence information. Because BACs contain on the average 20 to 30 genes each, further analysis on an individual basis is required to ultimately determine whether two contigs are derived from one or several genes on a particular BAC. Abundance of ESTs Derived from Specific Genes The number of sequences assembled in the contigs gives an indication of the degree of expression of the respective gene in developing seeds. Table III lists contigs containing more than eight ESTs. The accession numbers provide direct access to the sequence in GenBank (whenever possible, a cDNA sequence) that shows the best match to the contig consensus sequence. As predicted by the initial classification of individual ESTs (Table II), the most abundant ESTs form contigs that encode seed storage proteins. In agreement with the high demands for protein synthesis in developing seeds, ESTs for translational elongation factors were abundant in contigs (Table III, RB). ESTs for proteins possibly involved in storage protein body formation such as vacuolar processing enzyme (Kinoshita et al., 1995; Table III, TON) or proteases in general (Table III, PA) are highly abundant. In a similar manner, genes encoding enzymes involved in protein folding (Table III, CHP) such as protein disulfide isomerase genes are highly expressed in seeds (Boston et al., 1996). Developing embryos of Arabidopsis are green. Thus it is not surprising that ESTs encoding chlorophyll-binding proteins are present in high numbers (Table III, PS). The most highly abundant enzyme-encoding ESTs are those for S-adenosyl-Met decarboxylase (Table III, AA). This is a key enzyme of polyamine biosynthesis (Walden et al., 1997). However, ESTs encoding other enzymes of this pathway are not very abundant or are absent. Thus S-adenosyl-Met decarboxylase may be involved in addition in a pathway unrelated to polyamine biosynthesis. Among the contigs of abundant ESTs are 20 for which the consensus sequence did not have a match in GenBank or which are similar to proteins of unknown function (Table III, NSH and UF). These provide an interesting pool of novel proteins with a function that may be of special relevance for developing seeds and further functional analysis may lead to the discovery of molecular processes crucial to developing seeds. An obvious class missing in the contig list of most abundant ESTs (Table III) is that containing ESTs with similarity to transcription factor genes, even though the entire data set contains a considerable number of such ESTs (169, 1.6%; Table II, T). It is clear that regulatory genes are not as highly expressed as storage protein genes or genes essential for the biosynthesis of other storage compounds. Although this notion may be trivial, it nevertheless confirms that the observed abundance of ESTs in each contig or class is in agreement with common knowledge about the biology of plant cells and of developing seeds in particular. Table III. Most abundant contigs in the Seed EST database Different Representation of Genes in the Seed EST Set and the Public Arabidopsis EST Set The public EST data set for Arabidopsis available March 2000 consists of over 45,000 sequences derived from cDNA libraries produced from a range of tissues. The largest group of sequences (approximately 31,000) originated from sequencing a mixed population of cDNAs from etiolated seedlings, tissue culture-grown roots, and aerial tissue from flowering plants (Newman et al., 1994). The 10,522 sequences from a developing seed cDNA library described in this study represent the largest set of public Arabidopsis ESTs currently available from a narrowly defined developmental stage of the plant. How different is this new set from those sequences already deposited? To answer this question we compared the percentage of ESTs in the seed database for several genes with their abundance among the non-seed Arabidopsis ESTs previously deposited in dbEST. For example, for glyceraldehyde-3-P dehydrogenase, a gene that might be considered constitutive, or "housekeeping," the relative abundance in the two data sets is identical (0.3%). In contrast and as expected, genes that are known to be highly expressed in seeds were found to be abundant in the seed EST data set. For example, storage proteins represent at least 50% of the clones in the seed library, which is at least 500-fold more abundant than in the non-seed set. Likewise, oleosins are approximately 100-fold more prevalent in the seed library than in the non-seed data. In mature Arabidopsis seeds, lipid in the form of triacylglycerol is the major form of carbon storage, representing 30% to 40% of the seed dry weight. It might be expected that higher flux of carbon into lipid synthesis in seeds would be reflected in a higher proportion of clones for fatty acid synthesis within the seed data set than in dbEST. This is in fact the case: approximately 0.5% of the seed ESTs encode proteins of the plastidic fatty acid synthase compared with approximately 0.15% of Arabidopsis ESTs found in dbEST for the same reactions. Furthermore, we detected ESTs for seed-specific genes that are completely missing from the public data set. For example, clones corresponding to FAE1 encoding a protein that controls seed-specific fatty acid elongation occurred 20 times in our database, but not at all in dbEST. In general, the vast majority of these comparisons validate that this new EST set provides the expected tissue-specific representation of gene expression in seeds and contains a very different population of ESTs than previously available. The Conversion of Photosynthate into Fatty Acids Figure 1 depicts the major pathways involved in the conversion of Suc into fatty acids. These include the conversion of imported Suc by a cytosolic glycolytic pathway (reactions 1–16), transfer of intermediates across the plastid envelopes (reactions 17–20), intermittent starch biosynthesis and degradation in the plastid (reactions 21–26), a plastidic glycolytic pathway (reaction 27–36), the oxidative pentose phosphate cycle (reactions 37–42), the plastidic pyruvate dehydrogenase complex (reaction 44), as well as reactions involved in fatty acid biosynthesis and modification (reactions 45–52). In Figure 1 the thickness of arrows represents the number of ESTs in data sets I and II, which encode the respective enzyme. Because different enzymes have different turnover numbers and other kinetic factors, this number cannot be used to compare the magnitude of flux through the different reactions. However, EST numbers in many cases can provide useful comparisons between the same reaction in different compartments, or between similar biochemical reactions. The assignment of the plastidic and cytosolic isoforms was generally based on BLASTX results showing sequence similarity of the respective ESTs or contigs to genes encoding proteins of known function and subcellular location. In ambiguous cases, e.g. for Glc-6-P dehydrogenase (Fig. 1, reaction 37) we used multiple alignment of the respective ESTs from the seed database with all known Glc-6-P dehydrogenase-encoding plant genes in conjunction with cluster analysis. Further refinement could be achieved by predicting the presence of chloroplast transit peptides from genomic DNA sequences that correspond to the ESTs. However, in the absence of biochemical data these assignments must be considered preliminary. A list of each enzyme, the number of ESTs, and the clone and contig identifiers are given in Table IV. Reactions for which no corresponding EST is present are drawn with a dashed line in Figure 1. Schematic representation of metabolic pathways in a typical oil storing cell of a developing Arabidopsis embryo. The selective focus presented here is on carbohydrate metabolism and fatty acid biosynthesis. Only cytosolic and plastidic isoforms are considered. Double-headed arrows indicate readily reversible reactions, single headed arrows indicate typically irreversible reactions. Cosubstrates such as water or nucleotides have been omitted. Abbreviations are conventional, but can also be deduced from the enzyme descriptions given in Table IV. Numbers correspond to individual reactions and serve to identify the respective enzyme in Table IV. The thickness of arrows provides a coarse indication of the number of ESTs present in the seed EST data set for the respective reaction. The exact numbers for each reaction can be found in Table IV. Table IV. Enzymes involved in carbohydrate and lipid metabolism It is interesting that those reactions are often found in clusters, e.g. reactions 25 through 29 (plastidic glycolysis) or 38 through 41 (oxidative pentosephosphate cycle). It is tempting to speculate that the observed clustering reflects the coordinated regulation of gene expression according to metabolic pathways and may provide a first glimpse at the regulatory network governing seed metabolism. However, it must be emphasized that even though this new data set is large, it still is incomplete and the resolution for differential expression is lost for reactions that are not represented by ESTs. Membrane Transporters Suc is the transport form of CO2 fixed by photosynthesis and must be imported into the developing embryo. Studies with developing bean seeds suggest that Suc and hexose transporters located in the epidermis of the embryo are involved (Weber et al., 1997). Two Suc transporter genes are known for Arabidopsis,SUC1 and SUC2 (Sauer and Stolz, 1994) and corresponding ESTs are present in the seed database (Table IV; Fig. 1, reaction 1). Most ESTs correspond to SUC2, but there is also a contig of ESTs that are more similar to the Suc transporter from bean (Tab IV). Whether this class of ESTs represents a third Suc transporter gene from Arabidopsis specific for developing seeds needs to be further investigated. Furthermore, several ESTs with similarity to hexose transporters are present, which may be involved in the import of hexoses derived from Suc cleavage by apoplastic invertase. Hexose metabolites enter the plastid to provide precursors for starch and fatty acid biosynthesis. Using isolated plastids of developing embryos of oilseed rape, it has been shown that labeled Glc-6-P and pyruvate are the most efficient of all the different possible substrates tested in labeling starch and triacylglycerols, respectively (Kang and Rawsthorne, 1994). Furthermore, fatty acid biosynthesis was stimulated if Glc-6-P and pyruvate were present (Kang and Rawsthorne, 1996). ESTs with similarity to a plastid Glc-6-P/phosphate (or triosephosphate) antiporter (Kammerer et al., 1998) are abundant in the seed EST database (Table IV; Fig. 1, reaction 17). However, we were unable to identify a set of ESTs with similarities to any known pyruvate or monocarboxylic acid transporter (Table IV; Fig. 1, reaction 20). Either pyruvate does not require a specific translocator, the respective protein cannot be identified without further biochemical or molecular information, or pyruvate is not the metabolite imported into plastids in vivo. It has been previously suggested that a plastid phosphoenolpyruvate/phosphate antiporter may be providing the plastid with pyruvate following metabolism of the imported phosphoenolpyruvate (Fischer et al., 1997). There are several ESTs present encoding proteins with similarity to a phosphoenolpyruvate translocator (TableIV; Fig. 1, reaction 19). A high expression of this antiporter in non-green plant tissues has also been observed using conventional methods (Kammerer et al., 1998). In the same study it was also shown that the gene for the triosephosphate/phosphate translocator is much more highly expressed in green tissues as compared with non-green tissues. Thus, the presence of only one EST for the respective gene in the seed database (Table IV; Fig. 1, reaction 18) is in agreement with the conventional northern analysis. Glycolysis, Oxidative Pentose Phosphate Cycle, and Starch Metabolism In general, plants do have a complete glycolytic pathway in the cytosol (Plaxton, 1996) and it has been shown that a complete pathway also exists in the plastids of oil seeds (Dennis and Miernyk, 1982;Kang and Rawsthorne, 1994). The question remains to what extent both pathways are utilized in the conversion of carbohydrates into precursors of fatty acid biosynthesis. All genes encoding glycolytic enzymes of the cytosol are expressed, whereas ESTs encoding plastidic isoforms are absent in many cases (Fig. 1; Table IV). Exceptions are the central reactions 30 through 33 of the plastidic glycolytic pathway, as well as the plastidic isoform of pyruvate kinase (reaction 36). It seems certain that there is differential transcriptional regulation of the two pathways. Assuming that there is no general difference between the specific activities of the cytosolic and plastid enzymes, the data would be consistent with a more active cytosolic pathway. The peculiar high expression of plastidic pyruvate kinase genes (reaction 33) in conjunction with the relatively high abundance of phosphoenolpyruvate transporter ESTs (reaction 19) is consistent with a major route of carbon from Suc into precursors of fatty acid biosynthesis involving the cytosolic glycolytic pathway up to phosphoenolpyruvate, import of this compound into the plastid, and subsequent conversion to pyruvate. It is interesting that ESTs for plastid isoforms of pyruvate dehydrogenase (27 ESTs) are approximately 2-fold more abundant than for mitochondrial isoforms (13 ESTs). This contrasts with the non-seed Arabidopsis EST set in dbEST where ESTs are approximately equal for the two subcellular localizations. These comparisons are clearly consistent with our expectations of the relative flux through fatty acid synthesis and the tricarboxylic acid cycle in seed and non-seed tissues. Biosynthesis of fatty acids does not only require carbon units, but more than twice as many moles of reduced nicotinamide nucleotides per fatty acid (Ohlrogge et al., 1993). Reductants for fatty acid biosynthesis can be generated in the heterotrophic plastid by the pyruvate dehydrogenase reaction (reaction 44), by the initial reactions (reactions 37 and 39) of the oxidative pentose phosphate cycle, and in green seeds by photosystem I. Although the different subunits of the plastidic pyruvate dehydrogenase complex are highly expressed (TableIV, reaction 44), only one out of seven Glc-6-P dehydrogenase- (reaction 37) encoding ESTs could be clearly identified as plastidic. No ESTs were found for reactions 38 through 41 of the plastidic oxidative pentose phosphate cycle, but ESTs encoding enzymes involved in recycling the carbon moieties were plentiful (reactions 42 and 43). It is known that plastidic Glc-6-P dehydrogenase is allosterically regulated in sophisticated ways in photosynthetic tissues (Wenderoth et al., 1997). Thus it seems possible that this tight regulation of the oxidative pentose phosphate pathway begins already at the level of transcription and is visible in the low abundance of the respective ESTs. Plastids of developing Arabidopsis seeds are transiently green and some of the most abundant ESTs encode proteins of the photosynthetic membrane (Table III), supporting the conclusion (Browse and Slack, 1985; Eastmond et al., 1996; Asokanthan et al., 1997; Bao et al., 1998) that some of the reducing equivalents required for fatty acid biosynthesis are derived from photosynthesis. Developing seeds of Arabidopsis transiently accumulate starch (Focks and Benning, 1998). In accordance with this, ESTs encoding enzymes involved in starch biosynthesis and degradation are quite abundant (Fig. 1; Table IV, reactions 21–24), similar to those encoding enzymes that catalyze the initial reactions of fatty acid biosynthesis (reactions 45–48). The ESTs of starch metabolism represent an example of the apparent coordinate expression of genes encoding enzymes of the same metabolic pathway and may reveal a regulon. Given that the major carbon storage in developing oil seeds is associated with triacylglycerol, but not starch, one would expect that ESTs encoding enzymes directly involved in fatty acid biosynthesis are at least as abundant as those encoding starch metabolic enzymes. This seems to be true for the ketoacyl-acyl carrier protein synthases (reactions 46, 47, and 51) as well as for acetyl-coenzyme A (CoA) carboxylase (reaction 45), which provides the malonyl-CoA substrate for fatty acid biosynthesis. In general the relative abundance of the cDNAs encoding different enzymes of fatty acid synthesis is similar in the seed and non-seed EST sets, suggesting that seeds do not alter to a substantial degree the relative expression of genes encoding pathway components to accomplish the increased flux through the pathway in seeds. Rather, the entire pathway is apparently up-regulated, as suggested by the overall higher relative abundance of ESTs noted for fatty acid synthesis ESTs in the seed compared with the non-seed sets (Mekhedov et al., 2000). These data, therefore, confirm tissue mRNA expression data from several studies of genes encoding individual enzymes of fatty acid synthesis (e.g. Fawcett et al., 1994), but furthermore suggest that at least nine genes encoding enzymes or subunits involved in this pathway are coordinately regulated. The broader scale in silico expression analysis presented here has thus uncovered phenomena that were not apparent from the previous studies focusing on single genes. We have provided a large data set of ESTs from developing Arabidopsis seeds and have begun to analyze this rich resource. The analysis of this data set is not complete and some of the conclusions may have to be revised as better bioinformatics tools become available. However, based on our preliminary analysis it is clear that this data set is substantially different from the currently available public Arabidopsis EST data set. With few exceptions, there is considerable congruence between conventional biochemical wisdom regarding seed metabolism and the number of ESTs encoding seed metabolic enzymes. Even by examining only 52 reactions (Fig. 1), patterns of expression became obvious. These observed patterns may reflect the existence of metabolic regulons, groups of genes that are coordinately expressed. In many cases the current EST data set provides the first experimental access to these genes and the basis for their in-depth molecular analysis and for the biochemical studies of the encoded proteins. Library Preparation and Screening To construct the Arabidopsis developing seed cDNA library, immature seeds of Arabidopsis ecotype Columbia-2 were collected 5 to 13 d after flowering. RNA was extracted according to Hall et al. (1978) from 1 g of seed tissue and a directional Uni-ZAP XR cDNA library was commercially prepared from poly(A)+ mRNA (Stratagene, La Jolla, CA). The initial titer of the amplified library was 1.9 × 1010 plaque-forming units/mL. Based on 48 randomly selected clones, the average insert size was estimated to be 1.9 kb. Following the excision of phagemids, bacterial colonies were arrayed onto nylon membranes at a density of 36 clones cm−2 by Genome Systems (St. Louis). Data were generated in two stages corresponding to a membrane set with 9,136 cDNA clones and a second set containing 18,432 clones. The first set of membranes was hybridized with 12S and 2S seed storage protein cDNA clones. Non-hybridizing clones were selected for sequencing. The second set of membranes was hybridized with six pools of five different probes derived from cDNAs (Table I) that were highly abundant among the EST sequences from the first set. Non-hybridizing clones were sequenced following re-racking. The first set of cDNAs (data set I) was sequenced at Michigan State University from the 5′ ends using the SK primer for pBluescript II, or from the 3′ ends using the M13 21 primer. The second set of cDNAs (data set II) was sequenced by Incyte Pharmaceuticals (Palo Alto, CA) from the 5′ ends using the Bluescript T3 primer. Chromatograms from the data set I were processed in batches using Sequencher v.3.0 (Gene Codes, Ann Arbor, MI). The 5′- and 3′-ambiguous sequences were trimmed. Vector sequences were removed as part of this process. Sequences that were less than 150 bp long or had >4% ambiguity were not processed. Chromatograms from data set II were processed in bulk using PHRED (Phil Green and Brent Ewing, University of Washington, Seattle). Sequences that were less than 225 bp or >4% ambiguous were not further processed. At this time 95% of the sequences have been deposited at GenBank. The remaining 5% (exclusively derived from data set II) will be available in GenBank by March 2001. Database Searches For data set I, sequences were processed with the Genetics Computer Group programs (Wisconsin Package Version 9.1, Madison, WI), and used for similarity searches against GenBank by using shell or PERL scripts that call Genetics Computer Group NETBLAST (BLASTX version 1.4.11; Altschul et al., 1990) for each sequence. Searches were done in batches. For data set II, the FASTA file produced by PHRED/PHD2FASTA was processed by PERL scripts to do BLASTX searches with default parameters. The BLASTX searches were done over a period of 12 months from September 2, 1998 to September 21, 1999 using the most recent releases of GenBank. A subset was periodically retested (see below). The output from BLASTX was processed with PERL scripts to extract the top scoring hit from each result file. The following information for the top scoring entry in each result file was retained: gene identifier, description, BLAST score, probability, percent identity, alignment length, and reading frame. These results were compiled in text files. Each result was manually interpreted and categorized according to predicted biochemical function. BLASTN searches were done against a subset of dbBEST (available athttp://www.Arabidopsis.org/seqtools.html) containing only Arabidopsis sequences using a FASTA file with all raw sequences. Stand-alone BLASTN version 2.0.9 running under Linux 5.2 was used for this analysis. Contig Analysis Contig analysis was performed with PHRAP (Phil Green, University of Washington, Seattle). Chromatograms from both data sets were processed with PHRED/PHD2FASTA, CROSS_MATCH (to mask vector sequence), and PHRAP. The first 30 bp from each sequence were trimmed during assembly by PHRAP. The .ace output file from PHRAP was processed with a PERL script to obtain the list of ESTs in each contig. Contigs were manually screened and corrected in cases where obviously unrelated sequences were clustered together. All data were imported into a Microsoft Access 97 relational database. The database was built around unique clone identifiers that refer to clone locations in microtiter plates. In some cases entries for 3′ sequences are available. These can be recognized by the last letter X added to the clone identifier. In a few cases the same clone has been sequenced twice. This has been marked by adding the last letters A and B to the clone identifier. The database and the PERL scripts are available for viewing at our web page athttp://benningnt.bch.msu.edu/index.htm. We thank Sergei Mekhedov for advice and Jay Thelen for analysis of pyruvate dehydrogenase sequences. We would also like to thank Chris Eakin and Chris Beasley for their help with the annotation of data and construction of the web site. ↵1 This work was supported in parts by the National Science Foundation (grant nos. MCB–94–06466 and IBN–97–23778), the Midwestern Consortium for Plant Biotechnology Research, Dow Agroscience, and the Michigan Agricultural Experiment Station. ↵2 Present address: The Institute for Genomic Research, 9712 Medical Center Drive, Rockville, MD 20850. ↵212 The online version of this article contains Web-only data. The supplemental material is available at www.plantphysiol.org. ↵* Corresponding author; e-mail benning{at}pilot.msu.edu; fax 517–353–9334. Received April 7, 2000. Revision received May 24, 2000. Agyare FD, Lashkari DA, Lagos A, Namath AF, Lagos G, Davis RW, Lemieux B (1997) Mapping expressed sequence tag sites on yeast artificial chromosome clones of Arabidopsis thaliana DNA. Genome Res 7:1–9. Allona I, Quinn M, Shoop E, Swope K, Cyr SS, Carlis J, Riedl J, Retzel E, Campbell MM, Sederoff R, Whetten RW (1998) Analysis of xylem formation in pine by cDNA sequencing. Proc Natl Acad Sci USA 95:9693–9698. Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ (1990) Basic local alignment search tool. J Mol Biol 215:403–410. Asokanthan PS, Johnson RW, Griffith M, Krol M (1997) The photosynthetic potential of canola embryos. Physiol Plant 101:353–360. Audic S, Claverie JM (1997) The significance of digital gene expression profiles. Genome Res 7:986–995. Bao XM, Pollard M, Ohlrogge J (1998) The biosynthesis of erucic acid in developing embryos of Brassica rapa. Plant Physiol 118:183–190. Boguski MS (1999) Biosequence exegesis. Science 286:453–455. Boguski MS, Lowe TM, Tolstoshev CM (1993) dbEST: database for "expressed sequence tags." Nat Genet 4:332–333. Boston RS, Viitanen PV, Vierling E (1996) Molecular chaperones and protein folding in plants. Plant Mol Biol 32:191–222. Bouchez D, Hofte H (1998) Functional genomics in plants. Plant Physiol 118:725–732. Browse J, Slack CR (1985) Fatty acid synthesis in plastids from maturing safflower and linseed cotyledons. Planta 166:74–80. Cahoon EB, Carlson TJ, Ripp KG, Schweiger BJ, Cook GA, Hall SE, Kinney AJ (1999) Biosynthetic origin of conjugated double bonds: production of fatty acid components of high-value drying oils in transgenic soybean embryos. Proc Natl Acad Sci USA 96:12935–12940. Cooke R, Raynal M, Laudie M, Grellet F, Delseny M, Morris PC, Guerrier D, Giraudat J, Quigley F, Clabault G, Li YF, Mache R, Krivitzky M, Gy IJ, Kreis M, Lecharny A, Parmentier Y, Marbach J, Fleck J, Clement B, Philipps G, Herve C, Bardet C, Tremousaygue D, (1996) Further progress towards a catalogue of all Arabidopsis genes: analysis of a set of 5,000 non-redundant ESTs. Plant J 9:101–124. Dennis D, Miernyk J (1982) Compartmentation of non-photosynthetic carbohydrate metabolism. Annu Rev Plant Physiol 33:27–50. DeRisi JL, Iyer VR, Brown PO (1997) Exploring the metabolic and genetic control of gene expression on a genomic scale. Science 278:680–686. Eastmond P, Kolacna L, Rawthorne S (1996) Photosynthesis by developing embryos of oil seed rape (Brassica napus L.). J Exp Bot 47:1763–1769. Ewing RM, Kahla AB, Poirot O, Lopez F, (1999) Large-scale statistical analyses of rice ESTs reveal correlated patterns of gene expression. Genome Res 9:950–959. Fawcett T, Simon WJ, Swinhoe R, Shanklin J, Nishida I, Christie WW, Slabas AR (1994) Expression of mRNA and steady-state levels of protein isoforms of enoyl-ACP reductase from Brassica napus. Plant Mol Biol 26:155–163. Fischer K, Kammerer B, Gutensohn M, Arbinger B, Weber A, Hausler RE, Flugge UI (1997) A new class of plastidic phosphate translocators: a putative link between primary and secondary metabolism by the phosphoenolpyruvate/phosphate antiporter. Plant Cell 9:453–462. Focks N, Benning C (1998) wrinkled1: a novel, low-seed-oil mutant of Arabidopsis with a deficiency in the seed-specific regulation of carbohydrate metabolism. Plant Physiol 118:91–101. Hall TC, Ma Y, Buchbinder BU, Pyne JW, Sun SM, Bliss FA (1978) Messenger RNA for G1 protein of French bean seeds: cell free translation and product characterization. Proc Natl Acad Sci USA 75:3196–3200. Hieter P, Boguski M (1997) Functional genomics: it's all how you read it. Science 278:601–602. Hilpert B, Schubert S, (1998) Molecular characterization of a carbon transporter in plastids from heterotrophic tissues: the glucose 6-phosphate/phosphate antiporter. Plant Cell 10:105–117. Kang F, Rawsthorne S (1994) Starch and fatty acid biosynthesis in plastids from developing embryos of oil seed rape. Plant J 6:795–805. (1996) Metabolism of glucose-6phosphate and utilization of multiple metabolites for fatty acid synthesis by plastids from developing oilseed rape embryos. Planta 199:321–327. Kinoshita T, Nishimura M, Hara-Nishimura I (1995) Homologues of a vacuolar processing enzyme that are expressed in different organs in Arabidopsis thaliana. Plant Mol Biol 29:81–89. Loftus SK, Chen Y, Gooden G, Ryan JF, Birznieks G, Hilliard M, Baxevanis AD, Bittner M, Meltzer P, Trent J, Pavan W (1999) Informatic selection of a neural crest-melanocyte cDNA set for microarray analysis. Proc Natl Acad Sci USA 96:9277–9280. Meinke DW, Cherry JM, Dean C, Rounsley SD, Koornneef M (1998) Arabidopsis thaliana: a model plant for genome analysis. Science 282:679–682. Mekhedov S, Martinez de Ilarduya O, (2000) Towards a functional catalog of the plant genome: a survey of genes for lipid biosynthesis. Plant Physiol 122:389–401. Newman T, de Bruijn FJ, Green P, Keegstra K, Kende H, McIntosh L, Ohlrogge J, Raikhel N, Somerville S, Thomashow M (1994) Genes galore: a summary of methods for accessing results from large-scale partial sequencing of anonymous Arabidopsis cDNA clones. Plant Physiol 106:1241–1255. Moore TS Ohlrogge JB, Jaworski JG, Post-Beittenmiller D (1993) De novo fatty acid biosynthesis. in Lipid Metabolism in Plants. ed Moore TS (CRC Press, Boca Raton, FL), pp 3–32. Plaxton WC (1996) Organization and regulation of plant glycolysis. Annu Rev Plant Physiol Plant Mol Biol 47:185–214. Rafalski JA, Hanafey M, Miao GH, Ching A, Lee JM, Dolan M, Tingey S (1998) New experimental and computational approaches to the analysis of gene expression. Acta Biochim Pol 45:929–934. Glodek A, Sutton G, Adams MD, Somerville CR, Venter JC, Kerlavage AR (1996) The construction of Arabidopsis expressed sequence tag assemblies: a new resource to facilitate gene identification. Plant Physiol 112:1177–1183. Ruan Y, Gilmore J, Conner T (1998) Towards Arabidopsis genome analysis: monitoring expression profiles of 1,400 genes using cDNA microarrays. Plant J 15:821–833. Sauer N, Stolz J (1994) SUC1 and SUC2: two sucrose transporters from Arabidopsis thaliana: expression and characterization in baker's yeast and identification of the histidine-tagged protein. Plant J 6:67–77. Sterky F, Regan S, Karlsson J, Hertzberg M, Rohde A, Holmberg A, Amini B, Bhalerao R, Larsson M, Villarroel R, Van Montagu M, Sandberg G, Olsson O, Teeri TT, Boerjan W, Gustafsson P, Uhlen M, Sundberg B, Lundeberg J (1998) Gene discovery in the wood-forming tissues of poplar: analysis of 5,692 expressed sequence tags. Proc Natl Acad Sci USA 95:13330–13335. Van de Loo FJ, Broun P, Turner S, Somerville C (1995a) An oleate 12-hydroxylase from Ricinus communis L. is a fatty acyl desaturase homolog. Proc Natl Acad Sci USA 92:6743–6747. (1995b) Expressed sequence tags from developing castor seeds. Plant Physiol 108:1441–1150. Walden R, Cordeiro A, Tiburcio AF (1997) Polyamines: small molecules triggering pathways in plant growth and development. Plant Physiol 113:1009–1013. Weber H, Borisjuk L, Heim U, Wobus U (1997) A role for sugar transporters during seed development: molecular characterization of a hexose and a sucrose carrier in fava bean seeds. Plant Cell 9:895–908. Wenderoth I, Scheibe R, von Schaewen A (1997) Identification of the cysteine residues involved in redox modification of plant plastidic glucose-6-phosphate dehydrogenase. J Biol Chem 272:26985–26990. You are going to email the following A New Set of Arabidopsis Expressed Sequence Tags from Developing Seeds. The Metabolic Pathway from Carbohydrates to Seed Oil Plant Physiology Dec 2000, 124 (4) 1582-1594; DOI: 10.1104/pp.124.4.1582 Regulation and Function of the Arabidopsis ABA-insensitive4 Gene in Seed and Abscisic Acid Response Signaling Networks Profilin Plays a Role in Cell Elongation, Cell Shape Maintenance, and Flowering in Arabidopsis Pathogenesis of the Human Opportunistic PathogenPseudomonas aeruginosa PA14 in Arabidopsis Show more ARABIDOPSIS ARTICLES
Several animal models have been utilized for in-vitro experimentation and surgical training exercises of the vas deferens. The canine model is currently the standard for both in-vivo and ex-vivo study. Due to increasing costs associated with experimentation on canines, and in keeping with the principles of refine, reduce, and replace, a novel model that is cost-effective and easily obtained is desired. We compared morphology of the bull vas deferens to that of the human and the canine. Bilateral vas deferens tissue from the human (n = 6), canine (n = 6), and bull (n = 5) were compared. Outer diameter (OD), inner diameter (ID), and microscopic measurements of the luminal mucosa and muscularis were then determined from each of these tissues. Histological comparisons were performed by a single pathologist. Data was analyzed using Two One-sided Tests (TOST) Analysis of Equivalence. According to the TOST statistical analysis, the vassal ID was equivalent for all three species. Similarly, equivalent microscopic measurements were noted for both vassal mucosal (human-canine and human-bull) and muscularis thicknesses (canine-bull). Lastly, all three species had similar histological characteristics. The vas deferens of the human, canine, and bull are equivalent in many ways, including histological similarities. It is reasonable to conclude that the bull vas could be substituted for the human vas for both in-vitro testing and microscopic vasovasostomy simulation exercises. Specimens are cost-effective, provide ample tissue length, and are easy to obtain.
We have characterized the erythrocytes, granulocytes, and platelets of 54 patients with paroxysmal nocturnal hemoglobinuria (PNH) with antibodies to glycosylphosphatidylinositol-anchored proteins (anti- CD55, anti-CD59, and anti-CD16) and flow cytometry to establish the usefulness of this technique in the diagnosis of this disorder. All patients demonstrated either completely (PNH III) or partially (PNH II) deficient red cells and granulocytes. Anti-CD59 best demonstrated PNH II red cells, which were present in 50% of the patients. The proportion of abnormal granulocytes was usually greater than the proportion of abnormal red cells; 37% of the patients had >80% abnormal granulocytes. Anti-CD55 did not delineate the erythrocyte populations as well as did anti-CD59. Either anti-CD55 or anti-CD59 could be used equally well to analyze granulocytes; anti-CD16 did not demonstrate cells of partial deficiency. Platelets could not be used for detailed analysis as the normal and abnormal populations were not well distinguished. Flow cytometry of erythrocytes using anti-CD59 or of granulocytes using either anti-CD55 or anti-CD59 provides the most accurate technique for the diagnosis of paroxysmal nocturnal hemoglobinuria; it is clearly more specific, more quantitative, and more sensitive than the tests for PNH that depend upon hemolysis by complement (the acidified serum lysis [Ham] test, the sucrose lysis test, and the complement lysis sensitivity [CLS] test). Hall, S., & Rosse, W. (1996). The use of monoclonal antibodies and flow cytometry in the diagnosis of paroxysmal nocturnal hemoglobinuria. Blood, 87(12), 5332-5340. Accessed April 18, 2019. Retrieved from http://www.bloodjournal.org/content/87/12/5332.
Characterization of Cu3SbS3 thin films grown by thermally diffusing Cu2S and Sb2S3 layers Hussain, Arshad, Ahmed, Rashid, Ali, N., Shaari, A., Luo, Jing-Ting and Fu, Yong Qing (2017) Characterization of Cu3SbS3 thin films grown by thermally diffusing Cu2S and Sb2S3 layers. Surface and Coatings Technology, 319. pp. 294-300. ISSN 0257-8972 Revised-Manuscript_SURFCOAT-D-17-00262.pdf - Accepted Version Official URL: https://doi.org/10.1016/j.surfcoat.2017.04.021 Copper antimony sulphide (Cu3SbS3) with a p-type conductivity and optical band gaps in the range of 1.38 to 1.84 eV is considered to be a promising solar harvesting material with non-toxic and economical elements. In this study, we reported the fabrication of Cu3SbS3 thin films using successive thermal evaporation of Cu2S and Sb2S3 layers followed by annealing in an argon atmosphere at a temperature range of 300-375°C. The structural and optical properties of the as-deposited and annealed films were investigated. The annealed films notably show the crystalline phase of the Cu3SbS3, identified from the X-ray diffraction analysis and endorsed by the Raman analysis as well. Whereas their chemical state of the constituent elements was characterized with X-ray photoelectron spectroscopy. The measured highest resistivity of the annealed film was found to be ~0.2 Ω-cm. Hence, our obtained results for the fabricated Cu3SbS3 thin films bring to light that Cu3SbS3would be a good absorber layer in solar cells due to their low resistivity, a higher value of the optical absorption coefficient (~105 cm-1), the low transmittance (<5%) and an optical direct band gap of 1.6 eV in the visible range of the solar spectrum. Thin films, Copper antimony sulphide, XRD, Optical properties, Resistivity F200 Materials Science Faculties > Engineering and Environment > Mathematics, Physics and Electrical Engineering Becky Skoyles
Sara Berg @SaraTheIceBerg Full Bio Serving a population made up largely of African-American and Hispanic patients, a Miami primary care and multispecialty group saw the same racial and ethnic health disparities in hypertension that are rampant in the American population at large. But the team at Doctor's Medical Center (DMC) was able to secure a 16 percent improvement in its BP-control rate by integrating their clinicians' expertise with a robust EHR system and implementing a population-health management strategy, a team-based approach and evidence-based medicine. DMC has 12 outpatient clinics, with 44 physicians and other clinicians providing care to approximately 50,000 patients, 27 percent of whom were diagnosed with hypertension. A majority of patients at DMC have low incomes and are living in the most underserved communities of Miami-Dade County, Florida. "We are extremely proud of this achievement because of the disparity among minority groups in reference to blood pressure control," said Claudio Micieli, MPH, the chief operating officer of DMC, in a video presentation available for viewing on Target: BP™. "And for us, this success is so important because more than 90 percent of our patient population is minority groups." "There are a lot of social determinants that have an impact on the control of blood pressure among these patients," Micieli added. "They're at a high risk of developing not only hypertension, but cardiovascular disease and other complications." 4 ways to partner with black patients to control hypertension Here the steps DMC took with its successful hypertension-control initiative. Identify the patient population. To improve on DMC's 60 percent rate of controlled hypertension, the first step was to identify the patients in need of better BP control and where they were located. To determine the patient population, DMC used its EHR system and put together a protocol to screen each patient every time they came into their clinics. Of patients with hypertension, 51 percent were African-American and 40 percent were Hispanic, Micieli said. Nearly half had a comorbidity such as obesity and diabetes. By flagging patients in their system, the physician and care team will see a potential opportunity to address BP control at each clinic visit. Create a care team. Once you understand the patient population and how many have uncontrolled BP, a care team needs to be put together. "We move from the physician to the care team," said Micieli. "And when I am talking about the care team, it's not just the medical assistant and nurses. It is every single person—from the front desk to the patient's driver." The most important member of the care team, however, is the patient. DMC provides patients with tools and counseling to help improve their lifestyles, but the group had to create a social services department to help overcome socioeconomic barriers. "Sometimes people don't have food on their tables or a way to get to the office," Micieli said. "If the patient can't come, we offer them a [ride]. We say, 'No problem. We will pick you up and bring you back home.'" Establish partnerships. Physician practices and health systems don't have to control BP in African-American and Hispanic patients on their own. By creating a partnership, many of the tools and resources are available already, such as Target: BP. "You don't have to reinvent the wheel," Micieli said. "Sometimes we want to do everything by ourselves, but every single ingredient that you need to be successful in controlling hypertension in your patients is out there. You need to establish those partnerships." He encouraged physicians and their groups to look to the subject-matter experts for guidance, such as the American Heart Association and the AMA. For example, DMC applied elements of these organizations' BP Improvement Program to help with training their teams. To ensure accuracy in treating patients with hypertension, DMC also provided physicians and support staff with training every six months. After reaching the initial goal of 70 percent BP control by 2017, DMC is now aiming for a BP control rate of 75 percent by 2018. Leaders there are continuing to assess their approach. Hypertension Control African-American Population Care Physician-led Team-based Care Essential Tools & Resources Target: BP Improvement Program Target: BP Recognition Program How to measure blood pressure accurately AMA Doc Talk podcast series Debunking 7 myths associated with BP measurement training How patients can start—and stick with—key lifestyle changes At Ochsner, innovation happens inside and outside system's walls
Home \| Pharmacovigilance \| Chiesi Group About Rare Diseases Alpha-mannosidosis Nephropathic Cystinosis Leber's Hereditary Optic Neuropathy ADA-SCID Our Mission in Patient Advocacy Enter at least 3 characters Chiesi Global Rare Diseases Announces Updated U.S. Prescribing Information for FERRIPROX® (deferiprone) BOSTON, Dec. 3, 2021 /PRNewswire/ – Chiesi Global Rare Diseases, a business unit of Chiesi Farmaceutici S.p.A., an international research-focused healthcare Group (Chiesi Group), announced today that the FERRIPROX® (deferiprone) Prescribing Information in the U.S. has been updated in the treatment of transfusional iron overload in patients with thalassemia syndromes, sickle cell disease (SCD) or other anemias. The updated prescribing information includes changes to the regular monitoring of the absolute neutrophil count (ANC) in patients while on therapy. Based on available patient data and aligning with the Phase 3 FIRST Study of FERRIPROX in SCD and other anemias, the revised ANC monitoring schedule is once prior to starting treatment with FERRIPROX; weekly for the first six months on therapy; once every two weeks for the following six months; and once every two to four weeks (or at a patient's regular blood transfusion interval) in patients who have not experienced an interruption in therapy due to a decrease in the ANC. This revised schedule, compared to the previous requirement of weekly ANC monitoring as long as a patient is on FERRIPROX, is aimed to help decrease the number of monitoring visits while continuing to ensure patients' safety while on therapy. Thalassemia and SCD are two disorders that affect red blood cells. Both conditions cause problems with hemoglobin, depriving many parts of the body of oxygen. People living with these conditions often require chronic blood transfusions that can put them at risk of developing very high levels of iron in their blood and vital organs. FERRIPROX is a synthetic, orally active iron-chelating agent shown to be effective in reducing iron concentration by penetrating cell membranes and removing toxic iron from organ tissues and extracellular fluids. U.S. Food & Drug Administration Approved Indication and Important Safety Information FERRIPROX® (deferiprone) is an iron chelator indicated for the treatment of transfusional iron overload due to: thalassemia syndromes sickle cell disease or other anemias FERRIPROX Tablets are indicated in adult and pediatric patients ≥8 years of age; FERRIPROX Oral Solution is indicated in patients ≥3 years of age. Limitations of Use Safety and effectiveness have not been established for the treatment of transfusional iron overload in patients with myelodysplastic syndrome or in patients with Diamond Blackfan anemia. WARNING: AGRANULOCYTOSIS AND NEUTROPENIA FERRIPROX can cause agranulocytosis that can lead to serious infections and death. Neutropenia may precede the development of agranulocytosis. Measure the absolute neutrophil count (ANC) before starting FERRIPROX and monitor regularly while on therapy. Interrupt FERRIPROX therapy if neutropenia develops. Interrupt FERRIPROX if infection develops, and monitor the ANC more frequently. Advise patients taking FERRIPROX to report immediately any symptoms indicative of infection. FERRIPROX is contraindicated in patients with known hypersensitivity to deferiprone or to any of the excipients in the formulations. In pooled clinical trials, 7.5% of 642 patients with thalassemia syndromes treated with FERRIPROX developed increased ALT values. Four (0.62%) FERRIPROX-treated subjects discontinued the drug due to increased serum ALT levels and 1 (0.16%) due to an increase in both ALT and AST. In pooled clinical trials, 7.7% of 196 patients with sickle cell disease or other anemias treated with FERRIPROX developed increased ALT values. Monitor serum ALT values monthly during therapy with FERRIPROX and consider interruption of therapy if there is a persistent increase in the serum transaminase levels. Decreased plasma zinc concentrations have been observed on deferiprone therapy. Monitor plasma zinc annually, and supplement in the event of a deficiency. FERRIPROX can cause fetal harm. Advise females of reproductive potential to use an effective method of contraception during treatment with FERRIPROX and for at least six months after the last dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with FERRIPROX and for at least three months after the last dose. Advise females not to breastfeed during treatment with FERRIPROX and for at least 2 weeks after the last dose. Avoid co-administration of FERRIPROX with other drugs known to be associated with neutropenia or agranulocytosis; however, if this is unavoidable, closely monitor the absolute neutrophil count. Avoid co-administration with UGT1A6 inhibitors. Allow at least a 4-hour interval between administration of FERRIPROX and drugs or supplements containing polyvalent cations (e.g., iron, aluminum, or zinc). The most common adverse reactions in patients with thalassemia (incidence ≥ 6%) are nausea, vomiting, abdominal pain, arthralgia, ALT increased and neutropenia. The most common adverse reactions in patients with sickle cell disease or other anemias (incidence ≥6%) are pyrexia, abdominal pain, bone pain, headache, vomiting, pain in extremity, sickle cell anemia with crisis, back pain, ALT increased, AST increased, arthralgia, oropharyngeal pain, nasopharyngitis, neutrophil count decreased, cough and nausea. Inform patients that their urine might show a reddish/brown discoloration due to the excretion of the iron-deferiprone complex. This is a very common sign of the desired effect, and it is not harmful. Advise patients to avoid alcohol while taking FERRIPROX tablets (twice-a-day). Consumption of alcohol while taking FERRIPROX tablets (twice-a-day) may result in more rapid release of deferiprone. Please see full Prescribing Information, including boxed WARNING and Medication Guide. About Chiesi Global Rare Diseases Chiesi Global Rare Diseases is a business unit of the Chiesi Group established in February 2020 and focused on research and development of treatments for rare and ultra-rare disorders. The Global Rare Diseases unit works in collaboration with Chiesi Group to harness the full resources and capabilities of our global network to bring innovative new treatment options to people living with rare diseases, many of whom have limited or no treatments available. The unit is also a dedicated partner with global leaders in patient advocacy, research and patient care. For more information visit https://www.chiesiglobalrarediseases.com/. About Chiesi Group Based in Parma, Italy, Chiesi is an international research-focused pharmaceuticals and healthcare group with over 85 years' experience, operating in 30 countries with more than 6,000 employees (Chiesi Group). To achieve its mission of improving people's quality of life by acting responsibly towards society and the environment, the Group researches, develops and markets innovative drugs in its three therapeutic areas: AIR (products and services that promote respiration, from new-born to adult populations), RARE (treatment for patients with rare and ultra-rare diseases) and CARE (products and services that support special care and consumer-facing self-care). The Group's Research and Development centre is based in Parma and works alongside 6 other important research and development centres in France, the U.S., Canada, China, the UK, and Sweden to promote its pre-clinical, clinical, and regulatory programmes. Chiesi, since 2019, is the world's largest B Corp certified pharmaceutical group. Chiesi Farmaceutici S.p.A. has changed in 2018 its legal status to a Benefit Corporation, by incorporating a double purpose for the creation of shared value, and to generate value for its business, for society and the environment. The global B Corp movement promotes business as a force for good. Moreover, as a Benefit Corporation, Chiesi Farmaceutici S.p.A. is required by law to include objectives of common benefit in its bylaws and to report annually in a transparent way. The Group is committed to becoming carbon neutral by the end of 2035. For further information: www.chiesi.com. Chiesi Global Rare Diseases Media Contact Jenna Urban Berry & Company Public Relations [email protected] PP-F-0233 V1.0 © 2022 CHIESI Farmaceutici S.p.A. Via Palermo, 26 A (entrance Via G. Chiesi 1) 43122 Parma - Italia PP-G-0429 V5.0
Citius Files Addendum to Mino-Lok Phase 3 Trial Record Keeping Protocol to Advance Trials with COVID-19 Compliance September 15, 2020, 10:17 AM ·4 min read -Mino-Lok trial continues to progress despite challenges of conducting clinical trials in COVID-stressed sites -Interim efficacy review with Drug Monitoring Committee planned for end of this month CRANFORD, N.J., Sept. 15, 2020 /PRNewswire/ -- Citius Pharmaceuticals, Inc. ("Citius" or the "Company") (Nasdaq: CTXR), a specialty pharmaceutical company focused on developing and commercializing critical care drug products, today announced that it has filed an amendment to its Mino-Lok phase 3 protocol. This amendment was designed to allow for more efficient follow-up and record-keeping of required clinical trial documentation given COVID-19 restrictions. With personal visits having been severely restricted, Citius issued instructions in the form of file notes to sites in April and has now formalized these instructions. The FDA released guidance on conduct of clinical trials of medical products during COVID-19 in March 2020, updated in July 2020. "In these challenging times we are working closely with our Principle Investigators (PIs) and their staff to keep the enormous amount of record-keeping associated with any clinical trial as simple and accurate as possible," said Myron Holubiak, Chief Executive Officer of Citius. Holubiak continues, "We have been pleased with the responsiveness of our partners and internal team to today's ever-changing situation. Like all other companies, Citius is facing significant challenges in maintaining progress in its clinical trials. We are especially affected since our site-of-care is frequently the ICU, which is the most resource-stressed site in the hospital because of COVID-19. We expect to be able to conduct our Drug Monitoring Committee meeting as planned at the end of the month, and we look forward to our discussions with these independent experts." About Citius Pharmaceuticals, Inc. Citius is a late-stage specialty pharmaceutical company dedicated to the development and commercialization of critical care products, with a focus on anti-infectives and cancer care. For more information, please visit www.citiuspharma.com. About Mino-Lok® Mino-Lok® is an antibiotic lock solution being developed as an adjunctive therapy in patients with central line-associated bloodstream infections (CLABSIs) or catheter-related bloodstream infections (CRBSIs). CLABSIs/CRBSIs are very serious, especially in cancer patients receiving therapy through central venous catheters (CVCs) and in hemodialysis patients, for whom venous access presents a challenge. There are currently no approved therapies for salvaging infected CVCs. This press release may contain "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. Such statements are made based on our expectations and beliefs concerning future events impacting Citius. You can identify these statements by the fact that they use words such as "will," "anticipate," "estimate," "expect," "should," and "may" and other words and terms of similar meaning or use of future dates. Forward-looking statements are based on management's current expectations and are subject to risks and uncertainties that could negatively affect our business, operating results, financial condition and stock price. Factors that could cause actual results to differ materially from those currently anticipated are: risks associated with conducting clinical trials and drug development; patent and intellectual property matters; market and other conditions; our ability to attract, integrate, and retain key personnel; our need for substantial additional funds; the risk of successfully negotiating within the option period a license agreement with Novellus, Inc. for our planned NoveCite therapy for ARDS; risks associated with conducting clinical trials and drug development; the estimated markets for our product candidates and the acceptance thereof by any market; risks related to our growth strategy; risks relating to the results of research and development activities; uncertainties relating to preclinical and clinical testing; the early stage of products under development; our ability to obtain, perform under and maintain financing and strategic agreements and relationships; our ability to identify, acquire, close and integrate product candidates and companies successfully and on a timely basis; our dependence on third-party suppliers; government regulation; competition; as well as other risks described in our SEC filings. We expressly disclaim any obligation or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein to reflect any change in our expectations or any changes in events, conditions or circumstances on which any such statement is based, except as required by law. Vice President, Corporate Development (O) 908-967-6677 x105 [email protected] View original content:http://www.prnewswire.com/news-releases/citius-files-addendum-to-mino-lok-phase-3-trial-record-keeping-protocol-to-advance-trials-with-covid-19-compliance-301131345.html SOURCE Citius Pharmaceuticals, Inc. Sustainable sneakers will be big in 2021: StockX German parliament presses Merkel to extend insolvency waiver Italy reports 377 coronavirus deaths on Monday, 8,824 new cases Dow Jones Futures: Stock Market Rally Has Healthy Pullback As Biden Stimulus Buzz Wanes; Tesla Model Y China Deliveries Begin Dow Jones futures: The stock market rally pulled back last week as Biden stimulus buzz wanes. Tesla Model Y China deliveries have begun.
Clinical Trials in Neonatal Medicine: Shrinking the Ninety Percent Gap Pediatric Neonatology Ninety percent of pharmaceutical agents that are used to treat or prevent various conditions in neonatal patients — medications that have been approved for similar usage in adult patients — have never actually been tested in neonates to determine their pharmacokinetics, pharmacodynamics, optimal dosing patterns, and other criteria. Use of these agents in this patient population is largely driven by empirical evidence of how they work in adults and physician discretion based on the available clinical guidance or institutional protocols. "The fact that most of the drugs we use in our neonatal patients have not undergone prior testing in this group is unsatisfactory at best," says Thomas Diacovo, MD, chief of the UPMC Newborn Medicine Program at UPMC Children's Hospital of Pittsburgh. "Yes, it is exceptionally difficult to conduct many of these studies. However, it is incumbent upon the field to do more and do better by our patients, regardless of the difficulty or barriers we face in building this badly needed evidence base." Increasing the evidence base for the use of pharmaceutical agents in neonatal patients is a priority for Dr. Diacovo and his colleagues in the UPMC Newborn Medicine Program. The program is currently participating in ongoing multicenter investigations examining the efficacy of various medications in neonates. In addition to the pharmaceutical clinical trials in progress, several new basic and translational investigations are examining aspects of necrotizing enterocolitis, immune and microbial development in the neonatal gastrointestinal tract, and a novel approach to using precision medicine in the diagnosis of genetic disorders in neonates. Below are summaries of these promising new trials currently in progress that seek to improve the care of neonatal patients everywhere. Cangrelor Use in Neonates This investigator-initiated study being conducted at UPMC Children's and led by Dr. Diacovo, will assess the pharmacodynamics and pharmacokinetics of cangrelor used in neonatal patients who are at risk for thrombosis related to the use of pulmonary arterial shunting. Dr. Diacovo and his study collaborators will seek to enroll up to 20 participants up to 28 days in age in this trial analyzing the safety and mechanistic properties of cangrelor in four discrete doses. The trial will start with a cohort of four subjects receiving the lowest dose and progress over time to additional cohorts of four — each receiving subsequently larger doses of the agent. Apixaban and Heart Disease in Children UPMC Children's is now participating in a multicenter, randomized study investigating the use of apixaban to prevent thromboembolism in pediatric patients with congenital heart disease or an acquired version of heart disease. Sponsored by Bristol-Myers Squibb in collaboration with the Pediatric Heart Network and Pfizer, the study — titled "Safety and Pharmacokinetics of Apixaban Versus Vitamin K Antagonist or LMWH in Pediatric Subjects with Congenital or Acquired Heart Disease for Thromboembolism Prevention" — is a badly needed examination of how this antithrombotic functions in pediatric patients, and how it compares in usage and efficacy with low molecular weight warfarin (LMWH) or vitamin K antagonist (VKA). Dr. Diacovo is serving as the site primary investigator for this study, and is collaborating internally with colleagues from the UPMC Heart Institute at UPMC Children's Hospital of Pittsburgh. This apixaban study is being conducted in pediatric patients from age 3 months to 18 years. Various aspects of pharmacokinetics and safety will be examined, as well as outcomes related to bleeding events, fatal bleeding, and bleeding that requires some form of medical or surgical intervention to restore hemostasis. Searching for High-Risk Markers for Necrotizing Enterocolitis Liza Konnikova, MD, PhD, FAAP, assistant professor of pediatrics and developmental biology at UPMC Children's Hospital, is a physician-scientist who broadly investigates how neonatal mucosal immunity develops and its role in the pathogenesis of diseases, including necrotizing enterocolitis (NEC) and very-early-onset inflammatory bowel disease (VEOIBD). NEC is the leading cause of death in preterm infants. Despite advances in neonatal care, the survival of infants with NEC remains low — less than 50 percent in many cases. In part, this is due to an inability to predict which infants are at risk for the development of NEC and the subsequent failure to utilize preventative strategies. One of Dr. Konnikova's current studies seeks to understand Toll-like receptor (TLR) biomarkers in necrotizing enterocolitis and how to use these markers to identify premature neonates who are at high risk for developing NEC. Dr. Konnikova's lab has identified that innate immune signaling via the Toll-like receptor 4 (TLR4) plays a key role in the development of NEC. Her team now is searching for novel biomarkers for NEC in a longitudinal cohort study of infants with NEC by assessing the TLR4 signaling capacity of these neonates, using combined in vitro and in silico approaches. In so doing, Dr. Konnikova and her team hope to advance the field by identifying newborns that are at risk for NEC development, thus creating a window for early prophylactic and interventional therapies. Uncovering the Mysteries of Immune and Microbial Development in the GI Tract The gastrointestinal (GI) tract is one of the body's largest immune organs. It is also host to 500 to 1,000 different bacterial species and as many as 1014 bacteria. The majority of these bacteria represent commensals that play an important role in the development and maintenance of the host immune system. The interplay between the immune cells and the commensal bacteria allows for host's immune system to respond to pathogenic bacteria while being tolerant of the commensal ones. However, how homeostasis is established and maintained in humans is very poorly understood. Through translational studies of human tissue throughout gestation, as well as tissue from neonates and young children, Dr. Konnikova is working to decipher how homeostasis is established and maintained. Dysregulation of the GI immune homeostasis leads to a number of diseases, such as necrotizing enterocolitis (NEC), very-early-onset inflammatory bowel disease (VEOIBD) and IBD. To facilitate studying mucosal immunity in health and diseases, Dr. Konnikova and colleagues have adapted mass cytometry (CyTOF) to perform deep immunophenotyping and functional analysis of immune cells at mucosal surfaces. These advances have allowed Dr. Konnikova to study immune dysregulation in various diseases such as NEC and VEOIBD. The PreMOD2 Study Toby D. Yanowitz, MD, MS, associate professor of pediatrics, obstetrics, gynecology, and productive sciences at UPMC Children's, serves as the site primary investigator for the PreMOD2 study. This study is investigating the benefits of delayed cord clamping (DCC) versus the use of umbilical cord milking (UCM) to mitigate bleeding in the brain in premature neonates and to prevent mortality. The trial is currently enrolling neonatal patients that are 30 to 32 + six weeks gestational age. Dr. Yanowitz and the other study leaders are primarily interested in both short- and long-term outcomes of the use of UCM or DCC in those neonatal subjects delivered before 32-weeks gestation. In this randomized study, patients will either receive UCM at the time of delivery (four times during a 15 to 20 second period) or DCC for a minimum of 60 seconds. The goal is to see if either method is better at preventing intraventricular hemorrhage or death in premature newborns. Combatting HIE with EPO: The HEAL Trial Hypoxic-ischemic encephalopathy (HIE) is a consequence of reduced blood flow and, ultimately, a reduced flow of oxygen to the brain that occurs close to the time of birth. Affecting approximately 12,000 babies each year in the United States, HIE has the potential to inflict devastating, permanent neurologic impairments. It leads to mortality in nearly 10 percent of cases, with higher rates attributable to more severe cases. The usual therapy for HIE involves the use of hypothermia. The HEAL trial (High-dose Erythropoietin for Asphyxia and Encephalopathy) is a multicenter, randomized investigation of the efficacy of erythropoietin (EPO) that is being conducted to see if its use can improve outcomes when given in tandem with the use of hypothermia. EPO acts both as a neuroprotective agent and as a growth factor in the brain. The study seeks to determine if EPO given in five doses of 1,000 units per kilogram, in combination with hypothermia, will reduce neurocognitive deficits and mortality in newborns. Dr. Yanowitz is the site primary investigator for this trial at UPMC Children's. Ceftobiprole Use in Neonates Kathleen Schwabenbauer, MD, assistant professor of pediatrics and a neonatologist with the UPMC Newborn Medicine program, is the site primary investigator for a multicenter study designed to characterize the pharmacokinetics of ceftobiprole — a broad-spectrum antibiotic in the cephalosporin family that is used to treat a range of Gram-positive and Gram-negative bacterial pathogens. The dynamics of the medication are being tested in neonates and infants who are up to three months of age but greater than or equal to 28-weeks gestation. This open-label interventional study will evaluate the dynamics and safety of a single dose of ceftobiprole given to patients currently undergoing some form of systemic antibiotic treatment at a dose of 7.5 mg/kg body weight via a four-hour infusion. Dr. Diacovo is serving as the co-primary investigator of this trial. ClinicalTrials.gov Identifier: NCT02527681. Genetics and Precision Medicine Co-primary investigators Thomas Diacovo, MD, and Jerry Vockley, MD, PhD, chief of medical genetics at UPMC Children's, currently are engaged in a collaborative effort between the UPMC Newborn Medicine Program, the Division of Medical Genetics at UPMC Children's Hospital of Pittsburgh, and the Institute for Precision Medicine (IPM) — a collaborative effort between the University of Pittsburgh and UPMC — to provide rapid genomic testing for NICU patients who present with rare and difficult-to-diagnose conditions that may have an underlying genetic cause. UPMC Children's also is participating in a new national precision medicine clinical trial sponsored by the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health. This trial is studying the use of rapid, targeted, next-generation sequencing technology to diagnose underlying genetic causes for disease in high-risk neonates. Led by researchers at Floating Hospital for Children at Tufts Medical Center, researchers at UPMC Children's will enroll neonates who may have a variety of genetic disorders, but whose diagnoses are unable to be determined through the use of standard testing. The new five-year study entails the conduction of whole-genome sequencing of the neonates, as well as a targeted examination of 1,722 genetic disorders known to afflict newborns. The study will then compare the results between the targeted screening and the whole-genome sequencing to determine the viability of the targeted panel approach.
A 21-year-old Hispanic male presented to the Clarity Refractive clinic in January 2013 referred by his family optometrist with newly diagnosed Keratoconus Attempts at finding an adequate spectacle correction or contact lens fit had been thus far unsuccessful. The patient felt frustrated with his level of vision in his right but felt his overall visual function was adequate for needs. On examination uncorrected acuity was 20/400 OD and 20/30 OS correctible to 20/100 OD with +1.50-5.50X20 and 20/25 OS with -0.75. Slit lamp biomicroscopy was consistent with round type Keratoconus OD without scarring. A vague suggestion of early round keratoconic deformity was also apparent OS on evaluation of red reflex (Charleaux sign). Tension by applanation was 16 mm Hg OU. Pentacam topographic study of the right eye (Figure 1) showed an asymmetric ectasia pattern with posterior corneal float abnormality measuring 66 microns with an associated anterior float of 31 microns. Thinnest Pentacam pachymetry was 518 microns. Keratometric readings were 42/49×23. Pentacam study of the left eye (Figure 2) revealed inferior steepening on sagittal curvature map as well as a minimal posterior corneal float pattern measuring 11 microns and unassociated with an associated anterior corneal abnormality. In view of the aggressive appearance of the ectasia in the right eye as well as the patient's ability to function visually it was advised that collagen cross-linking be performed for both eyes, right eye first. Pending the outcome of treatment INTACS intrastromal ring placement was discussed as a means of attaining improvement in vision. On 1/22/13 collagen cross-linking therapy was performed. After removal of 9 mm of central corneal epithelium assisted by application of a 20% alcohol solution, 15 applications of an isotonic solution of 1% Riboflavin were applied over 30 minutes. After re measurement of corneal pachymetry via ultrasound to assure at least 400 microns of corneal thickness the patient was positioned under the calibrated cross-linking apparatus and 5 minutes of UVA irradiation was delivered to the central cornea without complication. A therapeutic bandage contact lens was placed along with topical fluoroquinolone antibiotic and prednisolone acetate 1% drops. After five days of post-operative therapy the cornea was completely re epithelialized. At the three-month postoperative check uncorrected acuity was 20/80 with only mild residual haze. Best-corrected acuity with +1.50-3.75×20 was 20/70. Central pachymetry readings were 41.24/49.29X139. The patient was advised to return in three months for cross-linking therapy for the left eye. With the advent of collagen cross-linking technology the eye care physician now has the tools necessary to arrest the progress of ectactic corneal disease both idiopathic and post refractive laser procedures. In some cases where the ectactic process is early in evolution, such as the case in question, treated patients can also enjoy an improvement in uncorrected as well as correctable visual acuity. Collagen cross-linking works through the creation of a chemical reaction in the cornea that is brought on through UV photo-activation of the riboflavin molecule in the saturated cornea. This chemical reaction results in increased covalent bonding of collagen fibers and lamella in the cornea making the tissue harder and thus resistant to further shape distortion. Ten-year postoperative data seem to indicate that 97% of patients treated in this manner will demonstrate the arrest of further progression of their disease. In assessing patients with Keratoconus for treatment it is important to understand that this therapy is best offered early in the disease process where it has the greatest chance of having the desired therapeutic effect. Further, the therapy is not intended to improve acuity although in early ectasia cases it can sometimes improve vision. In the case presented in this review we elected to cross-link the cornea before considering INTACS ring placement. Patients need to be evaluated both from the standpoint of risk of disease progression as well as that of current visual function. Our patient should have prophylactic cross-linking for the left eye and then consideration for INTACS for the right cornea to produce improved morphology and with it better "walking around" as well as spectacle corrected visual acuity.
· How Does Chiropractic Care Help the Pregnant Woman? According to a study, patients who received chiropractic care from at least the tenth week of pregnancy through labor and delivery experienced significantly reduced mean labor times compared to women who were not receiving chiropractic care. Out of the two groups of women who were studied during their first pregnancy, those receiving chiropractic care averaged 24 percent shorter labor times than those not receiving chiropractic care. Of those women who were experiencing their second or third pregnancy, those under chiropractic care averaged 39% shorter labor times compared to those who were not receiving chiropractic care. These findings suggest that chiropractic methods would play an important expanded role in prenatal care. Chiropractic care throughout pregnancy could result in shorter labor times, decreased use of pain medications and increased quality health care for patients. During a clinical evaluation of two competing hospitals, it was noted that chiropractic care reduced the need for painkillers by 50 percent. Patients have received adjustments even during labor. There have been cases when chiroprac~ors have been called in to perform spinal adjustments when labor had stopped. Immediately after the adjustment, labor resumed normally. Chiropractic during pregnancy has been known to shorten the labor time to ~—50 to 60 percent and lessens medication requirements by at least 50 percent. Postpartum depression is a rarity in patients receiving chiropractic treatment. One study found improvement in postpartum spinal pain after chiropractic treatment was initiated in 90 to 120 patients. In 1991, Diakow, et. al. published a retrospective study of 400 pregnancies in the Journal of Manipulative and Physiological Therapeutics. The study investigated the relationship between the presence of back pain during pregnancy and labor and the effects of chiropractic care on back pain and labor. The study found that back pain was experienced during 42.5% of the pregnancies and 44.7% of the labor periods. The findings also established a clear association between the presence of back pain during the course of the pregnancy and the likelihood of back pain during labor. Of 400 pregnancies, 37 patients received manual spinal adjustments for relief of symptoms. In this group, relief of back pain was reported by 84% of the women. No instances of adverse effects as a result of the care were reported, indicating the relative safety of the procedures. The researchers also reported a decreased likelihood of back labor in the group under chiropractic care, leading them to conclude: "If this effect can be confirmed by future studies, one of the most severe aspects of labor pain may be prevented." Perinatal medication as a potential risk factor for adult drug abuse in a North American cohort. Babies exposed to drugs during labor are 5 times more likely to become drug abusers later in life. They looked at the background of 200 opiate addicts born in Stockholm from 1945 to 1966 and took non-addicted siblings as controls. They found that if the mother had been given certain painkillers during labor, her child was statistically at an increased risk of becoming drug-addicted in adolescence. "Can Drug Addiction Start at Birth?" by Michel Odent from the Primal Health Research Newsletter. Here is the reference: Odent, Michel, and the Primal Health Research Centre. Can drug addiction start at birth? Primal Health Research, 1993; vol. 1, no. 1: 3-7. In this article, the author reviews several studies to explore two statements, first that in wealthy countries a majority of children are born with the use of drugs, and second, that in wealthy countries drug addiction is increasing. He reviews two works by B. Jacobson. In one paper, Jacobson studied the birth records of 200 opiate addicts born in Stockholm between 1945 and 1966. The control group consisted only of siblings of drug addicts, also born in Stockholm during the same period. "The main finding is that in the study group a higher proportion of mothers received opiates (morphine or pethidine) or barbiturates, or both, during labor and delivery...The risks increased when the drug had been administered several times." Jacobson wrote an earlier paper that focused on amphetamine addiction. "The main conclusion of this study is that nitrous oxide administration during delivery is an essential risk factor for eventual amphetamine addiction in offspring and that the risks of addiction are proportional to the duration of the nitrous oxide exposure." Jacobson earlier had found (by accident) a relationship between traumatic birth and self-destructive behaviors later in life. Lee Salk found similar conclusions about adolescent suicides. In his study, "one of the most significant findings is that respiratory distress for more than one hour at birth is a specific risk factor for committing suicide when adolescent... The authors suggest a link between the dramatic increase of suicide rates among teenagers and the fact that more and more infants can survive thanks to modern methods of resuscitation." Later, Dr. Odent explains more..."The reports about the probable long-term effects of drugs used in the period around birth are not surprising. Brain receptors reorganize themselves during precise stages of development, and in particular in the perinatal period and at puberty. This is probably the case for oxytocin receptors, opiate receptors, insulin receptors, etc. In the scientific context of the 1990s it is increasingly easy to understand that there are no innocent drugs." Chiropractic Prenatal care definitely decreases the necessity of drugs during labor and allows a much more natural delivery for mother and child. While we're on the subject of pregnancy, the "due date" may be a thing of the past. Only 5% of babies show up "on time" anyway. Dr Vein Katz, of the Center for Genetics and Maternal Fetal Medicine in Oregon says that a due date frustrates and makes expecting parents anxious if their baby is late. This, in turn, tends to put pressure on doctors to "do something." As a result, the number of induced labors has skyrocketed in the last few years, many of them unnecessary. One reason due dates are flawed is that the 14-days-from-the-last-period formula doctors use to figure it out is flawed. "How often," Katz asks, "does conception occur exactly 14 days to the minute after the first drop of menstrual blood appeared?" Variability among women is also a factor. Women expecting twins or in poor health with hypertension or diabetes can all expect to deliver early. Katz suggests that doctors start using the concept of a "delivery week." Pregnant and breast-feeding women who add cod liver oil to their diets may improve their children's intelligence, according to an ongoing study. The study involved 300 women who were given either cod liver oil or corn oil supplements. The women took the supplements daily from the 18th week of pregnancy until their child was 3 months old. The supplementation was the only nutritional difference among the mothers' diets. When the children reached 4 years of age they were given intelligence tests to gauge problem solving and information processing ability. Children with mothers who took cod liver oil scored higher than the other children, according to the test results of 84 children. Researchers will test the children again when they reach 7 years of age to further confirm findings; however the study results indicate that supplementing pregnant and lactating women with cod liver oil supplements may increase their children's intelligence. DHA, an omega-3 fatty acid found in cod liver oil, plays an important role in the development of the central nervous system. It is thought that this fatty acid may be particularly valuable to the developing child during the third trimester of pregnancy and in the first three months of life, as the brain undergoes growth spurts during these times. Although pregnant women are generally told to avoid supplements and medication during pregnancy, researchers say that no negative effects are associated with the use of cod liver oil. The study findings are in line with other recent research indicating that breast-fed infants tend to have higher intelligence than formula-fed infants. This may be due to certain compounds found in breast milk, including omega-3 fatty acids. Because of the additional weight and stress on the framework of the body in pregnant women, chiropractic adjustments can help lower the incidence of pain in the low back and legs, and between the shoulder blades. In some cases, fewer headaches and problems with nausea and elimination may also result. Many chiropractors care for expectant mothers in the regular course of their daily practices. Most importantly is that chiropractic helps the expecting mother by improving nerve system function. Chiropractic has been based for over 100 years on correcting interference to the nervous system known as subluxations. With a properly functioning nerve system free of subluxations it is easy to see how many aspects of this important time for an expectant mother will be made easier. Many women rely on chiropractic care as a regular part of their pre-natal routine. As an added bonus, proper pelvic alignment allows for easier delivery of the baby. Many studies have shown that women under chiropractic care deliver their babies in less time than those who are not under care. The longest delivery time by one of our patients was 4 hours, and the fastest was 15 minutes. This shot is given to make sure the baby has enough clotting factors in his blood. Sufficient amounts of breast milk will aid in ensuring the baby has enough clotting factors in his blood. Vitamin K can cause jaundice in a newborn. The infant's liver is too immature to process or store it, so it ends up in the tissues and causes a yellow color in the skin. This then make more interventions necessary such as bilibrubin lights! If babies needed Vitamin K right after birth nature would have provided it! Your breast milk is all your babies' needs. You can request this shot not be given in your birth plan. Everyone knows about the flu and the flu vaccine. What people do not know is that flu vaccines are nearly useless in preventing flu, they will cause the flu, and they often result in nervous system damage that can take years for the body to repair. Other nations chuckle at Americans' infatuation with the flu vaccine. The joke would indeed be funny, if it weren't for the damaging effects caused by the vaccine.

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